Class of 2008 Abstract / Objectives: The purpose of this study is to compare the critical drug-drug interaction alerting software at the Department of Veteran Affairs with Hansten and Horn's drug analysis and management (DIAM) and Micromedex®. Methods: The Department of Veterans Affairs supplied a list of drug-drug interacting (DDI) pairs. Each pair was labled as significant or critical. The critical interactions were included in the study (n=1018). Two researchers inputed the interactions into Micromedex and looked up the interactions in Hansten and Horn's drug interactions analysis and management (DIAM). A Kappa statistic was used to calculate the agreement between the 2 researchers. Results: The researchers differed in the number of interactions found to be "contraindicated" or "major" in Micromedex and "avoid" or "usually aviod" in DIAM (researcher 1= 683, 330, respectively; researcher 2= 672,176, respectively) with a Kappa of 0.9 for Micromedex and 0.57 for DIAM. Conclusions: Our study suggests that there is a difference between the VA drug interaction alerting system, Micromedex ® and DIAM in regards to the way they list interactions and their method of rating the level of severity of the interactions. Also, there may be a difference in the way each researcher interprets the information.

During the COVID-19 pandemic, the Veterans living in the Kerrville VA community living center were required to shelter in place, isolate, and quarantine, much like the rest of the world during the Spring of 2020. Although the Veterans were potentially safe, they were experiencing increased loneliness and feelings of isolation; in turn, their quality of life suffered. In the Ibrahim & Dahlan (2015) article, the authors underscore the importance of engagement in occupations to improve quality of life, as occupational engagement facilitates life’s purpose. Healing Heroes Virtually aims to improve quality of life, provide opportunities for occupational engagement, learning a new skill to bridge the digital divide gap among the older adult population living in long-term care facilities. The Diffusion of Innovation Theory (DOI) will direct this program improvement project within long-term care facilities. This theory introduces innovation to potential adopters (Veterans & staff at the Kerrville VA) and disseminates it into social systems. Timing is also essential when utilizing the DOI theory to move the program. The authors (Abbott-Gaffney et al., 2022) found that “organizations can remove barriers by providing multiple learning opportunities and support to reinforce the learner’s confidence, therefore increasing the likelihood of continued use of telehealth as a service delivery model.” Adult Learning Theory will also be utilized considering the various learning styles adult learners receive/learn information. It is essential for the Veteran to feel comfortable and confident in the newfound skill. The program should run for ten weeks, two times a week, to educate and introduce the iPad, Zoom application, and program to the Veterans. Between weeks four and seven, the goal will be troubleshooting and increasing independence with technology use. During weeks eight through ten, programs such as an exercise session, current events hour, or a virtual Bible study will occur. The Veterans will be given surveys, and staff will evaluate the program’s success for future use. The goal is to create a library of various activities/sessions available to Veterans. Healing Heroes was made with the idea that if the world shuts down again, these Heroes will have the opportunity for occupational engagement and not have to endure occupational deprivation and alienation.

Thesis (D. Min.)--Covenant Theological Seminary, 1997. / Abstract. Includes bibliographical references (leaves 204-210).

Class of 2017 Abstract / Objectives: To determine the efficacy and toxicity of fluorouracil/leucovorin/oxaliplatin (FOLFOX) versus capecitabine/oxaliplatin (XELOX) in the treatment of colorectal cancer (CRC) in the adjuvant (aCRC) and metastatic (mCRC) setting in Veterans at the Southern Arizona Veteran Affairs Health Care System (SAVAHCS). Methods: A retrospective chart review was conducted to collect efficacy and toxicity data. Subjects were included based on age, treatment setting and regimen in the preset 5-year period, and appropriate diagnosis via International Classification of Diseases-Revision 9 (ICD-9) codes. Efficacy was measured via 1-year disease-free survival (DFS) for aCRC, progression-free survival (PFS) for mCRC, and overall survival (OS) for both settings. Results: A total of 79 subjects were initially enrolled with 51 and 54 all-male subjects included in the efficacy and toxicity analysis, respectively. Mean range of age was 63-72 years old. Subjects were divided into four groups: FOLFOX aCRC (17) and mCRC (19), XELOX aCRC (10) and mCRC (8). No difference was found in 1-year DFS and OS between aCRC groups, and PFS between mCRC groups; a higher incidence of 1-year OS with FOLFOX in the mCRC setting was noted (p = 0.03). No difference was found in toxicity between FOLFOX and XELOX, except a higher incidence of hand-foot syndrome in XELOX (p = 0.0007). Conclusions: Efficacy between FOLFOX and XELOX in aCRC and mCRC is similar, while toxicity is slightly more prevalent in XELOX due to increased hand-foot syndrome incidence. These findings agreed with the results reported by prospective clinical trials.

Self-assessment forms and diagnostic tests were used to assess benefits of a treatment program that addressed tinnitus and hyperacusis severity in a population of 30 veterans (29 males, 1female) between the ages of 43 and 79. Patients were enrolled in the treatment program for an average of 20.8 months (range=12-31 months). For the purposes of this study, tinnitus was defined as the subjective perception of a sound lacking an environmental correlate. Hyperacusis was defined as the over-sensitivity to an environmental sound present at a level that would not produce excessive loudness for individuals with normal hearing sensitivity. Treatment strategies included guided counseling regarding auditory and neurological mechanisms of tinnitus coupled with sound therapy designed to reduce the tinnitus disruption. Sound therapy instruments utilized by the subjects included hearing aids, cochlear implants, bedside noise generators, and near-level tinnitus maskers. The tinnitus handicap inventory (THI), self-assessment forms, and loudness discomfort level (LDL) testing were administered to assess benefit of the treatment program. Subjects were first interviewed using an interview form adapted from Jastreboff and Jastreboff, 1999. The THI was then administered in interview format to all patients. Initial sessions were approximately two hours in length. Follow-up sessions lasted approximately one hour. Most patients returned for at least three follow-up visits over the course of their treatment. The correlation between the patients hearing thresholds and the tinnitus handicap inventory (THI) score were poor, consistent with previous reports. Pre and post-testing with the THI indicated that 36.7% of the test subjects experienced significant improvement in tinnitus handicap. The total scores and all sub-scale scores on the THI showed statistically significant improvements. An analysis of the self-assessment forms revealed that 27% of the subjects experienced improvement with concentration, 27% experienced improvement with sleep, 36.7% experienced improvement with quiet recreational activities, and 23.3% experienced improvement with social activities. LDL testing was administered at the initial and post treatment sessions with twenty-two of the thirty subjects. LDL testing indicated that hyperacusis severity was reduced by 13.6% in the right ear and 4.6% in the left ear from the initial evaluation to the post treatment evaluation. Regarding test subject satisfaction with the treatment program, 93.3% expressed satisfaction, and 90% indicated they would be unhappy if asked to return their sound generating devices. Test subjects appeared to be satisfied with their overall experiences with the tinnitus treatment program. The clinical implications of these findings will be discussed.

No description available.