Extracting antibiotic susceptibility from free-text microbiology reports using natural language processing.

There is a clinical need to appropriately apply large language model (LLM)-based systems for use in infectious diseases. We sought to use LLM and machine learning for extracting antibiotic susceptibility from clinical microbiology free-text reports, allowing use for outbreak detection, increasing information gathering efficiency, and public health reporting.

The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients.

Objectives: Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2.

Insomnia, sleep apnea, and incidence of hypertension and cardiovascular disease.

Introduction: Comorbid insomnia and obstructive sleep apnea (OSA, i.e., COMISA) are associated with cardiovascular disease (CVD) among older adults.

The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care.

Background: Key nonpharmacologic therapies, including those routinely provided by chiropractors, are recommended first-line treatments for low back pain (LBP). Little is known on whether such care provided in the Veterans Health Administration (VA) has a downstream effect on the use of other healthcare services, including opioid prescriptions.

Objective: To evaluate the impact of chiropractic care on receipt of opioid prescriptions within 365 days of an incident primary care provider (PCP) visit for LBP among opioid-naïve VA patients.

Clinical Management of Sleep Disturbances in Post-9/11 Men and Women Veterans: A 20-year Prospective Cohort Study.

Introduction: Sleep disorders and chronic conditions that are comorbid with disordered sleep represent a high burden to the U.S. population, and Veterans have a particularly high risk for disordered sleep.

"Sleep Is Not Getting the Attention It Deserves": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration.

Background: Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities.

Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis.

Background: The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA.

Cardiac Rehabilitation Among Veterans: A Narrative Review.

Purpose: Cardiac rehabilitation (CR) is a valuable secondary preventive intervention for Veterans given their increased risk of cardiovascular disease. Adults cared for in the Veterans Affairs (VA) healthcare system are a unique population that receives healthcare from the largest integrated care network in the United States. Yet, this group faces distinct challenges in utilizing CR.

Natriuretic peptide testing in veterans hospitalized with heart failure: Potential differences by sex.

Background: Natriuretic peptide testing (NPT) is recommended to assist in diagnosis and prognostication during heart failure hospitalization (HFH). NPT on admission for HFH and sex-based variation in NPT are unknown.

Objectives: We investigated the utilization of NPT among Veterans with HFH, evaluated for sex-based differences, and examined associations with demographic, clinical, and facility characteristics.

The PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department.

Background: Existing risk scores assessing geriatric vulnerability in the emergency department (ED) have shown limited predictive power, especially in diverse populations. We investigated the relationship of a quick and easy-to-administer geriatric vulnerability scoring system with functional decline and mortality in older patients admitted to multiple hospitals through the ED in the United States (US) and Brazil (BR).

Method: Federated, international, multicenter observational study of hospitalized ED patients aged ≥ 65 from US and BR.

LGBTQ+ status and sex of record in Veterans with post-traumatic stress disorder: demographics, comorbidities, and outpatient encounters.

Objectives: This study aims to analyze differences between lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ+ Veterans with post-traumatic stress disorder (PTSD) in terms of demographics, comorbidities, and medical care usage, including differences by sex of record, including separate analyses for transgender and non-transgender Veterans.

Methods: Chi-square, -test, ANOVA Welch one-way testing, and absolute standardized difference analyses were conducted on a cohort of 277,539 Veterans diagnosed with PTSD.

Results: The study found significant differences, particularly concerning positive LGBTQ+ status and sex of record.

Factors Associated With Influenza Vaccination in a National Veteran Cohort.

Introduction: Only 53% of American adults receive influenza vaccination, and disparities in vaccination exist among particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration cohort.

Methods: The authors examined differences in documented influenza vaccinations for the 2019-2020 influenza season among Veteran Health Affairs Administration patients in a retrospective cohort study using Veteran Health Affairs Administration administrative electronic health record data.

Interventions to Mitigate EHR and Documentation Burden in Health Professions Trainees: A Scoping Review.

