Background Male breast cancer (MBC) comprises <1% of all cancers and continues to rise. Because of rarity, there is paucity in the literature; therefore, management of MBC is generalized from female breast cancer (FBC). Methods Data from 152 VA Medical Centers were used to analyze the database of Veteran patient with breast cancer diagnosed between 1998 and 2016 using biostatistical software (SAS 9.3). Our primary objective is to compare patient's demographics, breast cancer characteristics, and outcomes for male and female Veterans. Finding In total, 8864 patients' records were reviewed;1528 MBC were compared with 7336 FBC with a mean follow up time of 5.5 years (SD 4.17). The mean age at diagnosis was 68.6 years and 57.3 years for MBC and FBC, respectively (P < .0001). Higher numbers of MBC patients (95%) were >50 years of age compared to FBC patients (72%). More MBC patients (16.8 vs. 9.1% and 9 vs. 4%) presented with higher disease stage (III and IV, respectively). Estrogen receptor-positive tumors were more common in MBC (59 versus 52%). Hormonal treatment was received by 27% of MBC versus 19% FBC; chemotherapy 21.3% versus 41.5% and radiation 23.5% versus 60.9%. Forty-two percent MBC and 20% FBC Veterans died during study. Male patients had higher death rate 1.285 (95% CI: 1.150, 1.434, P < .0001) compared to females after adjusting data for age, race, stage, and grade. Interpretation To the best of our knowledge, this is the largest comparison series of MBC and FBC to date in the Veterans population. The higher mortality rate in MBC patients may be due to late presentation, higher stage at the time of diagnosis and/or tumor biology. Veteran's exposures to hazardous materials during their military deployments as an additional factor for worse prognosis need further investigation.

Introduction Optimal community reintegration is an integral part of the clinical management of patients with mild traumatic brain injury. Background/Objective We sought the contribution and inter-relation of such variables as balance, executive function, and affective regulation to the community reintegration of veterans with mTBI. Methods We examined the statistical relationship among the above variables by conducting a series of objective evaluations to assess the balance, gait, executive function, affective regulation, and scores representing the patients’ issues with community reintegration. The data were statistically analyzed for correlation and regression. Results High correlation was found among scores for balance and gait, executive function and affective regulation. The first and second best predictors of success with patient’s community reintegration were data representing affective regulation and cognitive impairments, respectively. However, the data for dynamic balance correlated weakly and insignificantly with scores for the three subsets of community reintegration. Conclusions We revealed varying degrees of correlation among balance, executive function and affective regulation, and as they related to the community reintegration success of patients with mTBI. The strongest, intermediate and weakest predictors for these patients’ success with community reintegration represented those for affective regulation, executive function, and dynamic balance and gait performance, respectively.

Background: This study focussed on the effect of dual versus single tasking on balance, gait and cognition in veterans with mild traumatic brain injury (mTBI).We examined the correlation between these parameters, with responses to questions on community reintegration activities.Method: 22 male and female veterans (aged 19-65) walked along a narrow and 6.1-meter long path, both at their self-selected and fastest but safe pace under single and dual tasking conditions.For dual tasking, participants were required to recall and vocalize a 5-digit number at the end of the path.The outcome measures were the accuracy, velocity, cadence, stride length, and number of steps off the path.We calculated the reliability and correlation coefficient values for the walking time compared with the stride length, velocity, and percentage of swing and stance.Results: Under dual task, the participants demonstrated slower gait, recalled shorter digit span and stepped off the path 12.6% more often than under single task.The stride length decreased by about 20% and the stride velocity increased by over 2% in dual compared with single tasking.Conclusions: Dual tasking slows down the gait and reduces the attention span in patients with mTBI, which can negatively impact their community reintegration, at least early after their hospital discharge, hence the need for exercising caution with their community reintegration activities.Dual tasking may have the potential to improve balance, gait and attention span of the patients in the longterm, thus leading to safer community integration, if incorporated in the rehabilitation plans.

Background: The VA Electronic Health Record (VAEHR) contributes to effective management and control of hypertension and stores data longitudinally. We examined associations of BP control with age, race, ethnic group, and hypertensive drug treatment. Methods: In the VAEHR, vital signs were analyzed from 2000 through 2014 and medication records from 2004 to 2014. Patients with elevations >140 systolic or >90 diastolic on three separate days were considered hypertensive. Prescription coverage gaps due to late filling and renewals were examined to compute each patient’s % of days covered per month. Results: Of 8,813,000 patients followed in the VA system, 3,160,606 were hypertensive. In the total population BP control rates improved from 41.3% in 2000 to 74.6%.in 2010, but gradually declined to 71.3% by 2014. African Americans increased from 40.1% in 2000 to 70.8% in 2010 and declined to 67.4% in 2014 while Whites increased from 42.0% in 2000 to 75.7% in 2010 and fell to 72.4% in 2014. Hispanic control rates were initially 2% worse but are similar to Whites since 2004. While the increase was 5% better in Whites and Hispanics than in African Americans the decline in control rate of 3.3% (p<.0001) starting in 2010 was similar in all racial and ethnic groups (fig.), and in all age groups. For ACEi, alpha blockers, beta blockers, and diuretics, the average coverage per month was 72% for Whites and 67% for African Americans. This 5% disparity did not change after 2010. These gaps can be reduced using “Park a Prescription” to maintain coverage while waiting for drug renewal. Conclusions: Data from VAEHR over a 14 year period shows a marked improvement over 30% for the first 10 years but a slow decline of 3.3% in the last 4 years. Eliminating drug gaps, which occur in all races, and improving treatment of hypertension should increase BP control rates to and above previous levels. Figure: Percent of hypertensive patients with controlled BP each month, stratified by race improving each summer.

National guidelines for a number of health conditions recommend that practitioners assess and reinforce patient's adherence to specific diet and lifestyle modifications. Counseling intervention has shown to have a long-term positive effect on patient adherence but the extent to which physicians comply is unknown. Evidence of counseling provided by practitioner is recorded only as free text in electronic medical records. To identify physicians' counseling practices we developed a natural language processing system to detect text documentation of dietary counseling in gout patients.