News

In recent years, the Veterans Administration (VA) Healthcare System has expanded its efforts to target groups of veterans facing disparities in healthcare access and outcomes. An update on research toward advancing equitable healthcare for all veterans is presented in a September supplement to Medical Care, published by Wolters Kluwer. The special issue papers "add incrementally to the state of the science surrounding the equity of health and healthcare for potentially vulnerable veterans who are managed in the VA Healthcare System," according to a guest editorial by Drs. Said A. Ibrahim, Leonard E. Egede, and Michael J. Fine. Drs. Ibrahim and Fine are Directors of the VA's Center for Health Equity Research and Promotion (CHERP). Dr. Egede was previously Director of the Health Equity and Rural Outreach Innovation Center (HEROIC) New Studies on Reducing Health Disparities among Veterans The supplement presents original research and perspectives informing VA's efforts to ensure high-quality patient-centered care for all veterans. It grows out of a recent VA-sponsored "state of the science" conference, hosted by CHERP and HEROIC. The special issue was posted today on the Medical Care website. The supplement includes 12 original research papers, focusing on advancing health equity for three groups of vulnerable veterans: Racial and ethnic minorities. One study found lower rates of recommended psychotherapy or medications for African American and Latino veterans with posttraumatic stress disorder (PTSD). Another paper reported that veterans with multiple substance use disorders were more likely to be African American; they also had higher rates of homelessness and increased physical and mental health problems. Veterans from the lesbian, gay, bisexual, and transgender (LGBT) community. One study found that transgender veterans are generally satisfied with VA healthcare, although satisfaction with mental care was lower for transgender men. A survey of more than 5,000 transgender veterans suggested higher rates of PTSD and tobacco use disorder among those living in smaller towns. Studies of other sex/gender issues highlighted the impact of military sexual trauma and intimate partner violence among male and female veterans. Homeless veterans. One study evaluated a successful effort to reduce high use of emergency department care by homeless veterans. Another reported a high burden of physical and mental health problems in homeless women veterans. The supplement includes a review article showing a "dearth of interventions" to reduce disparities in recently recognized groups of vulnerable veterans, including the LGBT population. Another article paper highlights the role of implementation science in efforts to improve equity throughout the VA Healthcare System. Ensuring health equity takes on new importance with the passage of the Veterans Choice Act of 2014, under which some veterans are eligible to receive care from non-VA community providers, based on waiting times and travel distance to VA facilities. VA's health equity efforts have expanded to include a wide range of vulnerable veterans—not just racial/ethnic minorities, but also populations characterized by gender/gender identity, age, geographic location, religion, socioeconomic status, sexual orientation, mental illness, and disability. Drs. Ibrahim, Egede, and Fine hope the "first and second generation health equity studies" presented in the special issue will create a broader foundation of knowledge for future research—particularly as more veterans receive care outside the VA Healthcare System. A pair of editorials by VA leadership highlight VA's commitment to continued research and leadership in promoting health equity—including through the Veterans Choice Act and other new programs. Deputy Under Secretary for Health for Community Care Dr. Baligh R. Yehia and coauthors write, "As the largest integrated health care system in the nation, VA has an opportunity to lead the rest of the country in reducing health and health care disparities." Click here to read the September supplement issue. ### About Medical Care Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association About Wolters Kluwer Wolters Kluwer N.V. (AEX: WKL) is a global leader in information services and solutions for professionals in the health, tax and accounting, risk and compliance, finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported 2016 annual revenues of €4.3 billion. The company, headquartered in Alphen aan den Rijn, the Netherlands, serves customers in over 180 countries, maintains operations in over 40 countries and employs 19,000 people worldwide. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and the organization, visit http://www.wolterskluwer.com/, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube. For more information about Wolters Kluwer’s solutions and organization, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.
