Credit Newswise — An estimated 15-20 percent of U.S. troops returning from Iraq and Afghanistan suffer from some form of traumatic brain injury (TBI) sustained during their deployment, with most injuries caused by blast waves from exploded military ordnance. The obvious cognitive symptoms of minor TBI -- including learning and memory problems -- can dissipate within just a few days. But blast-exposed veterans may continue to have problems performing simple auditory tasks that require them to focus attention on one sound source and ignore others, an ability known as "selective auditory attention." According to a new study by a team of Boston University (BU) neuroscientists, such apparent "hearing" problems actually may be caused by diffuse injury to the brain's prefrontal lobe. "This kind of injury can make it impossible to converse in everyday social settings, and thus is a truly devastating problem that can contribute to social isolation and depression," explains computational neuroscientist Scott Bressler, a graduate student in BU's Auditory Neuroscience Laboratory, led by biomedical engineering professor Barbara Shinn-Cunningham. For the study, Bressler, Shinn-Cunningham and their colleagues -- in collaboration with traumatic brain injury and post-traumatic stress disorder expert Yelena Bogdanova of VA Healthcare Boston -- presented a selective auditory attention task to 10 vets with mild TBI and to 17 control subjects without brain injuries. Notably, on average, veterans had hearing within a normal range. In the task, three different melody streams, each comprised of two notes, were simultaneously presented to the subjects from three different perceived directions (this variation in directionality was achieved by differing the timing of the signals that reached the left and right ears). The subjects were then asked to identify the "shape" of the melodies (i.e., "going up," "going down," or "zig-zagging") while their brain activity was measured by electrodes on the scalp. "Whenever a new sound begins, the auditory cortex responds, encoding the sound onset," Bressler explains. "Attentional focus, however, changes the strength of this response: when a listener is attending to a particular sound source, the neural activity in response to that sound is greater." This change of the neural response occurs because the brain's "executive control" regions, located in the brain's prefrontal cortex, send signals to the auditory sensory regions of the brain, modulating their response. The researchers found that blast-exposed veterans with TBI performed worse on the task -- that is, they had difficulty controlling auditory attention -- "and in all of the TBI veterans who performed well enough for us to measure their neural activity, 6 out of our 10 initial subjects, the brain response showed weak or no attention-related modulation of auditory responses," Bressler says. "Our hope is that some of our findings can be used to develop methods to assess and quantify TBI, identifying specific factors that contribute to difficulties communicating in everyday settings," he says. "By identifying these factors on an individual basis, we may be able to define rehabilitation approaches and coping strategies tailored to the individual." Some TBI patients also go on to develop chronic traumatic encephalopathy (CTE) -- a debilitating progressive degenerative disease with symptoms that include dementia, memory loss and depression -- which can now only be definitively diagnosed after death. "With any luck," Bressler adds, "neurobehavioral research like ours may help identify patients at risk of developing CTE long before their symptoms manifest."
Credit Newswise — When members of the U.S. military leave the service, they tend to settle in neighborhoods with greater overall diversity than their civilian counterparts of the same race, according to a new study that was presented at the 110th Annual Meeting of the American Sociological Association (ASA). “It’s encouraging that having served in the military appears to have a long-term impact on how people choose their neighborhoods,” said study co-author Mary J. Fischer, an associate professor of sociology at the University of Connecticut. “According to the social contact hypothesis, racial attitudes are improved and stereotypes are broken when diverse groups come together under circumstances that promote meaningful cross-group interaction, such as in the military.” Using data from the Home Mortgage Disclosure Act on 13 million home mortgage loans from 2008 to 2013 across 98 metropolitan areas, the study represented the first and largest examination of residential integration among white, black, and Latino homeowners. The researchers compared conventional mortgages with Veterans Affairs mortgages to determine differences in residential patterns between veterans and civilians, and controlled for a number of variables that could explain where people lived, including partnership status, income, and metropolitan characteristics. U.S. cities remain highly segregated by race despite several decades of laws against discrimination in housing and lending, according to Fischer. “One of the reasons racial segregation may self-perpetuate is that many whites have grown up in homogeneous communities and thus are more prone to rely on stereotypes to understand out-groups,” Fischer said. Fischer and her co-author Jacob S. Rugh, an assistant professor of sociology at Brigham Young University, note that making decisions on where to live after serving in the military is a strong test of the premise that prolonged interracial contact will have a positive effect on long-term intergroup relationships. Fischer said this study along with related research she is working on with colleagues contribute to society’s understanding of the potential longer-term effects of military service on race relations.
