[TELEPHONE LINES OPEN]
- HELLO. THIS IS DREW HELMER AT THE WAR RELATED ILLNESS AND INJURY STUDY CENTER.
IN EAST ORANGE, NEW JERSEY.
I AM HERE TO WELCOME EVERYBODY TO THE "AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY:
WHAT PROVIDERS NEED TO KNOW" WEBINAR.
AND I’M GONNA TAKE IT A LITTLE SLOW TO JUST GIVE A FEW OTHER PEOPLE A CHANCE TO JOIN.
WE SEE THE NUMBER OF PARTICIPANTS CONTINUES TO INCREASE.
I WOULD JUST LIKE TO POINT OUT THAT THIS WEBINAR IS ONE OF A SERIES
THAT THE WRIISC PROGRAM OFFERS TO PROVIDERS
AND OTHER INTERESTED PEOPLE
RELATED TO DEPLOYMENT HEALTH ISSUES.
WE HAVE A MONTHLY SERIES THAT IS GONNA BE ADVERTISED TOWARD THE END OF THIS,
AND YOU CAN ALWAYS CHECK OUT OUR WEBSITE
AT THEWARRELATEDILLNESS.VA.GOV.
SO, LET ME SEE.
AT THIS POINT, IT LOOKS LIKE WE HAVE, UH...
OUR NUMBER OF PARTICIPANTS IS MAYBE SLOWING DOWN A LITTLE BIT.
SO, LET ME GO AHEAD AND INTRODUCE TODAY’S SPEAKER.
DR. OMOWUNMI OSINUBI IS AN OCCUPATIONAL AND ENVIRONMENTAL MEDICINE PHYSICIAN.
SHE’S ALSO TRAINED IN ANESTHESIOLOGY
AND INTERVENTIONAL PAIN MANAGEMENT.
SHE GOT BOTH OF HER TRAININGS AT YALE AND AT MT. SINAI.
SHE’S WORKED WITH THE WRIISC AND WITH VETERANS
ON THEIR DEPLOYMENT-RELATED HEALTH CONCERNS SINCE 2008.
AND DR. OSINUBI IS REALLY JUST A GREAT COLLEAGUE.
SHE SEES OUR PATIENTS HERE AT THE WRIISC.
SHE DOES EXPOSURE CONSULTS.
SHE WORKS WITH OUR MULTIDISCIPLINARY TEAM
ON DOING WHAT WE CALL OUR COMPREHENSIVE EVALUATIONS
FOR CHRONIC MEDICALLY UNEXPLAINED SYMPTOMS.
AND NOT ONLY THAT, SHE’S WORTH A MILLION BUCKS.
ONE OF HER MOST RECENT PATIENTS GAVE HER A REPLICA BILL
OF $1 MILLION U.S. DOLLARS.
AND THE QUESTION FOR ANYBODY ON THE CALL IS
IS RUTHERFORD B. HAYES REALLY THE PERSON ON THE MILLION-DOLLAR BILL?
SO, WITH THAT, I’M GONNA HAND IT OVER TO DR. OSINUBI,
AND SHE’S GONNA WALK YOU THROUGH WHAT PROVIDERS NEED TO KNOW
ABOUT THE "AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY."
THANK YOU.
- THANK YOU, DREW, FOR THAT INTRODUCTION,
AND THANK YOU ALL FOR JOINING US THIS AFTERNOON
ON YOUR PRECIOUS LUNCH HOUR TO LISTEN TO THIS WEBINAR.
AND BEFORE WE GET STARTED, JUST A FEW HOUSEKEEPING ANNOUNCEMENTS.
FOR AUDIO, YOU WANT TO CALL 1-855-767-1051.
AGAIN, IT’S 1-855-767-1051.
AND YOU CAN USE THE CONFERENCE CODE ID.
THAT’S 96926984.
IF YOU HAPPEN TO GET DROPPED FROM THE CALL,
JUST TRY THAT NUMBER AGAIN.
OR YOU CAN USE YOUR COMPUTER SPEAKERS OR HEADSET.
JUST SO YOU KNOW THAT WE WILL BE TAKING QUESTIONS.
THROUGHOUT THIS WEBINAR, YOU CAN TYPE IN YOUR QUESTION IN THE CHAT BOX.
AND AT THE END OF THIS SEMINAR, WE WILL READ OUT THOSE QUESTIONS AND ADDRESS THEM.
ALSO, ON THE RIGHT-HAND SIDE OF YOUR SCREEN,
YOU WILL SEE A PAPER CLIP WITH A NUMBER 3 ON THERE.
YOU WILL BE ABLE TO DOWNLOAD THIS WEBINAR IN THE NEXT HOUR,
AND THERE ARE A COUPLE OF FACT SHEETS THAT ARE THERE FOR YOU AS A RESOURCE.
SO, THOSE ARE JUST THE HOUSEKEEPING ANNOUNCEMENTS BEFORE WE GET STARTED.
SO, WHY ARE WE OFFERING THIS SEMINAR?
WELL--OR THIS WEBINAR.
WELL, YOU MAY HAVE HEARD THAT THERE’S THE AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY
THAT IS GOING TO BE LAUNCHED IN APRIL THIS YEAR.
AND THE OBJECTIVES OF THIS PRESENTATION
IS FOR YOU, AS A VA CLINICIAN,
TO BE ABLE TO RECOGNIZE THE MOST COMMON EXPOSURE CONCERNS RELATED TO AIRBORNE HAZARDS.
AT THE END OF THIS PRESENTATION, YOU SHOULD BE ABLE TO PROVIDE
EACH VETERAN WITH THE MOST APPROPRIATE EVIDENCE-BASED DIAGNOSTIC EVALUATION
AND TREATMENT OF THEIR AIRBORNE HAZARD-RELATED SYMPTOMS AND HEALTH CONCERNS.
THE GOAL IS FOR EACH VA CLINICIAN TO BE ABLE TO ENGAGE EVERY VETERAN
IN A THERAPEUTIC RELATIONSHIP
TO OPTIMIZE THEIR MEDICAL MANAGEMENT AND THEIR OVERALL HEALTH.
AND AT THE END OF THIS PRESENTATION,
YOU SHOULD BE ABLE TO USE THE DESIGNATED CLINICAL ASSESSMENT TOOL
TO DOCUMENT THAT EVALUATION AND CARE PLAN
TO ENABLE REGISTRY ANALYSIS AND REPORTING.
SO, WHY IS IT IMPORTANT, THEN, TO FOCUS ON VETERANS’ EXPOSURE CONCERNS?
WELL, IT’S IMPORTANT BECAUSE IT IS VERY COMMON THAT VETERANS
HAVE CONCERNS ABOUT THEIR EXPOSURES.
AT LEAST 1/3 OF DEPLOYED SOLDIERS
REPORT THAT THEY’VE EXPERIENCED DEFINITE OR PROBABLE EXPOSURES TO ENVIRONMENTAL HAZARDS
DURING THEIR MILITARY SERVICE.
FOR EXAMPLE, MORE THAN 1/4 OF SOLDIERS THAT WERE DEPLOYED TO THE JOINT BASE BALAD IN IRAQ
REPORT THAT THEY HAVE PERSISTENT HEALTH CONCERNS
DUE TO DEPLOYMENT EXPOSURES ON THEIR POST-DEPLOYMENT HEALTH REASSESSMENT QUESTIONNAIRE.
AND THE TYPES OF HEALTH EFFECTS THAT THESE VETERANS ARE CONCERNED ABOUT INCLUDE:
RESPIRATORY, CARDIOVASCULAR, GASTROINTESTINAL,
DERMATOLOGIC, AND CANCER CONCERNS.
IT’S THEREFORE IMPORTANT THAT AS A VA CLINICIAN,
THAT WE ADDRESS THESE CONCERNS IN A TIMELY MANNER.
SO, IN THE NEXT FEW SLIDES, WE’RE GOING TO BRIEFLY DISCUSS
WHAT SOME OF THESE EXPOSURES ARE AND WHAT THE POTENTIAL HEALTH EFFECTS MIGHT BE.
SO, WHAT ARE AIRBORNE HAZARDS?
WHEN WE TALK ABOUT AIRBORNE HAZARDS, WE ARE TALKING ABOUT PARTICULATE MATTER
THAT MAY BE EMITTED DIRECTLY FROM A SOURCE OR FROM COMPLEX REACTIONS.
THEY INCLUDE ORGANIC CHEMICALS, METALS, SOIL, DUST PARTICLES,
AND THESE INHALED MATERIALS, ONCE YOU INHALE THEM,
THEY CAN BE TOXIC TO THE LUNGS OR TO OTHER ORGANS.
SOME OF THEM MAY BE GASES, HEAVY METALS,
CHEMICALS SUCH AS PCBs, DIOXINS, AND POLYCYCLIC AROMATIC HYDROCARBONS.
SO, WHAT ARE THE SOURCES OF THESE AIRBORNE HAZARDS?
WELL, YOU’VE PROBABLY HEARD IN THE NEWS THAT BURN PITS,
THE OPEN BURN PITS AND THE BURN PIT SMOKE.
THERE WAS A LOT OF OPEN AIR WASTE INCINERATION,
ESPECIALLY IN IRAQ AND AFGHANISTAN.
AS OF 2010, THERE WERE ABOUT 273 OF THESE OPEN BURN PITS
THAT WERE IN OPERATION.
AND SERVICEMEMBERS MAY HAVE BEEN EXPOSED TO THE SMOKE
ON A DAY-TO-DAY BASIS.
FOR SOME PEOPLE, IT WAS ALMOST 24/7.
AND THE CLOSER THE SERVICEMEMBER IS TO THAT BURN PIT,
THE MORE LIKELY THAT THEY’RE GONNA BE EXPOSED,
ESPECIALLY IF THEY ACTUALLY DID THE BURNING OF THE MATERIALS THEMSELVES
OR THEIR SLEEPING QUARTERS WAS LOCATED CLOSE TO THE BURN PITS.
ANOTHER COMMON SOURCE OF CONCERN IS THE SAND AND DUST STORMS.
THIS HAPPENED-- THEY WERE SEASONAL,
BUT THEY WERE VERY FREQUENT WHEN THEY OCCURRED.
THEY WERE INTENSE.
WHY IS THE SAND DIFFERENT FROM WHAT WE EXPERIENCE HERE
IN THE UNITED STATES?
WELL, THE SAND IS VERY FINE. IT’S TALC-LIKE.
AND IT’S READILY INHALED, BECAUSE THEY’RE RELATIVELY SMALL PARTICLES.
AND THESE PARTICLES CAN ABSORB SOME TOXIC METALS OR BACTERIA
OR VIRAL RNA OR FUNGI.
AND IF YOU INHALE THAT DUST DEEP INTO YOUR LUNGS,
ESPECIALLY FOR VETERANS WHO ARE EXERCISING,
THAT CAN POSE A HEALTH HAZARD.
SO, MANY VETERANS WILL TELL YOU THE SAND WAS SO INTENSE
THAT THEY COULD NOT SEE THEIR HAND IN FRONT OF THEM,
AND SOME OF THEM WERE STANDING IN CONVOY AND COULD NOT GO FOR COVER
WHEN THE SAND AND DUST STORMS HIT.