Craig J. Bryan, executive director of the National Center for Veterans Studies at the University of Utah, testified today before the Senate Committee on Veterans’ Affairs on what more can be done to prevent veteran suicide. Bryan, who also is an assistant professor in the Department of Psychology, is a nationally recognized expert on military suicide and serves as a consultant to the Department of Defense for psychological health promotion initiatives and suicide prevention. He has conducted numerous studies about suicide risk and suicide prevention strategies. Craig J. Bryan | executive director, National Center for Veterans Studies, University of Utah | craig.bryan@utah.edu
argaret Meyers, MAE, CRNA a Certified Registered Nurse Anesthetists (CRNA), from Spokane, Wash. will receive the Helen Lamb Outstanding Educator Award during the American Association of Nurse Anesthetists (AANA) Annual Congress, September 8-12, 2017 in Seattle, Wash.   “I am humbled to be selected by the AANA for this award and am especially happy to receive it in Seattle,” said Margaret Meyers, MAE, CRNA.  “I enjoyed a faculty clinical practice, something I encourage all educators to maintain for that “in-the-trenches” real life experience.”  A CRNA for more than 40 years, Meyers is responsible for instructing, nurturing, and molding more than 200 registered nurses into CRNAs.  Providence Sacred Heart Medical Center Gonzaga University’s nurse anesthesia program has a rich 82-year history, and Meyers played an important role in that history as program administrator for 34 years.  Over the years she taught basic principles of anesthesia and research based anesthesia practice.  Meyers transitioned out as the program administer in 2015 and retired with the graduation of the last Masters cohort in 2016.     Education Master of Anesthesiology Education degree from Gonzaga University in Spokane, Wash.. Bachelor’s of Arts degree from Gonzaga University, Spokane, Wash. Certificate in nurse anesthesia from Sacred Heart School of Anesthesia in Spokane, Wash. Diploma in nursing from Sacred Heart School of Nursing       Helen Lamb Outstanding Educator Award  The Helen Lamb Award was established in 1980 in memory of Helen Lamb Frost, an AANA founding member, past president, and nurse anesthesia educator.  This award recognizes the commitment of an individual to the educational standards of nurse anesthesia.           About the AANA Founded in 1931 and located in Park Ridge, Ill., and Washington, D.C., the American Association of Nurse Anesthetists (AANA) is the professional organization representing more than 52,000 Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists across the United States. As advanced practice registered nurses and anesthesia specialists, CRNAs administer approximately 43 million anesthetics to patients in the United States each year and are the primary providers of anesthesia care in rural America. In some states, CRNAs are the sole anesthesia professionals in nearly 100 percent of rural hospitals.   More Information Visit www.aana.com and www.future-of-anesthesia-care-today.com   Follow @aanawebupdates on Twitter Call Marlene McDowell, Assistant Director, Public Relations (847) 655-1145, or email mmcdowell@aana.com        
Cohen Veterans Bioscience today announced its partnership with the Open Commons Consortium to establish the Brain Commons – a one-of-a-kind cloud-hosted site for combining Big Data that will be critical for the understanding of brain conditions. The OCC platform is uniquely positioned to manage large-scale imaging data, genomic data, wearables, and clinical data, as well as enable machine learning and analytics at state-of-the-art computing speeds to accelerate our understanding of brain conditions and brain health. The Brain Commons database will be hosted at the University of Chicago's Open Commons Consortium – a leading organization in the drive to Open Data sharing, and a driving force in new technologies for Genomics data sharing. Its Chair, and Director of the Center for Data Intensive Science, Robert Grossman said, "We are thrilled to collaborate with a progressive organization like Cohen Veterans Bioscience to develop an entirely new way to bring together brain data from across the community. This has already been a powerful approach in cancer genomics, and we are excited to work with Dr. Haas and her team to see how our experience can now be extended to impact brain health." The Brain Commons will also leverage the partnership between Cohen Veterans Bioscience and Exaptive, Inc. to build a Cognitive City – a user interface to the Commons. The Cognitive City brings data, software tools, and people together in an ecosystem where interoperability, modularity, and community are core features and boundary-crossing through repurposing data and code is actively facilitated. "Just like physical cities are built where there are ample natural resources, a Cognitive City must be built atop an easily accessible supply of data," said Dave King, Founder and Chief Executive Officer, Exaptive, Inc. "The Brain Commons offers just such an abundance – a flexible repository that can scale in both breadth and depth, allowing for new types of analyses to be performed across diverse datasets."  "Many organizations are gathering excellent datasets but don't necessarily have the means to share them, and analyze them together. It is going to take a highly motivated, interconnected village to tackle the obstacles posed by brain diseases. We very much hope that the village will be the Brain Commons," said Dr. Jane Roskams, Executive Director for the Commons. About Cohen Veterans Bioscience Cohen Veterans Bioscience is a national, nonpartisan research 501(c)(3) organization dedicated to fast-tracking the development of diagnostic tests and personalized therapeutics for the millions of veterans and civilians who suffer the devastating effects of trauma-related and other brain disorders. To support & learn more about our research efforts, visit www.cohenveteransbioscience.org. About Open Commons Consortium The Open Commons Consortium (OCC) is a not for profit that manages and operates cloud computing and data commons infrastructure to support scientific, medical, health care and environmental research. OCC members span the globe and include over 30 universities, companies, government agencies and national laboratories. For more information, see occ-data.org About the Center for Data Intensive Science The Center for Data Intensive Science is a research center at the University of Chicago focused on data science and its applications to advancing biology, medicine, health care and the environment. It is part of University of Chicago Medicine & Biological Sciences, one of the nation's leading academic medical institutions. For more information, see cdis.uchicago.edu CONTACT: Cohen Veterans Bioscience, press@cohenbio.org
Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are considered the signature wounds of the wars in Afghanistan and Iraq. It is estimated that 500,000 veterans live with the symptoms of PTSD; around 320,000 have a TBI. These trauma-related issues can contribute significantly to suicidal thoughts or tendencies. It is estimated more than 20 veterans take their life each day. There are few proven methods to accurately diagnose and treat PTSD and TBI. Today, Wounded Warrior Project® (WWP) and Cohen Veterans Bioscience (CVB) announced a shared initiative to better diagnose and treat PTSD and TBI. The collaboration, known as Research Alliance for PTSD/TBI Innovation and Discovery Diagnostics (RAPID-Dx), is a public-private partnership led by CVB with WWP supporting biomarker research. Biomarkers help doctors measure the effectiveness of treatment better than what a patient reports on his or her own health. RAPID-Dx helps discover, replicate, and qualify biomarkers for PTSD and TBI care. "Identifying biomarkers is an important step in care for PTSD and TBI," said Mike Richardson, WWP vice president of mental health and independence services. "We can better target treatment to individual patients and see improved results." The partnership between RAPID-Dx and Warrior Care Network® will help expand this important research. Warrior Care Network is an innovative partnership between WWP, four top academic medical centers, and the Department of Veterans Affairs (VA). Warrior Care Network treats the invisible wounds of war through intensive outpatient programs. "RAPID-Dx will provide vital information for the precision treatment of patients with PTSD and TBI," said Dr. Magali Haas, CEO of Cohen Veterans Bioscience. "This partnership represents a best-in-class approach to helping the thousands of veterans in need, as well as others affected by these debilitating injuries." About Wounded Warrior Project Wounded Warrior Project® (WWP) connects, serves, and empowers wounded warriors. Read more at http://newsroom.woundedwarriorproject.org/about-us. About Cohen Veterans Bioscience Cohen Veterans Bioscience is a national, nonpartisan research organization dedicated to fast-tracking the development of diagnostic tests and personalized therapeutics for the millions of veterans and civilians who suffer the devastating effects of trauma-related and other brain disorders. To support & learn more about our research efforts, visit www.cohenveteransbioscience.org CONTACT: Wounded Warrior Project, Rob Louis, Public Relations, rlouis@woundedwarriorproject.org, 904.627.0432; Cohen Veterans Bioscience. press@cohenbio.org
Gulf War veterans with low-level exposure to chemical weapons show lasting adverse effects on brain structure and memory function, reports a study in the October Journal of Occupational and Environmental Medicine. In previous research, Linda Chao, PhD, and colleagues of San Francisco VA Medical Center reported decreased volume of the hippocampus—a brain area involved in memory processing—in Gulf War veterans exposed to the Khamisiyah plume. In that 1991 event, demolition of an Iraqi munitions depot caused US soldiers to be exposed to low levels of nerve agents, carried downwind in a smoke plume. The previous studies had some key limitations, including a lack of data on other risk factors. The new study compared an independent group of 113 veterans with predicted exposure to the Khamisiyah plume, based on Department of Defense models, and 62 nonexposed veterans. On brain magnetic resonance imaging scans, the hippocampus was significantly smaller in veterans with predicted exposure. The difference remained significant even after accounting for a wide range of other factors, including meeting criteria for Gulf War illness, the presence of an Alzheimer's disease risk gene (ApoE4), brain injury, or depression. Among veterans with predicted exposure to the Khamisiyah plume, smaller hippocampus volume was correlated with lower scores on a test of verbal learning and memory. Scores on the memory test were also lower for veterans with higher estimated exposure and those with self-reported memory difficulties. The finding that these effects are still present 25 years later, after adjusting for potential confounding factors, supports the conclusion that exposure to the Khamisiyah plume had lasting adverse effects on Gulf War veterans. Since memory problems and smaller hippocampal volumes have both been linked to the risk of late life dementia, Dr. Chao and colleagues believe that exposed veterans should receive regular follow-up, especially as they approach old age. ### About the Author Dr. Chao may be contacted for interviews at linda.chao(at)ucsf.edu. About ACOEM ACOEM (www.acoem.org), an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments. About the Journal of Occupational and Environmental Medicine The Journal of Occupational and Environmental Medicine (www.joem.org) is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.
