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ii S t a t e o f V A R e s e a r c h

As the largest integrated health care system in the country, the Veterans Health Administration (VHA), part of the Department of Veterans Affairs (VA), provides health care to more than five million Veterans each year.

VA is committed to providing the best care possible to all Veterans, including our newest generation of Veterans—the men and women returning from combat in Afghanistan and Iraq. Many of the brave men and women who served and were injured in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF)are returning home with complex medical conditions such as traumatic brain injury, limb amputations, and burns.

Furthermore, due to improved body armor and exceptional medical care provided on the battlefield, many service members are surviving major blast-related injuries and will require long-term, specialized care here at home. For some of the new Veterans, readjustment to civilian life and mental health challenges such as posttraumatic stress disorder anddepression may be critical issues. While VA’sOffice of Research and Development is dedicated to conducting research that will advance

the care for all Veterans, the urgent health care needs of military members returning from conflicts in Afghanistan and Iraq are a top research priority.

This booklet provides an overview of deployment-related health issues and highlights research advances that we hope will improve the health care of returning OEF/OIF Veterans.

Joel Kupersmith, M.D.Chief Research and Development OfficerDepartment of Veterans Affairs

A Message From the Chief

The State of VA Research /2009-2011

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2 APT Center is home to emerging technology for Veterans with disabilities From ‘smart’ electrodes to electric bandages, APT researchers are creating a new generation of adaptive and therapeutic devices

6 From cancer to cardiology, Nobel-winning scientist is closing in on cures Dr. Andrew Schally is still going strong in VA after nearly five decades of groundbreaking re-search

9 Facing down COPD: Learning to live with chronic lung ailments A trial at the Phoenix VA and 21 other sites is teaching Veterans better ways of coping with chronic obstructive pulmonary disease

13 Genomics research: Paving the way to personalized careVA researchers are helping to unlock genetic keys to health risks and treatment responses

18 Lifelong disability can’t keep her down Determination and a soaring spirit underpin Dr. Lisa Hannold’s work on behalf of injured Vet-erans

21 Research targets wars’ signature injuries Researchers are probing new types of brain scans and other tools to boost diagnosis and treat-ment for traumatic brain injury and posttraumatic stress disorder

34 VA’s Cooperative Studies Program: Large-scale trials to inform evidence-based medicine From heart disease to mental health, CSP comparative effectiveness trials and other studies yield valuable data to help guide health care for VA and the nation

38 Major meeting marks milestone for VA research on women’s health Top experts are gathering to help plan the next steps for VA women’s care

41 A biohybrid approach to rebuilding the body At VA’s Center for Restorative and Regenerative Medicine, leading-edge scientists are working on innovative ways to help injured Veterans regain their independence

CONTENTS

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The State of VA Research /2009-2011

2 S t a t e o f V A R e s e a r c h

Overview

The VA Office of Research and Development (ORD, also R&D or VA Research) plays a key role in advancing the health and care of Veterans and is uniquely positioned to lead a national transformation of American health care. As part of the largest integrated health care system in the United States, VA Research relies on committed clinician-scientists, engaged patients and families, and an unparalleled national health care delivery infrastructure. These resources provide a rich base for VA to deliver the best health care and develop cutting-edge medical treatments for Veterans, their families, and the country.

Covering a spectrum of topics from pre-clinical to health services research, VA Research discovers ways to make health care better for Veterans. And, through this focused mission of advancing health care for Veterans, VA Research can serve as a 21st-century model of how scientific inquiry and innovative thought can transform medicine in America.

This report highlights some of VA’s major research accomplishments, with an emphasis on 2010 progress. As such, the report presents a snapshot of the types of research that make VA Research an acclaimed model for conducting bench-to-bedside research.

