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