https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840050313

Portal pressure, presence of gastroesophageal varices and variceal bleeding.

Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840160309

Increased spontaneous and lymphokine-conditioned IgA and IgG synthesis by B cells from alcoholic cirrhotic patients.

Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension

Abstract Objective To identify work–environment characteristics associated with Veterans Health Administration (VHA) behavioral health provider (BHP) burnout among psychiatrists, psychologists, and social workers. Data Sources The 2015–2018 data from Annual All Employee Survey (AES); Mental Health Provider Survey (MHPS); N = 57,397 respondents; facility‐level Mental Health Onboard Clinical (MHOC) staffing and productivity data, N = 140 facilities. Study Design For AES and MHPS separately, we used mixed‐effects logistic regression to predict BHP burnout using surveys from year pairs (2015–2016, 2016–2017, 2017–2018; six models). Within each year‐pair, we used the earlier year of data to train models and tested the model in the later year, with burnout (emotional exhaustion and/or depersonalization) as the outcome for each survey. We used potentially modifiable work–environment characteristics as predictors, controlling for employee demographic characteristics as covariates, and employment facility as random intercepts. Data Collection/Extraction Methods We included work–environment predictors that appeared in all 4 years (11 in AES; 17 in MHPS). Principal Findings In 2015–2018, 31.0%–38.0% of BHPs reported burnout in AES or MHPS. Work characteristics consistently associated with significantly lower burnout were included for AES: reasonable workload; having appropriate resources to perform a job well; supervisors address concerns; given an opportunity to improve skills. For MHPS, characteristics included: reasonable workload; work improves veterans' lives; mental health care provided is well‐coordinated; and three reverse‐coded items: staffing vacancies; daily work that clerical/support staff could complete; and collateral duties reduce availability for patient care. Facility‐level staffing ratios and productivity did not significantly predict individual‐level burnout. Workload represented the strongest predictor of burnout in both surveys. Conclusions This study demonstrated substantial, ongoing impacts that having appropriate resources including staff, workload, and supervisor support had on VHA BHP burnout. VHA may consider investing in approaches to mitigate the impact of BHP burnout on employees and their patients through providing staff supports, managing workload, and goal setting.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/1475-6773.13964

Relationships between work–environment characteristics and behavioral health provider burnout in the Veterans Health Administration

Achieving quality outcomes and cost efficiency within mental health are overarching objectives of the Veterans Health Administration (VHA). The mental health care workforce has long been oriented toward the goal of high quality outcomes; however, cost efficiency has only recently been elevated into this important value equation. With increased demand for access to mental health services within the VHA, leadership sought to advance methods of determining and improving mental health provider productivity. Monitoring of productivity data may also provide data signaling the potential need for additional staffing to keep up with demand for services. This article outlines VHA's development and specification of mental health productivity policy, implementation strategies, and a discussion of challenges and lessons learned for other systems to consider in implementing productivity monitoring. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned.

The significance of small esophageal varices in portal cirrhosis.

New mental health leaders must be given leadership development opportunities to support the expansion of critical skills often not conveyed within mental health graduate programs. To meet this need, the Veterans Health Administration piloted a structured national mental health leadership mentoring program focused upon the development of leadership skills in these areas: strategic planning, human resources, systems understanding, administrative operations and program evaluation, and professional and personal development. Thirty-one participants were recruited from among new mental health facility leaders or mental health discipline service chiefs. Statistically significant improvement was found across all 5 skill areas. External validation of the program’s success was also shown, with improvement in local mental health providers’ employee satisfaction and burnout. Implications for other organizational settings desiring to develop mental health leadership mentoring programs are discussed.

Veterans Health Administration’s (VHA) National Mental Health Leadership Mentoring Program: A pilot evaluation.

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Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned.

The significance of small esophageal varices in portal cirrhosis.

Veterans Health Administration’s (VHA) National Mental Health Leadership Mentoring Program: A pilot evaluation.