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BACKGROUND Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service. OBJECTIVE Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration’s Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT. METHODS ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals. RESULTS As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR–related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination. CONCLUSIONS The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/42029

BACKGROUND Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program that will provide supportive resources for veterans with interests in agricultural vocation. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while simultaneously supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol which will be used to evaluate VA FARMS, which has been specifically designed to allow for site variation by providing both site-specific and cross-site understandings of site implementation processes and outcomes. OBJECTIVE The objectives of this paper are to (1) describe the protocol that will be used for evaluating an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program which serves veterans at ten pilot sites across the VHA enterprise and (2) provide guidance to other evaluators who are assessing innovative programs. METHODS This evaluation uses the Context, Inputs, Process, Product (CIPP) model, which is designed to evaluate a program’s content and implementation strategies to identify strengths and areas for improvement, enhancing program effectiveness and planning efforts. Data collection for the evaluation will use a concurrent mixed methods approach, including both quantitative and qualitative methodologies. Quantitative data collection will take place using Quarterly Program Surveys, as well as three Individual Veteran Participant Surveys administered at the veteran’s entrance and exit of the pilot program and 3 months later. Quantitative data will provide baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site and interviews with participants, staff, and community stakeholders. Qualitative data will include insights about pilot program implementation processes, veterans’ experiences, and short-term participation outcomes. RESULTS Evaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, a total of 494 veterans had enrolled in VA FARMS, and 1,326 veterans were reached through program activities like demonstrations, informational presentations, and town-hall discussions. In addition, a total of 1,623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data was collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. CONCLUSIONS This evaluation protocol will provide guidance to other evaluators who are assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims adds to existing literature on nature-based therapies (NBTs) and the rehabilitation outcomes of agricultural training programs for veterans. When evaluation is complete in late 2022, results will provide programmatic insights on the implementation of pilot programs and needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs.

Background Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program to provide supportive resources for veterans with interests in agricultural vocations. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol to evaluate VA FARMS, which was specifically designed to enable site variation by providing both site-specific and cross-site understanding of site implementation processes and outcomes. Objective The objectives of this paper are to (1) describe the protocol used for evaluating VA FARMS, as an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program serving veterans at 10 pilot sites across the Veterans Health Administration enterprise; and (2) provide guidance to other evaluators assessing innovative programs. Methods This evaluation uses the context, inputs, process, product (CIPP) model, which evaluates a program’s content and implementation to identify strengths and areas for improvement. Data collection will use a concurrent mixed methods approach. Quantitative data collection will involve quarterly program surveys, as well as three individual veteran participant surveys administered upon the veteran’s entrance and exit of the pilot program and 3 months postexit. Quantitative data will include baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site, and interviews with participants, staff, and community stakeholders. Qualitative data will provide insights about pilot program implementation processes, veterans’ experiences, and short-term participation outcomes. Results Evaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, 494 veterans had enrolled in VA FARMS and 1326 veterans were reached through program activities such as demonstrations, informational presentations, and town-hall discussions. A total of 1623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data were collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. Conclusions This evaluation protocol will provide guidance to other evaluators assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims to add to existing literature on nature-based therapies and the rehabilitation outcomes of agricultural training programs for veterans. Results will provide programmatic insights on the implementation of pilot programs, along with needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs. International Registered Report Identifier (IRRID) DERR1-10.2196/40496

Community gardens have the potential to positively impact the quality of life for veterans in the process of reintegrating into the community. This Field Note will describe the implementation of a ...

The objective of this paper is to characterize barriers and facilitators reported by U.S. military veterans related to campaigns promoting help seeking during suicidal crisis. Individual telephone interviews (N = 40) were conducted from August 2018-April 2019 with a sample of veterans who had a recent non-fatal suicide attempt. Interview transcripts were analyzed using a constant comparison analytic strategy. Participants reported the four facilitators to message effectiveness: (a) potential reach of specific channels; (b) interruption of suicidal thoughts; (c) normalizing the suicidal experience and help seeking; and (d) modeling desired behavior change. Barriers that hindered campaigns were also identified and include (a) broad messages, (b) challenges in cognitive processing, (c) media avoidance and (d) a boomerang effect. This study underscores the significance of involving those with lived experience to identify factors that may improve or hinder message effectiveness.

