Missionary Renegade: Women Veterans: Help for Postpartum Depression for Tuesday, 16 May 2017

Tuesday, May 16, 2017

Women Veterans: Help for Postpartum Depression for Tuesday, 16 May 2017 - Washington, D.C., United States

Women Veterans: Help for Postpartum Depression for Tuesday, 16 May 2017 - Washington, D.C., United StatesVeterans Health Administration Update
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VETERANS HEALTH ADMINISTRATION
UPDATE

Inside Veterans Health
Women Veterans: Help for Postpartum Depression
Pregnant Women Veterans have an increased likelihood of a mental health issue and a higher risk for postpartum depression. Learn the symptoms and treatment options from VA's Women's Health Services. Read the full story

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Healthcare Inspection – Alleged Pathology and Laboratory Medicine Service Quality of Care Issues, Wilmington, VA Medical Center, Wilmington, Delaware - Veterans Affairs Office of Inspector General (OIG) - Washington, D.C., United States

Healthcare Inspection – Alleged Pathology and Laboratory Medicine Service Quality of Care Issues, Wilmington, VA Medical Center, Wilmington, Delaware

OIG conducted a healthcare inspection to evaluate allegations that a pathologist misread oncology test results, did not complete pathology tests timely, inappropriately sent some tests outside the facility on a fee for service basis, and altered pathology reports from alternate Veterans Health Administration (VHA) and non-VHA laboratories to make it appear as though he performed the tests at the facility laboratory. We could not substantiate that the pathologist misread oncology tests. We reviewed electronic health record data, and found that the pathologist replaced preliminary pathology results with final results; therefore initial test results were not available for comparison to final test results or to the facility’s data. We interviewed oncology staff who could not recall any instances of misread tests. We substantiated that the pathologist did not always have pathology test results available to ordering providers within required timeframes and had, with facility leadership approval, sent specimens to Fee Basis vendors for processing. We did not substantiate that the pathologist altered reports of pathology tests. However, we discovered inconsistent documentation identifying non-VHA pathologists on final pathology reports and incomplete documentation for specimens sent to alternate VHA and non-VHA laboratories. We found that the pathologist utilized a non-VHA laboratory to process pathology tests without a required VHA contractual arrangement and inappropriately revised a facility laboratory standard operating procedure. In addition, oversight services and committees did not consistently report accurate statistical and performance information to facility leadership, and did not complete and monitor internal review action plans and ongoing professional performance evaluations using current facility performance data. We recommended that the Facility Director ensure the use of acceptable processing procedures for pathology testing; that staff follow facility documentation requirements for non-Veterans Health Administration laboratory pathology reports; that the pathology tests performed at the unofficial non-Veterans Health Administration laboratory are reviewed; that oversight service and committees review current performance data and follow VHA and facility quality assurance policies and practices; and that facility managers complete ongoing professional performance evaluations and other internal reviews as required by VHA and facility policies.
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Pain, pain, go away: Improving care and safety when managing pain - Military Health System - Washington, D.C., United States

Pain, pain, go away: Improving care and safety when managing pain
Recently published opioid therapy clinical practice guideline focuses aims to improve quality of care and patient safety when treating acute and chronic pain (U.S. Air Force photo by Airman Valerie Monroy).

ou’re in pain, and it’s not going away. You go to your doctor wondering if there’s a way to relieve it, and you rest easy knowing you’re in good hands. With patient safety as a top priority, the Department of Defense and Department of Veterans Affairs have updated their clinical guidance on opioid therapy used to manage chronic pain.

“There has been a rapid advancement in the science and the knowledge of opioid therapy, and of the risks associated with it,” said Dr. Christopher Spevak, director of the National Capital Region Opioid Safety Program and a provider at Walter Reed National Military Medical Center in Bethesda, Maryland.

Updated every five years - available online and in a “pocket card” version - this clinical practice guideline is a tool that helps providers better manage the use of powerful drugs. It serves as a resource rather than a standard of care by helping doctors set reachable goals while coming up with treatment plans for their patients.

The updates in the 2017 guideline reflect a continued commitment to beneficiaries for safety and safe opioid prescribing, which will result in better quality of care, said Spevak. Since opioids like Vicodin, OxyContin, and morphine are powerful pain relievers, they can lead to dependence, misuse, or overdose if they’re not managed properly. Some of the most important updates to the recommendations include avoiding long-term opioid prescriptions for patients under the age of 30 and putting strategies in place to lessen risk.

The guideline also recommends helping patients manage their pain symptoms through non-drug and non-opioid treatments whenever possible. This can include a range of options, such as behavioral health, mental health, or physical approaches, and non-opioid based medications.

Army Lt. Col. Robert Brutcher, deputy director of the Department of Pharmacy at Walter Reed in Bethesda, supports the use of alternative approaches to care for chronic pain.

