Partner Aggression Among Iraq and Afghanistan Veterans with PTSD May be an Important Treatment Consideration and Target for Prevention.

Intimate Partner Aggression Perpetrated and Sustained by Male Afghanistan, Iraq, and Vietnam Veterans With and Without Posttraumatic Stress Disorder. 12/23/09. Veterans with posttraumatic stress disorder (PTSD) consistently evidence higher rates of intimate partner aggression perpetration than veterans without PTSD, but most studies have examined rates of aggression among Vietnam veterans several years after their deployment. The primary aim of this study was to examine partner aggression among male Afghanistan or Iraq veterans who served during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and compare this aggression to that reported by Vietnam veterans with PTSD. Three groups were recruited, OEF/OIF veterans with PTSD (n = 27), OEF/OIF veterans without PTSD (n = 31), and Vietnam veterans with PTSD (n = 28). Though only a few comparisons reached significance, odds ratios suggested that male OEF/OIF veterans with PTSD were approximately 1.9 to 3.1 times more likely to perpetrate aggression toward their female partners and 1.6 to 6 times more likely to report experiencing female perpetrated aggression than the other two groups. Significant correlations among reports of violence perpetrated and sustained suggested many men may have been in mutually violent relationships. Taken together, these results suggest that partner aggression among Iraq and Afghanistan veterans with PTSD may be an important treatment consideration and target for prevention. Journal of Interpersonal Violence via PubMed

DoD-VA Deployment Health Working Group Sponsors Workshop on the Challenges of Environmental Exposures

DoD and VA Discuss Environmental Exposure Challenges 12/23/09. Last November, an assembly of some of the top physicians, epidemiologists, and researchers from across the Department of Defense (DoD), the Department of Veterans Affairs (VA), and even the United Kingdom Ministry of Defense gathered in a day long workshop to discuss the challenges of environmental exposures within the Iraqi and Afghan theaters of operation, and what was being done to address them. Military Health System

VAOIG Inspection of Unexpected Death at North Chicago VA Medical Center

Healthcare Inspection Review of an Unexpected Death North Chicago VA Medical Center North Chicago, Illinois 12/22/09. The purpose of this inspection was to determine the validity of allegations regarding the care provided to a patient who died within 24 hours of admission to the North Chicago VA Medical Center (VAMC), North Chicago, Illinois. The complainant suggested that a medical trainee may have been inadequately supervised. We found the quality of care reviews conducted by the VAMC to be thorough. Although we found deficiencies in the quality of care provided for this patient, we did not demonstrate a connection with the patient’s death. We recommended that managers evaluate this case with Regional Counsel for possible disclosure to the patient’s family. We also recommended that staff comply with the VAMC’s policy for rapid intervention in patients with deteriorating clinical conditions. Management submitted appropriate implementation plans. VAOIG

Diagnosis and Management of Cardiovascular Disease in Women Veterans

Risk factor treatment in veteran women at risk for cardiovascular disease. 12/22/09. CONCLUSIONS: Our findings show a high prevalence of cardiovascular disease (CVD) risk factors and low knowledge levels among ambulatory veteran women. There is a need for improvement in recognition and aggressive management of CVD risk factors, including the use of noninvasive studies as surrogate markers for early diagnosis. Continued efforts to educate women and providers about CVD risk factors, heart-healthy behaviors, screening, and treatment are vital to improve the current state of women's health and decrease future adverse cardiac event rates. Journal of Surgical Research via PubMed

Virtual Reality Exposure Therapy for Portugesse War Veterans Suffering From PTSD

PTSD Elderly War Veterans: A Clinical Controlled Pilot Study. 12/22/09. Abstract: Around 25,000 war veterans in Portugal suffer posttraumatic stress disorder (PTSD). This clinically controlled study evaluates virtual reality exposure therapy (VRET) as an alternative procedure to reduce PTSD symptoms. Ten patients were assigned to three groups: VRET, exposure in imagination (EI), and waiting list (WL). The patients were Portuguese veterans from a series of wars fought in former African colonies more than 30 years ago. While the EI group participated in traditional imagination therapy, the VRET group was exposed to a virtual reality (VR) war scenario. Cues such as ambush, mortar blasting, and waiting for rescue were used in the VR. Patients enrolled in the VRET group showed statistical reduction of PTSD-associated disorders like depression and anxiety. Far from being conclusive, this pilot study nonetheless presents some promising data on the use of VRET on old war veteran populations. Cyberpsychology & Behavior via PubMed

Journal of Rehabilitation Research & Development (JRRD) Volume 46, 2009

Single-Topic Issue: Pain after Spinal Cord Injury 12/21/09. The present single-topic issue concerns several important research areas relevant for both the understanding of pain and the development of future effective treatments for pain associated with SCI. Because the pains that are experienced after an SCI are particularly complex, effective communication between the basic and clinical research communities and clinical care providers is critical for the progress in this area. JRRD

VA Adopts New Care Delivery System for Chronic Diseases

VA Adopts Patient-Centered Care Model Based on Treatment of Chronic Conditions 12/31/09. WASHINGTON, DC—Diabetes is, in many ways, the prototypical chronic disease. It is slow moving, progressive, complex, and it impacts patients’ lives in ways that cannot be quantified on a medical chart. Physicians at the Department of Veterans Affairs have learned a lot about treating diabetes over the last several decades, and during that time, certain concepts have emerged: shared decision-making processes, patient-guided treatment, and population management. Now, as VA undertakes a system-wide effort to evaluate and redesign its primary care delivery system, those concepts are helping to guide a process that will help move VA care, including diabetic care, into the 21st century. U.S. Medicine

DoD Launches Study of Female Vietnam Vets Health and Impact of War

DoD to Study the Impact of Wartime Deployment on Women's Health and Mental Outcomes 12/21/09. WASHINGTON, DC—As women Vietnam veterans approach their mid-60s, physicians are finding it more important to understand the impact of wartime deployment on their health and mental outcomes nearly 40 years after service on this under-researched demographic. To try to fill in those research gaps, the DoD is launching a comprehensive study of women veterans who served in the military during the Vietnam War, exploring the effects of their military service on their health. U.S. Medicine

NFL & DoD Collaborate on Managing TBIs

Collaboration Between Department of Defense and National Football League on Response to Traumatic Brain Injury 12/21/09 WASHINGTON, DC—Lately, traumatic brain injury (TBI) is receiving due attention on both the battlefield and the gridiron. An October 28, 2009 hearing before Congress has prompted NFL Commissioner Roger Goodell to implement a new policy for players with suspected head injuries. The NFL is also reportedly initiating collaboration with the Department of Defense to share information on the most successful strategies for managing head injuries U.S. Medicine

Congressional Research Service Report on TBI in Military

Traumatic Brain Injury: Care and Treatment of Operation Enduring Freedom and Operation Iraqi Freedom Veterans 12/20/09. Traumatic brain injury (TBI), defined in the medical literature as a disruption in brain function
that is caused by a head injury, has become known as one of the “signature wounds” of the wars in Iraq and Afghanistan due to its high occurrence in post-deployment servicemembers and veterans of these wars. As servicemembers return home, many need ongoing care for mild, moderate, or severe TBI. The growing number of TBI patients and the nature of their injuries creates the need for increased treatment capacity for veterans, and raises a number of policy issues that Congress may move to consider. CRS via FAS

Veterans With Mental Health Diagnoses, Especially PTSD, Utilize Significantly More VA Non-mental Health Medical Services.

Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans. 10/04/09. BACKGROUND: Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization. OBJECTIVE: To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD. DESIGN AND PARTICIPANTS: National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008. MEASUREMENTS: We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics. MAIN RESULTS: Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization. CONCLUSIONS: Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs. Journal of General Internal Medicine via PubMed

Case Management of Older Veterans

Veterans Affairs Intensive Case Management for older veterans. 10/04/09. CONCLUSION: These data highlight the unique characteristics of older veterans receiving assertive community treatment (ACT) type of services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup. American Journal of Geriatric Psychiatry via PubMed

Sexual Behavior and Sexual Concerns in Women Veterans Treated for PTSD

Sexual Function Outcomes in Women Treated for Posttraumatic Stress Disorder. 10/04/09. Abstract Background: This study examined dysfunctional sexual behavior and sexual concerns in women treated for posttraumatic stress disorder (PTSD). There were three objectives: to characterize the relationship between symptoms of PTSD and sexual outcomes, to examine the effect of treatment on sexual outcomes, and to examine the relationship between change in PTSD and change in sexual outcomes. Methods: Female veterans and active duty personnel with PTSD (n = 242), 93% of whom had experienced sexual trauma, were randomly assigned to receive 10 weekly sessions of either Prolonged Exposure or Present-Centered Therapy. PTSD and sexual outcomes were assessed before and after treatment and then 3 and 6 months later. Results: At baseline, the reexperiencing, numbing, and hyperarousal symptom clusters were related to one or both sexual outcomes. Although prior analyses had shown that Prolonged Exposure resulted in better PTSD outcomes, there were no differences between treatments for either dysfunctional sexual behavior or sexual concerns. However, loss of PTSD diagnosis was associated with improvements in sexual concerns. Conclusions: The findings suggest that clinically meaningful improvements in PTSD are necessary in order to reduce sexual problems in traumatized women. Journal of Women's Health via PubMed

Headaches in Veterans With PTSD and/or Combat Injuries

PTSD, combat injury, and headache in Veterans Returning from Iraq/Afghanistan. 10/04/09. CONCLUSION: Posttraumatic stress disorder and combat-related physical injury were related to higher rates of self-reported headache in newly returning veterans. Our finding that posttraumatic stress disorder and injury during combat are differentially related to migraine and tension-type headache, point to a complex relationship between physical and psychological trauma and headache. These findings have implications for a comprehensive approach to interventions for headache and the physical and psychological sequelae of trauma. Headache via PubMed

Cholinesterase Inhibitors and Incidence of Bradycardia in Veterans With Dementia

Cholinesterase Inhibitors and Incidence of Bradycardia in Patients with Dementia in the Veterans Affairs New England Healthcare System. 10/04/09. CONCLUSION: Using a large cohort, a modestly greater risk of bradycardia was found in patients with dementia taking cholinesterase inhibitors (ChE-Is) than in those not taking these drugs. In patients taking donepezil, the risk of bradycardia may increase with increasing doses. Because of the potential clinical consequences, monitoring for bradycardia may be warranted in patients with dementia treated with ChE-Is. Journal of the American Geriatrics Society via PubMed

Telemedicine vs In-Person Consultation Communication Sytles

An evaluation of patient-physician communication style during telemedicine consultations.(Free full-text) 10/04/09. CONCLUSIONS: The study findings indicate differences between telemedicine (TM) and in-person (IP) consultations in terms of physician-patient communication style. Results suggest that, when comparing TM and IP consultations in terms of physician-patient communication, TM visits are more physician centered, with the physician controlling the dialogue and the patient taking a relatively passive role. Further research is needed to determine whether these differences are significant and whether they have relevance in terms of health outcomes and patient satisfaction with care. Journal of Medical Internet Research via PubMed

Pharmacological Treatment of PTSD

Pharmacotherapy treatment of PTSD and comorbid disorders. 10/04/09. Comorbity is very high in posttraumatic stress disorder (PTSD) patients. PTSD is very often complicated with depressive disorder, substance abuse, other anxiety disorders, personality disorders, psychotic features, etc. There have been few pharmacotherapy studies in this complicated field. In the past few years the literature on pharmacotherapy treatment for PTSD and comorbidity has arisen. From empirical evidence (level A) exist three sertraline studies in PTSD comorbid with: 1) anxiety, 2) depression, and 3) anxiety and depression, and one risperidone study in PTSD comorbid with psychotic symptoms. From empirical evidence (level B) exist two disulfiram, naltrexone, and their combination studies in patients with PTSD comorbid with alcohol dependence and one paroxetine or bupropion versus cognitive behavioral therapy (CBT) versus community mental health referral study in PTSD women outpatients with major depressive disorder. The results from our label trials in the Croatian war veterans with chronic PTSD comorbid with psychotic features treated with novel antipsychotics (olanzapine, risperidone, or quetiapine) are promising. In the future more rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder, especially the trials from level A. Psychiatria Danubina via PubMed

Non-invasive Ventilation Use in VA Hospitals

Noninvasive ventilation for acute respiratory failure: a national survey of veterans affairs hospitals. (Free full-text) 10/04/09. The perception of noninvasive ventilation (NIV) use in the Veterans Affairs hospitals varies significantly. This survey revealed a wide range of training and experience, location of use, presence of written guidelines, and methods of delivery. Notable perceptual differences exist between respiratory therapists and physicians. Underutilization of NIV and low rates of perceived efficacy are major findings. Respiratory Care via PubMed

VAOIG Inspection of Edward Hines Jr. VA Hospital

Healthcare Inspection Alleged Nursing Quality of Care Issues Edward Hines Jr. VA Hospital Hines, Illinois 10/04/09. This purpose of the review was to determine the merit of allegations concerning nursing quality of care involving one nursing unit at the Edward Hines Jr. VA Hospital. Specifically the complainant alleged that: On two occasions, nurses attempted to administer a medication to a patient who was allergic to the medication. A nurse failed to remove a tourniquet from a patient who was diagnosed with dementia. A patient with large wounds on the buttocks was left lying in feces because the nurse called to the bedside said the next shift should clean the patient. We substantiated that nurses attempted to administer a medication to a patient who was allergic to the medication and that a nurse failed to remove a tourniquet from a patient with dementia after drawing blood for testing. We did not substantiate that a nurse left a patient lying in feces or that the nurse told the patient that the next shift should clean the patient. Although we substantiated two of the allegations, we concluded that clinical managers took appropriate administrative actions prior to our review; therefore, we made no recommendations. VAOIG

VAOIG Inspection of Cambridge, MD, Fort Howard, MD, Alexandria, VA, Greenbelt, MD, Wilmington, NC, and Jacksonville, NC.

