$215 Million for Rural Veterans' Projects

Secretary Shinseki Announces $215 Million in Projects for Rural Veterans 05/23/09. The Department of Veterans Affairs (VA) has provided $215 million in competitive funding to improve services specifically designed for Veterans in rural and highly rural areas. VA

Two year VA Funding Possible

Two-year funding for VA appears likely 05/23/09. Momentum has gathered behind the idea of advanced appropriations for the Veterans Affairs Department to the point that a chief supporter of says he would be stunned if anything derails what has become the top priority for veterans groups.

The Senate Veterans’ Affairs Committee unanimously approved an advanced appropriations bill Thursday. Sen. Daniel Akaka, D-Hawaii, the committee chairman, said the proposal “has the potential to strengthen every aspect of VA’s national health care system.” Federal Times

Nicotine Dependence& Psychiatric Issues in Sample of American Indian Veterans

Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. 05/23/09. American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. METHODS: This study analyzes the co-occurrence of current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. RESULTS: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. CONCLUSIONS: Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended. Drug and Alcohol Dependence via PubMed

PTSD in Substance Abusing Veterans

Posttraumatic stress disorder and other psychopathology in substance abusing patients. 05/23/09Studies demonstrating greater problem severity in substance abuse patients with posttraumatic stress disorder (PTSD) versus those without have rarely considered other co-occurring psychiatric disorders. This study of 466 male veterans recently admitted to outpatient substance abuse treatment attempts to identify problems associated with PTSD versus those associated with other nonsubstance use Axis I disorders. Problem severity, particularly psychiatric, was examined across four groups of patients with substance use disorders (SUDs). Those with: 1, SUDs only (SU-Only); 2, PTSD, but no other Axis I disorders (SU+PTSD); 3, PTSD and other Axis I disorders (SU+PTSD+Axis I); and 4, no PTSD, but other Axis I disorders (SU+other Axis I). Results suggested a hierarchy of psychiatric, and to a lesser extent, other life problem severities associated with these diagnostic groupings. The most severe group was SU+PTSD+Axis I, followed in decreasing severity by the SU+other Axis I, SU+PTSD, and SU-Only groups. Additional analyses comparing the SU+PTSD+Axis I patients with a subgroup of Axis I patients with more than one Axis I disorder (SU+multiple Axis I) revealed few group differences except for more lifetime suicide attempts and psychiatric hospitalizations in the SU+PTSD+Axis I group. The findings suggest that it is not PTSD per se, but the frequent co-occurrence of PTSD and other psychopathology that largely accounts for previously reported greater problem severity of SUD patients with PTSD. Drug and Alcohol Dependence via PubMed
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PTSD Assessment via Videoconferencing Compared with Face to Face

Assessment of post-traumatic stress disorder in veterans by videoconferencing and by face-to-face methods. 05/23/09. We compared videoconferencing and face-to-face (FTF) assessments for veterans seeking a mental health evaluation for post-traumatic stress disorder (PTSD). The Clinician-Administered PTSD Scale (CAPS) interview was used in 20 male veterans. There were significant correlations (ranging from 0.74 to 0.92) between the CAPS administered FTF and by videoconferencing on all three subscales, as well as on the total severity score. The confidence intervals for the CAPS scores indicated statistical equivalence between administration FTF and by videoconferencing. The sensitivity of videoconferencing was 0.94 and the specificity was 0.33, compared with FTF assessment. The total and subscale scores suggested that there was a moderate working alliance with both methods. The patients indicated general satisfaction with the videoconferencing method. Most of them indicated that they would prefer to see a clinician FTF, but would utilize videoconferencing if there were distance barriers to services. Overall, the results of the present study support the use of videoconferencing in the assessment of PTSD. Journal of Telemedicine and Telecare via PubMed

