Treatment duration of immune checkpoint inhibitors and overall survival in U.S. veterans with Cancer.

BackgroundOptimal treatment duration for immune checkpoint inhibitors (ICI) remains a clinical debate. The objective of this study was to contrast mortality rates between 2-year fixed versus indefinite treatment duration among patients initiating ICIs across a variety cancer types.MethodsThis retrospective observational study used national administrative data from the Veterans Health Administration to select patients who initiated an ICI between January 1, 2014, and December 31, 2020.

A clinical trial evaluating pharmacist-guided self-management of hypertension among veterans with CKD, rationale and study design.

Rationale & Objective: Chronic kidney disease (CKD) associates with high morbidity and mortality due to CKD progression and cardiovascular disease (CVD). Blood pressure (BP) lowering reduces the risk of CVD and CKD progression. Despite the large number of BP medications available, a significant proportion of patients with CKD have BP above the goal.

Continuity of pain clinic care among rural and urban veterans.

Purpose: In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care varied for rural compared to urban veterans, following an initial pain clinic visit. Specifically, the frequency of general pain clinic visits and pain clinic psychology visits were contrasted between rural and urban veterans in 2015 and 2022.

Methods: National VHA administrative data were used to build two cohorts of veterans with an initial pain clinic visit in 2015 or 2022.

Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care.

Introduction: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings.

Materials And Methods: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans.

Antimicrobial Exposure and Risk for Incident Major Depressive Disorder.

Background: Antibacterials are among the most frequently prescribed medications. Antibacterial drugs have the unintended consequence of destroying healthy gut flora, which can lead to known adverse events such as Clostridium difficile infection. Given emerging research concerning the role of these microorganisms in the gut-brain axis and some limited epidemiological studies, the objective of this study was to determine if antimicrobial exposure is associated with increased risk for depression.

Long-Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long-Term Survival Study (PEARLS).

Background: Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify patients with PAD.

Methods: Leveraging a novel natural language processing system that identifies PAD with high accuracy using ankle-brachial index and toe-brachial index values, we created a registry of 103 748 patients with new-onset PAD in the Veterans Health Administration. Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and non-Veterans Affairs encounters.

Rural-urban differences in opioid prescribing in the Veterans Health Administration.

Purpose: To determine whether higher rates of opioid prescribing among rural Veterans in the Veterans Health Administration (VHA), previously observed through 2016, persisted through 2023.

Methods: National VHA administrative data were used to contrast opioid prescribing between urban and rural Veterans for annual veteran cohorts from 2016 through 2023. The primary prescribing metric was per capita volume expressed as morphine milligram equivalents (MME).

The Association Between Telehealth Use During Buprenorphine Treatment for Opioid Use Disorder and Clinical Outcomes: A Retrospective Cohort Study.

Patients with opioid use disorder (OUD) represent a high-risk population due to increased rates of adverse health outcomes and death. To evaluate whether telehealth utilization during OUD treatment compared with in-person encounters alone was associated with emergency department (ED) utilization, inpatient admissions, and mortality within three years of initiating buprenorphine. We conducted a retrospective cohort study within the Veterans Health Administration among Veterans treated for OUD between 2012 and -2022.

Characteristics of incident benzodiazepine recipients among US veterans with posttraumatic stress disorder.

Purpose: While benzodiazepine prescribing among veterans with posttraumatic stress disorder (PTSD) declined substantially in the Veterans Health Administration over the past decade, little is known about current incident prescribing. Our objective was therefore to describe patient, provider, facility, and prescribing characteristics among veterans with PTSD who were incident benzodiazepine recipients in 2022 and contrast these to the characteristics for incident recipients in 2012.

Methods: This retrospective observational study included all veterans with PTSD who received an incident benzodiazepine prescription during calendar year 2022 and separately for 2012.

Assessing 1-year sodium-glucose co-transporter-2 inhibitor tolerance in older adults.

Background: Evidence concerning tolerability of sodium-glucose co-transporter-2 (SGLT2) inhibitors in older adults is limited due to under-representation in clinical trials. Our study aimed to determine the extent to which SGLT2 inhibitor intolerance increases with age and explore additional factors associated with intolerance.

