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This Issue: The Returning Veteran | Table of Contents: Winter 2018 | Download this issue

Editorials from VA Research Scientists

Dr. Jennifer C. Kerns Dr. Jennifer C. Kerns

Weight loss maintenance: a losing battle? Jennifer C. Kerns, M.D., Nutrition Research, July 2017.

Maintaining long-term weight loss in individuals who struggle with obesity is a major challenge, one that the public often views as a losing battle.

Dr. Jennifer C. Kerns, co-director of bariatric surgery at the Washington D.C. VA Medical Center, suggests that first defining successful weight loss maintenance may be a better approach to weight loss. In an editorial published in Nutrition Research, she argues that long-term maintenance of a modest weight loss may be a more realistic goal for an obese individual, and can bring real health benefits. She says studies show that losing just 5 percent of a person's body weight has been associated with reducing the risk of developing type 2 diabetes and providing improvements in blood pressure, serum lipids, and mood.

Kerns notes that there are few randomized controlled studies that address long-term maintenance of weight loss. She suggests that the National Weight Control Registry, a database of more than 10,000 people who have lost at least 30 pounds and kept it off for at least one year, is a good resource for physicians and patients. Based on the data from the NWCR, Kerns says regular vigorous exercise (60 minutes per day), limited screen time, and a low-fat diet all contribute to weight loss maintenance.

Dr. Thomas F. Imperiale Dr. Thomas F. Imperiale

The rising prevalence of early onset colorectal cancer: Ready and FIT to tackle? Thomas F. Imperiale, M.D., Gastrointestinal Endoscopy, November 2017.

The incidence of early-onset colorectal cancer (under age 50) has been rising over the past several decades. Individuals in this group now account for 8 to 10 percent of CRC diagnoses. They also tend to have more advanced illness and less favorable outcomes than do people who are over the age of 50.

Dr. Thomas Imperiale, a researcher at the Roudebush VA Medical Center in Indianapolis, Indiana, asks in an editorial in Gastrointestinal Endoscopy whether clinicians should start screening at an earlier age for CRC. He notes that the answer isn't always simple, and should involve an analysis of cost, harms, and benefits, starting at different ages.

Early screening that surveys only people who are at high risk could spare unnecessary testing for those at low risk, says Imperiale. But what metric should be used to identify high risk for early onset CRC? Early onset CRC is not associated with a high-risk family history of CRC. Likewise, testing people under age 50 with a fecal immunochemical test (FIT) is not a panacea either. Studies do not conclusively show a benefit from early FIT testing, and the U.S. Preventive Task Force recommends that screening starting at age 50 is the best approach.

Imperiale concludes that public education on the signs and symptoms of CRC and the increasing risk for younger people would be more helpful than across-the-board screening. Primary care physicians need to have a dialogue with their patients and ask them to report suspicious symptoms, he says. Physicians should also consider adjusting the threshold at which they work-up reported symptoms like blood in the stool.

Dr. Jessica Breland Dr. Jessica Breland

Social media as a tool to increase the impact of public health research. Jessica Y. Breland, Ph.D.; Lisa M. Quintiliani, Ph.D.; Kristin L. Schneider, Ph.D.; Christine N. May, Ph.D.; and Sherry Pagoto, Ph.D. American Journal of Public Health, December 2017.

In an editorial published in the American Journal of Public Health, Dr. Jessica Breland and associates assert that social media can be an important tool for health researchers to share their work with the public and promote social discourse. Breland, who is a researcher with the VA Palo Alto Health Care System, in Menlo Park, California, and her team point out that roughly 69 percent of U.S. adults use some kind of social media. That number rises to 90 percent for adults under age 30. Yet, despite the degree of social media saturation, one study showed only 47 percent of U.S. scientists had ever used social media to share their research.

Breland's team says there are multiple benefits that come from using social media channels like Facebook, Twitter, YouTube, and web blogs. 1) Social media can help disseminate the results of public health research by expanding readership to a wider audience. 2) Social media can be used to correct public health misinformation. 3) Social media can help influence health policy. 4) Social media can be used to facilitate public health research. 5) Social media can enhance professional development, e.g., public health chats on Twitter.

There are a few caveats to consider if researchers do choose to use social media, says Breland's team. Social media posts are open to the public, and create searchable records. Therefore, any transgression, like breaching the boundary between public and private social media accounts, may have serious consequences.

Dr. Carolyn Clancy Dr. Carolyn Clancy

Advancing high performance in Veterans Affairs health care. David Atkins, M.D., M.P.H., and Carolyn M. Clancy, M.D., JAMA Internal Medicine, November 2017.

In an analysis published in JAMA Internal Medicine, Dr. David Atkins, director of VA Health Services Research and Development, and Dr. Carolyn Clancy, executive in charge of the Veterans Health Administration, compared patient experiences, outcomes, and mental health measures at VA medical centers with those at non-VA hospitals.

The comparison used data from the Centers for Medicare and Medicaid Hospital Compare website, for the period July 2012–March 2015. VA outperformed public sector hospitals on six of nine patient safety indicators. VA hospitals also had better patient outcomes on mortality and readmission measures and performed as well or better on most clinical metrics. However, non-VA hospitals performed better on measures of patient experience like nursing and physician communication, responsiveness, and pain management.

The authors suggest that VA's early adoption of an electronic health record was key in collecting and analyzing system-wide patient data, facilitating research efforts, and improving physician-patient communication. VA also excels at integrating primary care and mental health programs. But they note there is more work to be done, especially in areas where patient satisfaction is a component. To that end, VA is beginning to adopt private-sector practices like setting customer service standards, implementing tools to collect customer feedback, and hiring staff that will be dedicated to improving the health care experience for Veterans.

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