Aimee Kroll-Desrosiers

Within the Veteran’s Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in mental health and behavioral health settings. PSS-facilitated cancer support groups are less common and underused in this setting. The purpose of this study was to understand the acceptability, feasibility, and perceived benefits of a PSS-facilitated peer support group for women veterans with breast cancer. Semi-structured interviews were conducted among veteran participants and health system leaders (HSLs) and were recorded, transcribed, and analyzed using rapid qualitative analysis. Key findings from interviews with veterans and HSLs emerged across several domains: The value of shared experiences, peer status and “matching”, virtual aspect, group structure, beneficial topics, and desired outcomes. Veteran participants greatly valued the ability to share experiences and connect with other women veterans with breast cancer and shared a desire for the facilitator to be a peer with an overlapping shared lived experience as they described benefits from peer interactions including supportive coping and instrumental coping. Veterans also reflected on the acceptability of the group being virtual, and uncovered attitudes and preferences regarding group structure, beneficial topics, and desired outcomes. HSLs noted that target outcomes might be linked to feeling connected with community and having an increased feeling of support. Findings suggest that cancer support groups, unlike more traditional mental health support groups at the VHA, may require greater specificity regarding programmatic content and PSS-cancer-experience-matching for group experience to feel authentic and meaningful.

Key Points: We examined clinical characteristics of Veterans receiving telenephrology care. Telenephrology was associated with higher prescription rates of guideline directed therapies and longer survival in Veterans with CKD. Adjusting for telenephrology visits and other clinical factors, rurality and heart disease were associated with an increased risk of mortality. Background: Veterans with CKD residing near lower complexity Veterans Health Administration facilities are often managed by primary providers. To improve access to nephrology for rural Veterans, we established a hub-and-spoke network that used telemedicine to connect nephrologists to Veterans at Veterans Affairs facilities lacking nephrology services (spokes). Methods: Veterans with CKD, refractory hypertension, and electrolyte disorders cared for at spoke sites were defined as eligible. Patients requiring dialysis or hospital management were excluded. We compared demographics, clinical characteristics, prescription rates, and mortality of the Veterans cared for by telenephrologists (Telenephrology+) with those cared for by primary providers (Telenephrology−). Results: The Telenephrology+ group consisted of 2147 eligible Veterans who had telenephrology visit(s) during the study period (2021–2024). The Telenephrology- control group consisted of 9678 telenephrology eligible Veterans who were managed by primary providers. At baseline, Telenephrology+ Veterans were younger (69±12 versus 74±10 years; P < 0.001) but had more advanced CKD (eGFR 47±21 versus 55±16 ml/min per 1.73 m ² , P < 0.001) than Telenephrology- Veterans. Hypertension, diabetes mellitus, and heart disease were common in both groups. During the course of the study, more of the patients in the Telenephrology+ group were started on guideline directed therapies ( P < 0.001). Survival analysis showed that the Telenephrology+ group had a significantly lower mortality compared to the Telenephrology- group (hazard ratio [HR], 0.62; confidence interval [CI], 0.55 to 0.71; P < 0.001). Mortality in the Telenephrology+ Veterans remained lower (HR, 0.85; CI, 0.74 to 0.98; P = 0.02) after adjustment for confounders and medication use. In addition to telenephrology visits, major factors influencing mortality were rurality (HR, 1.52; CI, 1.39 to 1.67; P < 0.001), heart disease (HR, 1.95; CI, 1.76 to 2.17; P < 0.001), and prescription of sodium glucose transporter 2 inhibitors during the study period (HR, 0.50; CI, 0.44 to 0.57; P < 0.001). Conclusions: Telenephrology was associated with higher prescription rates of guideline directed therapies and longer survival in Veterans with CKD.

Background: Severe alcoholic hepatitis (AH) has a high short-term mortality rate. The MELD assesses disease severity and mortality; however, it is not specific for AH. We screened plasma samples from patients with severe AH for biomarkers of multiple pathological processes and identified predictors of short-term mortality. Methods: Plasma was collected at baseline from 85 patients with severe AH (MELD≥20, Maddrey’s discriminant function≥32) enrolled in the Defeat Alcoholic Steatohepatitis clinical trial (investigating IL-1 receptor antagonist+pentoxifylline+zinc vs. methylprednisolone+placebo). Samples were analyzed for 43 biomarkers and the markers’ association with 28- and 90-day mortalities was assessed. Results: Thirty-one (36.5%) patients died during the 90-day follow-up with similar ratios in the treatment groups. Eight biomarkers showed an association with mortality. IL-6, IL-22, interferon-α2, soluble TNF receptor 1, lipocalin-2, and α-fetoprotein levels were associated with 28-day mortality, while IL-6, IL-13, and endotoxin levels with 90-day mortality. In multivariable Cox regression, encephalopathy, lipocalin-2, and α-fetoprotein levels were independent predictors of 28-day mortality, and IL-6, IL-13, international normalized ratio levels, and age were independent predictors of 90-day mortality. The combination of IL-13 and age had superior performance in predicting 90-day mortality compared with MELD in the total cohort and the individual treatment groups. Conclusions: We identified predictors of short-term mortality in a cohort exclusively involving patients with severe AH. We created a composite score of IL-13 and age that predicts 90-day mortality regardless of the treatment type with a performance superior to MELD in severe AH.