“The goal of updating recommendations is to help providers improve the quality of the care for patients who experience chronic pain,” said Brutcher, describing the new approach to pain management as holistic.

Physicians may discuss alternative pain therapies and remedies with their patients. By focusing less on strong pain medication, surgery or other treatment options, patients can work with doctors to learn how to self-manage their pain, which can lead to better quality of life, increased physical function, and improved pain coping skills.

That’s not to say prescriptions are discouraged in all cases. When patients start, or continue, opioid therapy, doctors are encouraged to evaluate the risks and benefits of this treatment plan every three months. The guideline encourages providers to start opioid therapy when needed for a short amount of time with the lowest dose allowed depending on a patient’s needs and health risks. Risk strategies for patients who are already on long-term treatment plans include overdose education and random urine drug testing.

“As research evolves and more evidence becomes available,” said Brutcher, “you have to adapt treatment strategies, and health care has to change with the information available. We’re trying to look out for what’s best for the patient.”

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Innovative scanner designed to save Marines' lives on the battlefield

Mark Urrutic, project officer for Family of Field Medical Equipment Team at Marine Corps Systems Command, uses an Infrascanner to locate a simulated hematoma on a mannequin's skull. The Infrascanner is a portable, medical diagnostic device that provides early detection of intracranial hematomas-or bleeding within the skull-in the field, potentially saving lives and improving casualty care and recovery. (U.S. Marine Corps photo by Ashley Calingo) by: Ashley Calingo

MARINE CORPS BASE QUANTICO, Va. — Marine Corps Systems Command is bringing innovative, life-saving and award-winning technology to Marines on the front line.

The Infrascanner is a portable, medical diagnostic device that provides early detection of intracranial hematomas – or bleeding within the skull – in the field, potentially saving lives and improving casualty care and recovery. The handheld device uses near-infrared light – invisible light that is nearly visible to the naked eye – to effectively check for intracranial hematomas on different parts of the skull. With the device, medical personnel at battalion aid stations can quickly assess Marines who may have suffered a head injury.

“Intracranial hematomas – if gone untreated – can put pressure on the brain, causing potential brain damage or even death,” said Mark Urrutic, project officer for the Family of Field Medical Equipment Team at MCSC. A retired Navy chief hospital corpsman, Urrutic is familiar with the scenarios Marines face that can lead to this type of injury.

“Marines can sustain these types of injuries by falling and hitting their heads, or by being in close proximity to a blast, which could damage the brain by rattling it within the skull,” he said.

Successful treatment of traumatic brain injuries often relies on timely diagnosis and intervention to prevent long-term brain damage. Because serious brain injuries can sometimes be asymptomatic, meaning there are no outward signs of injury and those injured report feeling “fine,” it is important to detect these types of injuries quickly, said Urrutic.

Prior to the fielding of the Infrascanner in 2015, the Marine Corps did not have the technological capability to assess brain injuries on the battlefield. Medical personnel instead relied primarily on the Military Acute Concussion Evaluation, a questionnaire and screening tool gauging the severity of symptoms and potential cognitive deficits associated with concussions.

“Before the Infrascanner, all we could do to assess brain injuries in the field was complete a MACE form. For more definitive care, we would perform a [Computed Tomography] CT scan, a series of high-resolution X-rays, to look for any kind of brain squishing in from blood,” said John Philpott, Medical Team engineer at MCSC. “No capability like this existed before the Infrascanner.”

While most hospitals have state-of-the-art CT scanners to diagnose intracranial hematomas, remote battlefield facilities lack the necessary capabilities to diagnose this condition due to the size and logistics of transporting and operating one in the field. Marines with a potential brain injury would need to be flown out to another facility to receive the scan and subsequent treatments. With the Infrascanner, corpsmen in the field can quickly determine whether someone has suffered serious brain trauma and needs additional treatment.

“This isn’t going to replace the CT scan,” said Philpott. “In addition to helping us determine if Marines have suffered brain injuries, it can help us rule out Marines who haven’t. So, Marines who aren’t suffering from a brain hematoma can get back to the action sooner, rather than having to send every Marine back for a CT scan, which uses time and resources.”

The Infrascanner project started as a small business innovation research grant before successfully being transitioned into a program of record at MCSC. In recognition for their efforts, the Infrascanner team at MCSC received the Department of the Navy’s 2016 Ron Kiss Maritime Technology Transition Award. The award recognizes the individual or team in the defense acquisition community for outstanding achievement as a result of successfully transitioning a technology into a program of record or into operational use.

“As systems engineers, we serve as the middle man between the users and developers,” said Philpott. “We need to make sure that, at the end of the day, the product that is delivered meets our requirements, not just for us, but for our sailors and Marines.”

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.