Value of an intramural research program with priceless partnershipsOne major advantage of VA R&D is that it is an intramural program where clinical care and research occur together within the VA system. Because of this, VA can bring scientific discovery from the patient’s bedside to the laboratory and back, making this program one of VA’s most effect tools for improving care for Veterans. Embedding research within an integrated health care system, with a state-of-the-art electronic health record, creates a national laboratory for the discovery of new medical knowledge and the

VA Research plays key role in advancing health care for Veterans

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translation of that knowledge into improved health. The fundamental goal is to address the needs of the entire Veteran population from the recruit who returns with injuries from recent a conflict to the aging Veteran. Ultimately, this research can benefit all those who receive health care in the United States .

VA is able to conduct innovative trials across multiple VA sites—often including thousands of Veterans—thanks to its Cooperative Studies Program. CSP’s clinical trials and epidemiological studies cover a wide range of health topics, such as heart disease, diabetes, cancer, infectious diseases, mental health, and prosthetics. CSP’s large-scale leading-edge trials allow VA to generate strong evidence to help guide clinical practice.

At the same time VA embraces the advantages of an intramural program, VA R&D also embraces its close ties to academic affiliates and fosters dynamic collaborations with other federal agencies, nonprofit organizations, and private industry—thus magnifying the program’s impact on the health of our Veterans and the nation.

Study exams long-term effects of HIV/AIDS treatmentsA clinician investigator, Dr. Amy C Justice, who cared for VA patients with HIV infection and AIDS noticed that patients on combination antiretroviral therapy were living longer, but seemed to have an increased risk for “non-AIDS” events. That is illnesses not specifically tied to AIDS infection. She began a longitudinal clinical trial to follow these patients over a long time to understand how treatment approaches were working and better understand the risks associated with the illness.

The trial is called SMART (Strategies for Management of Antiretroviral Therapy). Justice and her coworkers identified that there were 1.7 times as many major coronary artery disease, renal, and liver disease events among those in the structured treatment interruption arm compared with those receiving continuous therapy. In addition, models accounting for CD4 count and HIV-1 RNA did not fully explain these differences in outcome. A conclusion was that risk of common


An example of two CSP studies that highlight the benefits of an

embedded research system include a study of the use of a heart- lung pump during cardiac surgery and evaluation of percutaneous coronary intervention treatment. Both studies were published in the New England Journal of Medicine. The clinical trial involved 18 VA medical centers and evaluated whether surgery with or without a heart-lung pump, that allows doctors to stop the heart while they operate, found that while both methods are generally safe and effective, the more traditional on-pump method yields better outcomes after one year.

After a year, patients in the on-pump group fared better on a composite measure that included death, repeat cardiac procedures, or nonfatal heart attacks. Their vein grafts were also more likely to remain open. The study included follow-up angiograms performed by cardiologists who were “blinded” as to which type of bypass the patients had undergone.

In particular, Grover pointed to the fact that both groups scored equally well a year after surgery on neuropsychology tests. Some experts have believed the on-pump method is riskier for cognitive health. According to first author A. Laurie Shroyer, PhD, the findings of the large, multisite VA study contradict findings from earlier studies that showed “some

advantages of [heart bypass] surgery using the off-pump procedure, including quicker recovery and less impact on cognitive function. This study indicated a consistent trend toward better outcomes in patients who had undergone the conventional on-pump technique.”

The 2,203 veterans in the study all had clogged or narrowed coronary arteries, resulting in less blood flow to the heart. This can cause chest pain and increase the risk of heart attack. In bypass surgery, also known as coronary artery bypass grafting

VA Cooperative Studies Program Studies highlight the benefits of embedded research system

This would be a creative caption, It would state something like the place, subject, and other important information the ready may want to know. (Right) A VA employee inter-acts with a Veteran. This is a very important part of VA research in that all that is done, is done for the nation’s Veterans, all of whom deserve the very best.

Research Spotlight

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(CABG), doctors take a healthy piece of vein from elsewhere in the body and sew it in place as a “detour” between the heart and a point in the problem artery below the blockage. As long as the graft remains open—”patent,” in medical terms—and doesn’t close down over time, the heart enjoys a renewed flow of blood and oxygen.