Credit Newswise — To the nearly 2 million people in the U.S. living with the loss of a limb, including U.S. military veterans, prosthetic devices provide restored mobility yet lack sensory feedback. A team of engineers and researchers at Washington University in St. Louis is working to change that so those with upper limb prosthetics can feel hot and cold and the sense of touch through their prosthetic hands. Daniel Moran, PhD, professor of biomedical engineering in the School of Engineering & Applied Science and of neurobiology, of physical therapy and of neurological surgery at the School of Medicine, has received a three-year, nearly $1.9 million grant from the Defense Advanced Research Projects Agency (DARPA) to test a novel device his lab developed that would stimulate the nerves in the upper arm and forearm. If it works, upper-limb amputees who use motorized prosthetic devices would be able to feel various sensations through the prosthetic, which would send sensory signals to the brain. DARPA is already funding the “Luke Arm,” a high-tech bionic limb created by DEKA Research. The prosthetic, named for “Star Wars” character Luke Skywalker, who received a prosthetic after losing his right hand in an epic battle with Darth Vader, is designed to help servicemen and women and veterans who had upper limb amputations. While the advanced prosthetic arm allows users to perform six different grips, such as picking up small objects, it does not provide users with the senses of touch and orientation of a natural hand. Moran, whose expertise is in motor neurophysiology and brain-computer interfaces, and his team have developed an electrode designed to stimulate sensory nerve cells in the ulnar and median nerves in the arms. The ulnar nerve, one of three main nerves in the forearm, is the largest nerve in the body unprotected by muscle or bone and is connected to the ring finger and pinkie finger on the hand. It’s the nerve that is stimulated when you hit your elbow on something and trigger your “funny bone.” The median nerve in the upper arm and shoulder is connected to the other fingers on the hand, so together, the two nerves control movement and sensations including touch, pressure, vibration, heat, cold and pain in all of the fingers. People using arm prosthetics have to rely on their vision to use them properly, Moran says. To pick up a cup of coffee, they have to be able to see the cup, place the fingers of the prosthesis around it and lift it. They are unable to feel whether the cup is in their hand, if the cup is hot or cold or if they are about to drop it. By enabling the ability to feel, users will have more control over the prosthesis. Moran and his team, which includes Harold Burton, PhD, professor of neurobiology; Wilson (Zach) Ray, MD, assistant professor of neurological surgery, both at the School of Medicine; and Matthew MacEwen, who will graduate with an MD/PhD in May 2015 and worked on this project for his dissertation, have developed a macro-sieve peripheral nerve interface designed to stimulate regeneration of the ulnar and median nerves to transmit information back into the central nervous system. Ray will implant the device — which is made of an ultrathin, flexible material similar to a soft contact lens and is about 1/8th the size of a dime — into the forearms of anesthetized nonhuman primates. The research team will then determine the amount of sensory information that is encoded by providing low levels of stimulation to small groups of nerves. The device, which looks like a wagon wheel with open spaces between the “spokes,” allows the nerve to grow. Ray also will implant a small cuff electrode, the current standard of care, to compare the performance. Once implanted, Moran and the team will train the nonhuman primates to play a joystick-controlled video game in which the team will give them cues as to where to move the joystick by stimulating specific sectors in the ulnar and median nerves so it feels as if someone is touching them, Moran said. Their reward for advancing through the various stages of the game successfully is fruit-flavored juice. “We want to determine what they can perceive through artificial stimulation of the nerves,” Moran says. “If we stimulate a particular sector of the nerve, that tells them to reach to a specific target. Using very low levels of stimulation (i.e. sensation), we want to figure out how many different nerve sectors we can independently encode with a unique target location.” In particular, Moran and the team will analyze how many different independent channels they can stimulate on the nerve to determine how many sensors will work on the prosthetic hand. Using a method called current steering, they can move different amounts of current around the nerve to activate different sectors to connect the touch sensors on the hand to a different sector on the nerve. His team has already had success with this method in motor neurons in a rat model. “If this works to stimulate motor neurons in muscles, we can certainly stimulate sensory neurons, and that’s never been done in a behavioral model in nonhuman primates,” Moran says. Burton, an expert in sensory neurophysiology, will analyze how the brain processes the feedback from the nerve stimulation. “The more real estate the brain uses, the more processing power and the more important something is,” Moran says. “The hand area in the somatosensory cortex is a big piece of brain, so there should be a lot of bandwidth. We think we’ll be able to send a lot of information to it.” Moran and his team will work with DARPA to determine how many sensors to put on the prosthetic hands. “If the nervous system can’t handle more than eight or 10 channels, there is no sense in putting more on there,” he says. “We want to find the bandwidth and what the nervous system can interpret with artificial sensation.” The School of Engineering & Applied Science at Washington University in St. Louis focuses intellectual efforts through a new convergence paradigm and builds on strengths, particularly as applied to medicine and health, energy and environment, entrepreneurship and security. With 91 tenured/tenure-track and 40 additional full-time faculty, 1,300 undergraduate students, more than 900 graduate students and more than 23,000 alumni, we are working to leverage our partnerships with academic and industry partners — across disciplines and across the world — to contribute to solving the greatest global challenges of the 21st century.
