Office of Research & Development

VA Research News Briefs

Psychotropic medication linked to higher dementia risk in patients with PTSD

Psychotropic medication linked to higher dementia risk in patients with PTSD - Photo: ©iStock/KwangmoozaaPhoto: ©iStock/Kwangmoozaa

PTSD by itself has been linked to a higher risk for dementia later in life, but certain medications often used as part of PTSD treatment appear to compound that association. An analysis of data on more than 417,000 Veterans found that those with PTSD who were treated with selective serotonin reuptake inhibitors (SSRIs), novel antidepressants, or atypical antipsychotics were more likely to be diagnosed with dementia, relative to those with or without a PTSD diagnosis but not using any of these drugs. The patients in the study had an average age of 67.7 at the start of the study period, back in 2003, and they were followed, on average, for about 9 years. Those using benzodiazepines or serotonin-norepinephrine reuptake inhibitors (SNRIs) had an increased dementia risk, regardless of whether they had PTSD. The researchers say while it's possible some of the drugs may directly contribute to dementia risk, it's also possible that their use is a marker for more severe PTSD symptoms, or other underlying brain conditions, that may account for the higher dementia risk. They recommend further study. (Journal of the American Geriatrics Society, January 2017)

Wii Fit exercise program boosts balance in older adults

Wii Fit exercise program boosts balance in older adults - A Veteran receives an explanation of the Wii-Fit from Dr. Kalpana Padala at the Central Arkansas Healthcare System.  (Photo by Jeff Bowen)A Veteran receives an explanation of the Wii-Fit from Dr. Kalpana Padala at the Central Arkansas Healthcare System. (Photo by Jeff Bowen)

A Wii Fit exercise program improved balance in older adults, found a Central Arkansas Veterans Healthcare System study. Fifteen Veterans participated in an exercise program on the Wii Fit video game for 45 minutes, three days a week for eight weeks. The control group, also including 15 Veterans, performed a computer-based cognitive program. Those in the exercise group scored significantly better than controls on measures of balance. The results show that a Wii Fit exercise program is safe and feasible for community-dwelling older adults with balance problems. (Journal of Aging Research, Feb. 5, 2017)

Physical activity counseling improves activity levels at low cost

Physical activity counseling improves activity levels at low cost - Photo: ©iStock/kali9Photo: ©iStock/kali9

A physical activity counseling program improved activity levels and gait speed in older Veterans at only a small percentage of patients' health care costs in a VA Mid-Atlantic Health Care Network study. The program included initial in-person exercise counseling, followed by telephone counseling at two, four, and six weeks, and monthly thereafter for one year. The total cost of the program per participant averaged $696, about 6 percent of patients' estimated annual health care costs. The cost of this program may be offset by lower health care costs due to improved physical fitness, but that result was not statistically significant in the study. (Journal of the American Geriatrics Society, January 2017)

Thiazide blood-pressure drugs could lower fracture risk

Thiazide blood-pressure drugs could lower fracture risk - ©iStock/Sutthaburawonk©iStock/Sutthaburawonk

A certain class of blood pressure medication may improve bone strength in patients with osteoporosis, according to a secondary analysis of data from a larger study involving VA medical centers. Research shows that people with high blood pressure tend to have more osteoporotic fractures. This study showed that patients on chlorthalidone, a thiazide-type medication also sold as Hygroton, had lower risk of hip and pelvic fracture than those on amlodipine (sold as Norvasc) or lisnopril (sold as Zestril). Thiazides are one class of diuretics, or water pills. They increase the amount of water and salt expelled from the body as urine. They also affect the body’s balance of minerals. The results suggest that thiazide-type blood pressure medication could reduce fracture risk in older adults. (JAMA Internal Medicine, January 2017)

Transparent clinical notes can build trust with mental health patients

Transparent clinical notes can build trust with mental health patients - ©iStock/Steve Debenport©iStock/Steve Debenport

Allowing patients in VA mental health care to view clinical notes about their visits with providers can strengthen or strain their trust in those providers, depending on the contents of the notes. Researchers interviewed 28 patients who had access to OpenNotes, allowing them to see what their clinicians wrote about their treatment. The study found that ensuring consistency between what occurs during appointments and what the notes say makes patients trust their clinicians more. Notes that highlight patient individuality and strengths also help create trust. Showing transparency and respect in clinical notes can help build trust with patients, say the researchers. (Psychiatric Services, Feb. 1, 2017)

Modest brain changes seen in patients with schizophrenia after computer exercises

Modest brain changes seen in patients with schizophrenia after computer exercises - ©iStock/Image Source©iStock/Image Source

