Jan Dyer

“We were kind of astounded by this—it’s a very unrecognized phenomenon,” said Richard Leigh, MD, assistant clinical investigator at the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Leigh and his co-researchers had discovered that gadolinium, used in brain scans for stroke patients, sometimes leaks into eyes—literally highlighting abnormalities. The finding could lead to more accurate stroke treatment.

The researchers performed MRI scans on 167 stroke patients on admission to the hospital without administering gadolinium and compared those scans to scans taken using gadolinium 2 hours and 24 hours later.

They found that the gadolinium made some eyes glow brightly, marking the location of brain damage. It appeared that the stroke could compromise the blood-ocular barrier. “It looks like the stroke is influencing the eye, and so the eye is reflective of what is going on in the brain,” said Dr. Leigh.

In about three-fourths of patients, gadolinium leaked into the eyes on 1 of the scans: 66% in the 2-hour scan (typically leaking in the aqueous chamber, in the front of the eye) and 75% in the 24-hour scan (typically in in the vitreous chamber, in the back of the eye).

Older patients, those with hypertension and those with brighter spots on their brain scans (associated with brain aging) were more likely to show gadolinium in the vitreous chamber at 24 hours. In a minority of patients, both eye chambers showed gadolinium at 2 hours. In those patients, stroke tended to affect a larger portion of the brain and cause more damage to the blood-brain barrier than did strokes in patients with a slower pattern of gadolinium leakage or no leakage. The researchers observed the phenomenon in both untreated patients and in those who received tPA.

The findings raise the possibility that clinicians could administer a substance to patients that would collect in the eye, like gadolinium, and quickly yield information about the stroke without the need for an MRI, the researchers say. “It’s much easier for us to look inside somebody’s eye than to look into somebody’s brain,” Dr. Leigh said. “So if the eye truly is a window to the brain, we can use one to learn about the other.”

“We were kind of astounded by this—it’s a very unrecognized phenomenon,” said Richard Leigh, MD, assistant clinical investigator at the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Leigh and his co-researchers had discovered that gadolinium, used in brain scans for stroke patients, sometimes leaks into eyes—literally highlighting abnormalities. The finding could lead to more accurate stroke treatment.

The researchers performed MRI scans on 167 stroke patients on admission to the hospital without administering gadolinium and compared those scans to scans taken using gadolinium 2 hours and 24 hours later.

They found that the gadolinium made some eyes glow brightly, marking the location of brain damage. It appeared that the stroke could compromise the blood-ocular barrier. “It looks like the stroke is influencing the eye, and so the eye is reflective of what is going on in the brain,” said Dr. Leigh.

In about three-fourths of patients, gadolinium leaked into the eyes on 1 of the scans: 66% in the 2-hour scan (typically leaking in the aqueous chamber, in the front of the eye) and 75% in the 24-hour scan (typically in in the vitreous chamber, in the back of the eye).

Older patients, those with hypertension and those with brighter spots on their brain scans (associated with brain aging) were more likely to show gadolinium in the vitreous chamber at 24 hours. In a minority of patients, both eye chambers showed gadolinium at 2 hours. In those patients, stroke tended to affect a larger portion of the brain and cause more damage to the blood-brain barrier than did strokes in patients with a slower pattern of gadolinium leakage or no leakage. The researchers observed the phenomenon in both untreated patients and in those who received tPA.

The findings raise the possibility that clinicians could administer a substance to patients that would collect in the eye, like gadolinium, and quickly yield information about the stroke without the need for an MRI, the researchers say. “It’s much easier for us to look inside somebody’s eye than to look into somebody’s brain,” Dr. Leigh said. “So if the eye truly is a window to the brain, we can use one to learn about the other.”

“We were kind of astounded by this—it’s a very unrecognized phenomenon,” said Richard Leigh, MD, assistant clinical investigator at the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Leigh and his co-researchers had discovered that gadolinium, used in brain scans for stroke patients, sometimes leaks into eyes—literally highlighting abnormalities. The finding could lead to more accurate stroke treatment.

The researchers performed MRI scans on 167 stroke patients on admission to the hospital without administering gadolinium and compared those scans to scans taken using gadolinium 2 hours and 24 hours later.

They found that the gadolinium made some eyes glow brightly, marking the location of brain damage. It appeared that the stroke could compromise the blood-ocular barrier. “It looks like the stroke is influencing the eye, and so the eye is reflective of what is going on in the brain,” said Dr. Leigh.

In about three-fourths of patients, gadolinium leaked into the eyes on 1 of the scans: 66% in the 2-hour scan (typically leaking in the aqueous chamber, in the front of the eye) and 75% in the 24-hour scan (typically in in the vitreous chamber, in the back of the eye).

Older patients, those with hypertension and those with brighter spots on their brain scans (associated with brain aging) were more likely to show gadolinium in the vitreous chamber at 24 hours. In a minority of patients, both eye chambers showed gadolinium at 2 hours. In those patients, stroke tended to affect a larger portion of the brain and cause more damage to the blood-brain barrier than did strokes in patients with a slower pattern of gadolinium leakage or no leakage. The researchers observed the phenomenon in both untreated patients and in those who received tPA.