Credit Newswise — Wounded Warrior Project, a national nonprofit veterans service organization based in Jacksonville, Florida, initiated a $100 million commitment to launch a first-of-its-kind national medical care network to connect wounded veterans and their families with world-class, individualized health care. Rush University Medical Center is one of four academic medical centers in the U.S. and the only center in the Midwest to be part of this new, national network, which will provide mental health care for post-traumatic stress disorder, or PTSD, and traumatic brain injury, also known as TBI. According to Wounded Warrior Project’s annual survey of the current generation of injured veterans, 75.2 percent of respondents (an estimated 41,000) experience PTSD, and 43.2 percent (an estimated 23,000) have incurred a TBI. “The invisible wounds that our injured warriors struggle with every day have devastating long-term consequences on their health, yet too often they have difficulty seeking and getting the care they need for these conditions,” said Jeremy Chwat, chief program officer at Wounded Warrior Project. “We envision and seek to create a world where warriors who live with PTSD and TBI have improved, timely access to the quality care they need to recover, heal and move forward with their lives.” Wounded Warrior Project has committed to expand regional outpatient programs and develop innovative two- to three-week inpatient programs over three years to help veterans and their families at the Road Home Program: The Center for Veterans and Their Families at Rush in Chicago; Emory’s Veterans Program at Emory University in Atlanta; The Red Sox Foundation and Massachusetts General Hospital Home Base Program in Boston; and Operation Mend Program at the University of California, Los Angeles. Counting the Wounded Warrior Project grant, as well as the matching funds that each institution will secure, a total of $100 million will be invested in the four programs to serve veterans. Rush’s Road Home Program will receive $15 million through a three-year challenge grant from Wounded Warrior Project, which will make matching contributions of $2 for every dollar Rush secures for the Road Home Program, up to $2.5 million a year raised by Rush. Each of the other network partners also will raise an additional $7.5 million for the initiative. A $15 Million JumpstartThe Road Home Program will use these grant funds and the philanthropic gifts and in-kind resources they match to expand its existing center and develop an intensive outpatient evaluation and treatment program. “In establishing this national network, Wounded Warrior Project will catalyze a profound expansion of our collective efforts,” noted Dr. Mark Pollack, Grainger professor and chairman of the Rush Department of Psychiatry. “In partnership with our colleagues, we will better serve veterans and families in the Midwest and across the country.” The treatment program will integrate behavioral health care, rehabilitative medicine, wellness, nutrition, mindfulness training and family support. Through this cutting-edge initiative, Wounded Warrior Project and its partners plan to serve thousands of wounded veterans and family members over the next three years. “The program will pinpoint veterans’ and families’ needs and identify tools to help with specific problems and jumpstart the healing,” explained Ellen McElligott, outreach coordinator at Road Home Program and a former U.S. Navy lieutenant commander. “Veterans and family members will be able to stay at Rush’s campus while taking part in the program.” Offering the Road HomeRush launched the Road Home Program in 2014 and to date has treated nearly 200 veterans and family members for a range of issues related to military service. These conditions include post-traumatic stress disorder, military sexual trauma, traumatic brain injury, child and family counseling, and other specific psychological and emotional needs. Road Home also offers public awareness programming and training for primary care physicians and others to more effectively interact with and treat military personnel. “Last year, Rush opened the doors of the Road Home Program, dedicating a unique combination of resources to address the emotional and physical repercussions of combat injury for veterans as well as their family members,” said Dr. Larry Goodman, chief executive officer, Rush University Medical Center. “In keeping with our long-standing commitment to the Chicago area community, Rush recognized an opportunity to contribute its clinical expertise to assuring veterans and their families timely access to evidence-based care for post-traumatic stress disorder, traumatic brain injury and related conditions. The Road Home Program functions as a regional health care hub, reinforcing the continuum of care in collaboration with VA and other providers as well as social service and educational organizations.” Several aspects set Road Home apart from many other veterans’ service providers. “We recognize family from an open and expansive perspective. A girlfriend, neighbor or friend could be part of a veteran’s family, as well as parents, spouses and children,” says Will Beiersdorf, the program’s executive director. In addition, veterans can receive services at Road Home regardless of their discharge status or ability to pay. “If a man or woman has put on the uniform, we will try to help him or her,” said Beiersdorf. The program comprises staff, including veterans, with expertise in physical and psychological conditions, as well as wellness practices. Road Home is flexible and willing to craft services specific to the needs. The Road Home ConnectsRoad Home has built strong relationships with Chicago-area Veterans Affairs institutions. VA offices refer veterans to Road Home, and likewise Road Home connects people to resources at the VA. Many referrals have come from veterans themselves. A major reason why the program saw close to double the expected number of patients in its first year is the trust built by veterans working at Road Home — those who deeply understand the struggles fellow military personnel face. “The fact that vets coming in are really benefiting from the care, and they believe in Road Home so much to stand behind us to bring in other vets, is a special thing,” McElligott says. “This is the first time since I left the military that I feel as if I’m actually making a difference.”
