One of the many challenges with treating COVID-19 is that acute respiratory distress syndrome associated with the infection is so different from what intensivists usually see. Another is that the influx of patients means that a lot of non-specialist physicians have been called on to care for these patients. In response, the Uniformed Service University of Health Sciences has created educational video series which provides critical information on ventilator usage and novel modes, such as airway pressure release ventilation, which allows for spontaneous breathing and has potential lung-protective benefits.
Injection or Pills?
Clinicians treating substance use disorder patients at the VA have faced a specific dilemma during the COVID-19 pandemic: How to deal with veterans who need to receive monthly injections at clinics and VAMCs as a critical component of their therapy. Making the choices even more difficult is recent research showing that injectables significantly extend time to relapse for those patients.
Pandemic Shows Value of Long-Acting Injectables for Severe Mental Illness
VA research has found that about half of veterans with diagnosed schizophrenia or bipolar I disorder have attempted suicide. Nearly 70% of veterans with schizophrenia and more than 82% of those with bipolar disorder reported suicidal ideation or behavior. That’s why it is so critically important to maintain their medications during a crisis such as the COVID-19 pandemic. Long-acting injectable drugs has helped the VA do that.
Multimodal Use of Non-Opioid Painkillers Urged for Postsurgical Patients
With a growing realization that post-surgical opioids might be neither the safest nor most effective way to reduce pain, VA facilities are using a variety of non-opioid painkillers to help patients manage their discomfort after undergoing surgery. In fact, opioids are no longer considered first line treatment for most types of acute pain, including that related to surgery.
Minneapolis VA Researcher Led Many Pain Management Changes
MINNEAPOLIS, MN – How post-operative pain is treated has changed at the VA, as research has demonstrated that opioids and nonopioids work comparatively well when it comes to relieving pain, with nonopioids having less serious adverse effects and much lower chance of addiction.
VA Seeks Increase in Medication Adherence Among Veterans With MS
A recent VA study found that 31% of MS patients in the VA system had suboptimal medication adherence. That can especially be an issue for relapsing forms of the disease, which affect 85% of MS patients, because there could be times of partial or complete remission when symptoms are reduced or absent.
Researchers note that recent exacerbations tended to increase adherence, although failing to regularly use disease modifying treatment has been associated with more relapses and exacerbations, a greater likelihood of disease progression and a poorer quality of life.
VA Has More Options as Treatment for Mantle Cell Lymphoma Expands Rapidly
Most patients with mantle cell lymphoma, which is considered a presumptive condition for veterans exposed to Agent Orange, face a rapidly progressive disease and higher mortality rates. New therapies are giving VA clinicians more options to help MCL patients. For example, the availability now of three Bruton tyrosine kinase [BTK] inhibitors is allowing treatment to be better matched to the needs of the patient.
Hepatitis C ‘Cure’ Doesn’t Always Prevent Hepatocellular Carcinoma Development
More than 100,000 VA patients have been cured of hepatitis C with direct-acting antiviral treatment. Even though HCV is the leading cause of hepatocellular carcinoma in the United States, curing the infection only reduces the risk; it doesn’t entirely eliminate it. That’s why the VA has continued with research to determine who is at greatest risk of HCC and is looking at expanding screening.
Many COVID-19 Crisis ‘Helpers” Wear Military Uniforms, VA Badges
With both a movie and a documentary in recent years about television personality Fred Rogers and his neighborhood, nearly everyone knows the advice he was given by his mother. “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’”
Insulin Errors Potentially Plague Hospitals Treating Diabetes Patients
Guidelines from the Institute of Safe Medication Practices have pointed out that insulin is associated with more medication errors than any other type or class of drugs. With more than 11,400 insulin-using veterans hospitalized in a recent two-year period at the VA, that is an especially critical issue for the healthcare system. Intense focus on avoiding problems with insulin, as well as new products, have improved the situation, both with subcutaneous administration – such as insulin pens – and with intravenous insulin in the critical care setting.
New Focus in the Fight to Reduce CV Risks in Type 2 Diabetes
At one point, intensive glycemic control was seen as a magic bullet to keep Type 2 diabetes patients from developing cardiovascular disease. That approach faded, however, when VA research cautioned that any benefits of intensive therapy must be weighed against adverse effects such as hypoglycemia and weight gain. Now the focus has shifted to better medication selection, with guidelines suggesting that, for Type 2 diabetes patients who have cardiovascular disease or are at high risk for it, therapy including an SGLT-2 inhibitor or GLP-1 RA should be considered as optimal treatment.
Servicemembers With Uncontrolled Diabetes Allowed to Remain In Military
While, in general, the U.S. military will not accept recruits diagnosed with diabetes, that is especially the case with patients who use insulin, which is seen as an automatic disqualification. The situation is different, however, in military personnel already serving. While most of those retained after diagnosis have well-controlled blood sugar, about a third have hemoglobin A1c measures greater than 7%. That’s why the ability to closely monitor those servicemembers with tools such as continuous glucose monitoring is increasingly important.