The findings raise the possibility that clinicians could administer a substance to patients that would collect in the eye, like gadolinium, and quickly yield information about the stroke without the need for an MRI, the researchers say. “It’s much easier for us to look inside somebody’s eye than to look into somebody’s brain,” Dr. Leigh said. “So if the eye truly is a window to the brain, we can use one to learn about the other.”

National Institute of Health’s researchers conducted a diagnostic assay of 60 cerebral spinal fluid samples: 12 from people with Parkinson disease, 17 from people with dementia with Lewy bodies, and 31 controls, including 16 with Alzheimer disease. The test correctly excluded all the 31 controls and diagnosed both Parkinson disease and dementia with Lewy bodies with 93% accuracy.

Moreover, test results were available within 2 days compared with 13 days for related assays.

Like prion diseases, Parkinson disease and dementia with Lewy bodies cause progressive deterioration of brain functions. The diseases typically progress for years before symptoms appear; once they do, distinguishing one from another can be difficult. The NIH says early, accurate diagnoses are essential for developing treatments and identifying patients eligible for clinical trials.

National Institute of Health’s researchers conducted a diagnostic assay of 60 cerebral spinal fluid samples: 12 from people with Parkinson disease, 17 from people with dementia with Lewy bodies, and 31 controls, including 16 with Alzheimer disease. The test correctly excluded all the 31 controls and diagnosed both Parkinson disease and dementia with Lewy bodies with 93% accuracy.

Moreover, test results were available within 2 days compared with 13 days for related assays.

Like prion diseases, Parkinson disease and dementia with Lewy bodies cause progressive deterioration of brain functions. The diseases typically progress for years before symptoms appear; once they do, distinguishing one from another can be difficult. The NIH says early, accurate diagnoses are essential for developing treatments and identifying patients eligible for clinical trials.

National Institute of Health’s researchers conducted a diagnostic assay of 60 cerebral spinal fluid samples: 12 from people with Parkinson disease, 17 from people with dementia with Lewy bodies, and 31 controls, including 16 with Alzheimer disease. The test correctly excluded all the 31 controls and diagnosed both Parkinson disease and dementia with Lewy bodies with 93% accuracy.

Moreover, test results were available within 2 days compared with 13 days for related assays.

Like prion diseases, Parkinson disease and dementia with Lewy bodies cause progressive deterioration of brain functions. The diseases typically progress for years before symptoms appear; once they do, distinguishing one from another can be difficult. The NIH says early, accurate diagnoses are essential for developing treatments and identifying patients eligible for clinical trials.

Snoring on 3 or more nights per week, older maternal age, and obesity—these are risk factors for sleep apnea in pregnancy, according to a National Institutes of Health-funded study. Checking for those factors is an easy, inexpensive way to rapidly identify women who may benefit from further testing, says Uma Reddy, MD, study coauthor.

In the study, 3,264 women in early pregnancy (6 -15 weeks) and 2,512 in mid-pregnancy (22- 29 weeks) responded to questionnaires about their sleep habits, snoring, and daytime sleepiness. Participants also used an at-home monitoring device to test for sleep apnea.

Nearly 4% of the women in early pregnancy and 8.3% of those in mid-pregnancy had sleep apnea. In an earlier study of first-time pregnancies, the researchers found that sleep apnea increases the risk of hypertensive disorders and gestational diabetes. A clinical study of the link between sleep-disordered breathing and adverse pregnancy outcomes is underway, expected to be completed by 2019.

Currently there are no medical guidelines or treatment recommendations for sleep apnea during pregnancy.

Snoring on 3 or more nights per week, older maternal age, and obesity—these are risk factors for sleep apnea in pregnancy, according to a National Institutes of Health-funded study. Checking for those factors is an easy, inexpensive way to rapidly identify women who may benefit from further testing, says Uma Reddy, MD, study coauthor.

In the study, 3,264 women in early pregnancy (6 -15 weeks) and 2,512 in mid-pregnancy (22- 29 weeks) responded to questionnaires about their sleep habits, snoring, and daytime sleepiness. Participants also used an at-home monitoring device to test for sleep apnea.

Nearly 4% of the women in early pregnancy and 8.3% of those in mid-pregnancy had sleep apnea. In an earlier study of first-time pregnancies, the researchers found that sleep apnea increases the risk of hypertensive disorders and gestational diabetes. A clinical study of the link between sleep-disordered breathing and adverse pregnancy outcomes is underway, expected to be completed by 2019.

Currently there are no medical guidelines or treatment recommendations for sleep apnea during pregnancy.

Snoring on 3 or more nights per week, older maternal age, and obesity—these are risk factors for sleep apnea in pregnancy, according to a National Institutes of Health-funded study. Checking for those factors is an easy, inexpensive way to rapidly identify women who may benefit from further testing, says Uma Reddy, MD, study coauthor.