Community-based organizations (CBOs) are critical sources of support for veterans. CBOs offer innovative and informed initiatives and are often nexuses that allow veterans and their allies to gather. Out of a commitment to veteran reintegration, Growing Veterans (GV), a veteran-founded CBO located in western Washington, created and implemented an evidence-based peer support training program (PST) for veterans and their allies. Building upon years of collaboration, GV partnered with the Veterans Health Administration (VHA) to conduct a formative evaluation of GV’s PST program, funded through the Bob Woodruff Foundation. The evaluation revealed that participants described the PST in largely positive ways and reported using learned skills with both veterans and nonveterans across their personal and professional lives. Specifically, participants reported learning tools through the PST that increased their patience, mindfulness, awareness, empathy, and confidence, resulting in improved interpersonal relationships and communications across multiple domains. The success of this community-engaged collaboration was due in part to the inclusion of veterans, allies, GV employees, and VHA evaluators throughout the evaluation, from grant applications to the final analysis. Using ethnographic methods of participant observation, in-depth interviews, focus groups, and surveys, VHA evaluators were able to gain a deep understanding of participants’ experiences of the PST as well as the program’s perceived usefulness.

The objective of this paper is to characterize barriers and facilitators reported by U.S. military veterans related to campaigns promoting help seeking during suicidal crisis. Individual telephone interviews (N = 40) were conducted from August 2018-April 2019 with a sample of veterans who had a recent non-fatal suicide attempt. Interview transcripts were analyzed using a constant comparison analytic strategy. Participants reported the four facilitators to message effectiveness: (a) potential reach of specific channels; (b) interruption of suicidal thoughts; (c) normalizing the suicidal experience and help seeking; and (d) modeling desired behavior change. Barriers that hindered campaigns were also identified and include (a) broad messages, (b) challenges in cognitive processing, (c) media avoidance and (d) a boomerang effect. This study underscores the significance of involving those with lived experience to identify factors that may improve or hinder message effectiveness.

Objective To assess the effect of a veteran-oriented community agricultural initiative on transitioning rural veterans. Design Convergent mixed-method program evaluation. Setting Veteran-oriented farm-to-market community agricultural initiative. Participants Veterans (N=43) who were members of the community agricultural initiative. Main Outcome Measures Health, well-being, and reintegration were assessed by self-reported data from interviews, a demographic survey, a validated health quality of life measure (Veterans RAND-12 [VR-12]), a validated reintegration measure (Military to Civilian Questionnaire), and a general satisfaction survey. Results Veteran participants were primarily white (88.4%, n=38) and men (74.4%, n=32), and most had a service-connected disability rating (58.2%, n=25). Qualitative and quantitative data revealed that the veterans participating in this community agricultural initiative experienced health and reintegration benefits. Results on the Military to Civilian Questionnaire, VR-12, and satisfaction survey suggest that participating in this community agricultural initiative contributed to improved mental, physical, and emotional health and vocational skills, community connectedness, and interpersonal communication. Qualitative interviews supported quantitative findings and revealed that participating in the community agricultural initiative provided veterans with a sense of satisfaction, a sense of belonging, and helped decrease the stigma surrounding their veteran status. Conclusions Veterans who participate in this community agricultural initiative reported general improvements in physical and mental health, including improvements in sleep, nutrition, and exercise, and decreases in anxiety, pain, depression, and medication and substance use, all known factors which effect veteran reintegration.