For more than 30 years, most bypass procedures have been done with the use of a cardiopulmonary bypass pump, or heart-lung machine. During an “on-pump” procedure, the heart is stopped with medication and the machine takes over blood circulation. This allows doctors to work on a still heart.

An alternative, “off-pump” method that has gained some popularity in the past decade is also known as “beating heart” surgery. As the name implies, the heart keeps beating during the procedure and no heart-lung machine is used. Doctors use special devices to stabilize only the small section of the heart where they are stitching in the graft.

Controversy has existed as to which method is safer and more effective. Some studies suggested that using

the pump could weaken heart function after surgery, harm the lung and kidneys, result in more blood use during surgery and longer hospital stays, and bring on problems with memory and thinking. Many experts came to see the off-pump method as enabling a quick recovery, with lower healthcare costs and less risk of cognitive decline.

Recent studies, though, have raised concerns about the newer procedure as well: Is it too technically difficult? Are surgeons sometimes unable to complete multiple grafts on a patient? Are the grafts more likely to fail? And as a result, are patients more prone to heart attacks or repeat procedures?

No studies to date have been conclusive, but the new VA trial results should greatly inform the debate. Grover said he thinks the results may influence cardiology referrals and cardiac surgery practice, but he stresses that individual patient differences still need to be taken into account. Patients with certain risk profiles and patterns of coronary damage, he said, may still be strong candidates for the off-pump method, notwithstanding the general results seen in the trial.


George Schmid, a 63-year-old Army Veteran living in southern New Jersey, decided three years ago with his VA doctor that it was time to try a new treat-ment for his Parkinson’s disease. His left side would often stiffen up, and the drugs he took to tame the symptoms were wearing off faster and faster. Schmid participated in a six-year study sponsored by VA’s Cooperative Studies Program and the National Insti-tutes of Health, in which some patients received “best medical therapy” (carefully managed medication plus speech, physical, or occupational therapy as needed), while another group of patients, including Schmid, received a procedure called deep brain stimulation. In DBS, electrodes are implanted into the brain,

with thin wires running under the skin to a small pacemaker-like device placed under the skin

near the collarbone.

Electrical stimulation from the battery-operated device

aims to jam the brain signals causing the

symptoms.

Research Spotlight

CSP Trial Looks at Brain Stimulation for Parkinson’s

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to know. (Right) A VA employee interacts

with a Veteran.

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The study involved 255 patients, ages 38 to 83. VA’s Cooperative Studies Program coordinated the trial, which took place at VA’s national network of Par-kinson’s centers (www.parkinson’s.va.gov) and six university hospitals.

Researchers found that DBS, while riskier than drug therapy, may hold significant benefits for those with Parkinson’s disease who, like Schmid, no longer respond well to medication alone. The results, published last year in the Journal of the American Medical Association, would come as no surprise to Schmid, who says he’s felt “very, very good” after

DBS—“at least 30 to 50 percent better” than before the procedure. Significant improvement on several measures was seen in patients who received DBS, which on the down side was associated with more serious side effects than drug therapy.

Caption (top): this would be a creative caption, It would state something like the place, subject, and other important infor-mation the ready may want to know. (Right) A VA employee interacts with a Veteran. This is a very important part of VA research in that all that is done, is done for the nation’s Veter-ans, all of whom deserve the very best.


Research Budget

VA R&D By the NumbersAn overview of the resources that fuel VA’s innovative medical and rehabilitation studies

In fiscal year 2010, VA R&D supported more than [number] research projects at VA medical centers nationwide, ranging from preclinical studies to health services research to multisite clinical trials. VA is an intramural program, meaning that only VA employees can conduct research under VA’s auspices. Typically, though, VA researchers collaborate with academic colleagues and others outside VA.

