Combating Tobacco Use

DOD, VA should take stronger steps to combat tobacco use in military, veteran populations 06/26/09. Because tobacco use impairs military readiness, harms the health of soldiers and veterans, and imposes a substantial financial burden on the departments of Defense and Veterans Affairs, these agencies should implement a comprehensive strategy to achieve the Defense Department's stated goal of a tobacco-free military, says a new report from the Institute of Medicine. National Academy of Sciences via Eurekalert!

VAOIG Review of Grand Junction VA Medical Center

Combined Assessment Program Review of the Grand Junction VA Medical Center Grand Junction, Colorado 06/25/09. 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 133 employees. The review covered seven operational activities. The medical center complied with selected standards in the following two activities (1) suicide prevention and (2) survey of healthcare experiences of patients. We made recommendations for improvement in the following five activities: QM. Environment of care. Coordination of care. Medication management. Emergency/Urgent care operations. VAOIG

VAOIG Audit of Incomplete C&P Exams

Audit of VA Incomplete Compensation and Pension Medical Examinations 06/25/09. The Office of Inspector General (OIG) conducted an audit to identify opportunities for the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) to increase the number of completed compensation and pension medical examinations (C&P exams). The audit also focused on identifying some of the causes of canceled C&P exams through a review of randomly sampled incomplete C&P exam requests. C&P exams are necessary for VBA personnel to make decisions on veterans’ disability claims. Reducing the number of canceled exams would enable VA to provide veterans C&P benefits more timely, reduce unnecessary work for VA personnel, and provide veterans with better customer service. VAOIG

VA’s Federal Benefits for Veterans, Dependents and Survivors

Veterans Benefits Reference Guide Now Available 06/25/09. The latest edition of VA’s Federal Benefits for Veterans, Dependents and Survivors is now available. The 164–page handbook provides the latest information on important changes in eligibility for VA medical care and benefits. It describes other federal benefits, including education, disability compensation, pension, home loan guaranty, vocational rehabilitation, life insurance and burial assistance. This year’s edition marks the addition of “Survivors” to the title as well as details on the Post–9⁄11 GI Bill signed into law in 2008. Printed copies may be ordered from the Government Printing Office at $5 a copy. VA

Plastic Surgery: Cosmetic vs Reconstructive

Plastic surgery within the veterans affairs medical system: proposed modified indications for operative procedures. 06/24/09. Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion. Ann Plast Surg. via PubMed

Virtual Reality Exposure for PTSD

VR PTSD exposure therapy results with active duty OIF/OEF combatants. 06/24/09. Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experience including military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Reports indicate that at least 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality exposure therapy has been previously used for PTSD with reports of positive outcomes. This paper will present a brief description of the USC/ICT Virtual Iraq/Afghanistan PTSD therapy application and present clinical outcome data from active duty patients treated at the Naval Medical Center-San Diego (NMCSD) as of October 2009. Initial outcomes from the first twenty patients to complete treatment indicate that 16 no longer meet diagnostic criteria for PTSD at post treatment. Research and clinical tests using the Virtual Iraq/Afghanistan software are also currently underway at Weill Cornell Medical College, Emory University, Fort Lewis and WRAMC along with 20 other test sites. Stud Health Technol Inform.

VA: Protection of Human Subjects

Interim Guidance On Research Warranting Special Safeguards To Protect The Rights And Welfare Of Human Subjects 06/24/09. In approving research, Department of Veterans Affairs (VA) regulations and the Federal Policy (Common Rule) for the Protection of Human Subjects at Title 38 Code of Federal Regulations Part 16 (38 CFR 16) require that Institutional Review Boards (IRBs) determine the following:
• The selection of subjects is equitable, “taking into account the purposes of the research
and the setting in which the research will be conducted,” and with particular attention to the
“special problems of research involving vulnerable populations” [38 CFR 16.111(a)(3)].
• “Additional safeguards” are included “to protect the rights and welfare” of subjects who are
likely to be vulnerable to coercion or undue influence” [38 CFR 16.111(b)]. VA Office of Research & Development

PTSD & Human Subject Research Guidelines

Should Veterans with a Diagnosis of Post-Traumatic Stress Disorder Be Considered a Vulnerable Population for the Purpose of Applying Guidelines for the Protection of Human Subjects in Research? 06/24/09. The Secretary of the Department of Veterans Affairs charged the Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research to examine the tension between the need to study veterans with PTSD to help improve their condition and the need to protect veterans with PTSD from further risk, given their potential vulnerability as research participants. VA Office of Research & Development

