June 30, 2008, 6:54 am

Veterans to be Awarded Purple Hearts for Psychological Scars?

Time Magazine’s Mark Thompson reports that with the growing numbers of veteran’s suffering from Post Traumatic Stress Disorder (roughly 40,000), military personnel are starting to think that individual’s suffering from mental injuries may deserve the Purple Heart, and the Pentagon is apparently listening.

The Purple Heart has traditionally been awarded to those with physical injuries or those killed while defending their country. Currently the “Army classifies PTSD as an illness, not an injury, which means it doesn’t qualify for the honor. But John Fortunato, an Army psychologist at Fort Bliss, Texas, argued in early May that PTSD affects soldiers by physically damaging their brains, making the condition no different than conventional wounds”.

According to Thompson (2008):

The suggestion has garnered high-level Pentagon attention. “It’s an interesting idea,” Defense Secretary Robert Gates recently noted. “I think it is clearly something that needs to be looked at.” The Defense Department’s awards advisory group, which previously ruled that PTSD doesn’t merit a Purple Heart, is now studying the issue again.

Click here to read the full article in Time Magazine

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June 27, 2008, 2:12 pm

Prevention of Neurological Damage via Hypothermia?

MedPage today’s Michael Smith reports that the evidence is showing that “inducing mild hypothermia – to between 32 and 35° C — can prevent or reduce permanent injury after certain types of neurological insult. Dr. Polderman shares that while this technique has been shown effective for post-ischemic injury after global anoxia and for lowering of intracranial pressure it still needs to be rigorously tested for traumatic brain injury, ischemic stroke, and thoracoabdominal aneurysm repair. Smith reports:

“Available evidence suggests that hypothermia will be more effective if it is applied soon after an injury, implying that, in the future, treatments would begin in the ambulance or emergency room,” he said.

Among the potential indications Dr. Polderman spelled out:

• Cardiac arrest and cardiopulmonary resuscitation, where the evidence is good that cooling the body to about 33° C improves the odds of a good neurological outcome. The number needed to treat is about six.
• Perinatal asphyxia, where hypothermia should “be strongly considered.” Side-effects seen in clinical trials seem to be minor and the number needed to treat is six.
• Reducing intracranial pressure in patients with cerebral edema, regardless of the cause. Several clinical trials have shown that hypothermia reduces pressure, although the reduction does not necessarily lead to improved outcome.

Evidence in traumatic brain injury is mixed, Dr. Polderman said, although he said it’s clear that cooling can be effective in cases of severe traumatic brain injury and intracranial hypertension provided that treatment starts early, continues for between two and five days, and is followed by a slow rewarming over at least 24 hours.

Click here to read the full article in MedPage Today

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June 20, 2008, 8:08 am

A Report Card for Insurance Companies

Your insurance company is rated by the American Medical Association in terms of claims processing, meeting contracted rate payments and denials of claims. Medicare topped the list, beating seven private health insurers when it came to claims processing time and  meeting the contracted rate. The seven private firms which were rated in the study were: Aetna; Anthem Blue Cross; CIGNA; Coventry Health Care; Health Net; Humana and United Healthcare.

Click here to read the Report Card story from Medline and learn how these insurance providers stack up

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June 19, 2008, 10:18 am

Epileptic Medication Compliance Affects Longevity

According to Edward Faught, M.D. of the University of Alabama at Birmingham and colleagues, a review of Medicaid databases in three states showed that individuals who took their epilepsy medication less than 80% of the time were three times more likely to die (Phend, 2008). Furthermore the study also showed that irregular medication use can also be associated with an 86% increase in hospital admission and 50% more emergency department visits. Phend reports:

Irregularity in the use of anti-epileptics was also associated during nonadherent periods with the following:

• 50% higher incidence of emergency department visits (incidence rate ratio 1.50, 95% CI 1.49 to 1.52)
• 86% higher incidence of hospitalization (IRR 1.86, 95% CI 1.84 to 1.88).
• Two-fold higher incidence of motor vehicle accident-related injuries (IRR 2.08, 95% CI 1.81 to 2.39).
• 21% higher incidence of fractures (IRR 1.21, 95% CI 1.18 to 1.23).
• No increase in head injuries (IRR 0.73, 95% CI 0.72 to 0.75).

Click here to read the full article in MedPage Today

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June 17, 2008, 9:15 am

Insurgency Phase of Iraq War Increases Wound Severity

The severity of combat wounds in Iraq increased significantly when the war shifted from invasion to counter-insurgency. In the June issue of Archives of Surgery, Stacy Brethauer. M.D. reported that in comparison to the invasion phase there has been a 50% increase in the mean number of major injuries per patient and in the percentage of patients dying before a physician could see them. The study compared 338 casualties treated by Marine Corps surgical team in March and April of 2003 with 895 treated from March 2004 to February 2005.The study looked at the causative factors in the increase, namely the increase in injuries from IED's, mortars and rocket propelled grenades as the combat shifted from invasion to guerrilla warfare. During the invasion phase 48% of the casualties had fragmentation wounds rising to 61% in the counter-insurgency phase. The rate of physician treated injuries who later died increased from 0.88% during the invasion to 5.5% during the counter-insurgency.The wounded individuals who arrive at battlefield hospitals are undergoing more procedures. This is attributed to the types of wounds caused by IED's and other explosive weapons. The body armor worn by soldiers and the armor on vehicles is inadequate in light of the explosive forces of IED's and other weapons inherent in this phase of the conflict.The military has addressed the more immediate transport of severely injured soldiers to surgical units in an effort to reduce mortality and provide more rapid response to the devastating injuries.

