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Introduction: Innovative healthcare delivery strategies are needed to address the healthcare needs of the 3.5 million older veterans living in US rural areas who face unique healthcare delivery challenges, including transportation barriers, poverty, and limited access to health professions and community-based programs. The care coordination home telehealth (CCHT) rural demonstration project was developed to address the mismatch between the timely identification of patient needs and the care delivered by the traditional disease-oriented institutionally-based healthcare delivery system for older rural veterans. The specific objectives were to: (1) serve as a facilitator of primary care; and (2) provide a portfolio of geriatric care management options to increase early detection of symptoms and to encourage adherence to care plans. Methods: Participants were recruited based on patterns of high outpatient, inpatient, and emergency care visits; 132 rural older veterans were enrolled. The CCHT applied care management principles to the delivery of healthcare services and used health informatics to facilitate access to evidence-based care. The CCHT's essential components, which were tailored to optimize remote access, included a face-to-face orientation, telephone contact with a designated care coordinator, and daily monitoring sessions using an in-home telehealth device to assess participants' medication usage, compliance, and symptoms, and to provide patient education. Results: One hundred eleven participants successfully installed and connected the telehealth monitoring device in their homes without hands-on assistance, monitored complex medical and psychiatric symptoms, and reported medication compliance remotely. Of the 93 participants who used the device for more than 10 sessions, 88 reported they did not have any difficulty using the device, 86 reported they were satisfied or very satisfied with the device, 73 reported they were likely to continue using the device, and 46 reported improved communication between themselves and their primary healthcare provider. Conclusion: Initial utilization and satisfaction evaluation data from this project supports the feasibility of employing a CCHT approach to serve medically-complicated older veterans in rural settings. This approach could also serve as a template for addressing a greater range of healthcare needs among other populations in hard-to-reach settings. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study evaluated predictors of attrition in data from veterans with chronic medical conditions who were enrolled in a Veterans Administration Care Coordination Home Telehealth program., Subjects and Methods: Data were collected over a 4-year period. The enrolled sample was 73 veterans, 55.3% of whom discontinued enrollment during this period., Results: Among the selected variables examined, program discontinuation was assessed within the first 30 days of enrollment by response frequency to the home telehealth device. Intermittent device response was associated with earlier dropout. Enrollment in the program via telephone (rather than in person) was the largest predictor of premature dropout., Conclusions: To ensure sustained home telehealth utilization, it is essential to engage patients through encouraging active and regular responding to the provider through the home telehealth device within the first 30 days of program initiation.

Context: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas., Purpose: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic. The clinic, located in Elko, Nevada, was created to meet the health care needs of veterans who expressed a desire for greater access to VA services., Methods: The Elko Telehealth Outreach Clinic is a specific example of the real-life implementation of the community-as-partner model as an operational framework for coordinating local, regional, and VA resources. The Elko Clinic provides a limited set of health care services including medication management, health education, prescription refills, routine lab tests, and specialty services through telehealth., Findings: From December 2006 to December 2007, a total of 84 unique veterans received health care services through the Elko Clinic., Conclusions: Our findings support the usefulness of an expanded community-as-partner model to guide a process for addressing the health care needs of veterans in Elko, Nevada, and they have implications for the development and maintenance of outreach clinics in other rural settings., (© 2010 National Rural Health Association.)

Introduction: After all options of conservative treatment of trigeminal neuralgia have been exhausted, surgical methods are used. Peripheral neurectomy is one of the simplest among them. It is a relatively obsolete method, but can still be useful and effective., Aims: To analyse the remission period after repetitive neuroexeresis of the same neural branch, to calculate "predicted" remission, and to evaluate the benefits of repetitive neuroexeresis., Patients and Methods: Total of 85 neurectomies were performed in 36 patients in 5 years by intraoral access. The recurrence time was analysed by simple regression analysis, using the method of the least-squares. Thus, the average pain free time after repetitive neurectomy can be predicted., Results: After the first operation on the infraorbital nerve, recurrence mainly appeared in the period between 12 and 15 months, after the second between 9 and 12 months. After the first operation on the mandibular nerve, recurrence took place mainly after 15-18 months, after the second 12.3 months on the average. No interventions were performed on the first branch. Calculated prediction of the average time of remission was in agreement with the actual duration of painlessness., Conclusion: Remission time after repetitive neurectomy decreases. There is no point in repeating the surgery on the same neural branch more than three times.

Wound infection is a common complication after oral cancer surgery and may result in significant functional morbidity, poor cosmetic results and prolonged hospitalization. The purpose of this study was to identify the most important factors contributing to operative wound infections in patients with oral and oropharyngeal cancer. A retrospective review of complications in 111 patients after oral and oropharynx cancer surgery with an immediate reconstruction is presented. Potential risk factors for infection were categorized based on the patient, the disease, and the treatment. Flap-related complications developed in 73 patients (65.76%). Wound infection occurred in 69 (62.12%), and a fistula in 10 patients (9%). Other complications developed in 41.44% of the patients. The analysis of risk factors for the development of infection showed the following factors to be significant: male sex, T and S tumour stages, reconstruction, tracheostomy, nasogastric tube or gastrostomy feeding and extent of surgery.

Special attention is paid to the problems of the donor site (the forearm) in a series of 75 patients who underwent orofacial malignancy excision. An island skin flap from the ulnar aspect of the forearm, used in 15 patients, is reported to be an improvement of the surgical technique. No healing complications were observed, and the aesthetic and functional results were very good.