Patients with schizophrenia showed cognitive improvements after cognitive remediation training in a Minneapolis VA Health Care System study. Cognitive remediation involves computer exercises that place demands on working memory. Patients who received 48 hours of cognitive remediation over a 16-week period showed increased activation of the left prefrontal cortex of the brain, compared with those in the placebo group, who received only basic computer skills training. Increased brain activation, as shown on a type of MRI scan that tracks blood flow, correlated with improved task accuracy and suggests improved neuroplasticity. According to the researchers, the results suggest that brain activation may be an important target for schizophrenia interventions. However, the results were modest, and significant changes were not reported in other areas of the brain, contrary to what the researchers expected. (British Journal of Psychiatry, February 2017)

C. difficile treatment with vancomycin results in fewer deaths than treatment with metronidazole

C. difficile treatment with vancomycin results in fewer deaths than treatment with metronidazole - ©iStock/Scharvik©iStock/Scharvik

The antibiotic vancomycin reduced the risk of death after C. difficile infection over another antibiotic, metronidazole, found a study of VA health care system data. In recent decades, C. difficile infection has become a major cause of death inside and outside of hospitals. Metronidazole is the most common drug used to treat C. difficile. While C. difficile recurrence rates were similar with both drugs, this study showed that those treated with vancomycin were less likely to have died than those treated with metronidazole within 30 days after treatment. The findings justify vancomycin as initial therapy for C. difficile infection, according to the researchers. (JAMA Internal Medicine, Feb. 6, 2017)

Unique challenges of delivering primary care to women Veterans

Unique challenges of delivering primary care to women Veterans - ©iStock/javi_indy©iStock/javi_indy

VA's Patient Aligned Care Team (PACT) initiative faces unique challenges in delivering care to women Veterans, according to a VA Greater Los Angeles Health Care System study. The researchers interviewed 73 primary care providers and other staff about the benefits and difficulties of providing PACT care to women Veterans. Those interviewed said that PACT improved continuity of care and helped nursing staff practice effectively. Problems included inconsistent implementation of PACT procedures, short staffing, and space constraints. Challenges unique to the care of women Veterans included more psychosocial needs, the need for specialized training for staff, and inadequate staffing due to a separation between woman's health and primary care services. (Women's Health Issues, Jan. 4, 2017)

Clock-in-the-Box test helps predict return home after hospital stay

Clock-in-the-Box test helps predict return home after hospital stay - ©iStock/monkeybusinessimages©iStock/monkeybusinessimages

The Clock-in-the-Box (CIB) test is effective at predicting whether older patients will return home after hospitalization, suggests a new study. The CIB is a brief cognitive screening measure that assesses memory and executive functions. This VA Boston Healthcare System study found that every unit of increase on the CIB was associated with a lower likelihood of being discharged to somewhere other than home, such as a nursing home or rehabilitation center. The results support the CIB as a tool to inform clinical treatment decisions and discharge planning, say the researchers. (Clinical Interventions in Aging, Nov. 11, 2016)

E. coli contamination widespread in U.S. chicken

E. coli contamination widespread in U.S. chicken - Photo: ©iStock/MikeyGen73Photo: ©iStock/MikeyGen73

Antibiotic-resistant E. coli contamination is widespread in commercial U.S. chicken meat, found a study that included Minneapolis VA Health Care System researchers. Many of the strains of E. coli found in chicken do not respond to antibiotics. This means that it can be much harder to treat people infected with E. coli from eating chicken. Organic chicken breasts had slightly lower levels of antibiotic resistance, but had just as strong E. coli contamination as non-organic chicken. The study, conducted in 2013, suggests retail chicken products in the U.S. pose a potential health threat to consumers even if they are labeled as organic. Food-safety experts say thorough cooking kills the bacteria in meat, but consumers don’t always follow guidelines. (Applied and Environmental Microbiology, Jan. 6, 2017)

Compound improves cognitive function after stroke

Compound improves cognitive function after stroke - Photo: ©iStock/FikMikPhoto: ©iStock/FikMik

A chemical compound called P7C3-A20 could help improve cognitive function after stroke. When given to rats, P7C30-A20 protected existing neurons from atrophy and promoted the regeneration of new neurons in the brain. The rats treated with P7C30-A20 performed better than controls on movement and memory tests after seven days. The researchers also found decreased cortical and hippocampal atrophy in the treated rats. This study suggests that P7C3 compounds may be useful in protecting the brain from stroke. This study was conducted by researchers with the University of Miami, University of Iowa, and Iowa City VA Health Care System. (Experimental Neurology, Jan. 8, 2017)

Review of significant infectious-disease research cites key VA study

Review of significant infectious-disease research cites key VA study - Photo: ©iStock/AlexRathsPhoto: ©iStock/AlexRaths

A recent review of infectious-disease research selected a 2015 VA study as contributing significantly to the field. The VA study, published in the journal Clinical Infectious Diseases, looked at the effectiveness of two drugs in fighting vancomycin-resistant Entrerococcus bloodstream infections (VRE-BSIs), bacterial infections that resist treatment with common antibiotics. The study found that treatment with the antibiotic linezolid resulted in significantly higher treatment failure than treatment with daptomycin. Linezolid treatment was also associated with a higher rate of mortality in the study group. According to the researchers, the results show that daptomycin is a better choice than linezolid for treating VRE-BSIs. (American Journal of Health-System Pharmacy, Feb. 15, 2017)