SO, THAT MAY BE AN ACCOUNT THAT THE VETERAN MAY RELATE TO YOU
AS YOU’RE DOING THESE EVALUATIONS.
ANOTHER SOURCE OF CONCERN IS THE SMOKE FROM BURNING OIL WELL FIRES.
FROM THE FIRST GULF WAR, MORE THAN 600 KUWAITI OIL WELL FIRES WERE SET ABLAZE
BY THE IRAQI TROOPS.
AND MANY TIMES, THE VETERANS WOULD TELL US, IT WAS AS BLACK AS NIGHT DURING THE DAY.
THAT WAS JUST HOW INTENSE THE SMOKE WAS.
AND MANY OF THESE VETERANS, YOU KNOW, BREATHED THIS SMOKE
FOR HOURS ON END AND INHALED COMBUSTION PARTICLES,
AND THESE MAY INCLUDE CARCINOGENS SUCH AS BENZENE,
POLYCYCLIC AROMATIC HYDROCARBONS,
SOOT, ACID, METALS, ET CETERA.
SO, THOSE ARE THE 3 MAJOR AIRBORNE HAZARDS THAT VETERANS TEND TO REPORT TO US.
THERE ARE ALSO OTHER TYPES OF EXPOSURES.
THIS WOULD INCLUDE EXPOSURES FROM INDUSTRIAL EMISSIONS,
AIRCRAFT AND AUTOMATIC ENGINE EXHAUST,
AS WELL AS AEROSOLIZED PARTICLES FROM BLAST EXPLOSIONS AND STRUCTURAL FIRES.
SO, TO SUMMARIZE--I KNOW I’VE SPENT A FEW MINUTES TALKING ABOUT THESE AIRBORNE HAZARDS.
TO SUMMARIZE, THESE AIRBORNE HAZARDS ARE DIVERSE.
THEY ARE COMPLEX. THEY ARE POTENTIALLY HAZARDOUS TO HEALTH.
SO, IT’S IMPORTANT THAT AS A VA CLINICIAN
THAT WE RECOGNIZE AND ACKNOWLEDGE
THAT THESE HAZARDS WERE PRESENT
AND HAVE THE ABILITY TO DISCUSS THAT WITH THE VETERANS
WHO ARE CONCERNED ABOUT THESE EXPOSURES.
SO, NOW WE’RE GOING TO SHIFT GEARS AND TALK ABOUT THE TYPES OF HEALTH EFFECTS
THAT WE MAY SEE FROM THESE TYPES OF AIRBORNE HAZARDS.
LET’S TALK ABOUT WHAT THE SHORT-TERM HEALTH EFFECTS MIGHT BE.
NASAL IRRITATION AND DISCHARGE FROM IRRITATION OF MUCOUS MEMBRANES,
EYE AND THROAT IRRITATION, COUGH AND/OR CHEST CONGESTION,
SHORTNESS OF BREATH--
SOME OF THE SYMPTOMS THAT THE VETERANS WOULD HAVE EXPERIENCED
OR MAY HAVE EXPERIENCED AT THE TIME THAT THEY WERE EXPOSED.
NOW FOR VETERANS WHO HAD-- OR SERVICEMEMBERS WHO HAD
PREEXISTING RESPIRATORY CONDITIONS,
LIKE A PREEXISTING ASTHMA THAT WAS QUIESCENT FOR MANY YEARS,
THEY MAY ACTUALLY--
THESE EXPOSURES MAY TRIGGER SUCH ASTHMA ATTACKS,
BRONCHITIS.
IF SOMEONE HAD PREEXISTING COPD, THEN THESE EXPOSURES
MAY CAUSE AN EXACERBATION OF SYMPTOMS.
AND WE HAVE HAD QUITE A NUMBER OF VETERANS COMPLAIN ABOUT SKIN RASHES.
BY AND LARGE, THOUGH, THESE SHORT-TERM HEALTH EFFECTS,
FOR THE MOST PART TEND TO RESOLVE WITHIN A FEW WEEKS, 2 TO 3 WEEKS,
AFTER THE EXPOSURES HAVE BEEN REMOVED
AND THE VETERAN RECOVERS FROM THAT.
BUT IN A SUBSET OF VETERANS, THOUGH,
THOSE WITH PREEXISTING CONDITIONS, AND EVEN SOME WITHOUT PREEXISTING CONDITIONS,
WE ARE FINDING SOME VETERANS ARE COMPLAINING OF ONGOING SYMPTOMS
AFTER THEY’VE BEEN REMOVED FROM EXPOSURE.
WHAT ABOUT LONG-TERM HEALTH EFFECTS, THEN?
IN A SUBSET OF VETERANS, WE HAVE SEEN INCREASED RATES OF SELF- REPORTED PULMONARY SYMPTOMS.
A STUDY BY ... IN 2009 DOCUMENTED THAT.
SOME HIGHER RATES OF ASTHMA HAVE BEEN REPORTED IN THOSE WHO WERE DEPLOYED
VERSUS NON-DEPLOYED VETERANS.
IN SOME VERY RARE CASES, WE HAVE SEEN UNUSUAL OR UNEXPECTED CONDITIONS,
SUCH AS EOSINOPHILIC PNEUMONITIS
OR CONSTRICTIVE BRONCHIOLITIS THAT HAS BEEN REPORTED
IN A SMALL GROUP OF VETERANS WHO WERE DEPLOYED TO IRAQ
AND SOME TO AFGHANISTAN.
THERE ARE SOME STUDIES, THOUGH, THAT DID NOT FIND HIGHER RATES OF CARDIORESPIRATORY DISEASE,
ESPECIALLY WHEN THEY LOOKED AT MODELED EXPOSURES.
SO, THE LITERATURE IS MIXED.
WE DO HAVE SOME CASES WHERE THERE ARE ASSOCIATED
LONG-TERM HEALTH EFFECTS,
AND IN SOME STUDIES THOSE HEALTH EFFECTS
HAVE NOT PANNED OUT.
SO, GIVEN THE CONCERN THAT THE VETERANS HAVE VOICED,
THE PUBLIC HEALTH CONCERN,
THE INSTITUTES OF MEDICINE WAS TASKED BY THE VETERANS’ ADMINISTRATION TO LOOK AT THIS--
OR THE DEPARTMENT OF VETERANS AFFAIRS TO LOOK INTO THE LONG-TERM HEALTH EFFECTS
OF THESE AIRBORNE HAZARD EXPOSURES.
AND THE INSTITUTES OF MEDICINE DID THE REVIEW OF THE LITERATURE,
AND THEY SUMMARIZED THEIR FINDINGS IN THE REPORT THAT WAS PUBLISHED IN 2011,
WHICH I HAVE THERE ON THIS SCREEN.
THE LONG-TERM HEALTH CONSEQUENCES OF EXPOSURE TO BURN PITS IN IRAQ
AND AFGHANISTAN.
AND WHAT THE INSTITUTES OF MEDICINE DETERMINED
IS THAT THERE IS SOME LIMITED OR SUGGESTED EVIDENCE
OF AN ASSOCIATION BETWEEN EXPOSURES TO COMBUSTION PRODUCTS IN GENERAL
AND REDUCTION IN PULMONARY FUNCTION IN THE POPULATIONS THAT THEY STUDIED.
THAT’S BECAUSE OF THE VERY HIGH LEVELS OF PARTICULATE MATTER THAT WERE IN THE ENVIRONMENT.
SO, THERE MIGHT BE LONG-TERM HEALTH EFFECTS.
HOWEVER, THEY COULD NOT TIE THAT SPECIFICALLY TO BURN PITS OR TO ANY SPECIFIC EXPOSURE,
BUT THEY TALKED ABOUT THAT BEING RELATED TO AIR POLLUTIONS IN GENERAL.
AND THEY COULD NOT, AT THIS POINT,
MAKE A STATEMENT ABOUT ASSOCIATION BETWEEN CANCER
OR SPECIFIC RESPIRATORY DISEASES OR CIRCULATORY DISEASES
OR EVEN NEUROLOGICAL DISEASES.
BUT STUDIES ARE STILL ONGOING, SO YOU NEED TO STAY TUNED
FOR RESEARCH STUDIES AS THEY COME ALONG.
SO, IN RESPONSE TO THE VETERAN CONCERNS
AND THE HEALTH ISSUES THAT COULD POTENTIALLY COME DOWN THE PIKE,
THE CONGRESS PASSED A LAW, THE PUBLIC LAW 112-260,
THAT IS THE...
DIGNIFIED BURIAL AND OTHER VETERANS’ BENEFITS IMPROVEMENT ACT OF 2012.
AND THAT LAW REQUIRED THAT THE VA ESTABLISH A REGISTRY--
THE AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY.
THE PURPOSE OF THIS REGISTRY IS TO MONITOR AND ASCERTAIN HEALTH EFFECTS
FROM EXPOSURES TO AIRBORNE HAZARDS.
IT’S TO MONITOR THE HEALTH CARE OF THE VETERANS WITH THESE CONCERNS
AND TO ENSURE THAT THE VA PROVIDES HIGH-QUALITY HEALTH SERVICES.
THE VETERANS THAT ARE ELIGIBLE FOR THIS SERVICE
FOR THE BURN PIT REGISTRY
INCLUDE THOSE WHO SERVED IN SOUTHWEST ASIA OF OPERATIONS
AFTER AUGUST 1, 1990,
AND THOSE WHO SERVED IN DJIBOUTI, AFRICA,
AND AFGHANISTAN AFTER SEPTEMBER 2011--
SEPTEMBER 11, 2011.
SO, THOSE ARE THE VETERANS AND THE SERVICEMEMBERS WHO ARE ELIGIBLE TO PARTICIPATE
IN THIS REGISTRY.
SO, NOW THAT WE HAVE AN UNDERSTANDING
OF WHAT THE POTENTIAL AIRBORNE EXPOSURES AND HEALTH EFFECTS ARE,
WE ARE NOW GOING TO SHIFT OUR ATTENTION
TO THE REGISTRY AND DISCUSS WHAT THIS REGISTRY PROCESS ENTAILS.
THERE ARE 2 MAIN ASPECTS OF THIS REGISTRY.
THERE IS AN ONLINE SELF-ASSESSMENT QUESTIONNAIRE,
AND THEN THE NEXT STEP IS AN OPTIONAL IN-PERSON CLINICAL EVALUATION.
AND ON YOUR SCREEN, YOU CAN SEE ON THE WEBSITE,
THE OFFICE OF PUBLIC HEALTH WEBSITE,
WHAT THE PORTAL IS GOING TO LOOK LIKE.
THE VETERAN HAS THE ABILITY TO SIGN INTO THAT PORTAL
USING A LOG ON NUMBER,
AND THEY WILL BE ABLE TO ACCESS THE REGISTRY THAT WAY.
SO, LET’S TALK A LITTLE BIT ABOUT THIS ONLINE SELF-ASSESSMENT QUESTIONNAIRE.
IT’S THE FIRST TIME THAT THE VA IS DOING THIS,
SO IT IS INNOVATIVE.
