Veterans Health Administration. (PROSPERO: CRD42015020347).

The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. We find that there has been a slow but steady increase in the use of medications for OUD and, despite system-wide mandates and directives, uneven uptake across VA facilities and within patient sub-populations, including some of those most vulnerable. We conclude with recommendations intended to support the greater use of medication for OUD in the future, both within VA as well as other large health care systems.

The recently revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2) was created to assess both neuropathic and non-neuropathic pain. The current study extends prior research by testing the reliability and validity of the SF-MPQ-2 in a sample of U.S. veteran patients with a range of chronic pain diagnoses. Participants (N = 186) completed the SF-MPQ-2, a sociodemographic questionnaire, the Structured Clinical Interview for the DSM-IV, and self-report pain and psychiatric measures. Pain diagnoses were extracted from the electronic medical record. The SF-MPQ-2 total and scale scores demonstrated good to excellent internal consistency. Convergent and discriminant validity were supported, and SF-MPQ-2 total and scale scores increased with number of pain diagnoses and pain severity. Confirmatory factor analyses indicated a four-factor model fit the data better than a single-factor model. However, high intercorrelations among the four latent constructs were observed, and a 2nd-order global pain construct also emerged. Overall, the SF-MPQ-2 demonstrated excellent reliability and validity in a sample of U.S. veteran patients with chronic neuropathic and non-neuropathic pain. Future psychometric studies of the SF-MPQ-2 should employ longitudinal data to evaluate the ability of scale scores to uniquely predict clinical and health service outcomes.

We conclude by offering exemplar reviews of a manuscript that was ultimately accepted for publication in the journal and provide commentary on specific aspects of these reviews.

By 2014, 50% of all adults living with HIV/AIDS will be 50-plus years of age. This pilot randomized controlled trial assessed the efficacy of two telephone-delivered motivational interviewing (MI) interventions to reduce risky sexual behavior in HIV-infected adults 45-plus years old. Eligible participants reported engaging in at least one occasion of unprotected anal and/or vaginal intercourse in the 3 months prior to study enrollment. Participants were randomly assigned to receive four sessions of telephone-delivered MI, one session of telephone-delivered MI, or no MI. Relative to 4-session MI participants, Controls reported approximately three times as many episodes of unprotected sex at 3- and 6-month follow-up, while 1-session MI participants reported four times as many unprotected sex acts at 3- and 6-month follow-up. No differences in condom use were observed between 1-session MI and Control participants. Additional large-scale studies that evaluate this intervention approach are warranted.