It's undeniable: a cancer diagnosis rocks the patient's family to its core. But what role does communication within the family play? Research by Wayne Beach, Ph.D., a professor of communication at San Diego State University, has proven that how a family communicates from diagnosis through cancer treatment plays a critical role in the patient's overall well-being and health. In recognition of October as National Breast Cancer Awareness Month, we spoke with Dr. Beach about his 10 years of research on communication and cancer, and we gathered his tips for communicating with a cancer patient. "How family members communicate when coping (with a diagnosis) is important," Beach says. Patients have reported feeling empowered when communication is comprehensive and constant in their home and medical surroundings, Beach explains. The American Cancer Society estimates three of four U.S. families have at least one member who is a cancer survivor, confirming the widespread impact and value of Beach's research. He and his team of researchers have and continue to study phone and face-to-face interactions between cancer patients and their families, and interactions between patients and healthcare professionals. "If you hear someone has been diagnosed with cancer, our natural inclination tends to be to think of it as a death sentence," he says.  This is why initial findings were surprising to Beach. Much of the communication observed between family members and cancer patients "focused on life, rather than death," he says. "It is so much more about hope than despair. I really didn't expect that going in." "So we're looking at how good and bad news relating to cancer gets delivered and responded to," he adds.  A Focus on Life, Hope Through communication, we share our fears and uncertainties with one another, but also our hope and optimism, which makes all the difference in a patient's well-being and outlook on life and their disease, Beach explains. Sharing stories and memories, in particular, serve as effective coping mechanisms for both patient and supporter.  Beach's studies, initially funded by the American Cancer Society, took on a personal meaning when his mother was diagnosed with lung cancer in 1998. She died just four months later. Now, Beach is working alongside collaborators at UC San Diego, San Diego State University and the National Health Institute to spread the word about communication and its critical role in a cancer patient's diagnosis, management and well-being. He has also developed, "When Cancer Calls…," a theatrical production based on his book "A Natural History of Family Cancer," which follows one family's telephone conversations following a member's cancer diagnosis. "Cancer patients do cope and heal better depending on their communication within their families. Without this proper communication, these patients don't heal as well or as long," he says. "Having a dysfunctional environment around you is not good, it's stressful." The Power of Positivity When someone you know is battling cancer, Do: Offer encouraging and positive words Communicate frequently Express your emotions  Actively listen to the patient's concerns and thoughts Communicate frequently; cancer patients need to be able and encouraged to vent and share their concerns, feats and fears. Do not: Stay silent Ignore the diagnosis and avoid speaking about anything cancer-related Focus on or introduce negativity 
The health effects of where people live, work, and interact are well documented, as are the value of neighborhood-level structural interventions designed to improve health. But place-based characteristics that contribute to disparities in HIV transmission and disease burden are poorly understood, possibly resulting in less-effective HIV risk reduction interventions and programming. A new study from the University of Pennsylvania School of Nursing (Penn Nursing) is helping to better understand the contextual social and structural factors that drive disparate HIV/AIDS rates and how place-based interventions can be more effective in fighting the HIV/AIDS pandemic. The 22-month pilot study – recently published in the Journal of Urban Health – explored racial/ethnic and geographic differences in mode of HIV transmission in Philadelphia, an urban HIV epicenter. Data indicated that certain geographic locations appear to have different modes of transmission profiles, with nuanced differences by gender and race/ethnicity. “Underlying geographical factors that contribute to disparities in HIV transmission and disease burden are poorly understood,” explains Bridgette M. Brawner, PhD, APRN, Assistant Professor of Nursing, and the lead author of the study. “‘One size’ does not fit all for individual-level interventions; the same is true in disproportionately affected neighborhoods, particularly when risk profiles differ by neighborhood characteristics and population demographics. The data generated from this research support a much needed paradigm shift to acknowledge the role negative social and structural factors like limited social cohesion, inadequate health-related resources and poverty have on the HIV/AIDS pandemic. The findings will also better inform the development of neighborhood-level structural interventions to address HIV/AIDS in overly burdened communities.”  Co-authors of the study include: Penn Nursing’s Robin Stevens, PhD, MPH; Barbara Guthrie, PhD, RN, FAAN, Bouvé College of Health Sciences at Northeastern University; Lynne Taylor, PhD, MS, Biostatistics Analysis Center at the University of Pennsylvania; Michael Eberhart, MPH, Philadelphia Department of Public Health; and Jean J. Schensul, PhD, Institute for Community Research at Yale University. The study was supported by funding through the National Institute of Mental Health R25MH087217.