THE VETERANS CAN REGISTER AND ACCESS THE ONLINE QUESTIONNAIRE
FROM THEIR PERSONAL COMPUTERS, THEIR SMART PHONE, TABLETS, LAPTOPS, AND MOBILE DEVICES,
SO IT MAKES IT REALLY CONVENIENT.
AND I HAVE THE WEBSITE FOR THE SELF-ASSESSMENT QUESTIONNAIRE
ON THE POWERPOINT PRESENTATION.
FOR A VETERAN OR SERVICEMEMBER TO ACCESS THE ...,
THEY MUST HAVE A DS LOG-ON.
THAT’S THE DEPARTMENT OF DEFENSE SELF-SERVICE LOG-ON.
AND THEY CAN GET THAT LOG-ON FROM THE WEBSITE THAT’S LISTED ON THE POWERPOINT.
IT TAKES ABOUT 30 TO 40 MINUTES TO COMPLETE THIS QUESTIONNAIRE,
AND THEY CAN PRINT THE COMPLETED QUESTIONNAIRE WHEN THEY ARE DONE.
A VETERAN WHO HAS COMPLETED THE QUESTIONNAIRE THAT THEY NEED MEDICAL EVALUATION
OR THEY FEEL THAT THEY WANT TO BE ASSESSED,
THEY CAN CONTACT THEIR VA FACILITY TO REQUEST THAT MEDICAL EVALUATION AT NO COST.
SO, WHAT’S IN THE SELF-ASSESSMENT QUESTIONNAIRE?
THE QUESTIONNAIRE WAS DEVELOPED TO ASSESS A BROAD ARRAY
OF EXPOSURE CONCERNS, HEALTH CONCERNS,
SO IT DETAILS THE DEPLOYMENT INFORMATION.
IT DISPLAYS THE NAME OF THE COUNTRY AND THE DATES FROM THE DoD.
THE VETERAN ONLY NEEDS TO VALIDATE THAT INFORMATION.
IT DETAILS THE EXPOSURE AND HEALTH CONCERNS,
WHAT THEY WERE EXPOSED TO, AT WHAT TIME THEY WERE EXPOSED TO,
AND THE LEVEL OF CONCERN--
WHETHER IT’S A HIGH LEVEL OF CONCERN OR A LOW LEVEL OF CONCERN.
IT DETAILS THE TYPE OF CONCERN THAT THEY HAVE,
WHETHER IT’S THE ILLNESS THEY’VE HAD IN THE PAST,
CURRENT ILLNESS, OR FUTURE ILLNESS THAT THEY’RE WORRIED ABOUT.
IT DETAILS THEIR HEALTH HISTORY,
THEIR ACTIVITY LIMITATIONS,
AND WHETHER OR NOT THE VETERANS ENGAGE IN OTHER RISK FACTORS
THAT MAY AFFECT THEIR HEALTH.
AND IT ALSO ASKS ABOUT THE PREFERRED TYPE OF COMMUNICATION,
WHETHER THE VETERAN WANTS TO BE CONTACTED VIA WEB E-MAIL, REGULAR MAIL,
OR IN PERSON.
SO, WHAT HAPPENS AFTER THE VETERANS COMPLETE THE SELF-ASSESSMENT QUESTIONNAIRES?
SOME VETERANS MIGHT DECIDE THEY’VE DOCUMENTED THEIR EXPOSURE CONCERNS,
AND THEY DON’T NEED TO DO ANYTHING FURTHER IF THEY’RE NOT HAVING ANY SYMPTOMS.
THAT’S FINE.
FOR THOSE WHO CONTINUE TO HAVE SYMPTOMS OR HEALTH CONCERNS,
THEY CAN SEEK MEDICAL EVALUATION.
AND FOR THOSE WHO ENROLLED AT THE VA,
WHAT THEY NEED TO DO IS TO CONTACT THEIR VA PRIMARY CARE PHYSICIAN
OR THE PACT TEAM-- THE PATIENT-ALIGNED CARE TEAM--
AT THE LOCAL VA FACILITY
TO SCHEDULE A REGISTRY MEDICAL EVALUATION.
AND THAT’S WHERE YOU, AS THE VA CLINICIAN, COMES IN.
YOU WOULD BE THE FIRST LINE OF CONTACT FOR THESE VA ENROLLEES,
WHO ARE SEEKING AN IN-PERSON MEDICAL EVALUATION.
FOR THOSE WHO ARE NOT ENROLLED IN THE VA,
THEY CAN CONTACT THE VA ENVIRONMENTAL HEALTH COORDINATOR
FOR A REGISTRY MEDICAL EVALUATION.
AND THE WEBSITE ON THIS POWERPOINT HAS THE LIST OF THE COORDINATORS
AT EACH VA FACILITY.
SO, THEY JUST NEED TO FIND THE COORDINATORS THAT’S CLOSEST TO THEM
AND ASK FOR A REGISTRY EVALUATION--
AIRBORNE REGISTRY EVALUATION.
AND THE VETERANS ARE ENCOURAGED TO TAKE PRINTED COPIES
OF THEIR COMPLETED SELF-ASSESSMENT QUESTIONNAIRE
TO THE MEDICAL EVALUATION.
SO, AS VA CLINICIANS, YOU MAY ALREADY BE SEEING VETERANS
WITH AIRBORNE HAZARD HEALTH CONCERNS,
BUT IF A VETERAN CONTACTS YOU AND IS REQUESTING FOR AN IN-PERSON REGISTRY EVALUATION
THEY MAY WANT TO DISCUSS SPECIFIC SYMPTOMS--YOU KNOW, THEIR RESPIRATORY SYMPTOMS,
OR PHYSICAL ACTIVITY LIMITATIONS,
OR OTHER CONCERNS RELATED TO THEIR EXPOSURE.
SOME OF THEM MAY NOT HAVE ANY CURRENT HEALTH PROBLEMS,
BUT THEY’RE CONCERNED ABOUT POSSIBLE FUTURE HEALTH EFFECTS OF EXPOSURES.
THEY ALSO WARRANT A MEDICAL EVALUATION
IF THEY’RE EXPRESSING SUCH CONCERN,
’CAUSE IT GIVES US AN OPPORTUNITY TO ENGAGE IN DISCUSSIONS WITH THE VETERAN
TO ALLAY THOSE CONCERNS.
NOW, THE REGISTRY HAS DEVELOPED A TEMPLATE IN CPRS
FOR US TO BE ABLE TO DOCUMENT THIS AIRBORNE HAZARDS RATE IN PERSONNEL EVALUATIONS.
SO, THERE IS AN INITIAL ASSESSMENT TEMPLATE IN CPRS.
AND THE NEXT FEW SLIDES IS GOING TO SHOW YOU WHAT THAT TEMPLATE IS LIKE IN CPRS.
WHAT THIS TEMPLATE DOES IS THAT IT FACILITATES A FOCUSED DIALOGUE
AND THOROUGH EVALUATION OF A VETERAN’S AIRBORNE HAZARDS CONCERNS.
AND THAT TEMPLATE MAY BE COMPLETED
BY THE PRIMARY CARE PROVIDER, ENVIRONMENTAL HEALTH CLINICIAN,
OR POST-APPOINTMENT HEALTH CHAMPION,
’CAUSE YOU WOULD BE THE FIRST LINE CLINICIAN FOR THESE VETERANS.
NOW, THE TEMPLATE ALLOWS YOU TO REVIEW THE COMPLETE SELF-ASSESSMENT QUESTIONNAIRE
USING THE WEB PORTAL.
SO, THAT’S ALREADY EMBEDDED IN THE TEMPLATE,
AND IT GOES THROUGH THE CLINICAL EVALUATION
MUCH AS YOU WOULD DO FOR A REGULAR EVALUATION.
IT’S JUST THAT IN THIS SITUATION,
YOU WILL BE TAKING A DEPLOYMENT HISTORY AND SUMMARIZING IT,
AND THEN YOU’LL REVIEW THEIR SYMPTOMS, HEALTH HISTORY,
GO THROUGH THEIR USUAL RISK FACTORS,
SUCH AS TOBACCO USE, ALCOHOL USE, FUNCTIONAL LIMITATIONS,
SPECIFY WHAT SYMPTOMS THEY ARE CONCERNED ABOUT AT THIS EVALUATION.
YOU’LL COMPLETE A PHYSICAL-- [AUDIO CUTS OUT]
...DO A DIAGNOSTIC WORKUP, FORM AN ASSESSMENT,
CREATE A CARE PLAN,
AND ENGAGE IN HEALTH RISK COMMUNICATION.
SO, THAT’S REALLY WHAT THE PROCESS ENTAILS,
AND WE’RE GONNA GO THROUGH THIS STEP BY STEP.
OK. SO, THE SCREEN THAT YOU SEE RIGHT IN FRONT OF YOU NOW
IS THE AIRBORNE HAZARD, OPEN BURN PIT REGISTRY
CLINICAL TEMPLATE IN CPRS.
AND THAT’S GONNA BE ACCESSED THROUGH THE NOTES SECTION IN CPRS.
THE BEAUTIFUL THING ABOUT THIS TEMPLATE
IS THAT IT GIVES YOU STEP-BY-STEP INSTRUCTIONS,
AND THOSE INSTRUCTIONS, ALTHOUGH EMBEDDED IN THE NOTES,
THEY WILL NOT PRINT OUT IN YOUR REGULAR NOTES.
SO YOU HAVE A LOT OF INFORMATION ON THE TEMPLATE TO GUIDE YOU,
AND YOU CAN ALSO SEE HYPERLINKS TO THE PATIENT’S RESPONSES TO THE QUESTIONNAIRE.
OR IF YOU HAVE QUESTIONS ABOUT WHAT BURN PITS ARE,
YOU CAN CLICK ON THAT HYPERLINK,
AND YOU, AS A CLINICIAN, CAN GET MORE INFORMATION.
SO, THE NOTE TEMPLATES INCLUDES A CHIEF COMPLAINT, HISTORY,
PHYSICAL EXAMINATION, THE DIAGNOSTIC EVALUATIONS TO DATE,
THE OVERALL ASSESSMENT, RECOMMENDATIONS,
AND QUICK ORDERS.
SO, YOU’RE PROBABLY THINKING, "OK, AS A PRIMARY CARE PHYSICIAN,
WHAT IS EXPECTED OF ME IN COMPLETING THIS TEMPLATE?"
WELL, WHAT WE’RE GOING TO DO IS USE A CLINICAL CASE VIGNETTE
TO ILLUSTRATE HOW A PATIENT MAY PRESENT TO YOU IN THE CLINIC
AND HOW YOU WOULD GO ABOUT COMPLETING THIS TEMPLATE.
SO THE CASE THAT WE HAVE IS VETERAN 00.
SHE’S A 40-YEAR-OLD OEF/OIF AIR FORCE RESERVE VETERAN.
SHE’S COMPLETED THE SELF-ASSESSMENT QUESTIONNAIRE,
AND SHE HAS REQUESTED FOR AN IN-PERSON EVALUATION AT HER LOCAL VA.
SHE PRESENTS WITH CHRONIC COUGH,
ALSO, SHE HAS SAID, WITH THROAT CLOSING,
HOARSENESS, AND DYSPHAGIA.
