VA Center Research Articles

S1780 “Up to Date”: A Quality Improvement Project for Printed Educational Material at a Tertiary VA Center

S1780 “Up to Date”: A Quality Improvement Project for Printed Educational Material at a Tertiary VA Center

HPV Status and Genotype in Veteran Population at an Urban VA Center

HPV Status and Genotype in Veteran Population at an Urban VA Center

0696 The Moderating Role of Sleepiness among Intraday Passive and Active Suicidal Ideation

Abstract Introduction Disrupted sleep has been linked to suicidal thought and behavior. Less is known regarding underlying mechanisms of this relationship. A more nuanced understanding of the link between sleep and suicide may help inform treatment decisions and the development of prevention and intervention strategies. We examine prior day sleepiness as a moderator to the relationship between passive and active suicidal ideation (SI). Methods Young adults (mean age=21.04; SD=2.22) endorsing SI (n=59) at least twice in the past two weeks were enrolled in a trial examining potential iatrogenic effects of the ecological momentary assessment (EMA) of SI. A baseline battery collected data on past suicidal thought and behavior, demographics, and psychological distress. EMA surveys were administered randomly five times per day over four weeks and assessed sleepiness and current emotional state including occurrence and severity of SI and passive/active ideation. Results Altogether, 835 daily average EMA entries were utilized in the present analysis. A significant relationship (p<.05) was observed between sleepiness and passive SI and its impact on the intensity and duration of SI. Specifically, the association between passive and active SI was stronger on days that participants endorsed greater sleepiness. There was also a significant interaction such that one’s desire to die and a low desire to stay awake significantly interacted (p<.05) to predict same-day perceived controllability of SI. Meaning that when participants had a lower desire to stay awake, there was a stronger relationship among perceived ability to control one’s SI and lower desire to live. Conclusion This study examined the impact of daily sleepiness on relationships among passive and active SI among young adults endorsing suicidal thought. Findings indicate that the relation between daily passive and active SI severity grows stronger the sleepier one is relative to their average level of sleepiness. Future studies should incorporate objective measures of sleep to further explore these findings and clinical implications. Support (if any) This study was funded by the American Psychological Foundation. This work was also supported, in part, by the VA Center of Excellence for Suicide Prevention. Authors’ views do not necessarily represent those of the Department of Veterans Affairs or the United States Government.

0423 The Role of Fear of Sleep in Cognitive Behavioral Therapy for Insomnia and Cognitive Processing Therapy

Abstract Introduction Fear of sleep (FoS) is linked to symptoms of PTSD. Additionally, cognitive behavioral therapy for insomnia (CBTi) can reduce FoS. Utilizing data from a randomized controlled trial of CBTi followed by Cognitive Processing Therapy for PTSD (CPT), this secondary data analysis sought to examine the relationship between FoS and PTSD symptoms, and how FoS is impacted by CBTi, in individuals exposed to interpersonal violence with PTSD. Additionally, we sought to extend the literature by examining whether FoS predicts the effect of subsequent CPT on PTSD severity or if CPT further reduces FoS. Methods A sample of 83 participants were randomly assigned to either receive sequential delivery of four weekly sessions of CBTi, which included modules to address FoS, followed by 12 weekly sessions of CPT (Group 1: CBTi+CPT) or receive four weekly phone check-ins (CTRL) followed by CPT (Group 2: CTRL+CPT). Participants were assessed at baseline (T1), after CBTi/CTRL (T2), and after CPT (T3). Relevant measures included the Fear of Sleep Inventory (FoSI) and Clinician Administered PTSD Scale (CAPS). Analyses included correlations, mean differences tests, and regression-based analyses. Results At T1 FoSI and CAPS were positively correlated (r = 0.47, p < 0.001). At T2 a significant reduction in FoSI scores was observed after CBTi/CTRL for Group 1 (t = 4.81, p < 0.001), but not Group 2, and a significant difference in FoSI scores between Group 1 and Group 2, all while controlling for baseline differences (F (1, 80) = 3.99, p < 0.05). Lastly, for the entire sample lower T2 FoSI scores predicted lower T3 CAPS scores (B = 0.42, p < 0.01) and FoS was not further reduced following CPT. Conclusion Results replicate previous work by demonstrating a positive relationship between FoS and PTSD severity. Additionally, FoSI was significantly reduced after CBTi. Lastly, lower levels of FoS predicted reduced PTSD symptoms following CPT, although CPT was not associated with significant reductions in FoS. Results highlight that CBTi that explicitly addresses FoS may reduce FoS, and findings also suggest that effectively reducing FoS prior to PTSD treatment may improve treatment outcomes. Support (if any) NIH/NINR R01 NR013909; VA Center of Excellence for Suicide Prevention