Research Objectives The goal of the Enhancing Veteran Community Reintegration Research (ENCORE) project is to maximize Veteran and family reintegration by promoting innovative research and knowledge translation that informs and improves equitable VA policies, programs, and services. Two strategic objectives guide ENCORE activities: (1) mobilize Veteran community reintegration (CR) research and (2) promote innovation, relevance and acceleration of Veteran CR research and knowledge translation. Design ENCORE used a stakeholder-engaged approach to achieve objectives. In the first 2 years, the team assembled a Multi-Stakeholder Partnership (MSP), reviewed the VA funding portfolio and CR research literature, interviewed stakeholders from VA program offices to identify existing funded CR research and stakeholder needs, and conducted a gap analysis. Setting Data collection and stakeholder activities are all conducted remotely due to the COVID-19 pandemic. Participants We interviewed 20 participants from 16 VA program offices providing CR-related services. MSP participants represent 10 VA program offices, 5 Veterans and caregivers, 5 established CR researchers, and 5 strategically identified community organizations. Interventions Not applicable. Main Outcome Measures Primary outcome measures include results from feedback surveys. Results The MSP has achieved several goals and deliverables: Mission, Vision and Values statements, and consensus-based definition of CR and inclusive research guidelines. ENCORE is completing a scientific gap analysis. Future products include a stakeholder-driven research agenda on Veteran CR, the development of an effective and relevant dissemination plan, and the generation of innovative, relevant dissemination products designed for rapid knowledge translation. Conclusions The goal of this program is to improve the impact of CR research on policies and programs. Using a stakeholder-engaged process, we are incorporating insights from key stakeholder groups to set a research agenda more likely to result in a relevant and responsive CR research program. Author(s) Disclosures This work was supported by the Award IVI 19-487 from Health Services Research and Development Service of the Office of Research and Development, VHA, US Department of Veterans Affairs. The contents of this presentation do not represent the views of the Department of Veterans Affairs or the US Government.

BACKGROUND Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in civilian populations, but research is limited in veteran and military service member populations. Little is known about how knowledge from civilian studies translates into veterans’ experiences and needs. The US Department of Veterans Health Administration (VHA) recognizes the distinctive health care needs of post-9/11 veteran and military service members, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to veteran and military service members’ homes and communities to facilitate CR. OBJECTIVE The goal of this study is to better understand the experiences of veterans with complicated mild, moderate, or severe TBI; their families; and CR workers as veterans and servicemembers transition to and sustain living in communities. This paper describes the rationale, design, and methods used to reach this goal. METHODS This five-year longitudinal mixed methods study uses both a community-engaged research (CEnR) approach and an ethnographic approach. The sample includes 30 veterans and service members with TBI, 13 family caregivers, 11 CR specialists, 16 key stakeholders, and 82 community events. Interviews and observations are coded and analyzed using hierarchical coding schemes and thematic analysis. Analyses include data from surveys, interviews, and participant observations. Content analysis is used to highlight the complex social context of reintegration and to triangulate quantitative data. Egocentric (personal) social network analysis is used to examine the support system a veteran or service member has in place to facilitate reintegration. RESULTS Study enrollment and data collection are completed. Data analyses are underway. CONCLUSIONS The results of this study may provide a heightened understanding of environmental factors affecting CR in complicated mild, moderate, or severe TBI. Veteran, servicemember and family voices and insights provide VHA clinicians and policy makers with an ecological view of CR that is grounded in the life experiences of veterans, military service members, and families. The results of this study provide a roadmap for designing and testing interventions to maximize CR in a variety of domains. The longitudinal ethnographic approach allows for capturing detailed experiences within the naturalistic context. CEnR allows collaborative assessment of the social context of reintegration with community members. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14170

