War injuries advance treatment of brain injuries
In a three-part package published this month, the Los Angeles Times‘ Melissa Healy explains recent advances in the diagnosis and treatment of traumatic brain injury, with special focus on the United States armed forces.
- Treating traumatic brain injuries: Anecdotes from an Army National Guard medic and an equipment officer show how much lives can be changed by traumatic brain injury, an ailment that doesn’t even show up on CT scans or MRIs, and how a simple accurate diagnosis can provide patients with hope and understanding.
- War injury leads to advances at home: Healy writes that while combat veterans with traumatic brain injury are receiving the lion’s share of the attention, they’re just the tip of the iceberg. The “silent epidemic” has hit about 2 percent of the civilian population as well, which totals up to about 11 million since the wars in Iraq and Afghanistan began.
- Treating brain injuries on the sports field and battlefield: Finally, after tackling diagnosis and prevalence, Healy moves on to treatment. She walks through every step, from prevention to diagnosis to treatment, examining the latest in medical science along the way. It’s the longest piece in the package, and the best to start with if you’re looking for a better technical understanding of traumatic brain injury.
VA: Consent forms for human studies incomplete
According to a report released by the Department of Veterans Affairs Office of Inspector General, an audit of representative VA hospitals found that about 31 percent of informed consent documentation for human studies was incomplete. In the vast majority (97 percent) of cases, this was due to lack of a witness signature.
Among the report’s other findings:
- An estimated 1 percent (1,023) of the 110,231 non-compliant lacked the subject’s signature or that of their authorized representative, rendering them legally ineffective.
- An estimated 1.7 percent of the 367,103 consent forms could not be located, the report extrapolated the national range to be somewhere between 0.6 percent and 4.5 percent.
- In specific situations, Institutional Review Boards can waive informed consent. In two of the 33 such cases examined, sufficient documentation of this waiver was not found.
VA officials seize reporter’s audio recording
Mark Segraves of WTOP-FM reports that the memory card from reporter David Schultz’ audio recorder was confiscated by a communications specialist with the US Department of Veterans Affairs while he was interviewing a veteran about “the poor treatment he was receiving at the hands of the V.A.”
Schultz, who is with public radio station WAMU, was covering a public event at the V.A. hospital in Washington, D.C., when the incident happened. Segraves reports that four armed security guards and two other V.A. employees were also involved.
Barbara Cochran, president of RTNDA, comments on the incident:
“The government may not lawfully seize audio or videotape at a scene of news gathering,” she says. “It’s a form of prior restraint.”
Schultz was trying to talk to a veteran with a terminal illness who says he is receiving less-than-adequate care.
Update
Federal agency still holds reporter’s equipment
Advocates call for enhanced prosthetic insurance
Unlike Medicare or Medicaid, private insurers often cap annual coverage for prosthetics. In recent years, some insurers have reduced or eliminated these caps, driving up patient costs for already-expensive prosthetics and sparking a nationwide push for so-called “prosthetic parity,” or an equality in prosthetic coverage for public and private insurers. The almost decade-long effort is making headlines again, with several states passing or considering legislation in 2008 and 2009.
by Susan Schulman via Flickr
Eleven states have passed laws requiring private insurers to offer prosthetic coverage equal to Medicare standards or to hip and joint replacement coverage, and amputee advocates are pushing for legislation in a number of other states (including Pennsylvania, Utah, Texas, Idaho and Iowa) and at the federal level (alternative link).
The organization behind the campaign, the Amputee Coalition of America, estimates that almost 2 million Americans are living without limbs, and says 185,000 more amputations are performed each year. The ACA says that while prosthetic limbs often have a lifespan of 3 to 5 years, many private insurers either place a lifetime cap on coverage of prosthetic purchases or will only cover the purchase of one such device during a patient’s lifetime. According to the ACA, financial hardship is the main obstacle preventing amputees from gaining access to prosthetics.
It is well known that lack of access to these devices leads to poor rehabilitation outcomes, and places amputees at a greater risk of developing dangerous and costly secondary conditions such as obesity, diabetes, cardiovascular disease and additional amputation. These in turn lead to decreases in mobility, productivity and the ability to live independently. These factors combine to create additional costs of care, significantly impact the quality of life and shorten life expectancy.
Here’s the ACA’s campaign and talking points (PDF).
Software glitch exposes VA patients to errors
As a result of software glitches, “Patients at VA health centers were given incorrect doses of drugs, had needed treatments delayed and may have been exposed to other medical errors,” the Associated Press reports.
The errors, involving faulty displays of electronic health records, were exposed after the AP received internal documents requested under the Freedom of Information act.
“The glitches, which began in August and lingered until last month, were not disclosed to patients by the VA even though they sometimes involved prolonged infusions for drugs such as blood-thinning heparin, which can be life-threatening in excessive doses.”
As the AP points out, such glitches are worrisome as the federal government is expected to strongly promote the use of electronic medical records.
While there is no evidence that any patients were harmed, there were nine reported cases in which patients received incorrect doses and nearly one-third of the VA’s medical centers reported seeing some kind of glitch.
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