Two-year VA Funding Bill Progresses

Two-year VA funding advances in Congress 06/24/09. Congressional efforts to provide advanced funding for veterans’ health programs made significant progress Tuesday. The House Appropriations Committee approved by voice vote the first advance budget for the Veterans Affairs Department. The 2010 spending bill for the VA and military construction includes fiscal 2011 health care funding. Veterans’ organizations have pushed for advance appropriations to keep VA hospitals running smoothly in case Congress does not pass the annual VA appropriation bill by the end of the fiscal year Sept. 30. Federal Times

Senator Calls For Changes At VA

Top senator calls for structural changes at VA 06/24/09. The chairman of the Senate Veterans Affairs Committee on Wednesday called for more centralized control of the VA medical system after recent breakdowns in cleaning colonoscopy equipment exposed thousands of veterans to the risk of contracting HIV and other infections. AP

Audit of VA's Non-controlled Drug Program

Audit of Veterans Health Administration’s Management of Non-Controlled Drugs 06/23/09. The Office of Inspector General (OIG) conducted an audit to determine how accurately the Veterans Health Administration (VHA) could account for inventories of non-controlled drugs at increased risk for waste and diversion in its health care facilities (facilities). VHA needs to improve the accountability for non-controlled drugs to reduce the risk of waste, and diversion. VHA cannot accurately account for its non-controlled drug inventories because it lacks effective controls and reliable information to do so. The accurate and complete data needed to account for these drugs is not available, and the current system lacks the capability to capture information on some drugs that are returned to a facility and restocked. The implementation and enforcement of sufficient controls to ensure accurate and complete information is imperative to VHA’s ability to account for and safeguard non-controlled drug inventories. Complete and standardized annual physical inventory data is needed to help VHA establish accountability for its non-controlled drug inventories. The Acting Under Secretary for Health agreed with the report’s findings and recommendations. We consider VHA’s planned actions acceptable and will follow up on the implementation of each action. We will close the recommendations when all proposed actions are completed. VAOIG

VA Launches 10 Year Study: National Health Study for a New Generation of U.S. Veterans

VA Launches 10-Year Health Study of 60,000 New Veterans 06/23/09. The Department of Veterans Affairs (VA) has initiated a large, long-term study to look carefully at a broad array of health issues that may affect Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans and their counterparts who served during the same time period. VA’s “National Health Study for a New Generation of U.S. Veterans” will begin with 30,000 Veterans deployed to OEF/OIF and 30,000 comparison Veterans who were not deployed. VA

American Legion Assails VA Disability Claims Processing

"Body-count" Processing Must End At VA, Says The American Legion 06/23/09. An immediate overhaul of the Department of Veterans Affairs disability claims processing system is the only way out of a fast-growing nationwide backlog of unresolved cases, American Legion National Commander David K. Rehbein said after a congressional hearing last Thursday evening. American Legion via Medical News Today

Resource Sharing Betweenthe Veterans Health Administration & the Indian Health Service

Veterans Health Administration and Indian Health Service: healthcare utilization by Indian Health Service enrollees. 06/22/09. The Veterans Health Administration (VHA) and Indian Health Service (IHS) have executed an agreement to share resources to improve access and health outcomes for American Indian and Alaska Native (AIAN) veterans. OBJECTIVES: To describe the extent of dual use, health needs, and utilization patterns for IHS-enrollees served by VHA and IHS. Our objective is to fill those gaps in knowledge to inform strategic planning between these federal agencies. Medical Care via PubMed

Effects of Depression/Anxiety on Health Satisfaction in Veterans With PTSD

Relationship between anxiety, depression, and health satisfaction among veterans with PTSD. 06/22/09. Depression and anxiety are associated with significantly increased healthcare costs that include costs of non-psychiatric medical care. PTSD has been found to be related to many negative health perceptions and outcomes (e.g., [Resnick, H.S., Acierno, R., Kilpatrick, D.G., 1997. Health impact of interpersonal violence: II. Medical and mental health outcomes. Behavioral Medicine 23, 65-78]). The presence of comorbid depression and anxiety disorders in patients with posttraumatic stress disorder (PTSD) is well documented. This study aims to examine the effects of depression and anxiety on health satisfaction in veterans with PTSD. Journal of Affective Disorders via PubMed

Resident Duty Hour Reform & Patient Safety

Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients. 06/22/09. Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Medical Care via PubMed

Sad Story from New York Times About Philadelphia VA Cancer Unit

At V.A. Hospital, a Rogue Cancer Unit 06/22/09. For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off. Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear. NYT