Background Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in civilian populations, but research is limited in veteran and military service member populations. Little is known about how knowledge from civilian studies translates into veterans’ experiences and needs. The US Department of Veterans Health Administration (VHA) recognizes the distinctive health care needs of post-9/11 veteran and military service members, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to veteran and military service members’ homes and communities to facilitate CR. Objective The goal of this study is to better understand the experiences of veterans with complicated mild, moderate, or severe TBI; their families; and CR workers as veterans and servicemembers transition to and sustain living in communities. This paper describes the rationale, design, and methods used to reach this goal. Methods This five-year longitudinal mixed methods study uses both a community-engaged research (CEnR) approach and an ethnographic approach. The sample includes 30 veterans and service members with TBI, 13 family caregivers, 11 CR specialists, 16 key stakeholders, and 82 community events. Interviews and observations are coded and analyzed using hierarchical coding schemes and thematic analysis. Analyses include data from surveys, interviews, and participant observations. Content analysis is used to highlight the complex social context of reintegration and to triangulate quantitative data. Egocentric (personal) social network analysis is used to examine the support system a veteran or service member has in place to facilitate reintegration. Results Study enrollment and data collection are completed. Data analyses are underway. Conclusions The results of this study may provide a heightened understanding of environmental factors affecting CR in complicated mild, moderate, or severe TBI. Veteran, servicemember and family voices and insights provide VHA clinicians and policy makers with an ecological view of CR that is grounded in the life experiences of veterans, military service members, and families. The results of this study provide a roadmap for designing and testing interventions to maximize CR in a variety of domains. The longitudinal ethnographic approach allows for capturing detailed experiences within the naturalistic context. CEnR allows collaborative assessment of the social context of reintegration with community members. International Registered Report Identifier (IRRID) DERR1-10.2196/14170

Gail Powell-Cope, PhD, ARNP, FAANPeter Toyinbo, PhDNitin Patel, MPHDeborah Rugs, PhDChristine Elnitsky, PhD, RNBridget Hahm, MA, MPHBryce Sutton, PhDRobert Campbell, PhDKaren Besterman-Dahan, PhDMary Matz, MSPH, CPE, CSPHPMichael Hodgson, MD, MPHOBJECTIVE: Theobjectiveofthestudywastoidentifywhichcomponentsof asystem-wide safepatienthand-ling(SPH)programreducedmusculoskeletalinjury(MSI) due to patient handling among nurses.METHODS: The3-yearlongitudinalstudyfrom2008to2011usedapretest-posttestdesign.ThestudywasconductedintheVeteransHealthAdministration,andallmedicalcentersparticipated.Theoutcomewas2011MSI incidence rates due to patient-related handlingfor nurses, expressed as injuries per 10000 full-timeemployees.RESULTS: Threeorganizationalriskfactors,beddaysof care, facility complexity level, and baseline MSIincidence rate, were significantly associated with MSIincidencerateandexplained21%ofitsvariation.FiveSPHcomponents,includingdeploymentofceilingliftsand other new technologies, peer leader effectiveness,competencyinSPHequipmentuse,facilitycoordinatorlink with safety committee, and peer leader training,uniquelyaccountedforanadditional23%ofthetotalvariation.CONCLUSIONS: Findings provide evidence to sup-port the effectiveness of a multicomponent approachto SPH programs given contextual considerations.Healthcare workers responsible for manual patienthandling,particularlynursesandnursingassistants(NAs), have among the highest rates of nonfatal occu-pational injuries requiring days away from work.

Exercise and training programs improve strength, functional balance, and prevent falls in a variety of populations. This article presents the qualitative findings related to the perceived benefits of participants in a randomized controlled trial that compared the effectiveness of group exercise on gait and balance in persons with peripheral neuropathy (PN). Participants with moderately severe PN were randomized into groups that received 10-week classes of Functional Balance Training (FBT) or Tai Chi or education alone. Perceptions of the intervention were overwhelmingly positive regardless of the study group. Perceived benefits reported by participants in the FBT and Tai Chi groups included awareness of how to deal with the effects of neuropathy by implementing balance strategies and a heightened sense of walking to prevent falls. This study offers a guide to design future exercise studies that promote simple balance exercises that can be performed in group settings.

