Browsing by Subject "veteran"

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    Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center
    (Wiley, 2019-04) Schubert, Cathy C.; Parks, Rebecca; Coffing, Jessica M.; Daggy, Joanne; Slaven, James E.; Weiner, Michael; Medicine, School of Medicine
    OBJECTIVE Describe the implementation and effects of Mobile Acute Care for Elders (MACE) consultation at a Veterans Affairs Medical Center (VAMC). DESIGN Retrospective cohort analysis. INTERVENTION Veterans aged 65 or older who were admitted to the medicine service between October 1, 2012, and September 30, 2014, were screened for geriatric syndromes via review of medical records within 48 hours of admission. If the screen was positive, the MACE team offered the admitting team a same‐day consultation involving comprehensive geriatric assessment and ongoing collaboration with the admitting team and supportive services to implement patient‐centric recommendations for geriatric syndromes. RESULTS Veterans seen by MACE (n = 421) were compared with those with positive screens but without consultation (n = 372). The two groups did not significantly differ in age, comorbidity, sex, or race. All outcomes (30‐day readmission, 30‐day mortality, readmission costs) were in the expected direction for patients receiving MACE but did not reach statistical significance. Patients receiving MACE had lower odds of 30‐day readmission (11.9% vs 14.8%; odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.54‐1.25; p = .360) and 30‐day mortality (5.5% vs 8.6%; OR = 0.64; CI = 0.36‐1.12; p = .115), and they had lower 30‐day readmission costs (MACE $15,502; CI = $12,242‐$19,631; comparison = $18,335; CI = $14,641‐$22,962; p = .316) than those who did not receive MACE after adjusting for age and Charlson Comorbidity Index. CONCLUSION Our MACE consultation model for older veterans with geriatric syndromes leverages the limited supply of clinicians with expertise in geriatrics. Although not statistically significant in this study of 793 subjects, MACE patients had lower odds of 30‐day readmission and mortality, and lower readmission costs.
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    The true war story: ontological reconfiguration in the war fiction of Kurt Vonnegut and Tim O'Brien
    (2017) Aukerman, Jason Michael; Marvin, Tom; Eller, Jonathan; Rebein, Robert
    This thesis applies the ontological turn to the war fiction of veteran authors, Kurt Vonnegut and Tim O’Brien. It argues that some veteran authors desire to communicate truth through fiction. Choosing to communicate truth through fiction hints at a new perspective on reality and existence that may not be readily accepted or understood by those who lack combat experience. The non-veteran understanding of war can be more informed by entertaining the idea that a multiplicity of realities exists. Affirming the combat veteran reality—the post-war ontology—and acknowledging the non-veteran reality—rooted in what I label “pre-war” or “civilian” ontology—helps enhance the reader’s understanding of what veteran authors attempt to communicate through fiction. This approach reframes the dialogic interaction between the reader and the perspectives presented in veteran author’s fiction through an emphasis on “radical alterity” to the point that telling and reading such stories represent distinct ontological journeys. Both Kurt Vonnegut and Tim O’Brien provide intriguing perspectives on reality through their fiction, particularly in the way their characters perceive and express morality, guilt, time, mortality, and even existence. Vonnegut and O’Brien’s war experiences inform these perspectives. This does not imply that the authors hold an identical perspective on the world or that combat experience yields an ontological understanding of the world common to every veteran. It simply asserts that applying the ontological turn to these writings, and the writings of other combat veterans, reveals that those who experience combat first-hand often walk away from those experiences with a changed ontological perspective.