New evidence on how aspirin may help prevent cancer

New evidence on how aspirin may help prevent cancer -

Researchers with the Michael E. DeBakey VA Medical Center and University of Texas may have found why aspirin can help prevent and treat some cancers. Scientists have long known that taking aspirin can lower the risk of certain cancers and stop the spread of cancer cells, but how this works is not well understood. The new research suggests that aspirin stops platelets from interacting with cancer cells, which affects cancer growth. The researchers further found that a new type of aspirin (based on lipid molecules) may be even more effective at preventing cancer. (Cancer Prevention Research, Dec. 20, 2016)

Protein in lungs could be target for asthma drugs

Protein in lungs could be target for asthma drugs - Photo: ©iStock/yodiyimPhoto: ©iStock/yodiyim

Targeting asthma drugs to a specific protein (HIF-1alpha) in the lungs could help limit airway inflammation, according to a VA San Diego Healthcare System study. A drug to inhibit HIF-1alpha in mice led to less allergic inflammation in the airway, although the response varied based on genetic factors. Asthma can be caused by different genetic variants, and current therapies are limited in their effectiveness. The researchers suggest HIF-1alpha inhibitors may be a way to effectively target certain forms of the disorder. (Clinical Immunology, Jan. 13, 2017)

Pay-for-performance has limited effect on health care

Pay-for-performance has limited effect on health care - Photo: ©iStock/simarikPhoto: ©iStock/simarik

Pay-for-performance programs may improve health care procedures, but evidence does not show that they improve patient outcomes. Pay-for-performance programs give financial rewards or penalties to health care providers and institutions according to their performance on quality measures. A literature review found some evidence that these programs improve the processes that institutions use, but this evidence was low-strength and somewhat contradictory. The review found no evidence that these programs improve patient outcomes. (Annals of Internal Medicine, Jan. 10, 2017)

Few Veterans with moderate or severe TBI go back to work

Few Veterans with moderate or severe TBI go back to work  - Photo: ©iStock/lentoloPhoto: ©iStock/lentolo

Few service members and Veterans with moderate to severe traumatic brain injury (TBI) return to work one year after their injury, according to a VA Polytrauma Rehabilitation Centers study. In a study of 293 Veterans and service members, only 21 percent were employed one year after a TBI. Those who were older, were minorities, or had a more severe TBI were more likely to be unemployed. Every additional year of age was linked to a 2 percent decrease in employment likelihood. Eighty-three percent of minorities were unemployed after one year, compared with 76 percent of nonminorities. Eighty-five percent of subjects with severe TBI were unemployed, while only 63 percent of subjects with moderate TBI were unemployed. These results will help VA plan rehabilitation services, say the researchers. (Journal of Head Trauma Rehabilitation, Jan. 5, 2017)

Rewards can push older adults to walk more

Rewards can push older adults to walk more - Photo: ©iStock/FatCameraPhoto: ©iStock/FatCamera

Older adults were more likely to meet daily step goals when they received reward money or had money donated to charity for reaching those goals. Study participants were challenged to increase their daily step counts by 50 percent. Those who were offered a reward of $20, a $20 donation to the charity of their choice, or a combination of the two were more likely to meet the step goal than those who were offered only feedback during a 16-week period. According to the researchers, incentives such as these could be used to get older adults to walk more. (American Journal of Preventive Medicine, Jan. 3, 2017)

Toxic exposures common in recent wars

Toxic exposures common in recent wars  - Photo: Airman 1st Class Christopher Griffin/USAFPhoto: Airman 1st Class Christopher Griffin/USAF

A study of 224 Iraq and Afghanistan Veterans found that 97.2 percent were exposed to toxic hazards during deployment. Toxic exposure was associated with chronic multisymptom illness (CMI) symptoms in these Veterans. The most common type of toxic exposure was breathing in smoke or fumes. Pesticide exposure was the most likely predictor of CMI. More analysis is needed on specific toxic hazards Veterans face and the relationship with CMI in order to improve prevention, say the researchers. (Journal of Occupational and Environmental Medicine, January 2017)

Sunlight improves function of immune cells

Sunlight improves function of immune cells - Photo: ©iStock/selvanegraPhoto: ©iStock/selvanegra


Researchers with VA, Georgetown University, and Vinh University in Vietnam found a mechanism that may explain why sunlight can reduce instances of autoimmune disease and some cancers, as shown in past research. Through experiments with human cells and mouse tissue, they found that T cells within skin are naturally sensitive to blue light. T cells serve an important purpose in the immune system and help the body adapt to disease. Blue light, which is absorbed by the skin from sunlight, appears to improve the movement of T cells within the body, which benefits the immune system. Scientists have long known that sunlight can have positive effects on the immune system, but were not sure why. (Scientific Reports, Dec. 20, 2016)