In the study, 3,264 women in early pregnancy (6 -15 weeks) and 2,512 in mid-pregnancy (22- 29 weeks) responded to questionnaires about their sleep habits, snoring, and daytime sleepiness. Participants also used an at-home monitoring device to test for sleep apnea.

Nearly 4% of the women in early pregnancy and 8.3% of those in mid-pregnancy had sleep apnea. In an earlier study of first-time pregnancies, the researchers found that sleep apnea increases the risk of hypertensive disorders and gestational diabetes. A clinical study of the link between sleep-disordered breathing and adverse pregnancy outcomes is underway, expected to be completed by 2019.

Currently there are no medical guidelines or treatment recommendations for sleep apnea during pregnancy.

Healthy foods may be available in grocery stores in rural American Indian communities, but the price can be high. Researchers from University of Washington looked at the availability and cost of 68 food items that comprise the Nutrition Environment Measures Survey in Stores (NEMS-S), which evaluates whether food items adhere to the USDA Thrifty Food Plan (TFP). The TFP “market basket” represents the minimal cost of a healthy diet for a family of 4 for 1 week. The study included 27 stores within a 90-mile radius of the town center of a large American Indian reservation: 13 convenience stores, 10 grocery stores, 3 discount/dollar stores, and 1 discount supermarket. Of the surveyed stores, 10 were on the reservation, including 4 grocery stores.

All NEMS-S foods were available at the discount supermarket, and about 97% of the foods were available at the grocery stores. Convenience and discount/dollar stores were less likely to carry the foods.

The cost of a TFP market basket ranged from 3% lower to 24% higher than the national average. It also varied among the community stores: The TFP cost  > 15% at the discount supermarket than at grocery stores ($152.91 vs $179.52). However, the researchers note that the cost of foods that made up the TFP market basket varied across food groups. For instance, the mean cost of dairy products was 43% lower at the discount supermarket than at the grocery stores, while fresh fruits and vegetables were 6% higher.

Healthy foods may be available in grocery stores in rural American Indian communities, but the price can be high. Researchers from University of Washington looked at the availability and cost of 68 food items that comprise the Nutrition Environment Measures Survey in Stores (NEMS-S), which evaluates whether food items adhere to the USDA Thrifty Food Plan (TFP). The TFP “market basket” represents the minimal cost of a healthy diet for a family of 4 for 1 week. The study included 27 stores within a 90-mile radius of the town center of a large American Indian reservation: 13 convenience stores, 10 grocery stores, 3 discount/dollar stores, and 1 discount supermarket. Of the surveyed stores, 10 were on the reservation, including 4 grocery stores.

All NEMS-S foods were available at the discount supermarket, and about 97% of the foods were available at the grocery stores. Convenience and discount/dollar stores were less likely to carry the foods.

The cost of a TFP market basket ranged from 3% lower to 24% higher than the national average. It also varied among the community stores: The TFP cost  > 15% at the discount supermarket than at grocery stores ($152.91 vs $179.52). However, the researchers note that the cost of foods that made up the TFP market basket varied across food groups. For instance, the mean cost of dairy products was 43% lower at the discount supermarket than at the grocery stores, while fresh fruits and vegetables were 6% higher.

Healthy foods may be available in grocery stores in rural American Indian communities, but the price can be high. Researchers from University of Washington looked at the availability and cost of 68 food items that comprise the Nutrition Environment Measures Survey in Stores (NEMS-S), which evaluates whether food items adhere to the USDA Thrifty Food Plan (TFP). The TFP “market basket” represents the minimal cost of a healthy diet for a family of 4 for 1 week. The study included 27 stores within a 90-mile radius of the town center of a large American Indian reservation: 13 convenience stores, 10 grocery stores, 3 discount/dollar stores, and 1 discount supermarket. Of the surveyed stores, 10 were on the reservation, including 4 grocery stores.

All NEMS-S foods were available at the discount supermarket, and about 97% of the foods were available at the grocery stores. Convenience and discount/dollar stores were less likely to carry the foods.

The cost of a TFP market basket ranged from 3% lower to 24% higher than the national average. It also varied among the community stores: The TFP cost  > 15% at the discount supermarket than at grocery stores ($152.91 vs $179.52). However, the researchers note that the cost of foods that made up the TFP market basket varied across food groups. For instance, the mean cost of dairy products was 43% lower at the discount supermarket than at the grocery stores, while fresh fruits and vegetables were 6% higher.

The VA is examining two alternative treatments for TBI and PTSD: a light-emitting diode (LED) treatment for mild to moderate TBI and stellate ganglion block (SGB) for PTSD. 

In the LED treatment, which takes about 30 minutes, a lightweight LED-lined helmet is placed on the patient’s head, and more diodes are placed inside the nose to deliver photons to the deeper parts of the brain. The light is painless and generates no heat.

