Couple-based Therapy for PTSD

A couple-based approach to the reduction of PTSD avoidance symptoms: preliminary findings. 08/29/09. This study reports preliminary findings regarding the feasibility and efficacy of a novel couple-based treatment, named Strategic Approach Therapy (SAT), for reducing avoidance symptoms of posttraumatic stress disorder (PTSD). Six male Vietnam combat veterans diagnosed with PTSD and their cohabitating marital partners participated in 10 weeks of SAT treatment. Self-report, clinician ratings, and partner ratings of PTSD symptoms were obtained before the first session and after the tenth session of treatment. Veterans reported statistically significant reductions in self-reported, clinician-rated, and partner-rated effortful avoidance, emotional numbing, and overall PTSD severity. These data indicate that SAT offers promise as an effective treatment for PTSD avoidance symptoms. Journal of Marital and Family Therapy via PubMed

Mental Health of Iraq and Afghanistan Veterans

Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. 08/29/09. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness. American Journal of Public Health via PubMed

Critical Limb Ischemia

Clinical outcomes using aggressive approach to anatomic screening and endovascular revascularization in a veterans affairs population with critical limb ischemia. 08/28/09. An aggressive approach to anatomic screening and contemporary endovascular treatment of critical limb ischemia (CLI) resulted in a higher rate of revascularization as the primary treatment for CLI than previously reported, and was associated with high rates of overall and amputation-free survival. Catheter Cardiovasc Interv via PubMed

VA Plans New Healthcare Tech Center

VA plans emerging tech center for healthcare 08/28/09. The Veterans Affairs Department wants to build an advanced research center dedicated to prototyping new health technologies, including systems to manage privacy and security to foster health information exchange and improve the quality of veterans’ healthcare. Government Health IT

Prosthetics at the Cutting Edge: Single-Topic Issue

Journal of Rehabilitation Research and Development Volume 46 Number 3, 2009. 08/27/09. Current issue of the JRRD is devoted to prosthetics and is available free online.  JRRD

VAOIG Inspection of Salisbury, North Carolina VA Medical Center

Healthcare Inspection Quality of Care Issues W.G. (Bill) Hefner VA Medical Center Salisbury, North Carolina 08/27/09.The purpose of the review was to evaluate allegations regarding the emergency department (ED) at the Salisbury VA medical center. We did not substantiate that the patient’s treatment was delayed or that the ED staff did not complete a comprehensive assessment. We substantiated that the patient was improperly discharged to home from the ED and concluded that the implementation of an algorithm for treatment of stroke would be a reasonable step to address this issue. We recommended that the VISN Director ensure that the Medical Center Director completes the plan for development and implementation of an algorithm for ED patients with pre-stroke or stroke symptoms. VAOIG

Use of Zopiclone in Veterans With PTSD

A Qualitative Investigation of Long-Term Zopiclone Use and Sleep Quality Among Vietnam War Veterans with PTSD(October) 08/27/09. Overall, the results of this study suggest that, although the subjects in the follow-up phase of the research continued to use zopiclone on a regular basis for an extended period, the efficacy of this intervention for addressing PTSD-related sleep disturbance was low. Extended treatment with zopiclone may not necessarily be associated with increased risk for dependence. Further robust research to examine the consequences of long-term zopiclone therapy for PTSD-related sleep disturbance is warranted. The Annals of Pharmacotherapy via PubMed

Pharmacy Prescription Coverage Within Medicare Affects the Use of Evidence-based Medications for Specific Disease Conditions in the VA.

The Association of Medicare Drug Coverage with Use of Evidence-Based Medications in the Veterans Health Administration(October). 08/27/09. BACKGROUND: Veterans with Medicare managed-care plans have access to pharmacy benefits outside the Veterans Health Administration (VA), but how this coverage affects use of medications for specific disease conditions within the VA is unclear. OBJECTIVE: To examine patterns of pharmacotherapy among patients with diabetes mellitus, ischemic heart disease, and chronic heart failure enrolled in fee-for-service (FFS) or managed-care (HMO) plans and to test whether pharmacy benefit coverage within Medicare is associated with the receipt of evidence-based medications in the VA. METHODS: A retrospective analysis of veterans dually enrolled in the VA and Medicare healthcare systems was conducted. We used VA and Medicare administrative data from 2002 in multivariable logistic regression analysis to determine the unique association of enrollment in Medicare FFS or managed-care plans on the use of medications, after adjusting for sociodemographic, geographic, and patient clinical factors. RESULTS: A total of 369,697 enrollees met inclusion criteria for diabetes, ischemic heart disease, or chronic heart failure. Among patients with diabetes, adjusted odds ratios (ORs) of receiving angiotensin-converting enzyme (ACE) inhibitors and oral hypoglycemics in the FFS group were, respectively, 0.86 and 0.80 (p < 0.001). Among patients with ischemic heart disease, FFS patients were generally less likely to receive beta-blockers, antianginals, and statins. Among patients with chronic heart failure, adjusted ORs of receiving ACE inhibitors, angiotensin-receptor blockers, and statins in the FFS group were, respectively, 0.90, 0.78, and 0.79 (all p < 0.05). There were few systematic differences within HMO coverage levels. CONCLUSIONS: FFS-enrolled veterans were generally less likely to be receiving condition-related medications from the VA, compared with HMO-enrolled veterans with lower levels of prescription drug coverage. Pharmacy prescription coverage within Medicare affects the use of evidence-based medications for specific disease conditions in the VA. The Annals of Pharmacotherapy via PubMed