Multiple medical conditions linked to arthritis-causing disease

Multiple medical conditions linked to arthritis-causing disease - Photo: ©iStock/bloodstonePhoto: ©iStock/bloodstone


Researchers looked at a large Veteran population to identify other conditions associated with calcium pyrophosphate crystal deposition disease (CPDD), a common cause of arthritis. They found that people with CPDD had high rates of hyperparathyroidism, gout, osteoarthritis, rheumatoid arthritis, hemochromatosis, hypomagnesemia, and chronic kidney disease. These patients also tend to take calcium supplements, the study found. The use of common high blood pressure and heartburn medicines was not associated with CPDD. Knowing these links could help doctors develop treatment strategies for CPDD. (Arthritis Care & Research, Nov. 29, 2016)

Health-promoting behaviors may reduce suicidal thoughts in Veterans with PTSD

Health-promoting behaviors may reduce suicidal thoughts in Veterans with PTSD - Photo: ©iStock/PeopleImagesPhoto: ©iStock/PeopleImages


A survey of more than 100 Iraq and Afghanistan Veterans found that those who participated in health-promoting behaviors had a lower rate of suicidal thoughts. Research shows that Veterans with PTSD are more likely to have suicidal thoughts. But the link was less pronounced among those in the study with PTSD who said they routinely engaged in activities to foster good nutrition, physical activity, stress management, spiritual growth, health responsibility, and interpersonal relationships. The researchers say promoting these activities in Veterans with PTSD could help lower suicide risk. (PLoS One, Dec. 21, 2016)

High-protein diet linked to lower bone risk

High-protein diet linked to lower bone risk - Photo ©iStock/stock colorsPhoto ©iStock/stock colors

Older men who eat more protein have a lower risk of broken bones, according to a recent study. The study looked at 5,875 men over 15 years. Those with more protein in their diet had fewer broken bones than those who ate less protein, and the source of protein also mattered. More protein from dairy and other animal sources (meat, fish, poultry, eggs) was linked to lower hip fracture risk, while protein from plants (such as legumes, grains, and nuts) was not. Higher protein was tied to fewer hip fractures but not fewer spine fractures, showing this connection might vary by body part. While the study focused only on men, and by itself does not prove a direct causal link between protein intake and bone strength, the researchers nonetheless suggest that adding one to two servings per day of protein-rich foods may help older adults cut fracture risk. (Journal of Bone and Mineral Research, Dec. 12, 2016)

Intensive outpatient program did not lower health care cost or use

Intensive outpatient program did not lower health care cost or use - Photo ©iStock/shironosovPhoto ©iStock/shironosov

Intensive outpatient care resulted in health care use and costs that were similar to those of standard care in a VA Palo Alto Health Care System study. The study compared 433 high-need patients in standard Patient Aligned Care Team (PACT) care with 150 patients in an Intensive Management program (ImPACT). Patients in ImPACT receive extra outpatient care, including tracking goals and priorities, care management for medical and social service needs, and coordination between VA and non-VA providers. Patients in both programs had similar costs and numbers of hospital visits. Those in the ImPACT group were slightly more satisfied with VA care. These results were surprising—the researchers expected ImPACT to reduce care utilization and cost. (JAMA Internal Medicine, Dec. 27, 2016)

'Safety huddles' ease risks linked to electronic health records

'Safety huddles' ease risks linked to electronic health records  - Photo ©iStock/sturtiPhoto ©iStock/sturti

"Safety huddles" can help limit safety risks related to electronic health records (EHRs), found a VA study. These risks include mislabeled medicine, data loss due to computers not working, and incorrect treatment doses. One medical center used a daily meeting of care providers and support staff to discuss safety concerns and "great catches" of potential problems. Over 249 meetings, they were able to identify and address 245 EHR-related safety concerns. The study authors recommend that health care systems use huddles to help improve EHR use. (Journal of the American Medical Informatics Association, Dec. 28, 2016)

Study compares infection control in VA, non-VA nursing homes

Study compares infection control in VA, non-VA nursing homes - Photo: ©iStock/WavebreakPhoto: ©iStock/Wavebreak

VA and non-VA nursing homes differed in their approach to catheter-associated urinary tract infections, according to a recent study. VA nursing homes reported more hours per week devoted to infection prevention, were more likely to have committees to review infection policies, had higher physician and nurse staffing-to-bed ratios, had higher percentages of 24-hour registered nurse supervision, and kept track of catheter-associated urinary tract infection rates more regularly, compared with non-VA nursing homes. Most VA nursing homes also had infection prevention programs integrated within VA acute-care programs. A lower percentage of VA nursing homes had policies on appropriate catheter use, compared with non-VA nursing homes. The authors suggest that universal practices should be adopted in both VA and non-VA nursing homes. (Infection Control and Hospital Epidemiology, online Dec. 5, 2016)

How do the experiences of U.S. and Australian Veterans compare?

