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VA Nursing: Maraline Torok, RN, BSN (VANAP Cohort Fall 2019) page 4

In this Edition VA’s Response to COVID-19 Pandemic

Guitars 4 Vets: Helping Veterans Cope with PTSD Through Music

www.northerncalifornia.va.gov

VA Committed to Diverse Workforce, Strengthening Care for Veterans

Lt. Col. Joseph Henry Ward, M.D., Dr. John A. Kenney, and his son, Dr. Howard W. Kenney, are not exactly household names. But these VA trailblazers deserve to be remembered for the great strides they made toward equality in health care leading up to and during the civil rights movement.

Fighting for equal care In 1924, Ward became VA’s first African American hospital director at the nation’s only segregated Veteran hospital in Alabama. He served there until his retirement in 1936. A World War I Veteran, Ward lived long enough to see the end of racial segregation in VA hospitals in 1954.

John Kenney was one of the hospital’s first physicians. He fought to have it staffed with African American medical professionals. Later forced to move to New Jersey due to threats to his life and family, Kenney went on to use his own money to build a hospital for African American patients.

But his son, Howard, would return to Alabama and continue his father’s legacy. He served as medical director at the same VA hospital where his father worked. Later, he became the first African American to integrate a formerly all-white VA hospital, as well as VA’s first African American regional director.

VA celebrates these heroes who not only served other American heroes at VA but worked to break down barriers.

Continuing a culture of community VA embraces inclusion and empowers employees to perform to their highest potential. Maintaining this culture of support and community allows employees to feel appreciated and respected. Only then can they provide exceptional care for the nation’s Veterans.

“There is strength in diversity,” said Cathy Mattox, a VA utilization management review registered nurse. “Every nurse brings something to the table; each one of their skillsets and individual experiences are valuable.”

Through VA’s Office of Resolution Management, Diversity & Inclusion, several special-emphasis programs focus on recruiting specific populations, including black/African American, Hispanic, LGBT, and individuals with disabilities. The Diversity and Inclusion in VA Council, an independent, executive-level body, advises the VA Secretary about issues related to diversity and inclusion.

Work at VA If you are interested in being part of a diverse organization that gives back to America’s Veterans, consider joining our team!

Contents

3 VA’s Response to COVID-19 Pandemic

4 The Future of VA Nursing: Maraline Torok, RN, BSN

5 VA NorCal Pharmacy Residency Programs

6 Guitars 4 Vets: Helping Veterans Cope with PTSD Through Music About the Publication

Will Martin Chief Public Affairs Officer

7 Veterans Canteen Service Jon-Nolan Paresa Publisher/

Visual Information Officer/Photographer

Produced by Forte Information Resources LLC

8 East Bay Institute for Research & Education: Reducing Suffering Through Science Understanding Dental Implants

The Northern | SUMMER 2020

The Northern is an authorized publication of the Department of Veterans Affairs.

All photographs are the property of VA, unless otherwise indicated.

The Northern – The Official Voice of VA Northern California Health Care System 2

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The Future of VA Nursing: Maraline Torok, RN, BSN (VANAP Cohort Fall 2019)

By Neftali Cabezudo, PhD VA Program Co-Director & Faculty, VANAP USF

Nursing Education & Professional Development

For the past five years, VA Northern California Health Care System (VA NorCal) has participated in

VANAP (VA Nursing Academic Partnership), an academic-practice collaborative with the University of San Francisco (USF) to

develop nurses who are Veteran-centric.This two-year accelerated program teaches the students

nursing fundamentals for clinical practice along with direct experience in caring for Veterans. From hospital care to

community services, the students are immersed in clinical rotations at our primary locations (Mather, McClellan, and Martinez) and learn

directly alongside VA staff nurses.

In December 2019, Maraline Torok graduated from VANAP and is now working in our Mather emergency department (ED) as a staff nurse. She completed 180 hours of clinical preceptorship in the ED and developed an evidence-based practice project for the unit. Her Veteran-centric passion, clinical skills, and positive attitude were instrumental in delivering high-quality care for our Veterans. This exceptional performance was recognized by the ED nurse manager and staff nurses and resulted in her being hired there after earning her Registered Nurse (RN) license.