Healthcare Inspection Community Based Outpatient Clinic Reviews Cambridge and Fort Howard, MD Alexandria, VA and Greenbelt, MD Wilmington and Jacksonville, NC 09/30/09. The VA Office of Inspector General reviewed six Community Based Outpatient Clinics (CBOCs) the week of August 10–14, 2009. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 5 were Cambridge and Fort Howard, MD; and Alexandria, VA and Greenbelt, MD; and, in VISN 6, Wilmington and Jacksonville, NC. The parent facilities of these CBOCs are VA Maryland Healthcare System, Washington DC VA Medical Center (VAMC), and Fayetteville VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, patient satisfaction, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISNs and facility management: Require that physician privileges are appropriate to the procedures performed. VAOIG

VAOIG Audit of the System Devleopment Life Cycle

Department of Veterans Affairs System Development Life Cycle Process 09/30/09. The Office of Inspector General conducted an audit to determine whether VA’s Office of Information and Technology (OI&T) effectively and efficiently used the System Devleopment Life Cycle (SDLC) process to manage VA’s major IT investments valued at approximately $3.4 billion. Although VA’s SDLC guide was adequate, OI&T needed to communicate and enforce the guidance to ensure major investments are effectively managed. Additionally, OI&T did not adequately monitor investments because they never fully centralized their management functions as they relate to the SDLC process. As a result, OI&T could not ensure investments were managed effectively and efficiently, leaving VA’s IT investment portfolio at risk. Given that OI&T is the steward of VA’s IT investments and responsible for managing a comprehensive IT investment portfolio, it is vital that immediate action be taken to implement management controls to ensure centralized oversight of VA’s IT investments. Otherwise, these management control deficiencies increase the risk that VA’s major IT investments could experience cost and schedule overruns which could ultimately lead to costly, unproductive, or failed programs and projects. The Assistant Secretary for Information and Technology agreed with our four recommendations and provided acceptable planned actions. Implementing these recommendations is expected to facilitate the implementation of management controls, ensure centralized management of VA’s IT investments, improve risk management and improve the overall governance of VA’s IT investments. We will follow up on their implementation until all proposed actions have been completed. VAOIG

VAOIG Inspection of Claim-Related Mail Handleing

Audit of VA Regional Office Claim-Related Mail Processing 09/30/09. The Office of Inspector General (OIG) conducted this audit to evaluate whether VA regional offices (VAROs) effectively managed mailroom operations and controlled the timely and accurate processing of claim-related mail. In fiscal year (FY) 2008, VBA processed about 20 million pieces of incoming mail and 13 million pieces of outgoing mail. Both the significant number of claim-related documents handled by VARO mailrooms and the potential effect on the processing of veterans claims that can occur if documents are inappropriately handled or destroyed make this a high-risk area for VBA. VAOIG

Integrated Treatment for Veterans With PTSD and Chronic Pain

Researchers develop an integrated treatment for veterans with chronic pain and posttraumatic stress 09/30/09. The wars in Iraq and Afghanistan have resulted in a growing number of soldiers evacuated to the United States for comprehensive care for physical and psychological trauma. Given the number of physical injuries often experienced by soldiers, it is not surprising that chronic pain is a frequent problem among returning soldiers from Operation Iraqi Freedom and Operation Enduring Freedom. Boston University Medical Center via Eurekalert!

Patients With Chronic Illnesses: Comparing the Health Care Systems

A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans. 09/29/09. We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems. Military Medicine via PubMed

PTSD and Poor Sleep

Is poor sleep in veterans a function of post-traumatic stress disorder? 09/9/09. Substantial research has demonstrated an association between post-traumatic stress disorder (PTSD) and quality of sleep, particularly in veteran populations. The exact nature of this relationship, however, is not clear. The possibility that poor sleep is a more general experience among veterans has not been explored to date, with most studies focusing only on veteran populations with PTSD. This pilot study aimed to explore whether sleep disturbance is common to veterans generally or simply those with PTSD. Data were collected from a community sample of 152 Australian Vietnam war veterans, 87 of whom did not meet criteria for PTSD. All those with PTSD and 90% of those without PTSD reported clinically significant sleep disturbance, indicating that serious sleep problems are common across the veteran population. Despite the limitations of this initial study, these results highlight the importance of ensuring that research into sleep disorders in veterans with PTSD pays attention to the potential etiological role of other military factors, including deployments. Military Medicine via PubMed

Civilian Social Workers: Serving the Veteran and Soldier

Civilian social work: serving the military and veteran populations. 09/29/09. This article discusses social work practice areas for civilian social workers who provide services to military service members,veterans, and their families. These practice areas include education, child welfare, domestic violence, mental health, health care, substance abuse, and criminal justice. The authors examine the impact of the contemporary military lifestyle and current military operations on service members and their families in the context of these practice areas, with the goal of compelling civilian social workers to acknowledge their responsibility to competently serve military and veteran clients. Social Work via PubMed

Case History: PTSD in a Female Veteran

Forever changed: posttraumatic stress disorder in female military veterans, a case report. 09/29/09. PURPOSE. This paper examines the experience of posttraumatic stress disorder (PTSD) in a female veteran of Operation Iraqi Freedom, including the barriers to treatment she encountered in an outpatient psychiatry clinic. DESIGN AND METHODS. Case report data were obtained through review of records and interviews with a veteran combat nurse diagnosed with chronic PTSD. CONCLUSIONS. Sex differences in PTSD are controversial, but PTSD in female military veterans is a significant problem. Gender may complicate diagnosis and treatment. This case report discusses these issues and invites further research. PRACTICE IMPLICATIONS. Advanced practice psychiatric nurses increasingly will see female veterans with PTSD in their practices. Perspectives in Psychiatric Care via PubMed

Intimate Relations and Veterans With PTSD

Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development. 09/29/09. Military operations in Iraq and Afghanistan have brought heightened awareness of military related PTSD, as well as the intimate relationship problems that accompany the disorder and can influence the course of veterans' trauma recovery. In this paper, we review recent research that documents the association between PTSD and intimate relationship problems in the most recent cohort of returning veterans and also synthesize research on prior eras of veterans and their intimate relationships in order to inform future research and treatment efforts with recently returned veterans and their families. We highlight the need for more theoretically-driven research that can account for the likely reciprocally causal association between PTSD and intimate relationship problems to advance understanding and inform prevention and treatment efforts for veterans and their families. Future research directions are offered to advance this field of study. Clinical Psychology Review via PubMed

VAOIG Audit of Veterans Benefits Administration’s Control of Veterans’ Claims Folders

Audit of Veterans Benefits Administration’s Control of Veterans’ Claims Folders 09/29/09. The Office of Inspector General (OIG) conducted this audit to evaluate the Veterans Benefits Administration’s (VBA) control of veterans’ claims folders. The objective for the audit was to determine if VBA had adequate procedures in place to locate veterans’ claims folders effectively.

VBA’s control of veterans’ claims folders, which contain personally identifiable information, was not effective because VBA managers did not track the number of lost or rebuilt folders, consistently enforce Control of Veterans Records System (COVERS) policies, and establish effective search procedures for missing claims folders. As of February 20, 2009, VBA had assigned about 4.2 million claims folders to regional offices for benefit claims processing and safeguarding. We projected the claims folders for an estimated 437,000 (10 percent) veterans were not at the location shown in COVERS. Claims folders for approximately 296,000 (7 percent) veterans were at locations different from that shown in COVERS (misplaced). Misplaced claims folders can cause unnecessary claim processing delays and increases the likelihood that folders will be lost. Claims folders for approximately 141,000 (3 percent) veterans were lost. Lost claims folders place additional burdens on the veterans and reduce the time regional office personnel have to spend processing claims. The Under Secretary for Benefits agreed with our findings and recommendations and made acceptable plans to implement appropriate actions. VAOIG

Group Therapy Helpful For Homeless Vets Prone to Violence

Researchers find group therapy benefits homeless veterans prone to violence 09/25/09. A new study finds that group therapy can benefit homeless veterans who have admitted taking physical or emotional abuse against their partners. The research – a collaboration between Gary Dick, associate professor of Social Work at the University of Cincinnati, and Brad Schaffer, corrections counselor for the Veterans Administration Cincinnati Medical Center – was presented this month at the 14th International Conference on Violence, Abuse and Trauma in San Diego. University of Cincinnati via Eurekalert!