How do the experiences of U.S. and Australian Veterans compare? - Photo courtesy of Australian ArmyPhoto courtesy of Australian Army

A recent comparison based on data from VA and the Australian Department of Veterans’ Affairs showed several differences in post-1990 deployment outcomes. The U.S. deployed significantly more personnel than Australia during this period. Veterans from the two countries had similar overall rates of PTSD. Gulf War Veterans from both countries had a reduced risk of suicide, compared with the general population, but U.S. Veterans of Iraq and Afghanistan had higher rates of suicidal thoughts. U.S. Gulf War Veterans had higher rates of multisymptom illness than Australians, and were also more likely to have been in combat. The two countries’ health care systems were alike in terms of their range of services, focus on mental health, and increasing use of technology, but different in some aspects of service provision and financial structure. (Australian DVA website, Dec. 14, 2016)

Concerns about falling not linked to low blood pressure

Concerns about falling not linked to low blood pressure - Photo: ©iStock/ ImagesbybarbaraPhoto: ©iStock/ Imagesbybarbara

In one of the latest findings to be reported from a major study on high blood pressure treatment that was funded by the National Institutes of Health and involved VA researchers, fear of falling was not associated with low blood pressure or with blood pressure medication use in older adults. While participants with more concern about falling were found to be taking more medicine to combat high blood pressure, the study did not find a link between actual low blood pressure due to medication use and fear of falling. Fear of falling is common in older adults with high blood pressure who take medication to manage the condition. Many do not wish to increase their dose because they fear medication-induced low blood pressure will increase their risk of falling. The researchers point out that it is important to address patients’ fear of falling, in addition to actual fall risk. (Journal of the American Geriatrics Society, November 2016)

Virtual training for staff helps prevent pressure ulcers

Virtual training for staff helps prevent pressure ulcers - Photo: ©iStock/ Johnny GreigPhoto: ©iStock/ Johnny Greig

A new training program decreased the rate of pressure ulcers in VA. The Virtual Breakthrough Series (VBS) is a teleconferencing and email-based training program that uses personalized coaching and group education to help staff implement care changes to prevent pressure ulcers in patients. After the project was implemented, the pressure ulcer rate dropped from 1.2 to 0.9 per 1,000 bed days of care. VBS has previously been used to prevent catheter-associated urinary tract infections and to prevent falls. The researchers say that together, these studies show that VBS could be a powerful tool to improve the quality and safety of care in VA. (Journal of Nursing Care and Quality, online Nov. 29, 2016)

Veterans show no health effects of uranium exposure 25 years later

Veterans show no health effects of uranium exposure 25 years later - Photo courtesy of www.gulflink.osd.milPhoto courtesy of

Gulf War Veterans wounded in depleted uranium friendly-fire incidents showed no uranium-related health effects 25 years after exposure. Veterans with embedded uranium fragments had elevated urine uranium concentrations, while those who had been exposed to uranium through inhalation had lower urine uranium concentrations. Although these Veterans did not show any negative health effects, metal fragments still in their bodies continue to expose them to uranium radiation, and dangerous concentration thresholds may still be reached. The researchers recommend continued health surveillance for this group. (Environmental Research, January 2017)

AspireAssist device leads to greater weight loss

Patients equipped with the AspireAssist System, a tube placed in the stomach that allows stomach contents to be drawn out, lost more weight than patients who received only lifestyle counseling. In a year-long study in obese patients, patients who received both lifestyle counseling and the AspireAssist lost an average of 12.1 percent of their body weight, compared with a 3.5 percent loss for patients who only received counseling. This treatment could prove effective for long-term treatment of obesity, according to the study authors. It should be noted that the company that makes the device funded the study, which involved the San Diego VA and numerous university sites, and was involved with analyzing the data and preparing the manuscript. (American Journal of Gastroenterology, Dec. 6, 2016)

HIV increases risk for lung cancer

HIV increases risk for lung cancer -

HIV infection could contribute to the development of lung cancer, according to a study of participants in the Veterans Aging Cohort Study. Chronic inflammation and a dysfunctional immune system, both associated with HIV, are two factors that could increase the cancer risk, say the researchers. The study also showed that patients with lower T-cell counts were more likely to develop lung cancer. These findings could be used to target lung cancer prevention to this high-risk group, say the researchers. (The Lancet HIV, Dec. 2, 2016)

TeleMOVE is an effective weight-loss program

A VA San Diego Healthcare System study found that participants in a VA telehealth weight-loss program lost more weight than those in the in-person program. Participants in the new TeleMOVE program lost an average of 8.6 pounds during the 90-day program, while those who attended the MOVE! in-person weight-loss classes lost an average of 4.5 pounds over the course of eight classes. Participants who adhered to the program lost more weight than those who missed sessions, regardless of which program they were in. (Obesity Research & Clinical Practice, Dec. 5, 2016)

Can neurocognitive function predict suicide?