Advances in Stroke: Quality Improvement.

HomeStrokeAhead of PrintAdvances in Stroke: Quality Improvement No AccessArticle CommentaryRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessArticle CommentaryRequest AccessAdvances in Stroke: Quality Improvement Dawn M. Bravata, Tara Purvis, Qinglan Pricilla Ding, Kimberly J. Waddell and Monique F. Kilkenny Dawn M. BravataDawn M. Bravata Correspondence to: Dawn M. Bravata, MD, Richard L. Roudebush VA Medical Center, 1481 W 10th St, 11H Indianapolis, IN 46202. Email E-mail Address: [email protected] https://orcid.org/0000-0002-3048-2536 Department of Veterans Affairs, Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.). Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.). Regenstrief Institute, Indianapolis, IN (D.M.B.). Search for more papers by this author , Tara PurvisTara Purvis Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (T.P., M.F.K.). Search for more papers by this author , Qinglan Pricilla DingQinglan Pricilla Ding https://orcid.org/0000-0001-7431-0288 Purdue University School of Nursing, West Lafayette, IN (Q.P.D.). Search for more papers by this author , Kimberly J. WaddellKimberly J. Waddell https://orcid.org/0000-0002-8137-2900 VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA (K.J.W.). Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.J.W.). Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia (K.J.W.). Search for more papers by this author and Monique F. KilkennyMonique F. Kilkenny https://orcid.org/0000-0002-3375-287X Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (T.P., M.F.K.). The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (M.F.K.). Search for more papers by this author Originally published13 Apr 2023https://doi.org/10.1161/STROKEAHA.123.042310Stroke. 2023;0FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page XXX.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.123.042310.Correspondence to: Dawn M. Bravata, MD, Richard L. Roudebush VA Medical Center, 1481 W 10th St, 11H Indianapolis, IN 46202. Email dawn.[email protected]gov Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.042310PMID: 37051910 Originally publishedApril 13, 2023 Keywordsstrokeoutcome assessment, health carequality improvementdeveloped countriesimplementation sciencePDF download Advertisement SubjectsHealth ServicesIschemic StrokeQuality and OutcomesTransient Ischemic Attack (TIA)

O.11.4 - Personal health planning for patients with COPD: Staff perspectives from VA’s Whole Health system: Presenter(s): Ekaterina Anderson, VA Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, United States

O.11.4 - Personal health planning for patients with COPD: Staff perspectives from VA’s Whole Health system: Presenter(s): Ekaterina Anderson, VA Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, United States

