New Guidelines Recommend TNFi Biologics as Initial Psoriatic Arthritis Treatment

BIRMINGHAM, AL For the first time, new guidelines have recommended the use of tumor necrosis factor inhibitor biologics as initial therapy for psoriatic arthritis. While current Group for Research and Assessment of Psoriasis and Psoriatic... View Article

From the Editor in Chief

Chester Buckenmaier III, MD COL (ret), MC, USA

“13. The delivery of good medical care is to do as much nothing as possible.” “Laws of the House of God,” —Samuel Shem

“When discussing collaboration, people often talk about ‘breaking down silos.’ ... ” —William D. Ramsey, MD

Political Issues Related to VA’s Limited Approval of Esketamine for Depression

WASHINGTON—A VA panel this summer opted not to add the new depression medication esketamine, Spravato, to the department’s formulary in the usual way. This came despite strong support from President Donald Trump and an effort... View Article

VA: Blue Water Veterans Must Wait Until 2020 for Claims to Be Processed

Vietnam Vets on Ships Won Fight for Presumptive Agent Orange Status WASHINGTON—Blue Water Navy veterans who want to file disability claims related to Agent Orange exposure will have to wait until next year to have... View Article

Whistleblowers Report Ongoing Harassment for Revealing VA Malfeasance

WASHINGTON—In 2014, Katherine Mitchell, MD, was one of a handful of employees at the Phoenix VAMC who blew the whistle on hospital leadership for keeping a separate, secret list of veterans seeking healthcare—a numerical sleight-of-hand... View Article

Featured Articles

VA: Blue Water Veterans Must Wait Until 2020 for Claims to Be Processed

August 16, 2019

Debate Continues on Esketamine Efficacy and Safety for Depression Treatment

August 12, 2019

Administrative Confusions Results in Little Oversight of VA’s Police Force

July 16, 2019

All VA Healthcare Facilities to Be Completely Smoke-Free by October

July 12, 2019

Cardiovascular Health Worse for Active-Duty Soldiers Than Same-Age Civilians

June 11, 2019

Departments

Department of Veterans Affairs (VA)

Ensuring Community Providers Meet Veteran Suicide Prevention Standards

WASHINGTON—As leaders from across multiple federal agencies begin work on a roadmap to combat veteran suicide, they are searching for ways to turn existing efforts in towns, cities, counties and neighborhoods across the country into... View Article

Department of Veterans Affairs (VA)

VA Manages Drug Costs Better than Medicare Part D

ST. LOUIS – Medicare Part D could save more than $14 billion annually if it paid the same prices for top medications as the VA, according to a new study. A research letter published earlier... View Article

Department of Veterans Affairs (VA)

House Passes Bill to Create Education/Employment Arm of VA

WASHINGTON,—Legislators have reintroduced plans to create a fourth administration within the Department of Veterans Affairs—one dedicated to overseeing veterans’ education, transition and employment benefits. Currently these operations fall under the Veterans Benefits Administration, with VBA... View Article

Department of Veterans Affairs (VA)

Administrative Confusions Results in Little Oversight of VA’s Police Force

Suicides, Violence at VMACs Put Spotlight on Security WASHINGTON—As the number of suicides and other violent incidents at VA facilities grows, a spotlight is being thrown on VA’s internal police force and its ability to... View Article

Department of Veterans Affairs (VA)

Veterans Using Dual Health Systems Have More Problems With Medications

CHARLESTON, SC—More than half of the patients treated by VA are also Medicare eligible, and that is increasing the risk for a range of prescription medication problems—from chronic disease medication nonadherence to opioid overdoses—among dual... View Article

Department of Veterans Affairs (VA)

All VA Healthcare Facilities to Be Completely Smoke-Free by October

New Directive Abolishes Designated Smoking Zones WASHINGTON—Starting in October, all VA healthcare facilities will be official no-smoking zones. While VA now permits smoking in designated areas, the department has issued a new policy restricting smoking... View Article

Ensuring Community Providers Meet Veteran Suicide Prevention Standards

VA Manages Drug Costs Better than Medicare Part D

House Passes Bill to Create Education/Employment Arm of VA

Department of Veterans Affairs (VA)

VA Isn’t Addressing Recommendations by Oversight Agencies

Too Many Leadership Vacancies Are Part of the Problem WASHINGTON—Deeply ingrained management problems are preventing VA from addressing priority recommendations from oversight agencies, leaving the department with long-standing weaknesses in its healthcare and disability benefits... View Article

Administrative Confusions Results in Little Oversight of VA’s Police Force

Veterans Using Dual Health Systems Have More Problems With Medications

All VA Healthcare Facilities to Be Completely Smoke-Free by October

Department of Veterans Affairs (VA)

VA MRSA Prevention Program Successfully Reduced Cases 43%

CDC, VA Authors Reject Calls to Lessen Interventions SALT LAKE CITY—Concerned about methicillin-resistant Staphylococcus aureus, one of the most common causes of healthcare-associated infections, the VA piloted a MRSA prevention program in 18 VAMCs beginning... View Article

