Nurse Navigator Simplifies the Maze for Patients



A woman stands at a computer in an office with a sign that says Nurse Navigator

Joan Stewart, Nurse Navigator, consults with Army Veteran Tom Eckerson.










A caller was distressed and needed immediate help for his elderly brother, a Veteran who had been treating his own condition with over the counter medicine. The Vet suddenly seemed incoherent.


From her control center at Fort Harrison’s VA Hospital, Nurse Navigator Joan Stewart listened and carefully coordinated the path for patient and caregiver alike. Having maneuvered one Veteran to safety, the registered nurse checked her computer and surveyed the hospital’s busy waiting area for the next person in need.


The Nurse Navigator is a recent, unique and important part of the hospital’s patient-centered strategy for efficient health care access that is personally rewarding for Veterans.


Debera Charlton, Nurse Manager for Ambulatory Care at VA Montana Health Care System, visualized and implemented the strategy a year and a half ago. She credited Stewart and two preceding Nurse Navigators, Loreen Skinner and Karen Zawacki, for helping her realize a dream she says works.


 I took this position so that I could have more contact with patients. 


Charlton, a cancer survivor, first saw the effectiveness of Nurse Navigators in the private sector. “They steer cancer patients through often complex treatment systems,” Charlton said. “Where non-emergency, walk-in patients had previously received treatment in the emergency department, the Nurse Navigator is able to identify what a patient needs through triage and direct the route to a point of access.”


She constantly interfaces with members of the Patient Aligned Care Teams (PACTs) to assure continuity of care is provided, a collaborative position with all the PACTs and not independent of them.


“I took this position in January so that I could have more contact with patients. I talk to about 27 patients daily, which is a lot,” Stewart said from inside the glass-walled cube that provides privacy for face-to-face and phone consults.


Someone covers for her during breaks. Otherwise, she is the only Nurse Navigator for VA in Montana.


“The most important thing is access.”


Most inbound calls for routine appointments are handled by other schedulers. “The Veterans that I speak to want same-day access and their medical need is either urgent or emergent,” Stewart said. She talks to patients with questions ranging from administrative matters like billing and enrollment to behavioral health consultations and treatment for complex physical ailments. “The most important thing is access.”


Stewart, a retired Montana Army National Guard lieutenant colonel, Helena native, mother of three, and nurse with 30 years of experience, knows her patients and her craft. “They don’t come in here unless they need help now,” Stewart said as she helped one Veteran enter the lab next door.


“I enjoy the patient education aspect of this job,” she added. Stewart recently earned a master’s Degree using the VA Scholarship Program and is one of four instructors who will participate in nurse-led education clinics aimed at building knowledge on personal health.


Fellow registered nurse Helen Williams, the Veteran Health Education Coordinator, said that Stewart is a shining example of someone who has personalized her education and is returning her knowledge to the VA.


“Joan, can I come in and talk?” asked a Veteran with silver hair, polarized glasses and cane. Joan Stewart, Nurse Navigator, immediately got up, smiled, greeted the man by name and helped her patient to a chair in the privacy of her navigation center.






Source Article from http://www.va.gov/health/NewsFeatures/2014/July/Nurse-Navigator-Simplifies-the-Maze-for-Patients.asp

VA Hosts July 4th Ceremonies for Veterans



A smiling girl holds a US flag

 










It’s time to honor the birthday of the United States of America and the adoption of the Declaration of Independence on July 4, 1776.


A day of picnics and patriotic parades, a night of concerts and fireworks, and a reason to fly the American flag. It’s a special time to remember those men and women whose sacrifices helped to keep America the land of the free and the home of the brave — our Veterans.


Across America, VA Medical Centers are celebrating with special events for Veterans and their families.


Marion, Illinois


The staff at the Marion, Illinois, VA Medical Center will be at their local baseball game handing out “VA FANS” and talking about VA health care services. They will also have a special Veteran guest, a ball player for the Negro League, Melvin Duncan, who will be throwing out the first pitch. All followed by fireworks for the entire city of Marion.


(Thanks Peggy Willoughby, PAO, Marion VAMC)




Man at a party smiling from behind a grill

VA Police Sgt. Marvin Seifer being “grilled” at White City, Oregon, BBQ


Southern Oregon


Every year, the VA Southern Oregon Rehabilitation Center & Clinics in White City, Oregon celebrate the 4th of July with a barbecue and carnival for the 500-plus residents. The day’s events include entertainment, “carnival” booths with prizes and music by “T.J. & The Spurs.” VA staff and volunteers prepare and serve hamburgers, chili dogs, salads, chips, pie, watermelon, ice cream and refreshments.


