Registered dietitian activities in a department of veterans affairs medical center: Patient care vs non-patient care

Objective To report a case of erythema multiforme (EM) major treated with cyclophosphamide and prednisone. Setting General medicine and dermatology consult services, Department of Veterans Affairs Medical Center. Case Summary A 44-year-old man with C4–C5 quadriplegia developed a skin reaction characterized by a painful, generalized maculopapular rash, bullae, ulceronecrotic lesions, and mucosal and epidermal sloughing after taking trimethoprim/sulfamethoxazole. The patient was treated with intravenous cyclophosphamide 150 mg infused over 1 hour every 24 hours and oral prednisone 15 mg every 6 hours. After two doses of cyclophosphamide, formation of bullae and epidermal sloughing had ceased, and the erythema was markedly diminished. Cyclophosphamide was discontinued before the third dose because of evolving leukopenia. Prednisone therapy was continued until the patient was discharged on hospital day 5, at which time the dosage was tapered. Discussion Cyclophosphamide has been used extensively for other dermatologic reactions. Relief of pain and regression of the lesions in our patient occurred more quickly than anticipated. Conclusions Treatment of EM major with cyclophosphamide combined with prednisone appeared to be highly successful in this patient. Cyclophosphamide may be an effective, empiric initial treatment in reversing EM major.

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Effect of a high cholesterol diet on DNA synthesis during the first cell cycle of rat liver regeneration Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs Medical Center, San Francisco

Hepatology ◽

10.1016/0270-9139(95)95540-2 ◽

1995 ◽

Vol 22 (4) ◽

pp. A455

Keyword(s):

Cell Cycle ◽

Dna Synthesis ◽

San Francisco ◽

Medical Center ◽

Veterans Affairs ◽

University Of California ◽

High Cholesterol Diet ◽

Department Of Veterans Affairs ◽

Cholesterol Diet ◽

High Cholesterol

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Excess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection

Infection Control and Hospital Epidemiology ◽

10.1086/651094 ◽

2010 ◽

Vol 31 (4) ◽

pp. 365-373 ◽

Cited By ~ 101

Author(s):

Gregory A. Filice ◽

John A. Nyman ◽

Catherine Lexau ◽

Christine H. Lees ◽

Lindsay A. Bockstedt ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistance ◽

Medical Center ◽

Patient Characteristics ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Accounting Systems ◽

Excess Costs ◽

Mrsa Infection ◽

Mssa Infection

Objective.To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults.Design.Retrospective study of all cases of S. aureus infection.Setting.Department of Veterans Affairs hospital and associated clinics.Patients.There were 390 patients with MSSA infections and 335 patients with MRSA infections.Methods.We used medical records, accounting systems, and interviews to identify services rendered and costs for Minneapolis Veterans Affairs Medical Center patients with S. aureus infection with onset during the period from January 1, 2004, through June 30, 2006. We used regression analysis to adjust for patient characteristics.Results.Median 6-month unadjusted costs for patients infected with MRSA were $34,657, compared with $15,923 for patients infected with MSSA. Patients with MRSA infection had more comorbidities than patients with MSSA infection (mean Charlson index 4.3 vs 3.2; P < .001). For patients with Charlson indices of 3 or less, mean adjusted 6-month costs derived from multivariate analysis were $51,252 (95% CI, $46,041–$56,464) for MRSA infection and $30,158 (95% CI, $27,092–$33,225) for MSSA infection. For patients with Charlson indices of 4 or more, mean adjusted costs were $84,436 (95% CI, $79,843–$89,029) for MRSA infection and $59,245 (95% CI, $56,016–$62,473) for MSSA infection. Patients with MRSA infection were also more likely to die than were patients with MSSA infection (23.6% vs 11.5%; P < .001). MRSA infection was more likely to involve the lungs, bloodstream, and urinary tract, while MSSA infection was more likely to involve bones or joints; eyes, ears, nose, or throat; surgical sites; and skin or soft tissue (P < .001).Conclusions.Resistance to methicillin in S. aureus was independently associated with increased costs. Effective antimicrobial stewardship and infection prevention programs are needed to prevent these costly infections.

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Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-019-0503-9 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Sara J. Landes ◽

JoAnn E. Kirchner ◽

John P. Areno ◽

Mark A. Reger ◽

Traci H. Abraham ◽

...

Keyword(s):

Emergency Department ◽

Suicide Prevention ◽

Medical Center ◽

Scale Up ◽

Veterans Affairs ◽

Advisory Board ◽

Department Of Veterans Affairs ◽

Emergency Department Setting ◽

Key Stakeholders ◽

Risk Period

Abstract Background Suicide among veterans is a problem nationally, and suicide prevention remains a high priority for the Department of Veterans Affairs (VA). Focusing suicide prevention initiatives in the emergency department setting provides reach to veterans who may not be seen in mental health and targets a critical risk period, transitions in care following discharge. Caring Contacts is a simple and efficacious suicide prevention approach that could be used to target this risk period. The purpose of this study is to (1) adapt Caring Contacts for use in a VA emergency department, (2) conduct a pilot program at a single VA emergency department, and (3) create an implementation toolkit to facilitate spread of Caring Contacts to other VA facilities. Methods This project includes planning activities and a pilot at a VA emergency department. Planning activities will include determining available data sources, determining logistics for identifying and sending Caring Contacts, and creating an implementation toolkit. We will conduct qualitative interviews with emergency department staff and other key stakeholders to gather data on what is needed to adapt and implement Caring Contacts in a VA emergency department setting and possible barriers to and facilitators of implementation. An advisory board of key stakeholders in the facility will be created. Qualitative findings from interviews will be presented to the advisory board for discussion, and the board will use these data to inform decision making regarding implementation of the pilot. Once the pilot is underway, the advisory board will convene again to discuss ongoing progress and determine if any changes are needed to the implementation of the Caring Contacts intervention. Discussion Findings from the current project will inform future scale-up and spread of this innovation to other VA medical center emergency departments across the network and other networks. The current pilot will adapt Caring Contacts, create an implementation toolkit and implementation guide, evaluate the feasibility of gathering outcome measures, and provide information about what is needed to implement this evidence-based suicide prevention intervention in a VA emergency department.

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