VA Isn’t Addressing Recommendations by Oversight Agencies

VA Study Raises Questions About Value of Readmission Metrics

Three VAMC Campus Suicides in a Week Heighten Concerns About Prevention

Clinical Topics

Psoriatic Arthritis

New Guidelines Recommend TNFi Biologics as Initial Psoriatic Arthritis Treatment

Depression

Political Issues Related to VA’s Limited Approval of Esketamine for Depression

Battlefield Medicine

Army Doctor’s Unique Training Helps Improve Battlefield Medicine

SAN ANTONIO— Col. Andrew Cap, the division chief of Acute Combat Casualty Research at the Army Institute of Surgical Research, admits that he’s the last person you want to ask for advice on how to... View Article

Respiratory

Tests Show No Lung Changes for Recent Veterans

SAN ANTONIO—Significant airborne hazards were reported during military conflicts in southwest Asia, including geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. Yet, despite significant concerns about the respiratory health of deployed... View Article

Neurology

Following Guidelines Reduced Morality in Veterans at High Risk of Recurrent Stroke

Only 15.3% of Eligible Patients Received All Interventions INDIANAPOLIS—Meticulously following clinical guidelines in VA patients who suffered transient ischemic attack or nonsevere ischemic stroke reduced by nearly one-third their risk of death within a year,... View Article

Depression

Debate Continues on Esketamine Efficacy and Safety for Depression Treatment

VA Panel Puts Limits on Use of Drug PHILADELPHIA—Is esketamine a revolutionary treatment for depression or just another moderately effective adjunctive medication with some potentially serious risks? The VA’s Medical Advisory Panel leaned toward the... View Article

Debate Continues on Esketamine Efficacy and Safety for Depression Treatment

VA Now Allows New Therapy Option for Treatment-Resistant Depression

VA Study Addresses Concerns About Anti-Epileptic Drugs, Suicidal Behavior Link

Oncology

Racial Disparities Found in BRCA Testing, Counseling

DURHAM, NC—Despite increases in BRCA mutation testing, racial/ethnic disparities in counseling and testing have persisted for decades, a study argued. The review published in the Journal of Racial and Ethnic Health Disparities said its purpose... View Article

VA Guideline Addresses Dental Management of Head/Neck Cancer Patients

Patients Treated with Thiopurines Have Higher Skin Cancer Mortality

Overcoming Radiation Resistant Prostate Cancer

Oncology

VA Guideline Addresses Dental Management of Head/Neck Cancer Patients

SAN FRANCISCO—Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy, according to a new study. The report in the... View Article

Surgical Staging Often Inadequate for Gallbladder Cancer

Use of Hospice During Treatment Has Limited VA Use

Hypertension, MGUS Associated with Herbicide Exposure in Vietnam Veterans

Non-Clinical Topics

Legislation

VA: Blue Water Veterans Must Wait Until 2020 for Claims to Be Processed

Whistleblowers Report Ongoing Harassment for Revealing VA Malfeasance

Pharmacy

Oral Cancer Therapies Create Critical Demand for Pharmacists

CHICAGO—The pace of U.S. Food and Drug Administration approval of oral anticancer medications has rapidly increased, from less than one a year at the turn of the century to 10 in 2018. While patients generally... View Article

Electronic Health Records

Technology Experts Question MISSION Act Electronic Systems

WASHINGTON—VA is working under a tight deadline to implement the community care provisions of the MISSION Act, the new law that goes into effect this summer and revises and codifies access standards for veterans receiving... View Article

Pharmacy

DCVAMC Acting Pharmacy Chief Ivan Cephas: ‘Caring Is the Reason’

WASHINGTON—Ivan Cephas, PharmD, the acting chief of pharmacy at the DCVAMC, would be the first to say that what he does is not above and beyond the call of duty. Despite having been awarded the... View Article

Legislation

VA Reverses Stance, Won’t Challenge ‘Blue Water’ Veteran Court Ruling

WASHINGTON—In an about-face, the VA will recommend that the federal government not challenge a recent court decision ruling that the department cannot deny benefits to Vietnam-era Blue Water Navy veterans claiming Agent Orange exposure. The... View Article

VA Reverses Stance, Won’t Challenge ‘Blue Water’ Veteran Court Ruling

Executive Order Creates Task Force to Combat Veteran Suicide

Legislators Express Outrage Over Military Sexual Trauma Issues Subhead: Senator Describes Her Experience as Air Force Rape Victim

Legislation

Executive Order Creates Task Force to Combat Veteran Suicide

WASHINGTON—President Donald Trump has signed an executive order aimed at lowering the rate of veteran suicides. The order—the President’s Roadmap To Empower Veterans and End a National Tragedy of Suicide—creates a Cabinet-level task force led... View Article

Republican-Led VA Committee Sets Oversight Agenda

New Law Creates National Plan to Combat Alzheimer’s

FDA Looking to Impact Preventable Medication Harm

News

Democrats Look at VA Role of Trump’s Mar-a-Lago Associates

WASHINGTON—Congress announced last month that it will be opening an investigation into alleged improper influence by three civilian consultants to President Donald Trump on administration of the VA. The three men—Ike Perlmutter, CEO of Marvel... View Article