2nd Annual National Veterans Summer Sports Clinic in San Diego

Wounded Veterans Find Therapy in Sports Clinic 09/24/09. More than 60 wounded veterans suffering disabilities ranging from post-traumatic stress to amputations are learning “to live again” this week through competition at the 2nd Annual National Veterans Summer Sports Clinic in San Diego. DefenseLink

10-Session Behavioral Course for Self-management of Veterans With Auditory Hallucinations

Behavioral management of auditory hallucinations. 09/24/09. A 10-session behavioral course for self-management of auditory hallucinations in patients with schizophrenia has demonstrated positive outcomes. This article evaluates both the course's implementation and benefits to patients attending the course. Teleconferencing, electronic media, and 26 monthly conference calls were used to educate six advanced practice nurses (APNs) at six sites about the course implementation. Thirty-two patients within the U.S. Department of Veterans Affairs participated in the course. All of the APNs reported course helpfulness, improved communication with patients about voices, and improved harm assessment. Of the patients, 96% found the course helpful: 67% no longer heard voices to harm self or others, and 60% had improved auditory hallucination intensity scores. The project demonstrated successful implementation and practice integration with APNs' activities corresponding to Rogers' stages of innovation adoption. Facilitators and barriers to implementation are also described. Journal of Psychosocial Nursing & Mental Health Services via PubMed

Educating Caregivers of Veterans With Strokes Results in Fewer Caregiver Injuries

Association Between Health Education Needs and Stroke Caregiver Injury. 09/24/09. OBJECTIVE: Many stroke caregivers are inadequately informed about stroke and its sequelae and have little preparation for the physical demands of moving, lifting, and handling often required. Our objectives are to examine the association between health education needs and physical injury sustained as a result of activities related to the caregiving role. METHOD: A total of 276 caregivers of veterans who suffered an acute stroke event were surveyed about their information needs and injury status.We used multivariate logistic regression analysis to calculate adjusted and unadjusted odds ratios for injury status. RESULTS: Results indicate that in the adjusted model, caregivers who had increased educational needs were almost twice as likely (OR: 1.80; 95% CI: 1.74-1.94) to have incurred an injury related to caregiving activities. CONCLUSIONS: Health education interventions that provide stroke caregivers with educational materials may help reduce caregiver injuries. Journal of Aging and Health via PubMed

VAOIG Inspections of Community Based Outpatient Clinics From Lockport and Olean, NY Monaca and Washington, PA Berwick and Sayre, PA Somerset, KY

Healthcare Inspection Community Based Outpatient Clinic Reviews Lockport and Olean, NY Monaca and Washington, PA Berwick and Sayre, PA Somerset, KY 09/23/09. The VA Office of Inspector General reviewed seven Community Based Outpatient Clinics (CBOCs) the week of July 13–17, 2009. The CBOCs reviewed in VISN 2 were Lockport and Olean, NY; in VISN 4, Monaca and Washington, PA; and Berwick and Sayre, PA; and, in VISN 9, Somerset KY. The parent facilities of these CBOCs are VA Western NY Healthcare System (HCS), VA Pittsburgh HCS, Wilkes-Barre VA Medical Center (VAMC), and Lexington VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, patient satisfaction, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to VISN and facility management: Require that contract providers are privileged according to VHA policy. Accomplish providers’ background checks according to VHA policy. Require physician assistants are consistently monitored and evaluated by the collaborative physician and that results of the evaluations are used during the re-credentialing process. Ensure clinical competencies are monitored by the appropriate discipline. Ensure staff are trained and evaluated, and that their competencies are documented. Conduct a security risk assessment and evaluate the assessment to determine appropriate measures. Implement appropriate measures as described in the vulnerability review. Maintain patients’ auditory privacy during their check-in process. Take appropriate actions to secure and protect health records. Provide proper CBOC access to disabled patients. Adhere to manufacturer’s equipment maintenance requirements. Ensure pharmaceuticals are dispensed according to VHA policy. Properly reprocess reusable medical equipment. Develop and maintain an emergency management plan that includes emergency response to all mental health emergencies and reflects current practices. Recover overcharges from the contractor and ensure that future invoices are verified for compliance with contract provisions. Ensure information is accurate and complete on contractor billings. Formalize the contractual agreement with the contractor regarding the “Point of Care” addendum. VAOIG

New Method for Preventing Heterotopic Ossification?

New study finds way to stop excessive bone growth following trauma or surgery 09/23/09. A recent United States Army study found that excessive bone growth, also known as A recent United States Army study found that excessive bone growth, also known as heterotopic ossificiation (HO), affects up to 70 percent of soldiers who are severely wounded during combat. The excessive bone forms within muscles and other tissues causing severe pain, reduced mobility and even local paralysis if untreated. A new study by Thomas Jefferson University researchers found a way to prevent HO in animal models by shutting the process off in its early stages. (HO), affects up to 70 percent of soldiers who are severely wounded during combat. The excessive bone forms within muscles and other tissues causing severe pain, reduced mobility and even local paralysis if untreated. A new study by Thomas Jefferson University researchers found a way to prevent HO in animal models by shutting the process off in its early stages. Thomas Jefferson University via Eurekalert!

Analysis of Fall Risk Factors in Elderly Veterans

Comparison of regression models for the analysis of fall risk factors in older veterans. 09/23/09. CONCLUSIONS: Risk of falling may be better analyzed using regression models for recurrent events. These results have important implications for the collection and analysis of fall outcome data. Annals of Epidemiology via PubMed

Outcomes of Venous Ulcers Care Following VA Guideline

Guideline concordant venous ulcer care predicts healing in a tertiary care Veterans Affairs Medical Center. 09/23/09. This study describes the impact of 80% adherence to guideline concordant care for compression therapy, moist wound-healing environment, and debridement on venous ulcer outcomes. The retrospective cohort design included patients from a tertiary care Veterans Affairs Medical Center from October 2003 to September 2007. During this 5-year interval, 155 patients with 400 venous ulcers met study inclusion. A majority of ulcers (n=362) healed, with an average time to healing of 18.1 weeks (range 2-209 weeks, median 10.4 weeks). From the multivariate Poisson regression, the likelihood of ulcer healing increased when compression therapy was provided during at least 80% of visits (relative risk [RR], 1.93; 95% confidence interval [CI], 1.27-2.92) or when a moist wound-healing environment was provided during at least 80% of visits (RR, 1.63; 95% CI, 1.09-2.42). Debridement alone was not significantly associated with ulcer healing (RR, 1.0; 95% CI, 0.61-1.64). Patients who received all three treatments during at least 80% of their visits were more likely to heal than those who received < 80% treatment (RR, 2.52; 95% CI, 1.53-4.16). Guideline concordant venous ulcer care was significantly associated with venous ulcer healing, when provided at 80% or more of patient visits. Wound Repair and Regeneration via PubMed

VAOIG Review of Amarillo Texas VA

Combined Assessment Program Review of the Amarillo VA Health Care System Amarillo, Texas 09/22/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 277 employees. The review focused on six operational activities. The system complied with selected standards in the following four activities: (1) contract/agency registered nurses, (2) coordination of care, (3) environment of care, and (4) physician credentialing and privileging. We identified the veteran and spouse flu vaccine clinic and the suicide prevention collaborative as organizational strengths. We made recommendations for improvement in the following two activities: QM. Medication management. VAOIG