Home Monitoring of Veterans With Diabetes

Mortality risk for diabetes patients in a care coordination, home-telehealth programme. We assessed a home monitoring/care coordination programme for veterans with diabetes. Patients enrolled in the programme (n = 387) were followed for four years and compared with a retrospective control group (n = 387). Each patient in the intervention group used a messaging device in the home that was connected by a conventional telephone line. Care coordinators monitored the answers from the devices daily so that early interventions could be made. There were significantly more deaths in the control group (n = 102, 26%) compared with the intervention group (n = 75, 19%). There was longer survival for the intervention group versus the control group (mean survival time 1348 vs 1278 days; P = 0.015). A multivariate analyses indicated that the telemonitoring programme was associated with reduced 4-year all-cause mortality (hazard ratio = 0.7, 95% CI 0.5-0.9, P = 0.013). The results suggest that daily management of patients with diabetes through home monitoring by a registered nurse reduces mortality. Journal of Telemedicine and Telecare via PubMed

Mental Health in Incarcerated Male Veterans

Mental health and other risk factors for jail incarceration among male veterans. Psychiatr Q. 2009 Mar;80(1):41-53. Epub 2009 Jan 28. Greenberg GA, Rosenheck RA. Background. Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veterans show that having mental health problems in addition to such sociodemographic characteristics as being a member of a minority group, not being married, having less education, and being younger are risk factors for incarceration among veterans, as they are for the general population. As in previous studies veterans who served during the Vietnam Era and to an even greater extent, those who served in the early years of the All Volunteer Force were at greater risk of incarceration than veterans from the most recent period of the AVF, after controlling for age and other factors. PMID: 19184431

Suicide in UK Veterans

Suicide after leaving the UK armed forces--a cohort study. PLoS Med. 2009 Mar 3;6(3):e26. Kapur N, While D, Blatchley N, Bray I, Harrison K. BACKGROUND: Few studies have examined suicide risk in individuals once they have left the military. We aimed to investigate the rate, timing, and risk factors for suicide in all those who had left the UK Armed Forces (1996-2005). METHODS AND FINDINGS: We carried out a cohort study of ex-Armed Forces personnel by linking national databases of discharged personnel and suicide deaths (which included deaths receiving either a suicide or undetermined verdict). Comparisons were made with both general and serving populations. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. Although the overall rate of suicide was not greater than that in the general population, the risk of suicide in men aged 24 y and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age groups in the general and serving populations (age-specific rate ratios ranging from 170 to 290). The risk of suicide for men aged 30-49 y was lower than that in the general population. The risk was persistent but may have been at its highest in the first 2 y following discharge. The risk of suicide was greatest in males, those who had served in the Army, those with a short length of service, and those of lower rank. The rate of contact with specialist mental health was lowest in the age groups at greatest risk of suicide (14% for those aged under 20 y, 20% for those aged 20-24 y). CONCLUSIONS: Young men who leave the UK Armed Forces were at increased risk of suicide. This may reflect preservice vulnerabilities rather than factors related to service experiences or discharge. Preventive strategies might include practical and psychological preparation for discharge and encouraging appropriate help-seeking behaviour once individuals have left the services. PMID: 19260757