Although it is considered investigational, LED therapy is available at the VAHS Boston, as well as for veterans to use at home. Dr. Margaret Naeser, a professor of neurology at Boston University School of Medicine and lead investigator of the Boston study team, interviewed in VA Research Currents, says the technology has been around a while, but it was previously used on the body for wound healing and pain. Using it on the brain is new. The LED light has been shown to boost the output of nitric oxide, improving blood flow. Studies have shown that LED improves brain function, including attention and memory, emotions, and sleep.

Naeser says most of the TBI and PTSD cases helped so far with LEDs on the head included cognitive rehabilitation therapy. The patients showed additional progress after the LED treatments. A combination of both treatments would likely produce the best results, she says.

Providers at the Long Beach VAMC have been using SGB, commonly used in pain management with ropivacaine or bupivacaine, to reduce the symptoms of PTSD. According to the VA Evidence-based Synthesis Program (ESP), SGB may ease anxiety and the alert response by inhibiting connections between the peripheral sympathetic nerve system and regions of the cerebral cortex, such as the amygdala, thought to be abnormally activated in PTSD. Stellate ganglion block also has been associated with biologic markers of sedation.

The ESP experts say there is insufficient information to determine which veterans are most likely to benefit from SGB for PTSD, but an uncontrolled, unblinded case series of 30 active duty service members with combat-related PTSD suggests that those with predominantly hyperarousal and avoidance symptoms might be the best candidates. Patients who have undergone SGB have found it highly acceptable, although the invasive nature of SGB may be a barrier for some. Findings from the first randomized controlled trial of SGB for PTSD were inconclusive, the panel said; further research is warranted.

The VA is examining two alternative treatments for TBI and PTSD: a light-emitting diode (LED) treatment for mild to moderate TBI and stellate ganglion block (SGB) for PTSD. 

In the LED treatment, which takes about 30 minutes, a lightweight LED-lined helmet is placed on the patient’s head, and more diodes are placed inside the nose to deliver photons to the deeper parts of the brain. The light is painless and generates no heat.

Although it is considered investigational, LED therapy is available at the VAHS Boston, as well as for veterans to use at home. Dr. Margaret Naeser, a professor of neurology at Boston University School of Medicine and lead investigator of the Boston study team, interviewed in VA Research Currents, says the technology has been around a while, but it was previously used on the body for wound healing and pain. Using it on the brain is new. The LED light has been shown to boost the output of nitric oxide, improving blood flow. Studies have shown that LED improves brain function, including attention and memory, emotions, and sleep.

Naeser says most of the TBI and PTSD cases helped so far with LEDs on the head included cognitive rehabilitation therapy. The patients showed additional progress after the LED treatments. A combination of both treatments would likely produce the best results, she says.

Providers at the Long Beach VAMC have been using SGB, commonly used in pain management with ropivacaine or bupivacaine, to reduce the symptoms of PTSD. According to the VA Evidence-based Synthesis Program (ESP), SGB may ease anxiety and the alert response by inhibiting connections between the peripheral sympathetic nerve system and regions of the cerebral cortex, such as the amygdala, thought to be abnormally activated in PTSD. Stellate ganglion block also has been associated with biologic markers of sedation.

The ESP experts say there is insufficient information to determine which veterans are most likely to benefit from SGB for PTSD, but an uncontrolled, unblinded case series of 30 active duty service members with combat-related PTSD suggests that those with predominantly hyperarousal and avoidance symptoms might be the best candidates. Patients who have undergone SGB have found it highly acceptable, although the invasive nature of SGB may be a barrier for some. Findings from the first randomized controlled trial of SGB for PTSD were inconclusive, the panel said; further research is warranted.

The VA is examining two alternative treatments for TBI and PTSD: a light-emitting diode (LED) treatment for mild to moderate TBI and stellate ganglion block (SGB) for PTSD. 

In the LED treatment, which takes about 30 minutes, a lightweight LED-lined helmet is placed on the patient’s head, and more diodes are placed inside the nose to deliver photons to the deeper parts of the brain. The light is painless and generates no heat.

Although it is considered investigational, LED therapy is available at the VAHS Boston, as well as for veterans to use at home. Dr. Margaret Naeser, a professor of neurology at Boston University School of Medicine and lead investigator of the Boston study team, interviewed in VA Research Currents, says the technology has been around a while, but it was previously used on the body for wound healing and pain. Using it on the brain is new. The LED light has been shown to boost the output of nitric oxide, improving blood flow. Studies have shown that LED improves brain function, including attention and memory, emotions, and sleep.

Naeser says most of the TBI and PTSD cases helped so far with LEDs on the head included cognitive rehabilitation therapy. The patients showed additional progress after the LED treatments. A combination of both treatments would likely produce the best results, she says.

Providers at the Long Beach VAMC have been using SGB, commonly used in pain management with ropivacaine or bupivacaine, to reduce the symptoms of PTSD. According to the VA Evidence-based Synthesis Program (ESP), SGB may ease anxiety and the alert response by inhibiting connections between the peripheral sympathetic nerve system and regions of the cerebral cortex, such as the amygdala, thought to be abnormally activated in PTSD. Stellate ganglion block also has been associated with biologic markers of sedation.