VAOIG Evaluation of the VA's Suicide Prevention Programs

Healthcare Inspection Evaluation of Suicide Prevention Program Implementation in Veterans Health Administration Facilities January–June, 2009 09/22/09. The purpose of this review was to evaluate the extent Veterans Heath Administration (VHA) facilities implemented suicide prevention programs in compliance with VHA requirements. The evaluation was conducted at 24 VHA facilities during Combined Assessment Program reviews performed during January–June, 2009. All 24 facilities implemented suicide prevention programs that generally met the VHA requirements. To strengthen the programs, we recommended that VHA ensure: documentation of collaboration between SPCs and MH providers, mental health providers develop comprehensive and timely safety plans, and full-time SPCs are appointed at very large CBOCs. VAOIG

Co-occurance of PTSD, Anxiety and Depression

Comorbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans. 09/22/09. Almost one half of war veterans would endorse a lifetime triple comorbidity, and those who do, are likely to have more impaired functioning. The findings support the perspective that views PTSD as the dominant disorder following traumatic events, which impels the development of comorbid anxiety and depression. Journal of Affective Disorders via PubMed

Stressors Faced by Women Veterans Serving in Iraq and Afghanistan

A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. 09/22/09. The extent of female service members' involvement in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), in terms of both the number of women deployed and the scope of their involvement, is unprecedented. While many of the mental health readjustment issues of female service members are likely to mirror those of the majority male Veteran population, this newest generation of women Veterans may also face unique threats to their mental health. The goal of this review it to highlight emerging issues relevant to the development of posttraumatic stress disorder (PTSD) among women deployed to Iraq and Afghanistan by reviewing the existing literature on gender-relevant issues among this cohort, as well as raising theoretically important issues that are worthy of further empirical investigation. Topics addressed include gender differences in combat experiences and in PTSD following combat exposure; sexual assault, sexual harassment and other interpersonal stressors experienced during deployment; women Veterans' experiences of premilitary trauma exposure; and unique stressors faced by women Veterans during the homecoming readjustment period. Given that most models of the impact of war zone deployment on PTSD are predicated on the experiences of male service members, women's expanding role in combat operations presents both an opportunity and a challenge to adapt these models to more effectively capture the experiences of female service members. Clinical Psychology Review via PubMed

New Treatment for Traumatic Spinal Cord Injury

New drug targets for spinal cord injury? 09/21/09. New research, to be published in the Journal of Clinical Investigation, has determined that immune cells known as B cells worsen outcome following traumatic spinal cord injury in mice, indicating that therapeutics that remove B cells or the molecules they produce (antibodies) or that inhibit B cell responses might be of benefit to individuals who experience traumatic spinal cord injury. Journal of Clinical Investigation via Eurekalert!

Physical, Psychological, and Functional Comorbidities in Australian Male Gulf War I Veterans

Physical, Psychological, and Functional Comorbidities of Multisymptom Illness in Australian Male Veterans of the 1991 Gulf War. 09/20/09. Multisymptom illness is more prevalent in 1991 Gulf War veterans than in military comparison groups; less is known about comorbidities. The authors compared physical, psychological, and functional comorbidities in Australian male Gulf War I veterans with those in actively (non-Gulf) deployed and nondeployed military personnel by using a questionnaire and medical assessment in 2000-2002. Multisymptom illness was more common in male Gulf War veterans than in the comparison group (odds ratio (OR) = 1.80, 95% confidence interval (CI): 1.48, 2.19). Stratifying by deployment status in the comparison group made little difference in this association. Gulf War veterans with multisymptom illness had increased psychiatric disorders, including major depression (OR = 6.31, 95% CI: 4.19, 9.52) and posttraumatic stress disorder (OR = 9.77, 95% CI: 5.39, 18.59); increased unexplained chronic fatigue (OR = 13.32, 95% CI: 7.70, 23.05); and more reported functional impairment and poorer quality of life, but objective physical and laboratory outcomes were similar to those for veterans without multisymptom illness. Similar patterns were found in the comparison groups; differences across the 3 groups were statistically significant for only hospitalization, obstructive liver disease, and Epstein-Barr virus exposure. Multisymptom illness is more prevalent in Gulf War I veterans, but the pattern of comorbidities is similar for actively deployed and nondeployed military personnel. American Journal of Epidemiology via PubMed

Sequential Appearance of Psycholoical Disorders in Australian Gulf War Veterans

Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans. 09/20/09. Our study found that psychological disorders occur in sequence following Gulf War deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy. Social Psychiatry and Psychiatric Epidemiology via PubMed

Appropriateness of Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans. 09/20/09. VA providers incorporate patient age, comorbidity, and past CRC screening history into CRC screening recommendations for elderly veterans; however, substantial proportions of these recommendations are inappropriate. Journal of General Internal Medicine via PubMed

Black Veterans With High LDL Levels at Increased Risk of Prostate Cancer

Increased Low Density Lipoprotein and Increased Likelihood of Positive Prostate Biopsy in Black Americans. 09/20/09. Increased serum low density lipoprotein is associated with an increased likelihood of prostate cancer diagnosis in black men but not in nonblack men. This association is strongest in the highest low density lipoprotein risk category. The reasons for the racial differences are unknown but may include genetic, dietary or other environmental factors. Journal of Urology via PubMed

Osteoporosis Therapy for Veterans With Prostate Cancer on Androgen Deprivation Therapy

Intravenous Zoledronic Acid to Prevent Osteoporosis in a Veteran Population With Multiple Risk Factors for Bone Loss on Androgen Deprivation Therapy. 09/16/09. Androgen deprivation therapy for prostate cancer is associated with osteoporosis and increased fracture risk. Previous studies of zoledronic acid demonstrated bone loss prevention in patients initiating androgen deprivation therapy. There are limited data on patients on prolonged androgen deprivation therapy or in Veterans Affairs patients with multiple risk factors for osteoporosis. CONCLUSIONS: Zoledronic acid improved bone mineral density in patients with M0 prostate cancer on androgen deprivation therapy for 1 year or less, or greater than 1 year. This finding indicates that bisphosphonate therapy remains effective when initiated later in the course of androgen deprivation therapy and is efficacious in Veterans Affairs patients with multiple risk factors for osteoporosis. Journal of Urology via PubMed

Veterans who Exercise Have a Reduced Risk of Prostate Cancer

Exercise and Prostate Cancer Risk in a Cohort of Veterans Undergoing Prostate Needle Biopsy. 09/20/09. To our knowledge, these results provide the first evidence of an association between exercise and prostate cancer risk as well as grade at diagnosis in men scheduled to undergo prostate biopsy. Specifically moderate exercise was associated with a lower risk of prostate cancer and in men with cancer, lower grade disease. Further investigation using an objective measure of exercise in a larger sample size is required to confirm these findings. Journal of Neurology via PubMed

VAOIG Inspection of Prescott Arizona VA

Healthcare Inspection Quality of Care Review Bob Stump VA Medical Center Prescott, Arizona 09/19/09. The purpose of the review was to evaluate allegations related to quality of care in several services and the rating change of a peer review at the Bob Stump VA Medical Center (Prescott), Prescott, AZ. Allegations of untimely consultation services; denial of a prompt transfer in an emergent situation; delayed follow up due to miscommunication; delayed orthopedic care; delay in urologic care; and a rating change for a peer review at Prescott, were not substantiated. Although the allegations were not substantiated, the inspection revealed that Prescott lacked a mechanism for tracking their large number of fee basis consults. A physician with fee basis management experience was hired to manage the process. Additionally, during our review, we found a Prescott provider failed to inform leadership about an unacknowledged abnormal chest x-ray from the Southern Arizona VA Health Care System (Tucson). The Prescott Chief of Staff (COS) was made aware of the finding and notified Tucson’s COS. VAOIG

