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Marcewicz LJ, O'Neill LB, Sigler LE. Caring for Veterans with Serious Illness. Clin Geriatr Med 2023; 39:417-422. [PMID: 37385693 DOI: 10.1016/j.cger.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
US Veterans comprise approximately 7% of the population. About half of these Veterans seek care within the Department of Veterans Affairs; the other half receive their health-care services in the wider community. Community providers should be familiar with the unique needs of Veterans and the resources that exist to provide care for them. This article discusses the unique culture of Veterans, conditions that are more common among Veterans and the challenges these conditions may pose, and the resources available to Veterans through the Veterans Health Administration.
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Affiliation(s)
- Lawson J Marcewicz
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA.
| | - Lynn B O'Neill
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Lauren E Sigler
- Department of Veterans Affairs, Atlanta Veterans Affairs Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, 1821 Clifton Road Northeast, Atlanta, GA 30329, USA
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Samuelson KW, Abadjian L, Jordan JT, Bartel A, Vasterling J, Seal K. The Association Between PTSD and Functional Outcome Is Mediated by Perception of Cognitive Problems Rather Than Objective Neuropsychological Test Performance. J Trauma Stress 2017; 30:521-530. [PMID: 29030878 DOI: 10.1002/jts.22223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/13/2017] [Accepted: 06/21/2017] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been consistently linked to poorer functional outcomes, including quality of life, health problems, and social and occupational functioning. Less is known about the potential mechanisms by which PTSD leads to poorer functional outcomes. We hypothesized that neurocognitive functioning and perception of cognitive problems would both mediate the relationship between PTSD diagnosis and functioning. In a sample of 140 veterans of the recent wars and conflicts in Iraq and Afghanistan, we assessed PTSD symptoms, history of traumatic brain injury (TBI), depression, self-report measures of quality of life, social and occupational functioning, and reintegration to civilian life, as well as perception of cognitive problems. Veterans also completed a comprehensive neuropsychological battery of tests. Structural equation modeling revealed that perception of cognitive problems, but not objective neuropsychological performance, mediated the relationship between PTSD diagnosis and functional outcomes after controlling for TBI, depression, education, and a premorbid IQ estimate, b = -6.29, 95% bias-corrected bootstrapped confidence interval [-11.03, -2.88], showing a large effect size. These results highlight the importance of addressing appraisals of posttrauma cognitive functioning in treatment as a means of improving functional outcomes.
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Affiliation(s)
- Kristin W Samuelson
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Linda Abadjian
- San Francisco VA Health Care System, Department of Mental Health, San Francisco, California, USA
| | - Joshua T Jordan
- Alliant International University, Department of Clinical Psychology, San Francisco, California, USA
| | - Alisa Bartel
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Jennifer Vasterling
- National Center for PTSD, VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen Seal
- San Francisco VA Health Care System, Department of Mental Health, San Francisco, California, USA.,Department of Medicine and Psychiatry, University of California, San Francisco, California, USA
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Caring for veterans in the private sector. JAAPA 2015; 28:23-7. [DOI: 10.1097/01.jaa.0000471614.84655.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saban KL, Hogan NS, Hogan TP, Pape TLB. He Looks Normal But … Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury. Rehabil Nurs 2015; 40:277-85. [DOI: 10.1002/rnj.182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/07/2022]
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Carrick FR, Pagnacco G, McLellan K, Solis R, Shores J, Fredieu A, Brock JB, Randall C, Wright C, Oggero E. Short- and Long-Term Effectiveness of a Subject's Specific Novel Brain and Vestibular Rehabilitation Treatment Modality in Combat Veterans Suffering from PTSD. Front Public Health 2015; 3:151. [PMID: 26082920 PMCID: PMC4450724 DOI: 10.3389/fpubh.2015.00151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/15/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Treatment for post-traumatic stress disorder (PTSD) in combat veterans that have a long-term positive clinical effect has the potential to modify the treatment of PTSD. This outcome may result in changed and saved lives of our service personnel and their families. In a previous before-after-intervention study, we demonstrated high statistical and substantively significant short-term changes in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores after a 2-week trial of a subject's particular novel brain and vestibular rehabilitation (VR) program. The long-term maintenance of PTSD severity reduction was the subject of this study. MATERIAL AND METHODS We studied the short- and long-term effectiveness of a subject's particular novel brain and VR treatment of PTSD in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. We analyzed the difference in the CAPS scores pre- and post-treatment (1 week and 3 months) using our subjects as their matched controls. RESULTS The generalized least squares (GLS) technique demonstrated that with our 26 subjects in the 3 timed groups the R (2) within groups was 0.000, R (2) between groups was 0.000, and overall the R (2) was 0.000. The GLS regression was strongly statistically significant z = 21.29, p < 0.001, 95% CI [58.7, 70.63]. The linear predictive margins over time demonstrated strong statistical and substantive significance of decreasing PTSD severity scores for all timed CAPS tests. DISCUSSION Our investigation has the promise of the development of superior outcomes of treatments in this area that will benefit a global society. The length of the treatment intervention involved (2 weeks) is less that other currently available treatments and has profound implications for cost, duration of disability, and outcomes in the treatment of PTSD in combat veterans.