VA Outlines Stepwise Treatment for Asthma-COPD Overlap Syndrome
Respiratory illnesses account for a significant proportion of all noncombat diagnoses among active duty forces and veterans deployed to southwest Asia; past research estimates that more than 3% of all veterans who served in this theater had newly diagnosed asthma and a similar percentage were diagnosed with chronic obstructive pulmonary disease. How to treat those patients is even more difficult when the conditions overlap. That’s why the VA has developed recommendations for the stepwise treatment of asthma-COPD overlap syndrome.
Vigilance at VA Community Living Centers in the Time of COVID-19
Editor’s note: The VA asked if U.S. Medicine could help disseminate important information on its response to the COVID-19 pandemic. Here is a discussion from some of the agency’s top leaders. By Carolyn Clancy, MD, Teresa Boyd, DO, and Scotte Hartronft, MD We believe...
VA Prepares for Increased Risk of Suicide With COVID-19 Isolation
WASHINGTON — As the COVID-19 pandemic continues and scientists predict more periods of social distancing and quarantine in the future, healthcare leaders in the VA and elsewhere are beginning to prepare for how this will impact the mental health of veterans and civilians alike.
Blood Pressure Therapy Type Affects Risk of Gout Development
Secondary Analysis of Study Using VA Data BOSTON –While gout often is linked to diet – such as consuming too much red meat, seafood, and alcohol – it also can be a common complication of hypertension management. In fact, according to an article in the Journal of...
Mortality, Amputation from Critical Limb Ischemia Declining at VA
IOWA CITY, IOWA — High rates of diabetes, obesity, smoking, and other risk factors elevate veterans’ risk of peripheral artery disease (PAD) and critical limb ischemia.
VA Trial Seeks to Determine if ADT Is Protective Against COVID-19 in Men
LOS ANGELES — That men tend to have worse outcomes with COVID-19 has been observed since the beginning of the novel coronavirus outbreak.
Sleep Apnea Increases Need for Opioids in Veterans
WEST HAVEN, CT — Does sleep disruption caused by obstructive sleep apnea lead to hyperalgesia and contribute to poor pain control and use of prescription opioids?
Auricular Acupuncture Effective for Short-Term Pain
FARGO, ND — Battlefield Acupuncture is a unique auricular procedure use by many VHA facilities, according to a new study which suggested that, based on past research, it can reduce pain for up to two weeks.
Statin Effect on Death in Veterans With Prostate Cancer
SAN ANTONIO — As the most common cancer in men in the United States, prostate cancer is associated with a prolonged survival and patient care often includes optimizing other comorbidities, such as cardiovascular disease.
PTSD Raises Risk for Cancer Pain in VHA Patients
BOSTON — While research has shown a link between chronic pain and post-traumatic stress disorder, not much is known about the longitudinal course of pain and PTSD during cancer treatment, according to a new study.
Does Medicare Policy Influence End-of-Life Care At VHA?
NEW HAVEN, CT — Although fee-for-service Medicare does not allows simultaneous receipt of cancer treatment and hospice care—i.e, concurrent care—VHA does.
VA Pushes for More Use of NSCLC Targeted Therapies
DURHAM, NC — To help guide therapeutic decisions for patients with advanced stage non-small cell lung cancer, Next-Generation Sequencing (NGS) gene panels are often completed.
IHS Faces Challenges as Navajo Nation Becomes New COVID-19 Epicenter
WINDOW ROCK, AZ — The Indian Health Service) and the Native American communities it serves saw the COVID-19 pandemic’s impact reach new heights in May.
Too High Rate of Diabetes Therapy Intensification at VA Hospital Discharge
BOSTON — About 10% of older veterans discharged from VAMCS had their diabetes medication intensified, even though half of them were unlikely to benefit because either they already had reached their blood glucose goals or had limited life expectancy.
McCoy Helps Rural VA Clinic Use Telehealth to Improve COPD Care
EAST LIVERPOOL, OH — As VA facilities across the country are transferring veterans’ care wherever possible to telehealth in an attempt to promote social distancing and curtail unnecessary visits to hospitals and clinics, one rural outpatient clinic in Ohio is well ahead of the curve.
VA Neurologists Find That Stroke Looks Different During Coronavirus Pandemic
SAN FRANCISCO—Since the novel coronavirus pandemic hit Europe in early March and washed across the United States later that month, emergency department staff and neurologists have asked, “Where are the stroke patients?” By April, they were asking another question of...
VA/DoD Take On Extensive Research Roles as Coronavirus Cases Wane
WASHINGTON—As the number of cases of COVID-19 seen in hospitals in many states decline, the VA and DoD have turned from active support of overwhelmed facilities to building deeper understanding of the disease and its impacts through new research studies and continued...
VA Vows to Be Better Prepared If COVID-19 Case Spike in Autumn
WASHINGTON — According to VA leaders, the department will be better prepared if COVID-19 infections spike again in the fall, as many health experts are predicting it will.
