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PubMed1983

Male breast carcinoma: an updated experience at a Veterans Administration Hospital and review of the literature.

Ten cases of male breast carcinoma are reviewed. Male patients with breast cancer on the average are 10 years older than females, and they delay twice as long as females after noting a breast mass before seeking medical attention. Because of this patient's delay, male breast cancer tends to be more advanced at the time of diagnosis and initial therapy than female breast cancer.

Adenocarcinoma↗
PubMed1983

Histoplasmosis in Veterans Administration hospitals in middle America.

A series of clinical studies of histoplasmosis based on demonstrations of etiology led to descriptions of chronic pulmonary histoplasmosis, the principal type in adults, and amphotericin B as an effective therapy. A participant recreates the atmosphere of discovery during the contributions of a team comprising a mycologist, a surgeon and two physicians using cultures of excised lung and sputum to clearly identify cases of chronic pulmonary histoplasmosis. Subsequently cooperating physicians in several V.A. Hospitals carried out randomized studies of treatment, dosage, and side effects that established Amphotericin B as the sole curative therapy for chronic pulmonary histoplasmosis for 20 years.

Amphotericin B↗
PubMed1978

Veterans Administration hospital staff attitudes toward alcoholism.

Attitudes toward alcoholism among psychiatrists, psychologists, social workers, registered nurses, licensed practical nurses, and nursing assistants (464 subjects) were surveyed. A nine-factor questionnaire was utilized (emotional difficulties, character defect, social status, illness conception, harmless indulgence and addiction liability). All groups were homogeneous in their perceptions about emotional difficulties contributing to alcoholism, alcoholics not coming from the lower socioeconomic strata of society, and the belief that alcoholics did recover and could be helped by treatment. Age, sex, and special training in the treatment of alcoholism did not have any significant influence on attitudes. All groups believed that periodic excessive drinkers could be alcoholics. None of the groups believed that the alcoholic had a character defect. Psychologists disbelieved the concepts of illness and addiction liability. All groups disagreed with harmless indulgence. Nursing assistants tended to see the alcoholic as a harmless heavy drinker. Working on a special alcoholism treatment unit did not alter the perceptions of psychiatrists, psychologists and nursing assistants. Social workers and registered nurses showed only a minor trend toward a positive attitude change, while the trend went in the opposite direction for licensed practical nurses.

Adult↗
PubMed1984

Uses and contributions of diagnostic electron microscopy in surgical pathology: a study of 20 Veterans Administration hospitals.

Although the capability of electron microscopy to contribute to histopathologic diagnosis in selected instances, e.g., renal biopsies and biopsies of certain tumors, is generally recognized, its contribution in a broader range of surgical pathology accessions is not well established. To gain further information concerning this aspect of the use of electron microscopy, 7,193 surgical pathology reports, 290 (4 per cent) of which included electron microscopic findings, were analyzed; these reports represented all such accessions during the same single month at 20 VA medical centers. It was found that malignancies constituted 62 per cent of the lesions examined by electron microscopy but only 20 per cent of the total number of surgical cases examined by light microscopy. It was also found that the distribution of specimens by tissue site of origin differed considerably for specimens examined by electron microscopy and light microscopy; positive contributions of electron microscopy to diagnosis were found in 146 of the 290 electron microscopy cases (50 per cent), with higher percentages found in malignancies and in certain tissue site subsets (lower respiratory tract, soft tissue, kidney, skin, and lymph nodes with metastases); failure to examine some specimens (lung metastases to lymph nodes or other tissues and endobronchial biopsy specimens) suggests slight, but common, underutilization of electron microscopy in diagnosis.

Adult↗
PubMed2003

Effect of comparative data feedback on intensive care unit infection rates in a Veterans Administration Hospital Network System.

BACKGROUND: Infection control surveillance is not performed with standardized methodology within the Veterans Affairs (VA) health system. The purposes of this study were (1) to provide network hospitals with a standardized intensive care unit (ICU) surveillance system developed by the Centers for Disease Control and Prevention (CDC); (2) to compare ICU infection rates in hospitals that receive comparative data with those that do not; and (3) to compare network device-associated infection trends to national trends. METHODS: One VA Medical Center served as the central coordination site where surveillance data were analyzed with CDC's criteria and reported back to the sites. During 1999, the experimental group received risk-adjusted infection rates with national comparative data, and the control group received only risk-adjusted infection rates without comparative data. In 2000, hospitals in both groups received risk-adjusted infection rates accompanied by national data. RESULTS: In 1999, the device-associated infection rates were significantly higher in the control group compared with the experimental group. In the control group, the device-associated infection rates were significantly higher than the national comparative CDC rates; in the experimental group, the device-associated infection rates were not significantly different from the national comparative CDC rates. In 2000, the control group device-associated infection rates were not significantly different from the experimental group. The observed rates in both groups were not significantly different from the CDC rates. CONCLUSIONS: Study results suggest that infection rate outcomes may be reduced when national comparative data are provided. The study may serve as an infection control surveillance model for VA hospital networks.

Case-Control Studies↗