0671 Nightmare type and its association with suicide attempts among veterans

Abstract Introduction Research has begun to distinguish between idiopathic (no known origin), trauma-related (recurring after a trauma), and complex nightmares (trauma-related nightmares that recur comorbidly with sleep disordered breathing). Nightmare type may impact symptom severity as well as treatment outcomes among various patient groups. Thus, we sought to examine the individual effects of nightmare type on suicide re-attempts and, secondarily, on treatment utilization. Methods This is a secondary analysis of electronic medical record data. Data were extracted for all Veterans with a documented suicide attempt (using ICD-10 codes) during FY13-14. A 1:1 case control was then created using age, sex, and prior year behavioral health treatment utilization. The present sample is comprised of all Veterans from that parent dataset who carry an ICD-10 diagnosis of nightmare disorder (n = 3207). Groups were defined as follows: 1) Idiopathic (n = 589; nightmare disorder only); 2) Trauma (n = 3207; nightmare disorder plus ICD-10 diagnosis of PTSD); 3) Complex (n = 576; nightmare disorder + PTSD + ICD-10 diagnosis of a sleep-related breathing disorder). Results Multiple logistic regression revealed that only trauma-related nightmares were positively associated with suicide re-attempts (B = 0.16, SE = 0.06, p < 0.01), with an estimated odds ratio of 1.27 (95% CI of 1.02-1.57). Regarding treatment utilization, regression analyses revealed that both complex nightmares (B = 0.36, p < 0.05) and trauma-related nightmares (B = 0.31, p < 0.05) were significantly associated with mental healthcare utilization (total days). Conclusion Our results revealed that both complex and trauma-related nightmares are associated with mental health treatment utilization. Only trauma-related nightmares were significantly associated with suicide re-attempts. Trauma-related nightmares may be distressing because of their trauma-related content, therefore making them more likely to predict reattempts. Overall, results suggest that nightmares are positively associated with suicide re-attempts and increased treatment utilization. Support (If Any) This work was supported by the VA Center of Excellence for Suicide Prevention in teh Finger Lakes Healthcare System.

502 Idiopathic hypersomnia and co-occurring psychopathology among veterans

Abstract Introduction Idiopathic hypersomnia (IH) is relatively rare and characterized by excessive daytime sleepiness despite prolonged and undisturbed sleep as well as the absence of cataplexy and other causes of hypersomnolence. The etiology of IH is largely unknown. The present study capitalized on electronic medical record (EMR) data from the Veterans Health Administration (VHA) to create a cohort of veterans diagnosed with IH in order to: 1) estimate the prevalence of IH diagnosis in the VHA, and 2) identify co-occurring physical and behavioral health conditions to characterize IH in the sample. Methods Using 2009–19 VHA EMR data, we created two cohorts: those with an IH diagnosis (N = 3,674) or a hypersomnia diagnosis (e.g., primary hypersomnia) other than IH (N = 110,530). Diagnostic data (i.e., ICD 9 and 10 codes) were extracted for the 6-months prior to index diagnosis to examine group differences in the prevalence of physical and behavioral health conditions. Results Veterans diagnosed with IH, as compared to veterans with another hypersomnia disorder, were more likely to be female (30.1% vs 12.3%) and less likely to be obese (16% vs 28.3%; chi-squared = 79.27, p <.001), or carry diagnoses of diabetes (type 1 or 2; 9.7% vs 24.4%; chi-squared = 123.02, p <.001), or anxiety disorders (5.8% vs 9.5%; chi-squared = 16.83, p <.001). Individuals with IH were more likely to carry diagnoses of chronic fatigue syndrome (4.2% vs 1.6%; chi-squared = 45.91, p <.001), depression (31.3% vs 23.4%; chi-squared = 36.04, p <.001), and posttraumatic stress disorder (29.5% vs 26.5%; chi-squared = 5.79, p = .02). Conclusion Data suggest that veterans diagnosed with idiopathic hypersomnia may present with different diagnostic profiles than veterans with other hypersomnia disorders. Far more basic and clinical research is needed in IH. Support (if any) This work was supported by the Hypersomnia Foundation and in part by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.

