Voices of VA Research Podcast

Mitch Mirkin of VA Research Communications interviews Dr. Cari Levy, chief of palliative care at the Denver VA Medical Center and associate director of the Center of Innovation for Veteran-Centered and Value-Driven Research. Levy talks about the concept of the VA medical foster home, and explains what her studies have shown regarding this innovative model of long-term care for Veterans. VA medical foster homes are private family homes in which trained caregivers provides 24/7 services to no more than three individuals. The homes go through a rigorous inspection and approval process. Read more: No place like home

Mike Richman of VA Research Communications interviews Dr. Samir Gupta, chief of gastroenterology at the VA San Diego Healthcare System. He’s leading the VA Colonoscopy Collaborative, which is aiming to provide a framework for maximizing VA’s effectiveness with colonoscopy and to ultimately improve health outcomes for Veterans. Colonoscopy has long been considered a good screening method for the early detection of colon cancer, the second-leading cause of cancer deaths in the United States. Colon cancer is also one of the most preventable forms of cancer, but making sure that Veterans are getting proper colon cancer screening is critical.

Mike Richman of VA Research Communications interviews Dr. Sara Knight of the VA Salt Lake City Health Care System. She’s leading a study that is exploring the return of genetic results to research participants, an area of genomic medicine that’s the topic of much debate. Her study aims to find out if Vets want their genetic results returned, why they’d want them returned, and what details they’d want to see and under what circumstances. Currently, VA’s Million Veteran Program is the agency’s most ambitious genomic initiative, but the MVP program doesn’t return genetic results to enrollees.

Mitch Mirkin of VA Research Communications interviews Dr. Ann Elizabeth Montgomery of VA’s National Center on Homelessness Among Veterans. Montgomery recently led a study titled “Veterans’ Assignment to Single-Site Versus Scattered-Site Permanent Supportive Housing.” The conversation focused on the HUD-VASH program and the types of living situations it offers Veterans. Read more: Housing for homeless Veterans

Mike Richman of VA Research Communications interviews Dr. Sarah Hartz, a psychiatrist at the VA Eastern Kansas Health Care System. Hartz led a study that found that consuming alcoholic beverages daily—even at low levels that meet U.S. guidelines for safe drinking—appears to be “detrimental” to your health. The researchers found that downing one to two drinks at least four days per week was tied to a 20 percent increase in the risk of premature death, compared with drinking three times a week or less. The study is one of a series of recent research papers that have challenged the theory that alcohol has health benefits.

Mike Richman of VA Research Communications interviews Dr. Robert Shura, neuropsychologist at the W.G. (Bill) Hefner VA Medical Center in North Carolina. Shura led a study that found that Iraq and Afghanistan Veterans with a history of multiple traumatic brain injuries—versus none—are at much greater risk for considering suicide. The study said Veterans in this cohort are about twice as likely to report recent suicidal ideation, which the study defines as suicidal thoughts over the past week—compared with Vets with one TBI or none at all. Traumatic brain injury is the signature injury from the wars in Iraq and Afghanistan. Suicide prevention is VA’s top clinical priority).

Mitch Mirkin of VA Research Communications interviews Drs. Lori Davis and J. Douglas Bremner about their research into mindfulness as a tool to help Veterans with PTSD. Davis is the associate chief of staff for research at the VA Medical Center in Tuscaloosa, Alabama. She's also a professor at the University of Alabama Health System in both Tuscaloosa and Birmingham. Bremner is the director of mental health research at the Atlanta VA Medical Center, and a professor at the Emory Clinical Neuroscience Research Unit at Emory University School of Medicine. Dr. Bremner is also the author of several books, some of which deal with the risks of prescription drugs. Read more: Mindfulness and PTSD: What does the research show?