The ESP experts say there is insufficient information to determine which veterans are most likely to benefit from SGB for PTSD, but an uncontrolled, unblinded case series of 30 active duty service members with combat-related PTSD suggests that those with predominantly hyperarousal and avoidance symptoms might be the best candidates. Patients who have undergone SGB have found it highly acceptable, although the invasive nature of SGB may be a barrier for some. Findings from the first randomized controlled trial of SGB for PTSD were inconclusive, the panel said; further research is warranted.

When blood pressure drops dangerously low, organ failure and death are real possibilities. Most deaths from trauma-related shock happen within 24 hours. But not all critically ill hypotensive patients respond to available therapies. A newly approved injectable drug could be a lifesaver for those patients.

Giapreza (angiotensin II/La Jolla Pharmaceutical, San Diego, CA) injection for intravenous infusion has been approved to increase blood pressure in cases of septic or other distributive shock. In a clinical trial of 321 patients with shock and critically low blood pressure, significantly more responded to treatment with Giapreza, compared with placebo. Giapreza effectively raised blood pressure when added to conventional treatments.

Giapreza can cause dangerous blood clots, including deep vein thrombosis. The FDA advises prophylactic treatment for blood clots.

When blood pressure drops dangerously low, organ failure and death are real possibilities. Most deaths from trauma-related shock happen within 24 hours. But not all critically ill hypotensive patients respond to available therapies. A newly approved injectable drug could be a lifesaver for those patients.

Giapreza (angiotensin II/La Jolla Pharmaceutical, San Diego, CA) injection for intravenous infusion has been approved to increase blood pressure in cases of septic or other distributive shock. In a clinical trial of 321 patients with shock and critically low blood pressure, significantly more responded to treatment with Giapreza, compared with placebo. Giapreza effectively raised blood pressure when added to conventional treatments.

Giapreza can cause dangerous blood clots, including deep vein thrombosis. The FDA advises prophylactic treatment for blood clots.

When blood pressure drops dangerously low, organ failure and death are real possibilities. Most deaths from trauma-related shock happen within 24 hours. But not all critically ill hypotensive patients respond to available therapies. A newly approved injectable drug could be a lifesaver for those patients.

Giapreza (angiotensin II/La Jolla Pharmaceutical, San Diego, CA) injection for intravenous infusion has been approved to increase blood pressure in cases of septic or other distributive shock. In a clinical trial of 321 patients with shock and critically low blood pressure, significantly more responded to treatment with Giapreza, compared with placebo. Giapreza effectively raised blood pressure when added to conventional treatments.

Giapreza can cause dangerous blood clots, including deep vein thrombosis. The FDA advises prophylactic treatment for blood clots.

About 30 million people in the U.S. have diabetes, and about 25% of those will have a foot ulcer at some point. When circulation is so poor that the ulcer does not heal, or when treatment cannot stop infection, amputation may be necessary. Diabetes is the leading cause of lower limb amputations.

The FDA has approved a new treatment to help heal diabetic foot ulcers. The Dermapace System (Sanuwave, Inc., Suwanee, GA) sends shock waves to mechanically stimulate the wound. The treatment is intended for adult patients with chronic foot ulcers with wound areas no larger than 16 cm², extending through the epidermis, dermis, tendon, or capsule, but without bone exposure. It is used along with standard diabetic ulcer care. 

In 2 multicenter studies of 336 patients, patients were given 1 to 7 treatments over 24 weeks. The shock wave systems increased wound healing by 44%. The patients treated with a sham shock wave therapy had a 30% wound closure rate.

About 30 million people in the U.S. have diabetes, and about 25% of those will have a foot ulcer at some point. When circulation is so poor that the ulcer does not heal, or when treatment cannot stop infection, amputation may be necessary. Diabetes is the leading cause of lower limb amputations.

The FDA has approved a new treatment to help heal diabetic foot ulcers. The Dermapace System (Sanuwave, Inc., Suwanee, GA) sends shock waves to mechanically stimulate the wound. The treatment is intended for adult patients with chronic foot ulcers with wound areas no larger than 16 cm², extending through the epidermis, dermis, tendon, or capsule, but without bone exposure. It is used along with standard diabetic ulcer care. 

In 2 multicenter studies of 336 patients, patients were given 1 to 7 treatments over 24 weeks. The shock wave systems increased wound healing by 44%. The patients treated with a sham shock wave therapy had a 30% wound closure rate.

About 30 million people in the U.S. have diabetes, and about 25% of those will have a foot ulcer at some point. When circulation is so poor that the ulcer does not heal, or when treatment cannot stop infection, amputation may be necessary. Diabetes is the leading cause of lower limb amputations.

The FDA has approved a new treatment to help heal diabetic foot ulcers. The Dermapace System (Sanuwave, Inc., Suwanee, GA) sends shock waves to mechanically stimulate the wound. The treatment is intended for adult patients with chronic foot ulcers with wound areas no larger than 16 cm², extending through the epidermis, dermis, tendon, or capsule, but without bone exposure. It is used along with standard diabetic ulcer care. 