435 Single Session CBT to Improve PAP Initiation and Adherence among Veterans with OSA

Abstract Introduction Obstructive sleep apnea (OSA) is a condition that is prevalent, pernicious, and linked to the development and exacerbation of several disease processes. Positive airway pressure (PAP) is a highly efficacious intervention; however, initiation and adherence rates are poor. This represents a critical gap in care and a missed opportunity to reduce morbidity and mortality associated with OSA. The present study piloted a single session of cognitive behavioral therapy for treatment seeking (CBT-TS) among veterans diagnosed with obstructive sleep apnea and newly prescribed PAP. Methods Participants were asked to complete assessments at baseline and at two- and four-weeks post-intervention. A sample of 40 Veterans were enrolled in the study and completed a baseline interview, 27 completed CBT-TS. A matched comparison group of 64 veterans who did not receive the intervention was constructed using electronic medical record and PAP adherence data. Mann Whitney U and Chi Square tests were used to examine group differences in initiation and adherence. Results Participants who completed the CBT-TS session were more likely to initiate PAP (at least 3 consecutive nights of use) as compared to those receiving treatment as usual (TAU) [(CBT-TS; 96.3%; 26/27) versus (TAU; 64.1%; 41/64); X2(1, N = 91) = 10.16, p = .001]. Participants in the CBT-TS group also used their PAP devices for a greater number of nights over the first month than the comparison group [(CBT-TS; M = 21.7 (SD = 8.9), Mdn = 26.0) versus (TAU; M = 14.4 (SD = 12.6), Mdn = 15.5); U = 555.0, p = .007] and were more likely to use the device in an adherent manner (i.e., ≥4 hours use in an evening); [(CBT-TS; M = 15.1 (SD = 11.2); Mdn = 15.0) versus (TAU; M = 10.3 (SD = 11.2), Mdn = 6.5); U =630.0, p = .038]. Conclusion These preliminary data suggest that CBT-TS may have utility in increasing initiation of PAP and subsequent treatment adherence among Veterans diagnosed with OSA and newly prescribed PAP. Support (if any) This work was supported by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.

CGRP antibody rescues tactile sensitization induced by mild traumatic brain injury in mice

Post-traumatic headache (PTH) after mild traumatic brain injury (mTBI) is debilitating and hard to diagnose. Unfortunately, PTH is highly prevalent in active duty personnel, Veterans, as well as sport athletes. The high incidence and chronic nature of PTH underscores the need to study these problems in animal models in order to develop new and effective treatments. Patients suffering from PTH often present the same symptoms as migraine patients, which can be studied in mice. We explored hypersensitivity to a tactile stimulation of the periorbital facial and plantar paw areas in a model of mTBI in mice using von Frey filaments. This mild closed head impact (mCHI) is induced by a weight (30 g) dropped onto the intact skull once a day over 3 consecutive days, after which mice develop a transient cephalic hypersensitivity between day 1 and day 5 after the injury, and then recover to normal thresholds. Additionally, after mice recover from this transient cephalic hypersensitivity, an injection of normally non-noxious triggers such as a low dose of calcitonin gene-related peptide (CGRP) or a low dose of sodium nitroprusside (SNP, a nitric oxide donor) can induce tactile hypersensitivity. This can last for at least 13 weeks after injury. Treatment with a CGRP-blocking monoclonal antibody after injury, but prior to CGRP or SNP administration can alleviate this sensitization. Preliminary data indicate that after injuries, administration of CGRP is also able to induce light aversion at usually non-noxious dim light intensities. In summary, we report that mice are primed by a mild TBI that sensitizes them to subsequent migraine triggers in a CGRP-dependent manner. Dept. Defense W81XWH-16-1-0071, W81XWH-16-1-0211 to AFR; VA-ORD (RRD IHA Research Award and Pilot Grant from Iowa City VA Center for the Prevention and Treatment of Visual Loss to ASW.