The congressional allocation for VA Research for fiscal year 2011 is $[x] million. VA studies are also supported in part by VA medical care dollars, as well as funding from non-VA sources, such as other federal agencies, nonprofit associations, and industry partners. In fact, VA researchers are expected to leverage their VA funding whenever possible—that is, seek additional support from non-VA sources—to maximize the scope, quality, and impact of their research and the resulting gains for Veterans.

The National Institutes of Health is the most prominent source of such funding for VA investigators. Another benefit of NIH funding is that it assures the public that VA and NIH research projects are of equally high quality.

Funding from industry comes mainly from drug companies and is typically administered through nonprofit corporations. In 1988, Congress passed legislation that empowered VA medical centers to establish VA-affiliated nonprofit research corporations. These entities provide flexible funding mechanisms for the

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Achievements

ORD-funded research is focused on identifying those Veterans who need care for their TBI ...


Although Kevlar helmets and improved body armor save lives, they cannot fully protect against blasts and impacts to the head, face, and cervical region of the spinal cord. Traumatic Brain Injury (TBI) from impacts or blasts can range from mild to severe.

Concussive or mild TBI is the most common form of combat-related injury, often associated with problems with memory, concentration, anxiety, and irritability, and sometimes with hearing and visual disturbances. For the vast majority of mild TBI cases, the most pronounced symptoms occur immediately after injury, with complete recovery within days or weeks. However, questions still remain about the possibility of long-term effects.

Service men and women with moderate to severe TBI have similar symptoms to those with mild TBI, but they also have more severe cognitive impairment and may experience symptoms such as worsening headaches, repeated vomiting or nausea, posttraumatic epilepsy, visual disturbances, sleep disturbances, slurred speech, weakness, numbness, and loss of coordination. Unlike in mild TBI, problems can persist long-term or result in permanent difficulties with memory, reasoning, emotion, and expression—issues that can make it difficult to hold steady employment or regain pre-injury quality of life. To advance treatment and rehabilitation following TBI, fundamental information about the post-acute and long-term physiological processes is essential.

ORD-funded research is focused on identifying those Veterans who need care for their TBI; treating them once they are identified; and continuing that care across their lifespan, supporting their caregivers and reintegrating those Veterans back into their communities. Highlights of the research that keeps VA at the forefront in improving functional recovery and quality of life for Veterans include:• Neuro-Imaging—VA supports a range of imaging research in technologies such as

magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). The goals of this research are to: 1) better “map” the brain changes associated with long-term TBI, 2) develop effective evidence-based rehabilitation strategies to improve the quality of life of our Veterans with TBI, 3) define the nature of blast-related TBI, and 4) track actual improvements in brain function associated with the intervention.

• Simulations—New VA research suggests that modern driving simulators may be useful in cognitive rehabilitation because they can track responses to realistic scenarios that approximate driving activities that are so important to independent functioning. Driving simulators and other virtual reality technologies are being applied to develop therapies to improve not only cognitive function, but also frequent co-morbid psychological health issues, such as PTSD and substance abuse.

VA Research Acheivements

Continuing care across a lifetime

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Traum

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Researchers are lookingat various potentialapproaches for treatingand preventing mentalhealth disorders.

VA Suicide Prevention Hotline: 1-800-273-TALK12 S t a t e o f V A R e s e a r c h

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VA investigators are pioneering advances in the understanding and treatment of mental health disorders. Current studies are looking at a wide range of mental health-related issues affecting Vet-erans—from aging Veterans to the new generation who served in Afghanistan and Iraq. Researchers are looking at various potential approaches for treating and preventing mental health disorders and also at related issues such as developing and evaluating col-laborative primary care models and improving access to services from remote areas using the Internet and other progressive technologies.

Focus areas include: mood disorders, such as depres-sion and bipolar disorder; anxiety disorders, such as posttraumatic stress disorder (PTSD); psychotic dis-orders, such as schizophrenia, dementia and memory disorders; and substance use disorders. VA inves-tigators also focus on the co-occurrence of mental health issues and physical disorders—depression in those with spinal cord injury or substance abuse by patients with chronic pain, for example.

