August 2008

Message from the Network Director

As I start as Network Director I want to take the opportunity to share some reflections with you.

First, I feel privileged to work in the area of health care.  People come to us with signs and symptoms of illness; with the tools of modern medicine, we are able to effectively address them.  They come to us with concerns; with “high touch” care we can relieve their anxiety.  With effective preventive medicine we can also maintain and prolong good health.  Through all ages and in all cultures the healing professions have been highly respected.  My motivation for taking leadership positions at different times in my career is that they have provided an opportunity to improve the systems of care, so that both patients and staff can have better experiences.  I have also continued to actively practice as a primary care provider, even in my most recent role in Washington as it allows me to stay in closer touch with the actual experience of providing health care, and I will continue this practice in my current role.
 
Second, I feel privileged to serve our veterans.  Starting with my experiences as a resident at Providence VAMC, I have felt a special regard for the veteran patients that we care for.  They, on the whole, are a group which is appreciative of the care they receive and represent in many ways the “salt of the earth.”  I have always appreciated the opportunity to learn about their military experiences.  Over the years, I have taken care of patients who fought in World War I, who landed on the beaches on D-Day, and survived the Bataan Death March in the Philippines.  I have had patients who suffered cold injury while fighting in the battle of the “frozen Chosin” reservoir in Korea or who’ve served in the jungles of Vietnam.  More recently I have taken care of men and women back from the conflicts in Iraq and Afghanistan.  I’ve also taken care of many who did not serve in conflicts but, nonetheless, every single one of them put on the uniform, served our country, and made a commitment to do whatever was needed, even the ultimate sacrifice for our country.  They are a special group of people, and it is an honor to serve them.

Third, I feel privileged to work for the VA.  The VA is not a perfect organization.  To paraphrase Bill Belichick, “It is what it is.”  However, among the things that the VA is, is an organization in which the staff has great dedication to their mission.  Over the years, individuals coming to the VA from outside have commented to me on the special commitment the staff have to the patients they serve, a relationship which is not present in many health care organizations.  It is an organization in which quality of care and evidence based medicine are genuine priorities and which does not chase the latest medical fad or high tech equipment simply because it provides high reimbursement.  It is an organization which is concerned about vulnerable populations in our society including the homeless, seriously mentally ill and the disabled.  These are populations too often ignored or abandoned by other groups.  It is an organization which values the development of new knowledge, research and the training of the future generations of health care professionals - education activities which have been an important part of my professional career.  It has been an innovator in health care leading cutting edge developments, such as a comprehensive electronic medical record, performance measures, patient safety, and universal primary care. 

These three things - being in health care, serving veterans, and working for the VA - are things all of us share.  Each of us has an important role in delivering care to veterans.  My role as a member of the leadership team is clear - to ensure we have a clear vision of where we want to go and what is expected of each one of us, to ensure resources are there so you can do the job you’re asked to do and each has the opportunity to participate, to learn and to grow.  I feel it is a privilege to serve in this role.  It is an exciting opportunity and I am looking forward to working with all of you. 

Sincerely,

Michael F. Mayo-Smith, MD, MPH
Network Director

Danielle Ocker, BSN, Appointed Associate Director at
White River Junction VAMC

Danielle S. Ocker, BSN, has been appointed as Associate Director, White River Junction (WRJ) VAMC effective July 20, 2008.  Prior to this appointment Ms. Ocker served as local service line manager, Sensory and Physical Rehabilitation Service Line.

Ms. Ocker joined the WRJ staff in 1985 as a student nurse, and progressed through several capacities during her tenure including: staff nurse, nurse manager of the Intensive Care Unit and Emergency Department.  Other accomplishments include: Polytrauma/TBI Program director where she facilitated the implementation of the WRJ program, Fellow Level Mentor, and Robert W. Carey Organizational Excellence Award Examiner.  Ms. Ocker has collaborated with Vermont National Guard to expand services for rural care to Polytrauma/TBI patients, and has worked with academic affiliates to provide quality educational experiences for students in various programs of study.