0596 Providers Rarely Assess Obstructive Sleep Apnea Symptoms Among Patients with Chronic Obstructive Pulmonary Disease

Abstract Introduction Professional societies recommend providers assess sleep symptoms in COPD, but it is unclear if this occurs. We aimed to evaluate OSA symptom assessment and documentation among patients with COPD, and the patient and provider characteristics associated with this assessment. Methods We conducted a cross-sectional study of adults aged ≥40 years with clinically diagnosed COPD and no prior diagnosis of OSA. We selected patients receiving care at two academic general internal medicine clinics between 6/1/2011 - 6/1/2013. We abstracted charts to assess how often OSA symptoms such as snoring, somnolence, witnessed apneas, or gasping/choking arousals were documented as present or absent. We performed multivariable mixed-effects logistic regression to assess associations of patient and primary care provider (PCP) factors with assessment of OSA symptoms. Patient factors included demographics, body mass index, comorbidities, healthcare utilization, and severity of COPD, and PCP factors including demographics, degree, and years of experience. Results Of 523 patients with COPD, only 26 (5.0%) had documentation of OSA symptom assessment within a one-year period. In mixed effects models, only referral to general pulmonary clinic was associated with the assessment of OSA symptoms (OR: 4.56, 95% CI 1.28-15.52). Among the 26 individuals who had OSA symptoms assessed, 9 (34.6%) reported snoring, 15 (57.7%) reported daytime somnolence, 2 (7.7%) reported gasping/choking arousals, and 5 (19.2%) reported witnessed apneas. Among those assessed for OSA symptoms, providers referred 11 (42.3%) for formal sleep consultation. Conclusion Providers rarely document OSA symptoms for patients with COPD in primary care clinic, but assessment is greater among those with pulmonary specialty consultation. Given time constraints in primary care, external facilitation of sleep symptom assessment may improve symptom recognition and receipt of appropriate services. Support NIH 5K23HL111116-05, VA Center of Innovation for Veteran-Centered and Value-Driven Care.

INTEREST GROUP SESSION—AGING VETERANS: EFFECTS OF MILITARY SERVICE ACROSS THE LIFE COURSE: OPTIMIZING VETERAN AND CAREGIVER WELL-BEING THROUGH TECHNOLOGY

Older Veterans account for more than half of Veterans receiving care through the VA. Many suffer from dementia, traumatic brain injuries, and mental health disorders, resulting in complex care needs, which may include need for caregiver support. Innovative approaches using technology have the potential to improve access to treatments that improve the well-being of older Veterans and their caregivers. This symposium will present data from three Veterans Health Administrative investigators who are examining the impacts of innovative technology-delivered interventions. First, Dr. Michelle Hilgeman will describe preliminary 6-month outcome findings from a telephone-delivered Care Consultation + Counseling (CC+C) intervention for Veterans with dementia and their caregivers. Second, Dr. Kaci Fairchild will detail the background, methodology, and preliminary results of The COACH Project (Combined Online Assistance for Caregiver Health). The COACH Project is a mobile-delivered intervention consisting of exercise and caregiver skills training designed to reduce caregiver burden in those caring for someone with cognitive impairment. Third, Dr. Christine Gould will describe the development and feasibility of the Geri-Mobile Health clinic, which helps older Veterans use VA mental health apps to meet their well-being and mental health goals. Dr. Gould will describe the clinic’s personalized coaching method to support Veterans unfamiliar with apps and will share findings regarding the program’s acceptance, feasibility, and preliminary outcomes. Dr. Laura Wray, the executive director of the VA Center for Integrated Healthcare, will serve as the discussant. She will comment on implementing these interventions in primary care settings and the potential barriers to their adoption.

659-P: Family Caregivers' Roles in Supporting Adults' Self-Management of Diabetes

Background: Increased social support positively influences self-management of diabetes, but limited data exist documenting the specific roles that family caregivers assume in supporting adults with diabetes. Moreover, explanations for why caregivers take on certain roles has received little attention. Understanding what roles caregivers fill and why is critical to informing and targeting services aimed at improving caregiver competency in promoting diabetes self-management for their loved ones. Methods: To characterize caregivers’ roles in supporting adults’ self-management of diabetes, as well as reasons for assuming those roles, 31 one-on-one, in-depth, semi-structured telephone interviews were conducted with adults with type 2 diabetes (n=19) and their family caregivers (n=12). Two coders independently reviewed transcripts from interview audio recordings in NVivo 12 Pro using interpretive phenomenological data analysis. Findings: Adults and their caregivers described three central roles of caregivers in diabetes self-management: care organizer, health motivator, and medication tracker. Caregivers also recognized another prominent role, knowledge seeker. Two explanations for assuming specified roles emerged: changes in health and healthcare expertise. Caregivers reported taking on care roles because their loved one experienced a health problem that required medical or surgical attention. Some adults described turning to caregivers for diabetes management support because their family member had a healthcare background, such as a nurse or paramedic. Conclusion: These adult and caregiver perspectives shed light on what roles families assume in supporting diabetes self-management and why. Information gleaned from this study may help healthcare providers target support for family roles to enhance caregivers’ ability to help adults with diabetes management. Disclosure B. Fields: None. K.L. Rodriguez: None. L.K. Makaroun: None. C.H. Robinson: None. J. Forman: None. A. Rosland: None. Funding Ann Arbor VA Center for Clinical Management Research; Michigan Center for Diabetes Translational Research (5P60-DK09292)

