2017 Issues



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December 2017

Agent Orange Exposure Doesn’t Reduce CLL Survival

MINNEAPOLIS—Exposure to Agent Orange was not associated with either poor prognostic factors or shortened overall survival in a large veteran population with chronic lymphocytic leukemia (CLL), even though it is associated with development of the... View Article

Clinical Topics Home

Optimizing Treatment of Peripheral T-cell Lymphoma

Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, no clear consensus exists on optimal initial therapy, according to a new study.

December 2017

Specialist Follow-Up Mitigates Anemia Risk of Bariatric Surgery

Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss, but it also increases the risk of adverse outcomes such as mineral and/or vitamin deficiency.

Cardiology

Aspirin Appears to Be Safe for Some Heart Failure Patients

SAN FRANCISCO – Does use of aspirin increase heart failure (HF) hospitalization or risk of death in patients with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB)? That was the question... View Article

Agencies Home

Veterans With Heart Failure, Methamphetamine Use Present Growing Challenges for VA

The rate of heart failure associated with methamphetamine (meth) use appears to be on the upswing in veterans, according to preliminary research presented at the American Heart Association's Scientific Sessions 2017.

Cardiology

All-Cause Mortality Reduced in Heart Failure Patients with Lower Discharge Heart Rate

WASHINGTON — Although a lower heart rate is known to be linked with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF), not as much research is available on the association in... View Article

December 2017

GAO: VA Quality Measures on Hospital Compare, Agency Websites Not Accurate, Complete Enough

VA does not have “reasonable assurance” that the healthcare quality measures it reports on Hospital Compare and its own website accurately assess how VAMCs are performing, a new study suggests.

December 2017

Shulkin Pushes for Funding so VA Can ‘Piggyback’ on DoD’s EHR Implementation

By Sandra Basu WASHINGTON—After announcing VA’s decision earlier this year to replace VistA with the same electronic health record (EHR) that DoD is using, VA Secretary David Shulkin, MD, made a trip to Capitol Hill... View Article

Clinical Topics Home

VA Study Finds Older Medicare Patients Often Are Overtreated for Diabetes

It’s not only the VA that struggles with the balance between just enough treatment of older Type 2 diabetes patients and too much.

Asthma

Underweight and Smoking Makes for a Lethal Combination in COPD

When counseling a patient with chronic obstructive pulmonary disease (COPD), many clinicians start with two words of advice: “Stop smoking.”

Asthma

VAMC Survey Found High Rates of Asthma, Respiratory Symptoms Among Staff

A survey at a VAMC recorded the prevalence of current diagnosed asthma at 17.6% but also found that nearly half of the healthcare workers reported some asthma-like symptoms.

December 2017

Navy Doctor Promotes the Healing Power of Artistic Expression

Patients who are struggling with TBI and PTSD often find themselves frustrated in a traditional model of care that involves sitting in a room and talking about what they’re experiencing.

Cardiovascular Disease

Previous VA Research Borne Out: PCI Provides No Symptom Relief in Stable Angina

In a move that reanimated a long-standing controversy in cardiology, a recently published study supports and extends the findings of landmark research done by the VA more than a decade ago.

Current Issue

VA Makes Decision on Expansion of Agent Orange Presumptive Conditions

VA Secretary David Shulkin, MD, said he has made a decision on the expansion of the list of presumptive conditions for Agent Orange compensation and has passed it on to the next step in the process.

December 2017

Trials Provide Promising Results for Army-Developed Zika Vaccine

A vaccine developed by Army researchers to combat Zika virus not only induced a robust immune response in trials but also was found to be safe and well-tolerated in healthy adults.

December 2017

VA Patients More Likely to Die on Kidney Transplant Wait Lists

Distance to VA Transplantation Centers Could Be a Factor By Brenda L. Mooney CLEVELAND—Veterans treated by the VA have lower rates of kidney transplantation when compared with patients who have Medicare or private insurance coverage,... View Article

December 2017

Mission First, Soldiers Always!