(Thanks Rhonda Haney, PAS, VA Southern Oregon)


 Saluting the men and women who help keep America the land of the free and the home of the brave — our Veterans. 


New York


The VA New York Campus of the New York Harbor Health Care System will be hosting a group from the New York Mets coming to visit with Veteran patients on Monday, July 7. NY Mets General Manager and Vietnam Veteran Sandy Alderson and former player Rusty Staub will meet with patients for a barbecue on the patio at VA St. Albans Community Center. Many of the Veterans at the long term care facility are big fans of the former Mets players.


(Thanks Claudie Benjamin, PAO, VA New York Harbor)




Woman on a motorcycle with a Veteran in the sidecar

Community Living Center Veteran residents enjoy motorcycle rides around Denver


Denver


Veteran residents at Denver’s VA Community Living Center will enjoy a special treat on July 6 with the 7th Annual Harley’s Heroes Run to the Community Living Center. Local motorcycle enthusiasts come in force to the Denver center with side-car equipped Harley Davidson Motorcycles and give Veterans rides around the Denver Metro Area. About 50 motorcyclists are expected and almost all of the 30 residents take up the offer for the ride. The event is supported by Buckley Air Force Base active duty participants along with Marine Reservists from the base.


(Thanks Dan Warvi, PAO, Eastern Colorado Health Care System)




Color guard marches across a baseball diamond as players watch and clap

Portland VA Medical Center hosts Welcome Home Celebration ceremonies on July 4th in Bend, Oregon


Portland, Oregon


Portland VA Medical Center hosts Welcome Home Celebration ceremonies on July 4th in Bend, Oregon


On July 4, the Portland, Oregon, VA Medical Center will honor and show its appreciation for service members by hosting a Welcome Home Celebration for Veterans and their families in the Pacific Northwest. The event takes place at a baseball game in Bend, Oregon, featuring the Bend Bucks vs. Tacoma. Veterans and their families were invited to enjoy free tickets and food and an opportunity to learn about VA benefits and services.


(Thanks Dan Herrigstad, PAO, Portland VA Medical Center)






Source Article from http://www.va.gov/health/NewsFeatures/2014/July/VA-Hosts-July-4th-Ceremonies-for-Veterans.asp

Senior Veterans Going for the Gold – One More Time



A senior man in a swimming pool smiles

Recreation therapy fills a special need in the lives of older patients.










The 2014 National Veterans Golden Age Games will take place June 28-July 2 in Fayetteville, Arkansas, at the foothills of the Ozark Mountains on the campus of the University of Arkansas.


It’s the premier senior adaptive rehabilitation program in the United States and the only national multi-event sports and recreational seniors’ competition program designed to improve the quality of life for all older Veterans, including those with a wide range of abilities and disabilities.


The competitive events include air rifle, bowling, cycling, field (discus, shot, javelin), golf, horseshoes, mind sports (checkers, dominoes), nine-ball, shuffleboard, swimming, table tennis and track, with demonstration sport badminton.



A senior man throws a horse shoe

James McDonough, 89, pitches horseshoes at the Golden Age Games.


James McDonough of Denver is a Veteran of the Coast Guard and brought soldiers ashore during the Normandy landings (D-Day) June 6, 1944. He is extremely active and prepares for the games year round. He will be participating in javelin, horseshoes, bowling, and table tennis this year. He will be 89 on June 24.


According to Carla Carmichael, “The National Veteran Golden Age Games provide opportunities for Veterans to compete in sports and recreational events. An active lifestyle is critical to promoting health and independence while preventing illness or disability and prolonging quality of life.”


National Director of the Golden Age Games, Carmichael added, “Recreational and other rehab therapists at local medical centers work with the Veteran to participate based on rehabilitative goals established individually.”


Sports and fitness are vital ingredients of VA’s National Rehabilitation Special Events. Physical activity and friendly competition engage the mind as well as the body and recreation therapy fills a special need in the lives of older patients at VA health centers across the country. VA research and clinical experience verify that physical activity is particularly important to the health, recovery and overall quality of life for older people.


 No matter what, make the effort. I can make the effort. 


A few of the “stars” from the 2013 games


Robert “Sparky” Sparkes, a 94 year-old World War II U.S. Army Air Corps Veteran, works out and trains year-round, hiked the Appalachian Trail between Georgia to Maine three times since the age of 60 and inspires teammates daily with a positive attitude and will to compete.