As her former faculty, I met with Maraline to talk about her VANAP education and nursing journey thus far. Her inspiration to choose nursing as a career path came from two significant family events. The first occurred when she had to “...help take care of [her] grandmother with stage 4 stomach cancer at a young age.” This showed her the importance of being present with people when they are vulnerable. The second experience occurred when her sister gave birth. Maraline was awe struck by the compassionate care and attentiveness that the nurses provided to her family during childbirth. These pivotal events impacted her tremendously and influenced her decision to become a nurse.

As a VANAP student, Maraline found it extremely gratifying to be in a program where she had the opportunity to learn about and care for Veterans. “When I am around Veterans, I feel protective of them because they have such a special place in my heart.” She expressed that the VANAP clinical rotations provided better insight into how Veterans cope with service-related illnesses and injuries. It also gave her a deeper understanding and appreciation for how VA nurses make a difference in the lives of Veterans.

Maraline’s future nursing ambitions are to stay in the VA system and continue caring for Veterans. Her next endeavor is to “...pursue the nurse practitioner role as another way of serving their health care needs.” Also, she would like to address the homeless Veteran population issue through a mobile trailer that would “...provide a variety of services for Veterans including hygiene stations, optometry, and other essential services so that they feel respected and valued.” Maraline firmly believes that what she is doing now and will do in the future are her way of giving back to these heroes. “The Veterans are the population I love to work with. They deserve the best care for making the sacrifice to serve our country and keep us safe.”

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VA NorCal Pharmacy Residency Programs By Caitlyn Lee, PharmD

Over the years, pharmacists have become increasingly recognized for their expertise in medications, which has led to expansion of their roles in both inpatient and outpatient settings. Although pharmacists have been mostly known for their traditional role in ensuring safe distribution and use of medications, they now are also utilized to manage medication therapy and chronic diseases, as well as contribute to treatment decisions as members of an integrated health care team. Pharmacists can gain further training to fulfill these roles through completion of a pharmacy residency. In fact, the American College of Clinical Pharmacy (ACCP) and American Society of Health-System Pharmacists (ASHP) advocate for all pharmacists in direct patient care roles to be residency-trained. A pharmacy residency is a program pursued after completion of a Doctor of Pharmacy (PharmD) degree, which allows residents to train as licensed pharmacists alongside experienced pharmacy preceptors. A residency provides accelerated growth beyond entry-level experience by providing residents with opportunities to practice and develop skills in various settings. There are two years of postgraduate training available. Postgraduate year one (PGY1) offers more generalized training, providing exposure to a broad range of clinical scenarios. Following PGY1 training, some pharmacists pursue a postgraduate year two (PGY2) program in a specific clinical area of interest (e.g., infectious diseases, psychiatric pharmacy, cardiology, pain management), which helps lead to specialization in that field.

The VA Northern California Health Care System (VA NorCal) offers both PGY1 and PGY2 pharmacy residency programs. The PGY1 program provides concentrated clinical, teaching, and administrative experiences. While offering a well-rounded experience in areas such as outpatient, inpatient, and mental health, VA NorCal specifically offers strong experiences in ambulatory care. Graduates of this program are well prepared to obtain advanced clinical roles across a variety of practice settings or to pursue further training in a PGY2 program.

The PGY2 psychiatric pharmacy residency program contributes to the development of clinical pharmacists in the specialized area of psychiatric pharmacy. PGY2 residents

SUMMER 2020 – www.northerncalifornia.va.gov

gain extensive experience in both inpatient and outpatient mental health settings. This program provides residents with opportunities to function independently as practitioners who improve medication therapy for individuals with psychiatric and neurologic disorders.

As one of the largest training programs for clinical pharmacists, VA pharmacy residency programs across the country produce pharmacists who are valued members of the health care team in various environments. Many VA NorCal pharmacy residents have continued to work within the VA, practicing in areas such as inpatient, ambulatory care, outpatient, pharmacoeconomics, and mental health.

