2015 Issues



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Evaluation of Allopurinol Use for Acute Gout Attack

SAN ANTONIO — Allopurinol traditionally has not been initiated during an acute gout attack to avoid prolonging the painful arthritis.Instead, the 2012 American College of Rheumatology Guidelines for the Management of Gout suggest that urate-lowering... View Article

December 2015

MD Lawmakers Urge VA to Hire Scribes to Increase Physician Efficiency

With medical staff often overwhelmed by documentation and data-entry requirements, VA should use medical scribes more widely across its system, two physician lawmakers recently urged.

December 2015

TRICARE Promises Cost Savings for Everyone with RX Shift

It’s a case of bad news-good news: TRICARE beneficiaries, as of Oct. 1, have fewer options for getting certain prescriptions filled, but their costs are lower.

Agencies Home

Cirrhosis Expected to Peak by 2021 in VA; Liver Cancer Epidemic Continues

For the VA, the combination of effective treatment options and much lower prevalence of HCV in younger veterans may offer a light at the end of the tunnel — and a turning point in the steady rise of HCV-associated complications such as cirrhosis and hepatocellular carcinoma (HCC) in only a few years.

Agencies Home

DoD, VA Scolded Again for EHR Interoperability Delays

By Sandra BasuWASHINGTON — DoD informed Congress last month that it has met key interoperability requirements set forth in the 2014 National Defense Authorization Act.DoD Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendell... View Article

December 2015

‘Big Data’ Helps Predict Which Soldiers Most Likely to Commit Violent Crimes

Technology Could Help DoD Better Address Workplace ViolenceBy Annette M. BoyleCAMBRIDGE, MA — As the DoD struggles with implementing a uniform workplace violence program that includes prevention and response protocols, a key tool has been... View Article

Clinical Topics Home

Diabetes Overtreatment Continues for Older VA Patients

Some Clinicians Worry More About Malpractice Than HypoglycemiaBy Brenda L. MooneyANN ARBOR, MI — Despite a VA campaign to raise awareness of hypoglycemia and recommendations from the national Choosing Wisely campaign to less aggressively treat... View Article

Clinical Topics Home

Veterans with Skin Cancer Lacked Awareness of Personal Risks

SAN ANTONIO — Veterans with skin cancer might not be as aware of the dangers of sun exposure or the necessity for skin protection as they should be.In a study published recently in Military Medicine,... View Article

Clinical Topics Home

Scarce Sun Protection in Iraq, Afghanistan Put Troops at Risk

NASHVILLE, TN — It wasn’t only the climate that increased the risk of skin cancer for military personnel serving in Iraq and Afghanistan. Lack of sun protection also was a contributing factor, according to a... View Article

Cardiovascular Disease

VA-Led Study: NPs, PA Provide Comparable Cardiac Care to Physicians

All Fail to Consistently Meet Performance MeasuresBy Brenda L. MooneyHOUSTON — Cardiac patients and even some medical staff might assume they will receive the best ongoing care when they see a physician, not an advanced... View Article

December 2015

Winter Event Director Promotes Fitness for Disabled Veterans

By Stephen SpotswoodGRAND JUNCTION, CO — When Teresa Parks arrived at the National Disabled Veterans Winter Sports Clinic in 1999, she brought with her a lifelong belief that sports and recreational activities could be used... View Article

December 2015

For Treated Patients, HIV Status No Greater Risk for Surgery Than Older Age

Subhead: Post-operative Mortality Rates Low Among ART UsersBy Annette M. BoyleWEST HAVEN, CT — Historically, high post-operative mortality rates among HIV-infected patients caused many physicians and patients to defer or avoid surgery all together. For... View Article

December 2015

Leaders don’t create followers, they create more leaders

“Leaders don’t create followers, they create more leaders.”               — Tom PetersI have been ruminating for the past few months over the bureaucracy of federal medicine and the importance of selfless service to... View Article

November 2015

Do multiple maps and reporting lines adversely affect the VA’s ability to meet veterans’ needs?

Please read this article and participate in this month’s online opinion poll: Do multiple maps and reporting lines adversely affect the VA’s ability to meet veterans’ needs? Yes No Not SureCurrent Results

Department of Veterans Affairs (VA)

VA Researchers Look at Offering Some Post-Op Follow-up Through Telehealth

As difficult as it is for some veterans to get to routine healthcare appointments, doing so after surgery — even with a low-complexity procedure — can be much worse.