Army Veteran Gael Keshoemaker experienced a stroke two years ago and faced speech and other significant physical challenges. In 2013, she participated in bowling as well as shuffleboard, table tennis and horseshoes. Her motto is, “No matter what, make the effort. I can make the effort.”


Dale Hosler, 83-year old Korean War Army Veteran, enjoys living a healthy lifestyle. He works out at least three times a week lifting weights and using cardio equipment and focuses on conditioning and strength training. “I look forward to it all year so I’m ready to participate.”



A woman in a wheelchair bowls

Judy Ruiz bowling at the Golden Age Games


Judy Ruiz, Marine Corps Veteran, lost her ability to work as a result of multiple sclerosis. She previously did not participate in sports but now feels that because of them, she has more hand and eye coordination, physical strength and range of motion. “Rehabilitative sports are great physically, mentally and socially. It’s good for the mind, body and soul.”


Read their stories (Inspiring Stories on the bottom of the page) and more about The National Veterans Golden Age Games.






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Senior-Veterans-Going-for-the-Gold-One-More-Time.asp

I Cannot Be This Person



Close up of a woman with an angry expression

Marine Veteran Laura Hendrixon










In observance of PTSD Awareness Month: June 2014, Inside Veterans Health, in collaboration with VA’s National Center for PTSD, presents the following profile of a Veteran who is living with PTSD and turning her life around with treatment.


Finding it hard to be home alone or feel comfortable in public places, Marine Veteran and MST survivor Laura Hendrixon is determined to get better for her family.


Laura Hendrixon had always thought PTSD came only after combat exposure — until it happened to her. “After being in the Marines for a year and a half, I was sexually assaulted by another Marine who was also a co-worker and a friend of mine,” she said. “It’s embarrassing to talk about, but I don’t want to be scared anymore. I want to be stronger.”


The trauma affected her so much that she was afraid to take a shower when she was home alone. “…I would basically be in panic mode the whole time,” she said. “I would think …‘Oh my gosh, I want to get a shower, but I can’t get a shower because I’m home by myself and if I’m in the shower, I’m not going to be able to hear if somebody comes in the house.’ I would get scared to the point that I wouldn’t close my eyes when I’m taking a shower.”


Laura was diagnosed with PTSD. Her VA doctor suggested she get into treatment. “I finally had a doctor point out to me that, you know, it would be really good if I went through this treatment,” she recalled. “I knew I needed to do it because I can’t wait to have kids and I was like, “I cannot be this person with kids. I’m going to, like, wrap them up in bubble wrap.”


 It’s embarrassing to talk about, but I don’t want to be scared anymore. I want to be stronger. 


Laura’s treatment at VA was a form of talk therapy called Prolonged Exposure (PE). In PE, the goal is for the patient to have less fear about her memories. It is based on the idea that people learn to fear thoughts, feelings and situations that remind them of a past traumatic event. By talking about her trauma repeatedly in a safe environment with a therapist, the patient learns to get control of her thoughts and feelings about the trauma. She learns that she does not have to be afraid of her memories.


“I made a list of things I needed to be able to do: make left-hand turns, ride in an elevator, go somewhere by myself, get showers. It’s like, I need to learn how to deal with this stuff, now,” she explained. “It was very difficult at first. I had to go back to that moment and, you know, describe exactly how I felt, emotions and fears and everything about the moment. It did get easier. You actually record yourself and then you listen to it, so in some way it tricks your brain into accepting that this did happen to me and, you know, I’m going to be OK and it’s going to get better.”


Laura also credits her husband for much of the progress she has made. “My husband is a lifesaver,” she said. “We’re going to counseling together and they’re helping us talk through some of the daily struggles that I have with PTSD. He’s so good for me; he encourages me to do things I’m not comfortable with. I definitely plan to keep moving forward with it. I’m always thinking, like, “Just do it!” I can do all kinds of stuff.”


You can see the entire AboutFace video profile of Laura Hendrixon.


For more information on PTSD and ways to raise awareness of this mental health problem during June and throughout the year, professionals and members of the public can visit the National Center for PTSD website. This site offers resources such as:


  • PTSD Coach Online and the award-winning PTSD Coach mobile app, which provide self-help symptom-management tools. The app is always with you when you need it.
  • PTSD Continuing Education opportunities for providers, including PTSD 101 Courses, on the best practices in PTSD treatment (CEs/CMEs offered).
  • AboutFace: Online videos of Veterans talking about how PTSD treatment can turn your life around.
  • For continued involvement, please subscribe to the PTSD Monthly Update. Stay up to date on new information about PTSD and trauma year round.