Can neurocognitive function predict suicide? - Photo: ©iStock/efksPhoto: ©iStock/efks

A study of Army administrative data found an association between decreased neurocognitive functioning and suicide in soldiers. Researchers found that lower scores on a computerized test of neurocognitive functioning—including problems in decision-making, problem-solving, verbal fluency, and memory—were linked to suicide attempts or death and suicidal thoughts in the following 12 months. The study showed more suicide attempts in soldiers who were female, less educated, white non-Hispanic, and younger at the time of testing, and who had a mental health diagnosis before testing. The researchers say that neurocognitive testing may be a useful tool in predicting future risk of suicide. (Suicide & Life-Threatening Behavior, Nov. 1, 2016)

Military sexual trauma linked to mental health problems in transgender Veterans

Military sexual trauma (MST) is associated with mental health problems in transgender Veterans. A study of 332 transgender Veterans who served in Iraq and Afghanistan found that MST was associated with likelihood of PTSD and personality disorder for both men and women, and with bipolar disorder and depressive disorder for women. Fifteen percent of the Veterans included in the study had experienced MST. The researchers conclude that medical forms should include gender identity in addition to biological gender, and that MST treatment should be culturally competent. (Journal of Traumatic Stress, December 2016)

Nanoparticle may aid in bladder cancer diagnosis, treatment

Nanoparticle may aid in bladder cancer diagnosis, treatment - (Photo courtesy of Pan lab)(Photo courtesy of Pan lab)

Researchers have developed a nanoparticle that promises to help in the diagnosis and treatment of bladder cancer. The particle, called PLZ4-nanoporphyrin (PNP), emits fluorescent light when exposed to infrared light. By coating PNP with a molecule specific to bladder cancer, researchers were able to identify cancer cells with the light and diagnose the condition in mice. PNP was also shown to be able to release chemotherapy drugs, as well as photodynamic and photothermal treatment agents, slower and more effectively than other methods. While this new technique of bladder cancer diagnosis and treatment has been shown to work so far only in mice, the researchers believe it could easily be adapted to individualized medicine in a clinical setting. (Biomaterials, October 2016)

Educational intervention targets racial gaps in use of knee replacements

African American patients who were shown an informational video about knee replacement surgery were 85 percent more likely than those who did not view the video to undergo the surgery, according to a study by researchers at the Philadelphia VA Medical Center and their partners. African Americans are significantly less likely than whites to have knee replacement surgery to relieve pain from arthritis, largely due to lack of knowledge about the treatment. The rate at which doctors recommended knee replacement was higher for those who viewed the video, but this result was not statistically significant. The researchers say that this low-cost, patient-centered intervention could increase use of an effective orthopedic procedure among minority patients. (JAMA Surgery, Nov. 23, 2016)

Telehealth versus in-person therapy for chronic pain

Video teleconferencing can be just as effective as in-person treatment for patients in acceptance and commitment therapy (ACT), a psychological approach that can be used to help people deal with chronic pain. This study found that Veterans receiving the therapy both in person and by video teleconferencing showed significant improvements in pain interference, pain severity, mental and physical health-related quality of life, pain acceptance, activity level, depression, and pain-related anxiety. The results suggest that teleconferencing is an acceptable way to deliver the therapy, although more participants in the teleconferencing group withdrew from the treatment than in the in-person group. (Journal of Pain, Nov. 9, 2016)

Pedestrian pathway roughness thresholds for wheelchair user safety and comfort

Pedestrian pathway roughness thresholds for wheelchair user safety and comfort - Photo: ©iStock/ands456Photo: ©iStock/ands456

Researchers at the Human Engineering Research Laboratories, a program of VA and the University of Pittsburgh, studied what level of roughness was acceptable for pedestrian pathways to avoid harmful vibrations and discomfort for wheelchair users. The researchers looked at previous studies on possible health effects of vibrations and engineering studies of wheel displacement when rolling over various surfaces, as well as surveys of wheelchair users about surfaces that cause discomfort. They found that a pathway roughness index threshold of < 50 millimeters per meter for a 100-meter-long surface and ?100 mm/m for a 3-meter-long surface would protect wheelchair users against discomfort and possible health risks. Finding these thresholds is important because current standards are not clear, according to the researchers. (>Assistive Technology, Sept. 2, 2016)