VAOIG Inspection of Tucson Arizona VA

Healthcare Inspection Surgical Quality of Care Review Southern Arizona VA Health Care System Tucson, Arizona 09/19/09. The purpose of the review was to evaluate allegations that a surgical technician had performed tasks beyond the standards of practice, which placed patients at risk for severe injuries, and that operating room managers failed to take corrective actions at the Southern Arizona VA Health Care System. We substantiated that on one occasion a surgical technician placed two sutures to close a patient’s incision, a procedure that exceeded the technician’s standards of practice. There was no evidence the incident resulted in patient harm. We did not substantiate that managers failed to take corrective actions when they became aware of the incident. Managers were in the process of finalizing SOPs to address standards of practice for all non-physician surgery staff. We made no recommendations and plan no further actions.VAOIG

VAOIG Inspection of Hampton VA Medical Center in Hampton, Virginia Reveals Patient Stroke Symptoms Were Ignored

Healthcare Inspection Quality of Care, Documentation, and Courtesy Issues Hampton VA Medical Center Hampton, Virginia 09/19/09. We conducted this evaluation in response to allegations of related to quality of care, documentation, and courtesy issues in the Emergency Department (ED) at the Hampton VA Medical Center in Hampton, VA. We substantiated the allegation that the treating physician did not conduct an adequate work-up of the patient’s stroke symptoms, and that the ED physician improperly copied and pasted another patient’s laboratory results into the medical record of the complainant. Despite VHA guidelines, the medical center did not monitor use of the copy and paste function. We determined that staff did not promptly respond to the patient’s concerns. We could not confirm that the patient’s blood pressure was inaccurately recorded or that the physician was discourteous. We made four recommendations to address the identified conditions. VAOIG

VA Hospital Ignored Vet's Stroke 09/19/09. The inspector general of the of the U.S. Department of Veterans Affairs has found the Hampton VA Medical Center at fault after a doctor there failed to diagnose a vet's stroke, leaving him permanently disabled. The investigation also found that the vet's medical record contained lab results from another patient. Military.com

Watch for Telephone Scams Aimed at Veterans

VA Warns Veterans of Telephone Prescription Scam 09/19/09. The Department of Veterans Affairs (VA) is warning Veterans not to give credit card numbers over the phone to callers claiming to update VA prescription information.  "Veterans have become targets in an inexcusable scam that dishonors their service and misrepresents the Department built for them," said Dr. Gerald Cross, VA’s Under Secretary for Health. "VA simply does not call Veterans and ask them to disclose personal financial information over the phone." VA

Comparing VA Database Diagnoses With Veterans Own Self Reported Diagnosis

Accuracy of veterans affairs databases for diagnoses of chronic diseases. 09/17/09. INTRODUCTION: Epidemiologic studies usually use database diagnoses or patient self-report to identify disease cohorts, but no previous research has examined the extent to which self-report of chronic disease agrees with database diagnoses in a Veterans Affairs (VA) health care setting. CONCLUSION: Diagnoses identified from databases agree with self-report for diabetes but not COPD/asthma, depression, or heart disease in a VA health care setting. (Free full-text) Preventing Chronic Disease via PubMed

Antipsychotics and Lipid Levels in a Veteran Population

Risk of lipid abnormality with haloperidol, olanzapine, quetiapine, and risperidone in a Veterans Affairs population. 09/17/09. Second-generation antipsychotics can cause lipid elevations at a greater rate than older typical antipsychotics. This risk may not be equivalent amongst the second-generation antipsychotics. We conducted a computerized, retrospective, nonrandomized, case-control analysis of 6331 patients receiving antipsychotics. In conclusion, treatment with risperidone or haloperidol was associated with a more favorable lipid profile than with olanzapine or quetiapine.  International Clinical Psychopharmacology via PubMed

Male and Female Immunization Status of Older Veterans

Does sex influence immunization status for influenza and pneumonia in older veterans? 09/17/09. Older female veterans have lower rates of immunization than older male veterans in VA settings. Although VA remains above community levels for immunization, older female veterans will benefit from targeted efforts to increase immunization prevalence. Journal of the American Geriatrics Society via PubMed

VAOIG Review of Loma Linda Healthcare System

Combined Assessment Program Review of the VA Loma Linda Healthcare System Loma Linda, California 09/17/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 587 employees. The review covered seven operational activities and three follow-up review areas. The system complied with selected standards in the following three activities: (1) contracted/agency registered nurses, (2) coordination of care, and (3) medication management. We identified the system’s breast cancer care collaborative, All Employee Survey scores, and the rapid response team as organizational strengths. We made recommendations for improvement in the following four activities: QM. Physician credentialing and privileging. Magnetic resonance imaging safety. Environment of care. VAOIG

VAOIG Inspection of Endoscopy Reprocessing at Veterans Health Administration Facilities

Healthcare Inspection Follow-Up Colonoscope Reprocessing at VA Medical Facilities 09/17/09. This inspection of endoscopy reprocessing at Veterans Health Administration (VHA) facilities is a follow-up of OIG’s initial report, Use and Reprocessing of Flexible Fiberoptic Endoscopes at VA Medical Facilities, Report No. 09-01784-146, published June 16, 2009. It provides results for all facilities not previously inspected and provides follow-up results for facilities previously found to be not compliant with VHA Directive 2009-004, Use and Reprocessing of Reusable Medical Equipment (RME) in Veterans Health Administration Facilities, issued February 9, 2009. Among the 129 facilities inspected in August, all 129 were compliant with respect to SOPs. All facilities had adequate documentation of demonstrated competence for reprocessing staff except for one.

In our initial report, we recommended that the Acting Under Secretary for Health ensure compliance with relevant directives regarding endoscope reprocessing, explore possibilities for improving the reliability of endoscope reprocessing with VA and non-VA experts, and review the VHA organizational structure and make the necessary changes to implement quality controls and ensure compliance with directives. The Acting Under Secretary for Health concurred with the recommendations and provided a plan of corrective action. OIG will follow up on actions until all recommendations have been fully implemented. VAOIG

Over 1/3 of Spinal Cord Injured Veterans Recieved Inadequate Treatment for Bloodstream Infections

Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury. 09/16/09. OBJECTIVE: To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI). CONCLUSIONS: Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or hospital length of stay postinfection. Archives of Physical Medicine & Rehabilitation via PubMed

Potential Treatment for Orthostatic Hypotension inVeterans With Chronic tetraplegia.