Source Article from http://www.va.gov/health/NewsFeatures/2014/June/I-Cannot-Be-This-Person.asp

Connecting Veterans with Telehealth



A nurse and Veteran talk with a physician through a video conference

Telehealth — making care accessible and patient-centered.










In fiscal year 2013, more than 600,000 Veteran patients received some element of their health care via telehealth.


That’s 11 percent of the Veterans in the VA health care system who participated in 1.7 million telehealth episodes of care.


For those thousands of Veterans, the future is now with telehealth, a radically different way for patients to receive and clinicians to provide care.


According to Dr. Adam Darkins, “Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”


Darkins is VA’s chief consultant for telehealth services.


Telehealth is aimed at making care convenient, accessible and patient-centered. Telehealth helps Veterans live independently in their own homes and local communities.


Covers Over 44 Clinical Specialties


A key component of VA telehealth is Clinical Video Telehealth, real-time video consultation that covers
over 44 clinical specialties including: Tele-Intensive Care, TeleMental Health, TeleCardiology,
TeleNeurology, TeleSurgery, Women’s Telehealth, Tele-Primary Care, TeleSCI care, TeleAmputation
Care, TeleAudiology, TeleSpeech, Remote Nursing Home Consultation, TelePathology and more.


Home Telehealth, which provided care for 144,520 Veterans in fiscal year 2013, helps patients with chronic conditions in their homes, providing non-institutional care, chronic care management, acute care management, health promotion and disease prevention.


Forty-five percent of these patients live in rural areas and may otherwise have had limited access to VA health care. The number of Veterans receiving care via VA’s telehealth services is growing approximately 22 percent annually.



An senior Veteran speaks to a nurse and doctor on a video screen

The number of Veterans receiving care via telehealth growing about 22% a year.


More Than a Million Mental Health Encounters


TeleMental Health — VA has delivered more than 1.1 million patient encounters from 150 VA facilities to 729 community based outpatient clinics, a 24-fold increase in consultations since fiscal year 2003.


In fiscal year 2013, VA delivered more than 278,000 telemental health patient encounters to over 91,000 patients.


The scope of VA’s telemental health services includes all mental health conditions with a focus on post-traumatic stress disorder, depression, compensation and pension exams, bipolar disorder, behavioral pain and evidence-based psychotherapy.


The ability to receive and store clinical images via telehealth is called Store-and-Forward Telehealth (SFT). This affected 311,369 Veterans in fiscal year 2013. It enables the acquisition of clinical images at sites close to the patient, and for the interpretation and reporting of these to occur remotely and asynchronously.


Use of TeleDermatology up by 279 percent


Currently the major areas of SFT care in VA are TeleRetinal Imaging, to screen for diabetic eye disease and prevent avoidable blindness, and TeleDermatology, which has increased by 279 percent over the past three years to more than 45,000 patients receiving care in fiscal year 2013.


New programs under development include Telepathology, TeleWound care, TeleSpirometry and TeleCardiology.


Dr. Darkins adds, “Telehealth is often described as helping provide the right care in the right place at the right time which translates into many Veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert VA that a patient needs to be rapidly seen in the clinic or hospital.”


Learn more about VA’s telehealth services and watch videos that do a great job of explaining telehealth programs and how they can provide better access to health care for Veterans.






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Connecting-Veterans-with-Telehealth.asp

Brain’s ‘Error Messages’ May Hold PTSD Clue



A doctor places electrodes on a man's head

Dr. K. Luan Phan adjusts a volunteer‘s electrode cap. He is studying the brain‘s “error alert” system as a potential key to stress resilience. Photo by Jerry Daliege










To err is human. Every day people forget to lock their door, pay a bill, or yield at a stop light. Like it or not, mistakes are part of life. Now VA researchers are looking at how Veterans with posttraumatic stress disorder react to their own mistakes. The results could reveal clues as to why some Veterans are more resilient to traumatic events than others.


The science of error-related negativity (ERN) is one way to study electrical activity in the brain. It works like this: When someone makes a mistake, the brain releases an electrocortical response. Think of the old science fiction movies where test subjects are shocked for answering incorrectly. The brain works in something of the same way, delivering a negative electrical signal whenever an error is made.


“Every time we make an error, our brain consciously or unconsciously recognizes it and lets us know,” says Dr. K. Luan Phan, a professor at the University of Illinois, Chicago, and chief of neuropsychiatric research at the Jesse Brown VA Medical Center. “It’s a neural signal so that we don’t keep making the same error in the future.”