Cedit Newswise — ‘They were my age.’Milwaukee journalism students research lives, unearth photos of Vietnam dead A team of University of Wisconsin-Milwaukee journalism students took on an unusual research project this spring – helping find the missing photos and stories of Wisconsin soldiers killed in Vietnam. With help from other volunteers, they succeeded in finding the final 64 missing photos of Wisconsin soldiers by Memorial Day Weekend. Their efforts were part of the Faces Never Forgotten project, a national effort to find approximately 17,300 missing photos for a digital Wall of Faces planned for the new Vietnam veterans Education Center at The Wall in Washington, D.C. Organizers hope that photos will be found to accompany all 58,300 names listed on the Vietnam Memorial Wall. (The photos found so far are online at http://www.vvmf.org/Wall-of-Faces) The Wisconsin project was completed just befoCrre Memorial Day when relatives confirmed that an old Milwaukee North Division High School yearbook photo showed Willie Bedford, the final image missing of the 1,161 Wisconsin service members who died in Vietnam.(Read student Rachel Maidl’s account of her search for the last image here: http://go.uwm.edu/1Ew04Il)With that confirmation, Wisconsin became the sixth state, and largest so far, to collect photos of all its service members killed in Vietnam. “The Wisconsin effort has been by far the most efficient and the most successful,” said George DeCastro, coordinator of the Faces Never Forgotten Program. “The high level of coordination and cooperation between all parties involved was astounding. And, of course, your students and all of the other volunteers are the ones who actually got it done.”Andrew Johnson, publisher of the Dodge County Pionier in Mayville, Wisconsin, spearheaded Faces Never Forgotten in Wisconsin. Jessica McBride, senior journalism lecturer at UWM, got her JAMS 320: Integrated Reporting classes involved after meeting Johnson in February 2015. ‘Stories that matter’“I thought it was an excellent way to teach basic research and storytelling skills, as well as the role the media can play in communities,” said McBride. “I want students to work on stories that matter. It’s moving how they embraced this cause.” UWM, which enrolls more veterans than any other university in the state, was also a natural fit for the project. When the journalism class got involved in February 2015, 64 Wisconsin soldiers’ photos were missing. Even after the semester ended in mid-May, McBride and several students continued their search for the remaining photos with the help of other volunteer researchers. North Dakota, South Dakota, New Mexico and Wyoming also have located all the missing photos, and Iowa is down to one missing, according to DeCastro. Johnson had two very personal reasons for getting involved. The Education Center at The Wall also will project photos of the nearly 8,000 service members killed in action since Sept. 11. One of those soldiers is Johnson’s son, U.S. Army 1st Lt. David Johnson, who was killed in Afghanistan in January 2012. Andrew Johnson says Vietnam veterans, like those in the Patriot Guard, have been supportive of his family as they mourned David’s death. Patriot Guard members helped lead his son’s funeral procession and accompanied Lt. Johnson’s casket up until his burial at Arlington National Cemetery. “Photos are so important in making a person ‘real,’” Johnson explains, adding that there are few photos of many of the soldiers who fought in the unpopular Vietnam War. Further compounding the problem is the 1973 fire at the National Personnel Records center that destroyed approximately 16-18 million official military personnel files. When Johnson first got involved in the project, 400 photos from Wisconsin were missing. Journalism students at UWM pored over cemetery records, checked phone directories and yearbooks, looked through veteran memorial sites and tracked down surviving family and friends any way they could – email, telephone, the U.S. Postal Service and in-person. Along the way, they got help from other volunteers: a veteran, a retired newspaper editor, a writer, a historical researcher, teachers and school officials who searched records and yearbooks, and a leader of the Wisconsin Association of Black Genealogists, who was also a UWM student. Mourning sons, remembering friendsThe research trail was often long and difficult. Senior Justin Skubal’s soldier, Thomas Shaw, had left a widow, but she and Shaw’s mother had both remarried and tracking stepsiblings was challenging. Fellow senior Jonathan Powell agreed: “It’s difficult to dig up information when people remarry, and sometimes families seem to fall apart after a death.” The project gave the students new insights into the sacrifices these and other soldiers had made. Skubal said he understands better why his stepfather, a Vietnam veteran, awoke some mornings startled and shaking Students heard stories from families about the devastating impact of their losses; fellow soldiers told them details of the battles and seeing their buddies die.“This was way more than a class assignment,” says Powell. Echoing Johnson, he adds, “A soldier never dies unless he’s forgotten.” “When we started this project, I thought about these Vietnam soldiers as old men, but they were my age, or my brother’s age,” says UWM junior Amanda Porter, who tracked down Sgt. Nathaniel Merriweather’s story and photo through cemetery records, help from the mayor of the small Tennessee town where Merriweather is buried, and an army buddy who remembered him. Touching an obituary photo of Merriweather on her computer screen, she said: “It gave me a warm feeling, but really sad. I’m grateful that they are going to be remembered and I was part of that.” McBride, Johnson and the students were impressed by all those who have helped. “This is a community effort. That’s what stands out to me,” McBride wrote in a May 20 story for “OnMilwaukee.com.” “Younger generations and old have come together to find these. Students and veterans. Black, Latino, American Indian and white. Republican and Democrat. This is a community effort. And, to me, that means this exemplifies Wisconsin at its finest.”
