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