Mike Richman of VA Research Communications interviews Dr. Jason Vassy, a clinician and researcher at the VA Boston Healthcare System. Vassy is leading a study that is focusing on whether a test for a specific gene can help patients and doctors choose the right type and dose of statin drugs, which are often used by people with high cholesterol, a risk factor for heart attack, heart disease, and stroke. Statins have been shown to help lower harmful cholesterol levels. Vassy is eager to learn whether pharmacogenetics can help in choosing the right statin medication. The relatively new field of medicine examines how a patient’s genetic make-up affects how he or she responds to a particular drug. Read more: It's in the genes

Mike Richman of VA Research Communications interviews Dr. Barbara Niles, a research psychologist in the National Center for PTSD at the VA Boston Healthcare System. Niles is leading a trial that is examining whether tai chi, an ancient Chinese mind-body therapy, can help ease the chronic pain and fatigue symptoms that are common among Veterans with Gulf War illness. Most of the treatments have been pharmaceutical. Tai chi is a graceful form of exercise that improves balance and coordination skills, with slow and deliberate balletic body movements. Read more: Meditation in motion

Erica Sprey of VA Research Communications speaks with Dr. Walid Gellad, a primary care physician and health services researcher at the VA Pittsburgh Healthcare System. Dr. Gellad's research is broadly focused on improving the delivery of health care services, and more specifically, improving Veterans' access to safe and appropriate prescription medications. Gellad and his colleagues published a study in the American Journal of Public Health that described the number of Veterans who receive opioid medications both through VA and Medicare Part D. The concern is that Veterans who use both systems may be getting potentially unsafe doses of opioids. Gellad says there is a danger that Veterans who are "dual users" will receive higher doses of opioids because of fragmentation of care and lack of communication between VA and community providers. "VA has done a tremendous amount to address prescription opioid use among Veterans to improve safety," he says. "All of that effort has focused within VA, because that is what they are measuring. There is still not an easy way to nationally measure opioids that Veterans might be getting outside the VA." Read more: 'Dual use' Veterans may be at risk for unsafe opioid use

Erica Sprey of VA Research Communications speaks with Dr. Joseph Frank, a primary care physician at the VA Eastern Colorado Health Care System in Denver. He is also a researcher at the Center of Innovation for Veteran-Centered and Value-Driven Care. Dr. Frank's research is focused on improving care for Veterans who are living with chronic pain—especially strategies for safely tapering the use of long-term opioid medication. For Veterans who are taking opioids long term, says Frank, the process of stopping or reducing those medications can be very challenging. His research aims to discover how to deliver high-quality pain care during and after opioid tapering. Read more: Helping Veterans safely stop long-term opioid use

Mike Richman of VA Research Communications interviews Dr. Harold Koenig, head of the Center for Spirituality, Theology, and Health at Duke University in North Carolina. Koenig is one of the top proponents in the research community for using religion as a therapy for Veterans with PTSD. He's aligning this approach with former service members who are victims of moral injury, which is essentially a conflict with one's personal code of morality. Koenig discusses his extensive work on moral injury, which is gaining recognition in VA. Read more: Man on a mission

Erica Sprey of VA Research Communications speaks with Dr. Katherine Iverson, a clinical psychologist and researcher at the Women's Health Division of the National Center for PTSD at the VA Boston Healthcare System. Dr. Iverson's research is focused on identifying and understanding intimate partner violence, or IPV, in women Veterans. She is also working together with other VA investigators to bring light to the problem of traumatic brain injury that stems from IPV. Women are often punched in the face during a violent encounter with an intimate partner and may not understand their risk for a brain injury. Read more: How intimate partner violence affects women Veterans

Mike Richman of VA Research Communications interviews Dr. Heather Reisinger, an infectious disease specialist at the Iowa City VA Health Care System. She and her colleague, Eli Perencevich, are leading VA’s efforts in a partnership with the U.S. Centers for Disease Control and Prevention, CDC, to ramp up the fight against infectious diseases. The highlight of the partnership is a research network that will identify ways to better protect patients and employees from infectious diseases in medical settings. Dangerous pathogens, such as bacteria, fungi, viruses, and parasites, can cause infectious diseases. Read more: Joining forces