ADDRESSING BEHAVIORAL HEALTH NEEDS OF FAMILY CAREGIVERS AND VETERANS WITH DEMENTIA IN PRIMARY CARE

AbstractThe New York/New Jersey VA Health Care Network maintains an evidence-based approach to improving dementia recognition and supporting family caregivers of primary care veterans with dementia. This telephone-based program is administered through a telehealth call center and currently provides services to primary care clinics and family caregivers across the upstate New York region. The program includes brief cognitive and health behavior assessment for veterans with identified risk for undiagnosed dementia, linkage between primary care providers and dementia specialists, and, care management services. Caregiver education and support emphasizes training in management of behavioral symptoms of dementia. Program evaluation by the VA Center for Integrated Healthcare has demonstrated positive outcomes including: more rapid recognition of dementia in primary care; improved caregiver attitude, self-efficacy, and, understanding of veteran behaviors; and, the decreased costs of care for these veterans.

INCIDENCE OF SMALL-BORE CHEST TUBE FAILURE IN MANAGEMENT OF IATROGENIC PNEUMOTHORAX FOLLOWING CT-GUIDED LUNG BIOPSY: A VA COHORT UNDERGOING CHEST TUBE PLACEMENT BY INTERVENTIONAL RADIOLOGY

SESSION TITLE: Interventional Pulmonary SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Our objective was to define the incidence of our institution's rate of small bore chest tube failure in the management of iatrogenic pneumothorax following CT-guided transthoracic lung biopsy by IR. Additionally, we looked to further assess for any difference that exists in incidence rate based on chest tube size. Ultimately, this analysis would be utilized to potentially modify current practices to improve patient safety in those veterans undergoing chest tube insertion following iatrogenic pneumothorax following IR lung biopsy. METHODS: Retrospective chart review of patients from September 2013 to December 2017 who had chest tubes placed by IR for iatrogenic pneumothorax after CT-guided transthoracic lung biopsy at this VA center. 94 cases were identified using the IR's departmental procedure log. 78 cases had sufficient documentation for analysis. Chest tube failure was defined as expanding pneumothorax requiring additional tube or upsized chest tube insertion or tension pneumothorax requiring urgent intervention. The most common reason for exclusion was lack of documentation about the size of chest tube placed. RESULTS: Four cases involved placement of a 6.5 Fr catheter, 3 cases with an 8.5 Fr catheter, 46 cases with a 10 Fr catheter, 5 cases with a 12/12.5 Fr catheter, and 20 cases with a 14 Fr catheter. The overall failure rate in small bore chest tubes was 6.4% (5/78). The failure in small bore chest tubes less than 10 Fr was 28.5% (2/7) compared to 4.2% (3/71) in small bore chest tubes greater than or equal to 10 Fr (p = 0.06 using Fisher Exact test). Tension pneumothorax requiring ICU admission for emergent chest tube upsizing occurred in 3 patients. CONCLUSIONS: In this retrospective analysis of a VA cohort undergoing CT guided lung biopsy whose course was complicated by pneumothorax requiring chest tube, there was an overall incidence of chest tube failure in 6.4%. Though there was a trend in favor of small bore tubes greater than or equal to 10 Fr, there was no statistical difference in complications between various sizes of small bore chest tubes. A larger analysis would be needed to further explore any statistically significant difference in rate of complications between these groups. CLINICAL IMPLICATIONS: In this analysis, the overall rate of small bore chest tube failure in management of iatrogenic pneumothorax following CT-guided lung biopsy was low. Currently, neither this study nor other reviewed research provides compelling data to demonstrate benefit of any one specific size of small bore chest tube versus another. Until this is demonstrated in a more appropriately powered study, management of this condition will be subject to institutional variation. DISCLOSURES: No relevant relationships by Stephen Bujarski, source=Web Response No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by Sarah Tuthill, source=Web Response