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Affiliation(s)
- Frederick Robert Carrick
- Carrick Institute , Cape Canaveral, FL , USA ; Global Clinical Scholars Research Training Program, Harvard Medical School , Boston, MA , USA ; Neurology, Carrick Brain Center , Dallas, TX , USA
| | - Guido Pagnacco
- Carrick Institute , Cape Canaveral, FL , USA ; Electrical and Computer Engineering, University of Wyoming , Laramie, WY , USA
| | - Kate McLellan
- Carrick Institute , Cape Canaveral, FL , USA ; Neurology, Carrick Brain Center , Dallas, TX , USA
| | - Ross Solis
- Neurology, Carrick Brain Center , Dallas, TX , USA
| | - Jacob Shores
- Neurology, Carrick Brain Center , Dallas, TX , USA
| | | | | | | | - Cameron Wright
- Carrick Institute , Cape Canaveral, FL , USA ; Electrical and Computer Engineering, University of Wyoming , Laramie, WY , USA
| | - Elena Oggero
- Carrick Institute , Cape Canaveral, FL , USA ; Electrical and Computer Engineering, University of Wyoming , Laramie, WY , USA
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Baldassarre M, Smith B, Harp J, Herrold A, High WM, Babcock-Parziale J, Louise-Bender Pape T. Exploring the Relationship Between Mild Traumatic Brain Injury Exposure and the Presence and Severity of Postconcussive Symptoms Among Veterans Deployed to Iraq and Afghanistan. PM R 2015; 7:845-858. [PMID: 25758529 DOI: 10.1016/j.pmrj.2015.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity. DESIGN The study design was observational. PARTICIPANTS The study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment. METHODS Veterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician-Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the 5 symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions was used. MAIN OUTCOME MEASURES Self-report of neurobehavioral symptoms categorized as affective, cognitive, somatic, and vestibular symptoms, in addition to the instruments specified above. RESULTS OEF/OIF veterans with mTBI, relative to veterans with no mTBI, were observed to have 30% more symptoms overall (P < .001), 34% more somatic symptoms (P < .001), 22% more cognitive symptoms (P = .008), 15% more affective symptoms (P = .017), and 59% more vestibular symptoms (P < .001). For adjusted models, variables significantly related to number of symptoms across all 4 symptom categories were anxiety (all P < .001) and insomnia (all P < .001). For the adjusted models, variables significantly related to symptom severity across all 4 symptom categories were insomnia (all P < .001), depression (P < .001-.05) and anxiety (all, P < .001). CONCLUSIONS OEF/OIF veterans with mTBI, relative to veterans with no mTBI, have significantly more and significantly more severe persisting symptoms, with vestibular symptoms reported with the greatest frequency. After accounting for behavioral health conditions and socio-demographic factors, OEF/OIF veterans with mTBI compared to veterans without mTBI had significantly more cognitive, affective, vestibular, and somatic symptoms persisting 4.8 years after the mTBI event(s).
