VA Palo Alto Healthcare System

About: VA Palo Alto Healthcare System is a healthcare organization based out in Palo Alto, California, United States. It is known for research contribution in the topics: Population & Health care. The organization has 2548 authors who have published 4605 publications receiving 209938 citations.

Anaesthesiology as a model for patient safety in health care.

Abstract: Although anaesthesiologists make up only about 5% of physicians in the United States, anaesthesiology is acknowledged as the leading medical specialty in addressing issues of patient safety.1 Why is this so? Firstly, as anaesthesia care became more complex and technological and expanded to include intensive care it attracted a higher calibre of staff. Clinicians working in anaesthesiology tend to be risk averse and interested in patient safety because anaesthesia can be dangerous but has no therapeutic benefit of its own. Anaesthesiology also attracted individuals with backgrounds in engineering to work either as clinicians or biomedical engineers involved in operating room activities. They and others found models for safety in anaesthesia in other hazardous technological pursuits, including aviation. 2 3 Secondly, in the 1970s and ‘80s the cost of malpractice insurance for anaesthesiologists in the United States soared and was at risk of becoming unavailable. The malpractice crisis galvanised the profession at all levels, including grass roots clinicians, to address seriously issues of patient safety. Thirdly, and perhaps most crucially, strong leaders emerged who were willing to admit that patient safety was imperfect and that, like any other medical problem, patient safety could be studied and interventions planned to achieve better outcomes. #### Summary points Anaesthesiology is acknowledged as the leading medical specialty in addressing patient safety Anaesthesia is safer than ever owing to many different types of solutions to safety problems Solution strategies have included incorporating new technologies, standards, and guidelines, and addressing problems relating to human factors and systems issues The multidisciplinary Anesthesia Safety Foundation was a key vehicle for promoting patient safety A crucial step was institutionalising patient safety as a topic of professional concern Although anaesthesiology has made important strides in improving patient safety, there is still a long way to go ### Anaesthesia: safer than ever It is widely believed that anaesthesia is …

Frontal Lobe Volume Loss Observed with Magnetic Resonance Imaging in Older Chronic Alcoholics

Abstract: This study used magnetic resonance imaging to quantify the extent and pattern of tissue volume deficit and cerebrospinal fluid volume enlargement in younger versus older chronic alcoholics relative to normal controls. In the present analysis, we divided our previously reported group of 62 alcoholic men into a younger group (n = 33, age mean = 37.5 +/- 4.5, and range = 26 to 44 years) and an older group (n = 29, age mean = 52.7 +/- 6.0, and range = 45 to 63 years) to examine whether, in addition to extent, the two age groups differed in pattern of tissue type and regional brain volume abnormalities quantified with magnetic resonance imaging. Brain volumes were adjusted for normal variation in head size and age established from a group of healthy controls and were expressed as Z-scores. The younger group had significant cortical gray, but not white, matter volume deficits and sulcal and ventricular enlargement relative to age-matched controls. The older group had volume deficits in both cortical gray and white matter and sulcal and ventricular enlargement that significantly exceeded the younger alcoholic group. An analysis of six cortical regions revealed that, although both age groups had gray matter volume deficits throughout the cortex, the older alcoholic group had a selectively more severe deficit in prefrontal gray matter relative to the younger alcoholic group. Similarly, the cortical white matter volume deficit in the older alcoholics was especially severe in the prefrontal and frontal regions. The differences in brain dysmorphology between the two alcoholic groups cannot easily be attributed to potential alcohol history differences typically related to age because the two groups had similar disease durations and amounts of lifetime alcohol consumption. These results provide in vivo evidence that the frontal lobes are especially vulnerable to chronic alcoholism in older men.

Protective Effect of Rotavirus VP6-Specific IgA Monoclonal Antibodies That Lack Neutralizing Activity

Abstract: Rotaviruses are the leading cause of severe gastroenteritis and dehydrating diarrhea in young children and animals worldwide. A murine model and "backpack tumor" transplantation were used to determine the protective effect of antibodies against VP4(an outer capsid viral protein) and VP6(a major inner capsid viral protein). Only two non-neutralizing immunoglobulin A (IgA) antibodies to VP6 were capable of preventing primary and resolving chronic murine rotavirus infections. These antibodies were not active, however, when presented directly to the luminal side of the intestinal tract. These findings support the hypothesis that in vivo intracellular viral inactivation by secretory IgA during transcytosis is a mechanism of host defense against rotavirus infection.

Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration.

Abstract: Unlike the post-Vietnam era, effective, specialized treatments for posttraumatic stress disorder (PTSD) now exist, although these treatments have not been widely available in clinical settings. The U.S. Department of Veterans Affairs (VA) is nationally disseminating 2 evidence-based psychotherapies for PTSD throughout the VA health care system. The VA has developed national initiatives to train mental health staff in the delivery of Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) and has implemented a variety of strategies to promote local implementation. In this article, the authors examine VA's national CPT and PE training initiatives and report initial patient, therapist, and system-level program evaluation results. Key issues, lessons learned, and next steps for maximizing impact and sustainability are also addressed.

The International Trauma Questionnaire: development of a self‐report measure of ICD‐11 PTSD and complex PTSD

Abstract: Sections ePDFPDF PDF Tools Share Abstract Objective The purpose of this study was to finalize the development of the International Trauma Questionnaire (ITQ), a self‐report diagnostic measure of post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD), as defined in the 11th version of the International Classification of Diseases (ICD‐11). Method The optimal symptom indicators of PTSD and CPTSD were identified by applying item response theory (IRT) analysis to data from a trauma‐exposed community sample (n = 1051) and a trauma‐exposed clinical sample (n = 247) from the United Kingdom. The validity of the optimized 12‐item ITQ was assessed with confirmatory factor analyses. Diagnostic rates were estimated and compared to previous validation studies. Results The latent structure of the 12‐item, optimized ITQ was consistent with prior findings, and diagnostic rates of PTSD and CPTSD were in line with previous estimates. Conclusion The ITQ is a brief, simply worded measure of the core features of PTSD and CPTSD. It is consistent with the organizing principles of the ICD‐11 to maximize clinical utility and international applicability through a focus on a limited but central set of symptoms. The measure is freely available and can be found in the body of this paper.