The wars in Iraq and Afghanistan have taken a toll on military chaplains (MCs) who often return from deployment with high levels of stress, yet are expected to counsel on a daily basis without decompression of their own, potentially exacerbating any personal trauma. MC with posttraumatic stress disorder (PTSD) who have had deployments abridged due to their positive PTSD screen have reported shame due to leaving service members in their unit in danger while they went to safety. Many MCs report compassion fatigue, PTSD, reintegration issues, and adverse effects to their personal energy, motivation, and mental and spiritual well-being postdeployment, related to stressors from deployment and combat exposure. Only 23–40 percent of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) service members with a psychiatric disorder seek mental health care, citing stigma as a primary barrier. For MCs, stigma is compounded by a culture in which military health care providers, including MCs, are encouraged to deny their own needs to provide the necessary support to beneficiaries. This paper reviews a pilot study, which explored the impact of operational stress on the psychosocial health and reintegration of MCs, focusing on findings related to mental health and stigma within the military chaplaincy.

In this paper we report on findings from the first known study using qualitative methods to explore factors influencing physicians' participation in an ongoing federally-funded prostate cancer chemoprevention clinical trial. We sought to identify ways to improve collaboration between researchers and physicians and enhance the success of future projects and employed purposive sampling to recruit physician/investigators who were involved or invited to participate in the trial. Using the data from open-ended semi-structured interviews, we examined patterns in their languaging and created themes. We found that individual and structural factors served as barriers and facilitators to participation. Willingness and desire to participate in the trial (individual factors) were not always enough to result in actual participation due to practice environment (structural) constraints. Our research provides a better understanding of the complex intersection of factors in this setting and through our findings we extend the theory of competing demands into the arena of prostate cancer prevention clinical trials, moving the science towards solutions to current challenges in recruitment to this type of trial. Keywords: Competing Demands, Barriers and Facilitators, Cancer, Screening and Prevention, Access to Participants, Open-Ended Semi-Structured InterviewsI, Dr. Crocker, conducted this research in partial fulfillment of the requirements for my doctorate in Applied Anthropology. During my doctoral program, I was uniquely situated, also working as a project director for a federally funded, multi-site, prostate cancer prevention intervention clinical trial (PCPICT). This resulted in the creation of a liminal space, often requiring navigation between the "rules" and languages of two very disparate worlds, biomedicine and anthropology, that seemed would never intersect. As the project director, I became increasingly aware of the challenges inherent in the design, implementation, and daily work of conducting a prostate cancer prevention trial. Simultaneously, through the requirements of the doctoral program, I experienced an increased skill set in which I acquired new perspectives and an expanded toolkit with which to examine the world. The overarching aim of my dissertation research was to show how the two worlds could merge, with each informing the other.As project director, I had observed recruitment below goal at most sites participating in the PCPICT. Upon review of detailed screening logs, our team was able to delineate patient, protocol and infrastructure related barriers that were contributing (Kumar et ah, 2012). Similar challenges to recruitment in chemoprevention clinical trials had been welldocumented by others (Chlebowski, Menon, Chaisanguanthum, & Jackson, 2010; Ruffin & Baron, 2000). What we also recognized as an important influence in recruitment was the support of committed physicians (Kumar et ah, 2012). Referring physicians had been recognized in other arenas for the major role they play in getting patients involved in clinical trials (Ford et ak, 2003; Miller, Crabtree, McDaniel, & Stange, 1998). In fact, physician involvement is considered essential for the provision of much of today's healthcare, and physicians serve as a critical link in the chain of events leading to the delivery of preventative services including cancer screening (Jaen et al., 2001; Nutting et al., 2001). What had not been explored using qualitative methods, and was the driving force behind this project was the role of physicians as the "link" to participation in prostate cancer prevention intervention trials (as PCPICT gatekeepers).Stange and Nutting (1994) used the theory of competing demands to describe the multiple factors competing for the provision and delivery of preventative services by primary care physicians. The main components (physician, patient, and practice environment) are thought to be influenced by factors such as attitudes, knowledge, expectations, practice organization, and alternative demands. …