Blood pressure variability leads to vascular problems

Blood pressure variability leads to vascular problems -

High blood pressure variability is linked to vascular problems in non-elderly people with diabetes. Variability in systolic blood pressure could be a sign of blood flow instability. A study of more than 200,000 patients tracked for more than three years in the VA health care system found that patients with the highest variability in systolic blood pressure had a 19 percent higher risk of microvascular complications than those with less varied blood pressure. Neuropathy (nerve damage) was 30 percent more likely, and retinopathy (disease of the retina that leads to vision problems) was 17 percent more likely for this group. (Journal of Diabetes and its Complications, Sept. 14, 2016)

Quality of care for diabetes and cardiovascular disease

A recent study found that quality of care for diabetes and cardiovascular disease in the VA health care system was comparable between physicians and advanced-practice providers, although a majority of patients did not meet measures of proper disease risk-factor control. Advanced-practice providers include nurse practitioners and physician assistants. Regardless of provider type, there is a need within VA to improve risk-factor control in patients with diabetes and cardiovascular disease, say the researchers. (American Heart Journal, November 2016)

The hippocampus' role in memory

A VA San Diego Healthcare System study suggests that the hippocampus is particularly important for linking and ordering events in memory. Patients with brain injury involving the hippocampus remembered fewer details than controls about events right after they occured. However, injured patients and controls remembered about the same amount of details when questioned one month after the event. The patients with hippocampal damage had no trouble remembering spatial details such as locations, but they were noticeably worse than controls at remembering details related to time and event sequence. (Proceedings of the National Academy of Sciences of the United States of America, Nov. 7, 2016)

Statins decrease progression of liver disease

Statins, drugs frequently prescribed to treat high cholesterol, may slow the progression of liver disease in patients with both HIV and hepatitis C, according to a study of VA electronic medical records. Infection with both HIV and hepatitis C carries increased risk of cirrhosis, hepatocellular carcinoma, and death. This study showed that patients with these diseases who were also on statins had a 32-percent decreased risk of developing cirrhosis, possibly due to statins' anti-inflammatory properties. (AIDS, Oct. 23, 2016)

Racial differences in knee replacement surgeries

Racial differences in knee replacement surgeries -

Black Veterans were less likely than white Veterans to undergo knee replacement surgery, according to data from the VA Musculoskeletal Disorders Cohort. Over a 10-year period, rates of knee replacements were much lower for black than white veterans. Hispanic Veterans had the same rates of knee replacement as white Veterans. This study shows the importance of developing ways to reduce racial differences in Veteran health care usage, say the researchers. (Arthritis Care & Research, Oct. 27, 2016)

Heart rate variability as a predictor of PTSD

Lower pre-deployment heart rate variability (HRV) can predict higher post-deployment PTSD symptom severity, according to a study of 343 Army National Guard soldiers. The results suggest that people with lower HRV, meaning fewer changes in the time between heart beats, are at higher risk for PTSD. This may be because lower HRV is associated with a reduced ability of the body to adapt to changing social or environmental demands. One caveat: The results were significant only in soldiers who scored above a cut-off score on a PTSD symptom test pre-deployment. (Biological Psychology, Oct. 20, 2016)

Internet-based smoking cessation programs

Internet-based smoking cessation programs may be an effective way to reduce smoking in Veterans, found a Durham VA Medical Center study. Veterans offered telehealth programs to help them quit smoking had about the same quit rates as those participating in smoking cessation programs in the clinic. Reach of the internet intervention was significantly higher than the in-person program: 50 percent of those assigned to the internet group registered for a smoking cessation program, while only 19 percent of those in the in-person group attended a clinic-based session. Results suggest that using electronic medical records to identify smokers and offering novel interventions—such as online programs—to help them quit can significantly reduce smoking in the Veteran population. (Journal of Substance Abuse Treatment, October 2016)

Antibiotic prescription trends

Antibiotic prescription trends -

Antibiotic prescription decreased for physicians and dentists but increased for nurse practitioners and physician assistants—so-called midlevel providers—over a six-year period, according to a recent study. Over-prescribing of antibiotics can lead to drug-resistant bacteria. Midlevel providers were particularly likely to prescribe broad-spectrum antibiotics, which are a major part of the problem. The researchers recommend efforts to reverse the trend. (Journal of the American Pharmacists Association, Oct. 8, 2016)

Depression risk factors among lung cancer patients

The main risk factors for depression among patients with lung cancer are younger age, female sex, low income, not being married, and being a smoker, found a study involving 15 VA medical centers. Researchers suggest that these risk factors should be monitored closely in this population. Patients with depression in this group had worse health-related quality of life, vitality, cancer-specific symptoms, and social support, although the study showed increased mortality only among patients with more lung cancer symptoms or less social support. (Lung Cancer, October 2016)

New technique to test Alzheimer's disease drugs

New technique to test Alzheimer's disease drugs -

Researchers at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, have demonstrated a new way to test Alzheimer's disease drugs in lab models. They used stem cells from patients' blood to create 3D cell cultures of brain tissue, and were able to measure drug penetration on the sample. Modeling Alzheimer's disease in the lab is hard because of the extremely complex anatomy of the brain, but new drugs need to be tested this way before they are used in humans. This new approach with 3D cell cultures could allow scientists to test drugs more accurately than in traditional 2D cultures by more closely modeling the biology of the brain. (PLOS ONE, Sept. 29, 2016)