THESE SYMPTOMS STARTED WHILE SHE WAS IN IRAQ,
AND SHE’S BEEN COUGHING EVER SINCE.
IN FACT, SHE WAS MEDEVACED OUT OF THEATER
BECAUSE OF THE SEVERITY OF HER RESPIRATORY SYMPTOMS.
SHE HAS ONGOING CHRONIC RHINOSINUSITIS,
HER DYSPNEA IS VERY LIMITING WITH MILD TO MODERATE ACTIVITIES.
BEFORE SHE WAS DEPLOYED,
SHE WAS RUNNING 5 TO 10 MILES A DAY,
TRAINING INTENSELY.
AND WHILE SHE WAS DEPLOYED, SHE DID THAT UNTIL SHE GOT SICK.
SHE CARRIED A LOT OF HEAVY GEAR,
BUT NOW HER ACTIVITY LIMITATION IN TERMS OF EXERCISE,
SHE CAN ONLY EXERCISE 30 TO 45 MINUTES A DAY.
AND ON TOP OF HER RESPIRATORY SYMPTOMS,
SHE ALSO HAS GASTROESOPHAGEAL REFLUX DISEASE.
NOW, HOW DO WE EVALUATE THIS PATIENT?
WELL, IN THE TEMPLATE THAT YOU HAVE IN CPRS,
IN YOUR INITIAL NOTE, YOU HAVE A CHECKLIST OF SYMPTOMS.
AND WHAT YOU NEED TO DO IS TO CHECK THOSE SYMPTOMS THAT THE PATIENT PRESENTED WITH.
SO, IN THIS CASE, YOU WOULD CHECK OFF RUNNY NOSE,
CHRONIC SINUS CONGESTION, SORE THROAT, COUGH FOR MORE THAN 3 WEEKS,
SHORTNESS OF BREATH, AND GASTROINTESTINAL PROBLEMS.
NOW, AT THE END OF THAT CHECKLIST,
YOU CAN SEE A BOX THAT YOU CAN CLICK
TO BE ABLE TO WRITE IN TEXT FORMAT
WHAT THE VETERAN COMPLAINED ABOUT IN THEIR OWN WORDS.
SO THIS IS A VERY FLEXIBLE TEMPLATE TO USE.
IT HELPS YOU DOCUMENT THE SYMPTOMS VERY QUICKLY,
AND THEN YOU ALSO HAVE A TEXT OPTION
TO BE ABLE TO PUT THE CLINICAL INFORMATION IN AS YOU DEEM APPROPRIATE.
SO LET’S SHIFT GEARS AND TALK ABOUT VET OO’S
DEPLOYMENT--RELATED HISTORY & EXPOSURES.
SO, SHE’S A COMBAT ENGINEER.
SHE SERVED IN TOLEDO, OHIO, BEFORE SHE WAS DEPLOYED TO AFGHANISTAN IN 2003-2004
AND TO IRAQ IN FEBRUARY 2011 TO OCTOBER 2011.
NOW, IN THE COURSE OF HER JOB AS A COMBAT ENGINEER,
SHE WAS INVOLVED IN PULLING DOWN ALL BUILDINGS THAT HAD ASBESTOS IN THEM,
SO SHE WAS EXPOSED TO ASBESTOS FIBERS.
SHE SUPERVISED POURING CONCRETE,
SO SHE WAS EXPOSED TO CEMENT DUST AND CONCRETE DUST.
WHEN SHE WAS DEPLOYED,
HER WORKSITE WAS LOCATED CLOSE TO A BURN PIT,
AND SHE BREATHED IN THE SMOKE PRETTY MUCH ALL OF THE TIME SHE WAS THERE.
THEY HAD A LOT OF SAND AND DUST STORMS THAT WERE SEVERE.
AND TO TOP ALL OF THIS,
SHE WAS LOCATED NEXT TO AN AIRFIELD,
SO SHE WAS EXPOSED TO JET ENGINE EXHAUST
AND AIRCRAFT NOISE AS THE PLANES AND HELICOPTERS LANDED AND TOOK OFF.
SHE ALSO DID MISSIONS OUTSIDE OF HER DAYS
DURING WHICH SHE WAS EXPOSED TO SAND AND DUST STORMS.
SHE DID CARRY A LOT OF WEIGHT,
BUT SHE DID NOT HAVE ANY COMBAT EXPOSURE.
SHE WAS NOT DIRECTLY ENGAGED IN COMBAT.
NOW, THAT’S A LOT OF INFORMATION.
HOW WOULD YOU AS A PRIMARY CARE PHYSICIAN
CAPTURE ALL OF THAT INFORMATION?
WELL, THE TEMPLATE IN CPRS
HELPS YOU TO ACTUALLY CATEGORIZE THOSE EXPOSURES.
AND IF YOU CAN SEE ON THE LOWER PORTION OF THIS TEMPLATE,
YES, YOU WOULD CHECK OFF THAT SHE HAD OFF-BASE AIR POLLUTION DURING HER DEPLOYMENT,
BECAUSE SHE WAS OUTSIDE THE BASE,
AND SHE WAS EXPOSED TO SAND AND DUST STORMS,
ON-BASE AIR POLLUTION DURING HER DEPLOYMENT--
YOU WOULD CHECK THAT OFF--
AS WELL AS MILITARY JOBS WHILE SHE WAS NOT DEPLOYED.
AND THERE’S ALSO AN OPPORTUNITY FOR YOU TO INPUT INFORMATION IN THE TEXT.
SO THAT WAY, YOU CAN STREAMLINE THE DEPLOYMENT-RELATED HISTORY
AND CAPTURE AS MUCH INFORMATION AS YOU WANT TO
IN THAT ENCOUNTER.
NOW THE NEXT PHASE OF DOING THE EVALUATION
IS ONCE YOU’VE COMPLETED THE PHYSICAL EXAM--
AND YOU WOULD DOCUMENT THAT AS YOU NORMALLY WOULD
FOR ANY PHYSICAL EXAMINATION--
THE NEXT PHASE IS TO LOOK AT THE DIAGNOSTIC WORKUP FOR THIS PATIENT.
SO, FOR OUR VET OO, BEFORE SHE CAME TO SEE US IN THE CLINIC,
SHE ACTUALLY HAD GOTTEN SOME TESTS DONE AT THE VA.
SHE’D HAD SPIROMETRY, CHEST X-RAY,
AN ECHOCARDIOGRAM, PULMONARY ANGIOGRAM,
AND ALLERGY SKIN TESTS HAD BEEN ORDERED BY VARIOUS CLINICIANS
WITHIN THE VA SYSTEM.
THE BEAUTY ABOUT THIS TEMPLATE IS THAT THE TEMPLATE IS GOING TO PREPOPULATE
ALL THE DIAGNOSTIC TESTS THAT HAVE BEEN DONE WITHIN THE VA IN THE LAST 2 YEARS
WITHIN THAT TEMPLATE, AND YOU CAN SEE THAT INFORMATION.
THEN, AS A CLINICIAN, YOU DECIDE, "OK, WHAT’S THE NEXT STEP FOR THIS VETERAN?"
AND IF THEY HAVEN’T HAD ANY DIAGNOSTIC WORKUP,
YOU HAVE THE ABILITY TO ORDER THOSE TESTS IN THE ORDER SECTION.
SO, WHAT’S NEXT FOR OUR VETERAN?
WELL, SHE’S HAD A NUMBER OF TESTS DONE,
BUT MAYBE THERE ARE SOME SPECIALTY CONSULTS THAT YOU WANT TO CONSIDER.
AND FOR ANY VET WHO PRESENTS WITH YOU WITH AIRBORNE, HAS THAT CONCERN,
YOUR CONSULTATION IS GONNA VARY DEPENDING ON WHAT YOUR CLINICAL FINDINGS ARE
AND HOW SERIOUS THE PATIENT’S CONCERN IS.
SO YOU MAY WANT TO ORDER A PULMONARY CONSULT--
EAR, NOSE, AND THROAT, IF THEY HAVE PROBLEMS WITH DYSPHAGIA OR HOARSENESS,
LIKE IN THE CASE OF VETERAN OO.
SOME OF THEM PRESENT WITH NEW-ONSET ALLERGY CONDITIONS,
SO YOU MAY WANT TO ORDER ALLERGY/IMMUNOLOGY.
AND THEN FOR GASTRO--
YOU MAY ORDER A GASTROENTEROLOGY CONSULT AS NEEDED.
AND THESE CONSULTS ARE PART OF THE REGISTRY,
AND THEY ARE PROVIDED TO THE VETERAN AT NO COST.
FOR PULMONARY CONCERNS, THERE ARE SPECIALTY DIAGNOSTIC ASSESSMENTS
THAT MAY BE ORDERED FOR THE VETERANS.
SO WE MAY DECIDE TO DO FULL PULMONARY FUNCTION TESTS,
WITH OR WITHOUT BRONCHODILATOR METHACHOLINE CHALLENGE TEST;
HIGH-RESOLUTION CT SCANS;
A CARDIOPULMONARY EXERCISE STRESS TEST;
AND BRONCHOSCOPY AND LUNG BIOPSY IN SELECTED CASES.
NOW, THESE ARE SPECIALIZED TESTS THAT A PULMONARY SPECIALIST MAY ORDER
AFTER THE PATIENT HAS BEEN REFERRED ONTO PULMONARY.
AND ALSO, ENT MAY ORDER SPECIFIC DIAGNOSTIC ASSESSMENTS
OF THEIR VOCAL CORDS TO LOOK FOR VOCAL CORD DYSFUNCTION.
SO THE TEMPLATE GIVES YOU THE OPPORTUNITY
TO CHECK OFF WHAT TESTS THAT NEED TO BE ORDERED
SO THAT THAT GOES OFF AS A CONSULT.
THAT STREAMLINES THE PROCESS FOR THE PATIENT AND FOR THE PROVIDER.
SO, FOR OUR VETERAN OO, WHAT DID HER TESTS SHOW?
WELL, HER PFTs WERE NORMAL.
THE HIGH-RESOLUTION CHEST CT WAS NORMAL,
BUT THEN SHE HAD A POSITIVE METHACHOLINE CHALLENGE TEST,
WHICH CONFIRMED THAT SHE HAD REACTIVE AIRWAYS DISEASE,
SO NOW SHE’S SEEING A PULMONOLOGIST AT HER LOCAL VA
WHO HAS AN INTEREST IN TREATING DEPLOYMENT- RELATED LUNG INJURY.
SHE DID HAVE AN ENT CONSULT,
AND THAT CONFIRMED VOCAL CORD DYSFUNCTION.
SO NOW SHE’S IN THE PROCESS OF GETTING SPEECH THERAPY
FOR HER CHRONIC RHINOSINUSITIS.
SHE WAS FOUND TO HAVE A DEVIATED NASAL SEPTUM,
AND SURGERY’S PLANNED FOR THAT.
AND FOR HER GERD, IT WAS CONFIRMED THAT
SHE HAD H. PYLORIC GASTRITIS,
AND SHE WAS STARTED ON MEDICAL TREATMENT.