To learn more about our pharmacy residency programs, please visit www.northerncalifornia.va.gov/careers/pgy1/.

Guitars 4 Vets: Helping Veterans Cope with PTSD Through Music Guitars 4 Vets (G4V) is a 501(c)(3) nonprofit organization dedicated to providing relief to struggling Veterans through the healing power of music and community. G4V offers instructional and supportive guitar programs for Veterans with physical injuries, post-traumatic stress disorder (PTSD), and other emotional distress. G4V pursues its mission by providing free guitar instruction (including a new acoustic guitar) in a structured program run by volunteers, primarily through VA facilities and community-based medical centers.

Mike Kelley heads up the VA NorCal Martinez chapter, providing guitar instruction as a form of therapy for Veterans of all ages. This local chapter averages 6 to 8 students per year who complete the entire program of individualized lessons. He also leads a graduate group, which meets weekly to further their musical development. The chapter is looking to expand with an upcoming “Uke-ladies” ukulele group for female Veterans.

“Stay busy and stay connected” is Mike’s philosophy when working with patients. G4V provides a fantastic way for that to happen: It offers the mood-lifting and depression-fighting benefits of music, while encouraging students to develop a new skill. This has been shown to promote growth and strengthening of the brain’s neural networks to aid recovery from brain injuries and neurocognitive disorders.

The graduate group has increasingly been traveling to other places, such as the Fairfield Outpatient Clinic, to perform for other Veterans and families. This is a way for them to pay it forward, while providing a means for them to continue building skills helpful in overcoming performance anxiety. Indeed, this can then be applied to help with

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PTSD, social anxiety, and more. Mike remarked, “I’ve been thrilled to see how it also increases staff morale when they play a show.”

Mike is far from the only advocate for G4V. “I’ve maintained a relationship with Mike and the Martinez instructors over the years, and I appreciate the value of the free services they provide,” says James Muir, PhD, and neuropsychologist at VA NorCal. “I’ve worked to help coordinate logistics ensuring the chapter has space at the Martinez Brain Health & Wellness building (23) without impacting patient care and normal clinic operations.”

G4V sponsors, ambassadors, and donors make the program possible. From guitars to gig bags and all the equipment in between, G4V supporters go above and beyond to provide Veterans with the gear they deserve and the opportunities to make music—and make themselves better.

For more information on G4V, please visit: www.guitars4vets.org

www.facebook.com/GuitarsForVets/

www.instagram.com/guitarsforvets/

Veterans Canteen Service (VCS) By Amelia M. Castro VA NorCal VCS Supervisor

Did you know…Veterans Canteen is part of the VA? Some think that we are a contracted company, but in fact VCS employees are federal employees. In addition, VCS is nonprofit and self-sustained. Also, VCS does not charge tax. The best part is that with every purchase, VCS gives back to Veteran programs, including:

• National Rehabilitation Events • Women Veterans • Suicide Prevention • Homeless Veterans • Disaster Relief

VCS gives back over $8.3 million each year to support those programs and more. For the Homeless program alone, VCS has given:

• $1.5 million • Over 10,000 beds and 4,000 move-in kits for Veterans

who are placed in housing • Coupon books to purchase necessities • Free meal cards • Employment opportunities

Contingency Management program– Substance Abuse Cessation

• Reward of canteen coupons for Veterans who test clean for drug test

Fisher House “A home away from home” that provides lodging to families while their loved one is being treated in a medical center

• Annual sale: portion of proceeds go to Fisher House • Certificates for families that stay with Fisher House,

to be used in the canteen

Emergency Mobile Unit • VCS provides 24-hour food service to Veterans, caregivers,

and first respondents involved in or deployed to emergency response situations caused by national disasters or emergencies which require VA’s support

National Rehabilitation Games • VCS supports all 6 events annually • VCS sponsors wheelchair Vets and pays for their travel

to attend • VCS purchased 10 special golf carts made specifically

for disabled Veterans to use at the TEE Tournament (TEE=TRAINING, EXPOSURE, EXPERIENCE)

When you ask yourself…Why shop at one of our PatriotStores, PatriotCafés, or vending machines?… there are 8.3 million reason why! Plus, there is now an online e-commerce site (shopvcs.com).