Department of Veterans Affairs (VA)

VA’s CKD Patients Lack Knowledge About Their Condition

CHICAGO — Chronic kidney disease (CKD) patients at the VA have insufficient knowledge about their condition, which is associated with poorer health outcomes, according to a recent study.The report, published in the Clinical Kidney Journal,... View Article

Current Issue

How Obesity Affects Kidney Function, Mortality in Veterans

MEMPHIS, TN — A new study investigated the association of body mass index with progressive loss of kidney function and all-cause mortality in U.S. veterans, finding that those who were overweight but not obese had... View Article

Current Issue

Dialysis Timing Tends to Be Different for VA Patients

SEATTLE — The estimated glomerular filtration rate (eGFR) tends to be lower at the VA when dialysis is initiated compared with other healthcare systems, according to a new study.The report, published recently in the Clinical... View Article

Clinical Topics Home

Cancer Stage, Weight Loss Most Affect Lung Cancer Survival

BRONX, NY — Survival in veterans with lung cancer is more related to their percentage weight loss and stage of cancer than the subtype of lung cancer, according to a new study.Background in the article,... View Article

Clinical Topics Home

Comorbidities Raise Mortality Risk in Lung Cancer Patients

OMAHA, NE — Comorbid conditions such as chronic obstructive pulmonary disease, diabetes, or congestive heart failure raise the mortality risk for lung cancer patients compared to those without the conditions, according to a study funded... View Article

November 2015

Effect of Lung Cancer Screening on Smoking Cessation

BOSTON — Are those with high-risk smoking histories more likely to quit after participation in annual lung cancer screening?That’s the question raised by a recent study published online by JAMA Internal Medicine.1The study, led by... View Article

Department of Veterans Affairs (VA)

‘Yuck Factor’ Notwithstanding, Maggots Highly Effective for Diabetic Foot Wounds at VA

The VA is proving that “everything old is new again” with an unusual medical device — medicinal maggots.

Department of Veterans Affairs (VA)

Philadelphia VAMC Pharmacy Focuses More on Customers to Increase Satisfaction

When outpatient pharmacy customer satisfaction scores plunged below 40% on a recent survey, pharmacists in Philadelphia responded with several quality-improvement initiatives and were rewarded with significantly improved ratings.

Agencies Home

Recommendations to Improve Governance at VA

Establish a governance board to develop fundamental policy, define the strategic path, insulate VHA leadership from direct political interaction, and ensure accountability for the achievement of established performance measures. Congress should consider the following alternatives... View Article

Department of Veterans Affairs (VA)

McDonald: Proposed Board ‘Abrogation’ of Congress’ Role

Sandra BasuWASHINGTON — An independent governance board, as defined in a recent report, would be redundant with the role of the congressional committees overseeing the VA, according to Secretary Robert McDonald.The recently released review was... View Article

Clinical Topics Home

A Personalized Approach Works Best in Prevention of Diabetes Development

For years, researchers have promoted the wonders of medical treatment customized to a patient’s specific genetic profile, but the reality in the exam room continues to be more “one size fits all.”

Department of Veterans Affairs (VA)

Maps and Much More Are Changing at VA

Five Regions with 18 VISNs by Late 2017By Annette M. BoyleWASHINGTON — For the VA, form affects function.Secretary Robert McDonald recognized that as soon as he stepped into the agency’s top leadership role. He made... View Article

Department of Defense (DoD)

Outgoing DHA Chief Discusses Success, Goals

Lt. Gen. Robb on Agency’s Second AnniversaryBy Sandra BasuWASHINGTON — DoD officials celebrated the second anniversary of the Defense Health Agency last month, marking what the agency says is its achievement of full operating capability... View Article

Department of Defense (DoD)

GAO Points to DHA Challenges

By Sandra BasuWASHINGTON — In a recent report, the Government Accountability Office (GAO) said that, while DoD has made progress in addressing concerns it highlighted in prior reviews regarding DHA’s implementation process, some issues will... View Article

Agencies Home

Electronic Triggers Speed up Follow-up for Cancer Diagnosis, Care at Houston VAMC

By Brenda L. MooneyHOUSTON — Over the last years, the VA has struggled with ways to reduce follow-up delays for patients, such as those being evaluated for cancer.Researchers at the Michael E. DeBakey VAMC and... View Article

HIV

Early HIV Researcher Continues Lifelong Battle Against Viruses

Raymond Schinazi, PhD, Hon DSc, still remembers how the patients lined the corridors. They were all too thin, too pale and much too weak.

Editor in Chief

There is no higher religion than human service

To work for the common good is the greatest creed. — Woodrow Wilson (1856-1924) Government service can be extremely trying at times. Last month, I touched on the difficulties of surviving the bureaucracy to which we submit ourselves each week in the care of our servicemembers and their families.