SO YOU CAN SEE THAT FOR OUR VETERAN OO,
THIS EVALUATION ALLOWED US TO FIGURE OUT WHAT HER MAIN HEALTH CONCERNS WERE,
AND WE WERE ABLE TO TREAT HER TO THE VARIOUS SPECIALISTS THAT SHE NEEDED,
AND SO SHE’S NOW GETTING MULTI-SPECIALTY CARE FOR HER AIRBORNE HAZARD HEALTH CONCERNS
AND CONDITIONS.
SO, WHEN YOU’VE COMPLETED YOUR EVALUATION WITH THE VETERAN,
YOU’VE DEVELOPED A CARE PLAN,
IT’S REALLY IMPORTANT TO HAVE A DISCUSSION
AND COMMUNICATE WITH YOUR VETERAN
IN TERMS OF THE EXPOSURE CONCERNS
AND THE FINDINGS OF YOUR EVALUATION.
FIRST AND FOREMOST, IT’S REALLY IMPORTANT
IN TERMS OF COMMUNICATING WITH THE VETERAN
TO LISTEN AND RESPECT THEIR CONCERNS.
IT’S IMPORTANT BECAUSE THIS HELPS YOU TO ESTABLISH TRUST AND RAPPORT
WITH YOUR PATIENTS.
YOU SHOULD IDENTIFY ANY GAPS IN KNOWLEDGE
ABOUT THE EXPOSURE THAT YOU IDENTIFY,
SO WE KNOW THAT, YES, THERE ARE ACUTE HEALTH SYMPTOMS THAT PEOPLE HAVE,
THERE ARE SOME LONG-TERM HEALTH CONDITIONS
THAT HAVE BEEN REPORTED IN THE MEDICAL LITERATURE,
BUT WE DON’T HAVE THE FULL PICTURE YET.
IT DOES TAKE A WHILE FOR SCIENCE TO CATCH UP WITH...
GIVE US ENOUGH INFORMATION TO BE ABLE TO SHARE WITH THE VETERAN.
SO, WE KNOW THAT PEOPLE MAY HAVE ASTHMA,
AND THERE ARE PEOPLE WHO HAVE ONGOING RESPIRATORY SYMPTOMS WITH THIS,
BUT THERE’S SOME CONDITIONS THAT WE STILL CAN’T SAY, ONE WAY OR THE OTHER,
WHETHER IT’S GONNA BE A PROBLEM IN THE FUTURE.
SO, FOR EXAMPLE, MAYBE LUNG CANCER
IS WHAT THE VETERAN IS CONCERNED ABOUT.
WE JUST DON’T HAVE THAT KIND OF INFORMATION YET.
SO WE’RE GONNA DISCUSS THESE TYPES OF--
WOULD HAVE THOSE KINDS OF DISCUSSIONS WITH THE VETERAN
AND THEN TALK TO THE VETERAN ABOUT THEIR WORKUP
AND CHECK BACK ON THEIR UNDERSTANDING
OF WHAT THE NEXT STEPS ARE.
SO, IN TERMS OF COMMUNICATION WITH THE VETERAN,
IT’S IMPORTANT THAT WE DISCUSS WITH THE VETERAN
THAT, YES, WE HAVE SOME INFORMATION ABOUT THEIR AIRBORNE EXPOSURES,
AND THE HEALTH CONDITIONS RELATED TO THESE ARE COMPLEX.
WE DON’T NECESSARILY HAVE ALL THE ANSWERS.
WHAT THIS EVALUATION ALLOWS US TO DO IS TO GATHER THE NECESSARY INFORMATION
AND HAVE A DISCUSSION WITH THE VETERAN ABOUT THEIR CURRENT HEALTH
AND THEIR FUTURE HEALTH CONCERNS.
BUT MORE IMPORTANTLY, THOUGH, WHAT WE WANT TO DO
IS FOCUS OUR MANAGEMENT ON SPECIFIC ACTION STEPS
THAT WE CAN TAKE RIGHT NOW TO REDUCE THEIR HEALTH RISKS
TO OPTIMIZE THEIR HEALTH AND FUNCTION.
SO, IF THEY’RE HAVING SYMPTOMS OF ASTHMA,
THEY NEED TO BE TREATED.
IF THEY ARE HAVING OTHER HEALTH CONDITIONS THAT YOU IDENTIFIED,
MAYBE NOT EVEN RELATED TO AIRBORNE HAZARDS,
THEN THAT NEEDS TO BE TREATED AS WELL.
SO, IT’S POSSIBLE, THEN, THAT THE VETERAN GOES THROUGH YOUR EVALUATION
AS A PRIMARY CARE PHYSICIAN,
AND THEY’VE GONE THROUGH THE SPECIALTY CONSULT AT YOUR VA,
AND YOU’VE EXHAUSTED YOUR LOCAL RESOURCES
IN TERMS OF SPECIALTY EVALUATION
AND THEY’RE STILL HIGHLY SYMPTOMATIC
OR THEY HAVE SIGNIFICANT FUNCTIONAL IMPAIRMENTS.
SO, WHAT’S THE NEXT STEP?
WELL, YOU CAN REFER TO THE WAR RELATED ILLNESS AND INJURY STUDY CENTERS.
THERE ARE 3 OF US IN THE NATION,
AND OUR WEBSITE IS RIGHT THERE ON YOUR SCREEN.
AT THE WRIISC, WE HAVE EXPERTISE IN POST-DEPLOYMENT HEALTH AND AIRBORNE HAZARD EXPOSURES.
AND FOR VETERANS WHO HAVE THE MOST COMPLEX AND DIFFICULT-TO-DIAGNOSE
OR MEDICALLY UNEXPLAINED HEALTH CONCERNS,
THOSE ARE THE VETERANS THAT YOU CAN REFER TO THE WRIISC.
OUR ASSESSMENTS AT THE WRIISC ARE INDIVIDUALIZED FOR EACH PATIENT,
AND THEY ARE APPROPRIATE TO THE PRESENTING COMPLAINT OF THE PATIENT.
SO, FOR EXAMPLE,
WE ARE ABLE TO DO EXTENDED PULMONARY EVALUATIONS AT THE WRIISC
TO INCLUDE THE LUNG FUNCTION TESTS WITH DIFFUSING CAPACITY.
WE’RE ABLE TO PERFORM FORCED OSCILLOMETRY,
EXHALED NITRIC OXIDE LEVELS,
AS WELL AS BRONCHOPROVOCATION CHALLENGE TESTING.
WE ALSO ARE ABLE TO TAKE IT A STEP FURTHER,
BECAUSE MANY VETERANS HAVE SYMPTOMS
WHEN THEY ARE EXERCISING,
SO WE HAVE THE ABILITY TO DO CARDIOPULMONARY EXERCISE FUNCTION TESTS
TO DETERMINE WHETHER THERE’S A LIMITATION WITH THE LUNG FUNCTION
OR IF IT’S THE CARDIAC OR ACTUALLY IT’S THE MUSCLES THAT’S IMPAIRING EXERCISE
IN THE VETERANS-- WE’RE ABLE TO DETERMINE THAT.
AND AT THE END OF THE EVALUATION,
WE GIVE THE VETERAN PRETTY MUCH A ROADMAP
OR A CARE PLAN THAT THEY CAN TAKE BACK TO THEIR REFERRING VA PCP
OR PACT TEAM, FOR THEM TO BE ABLE TO MOVE FORWARD WITH THEIR CARE.
SO, THAT TYPE OF EVOLUTION--
IT’S TYPICALLY DONE OVER 2 TO 3 DAYS AT THE WRIISC.
AND THEN THE VETERAN RETURNS TO THEIR HOME VA FOR IMPLEMENTATION
OF THE CARE PLAN THAT WE PROPOSE.
SO, NOW THAT WE’VE SUMMARIZED WHAT A CLINICAL EVALUATION IS GONNA BE LIKE
FOR A VETERAN WHO WANTS AN IN-PERSON EVALUATION,
AND WE’VE TALKED ABOUT WHAT THIS REGISTRY ENTAILS,
HOW ARE WE GETTING THE WORD OUT TO THE VETERANS?
WELL, THE VA PLANS TO INFORM VETERANS ABOUT THE REGISTRY
BY USING A NUMBER OF MECHANISMS.
THAT WOULD INCLUDE POST CARD MAILINGS;
FACT SHEETS; SOCIAL MEDIA, USING FACEBOOK AND TWITTER.
THEY ARE COMMUNICATING WITH VETERAN SERVICE ORGANIZATIONS.
DEPARTMENT OF DEFENSE IS ON BOARD WITH THIS,
SO THAT SERVICEMEMBERS WHO ARE STILL ACTIVE DUTY
HAVE THE ABILITY TO PARTICIPATE.
THE VET CENTERS ARE GONNA BE PROVIDED INFORMATION ABOUT THE BURN PIT REGISTRY.
AND THEN THERE ARE INTERNAL COMMUNICATIONS,
SUCH AS STAFF NOTES AND THE "HEY VA" REMINDERS.
WHAT ABOUT FOR VA PROVIDERS? HOW ARE WE GETTING THE WORD OUT?
WELL, THIS WEBINAR IS ONE WAY OF GETTING THE INFORMATION OUT TO YOU AS A VA CLINICIAN.
WE’RE HOPING THAT YOU WILL USE THE INFORMATION THAT YOU GET FROM THIS WEBINAR.
IT’S AVAILABLE TO YOU AS A DOWNLOAD, AS I INDICATED TO YOU EARLIER ON.
ON THAT CLIP--IT’S RIGHT THERE, THE PAPER CLIP.
YOU CAN DOWNLOAD 3 DOCUMENTS WITHIN THE HOUR--
HOPEFULLY, AFTER THIS PRESENTATION IS COMPLETED--
SO YOU HAVE THIS WEBINAR TO REFER TO,
AND YOU CAN SHARE IT WITH YOUR COLLEAGUES AS WELL.
WE HAVE PROVIDER FACT SHEETS SPECIFIC FOR AIRBORNE HAZARD CONCERNS,
SO THAT WILL BE AVAILABLE ON THE SHAREPOINT SITE
AS WELL AS THE WRIISC WEBSITE
AND THE OFFICE OF PUBLIC HEALTH WEBSITE.
THERE’S GONNA BE A VHA INFORMATIONAL LETTER THAT GOES OUT TO THE CLINICIANS.
THE WRIISC--WAR RELATED ILLNESS AND INJURY STUDY CENTER
IS PUTTING OUT A NEWSLETTER IN APRIL,
AND THAT WOULD FEATURE AIRBORNE HAZARDS
AND THE AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY.
AND THEN THERE’S THE PDICI COMMUNITY OF PRACTICE CALL--
THE POST-DEPLOYMENT INTEGRATIVE CARE INITIATIVE COMMUNITY OF PRACTICE CALL.
WE’LL BE GIVING A PRESENTATION OF THAT CALL AS WELL.
SO, THIS IS THE INFORMATION THAT WILL BE AVAILABLE TO ALL VA CLINICIANS,
AND WE’RE HOPING THAT EACH PERSON WOULD HAVE ACCESS TO THIS INFORMATION
SO THAT THEY ARE WELL-EQUIPPED TO EVALUATE VETERANS
THAT HAVE AIRBORNE HAZARD CONCERNS.