Orthostatic responses to nitric oxide synthase inhibition in persons with tetraplegia. 09/16/09. These data suggest that nitric oxide synthase inhibition may have clinical potential for treatment of orthostatic hypotension in persons with chronic tetraplegia. Archives of Physical Medicine & Rehabilitation via PubMed

Spiritually Based Caregiver Intervention

A spiritually based caregiver intervention with telephone delivery for family caregivers of veterans with dementia. 09/16/09. Caring for veterans with dementia is burdensome for family caregivers. This exploratory study tested the efficacy of an innovative, spiritually based mantram caregiver intervention delivered using teleconference calls. A prospective, within-subjects, mixed-methods, and 3-time repeated-measures design with 36-week follow-up telephone interviews was conducted. Sixteen caregivers (94% women, 94% Whites with mean age 69.2 years, SD = 10.35 years) completed the intervention. Significant effects for time and linear terms were found for decreasing caregiver burden, perceived stress, depression, and rumination and for increasing quality of life enjoyment and satisfaction, all with large effect sizes. Findings suggest that teleconference delivery of a spiritually based caregiver intervention is feasible. Family & Community Health via PubMed

VAOIG Review of Iowa City VA Medical Center

Combined Assessment Program Review of the Iowa City VA Medical Center Iowa City, Iowa 09/16/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we also provided fraud and integrity awareness briefings to 29 employees. This review focused on seven operational activities and one follow-up review area. The medical center complied with selected standards in the survey of healthcare experiences of patients review activity. We identified special programs provide therapeutic benefits as an organizational strength. We made recommendations for improvements in the following six activities and in the follow-up review area: QM program. Environment of care. Coordination of care. Medication management. Suicide prevention program. Emergency/urgent care operations. Follow-up on VA community nursing home program. VAOIG

Care of Iraq and Afghanistan Wounded Just Beginning

U.S. Just Beginning to Deal With War Wounds, Chairman Tells Defense Forum The United States is just beginning to deal with the long-term implications of caring for servicemembers and their families whose lives have been changed by the wounds of war, the chairman of the Joint Chiefs of Staff said here today. Navy Adm. Mike Mullen told those gathered for a forum on dealing with war injuries that the challenges of providing that care for troops and their families is just now beginning to be understood by the military’s top leaders. DefenseLink

Vietnam Veterans With Left Prefrontal Cortex Lesions Have No Significant Longterm Predisposition to Depression

Prefrontal asymmetry in depression? The long-term effect of unilateral brain lesions. 09/15/09. The proposal that a functional asymmetry in prefrontal cortex (PFC) may play a role in the pathophysiology of depression has sparked vigorous debate and investigation. One particularly contentious issue of clinical and theoretical importance is whether left PFC lesions are associated with the development of depression, and whether any such lesion-depression association is stable over time. To address this issue, we assessed the long-term depressive symptomotology of Vietnam veterans who had acquired left PFC lesions (n=21), right PFC lesions (n=18), non-PFC lesions (n=38), or no brain lesions (n=31) during the Vietnam War. Depressive symptoms were assessed at two different timepoints, approximately 15 and 35 years after lesion onset, respectively. There was no significant effect of PFC lesion laterality on overall depression severity at either timepoint. These data converge with previous stroke studies to suggest that PFC lesion laterality has no long-term systematic effect on vulnerability to depression. Neuroscience Letters via PubMed

Lowering Homocysteine Levels in Kidney Patients Does Not Improve Cognition

Homocysteine lowering and cognition in CKD: the Veterans Affairs homocysteine study. 09/15/09. Treatment with high daily doses of B vitamins, which decreased total homocysteine levels, did not affect cognitive outcomes in patients with advanced chronic kidney disease and end-stage renal disease. American Journal of Kidney Diseases via PubMed

Developing Prosthetic Legs That Recover From Stumbles

URI researcher trips amputees in effort to develop improved prosthetic legs 09/15/09. According to the URI researcher, the population of lower-limb amputees in the United States is large and growing, especially so during this time of war, and she believes that the design of a high performing prosthetic leg is critical to reducing the burden of this disability.  During the experimental phase of the study, Dr. Huang is collecting data from able-bodied individuals and those using prosthetic legs to determine what kind of physiological signals can be detected for use in developing a stumble detection system. Once she has analyzed the data, she hopes to develop an algorithm that can be used in computer-controlled artificial limbs to provide active stumble recovery. University of Rhode Island via Eurekalert!

VA to Explore Health Consequences of Service in Vietnam

Secretary Shinseki Announces New Efforts to Explore Health Consequences of Service in Vietnam 09/14/09. Secretary of Veterans Affairs Eric K. Shinseki announced today plans to begin additional research by the Department of Veterans Affairs (VA) to better understand the health consequences of service in Vietnam.“The National Vietnam Veterans Longitudinal Study (NVVLS) will allow VA to pursue another valuable research tool,” Secretary Shinseki said. “The insight we gain from this study will help give us an understanding of how to better serve America’s Veterans.” NVVLS will study the Vietnam generation’s physical and psychological health. The new study will supplement research already underway at VA, including studies on PTSD and on the health of women Vietnam Veterans. This is a follow-up study to a previous one that concluded in 1988. VA

PTSD Rates for Veterans Who Served in Iraq May Approach 35 Percent

Iraq troops' PTSD rate as high as 35 percent, says Management Insights study 09/14/09. The Veterans' Administration should expect a high volume of Iraq veterans seeking treatment of post traumatic stress disorder, with researchers anticipating that the rate among armed forces will be as high as 35 percent, according to the Management Insights feature in the current issue of Management Science, the flagship journal of the Institute for Operations Research and the Management Sciences. Institute for Operations Research and the Management Sciences via Eurekalert!

Veterans Who See Combat More Likely to Have High Blood Pressure

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study 09/14/09. High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment–induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001–2003) was completed by 77 047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55 021 responders {approx}3 years later (2004–2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension. Hypertension

CABG Procedure Death Rates Lower at VA Hospitals Than Non-VA Hospitals

Outcomes of coronary surgery at a Veterans Affairs hospital versus other hospitals. 09/12/09. Despite the higher prevalence of comorbidities, patients who underwent CABG at a VA hospital had a significantly lower mortality rate than CABG patients in non-VA hospitals. Journal of Surgical Research via PubMed

Trauma History and Combat Exposure Vary by Branch of Service

Trauma exposure, branch of service, and physical injury in relation to mental health among U.S. veterans returning from Iraq and Afghanistan. 09/12/09. Significant mental health symptoms are reported in troops deployed to Iraq and Afghanistan (OEF/OIF). Symptomatic troops are more likely to be discharged and become eligible for Department of Veterans Affairs (DVA) care. Prevalence and predictors of mental health symptoms were assessed in 339 OEF/OIF veterans and reservists registering at the San Diego DVA. Participants completed self-report questionnaires assessing combat exposure, posttraumatic stress disorder (PTSD) symptom frequency and severity, depression, and substance and alcohol abuse. A minority of participants (36%) did not screen positive for mental health symptoms; the remainder met threshold for caseness of PTSD, depression, or substance and alcohol abuse. Using a hierarchical logistic regression model, gender, age, race, and rank were not significantly related to PTSD caseness, whereas most recent branch of service and report of injury during combat were. Follow-up analyses revealed that trauma history and combat exposure varied by branch of service. Knowledge of base rates and vulnerability factors can aid in rapid detection of "at risk" individuals. Military Medicine via PubMed

Mental Health and Functional Impairment in Kosovo Peacekeepers

PTSD subclusters and functional impairment in Kosovo peacekeepers. 09/12/09. Peacekeepers deployed to Kosovo (N = 203) were evaluated prospectively, before the mission (August 2000) and at postdeployment, on a number of mental health and functional impairment variables. We examined the association between PTSD symptom subclusters and three indicators of functional impairment using hierarchical regression analyses, controlling for PTSD symptoms before the mission, and history of prior trauma. In the first model, avoidance and hyperarousal symptoms uniquely predicted a conglomerate of functional impact outcomes (e.g., employment, family relationships, social functioning). In the second model, emotional numbing was the only significant predictor of violent behaviors. In the third model, re-experiencing symptoms were the only significant predictor of alcohol abuse problems. Overall, the four PTSD subclusters are differentially associated with varying functional impairment outcomes, which is important to note for evaluation and treatment purposes for veterans returning from overseas deployments. Military Medicine via PubMed