Erica Sprey of VA Research Communications speaks with Dr. Steve Martino and Dr. Marc Rosen, both substance use researchers at VA Connecticut Healthcare System in New Haven. They are coinvestigators for a study that uses the VA compensation exam to reach out to Veterans who are applying for a service-connected disability for chronic pain. Their aim is to connect with Veterans who are suffering from pain and introduce them to the array of services available through VA. Read more: Brief screening key to referral for VA chronic pain treatment

Listen as Larry Whitler and Robin McBlane, hosts of the radio show AM Ocala on WOCA-AM in Florida, talk with Dr. Sumitra Muralidhar, program director for VA's Million Veteran Program (MVP). The interview took place in August 2016. MVP is building one of the world's largest databases of health and genomic information. Studies using MVP data, many of them already underway, will seek answers to improve health care for Veterans and others. The program has enrolled close to 625,000 Veterans as of mid-December 2017.

Erica Sprey of VA Research Communications speaks with Dr. Melissa Garrido, who is a health services researcher with the Geriatric Research Education and Clinical Center at the James J. Peters VA Medical Center in the Bronx, New York. Her research is focused on examining the quality of mental health care provided to Veterans with serious physical illnesses, such as advanced cancer. She hopes to better understand the need for mental health care in a palliative care setting, and if provided, the effects on health care utilization and cost. Read more: The impact of mental illness on palliative care outcomes for seriously ill Veterans

Mike Richman of VA Research Communications interviews Dr. Timothy Wilt, a physician-researcher at the Minneapolis VA Health Care System, about his 20-year landmark study on prostate cancer, the second-leading cause of cancer deaths among men. The study focuses on the best way to treat early stage prostate cancer, whether it's surgical removal of the prostate–the first choice of many patients–or observation, which involves monitoring using the prostate-specific antigen (PSA) blood test, and delayed surgery to reduce possible symptoms. The trial finds that surgery does not significantly reduce all-cause or prostate cancer deaths for men in the early stages of the disease. Read more: Prostate Cancer: Study Finds No Statistical Difference Between Surgery, Observation in Reducing Deaths

Mitch Mirkin of VA Research Communications talks with Dr. Paula Schnurr, director of VA's National Center for PTSD, about a major clinical trial now underway in VA called "Comparative Effectiveness Research in Veterans with PTSD (CERV-PTSD)." The trial is a head-to-head comparison of the two main psychotherapies VA uses to treat PTSD. The trial, sponsored by VA's Cooperative Studies Program, will involve 900 Veterans at nearly 20 VA sites. Read More: "Probing psychotherapies for PTSD"

Erica Sprey of VA Research Communications speaks with Dr. Stefan Kertesz, an internal medicine physician who works primarily with Veterans experiencing homelessness and substance use disorder. He runs the patient-aligned care team for homelessness at the Birmingham VA Medical Center in Alabama, and serves on its opioid safety initiative committee. In addition to conducting research on interventions for homelessness and substance use disorder, Kertesz has written extensively on the problem of opioid addiction and the movement to severely restrict opioid prescriptions. Read More: 'Will strict limits on opioid prescription duration prevent addiction?'

Erica Sprey of VA Research Communications speaks with Dr. Jack Tsai, clinical psychologist and researcher at the VA Connecticut Healthcare System and the New England Mental Illness Research, Education and Clinical Center (MIRECC) in West Haven, Connecticut. Dr. Tsai's research focuses on addressing and improving outreach and services for homeless Veterans, so that they can successfully live in independent housing. Read more: Improving services for homeless Veterans

Mike Richman of VA Research Communications interviews Dr. Ann McKee, a neuropathologist at the VA Boston Healthcare System, about her research on chronic traumatic encephalopathy, or CTE. The degenerative brain disease has been found in people with a history of repetitive brain trauma and can only be diagnosed posthumously. Dr. McKee, one of the top CTE experts in the country, has found traces of CTE in the brains of former athletes, mostly football players, and Veterans. Both groups are susceptible to head trauma and concussions.