Ms. Ocker received her associate degree in nursing in 1986 from the New Hampshire Technical College.  She earned her bachelor’s degree in nursing in 2001 from the University of Phoenix where she graduated with high honors, and is currently pursuing a dual master’s degree.  She is a member of Sigma Theta Tau International, Omicron Delta Chapter, and a member of the Health Financial Management Association. 

Providence VAMC Selected for Collaborative Partnership with Rhode Island College

Providence VA Medical Center (PVAMC) and Rhode Island College School of Nursing (RICSON) have been selected to participate in the VA Nursing Academy.  This partnership expands and strengthens the role of VA and the college by enhancing faculty and clinical resources needed to educate nurses.  

The PVAMC-RICSON Nursing Academy is a four-year program that will provide for faculty and student expansion.  The educational and practice innovations proposed include expanded use of the RIC Nursing Resource Laboratory for simulated learning experiences and competency assessment of both staff and students; expanded number of innovative clinical rotations that reflect current trends in veteran health services; and development of a collaborative approach to VA nurse and RIC faculty professional development related to scholarly projects, evidence-based practice and research.

VISN 1 Researchers Named Exceptional Reviewers by Medical Care

Three VA Health Services Research and Development (HSR&D) researchers from VISN 1 were named Exceptional Reviewers in the June 2008 issue of Medical Care, the official journal of the Medical Care Section of the American Public Health Association.

Medical Care is one of North America's leading outlets for peer-reviewed health services research, and its Exceptional Reviewer designation includes approximately the top 5 percent of its peer reviewers.  Top reviewers were chosen on the basis of quality, timeliness, and number of reviews performed.  VA HSR&D researchers included in this honor are:

• Dan Berlowitz, MD, MPH, Center for Health Quality, Outcomes, and Economic Research (CHQOER), Bedford VAMC
• Ann Hendricks, PhD, Health Care Financing and Economics, VA Boston Healthcare System Health and the Boston University School of Public Health
• Amy Rosen, PhD, Center for Health Quality, Outcomes, and Economic Research (CHQOER), Bedford VAMC and the Boston University School of Public Health

VISN 1 Energy Management Team Improving Energy Efficiency

In the face of spiraling energy costs, increasing dependence on foreign oil, and climate change, the Federal Government has enacted legislation which requires all government agencies, including VA, to improve energy efficiency and reduce greenhouse gas emissions by:

• Reducing energy consumption by 3% per year
• Reducing water consumption by 2% per year
• Reducing vehicle petroleum consumption by 2% per year
• Switching  to renewable energy sources

The Network will meet these energy efficiency and conservation targets while ensuring continued high quality patient care by managing energy to minimize consumption and costs, and maximize utilization of renewable energy resources where possible.  The team of engineers charged with leading these efforts for VA New England is:

Bedford VAMC Celebrates 80 Years of Compassion and Care

On July 17, 2008, the Edith Nourse Rogers Memorial VA Hospital (Bedford VAMC) celebrated 80 years of compassion and care to our Nation’s veterans.  It is one of the first hospitals established in the country to care for veterans.  The original buildings were completed in May 1928 with the first patient admitted on July 17, 1928. 

Bedford VAMC is primarily a long-term/psychiatric care facility.  It is a teaching hospital, providing a full range of patient care services, as well as education and research.  Comprehensive health care is provided through primary care and long-term care in areas of medicine, psychiatry, physical medicine and rehabilitation, dentistry, geriatrics, and extended care.  Specialized programs include the Veterans Community Care Center, Vietnam Veterans Outreach Center, Veterans Day Activity Center and four outpatient clinics.

Putting veterans first in their health care needs remains the number one focus and goal.

VA Boston Presents Innovation at ITC Conference

On July 7-11, 2008, representatives from VA Boston Healthcare System were selected to present their innovation on “Electronic Clinic Profile Management” at the Information Technology Conference (ITC) in Washington, D.C. 

Dan Clarke, DSS site manager; Anne Dow, patient services manager; Tom Pontes, primary care business manager; and Cheryl Estade-Simon, lead IT specialist, developed an Electronic Clinic Profile Management system utilizing Microsoft InfoPath and SharePoint.  The system is applicable to all VA health care facilities to manage their clinic profiles.  All clinic profiles are available on-line for mandatory review for accuracy, capacity and utilization.  By utilizing InfoPath, the clinic profiles populate a database which can be utilized to run a variety of reports.  