World-class investigators with the VA Research andVA is spending approximately $80 million annually on mental health research, which is an important issue for Veterans: Among active-duty Army and Marine Corps personnel who participated in combat during OEF/OIF, for example, 11 to 17 percent met screening criteria for major depression, generalized anxiety disorder, or PTSD.

VA studies looking at wide variety of mental health related issues


Sensory Loss

One of the most common conditions in returning OEF/ OIF Veterans who were

exposed to a blast is tinnitus (ringing noise in the ear). Investigators are addressing its debilitating effects. In a collaborative study between the National Center for Rehabilitative Auditory Research and the James A. Haley (Tampa) VA Medical Center, researchers are developing, testing, and evaluating a comprehensive tinnitus management program for Veterans. Tinnitus interventions are progressive—beginning with those considered minimal and progressing to more intense forms.

Veterans win with VA sensory loss research

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VA investigators have made vital strides in understanding how the brain works with PTSD, an anxiety disorder often associated with Veterans exposed to combat but that also occurs in the general population. VA researchers have established much of the evidence relating to the biological basis of PTSD—a disorder that during past wars was called “shell shock,” or “combat fatigue.”

To effectively understand, prevent, and treat post-traumatic stress disorder (PTSD), scientists must understand the psychological and biological impact of trauma exposure in the Veteran population. Currently, ORD is supporting over 100 PTSD studies at a cost of more than $25 million, including studies on women Veterans and research across different deployment eras—from Vietnam through OEF/OIF.

In addition to its groundbreaking study of prolonged exposure therapy for PTSD in women, VA has recently completed two large PTSD treatment trials, one with a drug, Risperidone, for chronic, unremitting PTSD, and another examining the way PTSD care is delivered. These study investments of, $9.7 million and $11.2 million respectively, have the potential to positively affect care for years to come.

Additional treatments currently being studied are an inexpensive medication, prazosin, to relieve trauma-related sleep disturbances; a drug in an early-stage trial to alleviate PTSD symptoms; complementary and alternative therapies for PTSD; and strategies to engage Veterans in early treatment for the condition. In OEF/OIF Veterans, extensive work is underway to identify risk and resilience factors for PTSD, early intervention/prevention strategies, and treatments including comorbid conditions.

One landmark study will assess cognitive and emotional changes that occur after deployment based on critical baseline assessment collected prior to deployment. The Marine Resiliency Study will characterize physiological reactivity in a large cohort with repeated post-deployment assessments.

To understand long-term consequences and healthcare needs in the Vietnam-era populations, several efforts are underway to assess current PTSD and mental and physical health status. This research includes a study of Vietnam-era women Veterans, and the important National Vietnam Veterans Longitudinal Study (NVVLS).

Investigators battle PTSD on many frontsAnswers on treatment will come from many medical disciplines



Women Veterans with PTSD use exposure therapy as way to gain hope, greater functionalityIn the largest randomized clinical trial to date involving women Veterans with PTSD, VA scientists and colleagues demonstrated that prolonged exposure (PE), a type of cognitive behavioral therapy, is an effective treatment for PTSD in female Veterans and active-duty military personnel. Women who received this therapy experienced greater reduction in PTSD symptoms, were more likely to no longer meet the PTSD diagnosis criteria, and were more likely to achieve total remission.

VA’s investment of $6.6 Million in the PE

therapy study led to results that have been felt throughout the VA health care system. This study directly resulted in the national dissemi-nation and implementation of evidence-based psychotherapies for PTSD, depression, and serious mental illness in the Veterans Health Administration. PE is currently considered one of the most effective treatments anywhere for PTSD, and is now recommended for PTSD in the VA/Department of Defense (DoD) Clini-cal Practice Guidelines for PTSD at the highest level, indicating “a strong recommendation that the intervention is always indicated and accept-

Posttraumatic Stress

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VA operates the nation’s largest network for the care of spinal cord injury (SCI). In a

recent year, VA treated more than 25,000 Veterans with the condition. VA’s research program leads all others in defining new methods of treatment and rehabilitation for Veterans with SCI, and information from VA studies could ultimately help the approximately 250,000 Americans with spinal cord injuries.