Department of Defense (DoD)

Contaminated Camp Lejeune Water Associated with Higher Cancer Incidence

Recent Study Finds Link to Early Onset Male Breast CancerBy Annette M. BoyleJACKSONVILLE, NC — Marines, sailors and their families who sought refreshment with a cool glass of water at Camp Lejeune got a little... View Article

Department of Veterans Affairs (VA)

VA Opposes Expansion of Hearing Aid Tech’s Scope of Practice

By Sandra BasuWASHINGTON — Legislation granting a greater scope of duties for licensed hearing-aid specialists at VA facilities is opposed by agency leadership, even though supporters argue that it would create better access to care... View Article

Agencies Home

VA Leads Nation in Using Big Data to Improve Healthcare

Developers Caution Against Too Much of a Good ThingBy Annette M. BoyleSEATTLE — Now that nearly every hospital in the United States uses electronic health records, healthcare systems across the country are wrestling with how... View Article

October 2015

Genitourinary Injuries Often Caused by Pelvic Fractures

SAN ANTONIO — Combat-related pelvic fractures often are associated with lower genitourinary injuries which cause a very high rate of erectile dysfunction, according to a new study.The report, published recently in the journal Military Medicine,... View Article

October 2015

Urologic Decision Aids Moderately Reduce Costs

SEATTLE — Rates of elective surgery for benign prostatic hyperplasia (BPH) and active treatment for localized prostate cancer declined over six months after a large health cooperative provided video-based decision aids for men with those... View Article

Clinical Topics Home

Sexual Dysfunction Common in Vets with PTSD

HOUSTON — In addition to all of their other issues, veterans with post-traumatic stress disorder (PTSD) also are at increased risk of sexual dysfunction.A review study published online in the Journal of Sexual Medicine found... View Article

Clinical Topics Home

New Veteran Study Further Complicates Testosterone Replacement Issue

VA Researchers Find Normalizing ‘T’ Levels Lowers Heart RisksBy Brenda L. MooneyKANSAS CITY, MO — The question over how testosterone replacement therapy (TRT) affects cardiovascular health became even more contentious with a new U.S. veterans... View Article

Department of Defense (DoD)

Putting Heads Together to Improve Brain Injury Care

By Sandra BasuWASHINGTON — If you had more money for traumatic brain injury research, where would you invest it?That is one of the questions VA Secretary Robert McDonald asked TBI researchers at a recent conference... View Article

October 2015

Most Common Causes of Death in RA Patients

OMAHA, NE — Noting limited research into cause-specific mortality and the associated risk factors in men with rheumatoid arthritis (RA), a new study sought to remedy that and found triple the risk of respiratory-related deaths... View Article

October 2015

Weight Loss Associated with Higher Risk of Death in RA

PHILADELPHIA — In an example of the so-called “obesity paradox,” a low body mass index (BMI) has been associated with accelerated mortality in patients with rheumatoid arthritis (RA).A study published recently in the journal Arthritis... View Article

Current Issue

Knee Arthroplasty Less Effective in RA, Compared to OA

OMAHA, NE — Total knee arthroplasty (TKA) is effective in reducing pain for patients with rheumatoid arthritis (RA) but not as much as with osteoarthritis (OA) patients, according to a new study.The report, published recently... View Article

Department of Defense (DoD)

Military Children Often Bear Brunt of Parents’ Service

Teens More Likely to Exhibit Violence, Use DrugsBy Brenda L. MooneyLOS ANGELES — With so much focus on the mental and physical health of servicemembers, especially those who have been deployed and injured, another group... View Article

Department of Veterans Affairs (VA)

VA Unsure Why Adverse-Event Analyses Have Declined

By Sandra BasuWASHINGTON — Fewer root-cause analyses (RCA) to identify and evaluate what went wrong in adverse events are being conducted at the VA, and no one seems quite sure whether that is good or... View Article

Department of Veterans Affairs (VA)

Common Dementia Drugs Linked To Dangerous Weight Loss in Veterans

By Brenda L. MooneySAN FRANCISCO – New research on cholinesterase inhibitors is reducing the already limited options VA clinicians have to treat VA patients with dementia.More than a half-million veterans have Alzheimer’s disease (AD) and... View Article

October 2015

Berlowitz Honored for Work Transforming Chronic Care Delivery

By Stephen SpotswoodBEDFORD, MA — In his role as the Bedford, MA, VAMC’s chief of staff, Dan Berlowitz, MD, MPH, has a vantage point that allows him to see the bigger picture when it comes... View Article

October 2015

Length of Colonoscopy Affects Cancer Development for Veterans

MINNEAPOLIS — How can the VA improve colorectal cancer detection and care?One answer is taking more time with a diagnostic procedure, according to a study of 76,810 veterans. Researchers from the Minneapolis VA Health Care... View Article

Editor in Chief

These walls are funny

Occasionally, there is a movie that just seems to resonate with many groups and situations. The 1994 movie “The Shawshank Redemption,” directed by Frank Darabout was certainly one of those movies. It was, and remains, common for myself and work colleagues to refer to being “Shawshanked” whenever we are confronted with laborious federal bureaucratic rules that are ubiquitously enforced with little apparent forethought or purpose.

October 2015

VA Treatment for Colorectal, Lung Cancer Often Better than Outside Care

Veterans with cancer who have dual coverage do best when they choose one system for all their healthcare and often do better when the VA is that choice.

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