Credit Newswise — Health care systems and providers need to understand the unique realities of military culture in order to work effectively with veterans and military families, according to the findings of a study by a University at Buffalo research team. Results of the paper published in the journal Military Behavioral Health suggest that health care and mental health care providers and staff should receive training that provides them with enough knowledge to understand the military’s culture and values and how that belief system also affects the veterans’ transition from a service member identity to a civilian identity. The paper is among the first to also document the necessity of addressing the many difficulties facing military families in the community, everything from challenges arising when family members are deployed to their return home following their discharge. “Military service – and combat experience in particular – is a profound life experience that many civilians do not understand – and veterans are well aware of this,” says Lisa Butler, associate professor in the UB School of Social Work and the paper’s first author. Using four different focus groups – two male veterans groups, one female veterans group and one comprised of veterans’ family members – the researchers asked about the collective health care experience and what participants perceived to be the gaps and needs in health care and mental health care provision. The research team used a sample of veterans in the community rather than one recruited from patients in the U.S. Department of Veterans Affairs (VA) health care system.“The VA research is important, but we don’t know if those findings can be generalized across the entire veteran population,” says Butler, who is also the principal investigator of Joining Forces-UB, a team comprised of UB faculty and staff from the schools of Social Work and Nursing who are collaborating to better address the needs of veterans and military families through research and by developing training programs for students in both schools. “Many people do not realize that only about one in three veterans turn to the VA for their health and mental health care and that most research on veterans is conducted with those in the VA system. This is why the research mission of our Joining Forces-UB project is so unique – we are seeking to better understand the needs of all veterans and military families by conducting community-based research.”Butler says health care and mental health care providers require what Joining Forces-UB is calling “military/veteran cultural competence.” “Just as you want to be culturally competent working with any population, with veterans it is particularly important because they may shut you out if they suspect a lack of understanding. They’ll walk away.” A military service history can have wide-ranging effects on a veteran’s life, according to Butler. Veterans feel the framework from which they emerge is not appreciated by the population at large and she says that shortcoming may create obstacles for health care providers that make it difficult for them to understand a veteran’s health care needs. “Providers who bring military/veteran cultural competence to their interactions with veterans have the potential to enhance outcomes and increase quality of care. This is in addition to preventing veterans from walking away from care that may be beneficial,” says Braden Linn, a doctoral candidate in the UB School of Social Work and one of the paper’s co-authors, along with Mary Ann Meeker, associate professor in the UB School of Nursing, Katie McClain-Meeder, project manager on Joining Forces-UB, and Thomas Nochajski, research professor in the UB School of Social Work.But the questions that might fill the gaps and satisfy the needs of veterans often go unasked because of the absence of that cultural competence. Butler says that outside of Veterans Affairs hospitals, asking about military service is rarely part of a patient’s intake.“Providers outside of the VA often don’t think about a client having military experience or how that service might affect the veteran’s presenting condition; how to treat them; or how they’ll respond to treatment,” she says. “The critical issue is to ask about past military service, and then follow up with questions about hazardous exposures that are known to be specific to their era of service – these are listed on the VA’s website. It is also important to have a basic knowledge of military culture and what that could mean for how veterans approach their health care.” Even the paper’s title, “We don’t complain about small things,” alludes to an ideal obvious to veterans that health care providers don’t always grasp.“That’s a quote from a veteran,” says Butler. “She was speaking to the lack of understanding often present in health care. She was saying that it takes a lot for a veteran to seek help and so a medical complaint should never be viewed as trivial.”She says that veterans are proud of their toughness but it can make it difficult for them to seek services. “Cultivating military/veteran cultural competence can help providers deliver better care—care that acknowledges the veteran’s unique history and its significance in a veteran’s life even after they transition to the civilian world,” says Butler. “If providers don’t understand that, they won’t be as effective in the care they provide.”