Mitch Mirkin of VA Research Communications interviews Dr. Amy Kilbourne, director of VA's Quality Enhancement Research Initiative (QUERI), about the program's history and current work and how it is impacting Veterans' care. The goal of QUERI is to support the implementation of research findings into everyday clinical services within the VA health care system.

Erica Sprey of VA Research Communications speaks with Dr. Karen Saban, a research scientist at Edward Hines, Jr. VA Hospital in Chicago. Dr. Saban is currently investigating the ways that stress can cause inflammation in the body, which can potentially lead to inflammatory-related conditions like heart disease. She is currently investigating the use of mindfulness-based stress reduction techniques to reduce the risk of heart disease in women Veterans. Read more: Using mindfulness to combat stress-related heart disease in women Veterans

Mitch Mirkin of VA Research Communications speaks with Dr. Steven Dobscha, director of the Center to Improve Veteran Involvement in Care, based at the VA Portland Health Care System, about his group's research into OpenNotes, which allows patients to view the notes their clinicians write about their health care visits. The team recently studied the use of OpenNotes for Veterans receiving mental health care in VA. Read more: What happens when patients access their mental health providers' notes?

Mike Richman of VA Research Communications interviews Dr. Peter Gutierrez, a clinical research psychologist with the VA Eastern Colorado Health Care System, about his study that finds military personnel and Veterans bereaved by suicide may themselves be at elevated suicide risk. The study looks at how active-duty service members and Veterans react when someone they are close with dies by suicide. Dr. Gutierrez is also co-director of the Military Suicide Research Consortium, a DoD-funded body that investigates the causes and prevention of suicide. Read more: Suicide exposure leaves emotional scars on Vets, service members

Erica Sprey of VA Research Communications speaks with Dr. Michael Cucciare, associate director for research training at the south central MIRECC in Little Rock, Arkansas. Dr. Cucciare is the principle investigator for the VA-funded study "Web-based Intervention to Reduce Alcohol Use in Veterans with Hepatitis C," which is part of a larger CREATE initiative that will study care innovations for substance use disorders in the VA. Read more: Improving care for Veterans with substance use disorders

Mitch Mirkin of VA Research Communication interviews Dr. William Walker, of the Chronic Effects of Neurotrauma Consortium, about a major study that will enroll at least 1,100 service members and Veterans who fought in Iraq or Afghanistan. The goal is to learn more about mild traumatic brain injury and how it can be best evaluated, and perhaps prevented and treated. The study aims to track the outcomes of TBI, and related health issues, for at least 20 years. Read more: VA-Defense study aims to track mild TBI over decades

Mike Richman of VA Research Communications interviews Dr. Linda Resnik, a research scientist at the VA Medical Center in Providence, Rhode Island, about her study on evaluating the needs of Veterans with traumatic upper-limb amputations. She has long been researching prosthetic technologies and the outcomes for upper-limb prosthesis users at VA and Defense medical sites—and in academia. DoD is funding Dr. Resnik's study, which will be the largest and most comprehensive study of Veterans and service members with upper-limb amputations. Read more: Study to explore needs of upper-limb amputees

Erica Sprey of VA Research Communications speaks with Dr. Keith Humphreys, associate director for the Veterans Health Administration's Center for Innovation to Implementation in Palo Alto, California. Dr. Humphreys is a national expert on substance use disorders. In this interview, he discusses the prevalence of substance use disorders in the Veteran population and how they differ from those in the general population. Read more: Improving care for Veterans with substance use disorders

Mike Richman of VA Research Communications interviews Dr. Apostolos Georgopoulos, head of the Brain Sciences Center at the Minneapolis VA Health Care System, about his team's work on Gulf War illness. The group has pinpointed genetic variants that appear to make Veterans more vulnerable to the illness. They also found that a certain type of brain scan can reliably distinguish between Vets with and without the condition. Read more: Studies point to gene-based glitches in ill Gulf War Vets