Rheumatoid Vasculitis Rates Declining in Veterans

Studies show dramatic decline in rheumatoid vasculitis in US veterans 08/27/09. Researchers at the University of Wisconsin School of Medicine and Public Health examined records of rheumatoid arthritis patients from the national Veterans Health Administration system to determine the prevalence of rheumatoid vasculitis in this population. Wiley-Blackwell via Eurekalert!

TBI Possible without Direct Head Impact

LLNL research reveals how blast waves may cause human brain injury even without direct head impacts 08/26/09. New research on the effects of blast waves could lead to an enhanced understanding of head injuries and improved military helmet design. Using numerical hydrodynamic computer simulations, Lawrence Livermore scientists Willy Moss and Michael King, along with University of Rochester colleague Eric Blackman, have discovered that nonlethal blasts can induce enough skull flexure to generate potentially damaging loads in the brain, even without direct head impact. Lawrence Livermore National Laboratory via Eurekalert!

VAOIG Reviews 6 CBOCs in Nevada and California

Community Based Outpatient Clinic Reviews Henderson and Pahrump, NV Palm Desert and Corona, CA Pasadena and Santa Maria, CA 08/26/09. The VA Office of Inspector General reviewed six Community Based Outpatient Clinics (CBOCs) the week of June 15–19, 2009. The CBOCs reviewed were Henderson and Pahrump, NV; Palm Desert and Corona, CA; and Pasadena and Santa Maria, CA. The parent facilities of these CBOCs are the VA Southern Nevada Healthcare System (HCS), VA Loma Linda HCS, and VA Greater Los Angeles HCS, respectively; they are all part of Veterans Integrated Service Network (VISN) 22. 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: (1) Ensure Performance Improvement (PI) data is collected consistently on all providers. (2) Initiate all background checks according to VHA policy. (3) Maintain auditory privacy during the check-in process and at the pharmacy pick-up window. (4) Develop a local policy and provide staff education for medical and mental health emergencies. (5) Recover the overcharges from the vendor for the billings for lapsed enrollees. (6) Include a timely analysis of enrollees in all future invoices. (7) Properly identify locations of all fire extinguishers. VAOIG

New Book From National Acadamies Press on Combating Tobacco Abuse in Military and Veteran Populations

Combating Tobacco Use in Military and Veteran Populations (2009) 08/26/09. The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs. (Free Online) NAP

Simplification of PTSD Compensation rules

PTSD Compensation Rules Simplified 08/26/09. The Veterans Affairs Department is taking steps to help veterans seeking compensation for post-traumatic stress disorder, VA Secretary Eric K. Shinseki announced Aug. 24. Military.com

VA Apologizes for Errant ALS Letters

VA Apologizes for Errant ALS Letters 08/26/09. The U.S. Department of Veterans Affairs will personally apologize to veterans who received erroneous letters saying they had been diagnosed with Lou Gehrig's disease, agency spokeswoman Katie Roberts said Tuesday. Military.com

Risk of Suicide in Veterans

Post-traumatic stress disorder primary suicide risk factor for veterans 08/26/09. Researchers working with Iraq and Afghanistan war veterans have found that post-traumatic stress disorder, the current most common mental disorder among veterans returning from service in the Middle East, is associated with an increased risk for thoughts of suicide. Journal of Traumatic Stress via Eurekalert

Suicide Among US Veterans: A Prospective Study of 500,000 Middle-aged and Elderly Men 08/26/09. Expert opinion is divided about whether US military veterans, the vast majority of whom are middle-aged or older, are at increased risk of suicide. To assess the risk of suicide associated with veteran status, the authors conducted a prospective cohort study of 499,356 male participants in the Cancer Prevention Study II. Participants reported their veteran status and other characteristics in 1982 and were followed for mortality through 2004. The relative risk of mortality from suicide according to veteran status at baseline was estimated by using Cox proportional hazards models. During follow-up, 1,248 veterans and 614 nonveterans died by suicide. In age-adjusted analyses, the risk of suicide did not differ by veteran status. Additional adjustment for several sociodemographic, behavioral, and clinical factors had little effect on hazard ratios. The authors concluded that the risk of death from suicide among middle-aged and older US males is independent of veteran status and suggest that policies to prevent veteran suicide should focus on factors that may heighten suicide risk rather than on veteran status per se. American Journal of Epidemiology