PENN NURSING AWARDED GRANT FROM JONAS CENTER FOR NURSING AND VETERANS HEALTHCARE TO FUND DOCTORAL NURSING STUDENTS
Credit Newswise — The University of Pennsylvania School of Nursing (Penn Nursing) today announced that with a new grant of $60,000 from the Jonas Center for Nursing and Veterans Healthcare, matched by $40,000 of its own monies, it will fund the scholarship of five doctoral nursing students in 2016. As a recipient of the Jonas Center grant, Penn Nursing is part of a national effort to stem the faculty shortage and prepare the next generation of nurses – critical as a clinical nurse shortage is anticipated just as an aging population requires care. The Penn Nursing Jonas Scholars join more than 1,000 future nurse educators and leaders at 140 universities across all 50 states supported by Jonas Center programs, the Jonas Nurse Leaders Scholars Program and Jonas Veterans Healthcare Program (JVHP). These scholarships support nurses pursuing PhDs and DNPs, the terminal degrees in the field. As the nation’s leading philanthropic funder of graduate nursing education, the Jonas Center is addressing the critical need for qualified nursing faculty. U.S. nursing schools turned away nearly 70,000 qualified applicants from baccalaureate and graduate nursing programs in 2014 due in large part to an insufficient number of faculty . Further, nearly two-thirds of registered nurses over age 54 say they are considering retirement . “In 2008, we set an ambitious goal to support 1,000 Jonas Nurse Scholars. This year, on our Center’s 10th anniversary, we celebrate this achievement and are amazed by the talent of this cohort of future nurse leaders,” said Donald Jonas, who co-founded the Center with Barbara Jonas, his wife. “In the decade to come, we look forward to continuing to work with our partner nursing schools and to the great impact that the Jonas Scholars will have on improving healthcare around the world.”The Penn Nursing Jonas Scholars will begin their graduate careers in the fall and will be supported through 2018. ###About the University of Pennsylvania School of Nursing The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing and is ranked the #1 graduate nursing school in the United States by U.S. News & World Report. Penn Nursing is consistently among the nation’s top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through research, education, and practice.
