Leveraging the ExpandNet framework and operational partnerships to scale-up brief Cognitive Behavioral Therapy in VA primary care clinics.

Evidence-based psychotherapies (EBPs) are underused in health care settings. Aligning implementation of EBPs with the needs of health care leaders (i.e., operational stakeholders) can potentially accelerate their uptake into routine practice. Operational stakeholders (such as hospital leaders, clinical directors, and national program officers) can influence development and oversight of clinical programs as well as policy directives at local, regional, and national levels. Thus, engaging these stakeholders during the implementation and dissemination of EBPs is critical when targeting wider use in health care settings. This article describes how research-operations partnerships were leveraged to increase implementation of an empirically supported psychotherapy - brief Cognitive Behavioral Therapy (brief CBT) - in Veterans Health Administration (VA) primary care settings. The partnered implementation and dissemination efforts were informed by the empirically derived World Health Organization's ExpandNet framework. A steering committee was formed and included several VA operational stakeholders who helped align the brief CBT program with the implementation needs of VA primary care settings. During the first 18 months of the project, partnerships facilitated rapid implementation of brief CBT at eight VA facilities, including training of 12 providers who saw 120 patients, in addition to expanded program elements to better support sustainability (e.g., train-the-trainer procedures).

Cognitive efficiency is associated with endogenous cytokine levels in patients with chronic hepatitis C.

The etiology of cognitive dysfunction in chronic hepatitis C (CHC) infection is unknown. Among the possibilities is cytokine activation, which has been associated with cognitive dysfunction in other chronic conditions. The purpose of this study was to investigate the relationship between endogenous IFN-alpha, IL-6, and TNF-alpha and cognitive functioning in CHC patients. Seventy-eight veterans with CHC underwent cognitive testing and measurement of serum cytokines. In patients with detectable IFN-alpha, higher levels of IL-6 and TNF-alpha were related to poorer cognitive functioning. Findings suggest CHC patients with immune responses characterized by elevated IFN-alpha may be at risk for cognitive difficulties.