In 2 multicenter studies of 336 patients, patients were given 1 to 7 treatments over 24 weeks. The shock wave systems increased wound healing by 44%. The patients treated with a sham shock wave therapy had a 30% wound closure rate.

Three in 10 U.S. veterans used some form of tobacco during 2010-2015—a higher number than among nonveterans across all age groups except men aged ≥ 50 years, according to a CDC analysis of data from the National Survey on Drug Use and Health. More than one-third of the veterans surveyed started smoking after enlisting.

The analysis also found that > 60% of the veterans who used tobacco products had no health insurance, more than half were living in poverty, and 48% reported serious psychological distress.

The toll is significant not only for the smokers and their families, but also for the health care system. The researchers estimate that during 2010, VHA spent nearly $3 billion on smoking-related ambulatory care, prescription drugs, hospitalization, and home health care.

“VA has more tobacco use treatment options available than ever,” said Kim Hamlett-Berry, PhD, program director of VA Tobacco and Health Policy, and that has led to declines in rates of smoking. She notes that the 2015 VA Survey of Enrollees reported that 16.8% of veterans enrolled for health care in VA identified as a current smoker.

In addition to the quit lines already available (800-QUIT-VET, 800-QUIT-NOW, and https://smokefree.gov/VET), veterans can access quit services through TRICARE. VA treatment centers also have integrated smoking cessation programs into treatment for PTSD and other disorders. Smokers with psychiatric illness are more likely to die of smoking-related diseases than of complications from their mental illness or substance use disorders, Hamlett-Berry said at an American Psychological Association conference in 2013. She added that people with alcohol dependence and other substance use disorders smoke at higher rates. Research shows that combining smoking cessation with substance use treatment increase patients’ likelihood of success.

The CDC says more can be done. Strategies could include promoting cessation to current military personnel and veterans, implementing tobacco-free policies at military installations and VA medical centers and clinics, increasing the age requirement to buy tobacco on military bases to 21, and eliminating tobacco product discounts through military retailers.

Three in 10 U.S. veterans used some form of tobacco during 2010-2015—a higher number than among nonveterans across all age groups except men aged ≥ 50 years, according to a CDC analysis of data from the National Survey on Drug Use and Health. More than one-third of the veterans surveyed started smoking after enlisting.

The analysis also found that > 60% of the veterans who used tobacco products had no health insurance, more than half were living in poverty, and 48% reported serious psychological distress.

The toll is significant not only for the smokers and their families, but also for the health care system. The researchers estimate that during 2010, VHA spent nearly $3 billion on smoking-related ambulatory care, prescription drugs, hospitalization, and home health care.

“VA has more tobacco use treatment options available than ever,” said Kim Hamlett-Berry, PhD, program director of VA Tobacco and Health Policy, and that has led to declines in rates of smoking. She notes that the 2015 VA Survey of Enrollees reported that 16.8% of veterans enrolled for health care in VA identified as a current smoker.

In addition to the quit lines already available (800-QUIT-VET, 800-QUIT-NOW, and https://smokefree.gov/VET), veterans can access quit services through TRICARE. VA treatment centers also have integrated smoking cessation programs into treatment for PTSD and other disorders. Smokers with psychiatric illness are more likely to die of smoking-related diseases than of complications from their mental illness or substance use disorders, Hamlett-Berry said at an American Psychological Association conference in 2013. She added that people with alcohol dependence and other substance use disorders smoke at higher rates. Research shows that combining smoking cessation with substance use treatment increase patients’ likelihood of success.

The CDC says more can be done. Strategies could include promoting cessation to current military personnel and veterans, implementing tobacco-free policies at military installations and VA medical centers and clinics, increasing the age requirement to buy tobacco on military bases to 21, and eliminating tobacco product discounts through military retailers.

Three in 10 U.S. veterans used some form of tobacco during 2010-2015—a higher number than among nonveterans across all age groups except men aged ≥ 50 years, according to a CDC analysis of data from the National Survey on Drug Use and Health. More than one-third of the veterans surveyed started smoking after enlisting.

The analysis also found that > 60% of the veterans who used tobacco products had no health insurance, more than half were living in poverty, and 48% reported serious psychological distress.

The toll is significant not only for the smokers and their families, but also for the health care system. The researchers estimate that during 2010, VHA spent nearly $3 billion on smoking-related ambulatory care, prescription drugs, hospitalization, and home health care.

“VA has more tobacco use treatment options available than ever,” said Kim Hamlett-Berry, PhD, program director of VA Tobacco and Health Policy, and that has led to declines in rates of smoking. She notes that the 2015 VA Survey of Enrollees reported that 16.8% of veterans enrolled for health care in VA identified as a current smoker.