Different patterns seen in anxiety, depression


Researchers suspect that higher intensities of ERN are tied to anxiety disorders, while lower intensities have been identified in people with depression. “We’ve known for about 20 years that ERN is elevated in people with obsessive compulsive disorders and that adds to their sense that something isn’t right, so they may check the doorknob repeatedly to ensure they locked it,” says Phan. “And in the last five years we’ve found increasing evidence tying ERN to a number of anxiety disorders. Until recently though, no one had studied how ERN interacted with traumatic experience and PTSD.”


On the surface, it seemed to make sense. PTSD is characterized by sustained anxiety and hypervigilance. Phan suspected that patients with PTSD would have greater concerns of mistakes and greater brain reactions to making mistakes, as evidenced by ERN.


Study involved 34 Veterans


Thirty-four Iraq and Afghanistan Veterans from the Ann Arbor Healthcare System were recruited for the study. While all 34 had experienced combat trauma, only 16 met the diagnosing criteria for PTSD. Another 16 presumably healthy participants without any history of trauma were recruited locally. The participants took a version of the Eriksen flanker task, a simple, timed conflict test involving lines of arrows. In some instances, the arrows would all point in the same direction. In others, they would appear at random which makes it harder to perform and increases the likelihood of making mistakes.


The participants were asked to click on either the left or right mouse button, depending on which direction the arrows faced. Throughout the test, the Veterans were monitored by an electroencephalographic (EEG) recording device.


“We expected to see higher ERN magnitude among patients with PTSD,” said Phan, “but were surprised to not observe this. In fact, the PTSD group scored very similarly with the healthy group.” This, according to Phan, is actually good news. “It means individuals with PTSD are still able to generate healthy signals for errors in their brains, which may help them not make the same mistakes over and over again.”


What did come as a surprise to Phan were the EEG measures in the 18 combat-exposed Veterans who did not have PTSD. In comparison to both the PTSD and healthy groups, the combat-exposed group displayed blunted error signals. In other words, they had lower-than-normal ERN intensity.


Future therapy goal: ‘Reduce the error signals’


The study, which was published in the July 30, 2013, edition of Psychiatry Research: Neuroimaging, suggests that for some people, having a less active error-monitoring system could make them more resilient to developing PTSD from combat trauma.


“We know all the participants had combat trauma exposure, but many came back unscathed at the time of our data collection,” says Phan. “Perhaps not being so sensitive to errors in your environment is actually protective. It might allow for the reduction of PTSD and anxiety disorders.”


While his study results need to be confirmed through further testing, he hopes one day scientists will learn how to therapeutically manipulate the ERN system for patients’ benefit: “If we can reduce the error signals, then maybe we can reduce PTSD,” says Phan, who is quick to point out that he’s looking years into the future. “First we need to replicate what we saw, but this gives us something to track.”






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Brains-Error-Messages-May-Hold-PTSD-Clue.asp

Sunday Was a Very Veteran Father’s Day



A family sits on steps decorated with green garlands

Clockwise: Crystal Schutter; SGT Jeff Schutter, Jr.; Sue Schutter; Robert Schutter; Tami Schutter; Jake Schutter










Becoming a father is a proud moment in any man’s life, but it was when my brother and I graduated from Army Basic Training that my father seemed the most proud.


My father, retired Lieutenant Colonel Jeff Schutter, completed his Army Basic Training at Fort Sill, Oklahoma, in 1984 and enjoyed a 25 year career that started out in Field Artillery.


“I remember my father telling me stories about being in the Army,” said retired Lt. Col. Schutter. “After I joined the Army, I was able to share stories with my kids and always encouraged them to think about joining.”


My grandfather, Robert Schutter, served in the Army from 1957 to 1959. After completing Army Basic Training at Fort Knox, Kentucky, he was deployed to Korea to serve with the 30th Ordnance Company.


“That was when we had the draft,” recalls Robert Schutter. “My friend and I decided to go ahead and volunteer instead of waiting to be drafted.”


 I remember my father telling me stories about being in the Army. 


While serving in Korea, Schutter recalls when he and his platoon saw three MiGs fly over the 38th parallel, and how alarmed he was.


“I was glad to get back home,” said Schutter, “but I believe my time in the service was beneficial and everyone should serve in the military. I was very proud when my son told me he had joined the Army.”


Retired Lt. Col. Schutter, a Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom Veteran, had his first duty assignment as an Artillery Officer in Garlstedt, Germany. Once the Berlin Wall came down, he returned to the states and deployed to Kuwait, Qatar and Afghanistan.