Applying the Chronic Care Model (CCM) to Improve Inpatient Smoking Cessation

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans. 09/12/09. Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. (Free full text) Implementation Science via PubMed

PTSD and Life Quality in Veterans Returning From Operation Enduring Freedom and Operation Iraqi Freedom

Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. 09/12/09. The wars in Iraq and Afghanistan-Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF-have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.  Clinical Psychology Review via PubMed

Mild TBI and PTSD in Veterans Returning From Operation Enduring Freedom and Operation Iraqi Freedom

Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. 09/12/09. A significant proportion of military personnel deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been exposed to war-zone events potentially associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). There has been significant controversy regarding healthcare policy for those service members and military veterans who returned from OEF/OIF deployments with both mild TBI and PTSD. There is currently little empirical evidence available to address these controversies. This review uses a cognitive neuroscience framework to address the potential impact of mild TBI on the development, course, and clinical management of PTSD. The field would benefit from research efforts that take into consideration the potential differential impact of mild TBI with versus without persistent cognitive deficits, longitudinal work examining the trajectory of PTSD symptoms when index trauma events involve TBI, randomized clinical trials designed to examine the impact of mild TBI on response to existing PTSD treatment interventions, and development and examination of potential treatment augmentation strategies. Clinical Psychology Review via PubMed

Hyperbaric Oxygen Therapy for Tinnitus

Tinnitus, a military epidemic: is hyperbaric oxygen therapy the answer? 09/12/09. Tinnitus is the phantom perception of sound in the absence of overt acoustic stimulation. Its impact on the military population is alarming. Annually, tinnitus is the most prevalent disability among new cases added to the Veterans Affairs numbers. Also, it is currently the most common disability from the War on Terror. Conventional medical treatments for tinnitus are well documented, but prove to be unsatisfying. Hyperbaric oxygen (HBO2) therapy may improve tinnitus, but the significance of the level of improvement is not clear. There is a case for large randomized trials of high methodological rigor in order to define the true extent of the benefit with the administration of HBO2 therapy for tinnitus. Journal of Special Operations Medicine via PubMed

Aluminum Hydroxide Adjuvant Possible Culprit in Gulf War Syndrome

Aluminum hydroxide injections lead to motor deficits and motor neuron degeneration. 09/12/09. Gulf War Syndrome is a multi-system disorder afflicting many veterans of Western armies in the 1990-1991 Gulf War. A number of those afflicted may show neurological deficits including various cognitive dysfunctions and motor neuron disease, the latter expression virtually indistinguishable from classical amyotrophic lateral sclerosis (ALS) except for the age of onset. This ALS "cluster" represents the second such ALS cluster described in the literature to date. Possible causes of GWS include several of the adjuvants in the anthrax vaccine and others. The most likely culprit appears to be aluminum hydroxide. Journal of Inorganic Biochemistry via PubMed

Injury to Caregiver May Result in Nursing Home Placement of Post-stroke Veteran

The prevalence of injury for stroke caregivers and associated risk factors. 09/12/09. Conclusion: This suggests that injury on the part of the family caregiver may lead to the veteran's placement in a skilled nursing facility and lead to increased costs for the Department of Veteran's Affairs. Topics in Stroke Rehabilitation via PubMed

Neuropsychological Assessment of Gulf War Veterans

Neuropsychologic assessment of a population-based sample of Gulf War veterans. 09/12/09. The objective of this project was to compare neuropsychologic performance and quality of life in a population-based sample of deployed Gulf War (GW) veterans with and without multisymptom complaints. Cognitive and Behavioral Neurology via PubMed

Firearm Suicide Rates in the Veteran and NonVeteran Populations

Firearm suicide among veterans in the general population: findings from the national violent death reporting system. 09/12/09. Although violent death and the use of firearms are generally associated with men, the results reported here suggest that firearms among female veterans deserve particular attention among health professionals within and outside the veterans affairs system. In addition, the focus should not be exclusively on the Operation Enduring Freedom/Operation Iraqi Freedom military cohort but also on men and women who served in earlier combat theaters, including the Gulf war, Vietnam Era, Korean Conflict, and World War II. Journal of Trauma via PubMed

Acute Renal Failure in U.S. Veterans

Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis. 09/12/09. When patients develop acute kidney injury, a small fraction of them will develop end-stage renal disease later. The severity of renal impairment in the remaining patients is uncertain because studies have not carefully examined renal function over time or the precise timing of entry into a late stage of chronic kidney disease. To determine these factors, we used a United States Department of Veterans Affairs database to ascertain long-term renal function in 113,272 patients. Kidney International via PubMed

New Brain Injury Therapy?

Brain Injury Therapy 09/12/09. The Department of Defense has estimated the number of Operation Enduring Freedom/Operation Iraqi Freedom veterans with combat-related traumatic brain injury (TBI) could reach 360,000. While more than $1 billion has been committed to fund academic research, almost eight years after the start of the war on terrorism, neither the Department of Veterans Affairs nor the Department of Defense has discovered, much less fielded, a treatment regimen or protocol that provides timely, assured relief for the disabling effects of this "signature injury."

The good news is that some members of Congress, particularly Reps. Walter B. Jones, North Carolina Republican; Pete Sessions, Texas Republican; and Chet Edwards, Texas Democrat, have found and are championing a treatment that works: hyperbaric oxygen therapy (HBOT 1.5) as pioneered by Dr. Paul G. Harch, a clinician and faculty member at the Louisiana State University School of Medicine in New Orleans. Sgt. Shaft via Military.com

Smoking Session Program for Veterans With PTSD

Public health clinical demonstration project for smoking cessation in veterans with posttraumatic stress disorder. 09/10/09. Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Addictive Behaviors via PubMed

Cumulative Lead Exposure Contributes to Higher Death Rates

A Prospective Study of Bone Lead Concentration and Death From All Causes, Cardiovascular Diseases, and Cancer in the Department of Veterans Affairs Normative Aging Study. 09/10/09. We found bone lead to be associated with all-cause and cardiovascular mortality in an environmentally exposed population with low blood lead levels. This study suggests that cumulative lead exposure from prior decades of high environmental exposures continues to significantly affect risk of death despite recent declines in environmental lead exposure. Circulation via PubMed

Long-term PTSD Symptoms May Result in Attention Difficulties

Study sheds light on post-combat mental problems 09/10/09. Symptoms of posttraumatic stress disorder (PTSD) are typical after deployment to a war zone, and may even represent a healthy reaction to stress, but can lead to problems with mental functioning if they persist, new research in Iraq vets suggests. Past research has demonstrated that people exposed to life-threatening situations will show changes in their nervous and hormonal systems, Dr. Jennifer J. Vasterling of the VA Boston Healthcare System and her colleagues note, but it's not clear how long such symptoms last after exposure ends, and if they do last, what the consequences might be. Reuters

Extreme Traumatic Experiences May Result in Greater Personal Strength

Ground Zero-scale trauma can prompt psychological growth, says UB researcher. 09/10/09. People who live through an extreme traumatic experience such as the 9/11 terrorist attacks or an airplane crash often have the capacity to bounce back or even grow to a higher level of functioning and personal strength, according to a University at Buffalo researcher and expert in the effects of horrifying trauma. University at Buffalo via Eurekalert!

Intense Wheelchair Propulsion May Increase Risk of Carpal Tunnel Syndrome

Ultrasonographic median nerve changes after a wheelchair sporting event. 09/09/09. OBJECTIVES: To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.  CONCLUSIONS: Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS. Archives of Physical Medicine & Rehabilitation via PubMed