It is now well known that up to 75 percent of women experience deficits in their intellectual capacity (i.e., cognitive impairment) during or after breast cancer treatment. Patients typically complain that they are “forgetful” and have “trouble concentrating or remembering” details like names, dates, and important events. They have difficulty multi-tasking, and it takes them longer to complete a task. Unfortunately for some women, these symptoms can persist for many months or years. These mental deficits are variable; they may be subtle or striking and temporary or permanent. Given that we continue to make strides in medicine to improve survival rates in breast cancer, there will be many more women living with cognitive impairment and it is important to not only be aware of but to address these issues, so that the quality of life for these women is maintained. Previously these cognitive difficulties were all attributed to chemotherapy such that the term “chemo brain” was coined. However, we now know that it is multifactorial. The menopausal status of the woman and endocrine (hormonal) therapy she receives for treatment can also influence cognitive function. Studies show that breast cancer patients who received chemotherapy and the anti-estrogen therapy tamoxifen have greater difficulty than those who received chemotherapy alone. Typical risk factors that can impact cognitive impairment from breast cancer treatment include being of elderly age and the intensity or number of chemotherapy doses received. There are also psychosocial risk factors like fatigue, anxiety, and depression. Other factors that can worsen the symptoms include drugs like pain killers, sleep disturbances, anemia and poor nutrition. Currently, there is no known way to prevent the cognitive difficulties caused by treatment. Medications like psychostimulants which can be prescribed by a doctor may help, but there are non-medicinal options that patients can explore. They include mind training exercises like puzzles, as well as games that use memory or learning a new language. Exercise, stress management, good nutrition filled with antioxidant-containing foods such as fruits and vegetables have also been recommended. Organization can be very helpful. Patients should set up and follow structured routines and use a detailed daily planner to keep track of appointments and schedules. Patients may sometimes feel embarrassed and not reach out for help. It is important to remember that these mental difficulties are a side effect that can be managed. Patients should ask for help from friends and loved ones and importantly inform their doctors for additional support.
Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers at the University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS) and collaborators elsewhere, report significantly improved neural function in participants with mild traumatic brain injury (TBI).Their findings are published online in the current issue of the journal Brain Injury.TBI is a leading cause of sustained physical, cognitive, emotional and behavioral problems in both the civilian population (primarily due to motor vehicle accidents, sports, falls and assaults) and among military personnel (blast injuries). In the majority of cases, injury is deemed mild (75 percent of civilians, 89 percent of military), and typically resolves in days.But in a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioral impairment. Much about the pathology of mild TBI is not well understood, which the authors say has confounded efforts to develop optimal treatments. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial electrical stimulation (LIP-tES), has shown promise. In their pilot study, which involved six participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The treatment effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex). “Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild traumatic brain injury (concussions), with about 85 percent sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said senior author Roland Lee, MD, professor of radiology and director of Neuroradiology, MRI and MEG at UC San Diego School of Medicine and VASDHS. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”The researchers found that the brains of all six participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores. “For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said first author Ming-Xiong Huang, PhD, professor in the Department of Radiology at UC San Diego School of Medicine and a research scientist at VASDHS. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic brain injuries.”Co-authors include: Ashley Robb Swan, Annemarie Angeles Quinto, Scott Matthews, Deborah L. Harrington, Sharon Nichols, Charles W. Huang, and Dewleen G. Baker, UC San Diego and VASDHS; Barry J. Bruder, IASIS Technologies, Los Angeles; and Corey C. Snook, Mind-Brain Training Institute, Mount Dora, FL. Funding for this research came, in part, from the U.S. Department of Veterans Affairs (I01-CX000499, I01-RX001988, MHBA-010-14F, NURC-022-10F, NEUC-044-065).