Benefits to utilizing the system include having a central depository, faster turn around time (averaging 1-2 days), no lost paperwork, real time requests, better tracking capability, ability to see the status of submissions, determine workload of clinic builders, accurately manage DSS assignments for cost accounting, and easily determine annual clinic review date.

Pictured at the conference are (left to right): Dan Clarke, DSS site manager; Anne Dow, patient services manager; and Tom Pontes, primary care business manager.

MIRECC Research
Images of Brain Activation Predict Drug Abuse Treatment Outcome

VISN 1 MIRECC researchers have used brain imaging to identify cocaine dependent patients who have a poor prognosis in treatment with cognitive behavioral therapy.  Prior to entering treatment, cocaine dependent patients received brain scans that detected areas of increased brain activity while they performed mentally challenging tasks.  Poorer treatment outcome was shown for individuals with decreased activity in brain regions related to control over attention and information processing.  

Cognitive behavioral therapy is thought to work by helping cocaine abusers learn new skills to avoid relapse.  These skills include coping with drug craving and learning to refuse offers to use drugs and alcohol.  Impaired control over thinking gets in the way of learning these new skills.  This study is the first to use brain imaging to predict behavioral therapy outcomes in substance abusers.

This study used Functional Magnetic Resonance Imaging (FMRI), an experimental type of brain scanning that detects areas of increased brain activity in real time while a person is exposed to stimuli or asked to perform tasks.  While FMRI is not an approved clinical tool at this time, it has promise for helping to match patients to treatments that are most likely to work for them.  In this study, brain imaging was a more potent indicator of who would succeed in treatment than standard psychological testing.  FMRI brain scanning also has the potential to identify how brain functions change when drug-abusing patients recover through treatment.

MIRECC researcher Marc Potenza led this research team that included MIRECC researchers Kathleen Carroll and Bruce Rounsaville, and Yale researchers Judson Brewer and Patrick Worhunsky.  

News Around the Network

Bedford VAMC - Tammy A. Follensbee, recently appointed director at Bedford VAMC, began her duties on Aug. 4.  Ms. Follensbee previously served as VISN 1 deputy network director since March 2006.

VA Boston HCS - The Red Sox Foundation, in conjunction with VA Boston HCS Voluntary Service, has begun work on renovating the gym and pool area at the Brockton campus.  Improvements will be made to the exercise area, pool and locker rooms, and storage area.  They will also be upgrading the outdoor softball fields. 

VA Connecticut HCS - “From the battlefield to the shelter,” ran on the front page of the July 13 New Haven Register.  The article included interviews by staff of the VA Connecticut HCS Errera Community Care Center, home to VA Connecticut’s homeless veterans outreach programs. 

Manchester VAMC - On July 1, Ehsan Biswas, MD, mental health team leader, and Terrie Raposo, MSW, LICSW, OEF/OIF program manager, represented Manchester VAMC at the signing ceremony of New Hampshire House Bill 1335 by Governor John Lynch.  This bill establishes a commission to study the effects of post-traumatic stress disorder and traumatic brain injury suffered by New Hampshire soldiers and veterans returning from Iraq and Afghanistan. 

Northampton VAMC - On July 17, Joanne Carney, associate director, and Mary Rodowicz, public relations manager, both at Northampton VAMC, attended the signing of a Statement of Support between the Easthampton Post Office and the Employer Support of the Guard and Reserve (ESGR).  ESGR was established in 1972 to enlist support of employers in development of human resource policies and practices that support and encourage employee participation in Guard and Reserve programs.

Providence VAMC - On July 10 and 14, representatives from Showtime cable television network (Brotherhood Productions, Inc. a subsidiary of Showtime Networks, Inc., a CBS company) visited Providence VAMC to scout a health care location for scenes for their upcoming season.  They identified several locations suitable for filming “The Brotherhood,” a series featured on Showtime and filmed in Providence, R.I.  Providence VA will be used as a generic health care location and will not be depicted in the film.

Togus VAMC - The first Graduate Nurse Intern Program at Togus VAMC began on July 7.  There are seven new graduate registered nurses in this program which consists of 16 weeks of guided learning with a preceptor including both clinical experience and didactic classes.  These nurses will rotate through several units and clinics prior to becoming permanently assigned to a unit. 