The Iraq and Afghanistan wars have brought about many advances in trauma medicine which will trickle down into the emergency rooms in our country as trauma surgeons and nurses return. But, the reality of the war is that the type of combat involving our troops is causing more severe and multiple injuries with a much higher death rate. We will see soldiers with very severe disabilities arising from multiple trauma returning home. Brain injury has been called "the signature wound" of the Iraq and Afghanistan War. We can expect that individuals with even more severe brain injuries and multi trauma related disabilities will be requiring rehabilitation and life time support as they leave military hospitals. Are we ready?

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June 16, 2008, 8:52 am

Sleep Disturbance Among Veterans

Michael Smith reports that Insomnia appears to be a problem in our Iraq war veterans. In a presentation at the Associated Professional Sleep Societies meeting, Dr Germain shared that “both subjective reports of sleep disturbances and objective measurement in a sleep lab show a pattern that more closely resembles people with chronic insomnia”.

Dr Germain conducted a comparative study of 11 veterans and 11 volunteers – none of which were taking any medications. She found that the veterans “had significantly worse sleep quality and sleep efficiency, took longer to go to sleep, woke up more often after they fell asleep, and were awake longer when they did.”

These findings were compared with a study consisting of 14 good sleepers and 14 people who suffer from chronic insomnia. Dr Germain stated that she found that there was no “significant differences between the veterans and the insomniacs … except in disruptive nocturnal behaviors”.

Click here to read the full article in MedPage Today

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June 10, 2008, 7:01 am

Virtual Tote Bags & Concussion Packets offered by Iowa

The virtual tote bag includes brochures, books, and a video DVD. The information is all available online and consists of information about Iowa’s family support network, protection and advocacy, as well as books ranging from assistive technology, to universal home design, as well as guides to help family members, friends, and employers understand Brain Injury.

The “Iowa Brain Injury Resource Network Virtual Concussion Packet” includes must have facts about concussion and brain injury as well as Brochures/links to The Brain Injury Association of Iowa, The Iowa Brain Injury Resource Network and Iowa Family Support Network, as well as Consultation Service for Students with Brain Injury.

Iowa Brain Injury Resource Network Tote Bag

Word - http://www.biausa.org/Iowa/docs/virtual_tote_bag.doc
html - http://www.biausa.org/Iowa/docs/virtual_tote_bag.htm

Virtual Concussion Packet

Word - http://www.biausa.org/Iowa/docs/virtual_concussion_packet.doc
html - http://www.biausa.org/Iowa/docs/virtual_concussion_packet.htm

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June 9, 2008, 7:41 am

Your Brain on Advertising

The amygdala, when aroused by emotions such as fear, can override logic. The recent crop of political ads which are based on arousing a response at a subconscious level are powerful in terms of influencing what we think about the candidate, their opponent and the latent message. Drew Westen, Ph.D., a psychologist at Emory University in Georgia studies how thew brain reacts to candidates' messages. Dr. Westen believes that the "gut level" responses are very important and that the conscious brain only processes a small amount of the information. Dr. Westen and his business partner, Joel Weinberger, have developed a software that measures a person's reaction time to certain words after they watch "attack" ads. Words such as "weak", "inexperienced", :lightweight" and "terrorist" when coupled with a solicited color response shows that the word has an impact. The analysis of the responses showed that a slowdown in response time indicated that the word had an unconscious impact. Undecided voters, who said that they didn't like the ads demonstrated little effect.

Political advertisements which are pitched to our subconscious can have a powerful effect on what we think about a candidate and ultimately, how we vote. Just think about what makes you respond to a political ad.

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June 4, 2008, 9:54 am

Exposure Therapy vs. Cognitive Restructuring in Preventing PTSD

John Gever, MedPage Today, reports that a recent study shows that exposure therapy is better than cognitive restructuring when it comes to preventing PTSD. The study consisted of 90 patients who met the criteria for acute stress disorder – and had not been a victim of sexual assault, the 90 patients were then divided up into three groups, one group received exposure therapy, another received cognitive restructuring and the 3rd group was placed on a waiting list. According to the article:

only 37% of patients who began prolonged-exposure therapy shortly after a traumatic event had developed PTSD six months later, compared with 63% of those treated with cognitive restructuring (P=0.05), reported Richard A. Bryant, Ph.D., of the University of New South Wales, and colleagues in the June issue of Archives of General Psychiatry.

Gever shares that 47% of individual’s treated using exposure therapy had full remission of acute stress disorder symptoms.

Click here to read the full article

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June 3, 2008, 1:01 pm

Awareness of Social Inference

Katherine Rankin, Ph.D., a neuropsychologist and assistant professor in the Memory and Aging Center at the University of California, San Francisco, has developed an innovative test known as the Awareness of Social Inference Test. The test, developed in 2002, uses videotaped vignettes of exchanges in which seemingly straightforward words are delivered in a overt sarcastic style. Dr. Rankin’s test relies on the person’s ability to detect paralinguistic cues. MRI scans revealed that those individuals who had a problem detecting sarcasm had dysfunction in the right parahippocampal gyrus. This finding highlighted that the right parahippocampal gyrus must detect more than just visual context, but also the social context. The right hemisphere language function is where the appreciation of humor and jokes resides. Dr. Rankin was asked how individuals with intact brains differ in their ability to pick up sarcasm. The case in point was Jon Stewart, who uses sarcasm effectively on The Daily Show. Dr. Rankin commented that Mr. Stewart “is probably just normal; the right parahippocampal gyrus is involved in detecting sarcasm, not in being sarcastic.” But then she added, “I bet Jon Stewart has a huge right frontal lobe; that’s where the sense of humor is detected on MRI.”

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