Evaluation of Genetic Counselling in Patients With High Adenoma Burden

Introduction: Up to 10% of cancers are caused by inherited mutations in genes. Identifying these patients is important as it leads to changes in the surveillance of the index patient and their the family and plays a very important role in further management of these patients. While genetic counselling/testing allow for identification of high-risk individuals and family members enabling enrollment into appropriate screening protocols. Currently, GI guidelines and the National Comprehensive Cancer Network guidelines suggest referral of individuals with ≥10 adenomatous polyps for evaluation and consideration of genetic testing. The goal of this study is to determine the efficacy of execution of genetic counselling at a teaching hospital. Methods: This study was an IRB approved retrospective review performed at a tertiary referral VA center in Tampa, Florida. We reviewed 11540 patients who underwent screening or surveillance colonoscopy and included patients who procedures noted more than 10 polyps<./p> Results: A total of 61 veterans (mean age 71 years old, 58 males and 3 females) met inclusion criteria for the study. The cohort included 54 Caucasian, 2 Hispanic and 3 African American patients. 52 patients were found to have >10 biopsy proven adenomas, the remaining patients with hyperplastic polyps. 1 patient underwent documented genetic counselling, and 4 patients underwent genetic testing; 7 patients were lost to follow-up. In patient's that did undergo genetic testing, APC was performed in 2 patients and 1 patient underwent MSI and IHC testing each. The importance of genetic intervention is reinforced as 5%(9/61) patients included in our study had a positive family history of colon cancer increasing their predisposition to develop genetic cancer syndromes. Despite follow up, 76% (40/52) patients did not undergo further evaluation. Conclusion: Current GI guidelines recommend genetic testing to confirm a diagnosis and allow for predictive testing of at-risk relatives. This study demonstrates the low overall referral rate for genetic counselling and testing in our academic center. We suspect that this low referral rate is consistent with current community practice. The causes for low genetic testing and counselling may be multifactorial such as patient compliance, poor communication with patients, and fear of testing. Further initiatives such as an automated genetic referral with detection of multiple adenomas may improve future outcomes and increase compliance with current guidelines.

Metacognitive self-reflectivity moderates the relationship between distress tolerance and empathy in schizophrenia

Deficits in empathy seen in schizophrenia are thought to play a major role in the social dysfunction seen in the disorder. However, little work has investigated potential determinants of empathic deficits. This study aimed to fill that gap by examining the effects of two variables on empathy – distress tolerance and metacognitive self-reflectivity. Fifty-four people with schizophrenia-spectrum disorders receiving services at an urban VA or community mental health center were assessed for empathy, metacognition, and distress tolerance. Bivariate correlations and moderation methods were used to ascertain associations amongst these variables and examine interactions. Results revealed that, against hypotheses, empathy was not related at the bivariate level to either distress tolerance or metacognitive self-reflectivity. However, consistent with hypotheses, moderation analyses revealed that participants with higher self-reflectivity showed no relationship between distress tolerance and empathy, while those with lower self-reflectivity showed a relationship such that reduced ability to tolerate distress predicted reduced empathy. Taken together, results of this study suggest that lack of distress tolerance can negatively affect empathy in people with schizophrenia with lesser capacity for metacognitive self-reflection; thus, fostering self-reflectivity may help overcome that negative impact. Future work is needed investigating the impact of metacognitively-tailored interventions on empathy in this population.

