Behavioural interventions are increasingly studied as adjunctive treatments for vaso-occlusive episodes (VOEs) among patients with sickle cell disease (SCD). To assess the feasibility of virtual reality (VR) and changes in VOE-related pain among adults with SCD, with secondary assessment of acceptability, perceived distraction, and side effects. Prospective pilot pre-post study. Twenty adult individuals with SCD (mean age 35 years; 90
Serious injection-related infections (SIRIs) have risen during the opioid overdose epidemic. SIRIs are morbid, costly, and lead to prolonged hospitalizations. Efforts to link patients to medications for opioid use disorder (MOUD) during SIRI hospitalizations have expanded. Additional understanding about patient experiences during SIRI hospitalizations may guide improving satisfaction with inpatient treatment as well as post-hospital care. To explore experiences in the hospital and with transitions of care, we conducted qualitative interviews of individuals with opioid use disorder (OUD) who had been diagnosed with a SIRI over a three-year period ending in 2022. Participants with a qualifying SIRI were identified and recruited directly from an inpatient hospital service, a harm reduction program or through telephone outreach to individuals previously discharged with a SIRI or enrolled in an outpatient parental antibiotic program. We administered a brief survey and conducted semi-structured interviews. Interviews were transcribed and inductively coded. Key themes were then identified. Participants (n = 30) were mostly male (19), white (21), housed (20), and had endocarditis (10) or osteomyelitis (9). Four themes emerged. First, participants delayed presentation to the hospital due to concerns about stigma, withdrawal, and pain control. Second, positive experiences in the hospital were shaped by empathy and adequate pain and withdrawal management; negative experiences were related to stigma, withdrawal and pain. Third, in-hospital substance use and patient-directed discharges (PDDs) were driven by withdrawal and conflict with hospital staff. Fourth, efforts to plan discharges were valued, though some participants identified opportunities for improvement, including greater emphasis on consistent protocols and shared decision-making. Individuals with OUD and SIRIs provided four themes of clinical care that can guide efforts to improve hospital experiences and discharge planning for people with SIRIs. MOUD and shared decision-making about treatments are practical approaches to improving care for people with SIRIs.
Lung cancer, the leading cause of cancer death in the USA, is an important indicator to track effects of the COVID-19 pandemic on cancer diagnosis trends. Evaluate pandemic impact on lung cancer screening, diagnosis, and cancer size at diagnosis. Cohort study (January 2017–June 2023). Veterans who were users of Veterans Affairs (VA) healthcare system, and subgroup of Veterans eligible for lung cancer screening. Pandemic (March 2020–June 2023) versus pre-pandemic period (January 2017–February 2020). Among lung cancer screening eligible Veterans: expected screening rates compared to observed rates and cancer size at diagnosis. Among users of VA: cancer size at diagnosis, lung cancer diagnosis rates, CT scan utilization. Among 1,867,387 screen eligible Veterans, annual screening fell from 7.3
Suicide is a public health crisis in the USA. Secure storage of firearms can reduce suicide risk by putting time and distance between a suicidal crisis and access to a firearm. However, physicians often do not provide counseling to patients. This scoping review examines educational interventions that provide physicians and physicians-in-training skills to counsel patients about firearm secure storage. This scoping review followed the Joanna Briggs Institute scoping review methodology and the Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews (PRISMA-ScR) format. A literature search was conducted across Medline, Embase, PsycInfo, Cochrane Library, CINAHL Plus with Full Text, and Web of Science and included publications through April 9, 2025. Eligibility criteria included articles that (1) involved trainings on firearm secure storage for suicide prevention or provided commentary on what should be included in potential trainings; (2) had study populations that included physicians; and (3) were available in English. Forty articles were included: 21 commentaries providing suggestions on physician firearm secure storage counseling education and training and 19 articles involving development and implementation of physician education and training. Training varied and included conversation strategies, facts about suicide, and storage methods and devices. Nineteen articles included study participant details, with emergency medicine (four studies), pediatrics (four studies), and psychiatry (three studies) most included. Most reported increased knowledge relating to firearms, improvements in attitudes and beliefs on importance of speaking with patients about firearm safety, and improvements in confidence and comfort in counseling. This review found limited but promising literature on training physicians to provide firearm secure storage counseling for suicide prevention. Limitations include that only records published in English were included and that, as a scoping review, the quality of individual studies was not assessed. Standardized, evidence-based curricula are needed for broader implementation.