A man and woman stand in the audience at an outdoor wedding ceremony

Retired Lt. Col. Jeff Schutter and wife Betsy, attending the wedding of their youngest son.


Proud His Kids Joined the Army


While serving with the 1st Cavalry Division at Fort Hood, Texas, retired Lt. Col. Schutter was able to watch his own son and daughter follow in his footsteps and join the Army.


“I was very proud when my son and daughter joined the Army,” recalls retired Lt. Col. Schutter. “I enjoyed my career in the Army, and I knew it would give them the chance to do things that others only dream about.”


My older brother joined the Army Reserves, and right after him, I joined the Army National Guard. I joined in June of 2001, right before the terrorist attacks of 9/11. I remember calling my father that day and telling him how worried I was that he would be deployed overseas very soon.


“I would be more worried about you being deployed before me,” retired Lt. Col. Schutter said.


I entered into the Army knowing I would eventually be deployed to Iraq or Afghanistan.


I finished Army Basic Training at Fort Jackson, South Carolina, and served with a National Guard unit in Austin, Texas. I served six years, and after finishing college and moving to Houston, I knew I wanted to stay close to the military culture and camaraderie.


I started working for VA last October, and I couldn’t be more proud of the service we provide to our Veterans. I look forward to learning and growing with the VA community.


Now retired and working on his second career, Lt. Col. Schutter has regular visits to the Michael E. DeBakey VA Medical Center in Houston, Texas. Having served his country, he enjoys the service he receives.


“There are a couple of outpatient clinics that are closer for me to travel to, but I really like my doctor at the Houston VA, and I wouldn’t go anywhere else,” said retired Lt. Col. Schutter.


Now, as an employee at the Houston VA, it warms my heart to know that Veterans, like my father, are receiving outstanding care.






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Sunday-Was-a-Very-Veteran-Fathers-Day.asp

Brain’s ‘Error Messages’ May Hold PTSD Clue



A doctor places electrodes on a man's head

Dr. K. Luan Phan adjusts a volunteer‘s electrode cap. He is studying the brain‘s “error alert” system as a potential key to stress resilience. Photo by Jerry Daliege










To err is human. Every day people forget to lock their door, pay a bill, or yield at a stop light. Like it or not, mistakes are part of life. Now VA researchers are looking at how Veterans with posttraumatic stress disorder react to their own mistakes. The results could reveal clues as to why some Veterans are more resilient to traumatic events than others.


The science of error-related negativity (ERN) is one way to study electrical activity in the brain. It works like this: When someone makes a mistake, the brain releases an electrocortical response. Think of the old science fiction movies where test subjects are shocked for answering incorrectly. The brain works in something of the same way, delivering a negative electrical signal whenever an error is made.


“Every time we make an error, our brain consciously or unconsciously recognizes it and lets us know,” says Dr. K. Luan Phan, a professor at the University of Illinois, Chicago, and chief of neuropsychiatric research at the Jesse Brown VA Medical Center. “It’s a neural signal so that we don’t keep making the same error in the future.”


Different patterns seen in anxiety, depression


Researchers suspect that higher intensities of ERN are tied to anxiety disorders, while lower intensities have been identified in people with depression. “We’ve known for about 20 years that ERN is elevated in people with obsessive compulsive disorders and that adds to their sense that something isn’t right, so they may check the doorknob repeatedly to ensure they locked it,” says Phan. “And in the last five years we’ve found increasing evidence tying ERN to a number of anxiety disorders. Until recently though, no one had studied how ERN interacted with traumatic experience and PTSD.”


On the surface, it seemed to make sense. PTSD is characterized by sustained anxiety and hypervigilance. Phan suspected that patients with PTSD would have greater concerns of mistakes and greater brain reactions to making mistakes, as evidenced by ERN.


Study involved 34 Veterans


Thirty-four Iraq and Afghanistan Veterans from the Ann Arbor Healthcare System were recruited for the study. While all 34 had experienced combat trauma, only 16 met the diagnosing criteria for PTSD. Another 16 presumably healthy participants without any history of trauma were recruited locally. The participants took a version of the Eriksen flanker task, a simple, timed conflict test involving lines of arrows. In some instances, the arrows would all point in the same direction. In others, they would appear at random which makes it harder to perform and increases the likelihood of making mistakes.


The participants were asked to click on either the left or right mouse button, depending on which direction the arrows faced. Throughout the test, the Veterans were monitored by an electroencephalographic (EEG) recording device.