In addition to the quit lines already available (800-QUIT-VET, 800-QUIT-NOW, and https://smokefree.gov/VET), veterans can access quit services through TRICARE. VA treatment centers also have integrated smoking cessation programs into treatment for PTSD and other disorders. Smokers with psychiatric illness are more likely to die of smoking-related diseases than of complications from their mental illness or substance use disorders, Hamlett-Berry said at an American Psychological Association conference in 2013. She added that people with alcohol dependence and other substance use disorders smoke at higher rates. Research shows that combining smoking cessation with substance use treatment increase patients’ likelihood of success.

The CDC says more can be done. Strategies could include promoting cessation to current military personnel and veterans, implementing tobacco-free policies at military installations and VA medical centers and clinics, increasing the age requirement to buy tobacco on military bases to 21, and eliminating tobacco product discounts through military retailers.

Cancer-related fatigue can linger long after treatments are ended, making daily activities harder and diminishing quality of life (QOL). But researchers from University of Alabama in Birmingham and Harvard Medical School in Boston suggest a nonpharmaceutical way to help patients feel better: placebo.

They compared an open-label placebo with treatment as usual in patients with cancer-related fatigue in a 21-day controlled trial. The patients had completed cancer treatment 6 months to 10 years prior to enrollment. Of 74 patients, 28 reported a moderate level of fatigue and 46 reported a severe level. The mean fatigue scores at baseline were similar for both groups.

The participants randomly assigned to placebo took 2 placebo pills twice a day. At 21 days, the average difference in scores was statistically significant. The placebo group reported a 29% improvement in fatigue severity and a 39% improvement in fatigue-disrupted QOL. Put another way, 76% of the placebo group had a change score above the mean change score of the usual-treatment group. The results were clinically meaningful, the researchers say. Moreover, there were no reported adverse events or adverse effects.

After that main study, the researchers also conducted a 21-day exploratory crossover extension, which began 1 week later. Their findings supported the main study results, with the same magnitude of improvement. The usual-treatment patients who chose to try the placebo also reported a similar magnitude of reductions in fatigue severity (23%) and fatigue-disrupted QOL (35%).

Interestingly, the effects seemed to be sustained, the researchers say. At day 48, there was no significant change in fatigue scores compared with day 21, an “exciting” preliminary finding they say that needs further exploration.

Source:
Hoenemeyer TW, Kaptchuk TJ, Mehta TS, Fontaine KR. Scientific Reports. 2018;8:2784.
doi:10.1038/s41598-018-20993-y.

Cancer-related fatigue can linger long after treatments are ended, making daily activities harder and diminishing quality of life (QOL). But researchers from University of Alabama in Birmingham and Harvard Medical School in Boston suggest a nonpharmaceutical way to help patients feel better: placebo.

They compared an open-label placebo with treatment as usual in patients with cancer-related fatigue in a 21-day controlled trial. The patients had completed cancer treatment 6 months to 10 years prior to enrollment. Of 74 patients, 28 reported a moderate level of fatigue and 46 reported a severe level. The mean fatigue scores at baseline were similar for both groups.

The participants randomly assigned to placebo took 2 placebo pills twice a day. At 21 days, the average difference in scores was statistically significant. The placebo group reported a 29% improvement in fatigue severity and a 39% improvement in fatigue-disrupted QOL. Put another way, 76% of the placebo group had a change score above the mean change score of the usual-treatment group. The results were clinically meaningful, the researchers say. Moreover, there were no reported adverse events or adverse effects.

After that main study, the researchers also conducted a 21-day exploratory crossover extension, which began 1 week later. Their findings supported the main study results, with the same magnitude of improvement. The usual-treatment patients who chose to try the placebo also reported a similar magnitude of reductions in fatigue severity (23%) and fatigue-disrupted QOL (35%).

Interestingly, the effects seemed to be sustained, the researchers say. At day 48, there was no significant change in fatigue scores compared with day 21, an “exciting” preliminary finding they say that needs further exploration.

Source:
Hoenemeyer TW, Kaptchuk TJ, Mehta TS, Fontaine KR. Scientific Reports. 2018;8:2784.
doi:10.1038/s41598-018-20993-y.

Cancer-related fatigue can linger long after treatments are ended, making daily activities harder and diminishing quality of life (QOL). But researchers from University of Alabama in Birmingham and Harvard Medical School in Boston suggest a nonpharmaceutical way to help patients feel better: placebo.

They compared an open-label placebo with treatment as usual in patients with cancer-related fatigue in a 21-day controlled trial. The patients had completed cancer treatment 6 months to 10 years prior to enrollment. Of 74 patients, 28 reported a moderate level of fatigue and 46 reported a severe level. The mean fatigue scores at baseline were similar for both groups.

The participants randomly assigned to placebo took 2 placebo pills twice a day. At 21 days, the average difference in scores was statistically significant. The placebo group reported a 29% improvement in fatigue severity and a 39% improvement in fatigue-disrupted QOL. Put another way, 76% of the placebo group had a change score above the mean change score of the usual-treatment group. The results were clinically meaningful, the researchers say. Moreover, there were no reported adverse events or adverse effects.