Background:  Health professions trainees (trainees) are unique as they learn a chosen field while working within electronic health records (EHRs). Efforts to mitigate EHR burden have been described for the experienced health professional (HP), but less is understood for trainees. EHR or documentation burden () affects trainees, although not all trainees use EHRs, and use may differ for experienced HPs.

Implementation and Impact of Intimate Partner Violence Screening Expansion in the Veterans Health Administration: Protocol for a Mixed Methods Evaluation.

Background: Intimate partner violence (IPV) is a significant public health problem with far-reaching consequences. The health care system plays an integral role in the detection of and response to IPV. Historically, the majority of IPV screening initiatives have targeted women of reproductive age, with little known about men's IPV screening experiences or the impact of screening on men's health care.

Risk of Serious Adverse Gastrointestinal Events with Potassium Binders in Hospitalized Patients: A National Study.

Background: Concerns about serious adverse gastrointestinal (GI) events with sodium polystyrene sulfonate (SPS) led to development of two new potassium binders, patiromer and sodium zirconium cyclosilicate (SZC), for treatment of hyperkalemia.

Objective: To compare risk of intestinal ischemia/thrombosis or other serious GI events associated with SPS, patiromer, or SZC in hospitalized patients.

Design: Retrospective cohort study.

Electronic Health Record Concordance with Survey-Reported Military Sexual Trauma Among Younger Veterans: Associations with Health Care Utilization and Mental Health Diagnoses.

Military sexual trauma (MST) is more common among post-9/11 Veterans and women versus older Veterans and men. Despite mandatory screening, the concordance of electronic health record (EHR) documentation and survey-reported MST, and associations with health care utilization and mental health diagnoses, are unknown for this younger group. Veterans' Health Administration (VHA) EHR (2001-2021) were merged with data from the observational, nationwide WomenVeterans Cohort Study (collected 2016-2020, = 1058; 51% women).

Leveraging Electronic Health Records to Assess Residential Mobility Among Veterans in the Veterans Health Administration.

Background: Residential mobility, or a change in residence, can influence health care utilization and outcomes. Health systems can leverage their patients' residential addresses stored in their electronic health records (EHRs) to better understand the relationships among patients' residences, mobility, and health. The Veteran Health Administration (VHA), with a unique nationwide network of health care systems and integrated EHR, holds greater potential for examining these relationships.

A roadmap to artificial intelligence (AI): Methods for designing and building AI ready data to promote fairness.

Objectives: We evaluated methods for preparing electronic health record data to reduce bias before applying artificial intelligence (AI).

Methods: We created methods for transforming raw data into a data framework for applying machine learning and natural language processing techniques for predicting falls and fractures. Strategies such as inclusion and reporting for multiple races, mixed data sources such as outpatient, inpatient, structured codes, and unstructured notes, and addressing missingness were applied to raw data to promote a reduction in bias.

Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health.

Background: Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation.

Methods: Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill.

Childhood Histories of Family Violence and Adult Intimate Partner Violence Use Among U.S. Military Veterans.

Objective: There is ample evidence for associations among childhood family violence and adult intimate partner violence (IPV) use. This study was designed to examine potential differential associations between childhood physical abuse, childhood sexual abuse, witnessing parental IPV, posttraumatic stress symptom (PTSS) severity, and IPV use for men and women veterans.

Method: Survey data from 825 veterans who participated in a longitudinal multisite investigation of post-9/11 veterans who completed measures of childhood family violence history, PTSS, IPV use and experiences were used.

Relationship Between Pain and LGBT Status Among Veterans in Care in a Retrospective Cross-Sectional Cohort.

Background: Pain assessment is performed in many healthcare systems, such as the Veterans Health Administration, but prior studies have not assessed whether pain screening varies in sexual and gender minority populations that include individuals who identify as lesbian, gay, bisexual, and/or transgender (LGBT).

Objective: The purpose of this study was to evaluate pain screening and reported pain of LGBT Veterans compared to non-LGBT Veterans.

Methods: Using a retrospective cross-sectional cohort, data from the Corporate Data Warehouse, a national repository with clinical/administrative data, were analyzed.