VA researchers are studying a variety of ways to help Veterans recover or rehabilitate after a SCI. Several teams of VA researchers have been tasked to address the issue of functional recovery. A team at the San

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VA researchers from some research laboratory conduct research on how effective research can be. This is part of a larger study on the effectiveness of studies.

Diego VA Medical Center pioneered the use of therapies to treat SCI with a focus on the recovery of upper limb function. This is an area of vast importance to returning OEF/OIF Veterans as well as older Veterans who are suffering from a stroke.

The team recently demonstrated the feasibility of using gene therapy to deliver neurotrophic factors to damaged neural tissue to promote repair and recovery of function.

Along with clinical care in VA’s polytrauma centers and other points of care, stem cell research and other SCI research will lead to breakthroughs for those living with this disorder. The ability will also exist for such breakthroughs in other neurological disorders such as stroke and multiple sclerosis.

Gene therapy targeted to repair, aid recoveryVA researchers study variety of ways to help Veterans recover or rehabilitate

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VA investigators often partner with other pioneering spinal cord injury investigators to advance SCI research as quickly as possible. Leading VA-affiliated Centers with this research focus include the APT Center and:

• Functional Electrical Stimulation Center. The Center—a consortium of the Louis Stokes Cleveland VA Medical Center with Case Western Reserve University and MetroHealth Medical Center—focuses on the application of electrical currents to either generate or suppress nervous system activity. This technique, known as functional electrical stimulation, or FES, is being studied to help those with paralysis from spinal cord injury, impaired movement from stroke, and other neurological and muscular skeletal conditions to grasp an object with their

hand; stand or walk; control bladder and bowel function; and achieve other bodily functions to restore function and improve quality of life.

• Center for Restorative and Regenerative Medicine. CRRM investigators, representing the Providence (RI) VA Medical Center, Brown University, and the Massachusetts Institute of Technology, study new-millennium methods for restoring quality of life to those hurt by disease or injury. A primary focus is the marrying of human tissue and mechanical elements into lifelike “biohybrid” limbs that handily outperform currently available prostheses. The efforts include investigators with expertise in orthopedics, tissue engineering, neurotechnoogy, prosthetic design, and rehabilitation.

VA partners with pioneering SCI investigators

Center for Restorative and Regenerative Medicine researchers are working on prostheses to respond more accurately to a user’s intent. “You can have the most beautiful prostheses, but if people can’t power them to perform as they intend,” they’re hardly useful, says CRRM director Roy Aaron, MD.

A system called BrainGate, developed by Brown-VA researcher John Donoghue, PhD, allows signals from the brain to be picked up by a sensor implanted in a part of the brain that controls voluntary movement. The signals are then decoded into commands that drive prosthetic or other robotic and electronic devices. In a pilot study, the BrainGate system enabled a 25-year-old man with quadriplegia to operate a computer cursor and perform other tasks solely through his thoughts. When the BrainGate study team, led by Leigh Hochberg, MD, PhD, published the results, the research earned headlines worldwide: A London newspaper, for example, referred to the trial participant as “the first bionic man” and a Canadian newspaper proclaimed,

“Movement by Thought: Science Fiction to Fact.”

The BrainGate research team is now focused on extracting the neural signals related to the intention to move one’s limb, and in turn a computer cursor, to use applications such as e-mail and word processing. The researchers are also working on allowing people to use the system to control prosthetic limbs or even their own limbs that have lost function. The device has the potential to restore the fundamental ability to communicate and to increase independence for those with spinal cord injury, stroke, ALS (also known as Lou Gehrig’s disease) and other disorders of the nervous system.