BACKGROUND: Falls are the leading cause of injury-related deaths among people age 65 and older, and fractures are the major category of serious injuries produced by falls. OBJECTIVE: Determine market segment–specific recommendations for “selling” falls prevention in acute inpatient psychiatry. DESIGN: Descriptive using focus groups. SETTING: One inpatient unit at a Veterans’ hospital in the Southeastern United States and one national conference of psychiatric and mental health nurses. PATIENTS: A convenience sample of 22 registered nurses and advanced practice nurses, one physical therapist and two physicians participated in one of six focus groups. INTERVENTION: None. MEASUREMENTS: Focus groups were conducted by expert facilitators using a semistructured interview guide. Focus groups were recorded and transcribed. Content analysis was used to organize findings. RESULTS: Findings were grouped into fall risk assessment, clinical fall risk precautions, programmatic fall prevention, and “selling” fall prevention in psychiatry. Participants focused on falls prevention instead of fall injury prevention, were committed to reducing risk, and were receptive to learning how to improve safety. Participants recognized unique features of their patients and care settings that defined risk, and were highly motivated to work with other disciplines to keep patients safe. CONCLUSIONS: Selling fall injury prevention to staff in psychiatric settings is similar to selling fall injury prevention to staff in other health care settings. Appealing to the larger construct of patient safety will motivate staff in psychiatric settings to implement best practices and customize these to account for unique population needs characteristics.

BackgroundHealth care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries. ObjectiveThe goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associated with patient handling, to explore the potential mediating and moderating mechanisms, and to identify unintended consequences of implementing the program. MethodsThis 3-year longitudinal study used mixed methods of data collection at 6- to 9-month intervals. The analyses will include data from surveys, administrative databases, individual and focus group interviews, and nonparticipant observations. For this study, a 3-tiered measurement plan was used. For Tier 1, the unit of analysis was the facility, the data source was the facility coordinator or administrative data, and all 153 VAMCs participated. For Tier 2, frontline caregivers and program peer leaders at 17 facilities each completed different surveys. For Tier 3, six facilities completed qualitative site visits, which included individual interviews, focus groups, and nonparticipant observations. Multiple regression models were proposed to test the effects of SPH components on nursing outcomes related to patient handling. Content analysis and constant comparative analysis were proposed for qualitative data analysis to understand the context of implementation and to triangulate quantitative data. ResultsAll three tiers of data for this study have been collected. We are now in the analyses and writing phase of the project, with the possibility for extraction of additional administrative data. The focus of this paper is to describe the SPH program, its evaluation study design, and its data collection procedures. This study evaluates the effects associated with the national implementation of a comprehensive SPH program that was implemented in all 153 VAMCs throughout the United States to reduce patient handling injuries. ConclusionsTo our knowledge, this is the largest evaluation of an SPH program in the United States. A major strength of this observational study design is that all VAMCs implemented the program and were included in Tier 1 of the study; therefore, population sampling bias is not a concern. Although the design lacks a comparison group for testing program effects, this longitudinal field study design allows for capturing program dose-response effects within a naturalistic context. Implementation of the VA-wide SPH program afforded the opportunity for rigorous evaluation in a naturalistic context. Findings will guide VA operations for policy and decision making about resources, and will be useful for health care, in general, outside of the VA, in implementation and impact of an SPH program.

Background External factors such as diet and lifestyle may be important in the etiology of invasive prostate cancer. Specific features of prostate cancer, including high prevalence, long latency, and significant mortality and morbidity, provide the opportunities for chemoprevention. Methods The authors examine the experimental and epidemiological data demonstrating the chemopreventive activity, safety, and toxicity of chronic administration of these specific nutrients as chemopreventive agents in prostate cancer. Results Several nutrients have been identified as agents that inhibit mutagenesis and hyperproliferation or induce apoptosis or differentiation, which are critical characteristics for chemoprevention. Successful chemopreventive strategies require well-characterized agents, suitable cohorts, and reliable intermediate biomarkers of cancer for evaluating efficacy. Phytoestrogens/isoflavones, vitamins D and E, selenium, and lycopene have been identified as promising nutrients in the role of chemoprevention of prostate cancer. Conclusions Clinical studies to evaluate the safety and effectiveness of these agents as future prospects in cancer chemoprevention, both individually and in combination, are warranted.