SO, IN SUMMARY, BASED ON WHAT WE’VE DISCUSSED TODAY AS A VA CLINICIAN,
YOU MAY BE THINKING, "WELL, WHAT’S MY ROLE? WHAT DO I NEED TO DO WITH THIS?"
WELL, YOU NEED TO BE FAMILIAR WITH THE EXPOSURE CONCERNS THAT THE VETERANS HAVE,
SPECIFICALLY RELATED TO AIRBORNE HAZARDS,
’CAUSE THEY WILL BE COMING TO THE VA FOR EVALUATION
AFTER THEY’VE COMPLETED THEIR SELF-ASSESSMENT QUESTIONNAIRE.
YOU SHOULD KNOW THAT THERE ARE NO SPECIFIC BIOMARKERS OF EXPOSURES
OF THESE AIRBORNE HAZARDS
OR EVEN BIOMARKERS OF DISEASE RELATED TO THESE AIRBORNE EXPOSURES
AT THIS PRESENT TIME.
SO, IT’S IMPORTANT THAT YOU, AS A VA CLINICIAN,
THAT YOU HAVE A HIGH INDEX OF CLINICAL SUSPICION
FOR RESPIRATORY CONDITIONS AND HAVE A LOW BAR FOR FURTHER EVALUATION.
IT’S IMPORTANT THAT YOU PERFORM THE APPROPRIATE WORKUP FOR EACH PATIENT
IN A TIMELY MANNER AND EXPEDITIOUSLY.
REMEMBER, THAT THESE MEN AND WOMEN WERE EXPOSED MANY YEARS AGO.
THEY’VE LIVED WITH THESE SYMPTOMS FOR QUITE A WHILE.
MANY OF THEM ARE ALREADY FRUSTRATED WITH THEIR HEALTH CONDITION
AND SOMETIMES WITH THE CARE THAT THEY’VE GOTTEN SO FAR
IN THE SENSE THAT THERE HASN’T BEEN A LOT OF ATTENTION FOCUSED ON THIS.
SO, IT’S IMPORTANT THAT WE EXPEDITE THEIR CLINICAL EVALUATION
TO THE EXTENT POSSIBLE,
AND YOU WANT TO REFER THEM FOR SPECIALTY CONSULTATIONS AS INDICATED.
SO I HAVE REFERENCES LISTED AS WELL IN THE PRESENTATION.
AND THE WEBINAR WILL BE AVAILABLE
AT THE END OF THIS PRESENTATION AS A DOWNLOAD,
AND THERE IS A WEBSITE THERE FOR YOU TO ACCESS THE WEBINAR.
AND NOW WE WILL TAKE QUESTIONS.
’CAUSE I SEE THAT THERE HAVE BEEN QUITE A NUMBER OF QUESTIONS
COMING UP ON THE SCREEN.
- THANK YOU, DR. OSINUBI. THIS IS DR. SANCHEZ.
I’VE BEEN TRYING TO ANSWER SOME OF THE QUESTIONS, AS HAS DR. HELMER,
BUT I THOUGHT WE SHOULD GO THROUGH A COUPLE CATEGORIES OF QUESTIONS
THAT SEEM TO BE COMING UP FREQUENTLY.
THE FIRST ONE IS "HOW MUCH TIME SHOULD A PROVIDER ALLOT FOR THE EXAM?"
- THAT’S A VERY GOOD QUESTION AND A REALLY PERTINENT QUESTION.
IT HAS BEEN FIELD-TESTED,
AND THE UNDERSTANDING THAT WE HAVE
IS THAT IT COULD TAKE BETWEEN 30 TO 40 MINUTES, ON THE AVERAGE,
BUT I WOULD SAY ABOUT AN HOUR AT THE MOST.
BUT I THINK 30 TO 40 MINUTES, IT’S ABOUT REALISTIC TIMEFRAME.
AGAIN, IT’S GONNA DEPEND IN PART, THOUGH, ON, YOU KNOW,
THE CONSENT OF THE VETERAN AND THE TIME THEY TAKE TO DESCRIBE THE EXPOSURES.
BUT ON THE WHOLE, WE’RE THINKING THIS WOULD BE WITHIN 30 TO 40 MINUTES
OR MAYBE AN HOUR AT THE MOST.
- AND CAN YOU ALSO JUST REITERATE EXACTLY WHERE THE TEMPLATE WILL BE FOUND IN CPRS
AND RECONFIRM THAT THE TEMPLATE WILL BE AVAILABLE
BEFORE THE REGISTRY GETS ADVERTISED?
- YES, MY UNDERSTANDING IS THAT IT WILL BE AVAILABLE EFFECTIVE APRIL 1st.
DR. HELMER, IS THAT YOUR UNDERSTANDING?
OK, HE’S NOT COMING ON.
- CAN YOU HEAR ME?
- YES, WE CAN.
- SO, THE TEMPLATE SHOULD BE READY FOR INSTALLATION THROUGH A PATCH
BY THE END OF MARCH.
AND MY UNDERSTANDING IS THAT THE VETERAN SELF-ASSESSMENT
WILL BE ROLLED OUT AFTER THAT.
- OK, AND PERHAPS AGAIN, WE CAN JUST CLARIFY THE EXPECTATIONS.
WE’VE GOT A LOT OF QUESTIONS ABOUT, YOU KNOW...
"WHAT AM I RESPONSIBLE FOR AS A PCP?"
AND "SHOULD THE ENVIRONMENTAL HEALTH CLINICIAN DO THIS,
OR SHOULD THE PCP?"
SO, DR. HELMER, I KNOW YOU TYPED YOUR RESPONSE TO THIS,
BUT COULD YOU AGAIN REITERATE WHAT THE ANSWER IS TO THAT?
- I’M SORRY. SUSIE, CAN YOU REPEAT THAT?
- WHO’S RESPONSIBLE FOR CONDUCTING THE EVALUATIONS?
- OH, YEAH.
SO, THE IDEA--ONE OF THE NEW THINGS ABOUT THIS REGISTRY
IS THAT WE WERE TRYING TO PROMOTE THE INTEGRATION OF THE INITIAL EVALUATION
INTO THE REGULAR CARE OF THE PATIENT.
AND SO, IN SOME WAYS, THE DEFAULT IS THAT THIS WOULD BE AN EXAM,
AN ENCOUNTER BETWEEN A PATIENT, A VETERAN, AND A PRIMARY CARE PROVIDER.
IF THE VETERAN DOES NOT HAVE A PRIMARY CARE PROVIDER,
THEN THE SECOND CHOICE WOULD THEN BE AN ENVIRONMENTAL HEALTH CLINICIAN.
NOW, THAT CAN VARY DEPENDING ON THE LOCATION AND THE SPECIFIC EXPERTISE
AND AVAILABILITY, WAIT TIMES.
ALL THOSE SORTS OF THINGS MAY DRIVE DIFFERENT SOLUTIONS,
AND THAT FLEXIBILITY IS GONNA BE THERE.
THE TEMPLATE IS ACTUALLY ABLE TO BE USED BY LOTS OF DIFFERENT PEOPLE.
I THINK ONE OF THE OTHER QUESTIONS THAT FLASHED THROUGH HERE WAS--
A PROVIDER, I GUESS, SAID, "YOU KNOW, IT TAKES ME--
"I HAVE AN HOUR TO DO AN INITIAL EVALUATION WITH A PATIENT.
IS THIS SUPPOSED TO BE PART OF THAT EVALUATION, OR IS IT SUPPOSED TO BE SEPARATE?"
YOU KNOW, I THINK IT DEPENDS ON THE PATIENT.
CERTAINLY, WE’D LIKE YOU TO DOCUMENT THE ASSESSMENT
FOR THE AIRBORNE HAZARD CONCERNS SEPARATELY,
BECAUSE THAT NOTE TAIL GIVES US THE ABILITY TO TRACK RESPONSES
AND KEEP AN EYE ON WHAT’S HAPPENING WITH PATIENTS WITH AIRBORNE HAZARD CONCERNS.
AND IT MAY OR MAY NOT FIT INTO THE FLOW OF YOUR REGULAR INITIAL HISTORY
AND PHYSICAL WITH THE PATIENT.
BUT I THINK IT DOES DEPEND, I THINK--YOU KNOW, THE IDEA IS THAT THE PATIENT
MAY BE COMING AND SAYING, "I’M HERE FOR MY INITIAL EVALUATION,
AND I HAVE AIRBORNE HAZARDS CONCERNS."
YOU DON’T WANT TO IGNORE THAT.
BUT IF YOU THINK IT’S GONNA TAKE A LOT OF TIME,
YOU MAY SAY, "WELL, LET’S FOCUS ON SOME OTHER THINGS,
AND LET’S SCHEDULE A SEPARATE VISIT TO DISCUSS THAT."
AND OMOWUNMI, I WAS HAVING SOME ISSUES WITH THE SOUND,
AND SO I’M NOT SURE IF YOU SAID THIS.
BUT THE ESTIMATE RIGHT NOW IS THAT THE VA OVERALL
WILL ONLY SEE AN INCREASE OF ABOUT 26,000 VISITS.
AND WHILE THAT MIGHT SOUND LIKE A LARGE NUMBER,
WHEN YOU THINK ABOUT THAT SPREAD ACROSS 154 DIFFERENT FACILITIES AND EVEN MORE CBOCs,
ANY GIVEN PROVIDER IS PROBABLY NOT GOING TO SEE A LARGE NUMBER OF EXTRA VISITS
BECAUSE OF THIS PARTICULAR REGISTRY.
AND LIKE I SAID, OFTEN TIMES, YOUR PATIENTS ARE ASKING ABOUT THESE SYMPTOMS
THAT THEY’RE EXPERIENCING OR EVEN BRINGING UP
THE CONCERN ABOUT THE EXPOSURE WHEN THEY COME AND SEE YOU.
- DR. HELMER, THAT JUST FALLS ONTO A QUESTION THAT WAS ASKED JUST A MINUTE AGO
ABOUT WHETHER OR NOT THE IMPACT HAS BEEN ASSESSED
RELATIVE TO THE PACTs AND PCPs.
SO I THINK YOU’VE ANSWERED THAT.
CAN WE JUST GIVE AGAIN THE NAME OF THE TEMPLATE
AND EXACTLY WHERE IT WILL BE LOCATED?
WE’VE HAD A NUMBER OF QUESTIONS ABOUT THAT.
- WELL, THE NAME OF THE TEMPLATE IS ACTUALLY
"THE BURN PIT AIRBORNE HAZARDS INITIAL EVALUATION NOTE."
BUT THE BEST THING ABOUT IT IS WHEN YOU GO TO OPEN A NEW NOTE--
LIKE YOU DO WITH ANY PATIENT, YOU OPEN THE ENCOUNTER
AND GO IN AND TYPE A NEW NOTE.
IF YOU TYPE IN "BURN PIT" OR "AIRBORNE HAZARDS," IT POPS UP.
RIGHT NOW, IT’S THE ONLY ONE IN THERE.