Turning brain waves into action

While nearly two-thirds of adult amputations may be due to peripheral vascular disease of

a lower extremity, the remaining are associated with trauma, such as trauma related to high-explosive blasts or other combat scenarios. High-impact explosive trauma from improvised explosive devices has become the signature injury of the OEF/OIF theaters, and restoring injured Veterans to their greatest possible functional capacity in their families, communities, and work laces is a primary mission of ORD.

Today’s VA researchers are using leading-edge technologies such as robotics, tissue engineering, and nanotechnology to build better prostheses for the 21st century, and are studying ways to best match available prosthetic components to the needs of individual amputees.

A modern prosthesis allows Luke Cassidy, a Veteran who lost his left foot and right toe in Operation Iraqi Freedom, to maintain his active lifestyle and a normal relationship with his young children. “I felt that I wasn’t going to be able to function and be able to do ‘dad’ things with them,” he says. With a prosthesis matched to his needs, the Veteran can now coach softball and his mindset has changed, he says, to “Okay, I can do this.”

The future of prosthetics is nowTrauma for IEDS becomes signature injury of OEF/OIF theaters



A futuristic tack is being taken by researchers at the Center for Restorative and Regenerative Medicine, a collaboration among VA, Brown University, and MIT. Researchers at the center are working to merge biological and nonbiological materials into high-tech “biohybrid” limbs. The effort includes investigators with expertise in orthopedics, tissue engineering, neurotechnology, prosthetic design, and rehabilitation.

But VA prosthetics research doesn’t stop at state-of-the-art limbs. Prosthetics also include wigs, eyeglasses, hearing aids, wheelchairs, GPS devices to help individuals with brain injuries become mobile, and adaptive equipment for cars and homes—“everything that’s necessary to help Veterans regain their mobility and independence,” says Downs.

Cutting-edge prosthetic arm restores measure of independence

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Prosthetics &

Am

putation Care

While nearly two-thirds of adult amputations may be due to peripheral vascular disease of a lower extremity, the remaining are associated with trauma, such as trauma related to high-explosive blasts or other combat scenarios. High- impact explosive trauma from improvised explosive devices has become the signature injury of the OEF/OIF theaters, and restoring injured Veterans to their greatest possible functional capacity in their families, communities, and work laces is a primary mission of ORD.

Today’s VA researchers are using leading-edge technologies such as robotics, tissue engineering, and nanotechnology to build better prostheses for the 21st century, and are studying ways to best match available prosthetic components to the needs of individual amputees.

A modern prosthesis allows Luke Cassidy, a Veteran who lost his left foot and right toe in Operation Iraqi Freedom, to maintain his active lifestyle and a normal relationship with his young children. “I felt that I wasn’t going to be able to function and be able to do ‘dad’ things with them,” he says. With a prosthesis matched to his needs, the Veteran can now coach softball and his mindset has changed, he says, to “Okay, I can do this.”

A futuristic tack is being taken by researchers at the Center for Restorative and Regenerative Medicine, a collaboration among VA, Brown University, and MIT. Researchers at the center are working to merge biological and nonbiological materials into high-tech "biohybrid" limbs. The effort includes investigators with expertise in orthopedics, tissue engineering, neurotechnology, prosthetic design, and rehabilitation.

(Left) Frederick Downs Jr., director of VA’s Prosthetic and Sensory Aids Service, begins his work day with the help of a new advanced prosthetic arm. Downs recently took part in a 2-week take-home trial of the groundbreaking artificial limb, which is a joint research and development project between the Defense Advanced Research Projects Agency and DEKA. (Above) Downs discusses treatment options with a Veteran amputee at Walter Reed Army Medical Center.