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East Bay Institute for Research & Education: Reducing Suffering Through Science By John C. Johnson, PsyD, MSW Executive Director, EBIRE

In the Summer 2019 edition of The Northern, we introduced readers to the East Bay Institute for Research & Education (EBIRE), VA NorCal’s affiliated nonprofit 501(c)(3) corporation that administers research activities funded by private pharma, federal institutions, and foundations, i.e., sources other than VA. EBIRE brings value to VA NorCal through the involvement of VA scientists seeking to add research to their already busy clinical, teaching, or administrative functions.

One of EBIRE’s most involved research teams is the husband-wife duo of Siba Raychaudhuri, MD, FACP, FACR, FAAD, and Smriti Kundu-Raychaudhuri, MD. Both were trained at Stanford University and abroad; currently both have joint appointments with the UC Davis School of Medicine. Over the years, the Raychaudhuris have been introducing VA NorCal and EBIRE to clinician-scientists from UC Davis Medical Center, encouraging them to consider pursuing new research grants at Mather. The Raychaudhuri research group works on inflammatory diseases of joints and skin, human autoimmune diseases, and animal models of inflammation. Their research group provides cutting-edge clinical care for Northern California’s Veterans suffering with joint and skin diseases.

The Raychaudhuris are internationally recognized, and their research work is funded by the National Institutes of Health, professional foundations, and several leading pharmaceutical companies. Their current research focus is to understand the

molecular mechanisms of immune mediated inflammatory diseases, with a particular focus on psoriasis and autoimmune arthritis. Their overarching goal is to provide the groundwork to streamline, accelerate, and promote therapies that benefit all patients, including translation of basic discoveries into effective therapies that benefit Veterans suffering from lifelong chronic autoimmune diseases. The Raychaudhuris pursue this goal by carrying out experiments with both humans and small animals, e.g., rats and mice. They established the role of neuroimmunologic inflammation in psoriatic disease.

In collaboration with the UC Davis Department of Radiology, the Raychaudhuris have developed a new method of in vivo (occurring in a live subject) molecular imaging of joints. The Raychaudhuris envision that this will be a significant achievement to reduce disabilities from rheumatoid and psoriatic arthritis; as well, there could be appreciable decreases in the overall cost of care.

Understanding Dental Implants By Diana L. Quilici, DDS Site Director, General Practice Residency McClellan Dental Clinic

Dental implants are widely discussed but often misunderstood.

People have tried to replace missing teeth for thousands of years. The first dental implant was attributed to the Mayans; they fashioned pieces of shell to look like a tooth, which was then implanted in the jaw. From ancient times to present day, different materials have been used: from rocks to gold and other precious metals.

By 1980, dental implants fabricated using titanium in the approximate shape of a root offered improved performance and longevity. A dental implant is actually a cylindrical titanium object that is screwed into the jaw if there is enough bone. After integration—during which the patient s bone grows next to the implant—the implant can be attached to an abutment, which is a metal rod that screws into the dental implant. This rod then can either be capped with a crown or have a denture snapped into place.

Factors that can significantly decrease the prognosis of a dental implant include uncontrolled diabetes, smoking, or periodontal disease. Improper medical work-up or diagnostic planning can also negatively impact it. Implants in such cases can fail or cause further bone loss and problems. Patients should be aware that without proper care, their investment may be lost.

When considering if you should get a dental implant, do your research and find a reputable dentist who will consider all factors, from your health history to whether or not you grind your teeth. A deal that sounds too good to be true probably is, and could result in more (not fewer) problems down the road. Some dental implant companies make their implants with poor grade titanium, resulting in a higher failure rate. When you get a dental implant, write down the name of the implant company, the type of implant, and the size. Keep this information in a file in case you need further work done in the future.

Ultimately, dental implants can be a great option for a missing tooth, but a healthy natural tooth is by far the best solution. So dont forget to brush and floss your teeth!

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