After that main study, the researchers also conducted a 21-day exploratory crossover extension, which began 1 week later. Their findings supported the main study results, with the same magnitude of improvement. The usual-treatment patients who chose to try the placebo also reported a similar magnitude of reductions in fatigue severity (23%) and fatigue-disrupted QOL (35%).

Interestingly, the effects seemed to be sustained, the researchers say. At day 48, there was no significant change in fatigue scores compared with day 21, an “exciting” preliminary finding they say that needs further exploration.

Source:
Hoenemeyer TW, Kaptchuk TJ, Mehta TS, Fontaine KR. Scientific Reports. 2018;8:2784.
doi:10.1038/s41598-018-20993-y.

The facts are dire: In 2014, people diagnosed with schizophrenia or mood disorders made 10.8 million visits to emergency departments (EDs). Between 2006 and 2014, the rate of ED visits related to mental health/substance abuse jumped 44%. The suicide rate among people with serious emotional disturbances (SEDs) is 25 times higher than that in the general population. Two million people with serious mental illness (SMI) are jailed annually, but only about 1 in 3 is currently receiving any treatment.

However, early intervention for SMI can help many people stay out of EDs and jails. That is the focus of The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, a report recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The emergency room is not a place for people that are experiencing exacerbations of mental health conditions,” says Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at SAMHSA and chair of the Interdepartmental Serious Mental Illness Coordinating Committee, which produced the report.

In the report, the committee cited the 2003 President’s New Freedom Commission on Mental Health, which concluded that America’s mental health service delivery system was “in shambles,” with “fragmented, disconnected and often inadequate” mental health services and supports. Yet a number of the commission’s recommendations still have not been implemented or only “partially realized,” the committee notes.

In an interview with MedPageToday.com, McCance-Katz says the solution is a “national system of crisis intervention services”—a continuum of care with outpatient services as alternatives to inpatient care. Most states report insufficient psychiatric crisis response capacity, as well as insufficient numbers of inpatient psychiatric hospital beds. If the right system, one that includes community interventions and adequate resources, were in place, McCance-Katz says, “we might not need so many beds.”

The facts are dire: In 2014, people diagnosed with schizophrenia or mood disorders made 10.8 million visits to emergency departments (EDs). Between 2006 and 2014, the rate of ED visits related to mental health/substance abuse jumped 44%. The suicide rate among people with serious emotional disturbances (SEDs) is 25 times higher than that in the general population. Two million people with serious mental illness (SMI) are jailed annually, but only about 1 in 3 is currently receiving any treatment.

However, early intervention for SMI can help many people stay out of EDs and jails. That is the focus of The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, a report recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The emergency room is not a place for people that are experiencing exacerbations of mental health conditions,” says Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at SAMHSA and chair of the Interdepartmental Serious Mental Illness Coordinating Committee, which produced the report.

In the report, the committee cited the 2003 President’s New Freedom Commission on Mental Health, which concluded that America’s mental health service delivery system was “in shambles,” with “fragmented, disconnected and often inadequate” mental health services and supports. Yet a number of the commission’s recommendations still have not been implemented or only “partially realized,” the committee notes.

In an interview with MedPageToday.com, McCance-Katz says the solution is a “national system of crisis intervention services”—a continuum of care with outpatient services as alternatives to inpatient care. Most states report insufficient psychiatric crisis response capacity, as well as insufficient numbers of inpatient psychiatric hospital beds. If the right system, one that includes community interventions and adequate resources, were in place, McCance-Katz says, “we might not need so many beds.”

The facts are dire: In 2014, people diagnosed with schizophrenia or mood disorders made 10.8 million visits to emergency departments (EDs). Between 2006 and 2014, the rate of ED visits related to mental health/substance abuse jumped 44%. The suicide rate among people with serious emotional disturbances (SEDs) is 25 times higher than that in the general population. Two million people with serious mental illness (SMI) are jailed annually, but only about 1 in 3 is currently receiving any treatment.

However, early intervention for SMI can help many people stay out of EDs and jails. That is the focus of The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, a report recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The emergency room is not a place for people that are experiencing exacerbations of mental health conditions,” says Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at SAMHSA and chair of the Interdepartmental Serious Mental Illness Coordinating Committee, which produced the report.

In the report, the committee cited the 2003 President’s New Freedom Commission on Mental Health, which concluded that America’s mental health service delivery system was “in shambles,” with “fragmented, disconnected and often inadequate” mental health services and supports. Yet a number of the commission’s recommendations still have not been implemented or only “partially realized,” the committee notes.

In an interview with MedPageToday.com, McCance-Katz says the solution is a “national system of crisis intervention services”—a continuum of care with outpatient services as alternatives to inpatient care. Most states report insufficient psychiatric crisis response capacity, as well as insufficient numbers of inpatient psychiatric hospital beds. If the right system, one that includes community interventions and adequate resources, were in place, McCance-Katz says, “we might not need so many beds.”