Surgical intervention for infective endocarditis in a veteran population

Abstract BACKGROUND: Surgical management of infective endocarditis can be challenging. Veteran patients are unique because they often have significant comorbidities, and surgical management of endocarditis in this population has not been well described. METHODS: Using a prospective database, 46 consecutive patients who underwent valve surgery for acute infective endocarditis between 1987 and 2009 were identified. Survival was assessed using the Kaplan-Meier method. RESULTS: All patients were men (mean age, 56±9 years). The most common indication for surgical intervention was congestive heart failure (60%). The aortic valve was the only valve infected in most patients (65%). Operative morbidity and mortality were 33% and 9%, respectively. The 1-year, 3-year, 5-year, and 10-year unadjusted survival rates were 72%, 57%, 51%, and 30%, respectively. CONCLUSIONS: Although acceptable short-term outcomes can be achieved in veterans undergoing surgical treatment for endocarditis, unadjusted long-term survival may be poor

The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

Background/Aims: Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia. Methods: We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management. Results: Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of ‘quite bad' or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused. Conclusion: Community-dwelling elders with dementia are underdiagnosed and undertreated for pain

Development of the Department of Veterans Affairs Centers of Excellence in Primary Care Education Trainee Participant Survey: Measuring Trainees’ Perceptions of an Interprofessional Education Curriculum

Background: The Trainee Participant Survey was developed for the evaluation of the Department of Veterans Affairs, Centers of Excellence in Primary Care Education (VA CoEPCE), which developed and delivered an interprofessional education (IPE) postgraduate curriculum to learners of multiple professions at seven geographically diverse VA facilities across the United States.Methods and findings: Perceptions of the curriculum by learners across professions were assessed to identify differences in curricular perceptions and unmet needs to inform programmatic changes. The comparison of responses by profession revealed no statistically significant differences across the core domains; precepting, supervising, mentoring; or program practices. Trainee professions differed significantly on satisfaction and system impacts.Conclusion: The Trainee Participant Survey has excellent psychometric properties and can serve as a model for evaluating future IPE programs