VETERANS AND CIVILIAN PATIENTS AT RISK OF ICU-RELATED PTSD UP TO A YEAR FOLLOWING HOSPITAL DISCHARGE
Credit Newswise — One in ten patients is at risk of having new post-traumatic stress disorder (PTSD) related to their ICU experience up to a year post-discharge. This was the finding from a multicenter, prospective cohort research study of veterans and civilians. The research was published online ahead of print in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. In the study “Incidence and Risk Factors for ICU-related Posttraumatic Stress Disorder in Veterans and Civilians,” researchers led by Mayur Patel, MD, MPH, FACS, Assistant Professor of Surgery & Neurosurgery at Vanderbilt University Medical Center and Staff Surgeon and Surgical Intensivist at the Nashville VA Medical Center, analyze data from a cohort of medical and surgical ICU survivors enrolled in studies from three Veterans Affairs hospitals (MIND-ICU Study, NCT00400062) and one civilian hospital (BRAIN-ICU Study, NCT00392795). Using the PTSD Checklist for the DSM-IV to determine PTSD for this study, among PTSD measurements listed by the U.S. Department of Veteran Affairs’ National Center for PTSD, a total of 181 patients were assessed at three months and 160 were further assessed at 12 months. The cumulative incidence of PTSD was 6 percent to 12 percent within one year following hospitalization. “Although lower than prior research and public perception suggests, the rate of ICU-related PTSD is very comparable to the 8 percent PTSD rates seen in current and former service members deployed to the recent Iraq and Afghanistan conflicts,” Patel said. “It is important to understand more about PTSD following the traumatizing events of a critical illness so we can better support the growing number of ICU survivors.” PTSD can occur in patients after the traumatizing events of critical illness, and this study provides estimates on new cases of PTSD stemming specifically from the ICU experience. Pre-existing PTSD has rarely been systematically assessed in prior cohorts, and this study took extra effort to distinguish pre-existing PTSD from new PTSD cases. Civilian populations have dominated the literature of PTSD after critical illness, and this study is the first to also include the expanding and aging Veteran population. Assessing risk factors for ICU-related PTSD, the researchers found that pre-existing PTSD as well as prior depression were strong risk factors associated with ICU-related PTSD at three and 12 months post-discharge. Being a veteran did not increase risk of ICU-related PTSD, nor did duration of delirium, amount of pain medication, or amount of sedative. “Currently, the international psychological aftercare for ICU survivors is not organized proactively; rather, it is largely reactive in response to disabling reports from survivors, caregivers, and primary care providers. The Institute of Medicine in the United States has recommended a systematic collection, analysis, and dissemination of data assessing the quality of post-conflict PTSD care in the military and veteran populations. We suggest that the same should apply to the large civilian and veteran populations of critically ill survivors,” the authors advised.
Credit Newswise — BIRMINGHAM, Ala. – As the daughter of a 27-year veteran of the U.S. Air Force, and herself an intensive care nurse for more than 20 years, University of Alabama at Birmingham School of Nursing Professor Jacqueline Moss, Ph.D., is familiar with the U.S. military and caring for its veterans. In a research partnership with the Veterans Health Administration, Moss has sought to understand veterans’ struggles and to help find ways to address their issues. As an educator of nurses, she has worked to teach others that they must be specially attuned to recognizing and caring for this group. To improve awareness of veterans’ health care needs, Moss collaborated with colleagues, Associate Dean for Clinical and Global Partnership and Professor Cynthia Selleck, Ph.D., and Assistant Professor Randy Moore, R.N., to develop a set of competencies designed to help new nurses be better prepared to identify and assist veterans and their families across the health care continuum. The resulting research paper, “Veteran Competencies for Undergraduate Nursing Education,” was published in the October/December 2015 issue of Advances in Nursing Science and is featured as an “Editor’s Pick” on the journal’s website. “There are 23 million military veterans living in the United States, and more than 16 percent have service-connected disabilities, yet only about 38 percent of those receive any portion of their health care at a VA facility,” Moss said. “That means 62 percent are receiving care at community hospitals, university medicals centers, local clinics and the like. So any nurse anywhere can encounter a veteran.” In clinical settings outside the VA, Moss says, a veteran’s prior military service often is not recognized — or even mentioned — so a nurse can be unaware of potential issues related to a patient’s military service that can arise. “Veterans come with unique backgrounds and needs, and it is imperative that nurses are adequately prepared to care for veteran patients and their families, regardless of the setting in which they practice,” Moss added. Using the Quality and Safety Education for Nursing Competencies as a framework, Moss and her colleagues developed a set of 10 competencies and associated knowledge, skills and attitudes new nurses need to be able to adequately care for veteran patients and their families. The QSEN Competencies are guidelines that have been developed as part of a national project to prepare future nurses with the knowledge, skills and attitudes to continuously improve the quality and safety of the health care systems in which they work, and provide the best care possible for the patients they serve. The overall competencies are: • Military and veteran culture• Post-traumatic stress disorder• Amputation and assistive devices• Environmental and chemical exposures• Substance use disorder• Military sexual trauma• Traumatic brain injury• Suicide• Homelessness• Serious illness at end of life At their core, the competencies are the basic tools nurses need to help them recognize veterans, recognize whether they have a problem, and determine whether they can address it themselves or need to refer it to someone else. “Wherever you practice, you are going to encounter veterans,” Moss said. “Understanding their experiences and knowing what to look for, how to intervene and when to refer are extremely important skills for nurses, and we want to do our best to make sure they have these skills.” The UAB School of Nursing and its faculty are uniquely positioned for this and other veteran health care research. The school has a strong working relationship with the U.S. Department of Veterans Affairs, which since 2009 has included the VA Nursing Academic Partnership in conjunction with the Birmingham Veterans Affairs Medical Center. This partnership — which won the 2015 American Association of Colleges of Nursing Exemplary Academic-Partnership Award — is part of an initiative to facilitate stronger and mutually beneficial ties between schools of nursing and VA Medical Centers across the country, and it has provided unique insights that shaped the competencies. This is something Moss hopes other schools of nursing and health care institutions hiring new graduates will note as they consider implementing the work. “We hope schools of nursing will take these competencies and knowledge, skills and attitudes and see where they might be able to implement either some or all of these suggestions into their curriculum,” Moss said. “We also hope institutions that are hiring new graduates may also look and see where they might be able to incorporate them into their new-hire orientations.”