~Anonymous This past October, I served as a staff platoon team leader for the annual Uniformed Services University (USU) Bushmaster exercise, which I have discussed in previous editorials.1 The training exercise is for senior nursing... View Article

Department of Veterans Affairs (VA)

Regional Anticoagulation Clinic Improvement Methods Bring Benefits Across VA

By Annette M. Boyle BEDFORD, MA—A program launched in eight VA New England medical center anticoagulation clinics not only achieved its goals of improving delivery of anticoagulation care, it also continues to pay dividends in... View Article

Mental Health

VA Is Struggling to Hire Enough Mental Health Clinicians by Year’s End

VA is falling short on its goals to hire more mental health professionals by the end of this year, VA Secretary David Shulkin, MD, told legislators at a recent Senate hearing on suicide prevention.

Neurology

Prevalence, Evolution of Non-Motor Symptoms in Parkinson’s Disease

Parkinson’s disease (PD) can cause a wide range of motor and nonmotor symptoms (NMS).

Alzheimer's/Dementia

Methylphenidate Improves Apathy in Veterans with Alzheimer’s

Apathy is a common behavioral problem in Alzheimer’s disease and can lead to everything functional impairment to higher medical costs to increased mortality.

Current Issue

Mild TBI Improved by Low-Impulse Electric Stimulation

Low-impulse electrical stimulation (LIP-tES) to the brain shows promise in improving neural function in mild traumatic brain injury (TBI).

Battlefield Medicine

Military’s Early Use of Blood Transfusions Saved Lives of Wounded Warriors

Blood transfusion as quickly as possible was a lifesaver for wounded warriors in Afghanistan.

November 2017

Video-assisted Thoracoscopic Lobectomy Improves NSCLC Survival

Should stereotactic body radiotherapy remain the standard treatment for medically inoperable early-Stage non-small cell lung cancer?

Clinical Topics Home

Metformin Shows Promise for Increasing NSCLC Survival

BETHESDA, MD—Past research has raised the possibility that a common blood sugar-lowering drug could be associated with improved survival in cancer patients with Type 2 diabetes. A study published recently in the International Journal of Cancer assessed... View Article

Clinical Topics Home

New Techniques Improved Survival for Veterans with Stage 1 NSCLC

Improved radiation and surgical techniques boosted overall survival in veterans diagnosed with Stage I non-small cell lung cancer (NSCLC) from 2001 to 2010.

Diabetes

Diabetic Foot Ulcers Increase Risk of Falls and Fractures

Diabetic foot ulcers (DFU) have long been known to increase the risk of infection and amputation.

Department of Veterans Affairs (VA)

VA/DoD Process Ensures Guidelines Reflect Current Research

By Annette M. Boyle WASHINGTON—Clinicians treating veterans and military patients can expect new guidelines in the coming year on sleep disorders, stroke, asthma, suicide prevention and chronic kidney disease. The VA/DoD guidelines for major diseases... View Article

Diabetes

High Glycemic Levels Have ‘Legacy Effect’ Even After Diabetic Patients Start Dialysis

By Annette M. Boyle LONG BEACH, CA—In recent years, the American Diabetes Association and other organizations have recognized that very low glycemic rates do not provide a cardiovascular benefit and might instead increase mortality risk... View Article

Agencies Home

VA’s Draft Legislation Seeks to Expand Criteria for Choice Program

By Sandra Basu WASHINGTON—The VA has sent draft legislation to Congress that would revamp criteria for outside care, including eliminating the controversial “30-day/40-mile” rule. “We want veterans to work with their VA physicians to make... View Article

Cardiology

Dorn VAMC Nurse Is National Spokesperson for ‘Go Red for Women’ Campaign

Beverly Buchanan’s symptoms didn’t immediately set off any red flags in her mind.

Department of Veterans Affairs (VA)

VA Dogged By Revived Bills Seeking Service Animals for PTSD Patients

By Sandra Basu WASHINGTON—VA pushed back against congressional bills under consideration last month that would create new pilot programs related to dog therapy. “We do not believe that creating yet another program would add significant... View Article

Late Breaking News

Procedure Determines How Long Post-Surgical Patients Should Receive Opioids

Study Uses MHS Data to Create Guidelines for Painkillers BOSTON – How long should patients use opioids after common surgical procedures? Until now, there hasn’t been much consensus on the answer. A new study analyzing... View Article

Editor in Chief

You know what they call alternative medicine that’s been proved to work?