Background: Reintegration is known to be a difficult time for Veterans. Peer support programs offer a good strategy for military and Veterans, particularly as it relates to reintegration. We review an innovative, peer support program implemented at a Veteran run community agricultural initiative (CAI).Methods: This project was a case-study evaluation using a mixed methods design including participant observations; qualitative interviews with a total of 34 CAI members and affiliates; and administered surveys to a total of 67 CAI members and affiliates.Findings: Survey results suggested that CAI participation contributed to improvements in communication, forming bonds, and developing new friendships with Veterans, non-Veterans, family members, and strangers, as well as increased involvement in community events. Interviews revealed that the CAI’s informal peer-support culture and intentional normalization of sharing stories helped promote recovery and reintegration.Conclusions: The CAI continues to refine its peer support model. The organization is overcoming common barriers by leveraging community partnerships to bring Veterans into the fold and expanding their peer support model to Veteran organizations with similar missions. This will ultimately lead to a culture of peer support across agencies and spread the reach of the CAI’s mission for Veterans.

Military Chaplains are a critical component of behavioral health and spiritual support in combat operations. Support of combat operations has taken a toll on these caregivers. The purpose of this study was to explore the impact of deployment on the psychosocial and health characteristics and reintegration of Army National Guard (ARNG) chaplains. Seventy-four ARNG chaplains participated in an anonymous, online survey. Results were categorized into two mutually exclusive groups, combat deployed and non-combat deployed. Although both groups tended to present similar results, Combat deployed group chaplains were significantly more likely to be of higher rank, have served in a pastoral role in the ARNG longer, and present with higher scores for combat exposure, resilience, and alcohol use. Further, five and seven participants, respectively, the majority of whom were from the combat deployed group, endorsed "frequently" or "a great deal" to negative religious coping. These endorsements of abandonment may relate back to Reserve component specific deployment concerns.

PurposeThe purpose of this Phase II randomized-controlled trial was to evaluate the safety and effect of administering several doses of lycopene to men with clinically localized prostate cancer, on intermediate endpoint biomarkers implicated in prostate carcinogenesis.MethodsForty-five eligible men with clinically localized prostate cancer were supplemented with 15, 30 or 45 mg of lycopene or no supplement from biopsy to prostatectomy. Compliance to study agent, toxicity, changes in plasma lycopene, serum steroid hormones, PSA and tissue Ki-67 were analyzed from baseline to completion of intervention.ResultsForty-two of forty-five five subjects completed the intervention for approximately 30 days from the time of biopsy until prostatectomy. Plasma lycopene increased from baseline to post treatment in all treatment groups with greatest increase observed in the 45 mg lycopene-supplemented arm compared to the control arm without producing any toxicity. Overall, subjects with prostate cancer had lower baseline levels of plasma lycopene similar to those observed in previous studies in men with prostate cancer. Serum free testosterone decreased with 30 mg lycopene supplementation and total estradiol increased significantly with 30 mg and 45 mg supplementation from baseline to end of treatment, with no significant increases in serum PSA or tissue Ki-67. These changes were not significant compared to the control arm for this sample size and duration of intervention.ConclusionsAlthough antioxidant properties of lycopene have been hypothesized to be primarily responsible for its beneficial effects, our study suggests that other mechanisms mediated by steroid hormones may also be involved.