Methods: This retrospective observational study included patients in the Veterans Health Administration who initiated an SGLT2 inhibitor between 1 January 2013 and 31 December 2021.

Reprint of: The impact of alpha-1-adrenergic receptor antagonists on the progression of Parkinson disease.

Background: Alpha-1-adrenergic receptor antagonists (AARAs) are used in the treatment of benign prostatic hypertrophy. Some AARAs, such as terazosin, stimulate glycolysis and increase cellular adenosine triphosphate levels through activation of phosphoglycerate kinase 1 (PGK1), which has been suggested to be of therapeutic benefit in patients with Parkinson disease (PD).

Objective: This study aimed to determine whether exposure to PGK1-activating AARAs was associated with slower PD progression.

Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans.

Introduction: This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD.

What's Gender Got to Do With It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans.

Women veterans are more likely than men veterans to receive medications that Department of Veterans Affairs clinical practice guidelines recommend against to treat posttraumatic stress disorder (PTSD). To understand this difference, we examined potential confounders in incident prescribing of guideline discordant medications (GDMs) in veterans with PTSD. Veterans receiving care for PTSD during 2020 were identified using Veterans Health Administration administrative data.

Association Between Clozapine Exposure and Risk of Hematologic Malignancies in Veterans With Schizophrenia.

The objective of this study was to examine the relationship between clozapine use and hematologic malignancies, using national administrative data from the United States Veterans Health Administration (VHA). This case-control study of veterans with schizophrenia matched cases with incident hematologic malignancy to 10 controls without hematologic malignancy by gender, age, and time since first schizophrenia diagnosis from October 1999, the beginning of VHA data archives, to June 2022. Schizophrenia diagnoses were identified using , code 295.

A Nationwide Emergency Department Data Analysis to Predict Beers List Medications Use Among Older Adults.

Background: The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting.

Study Objectives: To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States.

Methods: Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019.

Incidence of immune-related adverse events in U.S. veterans treated with immune checkpoint inhibitors.

Background: Immune checkpoint inhibitors (ICIs) are associated with potentially severe immune-related adverse events (irAEs). Emerging clinical practice reports have suggested higher incidence of irAEs in real-world settings than initially observed in phase III clinical trials. Objectives were to determine the incidence of irAEs associated with ICIs in a clinical population, the Veterans Health Administration, characterize their time to onset, and explore potential risk factors.

The impact of alpha-1-adrenergic receptor antagonists on the progression of Parkinson disease.

Background: Alpha-1-adrenergic receptor antagonists (AARAs) are used in the treatment of benign prostatic hypertrophy. Some AARAs, such as terazosin, stimulate glycolysis and increase cellular adenosine triphosphate levels through activation of phosphoglycerate kinase 1 (PGK1), which has been suggested to be of therapeutic benefit in patients with Parkinson disease (PD).

Objective: This study aimed to determine whether exposure to PGK1-activating AARAs was associated with slower PD progression.

Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score-Matched Cohort Across the Veterans Health Administration.

Background: Randomized controlled trials have shown that procalcitonin-guided algorithms can reduce antibiotic duration for lower respiratory tract infections (LRTIs). The goal of this study was to compare antibiotic duration for LRTIs with and without procalcitonin testing in real-life practice.

Methods: This retrospective cohort study included all acute care hospital admissions for presumed LRTIs between 1/2018 and 12/2021 at 81 Veterans Affairs facilities with on-site procalcitonin testing.

Continuation of Buprenorphine During Hospitalization and Subsequent Retention in Therapy: an Observational Study in Veterans Administration Hospitals.

Background: Inpatient hospitalization has the potential to disrupt buprenorphine therapy.

Objective: Among patients receiving outpatient buprenorphine prior to admission, we determined the rate of discontinuation during medical and surgical admissions to VA hospitals and its association with subsequent post-discharge continuation of buprenorphine therapy.

Design And Main Measures: We conducted an observational study using Veterans Administration data from 10/1/2018 to 3/31/2020 for all medical and surgical admissions where Veterans had active buprenorphine prescriptions at the time of admission.