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Affiliation(s)
- Megan Baldassarre
- Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Psychiatry, Neuropsychology Service, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
| | - Bridget Smith
- Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Northwestern University Feinberg School of Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Veterans Affairs (VA), Spinal Cord Injury QUERI, Edward Hines Jr. VA Hospital, Hines, IL
| | - Jordan Harp
- University of Kentucky College of Medicine, Department of Psychology, Lexington, KY
| | - Amy Herrold
- Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Walter M High
- Department of Psychiatry and Behavioral Sciences, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Physical Medicine and Rehabilitation, Neurosurgery, and Psychology, University of Kentucky College of Medicine, Lexington, KY
| | | | - Theresa Louise-Bender Pape
- Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Hines, IL; Edward Hines Jr. VA Hospital Research Service, Hines, IL; Department of Physical Medicine and Rehabilitation, Office of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
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Carrick FR, McLellan K, Brock JB, Randall C, Oggero E. Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries. Front Public Health 2015; 3:15. [PMID: 25699246 PMCID: PMC4316606 DOI: 10.3389/fpubh.2015.00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/14/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction: Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a “signature injury.” Vestibular complaints are the most frequent sequelae of mTBI, and vestibular rehabilitation (VR) has been established as the most important treatment modality for this group of patients. Materials and Methods: We studied the effectiveness of a novel brain and VR treatment post-traumatic stress disorder (PTSD) in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. (http://clinicaltrials.gov/ct2/show/NCT02003352?term=carrick&rank=6). We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores pre- and post-treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of <0.05 and power of 80%. Results: Prior to treatment, 75 subjects representing 76.53 % of the sample were classified in the 2 most severe categories of PTSD. Forty-one subjects, representing 41.80 % of the total sample, were classified in the extreme category of PTSD and 34 subjects, representing 34.70 % of the total sample, were classified in the severe category of PTSD. After treatment, we observed a large reduction in CAPS severity scores with both statistical and substantive significance. Discussion: Treatment of PTSD as a physical injury rather than a psychiatric disorder is associated with strong statistical and substantive significant outcomes associated with a decrease of PTSD classification. The stigma associated with neuropsychiatric disorders may be lessened when PTSD is treated with brain and VR with a potential decrease in suffering of patients, family, and society.
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Affiliation(s)
- Frederick R Carrick
- Neurology, Carrick Brain Centers , Dallas, TX , USA ; Neurology, Carrick Institute , Cape Canaveral, FL , USA ; Harvard Medical School Global Clinical Scholars Research Training (GCSRT) , Boston, MA , USA
| | - Kate McLellan
- Neurology, Carrick Brain Centers , Dallas, TX , USA ; Neurology, Carrick Institute , Cape Canaveral, FL , USA
| | - J Brandon Brock
- Neurology, Carrick Brain Centers , Dallas, TX , USA ; Neurology, Carrick Institute , Cape Canaveral, FL , USA
| | | | - Elena Oggero
- Neurology, Carrick Institute , Cape Canaveral, FL , USA ; Electrical and Computer Engineering Department, University of Wyoming , Laramie, WY , USA
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Stemper BD, Shah AS, Pintar FA, McCrea M, Kurpad SN, Glavaski-Joksimovic A, Olsen C, Budde MD. Head rotational acceleration characteristics influence behavioral and diffusion tensor imaging outcomes following concussion. Ann Biomed Eng 2014; 43:1071-88. [PMID: 25344352 DOI: 10.1007/s10439-014-1171-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
Abstract
A majority of traumatic brain injuries (TBI) in motor vehicle crashes and sporting environments are mild and caused by high-rate acceleration of the head. For injuries caused by rotational acceleration, both magnitude and duration of the acceleration pulse were shown to influence injury outcomes. This study incorporated a unique rodent model of rotational acceleration-induced mild TBI (mTBI) to quantify independent effects of magnitude and duration on behavioral and neuroimaging outcomes. Ninety-two Sprague-Dawley rats were exposed to head rotational acceleration at peak magnitudes of 214 or 350 krad/s(2) and acceleration pulse durations of 1.6 or 3.4 ms in a full factorial design. Rats underwent a series of behavioral tests including the Composite Neuroscore (CN), Elevated Plus Maze (EPM), and Morris Water Maze (MWM). Ex vivo diffusion tensor imaging (DTI) of the fixed brains was conducted to assess the effects of rotational injury on brain microstructure as revealed by the parameter fractional anisotropy (FA). While the injury did not cause significant locomotor or cognitive deficits measured with the CN and MWM, respectively, a main effect of duration was consistently observed for the EPM. Increased duration caused significantly greater activity and exploratory behaviors measured as open arm time and number of arm changes. DTI demonstrated significant effects of both magnitude and duration, with the FA of the amygdala related to both the magnitude and duration. Increased duration also caused FA changes at the interface of gray and white matter. Collectively, the findings demonstrate that the consequences of rotational acceleration mTBI were more closely associated with duration of the rotational acceleration impulse, which is often neglected as an independent factor, and highlight the need for animal models of TBI with strong biomechanical foundations to associate behavioral outcomes with brain microstructure.
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Affiliation(s)
- Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA,
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