Shingles in Vets With Rheumatoid Arthritis

Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis. 2009 May 15;48(10):1364-71.McDonald JR, Zeringue AL, Caplan L, Ranganathan P, Xian H, Burroughs TE, Fraser VJ, Cunningham F, Eisen SA. BACKGROUND: Herpes zoster occurs more commonly in patients taking immunosuppressive medications, although the risk associated with different medications is poorly understood. METHODS: We conducted a retrospective cohort study involving 20,357 patients who were followed in the Veterans Affairs healthcare system and treated for rheumatoid arthritis from October 1998 through June 2005. Cox proportional hazards regression was used to determine risk factors for herpes zoster and herpes zoster-free survival. Chart review was performed to validate the diagnosis of herpes zoster. RESULTS: The incidence of herpes zoster was 9.96 episodes per 1000 patient-years. In time-to-event analysis, patients receiving medications used to treat mild rheumatoid arthritis were less likely to have an episode of herpes zoster than patients receiving medications used to treat moderate and severe rheumatoid arthritis (P < .001). Independent risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, malignancy, chronic lung disease, renal failure, and liver disease. Among patients receiving tumor necrosis factor-alpha antagonists, etanercept (hazard ratio, 0.62) and adalimumab (hazard ratio, 0.53) were associated with a lower risk of herpes zoster. There was excellent agreement between the International Classification of Diseases, Version 9, Clinical Modification diagnosis of herpes zoster and diagnosis by chart review (kappa = 0.92). CONCLUSIONS: Risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, and several comorbid medical conditions. These results demonstrate that the Department of Veterans Affairs' national administrative databases can be used to study rare adverse drug events. PMID: 19368499

2 New VAOIG Reports

Combined Assessment Program Review of the North Chicago VA Medical Center North Chicago, Illinois 05/20/09. 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 171 employees. The review covered eight operational activities. The medical center complied with selected standards in the following five activities: (1) contracted/agency registered nurses, (2) coordination of care, (3) emergency/urgent care operations, (4) medication management, and (5) survey of healthcare experiences of patients. We identified the joint venture with the Department of Defense as an organizational strength. We made recommendations for improvement in the following three activities: QM program. Environment of care. Suicide prevention program. VAOIG

Combined Assessment Program Review of the Spokane VA Medical Center Spokane, Washington 05/20/09. 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 153 employees. The review covered seven operational activities. The medical center complied with selected standards in the following two activities (1) patient satisfaction survey scores and (2) suicide prevention program. We identified effective data sharing between Surgery Service and the Infection Control Practitioner, enhanced safety procedures for methadone use, and an environmental achievement award as organizational strengths. We made recommendations for improvements in the following five activities: QM. Environment of care. Emergency/urgent care operations. Coordination of care. Medication management. VAOIG

Wounded Warrior in Key VA Position

Wounded Warrior Takes Key VA Post 05/20/09. raq war amputee and veterans' advocate Tammy Duckworth was sworn in to be the assistant secretary for public and intergovernmental affairs with the Department of Veterans Affairs. Duckworth was shot down over Iraq in 2004 while co-piloting a UH-60 Black Hawk transport helo. Military.com

Veterans' Owned Biotech Startup Files Complaint

Veteran-owned Biotech Startup Company Charges Health Agency (NYSDOH) With Blackballing Its Initiatives 05/20/09. A U.S. company registered by the Department of Veterans Affairs and the Center for Veterans Enterprise as a veteran-run business filed complaints with the U.S. Department of Veterans Affairs, and with NYS Governor David A. Paterson, alleging discriminatory practices by the New York State Department of Health (NYS DOH). Ozonics via Medical News Today

VAOIG Evalution of VA Quality Management Programs

Healthcare Inspection Evaluation of Quality Management in Veterans Health Administration Facilities Fiscal Year 2008 05/19/09. The evaluation was conducted to determine whether Veterans Health Administration (VHA) facilities had comprehensive, effective quality management (QM) programs designed to monitor patient care activities and coordinate improvement efforts and whether VHA facility senior managers actively supported QM efforts and appropriately responded to QM results. Although all 44 facilities reviewed had established comprehensive QM programs and performed ongoing reviews and analyses of mandatory areas, 2 facilities had significant weaknesses. Senior managers at all facilities reported that they support their QM programs and actively participate. To improve operations, we recommended that VHA: Critically analyze patient complaints and take actions when trends are identified. Actively monitor medication reconciliation. Review medical records for inappropriate use of the copy and paste functions and raise the system-wide fix to a higher priority. Reinforce compliance with moderate sedation monitoring requirements. Ensure that the length of privileges granted to physicians matches the length of the employment association. VAOIG