Our purpose was to evaluate the safety and effectiveness of purified isoflavones in producing an increase in plasma isoflavones and a corresponding change in serum sex hormone binding globulin (SHBG) and steroid hormone levels in men diagnosed with early stage prostate cancer. In this Phase II randomized, double-blinded, placebo-controlled trial, 53 prostate cancer patients with a Gleason score of 6 or below were supplemented with 80 mg purified isoflavones or placebo for 12 weeks. Changes in plasma isoflavones, serum steroid hormones, and safety markers were analyzed from baseline to 12 wk. A total of 50 subjects completed the study. Although significant increases in plasma isoflavones (P < 0.001) was observed with no clinical toxicity, the corresponding modulation of serum SHBG, total estradiol, and testosterone in the isoflavone-treated group compared to men receiving placebo was nonsignificant. Increasing plasma isoflavones failed to produce a corresponding modulation of serum steroid hormone levels in men with localized prostate cancer. The study establishes the need to explore other potential mechanisms by which prolonged and consistent purified isoflavone consumption may modulate prostate cancer risk.

Our purpose was to evaluate the safety of 80 mg of purified isoflavones administered to men with early stage prostate cancer. A total of 53 men with clinically localized prostate cancer, Gleason score of 6 or below, were supplemented with 80 mg purified isoflavones or placebo for 12 wk administered in 2 divided doses of 40 mg to provide a continuous dose of isoflavones. Compliance, changes in plasma isoflavones, and clinical toxicity were analyzed at baseline, 4, and 12 wk. A total of 50 subjects completed the 12-wk intervention. A continuous, divided-dose administration of 80 mg/day of purified isoflavones at amounts that exceeded normal American dietary intakes significantly increased (P < 0.001) plasma isoflavones in the isoflavone-treated group compared to placebo and produced no clinical toxicity. With the current evidence on the cancer preventive properties of isoflavones, these results are significant and offer promise for these phytochemicals to be developed as potent agents to prevent cancer progression.

AIMS To evaluate the effectiveness of supplementing a group of early stage prostate cancer patients, with 60 mg of soy isoflavones in producing a change in hormonal and proliferative risk parameters that are implicated in prostate cancer promotion. METHODS Seventy six eligible prostate cancer patients with a Gleason score of 6 or below, between ages 50 and 80 were admitted and supplemented with soy isoflavones or placebo for a 12 week period and changes in PSA and steroid hormones were analyzed at baseline and post intervention. RESULTS Fifty-nine patients completed the 12-week intervention. Serum free testosterone was reduced or showed no change in 61% of subjects in the isoflavone group compared to 33% in the placebo group. Serum total PSA decreased or was unchanged in 69% of the subjects in the isoflavone treated group compared to 55% in the placebo group. However, we did not see an increase in SHBG levels. Nineteen percent of subjects receiving soy isoflavones reduced total PSA by two points or more during the intervention period. CONCLUSIONS These data suggest that supplementing early stage prostate cancer patients with soy isoflavones, even in a study of short duration, altered surrogate markers of proliferation such as serum PSA and free testosterone in a larger number of subjects in the isoflavone supplemented group than the group receiving placebo. The study establishes the need to explore further the effects of prolonged and consistent soy consumption, which could potentially delay onset of histologic disease in this patient population. © 2004 Wileey-Liss, Inc.

Background The objectives of this study were to determine the prevalence and characterize the use of complementary/integrative nutritional therapies (CINTs) by patients during cancer treatment. Methods This retrospective review used data collected as a part of standard clinical care provided by the registered clinical dietitians and included nutritional history, demographic variables, anthropometrics, prevalence of use, and the specific integrative nutritional therapies used by these patients during cancer treatment. Results Twenty-nine percent of 820 patients reported use of CINTs not prescribed by their physician. Caucasians and patients over age 60 were the principal users of CINTs during treatment. Modular vitamins were the most frequently reported additive (86.9%), followed by botanicals/biologics (43.8%) and mineral supplements (28.6%). Conclusions A considerable proportion of cancer patients use unproven CINTs during cancer treatment. The health professional should become more aware of the complementary/integrative therapies that their patients are using during cancer treatment.