AND WHEN THE NOTE TEMPLATE IS INSTALLED--
SO, IT’S NOT INSTALLED-- IT’S ONLY INSTALLED IN EAST ORANGE, DETROIT,
AND INDIANAPOLIS RIGHT NOW.
BUT WHEN IT IS INSTALLED AT YOUR SITE,
ALL YOU HAVE TO DO IS TYPE IN "BURN PIT,"
AND THAT NOTE TEMPLATE WILL POP UP FOR YOU.
- GREAT. AND SIMILARLY, WE’VE HAD SEVERAL QUESTIONS ABOUT WHAT GETS AUTOPOPULATED
INTO THE TEMPLATE.
AND I KNOW, DR. HELMER, YOU ANSWERED THAT,
THAT ESSENTIALLY WOULD NOT INCLUDE DoD INFORMATION
OR DoD STUDIES,
BUT IT COULD INCLUDE INFORMATION
IF IT WAS PART OF, AGAIN, CPRS OR VISTA.
SO IT MIGHT INCLUDE IT FROM OUTSIDE YOUR OWN FACILITY,
DEPENDING ON IF IT WAS CPRS OR VISTA, IS THAT CORRECT?
- YEAH, SO IT’S GONNA INPUT THE VITAL SIGNS.
IT’S GONNA TAKE SOME OF THE CLINICAL REMINDERS THAT MAY HAVE BEEN ANSWERED RECENTLY.
IT’S GOING TO PULL SOME OF THE RECENT DIAGNOSTIC WORKUP
THAT’S ACCESSIBLE IN YOUR SYSTEM.
AND IT WILL PULL ALL THOSE IN.
IN A WAY, IT PULLS IN THE PROBLEM LIST, IT PULLS IN THE MEDICATIONS.
SO, JUST LIKE WITH A LOT OF OUR TEMPLATES AND PRIMARY CARE,
YOU GET A LOT OF THAT INFORMATION RIGHT THERE
WHEN YOU’RE SEEING THE PATIENT ALREADY POPULATED INTO THE NOTE TEMPLATE.
- WE’VE HAD MORE QUESTIONS ON TRAINING.
AGAIN, THIS WAS ACTUALLY CONSIDERED INITIAL TRAINING FOR PROVIDERS.
IF PEOPLE FEEL THAT THERE’S ADDITIONAL INFORMATION THAT THEY NEED,
IT WOULD BE GOOD TO KNOW WHAT THAT IS.
WE HAVE HAD SOME DISCUSSIONS ABOUT OTHER THINGS THAT WE MIGHT DO,
ALONG WITH OFFICE OF PUBLIC HEALTH TO PROVIDE SOME ADDITIONAL TRAINING,
WHETHER IT’S SOMETHING IN ...OR ADDITIONAL WEBINARS LIKE THIS.
WE’RE LOOKING AT PERHAPS MAYBE A WEBINAR TAILORED WITH PULMONOLOGISTS.
AGAIN, IT’S ANOTHER EXAMPLE OF A TIER TRAINING,
AND WE’RE GONNA HAVE THIS SERIES OF FACT SHEETS THAT WILL BE AVAILABLE.
WE HAVE GOTTEN A QUESTION ABOUT WHAT IF WE WANT TO REFER SOMEBODY TO THE WRIISC,
HOW DO WE DO THAT.
SO, EITHER DR. OSINUBI OR DR. HELMER,
WOULD YOU LIKE TO DISCUSS THAT?
- YEAH, I CAN TAKE THAT QUESTION--
- SURE. - IF YOU GO TO-- GO AHEAD, DREW.
- NO, GO AHEAD.
- OK, SO IF YOU GO TO THE WEBSITE, WARRELATEDILLNESS.GOV,
THERE IS--SORRY. LET ME GET THAT.
WWW.WARRELATEDILLNESS.VA.G-O-V, OR DOT.GOV.
THE INFORMATION IS THERE AS TO HOW TO REFER THE PATIENT TO THE WRIISC.
YOU HAVE TO PUT IN A REFERRAL THROUGH CPRS,
BUT IT WILL GUIDE YOU.
THERE ARE SPECIFIC INSTRUCTIONS ON THE WEBSITE.
- AND I WILL SAY THAT WE’RE IN THE PROCESS RIGHT NOW
OF ACTUALLY PUTTING TOGETHER A BROCHURE FOR PROVIDERS
THAT WILL EXPLAIN, AGAIN, WHAT WE DO IN TERMS OF AIRBORNE HAZARDS AT THE WRIISC
AND, AGAIN, HOW TO GET THAT REFERRAL.
SO, THAT’S A PRODUCT THAT WILL BE FORTHCOMING.
WE ALSO HAD A QUESTION ABOUT WHO’S COVERED.
AND I THINK DR. ... HAS JUST ANSWERED THAT,
WHETHER OR NOT DoD CIVILIAN EMPLOYEES ARE COVERED,
AND ESSENTIALLY, WE HAD A SLIDE EARLIER THAT TALKED ABOUT WHO IS ELIGIBLE
FOR THE REGISTRY,
AND IT WOULD NOT INCLUDE DoD OR CIVILIAN EMPLOYEES.
LET’S SEE...
AGAIN, WE GOT ANOTHER QUESTION ABOUT CAN ANY PCP DO THE EVALUATION?
- YES.
- I’LL ANSWER THAT, BECAUSE NOT ONLY IS THE ANSWER YES,
BUT I SUSPECT THAT IF YOU HAD A PATIENT WALK INTO YOUR OFFICE SAYING,
"I’M HERE FOR A CHRONIC COUGH, AND I THINK IT’S RELATED TO THE BURN PIT,"
YOU WOULD ADDRESS IT.
AND I THINK IN SOME WAYS, CALLING IT A REGISTRY MAKES IT SOUND DIFFERENT AND UNUSUAL,
BUT IT REALLY IS A LOT OF PRIMARY CARE,
AND WHEN YOU GET TO THE POINT WHERE YOU DON’T KNOW THE NEXT STEP, YOU ASK FOR HELP.
YOU GET THE PULMONOLOGIST INVOLVED, MAYBE GET YOUR ENVIRONMENTAL HEALTH CLINICIAN.
MAYBE AFTER YOU’VE TAPPED INTO THOSE LOCAL RESOURCES,
YOU COME TO THE WRIISC AND SAY, "HEY, GOT THIS REALLY UNUSUAL CASE.
"THIS GUY HAS... HE’S HAD A COUGH. HE’S GOT WEIGHT LOSS.
"CAN’T FIND ANYTHING WRONG WITH HIM.
"PULMONARY FUNCTION TESTS AREN’T DEFINITIVE.
WHAT DO YOU GUYS THINK IS GOING ON?"
SO, I THINK ANY PCP CAN CERTAINLY START THE CONVERSATION WITH A PATIENT
AND SAY, "LET’S LOOK AT YOUR HEALTH,
LET’S LOOK AT YOUR CONCERNS, WHAT’S GOING ON HERE, AND LET’S MAKE A PLAN."
- 2 LATE-BREAKING QUESTIONS WITH REGARD TO ELIGIBILITY,
ALSO WHO CAN REFER.
"CAN A PRIVATE PHYSICIAN REFER THEIR PATIENTS
IF THE PATIENT IS A VET WHO REFUSES TO USE VA SERVICES?"
- I THINK THE ANSWER TO THAT IS NO.
WE REALLY NEED A REFERRAL TO COME FROM A VA PROVIDER.
THAT’S HOW WE COMMUNICATE.
WE’RE A SYSTEM OF CARE, AND I WILL SAY, THOUGH,
WE OFTEN GET PATIENTS WHO PRIMARILY SEE OUTSIDE PROVIDERS,
BUT IN TERMS OF THE ACTUAL REFERRAL TO THE WRIISC,
WE REALLY NEED A VA PROVIDER TO MAKE THAT REFERRAL.
- AND "DOES THE REGISTRY INCLUDE DUAL STATUS PERSONNEL
FOR A RESERVIST WHO MIGHT ALSO BE A CONTRACTOR?"
- A RESERVIST?
- DR. ... JUST ANSWERED THAT.
RESERVISTS ARE ELIGIBLE IF THEY ARE DEPLOYED WHILE CALLED TO ACTIVE DUTY.
ANOTHER QUESTION ABOUT WHETHER OR NOT A FEE-BASIS PROVIDER THAT’S CONTRACTED BY THE VA
CAN REFER.
- YES, I THINK THAT WOULD BE ACCEPTABLE.
- OK. AND BEFORE WE END THIS, WE WILL PUT UP THE URL FOR OUR SHAREPOINT SITE,
WHICH IS WHERE A RECORDING IS.
YOU CAN TELL YOUR COLLEAGUES, WE GOT TAPPED, EVIDENTLY, AT 400,
IN TERMS OF THE AUDIO FOR THIS.
SO THE RECORDING WILL GO UP ON OUR WRIISC SHAREPOINT SITE.
QUESTION: "CAN COMP AND PEN DO THIS REGISTRY EXAM?"
- THAT’S AN INTERESTING ONE.
I GUESS--THIS IS DREW AGAIN.
I THINK--AHEM--
I WOULD SAY IT’S PROBABLY NOT WHAT WE WOULD PREFER.
NOW, I KNOW A LOT OF PROVIDERS DO COMP AND PEN
AND ALSO DO PRIMARY CARE OR ALSO DO SOME OF THE OTHER REGISTRY EXAMS.
SO, THIS IS NOT A COMP AND PEN EXAM.
IT WOULD HAVE TO BE CONSIDERED CLINICAL CARE.
SO, CAN A COMP AND PEN PROVIDER DO IT? ABSOLUTELY.
IS IT A COMP AND PEN EXAMINATION? THE ANSWER IS NO.
- AND I’M TRYING TO SEE IF THERE ARE ANY OTHER QUESTIONS FROM FOLKS.
WE HAVE A COUPLE MORE PEOPLE WHO ARE TYPING.
- YES, THERE’S A QUESTION HERE, SUSAN, THAT SAYS,
"IF A VET IS REGISTERED AND EXAMINED PREVIOUSLY IN THE 1990s
"AND WAS NOT OFFERED CARE,
SHOULD THEY FILL OUT THE SELF-ASSESSMENT QUESTIONNAIRE?"
- I THINK THE ANSWER TO THAT IS PROBABLY YES.
SO, THIS IS DIFFERENT FROM THE GULF WAR REGISTRY.
THIS IS THE SEPARATE REGISTRY, AS DR. OSINUBI MENTIONED.
THE PERSONNEL WHO WERE DEPLOYED TO THE GULF REGION IN 1990 AND 1991
ARE ELIGIBLE FOR THIS REGISTRY AS WELL,
BUT THE SELF-ASSESSMENT QUESTIONNAIRE ASKS DIFFERENT QUESTIONS.
ENROLLMENT IN THE REGISTRY IS GONNA BE TRACKED SEPARATELY,
SO IF SOMEBODY HAS AN AIRBORNE HAZARDS CONCERN,
I WOULD ENCOURAGE THEM TO COMPLETE THIS SELF-ASSESSMENT,
EVEN IF THEY COMPLETED A GULF WAR REGISTRY EXAM IN THE PAST.
