Intravenous digoxin offers no substantial advantages over placebo in recent onset atrial fibrillation with respect to conversion, and provides weak rate control.

We found an association between current smoking and pain intensity. This effect was attenuated in former smokers. Our study highlights the importance of understanding reported pain intensity in OEF/OIF/OND Veterans who continue to smoke.

Nearly one-third of OEF/OIF/OND veterans receiving VA chiropractic services also received an opioid prescription, yet the frequency of opioid prescriptions was lower after the index chiropractic visit than before. Further study is warranted to assess the relationship between opioid use and chiropractic care.

Various QT interval variables and heart rate variability parameters were studied in six patients with ventricular fibrillation but without heart disease and compared with findings in 21 normal persons. QT and QT dispersion (QTd) were measured from conventional 12 lead ECGs: for dynamic QT analysis, QT intervals were automatically measured to the end of the T wave (QTe) on a 24 h ECG recording. The adaptation of the QT interval to changes in heart rate was expressed as the slope of the linear regression lines relating QTc to the RR interval (Sc). The complete 24 h ECG recording and four 6 h segments were studied (morning, day, evening, and night). Ventricular fibrillation patients had slightly prolonged QTmax intervals on the 12 lead ECG, QT dispersion was longer in ventricular fibrillation patients than in normal persons (88 +/- 29 ms vs 59 +/- 26 ms. P < 0.05), and on the 24 h ECG recording, normal persons and ventricular fibrillation patients had a comparable RR. In addition, parameters for long-term (SD, standard deviation of normal RR intervals) and short-term (RMSSD, the root-mean-square successive differences of normal RR intervals heart rate variability were not different. Automatic measurement of the QT interval and the QTc/RR slopes was possible over 24 h and in the 6 h intervals in a large majority of patients (25/27 and 88/108 readings). The mean 24 h QT and the mean 6 h QT interval were comparable in normal subjects and ventricular fibrillation patients except for the day segment. The 24 h Se was significantly lower in ventricular fibrillation patients, compared to normal individuals. Furthermore, Se in the morning and night segment was also significantly lower in ventricular fibrillation patients (both P < 0.05). In conclusion, patients with ventricular fibrillation but without underlying structural heart disease have normal heart rate variability parameters. However, abnormal repolarization behaviour, characterized by an increased QTd and a depressed adaptation of QT to variations in RR (especially during the night and the morning), is present. These findings may help to understand and treat arrhythmias in this patient group.

Rationale: As chronic obstructive pulmonary disease (COPD) prevalence in women has outpaced that in men, COPD-related hospitalization and mortality are now higher in women. Presentation, evaluation, and treatment of COPD differ between women and men. Despite higher smoking rates in Veterans, little work has characterized differences in Veterans with COPD by sex.Objectives: To determine risk factors for 30-day readmission among Veterans hospitalized for COPD exacerbations and how they differed by sex.Methods: We performed a retrospective observational analysis of Veterans receiving primary care in Veterans Health Affairs facilities. We included Veterans Administration-based hospitalizations for Veterans with a COPD exacerbation (identified by International Classification of Disease, Ninth Revision codes) who survived to discharge between fiscal years 2012 and 2015. Primary outcome was 30-day readmission. Predictors ascertained before hospitalization included smoking status (current, former, never), pulmonary function testing, pulmonary medication prescriptions, and medical and psychiatric comorbidities (identified by International Classification of Disease, ninth revision codes). We created combined and sex-stratified multivariate logistic regression models to identify associations with 30-day readmission.Results: Our sample included 48,888 Veterans (4% women). Compared with men, women Veterans were younger, more likely to be nonwhite, and differed in smoking status. Women were more likely to have asthma, drug use, and several psychiatric comorbidities. Before hospitalization, women were less likely to have pulmonary function testing (76% vs. 78%; P = 0.01) or be treated with antimuscarinic (43% vs. 48%) or combined long-acting bronchodilator/inhaled corticosteroid (61% vs. 64%) inhalers. Women were more likely to receive nicotine-replacement therapy (all P , 0.01). Women had shorter length of stay (median days, 2 vs. 3; P = 0.04) and lower 30-day readmission rate (20% vs. 22%; P = 0.01). In adjusted models including both sexes, age, antimuscarinic use, comorbidities, and diagnosis of drug or alcohol use were associated with readmission; there was no association with sex and readmission risk. In models stratified by sex, associations were similar between women and men.Conclusions: This study suggests differences between women and men hospitalized for COPD regarding presentation, evaluation, and management. Readmission is strongly influenced by comorbidities, suggesting individualized and comprehensive case management may reduce readmission risk for women and men with COPD.