Liver transplant outcomes after circulatory death

Liver transplants from younger donors after circulatory death had better outcomes than those from older donors after brain death, found researchers with the University of Wisconsin and William S. Middleton Memorial Veterans Hospital. Liver donation after circulatory death is generally considered to have worse outcomes than donation after brain death. However, this study showed that livers from circulatory death donors younger than 50 fared better than those from brain death donors older than 60. The researchers suggest that more liver donations after circulatory death should be accepted, which could lead to shorter transplant wait times. (Liver Transplantion, September 2016)

Personal stories more engaging for hypertension management

African-American Veterans felt more engaged when viewing interventions about hypertension management that included personal stories from other Veterans, compared with information-only interventions. The study included 618 African-American Veterans with uncontrolled hypertension from three VA medical centers. One group was shown a DVD of information about hypertension, while another was shown a DVD featuring other African-American Veterans telling stories about successfully managing their hypertension. The Veterans who watched real patients tell their stories were more emotionally engaged than the other group and more likely to report intentions to change their behavior, showing that personal stories may be an effective tool to teach patients how to manage their condition. (Patient Education and Counseling, September 2016)

No objective benefits of yoga or aerobic exercise on sleep in midlife women

No objective benefits of yoga or aerobic exercise on sleep in midlife women -

A study found no objective effects of yoga and aerobic exercise on sleep in menopausal women with hot flashes. Although yoga and exercise have been suggested as useful for midlife women experiencing sleep disturbances, researchers found no significant differences in sleep patterns between those who practiced yoga or exercise and those who did not. The researchers used actigraphy—the continuous measurement of movement to track periods of sleep and wakefulness. While some women reported small sleep improvement after yoga or exercise, these effects could not be objectively measured. (Journal of Clinical Sleep Medicine, Sept. 9, 2016)

PTSD therapies are still effective in presence of TBI

Both prolonged exposure (PE) and cognitive processing therapy (CPT) are effective treatments for Veterans with PTSD regardless of traumatic brain injury (TBI) status, according to a Salem (Virginia) VA Medical Center study. PE therapy involves emotionally reliving trauma in a safe and controlled manner. CPT focuses on evaluating and changing upsetting thoughts. Some clinicians have been reluctant to use PE for patients with both PTSD and TBI out of fear that they would be less able to tolerate the therapy or that cognitive limitations would make the therapy less effective. A previous study showed that Veterans with PTSD and TBI could benefit from PE. The current study showed that the presence or absence of traumatic brain injury did not change the effectiveness of either therapy and that PE provided greater PTSD symptom reduction than CPT. The researchers note important limitations to this study, including that it was not a randomized trial and the sample size was small. (Journal of Traumatic Stress, October 2016)

Aortic aneurysm repair

Two procedures to repair aneurysms (widening of an artery that could rupture and cause internal bleeding) in the aorta have similar health and cost outcomes, according to a multicenter VA study. One procedure involves open surgery to repair the aorta. In the other, called endovascular repair, a surgeon uses X-rays to thread a stent through the arteries to the damaged part of the aorta. Researchers found that survival, quality of life, and costs were not significantly different between these two procedures. Selection of either procedure can be guided by patient and physician preference, say the researchers. (JAMA Surgery, Sept. 14, 2016)

Disclosing adverse surgical events

Disclosing adverse surgical events -

Fully disclosing adverse effects to patients after surgery benefits both patients and surgeons. To study how often surgeons fully shared details with patients and their family, investigators surveyed surgeons at three VA medical centers. They found that after a negative event, most surgeons were likely to explain why the event happened, express regret and concern for the patient's welfare, disclose the event within 24 hours, and discuss steps taken to treat any subsequent problems. Fewer surgeons were likely to apologize to patients or discuss whether the event was preventable and how recurrences could be prevented. Surgeons who were less likely to disclose details were more likely to experience negative effects such as anxiety. The researchers believe better understanding surgeons' attitudes and experiences can help ensure full and open disclosure to patients and their families. (JAMA Surgery, July 20, 2016)

New device for self-administered pain relief after upper-limb injury

Patient-controlled analgesia (PCA) allows patients to manage their own pain while being treated in hospitals. However, Veterans and service members with limb dysfunction or loss are often not able to use these devices. This problem led to the design of a new PCA adapter for patients with severe upper-limb injuries. The new device features a large surface area that fits around traditional PCA equipment, allowing for easier use. Initial case studies show that patients and clinicians were happy with the device, which could improve treatment and functional independence of Veterans and service members with upper-limb injuries. (Military Medicine, August 2016)

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