“We expected to see higher ERN magnitude among patients with PTSD,” said Phan, “but were surprised to not observe this. In fact, the PTSD group scored very similarly with the healthy group.” This, according to Phan, is actually good news. “It means individuals with PTSD are still able to generate healthy signals for errors in their brains, which may help them not make the same mistakes over and over again.”


What did come as a surprise to Phan were the EEG measures in the 18 combat-exposed Veterans who did not have PTSD. In comparison to both the PTSD and healthy groups, the combat-exposed group displayed blunted error signals. In other words, they had lower-than-normal ERN intensity.


Future therapy goal: ‘Reduce the error signals’


The study, which was published in the July 30, 2013, edition of Psychiatry Research: Neuroimaging, suggests that for some people, having a less active error-monitoring system could make them more resilient to developing PTSD from combat trauma.


“We know all the participants had combat trauma exposure, but many came back unscathed at the time of our data collection,” says Phan. “Perhaps not being so sensitive to errors in your environment is actually protective. It might allow for the reduction of PTSD and anxiety disorders.”


While his study results need to be confirmed through further testing, he hopes one day scientists will learn how to therapeutically manipulate the ERN system for patients’ benefit: “If we can reduce the error signals, then maybe we can reduce PTSD,” says Phan, who is quick to point out that he’s looking years into the future. “First we need to replicate what we saw, but this gives us something to track.”






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Brains-Error-Messages-May-Hold-PTSD-Clue.asp

Sunday Was a Very Veteran Father’s Day



A family sits on steps decorated with green garlands

Clockwise: Crystal Schutter; SGT Jeff Schutter, Jr.; Sue Schutter; Robert Schutter; Tami Schutter; Jake Schutter










Becoming a father is a proud moment in any man’s life, but it was when my brother and I graduated from Army Basic Training that my father seemed the most proud.


My father, retired Lieutenant Colonel Jeff Schutter, completed his Army Basic Training at Fort Sill, Oklahoma, in 1984 and enjoyed a 25 year career that started out in Field Artillery.


“I remember my father telling me stories about being in the Army,” said retired Lt. Col. Schutter. “After I joined the Army, I was able to share stories with my kids and always encouraged them to think about joining.”


My grandfather, Robert Schutter, served in the Army from 1957 to 1959. After completing Army Basic Training at Fort Knox, Kentucky, he was deployed to Korea to serve with the 30th Ordnance Company.


“That was when we had the draft,” recalls Robert Schutter. “My friend and I decided to go ahead and volunteer instead of waiting to be drafted.”


 I remember my father telling me stories about being in the Army. 


While serving in Korea, Schutter recalls when he and his platoon saw three MiGs fly over the 38th parallel, and how alarmed he was.


“I was glad to get back home,” said Schutter, “but I believe my time in the service was beneficial and everyone should serve in the military. I was very proud when my son told me he had joined the Army.”


Retired Lt. Col. Schutter, a Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom Veteran, had his first duty assignment as an Artillery Officer in Garlstedt, Germany. Once the Berlin Wall came down, he returned to the states and deployed to Kuwait, Qatar and Afghanistan.



A man and woman stand in the audience at an outdoor wedding ceremony

Retired Lt. Col. Jeff Schutter and wife Betsy, attending the wedding of their youngest son.


Proud His Kids Joined the Army


While serving with the 1st Cavalry Division at Fort Hood, Texas, retired Lt. Col. Schutter was able to watch his own son and daughter follow in his footsteps and join the Army.


“I was very proud when my son and daughter joined the Army,” recalls retired Lt. Col. Schutter. “I enjoyed my career in the Army, and I knew it would give them the chance to do things that others only dream about.”


My older brother joined the Army Reserves, and right after him, I joined the Army National Guard. I joined in June of 2001, right before the terrorist attacks of 9/11. I remember calling my father that day and telling him how worried I was that he would be deployed overseas very soon.


“I would be more worried about you being deployed before me,” retired Lt. Col. Schutter said.


I entered into the Army knowing I would eventually be deployed to Iraq or Afghanistan.


I finished Army Basic Training at Fort Jackson, South Carolina, and served with a National Guard unit in Austin, Texas. I served six years, and after finishing college and moving to Houston, I knew I wanted to stay close to the military culture and camaraderie.


I started working for VA last October, and I couldn’t be more proud of the service we provide to our Veterans. I look forward to learning and growing with the VA community.


Now retired and working on his second career, Lt. Col. Schutter has regular visits to the Michael E. DeBakey VA Medical Center in Houston, Texas. Having served his country, he enjoys the service he receives.