Back in 2005, Kristofer Goldsmith thought he was prepared for war. Then just 19-years-old, the Army sergeant deployed to Iraq with the Third Infantry Division. It was a moment that he had been waiting years for. “I wanted nothing more but to be in the military my entire life, from the time that I was a little kid,” he says. Goldsmith’s assignment was to act as a documentarian and intelligence collector for his platoon. He wound up photographing mass graves, and dead Iraqi police officers and children. “It was something that I wasn’t prepared to deal with,” he says. “Even when I got home, PTSD was little more than an acronym to me—I didn’t understand what it meant. I didn’t understand the way that it would haunt me for years, and possibly the rest of my life.” In 2014, more than 530,000 service members received treatment for post-traumatic stress disorder (PTSD) at facilities run by the U.S. Department of Veterans Affairs. Before he even left the military, Goldsmith says that PTSD began to affect his life. He was written up in 2007 for missing his flight to Baghdad for his second deployment. The reason why Goldsmith wasn't on that plane? He was in a hospital after attempting suicide the night before. Goldsmith was hit with a misconduct charge for missing that flight, and he was subsequently forced out of the military with a general discharge—one rung below the honorable discharge that entitles veterans to full benefits. Because of his discharge status, he’s been denied access to healthcare services from the Department of Veterans Affairs (VA). “The Army knew why I missed my flight—when I survived my suicide attempt it was at Fort Stewart, Georgia, and I was found by military police,” he says. “I struggled for a year and a half, getting almost no help at all from the Army when I was asking for it, desperately.” But Goldsmith’s case is not unique. Though 85 percent of the more than 2.5 million veterans of the Iraq and Afghanistan wars have been released from their service with honorable discharges, 300,000 have been forced out of the military with less-than-honorable discharges. The U.S. government has acknowledged that some of these discharges were the result of PTSD. Goldsmith says that the military could have prevented his suicide attempt but failed to act when his cries grew louder. “Even when I told an Army psychiatrist that I was thinking about suicide, she told me that I had three choices,” he says. “She told me that I could one, suck it up, be a man, and I could deploy; two, I could go AWOL and live like a convicted felon for the rest of my life; or three, I could give up and commit suicide. Those were the suggestions that an Army psychiatrist offered me when I told her how I was feeling after struggling for so long with nightmares from Iraq.” When Goldsmith approached the U.S. military and asked that his discharge status be changed because of his untreated PTSD, the Army reject his appeal. He has spent the last eight years trying to get Washington to recognize that PTSD is often the source of the behavior that gets many vets pushed out. Congress has tried to put a stop to this practice—Section 512 of the 2009-2010 National Defense Authorization Act says that the Defense Department may not issue a discharge other than honorable if the service member has been diagnosed with PTSD or a traumatic brain injury. But since 2009, over 20,000 soldiers with mental health problems have been dismissed for misconduct. Without an honorable discharge, veterans cannot receive VA healthcare benefits. "I think it's damn near criminal that you could take a person, send them to war, they come home sick, and then you don't even provide them healthcare once they get home," Goldsmith says. In 2014, former Defense Secretary Chuck Hagel took things a step further and attempted to amend the rules regarding PTSD and discharge status. But Goldsmith says Hagel’s memo primarily focused on Vietnam-era veterans. “Secretary Hagel’s memorandum was too narrow—it doesn’t effect my generation at all,” he says. “Today, the discharge review boards, they’re still not recognizing PTSD the way Secretary Hagel intended.” Goldsmith says lawmakers in the House and Senate are signing on to the Fairness For Veterans Act, which he says will be formally introduced at the end of this week. He hopes to get others to sign on on to the bill, and is trying raise awareness among the public. “We could use all the help in the world,” he says. Click Here to see full story Credit The Take Away