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Promoting good health and managing chronic conditions remain high priorities for VA health care and VA research. Among the chronic conditions that rank high among VA’s health research priorities are:

Cardiovascular DiseaseTEXT NEEDED, groundbreaking, seven year multi-site clinical trial, VA investigators found that intensive blood sugar control, primarily using higher doses of medication, did not cut cardiovascular risks compared with recommended targets in older patients with long standing diabetes (N Engl J Med 2009;360:129-39). The trial also found that an intensive approach provided no added benefits for the kidneys or eyes which are often harmed by the high blood sugar levels in poorly-controlled diabetes. Altogether, these findings informed physicians on how to manage this complex disease and are helping to change prevailing thought that a more intensive approach is always more advantageous.

CancerTEXT NEEDED, groundbreaking, seven year multi-site clinical trial, VA investigators found that intensive blood sugar control, primarily using higher doses of medication, did not cut cardiovascular risks compared with recommended targets in older patients with long standing diabetes (N Engl J Med 2009;360:129-39).

The trial also found that an intensive approach provided no added benefits for the kidneys or eyes which are often harmed by the high blood sugar levels in poorly-controlled diabetes. Altogether, these findings informed physicians on how to manage this complex disease and are helping to change prevailing thought that a more intensive approach is always more advantageous.

Diabetes Diabetes affects about one million Veterans within the VA health care system--nearly 20 percent of the population. And diabetes is the leading cause of blindness, end-stage renal disease, and amputation in the VA. Given the impact of diabetes and its complications, VA supports an innovative and comprehensive diabetes research program directed at a range of immediate clinical concerns such as hyperglycemia, glaucoma, and high blood pressure, long-term complications such as amputation and kidney failure, and care delivery issues through a range of facilities such as outpatient clinics, nursing homes, and home-based care.

Managing chronic disease remains high priority for VA Research

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VA investigators continue to examine mechanisms and risk factors for one’s susceptibility to diabetes and its complications. In addition to cellular and molecular-based research, VA is supporting genetic studies on this complex disease, including one that is measuring gene expression and insulin resistance simultaneously in human fat, muscle, and blood samples from Mexican American Veterans and their family members.

Parkinson’s DiseaseTEXT NEEDED, groundbreaking, seven year multi-site clinical trial, VA investigators found that intensive blood sugar control, primarily using higher doses of medication, did not cut cardiovascular risks compared with recommended targets in older patients with long standing diabetes (N Engl J Med 2009;360:129-39). The trial also found that an intensive approach provided no added benefits for the kidneys or eyes which are often harmed by the high blood sugar levels in poorly-controlled diabetes. Altogether, these

findings informed physicians on how to manage this complex disease and are helping to change prevailing thought that a more intensive approach is always more advantageous.

Pain ManagementPain is one of the most common reasons Americans consult a physician, and it is cited as the most common symptom in U.S. Service members returning from combat. VA’s pain management program, which has existed for more than three decades, is a leader in pain research and care. VA is developing powerful new approaches to alleviate Veterans’ pain, which may result from spinal cord injury, burns, amputations, traumatic brain injury, cancer, arthritis, or other conditions.

VA’s pain research program covers a remarkably wide range of topics, from drug discovery to alternative treatments to the impact of pain on daily function and quality of life. In three studies that represent VA’s diverse research approaches on this issue, one VA research team has looked at whether yoga can help in pain reduction; another is testing a high-tech approach for delivering a pain-relieving gene to the nervous system; and a third is examining changes at the cellular and molecular levels for clues about what causes pain and how to treat it.

In a recently completed, groundbreaking, 7 year multi-site clinical trial, VA investigators found that intensive blood sugar control, primarily using high-er doses of medication, did not cut cardiovascular risks compared with recommended targets in older patients with long standing diabetes (N Engl J Med 2009;360:129-39). The trial also found that an in-tensive approach provided no added benefits for the kidneys or eyes which are often harmed by the high blood sugar levels in poorly-controlled diabetes. Altogether, these findings informed physicians on how to manage this complex disease and are helping

to change prevailing thought that a more intensive approach is always more advantageous.

VA investigators tackle blood sugar control


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Documents

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