“There are a couple of outpatient clinics that are closer for me to travel to, but I really like my doctor at the Houston VA, and I wouldn’t go anywhere else,” said retired Lt. Col. Schutter.


Now, as an employee at the Houston VA, it warms my heart to know that Veterans, like my father, are receiving outstanding care.






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Sunday-Was-a-Very-Veteran-Fathers-Day.asp

Brain’s ‘Error Messages’ May Hold PTSD Clue



A doctor places electrodes on a man's head

Dr. K. Luan Phan adjusts a volunteer‘s electrode cap. He is studying the brain‘s “error alert” system as a potential key to stress resilience. Photo by Jerry Daliege










To err is human. Every day people forget to lock their door, pay a bill, or yield at a stop light. Like it or not, mistakes are part of life. Now VA researchers are looking at how Veterans with posttraumatic stress disorder react to their own mistakes. The results could reveal clues as to why some Veterans are more resilient to traumatic events than others.


The science of error-related negativity (ERN) is one way to study electrical activity in the brain. It works like this: When someone makes a mistake, the brain releases an electrocortical response. Think of the old science fiction movies where test subjects are shocked for answering incorrectly. The brain works in something of the same way, delivering a negative electrical signal whenever an error is made.


“Every time we make an error, our brain consciously or unconsciously recognizes it and lets us know,” says Dr. K. Luan Phan, a professor at the University of Illinois, Chicago, and chief of neuropsychiatric research at the Jesse Brown VA Medical Center. “It’s a neural signal so that we don’t keep making the same error in the future.”


Different patterns seen in anxiety, depression


Researchers suspect that higher intensities of ERN are tied to anxiety disorders, while lower intensities have been identified in people with depression. “We’ve known for about 20 years that ERN is elevated in people with obsessive compulsive disorders and that adds to their sense that something isn’t right, so they may check the doorknob repeatedly to ensure they locked it,” says Phan. “And in the last five years we’ve found increasing evidence tying ERN to a number of anxiety disorders. Until recently though, no one had studied how ERN interacted with traumatic experience and PTSD.”


On the surface, it seemed to make sense. PTSD is characterized by sustained anxiety and hypervigilance. Phan suspected that patients with PTSD would have greater concerns of mistakes and greater brain reactions to making mistakes, as evidenced by ERN.


Study involved 34 Veterans


Thirty-four Iraq and Afghanistan Veterans from the Ann Arbor Healthcare System were recruited for the study. While all 34 had experienced combat trauma, only 16 met the diagnosing criteria for PTSD. Another 16 presumably healthy participants without any history of trauma were recruited locally. The participants took a version of the Eriksen flanker task, a simple, timed conflict test involving lines of arrows. In some instances, the arrows would all point in the same direction. In others, they would appear at random which makes it harder to perform and increases the likelihood of making mistakes.


The participants were asked to click on either the left or right mouse button, depending on which direction the arrows faced. Throughout the test, the Veterans were monitored by an electroencephalographic (EEG) recording device.


“We expected to see higher ERN magnitude among patients with PTSD,” said Phan, “but were surprised to not observe this. In fact, the PTSD group scored very similarly with the healthy group.” This, according to Phan, is actually good news. “It means individuals with PTSD are still able to generate healthy signals for errors in their brains, which may help them not make the same mistakes over and over again.”


What did come as a surprise to Phan were the EEG measures in the 18 combat-exposed Veterans who did not have PTSD. In comparison to both the PTSD and healthy groups, the combat-exposed group displayed blunted error signals. In other words, they had lower-than-normal ERN intensity.


Future therapy goal: ‘Reduce the error signals’


The study, which was published in the July 30, 2013, edition of Psychiatry Research: Neuroimaging, suggests that for some people, having a less active error-monitoring system could make them more resilient to developing PTSD from combat trauma.


“We know all the participants had combat trauma exposure, but many came back unscathed at the time of our data collection,” says Phan. “Perhaps not being so sensitive to errors in your environment is actually protective. It might allow for the reduction of PTSD and anxiety disorders.”


While his study results need to be confirmed through further testing, he hopes one day scientists will learn how to therapeutically manipulate the ERN system for patients’ benefit: “If we can reduce the error signals, then maybe we can reduce PTSD,” says Phan, who is quick to point out that he’s looking years into the future. “First we need to replicate what we saw, but this gives us something to track.”






Source Article from http://www.va.gov/health/NewsFeatures/2014/June/Brains-Error-Messages-May-Hold-PTSD-Clue.asp


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