“You know what they call alternative medicine that’s been proved to work? – Medicine.” ~Tim Minchin *Editor’s note: This month’s editorial was co-written by retired Lt. Gen. Eric Schoomaker. A recent announcement of a very... View Article

Late Breaking News

Be Aware of New Clinical Recommendations on Diabetes, Back Pain, PTSD, Amputation, Opioids

Diabetes Guidelines Don’t Include Specific Pharmacotherapy Advise By Annette M. Boyle WASHINGTON —The VA and DoD Evidence-Based Practice Work Group has recently released five updated clinical practice guidelines. They cover common conditions such as Type... View Article

Agencies Home

Draft Bill Calls for ‘BRAC’-like Commission on VA’s Outdated Infrastructure

By Sandra Basu WASHINGTON—Draft congressional legislation is calling for a commission to make recommendations regarding VA’s infrastructure. Even supporters admit the “deck is stacked against” it. In introducing the bill, which potentially could lead to... View Article

Department of Veterans Affairs (VA)

GAO: Applications for VHA Healthcare Benefits Frequently Mishandled

VHA does not have the right protocols in place to ensure applications for enrollment are processed in a timely manner or that enrollment determinations are accurate, according to a new report.

Department of Veterans Affairs (VA)

VA End-of-Life Care Push Increases Hospice Use Among Veterans

An intense effort by the VA to improve end-of-life care is paying off, with hospice use increasing more among veterans than nonveterans.

Department of Veterans Affairs (VA)

MHS Providers Lack Time,Travel Funding for PTSD, MDD Training

Limitations on travel and the lack of protected time might prevent MHS healthcare providers from receiving additional training in evidence-based therapies for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), a recent study suggested.

Department of Defense (DoD)

Army Pharmacy Finds Shorter Hours Reduces Wait Times

The pharmacy team at McDonald Army Health Center (MCAHC) on Joint Base Langley-Eustis in Virginia had a common problem—longer than desired wait times for patients to pick up prescriptions.

Department of Veterans Affairs (VA)

Living With a Mystery Disease: One Woman’s Story

At 31, Susan Thornton developed an itchy rash around her waist.

Cancer

Treatment Options Multiply for Cutaneous T-cell Lymphoma

After decades on the sidelines, research in cutaneous T-cell lymphoma (CTCL) has exploded in recent years, bringing patients with this rare disease new opportunities for treatment.

Cancer

VA Research Offers Reassurance on Safety of TKIs for Kidney Cancer

The U.S. Food and Drug Administration approval of several tyrosine kinase inhibitors (TKIs) over the last decade has substantially improved outcomes for patients with metastatic renal cell carcinoma.

Cancer

California Statistics Indicate Kidney Cancer Rates Might Be Declining Overall

After years of apparently rising rates of kidney cancer, the incidence of early-stage disease seems to be declining, at least in California.

Current Issue

Social Support Critical for Military Mental Health

The Marine Resiliency Study-II examined changes in symptomatology across a deployment cycle to Afghanistan. Results were published recently in the Journal of Psychiatric Research.1

Department of Veterans Affairs (VA)

Paliperidone Palmitate Helps Some Schizophrenia Patients

Even though nearly half of all patients diagnosed with schizophrenia have a history of substance abuse (SA), data on treatment of schizophrenia with paliperidone palmitate (PP) among patients with comorbid SA have been limited.

Clinical Topics Home

Augmentation Better Than Switching Drugs in MDD

The addition of an atypical anti-psychotic medication to an antidepressant regimen for veterans not responding to their current treatment led to greater improvement in symptoms of depression than switching to another antidepressant altogether.

Department of Veterans Affairs (VA)

How Do VA PCPs Respond to Insomnia Complaints?

Veterans have even higher rates of insomnia than other adults in the United States, and many seek treatment from their primary care physicians.

Department of Veterans Affairs (VA)

In-Person Cognitive Therapy Better for Insomnia

Internet-delivered cognitive behavioral therapy appears to be an effective alternative to regular in-person meetings with a therapist for military personnel with insomnia, but it still is only about half as effective as traditional methods.

Department of Veterans Affairs (VA)

Biomarkers Different in Acute HF Patients With, Without Diabetes

How diabetes affects pathophysiological processes among patients with acute heart failure (AHF) is unclear, according to a new study published in the European Journal of Heart Failure.1