White River Junction VAMC - Employees from Goldman Sachs, a global investment banking and securities firm, joined Dartmouth College students in a volunteer project at White River Junction VAMC on July 18.  The Goldman Sachs employees, graduates of Dartmouth College, wanted to collaborate on a community project.  They came to the medical center and painted several corridors and replaced ceiling tiles as a way to ‘give something back’ to veterans. 

Congratulations

Alan Bernhardt, PhD, director, Substance Abuse Program, Northampton VAMC, conducted a workshop on “Challenges of Depression, Substance Abuse and Suicide for Soldiers, Veterans and their Families” at the Smith College Conference, “Combat Stress: Understanding the Challenges, Preparing for the Return.”  The conference was held June 26-28, 2008, in Northampton.  Sheila Davies, MSW, OEF/OIF Program coordinator, and Ted Olejnik, MSW, Suicide Prevention coordinator, both from Northampton VAMC, provided information and answered questions on VA programs. 

Marilyn Bruderer, APRN, oncology nurse practitioner, Manchester VAMC, is the focus of an essay titled “Breaking Blockades” published in the summer edition of CURE Magazine.  CURE is a quarterly magazine that combines the science and humanity of cancer for those who have to deal with it on a daily basis.  Ms. Breuder was nominated by one of her patients for the magazine’s 2008 Extraordinary Healer Award for Oncology Nursing.  In the essay, which received Honorable Mention, the patient states that “For 10 years Marilyn has supplied my wife and me with the support necessary to give me hope of waking the next day and watching the sun rise. . . . Marilyn is the rock that keeps me in the world of the living.”

Sheila Davies, MSW, OEF/OIF Program coordinator, and Ted Olejnik, MSW, Suicide Prevention coordinator, both from Northampton VAMC, were guests on the Route 9 Veterans Forum Cable TV Show in Auburn, Mass.  During the live broadcast on July 7, they spoke about programs offered at Northampton VAMC for returning combat veterans.  

Sigmund Hough, PhD, ABPP, clinical neuropsychologist, Spinal Cord Injury Service, VA Boston HCS, was recently elected to the Board of Directors and Treasurer of Massachusetts Neuropsychological Society.  Dr. Hough also was elected as Fellow of the National Academy of Neuropsychology (NAN) which will be confirmed at the 28th Annual 2008 NAN Conference to be held in October 2008 in New York City.

Elaine Kersten, EdD, CAGS, patient safety officer, Northampton VAMC, was interviewed for an article titled “New Challenges in Acute Mental Health Wards,” which appeared in the July/August (Vol. 8, Issue 4) edition of Topics in Patient Safety, published by the VA National Center for Patient Safety. 

Maxine Krengel, PhD, polytrauma clinical neuropsychologist, VA Boston HCS, was recently elected to the Board of Directors and President of Massachusetts Neuropsychological Society.

William Milberg, PhD, ABPP/CN, neuropsychologist, VA Boston HCS, was awarded the Edith Kaplan Award at the Massachusetts Neuropsychological Society 20th Annual Meeting and Science Symposium in June 2008 for his significant accomplishments and impact upon the field of neuropsychology.

Andrew Pomerantz, MD, chief, Mental Health and Behavior Sciences Service Line, White River Junction VAMC, was interviewed for the July 8 “Vermont Edition” radio talk show on Vermont Public Radio.  The discussion focused on post traumatic stress disorder and its effects on soldiers.

Paula Schnurr, PhD, deputy executive director, National Center for PTSD located at White River Junction VAMC, received the 2008 Ladies Home Journal Health Breakthrough Award for her work with PTSD and veterans.  Dr. Schnurr is featured in the August 2008 edition of the magazine.

Cathy St. Pierre, PhD, APRN, BC, FNP, associate chief nurse for research, Bedford VAMC, was inducted as a Fellow into the American Academy of Nurse Practitioners on June 29, 2008, in Washington, D.C.  Professionals are selected for this honor based on their outstanding contributions to health care through nurse practitioner clinical practice, research, education or health policy.  

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