Abstract WP374: A Nurse Dyad Model for Collaborative Action Planning and Goal Attainment to Support Patient Self-Management of Stroke Risk Factors

Background and Purpose: Patient self-management (SM) of stroke risk factors is critical to prevent second stroke. Development of an action plan to reach behavior goals is established for chronic disease SM. In collaborative planning, patients identify a goal and then a healthcare provider helps develop action plan to attain the goal. We pilot-tested a model where nurses in stroke ward and in primary care worked as dyads to support stroke patients in setting goals. Nurses have been identified as front line health care providers for patient education and SM support. We conducted an IRB approved pilot of a nurse dyad model to determine feasibility of coaching patients in goal-setting and the Goal Attainment Measure for Stroke (GAM-S). Methods: A pre-experimental, pre/post design was applied. Ten registered nurses and 26 stroke patients were recruited from neurology at DeBakey VA Center. Nurses delivered one-on-one educational sessions to patients admitted with stroke and set goals and action plans in patients’ medical records. Nurses in primary care clinic called patients 2-weeks after discharge to evaluate goal attainment, which was documented and scored using GAM-S. The GAM-S components are scored as, 2 = attained, 1 = partially attained, and 0 = not attained. Results: Twenty six patients were enrolled: 24 males (92%) and 2 females (8%). Mean age was 67 years with 54% White, 34% African American, and 12% Hispanic. Of the 26 patients who completed GAM-S, 57% achieved a maximum total score of 8 for goal attainment. The mean GAM-S score was 6.7. Conclusions: Implementation of a nurse dyad model for collaborative action planning is feasible and shows promise for engaging patients in self-management of stroke risk factors. Findings will help design a self-management support intervention for stroke survivors using a nurse dyad delivery model.

Sa1018 - Levels of Inappropriate Fecal Immunohistochemistry Test use: Experiences at a Single VA Center

Sa1018 - Levels of Inappropriate Fecal Immunohistochemistry Test use: Experiences at a Single VA Center

Risk Factors for Metabolic Bone Disease in IBD

Introduction: Metabolic bone disease is a major extra-intestinal manifestation of inflammatory bowel disease (IBD), with prevalence of osteopenia and osteoporosis by densitometry being 55% and 37% for Crohn's disease (CD) patients, and 67% and 18% for ulcerative colitis (UC) patients, respectively. Age, female gender, and former smoking have been previously identified as independent risk factors. The aims of this study were to assess the prevalence of metabolic bone disease (MBD) in an IBD clinic population at a VA Center and determine whether bone loss correlated with degree of colitis and IBD treatment. Methods: A review was performed of 34 IBD patients who underwent bone mineral density (BMD) testing and colonoscopy and were seen in a tertiary VA IBD clinic within the past six months. Baseline characteristics, current IBD therapy, results of BMD and colonoscopies were collected. Osteopenia was defined as minimum T score between -1 and -2.5 and osteoporosis was identified as any T score ≤ -2.5. Detailed endoscopic and pathologic findings around the time of BMD were reviewed. Statistical analysis was performed using multivariate analysis. Results: Overall mean T score was -0.9 (median -1.0). Metabolic bone disease was present in 74% of patients, with osteoporosis in six (18%), and osteopenia in 19 (56%) patients. Patients were predominantly male (N=28, 82%) and Caucasian (N=27, 79%). The median BMI was 27.0 with a median age of 59 years. Age was the only factor that correlated with bone disease status (p=0.025) in univariate analyses. Increased number of IBD medications was associated with higher BMD scores (p=0.049). Patients on no IBD therapy had median T scores of -1.75, while those on more than two medications had a median score of -1.0. In multivariate models, increased age, female, and former smoking were all independently associated with worse bone disease. BMI, race, and alcohol consumption did not correlate with BMD results in univariate or multivariate analysis. Conclusion: Age, female gender, and former smoking were all identified as independent risk factors for MBD. While severity of colitis did not correlate with bone density studies, an increased number of IBD medications was associated with less bone loss.