- SO, WE HAVE THE WEBSITE TYPED UP THERE.
I’M GONNA ASK FOR THE URL.
IS THAT THE SAME AS OUR URL FOR OUR SHAREPOINT FOR THEM TO GET THE RECORDING?
- NO. THAT’S FOR THE WRIISC.
- CAN WE TYPE ALSO THE SHAREPOINT FOR WHERE THE RECORDING IS?
I KNOW FLORENCE IS THERE WITH YOU.
PERHAPS YOU CAN JUST HAVE HER TYPE IN THAT SHAREPOINT.
- OK. WE’LL DO THAT IN A MINUTE. WE’RE JUST GETTING INFORMATION.
- OK, THERE IS ANOTHER QUESTION THERE.
"A STUDY IN THE "NEW ENGLAND JOURNAL OF MEDICINE"
"ON RETURNING COMBAT VETS WITH DYSPNEA
"HAD OPEN LUNG BIOPSY,
"FINDING OF CONSTRICTIVE BRONCHIOLITIS.
CAN YOU COMMENT ON THIS?"
- THAT’S AN OMOWUNMI QUESTION. - YES, IT IS.
- YES, YES.
YES, CONSTRICTIVE BRONCHIOLITIS HAS BEEN DESCRIBED
IN A SUBGROUP OF VETERANS WHO WERE DEPLOYED TO IRAQ,
MOSTLY TO IRAQ.
MANY OF THEM WERE EXPOSED TO THE SULFUR FIRE INCIDENT IN MAZRAA,
ALTHOUGH THERE HAVE BEEN VETERANS WHO WERE NOT EXPOSED TO THE SULFUR FIRE INCIDENT
AND THEY HAVE FOUND CONSTRICTIVE BRONCHIOLITIS ON THEIR LUNG PATHOLOGY.
SO THAT STUDY HAS BEEN PUBLISHED.
DID I ANSWER THE QUESTION?
- WE DON’T HAVE A WAY FOR PEOPLE TO--
I GUESS WE COULD HAVE THEM TYPE IT IN.
- YES. SO, THERE HAS BEEN-- THAT STUDY--
THAT HAS BEEN REPORTED IN THE MEDICAL LITERATURE.
AND IT’S NOT UNIQUE JUST TO THIS TYPE OF EXPOSURE,
IN OTHER OCCUPATIONAL SETTINGS AS WELL
WHEN THEY HAVE HAD AIRBORNE HAZARDS EXPOSURES OF A DIFFERENT TYPE.
THERE HAVE BEEN CASES OF WHAT LOOKS LIKE A CONSTRICTIVE BRONCHIOLITIS
OR BRONCHIOLITIS OBLITERANS, FOR EXAMPLE,
IN POPCORN WORKERS LUNG.
SO, THESE ARE LUNG PATHOLOGIES IN RESPONSE TO TOXIC INSULTS.
- WE’RE GETTING A LOT OF LATE-BREAKING QUESTIONS.
WE HAD A QUESTION EARLIER THAT I FAILED TO SAY
ABOUT WHETHER THE STUDY LOOKED AT AMMO DEPOTS THAT WERE BLOWN UP
CREATING AIRBORNE HAZARDS.
WE JUST GOT ANOTHER QUESTION ON THE SULFUR FIRES
AND IF YOU COULD PROVIDE SOME MORE INFORMATION OR A REFERENCE
WHERE PEOPLE COULD GET THAT.
- OK. THE U.S. ARMY PUBLIC HEALTH COMMAND
ALSO HAS--THEY HAVE FACT SHEETS ON THOSE SPECIFIC EXPOSURES.
THE WRIISC WEBSITE ALSO HAS FACT SHEETS
ON SOME OF THOSE SPECIFIC EXPOSURES,
SO WE CAN UPDATE WEBSITES IF THAT INFORMATION IS NOT ALREADY THERE.
- I’D LIKE TO ANSWER THE QUESTION ABOUT "IS THERE GOING TO BE A REPORTING FORM,
LIKE THE AGENT ORANGE AND PERSIAN GULF WAR REGISTRIES?"
THE ANSWER IS NO. THAT’S THE BEAUTY OF THIS.
THE VETERAN IS RESPONSIBLE FOR ENTERING THEIR SELF-ASSESSMENT INFORMATION ON THE WEB,
AND THAT FORMS THE BASIS FOR PARTICIPATION IN THE REGISTRY.
AND THEN THE IN-PERSON EVALUATION IS CONSIDERED OPTIONAL.
BUT IF YOU USE THE NOTE TEMPLATE THAT WE’VE DEVELOPED,
THAT’S IT--THERE’S NO OTHER DOCUMENTATION REQUIRED.
WE’LL USE SOME OF THE DATA MINING TECHNOLOGIES
TO PULL OUT SOME OF THE HEALTH FACTORS
OR THE DATA OBJECTS FROM THAT NOTE
TO TRACK THE HEALTH STATUS AND THE CONCERNS OF THE PATIENTS,
AS WELL AS THE PATTERNS OF THEIR WORKUP.
SO, ONCE YOU DOCUMENT-- ONCE YOU SIGN THAT NOTE TEMPLATE, YOU’RE DONE.
YOU DON’T HAVE TO DO ANYTHING ELSE FROM A DOCUMENTATION STANDPOINT.
YOU HAVE TO TAKE CARE OF THE PATIENT, OF COURSE,
BUT THAT’S WHY WE DID IT THAT WAY.
- JUST ONE THING WE SHOULD POINT OUT.
WE’VE BEEN TELLING ALL OF YOU THAT YOU CAN GO TO SHAREPOINT FOR THE RECORDING.
I GUESS TO GET ACCESS TO THAT SHAREPOINT,
WE’LL HAVE TO GIVE YOU ACCESS.
SO IF YOU’RE INTERESTED IN THAT,
E-MAIL FLORENCE.CHUA@VA.GOV.
AND WE’LL HAVE TO PUT THAT INFORMATION SOMEHOW OUT MORE BROADLY
SO THAT FOLKS WILL KNOW THAT TO GET ACCESS TO THAT SHAREPOINT SITE.
WE HAD ANOTHER QUESTION ABOUT "ANY ADDITIONAL INFORMATION
REGARDING SKIN DISORDERS WITH EXPOSURE?"
- YEAH, I WAS JUST GONNA RESPOND TO THAT.
SO THERE HAVE BEEN A COUPLE QUESTIONS
ABOUT OTHER EXPOSURE CONCERNS AND OTHER HEALTH CONDITIONS
THAT MIGHT BE RELATED TO DEPLOYMENT.
IF YOU HAVEN’T DONE IT, CHECK OUT THE WRIISC WEBSITE,
BECAUSE WE DO ADDRESS A COUPLE OF THE MORE COMMON DEPLOYMENT- RELATED HEALTH CONCERNS,
AND SO DOES THE OFFICE OF PUBLIC HEALTH WEBSITE.
I’LL PULL THAT UP AND TYPE IT IN THERE.
BUT THERE ARE SOME REALLY NICE MATERIALS ALREADY DEVELOPED
THAT DESCRIBE A LOT OF THE COMMON EXPOSURE CONCERNS
AND THE WORK THAT’S BEEN DONE TO UNDERSTAND THOSE.
- NOW, THERE’S ONE OTHER QUESTION THAT I WANTED TO ANSWER, FROM PORTLAND,
THE QUESTION IS: "THE GULF WAR REGISTRY EVALUATIONS AT THE PORTLAND VA MEDICAL CENTER
"INCLUDE ALL THE INFORMATION FOR THE AIRBORNE HAZARDS TEMPLATE.
WHY ARE WE HAVING TO DO THIS TEMPLATE WHEN THIS IS AVAILABLE?"
ANYONE WANT TO TACKLE THAT ONE? HA HA!
- WELL, THERE’S A NEW LAW REQUIRING AN AIRBORNE HAZARDS REGISTRY,
SO THAT’S PART OF THE ANSWER.
UM...
I THINK, IN SOME WAYS, THE NEW PROCESS OF DOING THIS--
AND SO, ALSO THERE ARE PEOPLE WHO ARE NOT ELIGIBLE FOR THE GULF WAR REGISTRY
WHO ARE ELIGIBLE FOR THE AIRBORNE HAZARDS REGISTRY.
AND I DO THINK THAT, YOU KNOW, BY INTEGRATING IT INTO THE CLINICAL CARE,
PARTICULARLY INTO PRIMARY CARE,
INTO THE PRIMARY CARE OF THE PATIENT,
THAT YOU’RE POTENTIALLY DOING SOMETHING BETTER FOR THE PATIENT.
UM...
BUT IF YOU HAVE THAT TEMPLATE AVAILABLE AND PREFER TO USE THAT,
I WOULD JUST ASK THAT YOU CUT-AND-PASTE IT INTO THE NOTE TITLE FOR THE AIRBORNE HAZARDS.
I MEAN, IF YOU’VE ALREADY COLLECTED THAT INFORMATION.
YOU KNOW, SO, IT WOULDN’T MAKE SENSE TO DO 2 DIFFERENT REGISTRIES NECESSARILY,
BUT THAT’S A QUESTION THAT PROBABLY NEEDS TO BE ADDRESSED WITH THE PATIENT,
BECAUSE BOTH OF THESE ARE CONSIDERED VOLUNTARY.
THEY’RE SUPPOSED TO WANT TO PARTICIPATE IN THE REGISTRY.
- JUST TO POINT OUT, THERE’S SOME TYPING THAT’S GOING ON
ON THE QUESTIONS SLIDE RIGHT NOW,
SO DR. OSINUBI OR FLORENCE, YOU PROBABLY DON’T WANT THAT THERE.
SO, THERE IS SOME TYPING THAT’S--
- YEAH, I DON’T KNOW WHO’S-- IT’S AN UNUSUAL THING.
SOMEONE IS PUTTING THIS ON, AND IT’S NOT FROM US HERE.
IT’S KIND OF RANDOM.
- YEP. THERE WAS SOME OTHER WRITING THERE BEFORE--
- DON’T KNOW HOW IT GOT ON THERE.
THAT’LL HAVE TO BE SOMETHING WE HAVE TO LOOK AT FOR LINK.
SO, THERE WAS A QUESTION ABOUT WHETHER OR NOT THERE’LL BE A MASS MAILING
TO ALL VETERANS ABOUT THE REGISTRY.
AGAIN, I THINK THAT WAS POINTED OUT ON AN EARLIER SLIDE
WHAT THE COMMUNICATION PLAN IS.
AND, SO...YES,
THERE WILL BE A MAILING.
THERE’LL BE LOTS OF WAYS THAT VETERANS WILL BE INFORMED ABOUT THE REGISTRY.
AND JUST A POINT OF INFORMATION
THAT THERE WILL BE MORE INFORMATION, AGAIN,
AT THE NEXT ENVIRONMENTAL HEALTH QUARTERLY PROGRAM CALL.
THAT’S SCHEDULED FOR WEDNESDAY.
I DON’T KNOW IF THAT WAS A QUESTION TO DR. ...,
WOULD THIS BE DISCUSSED OR NOT.
AND WE CAN ALSO PROVIDE INFORMATION OR DO A WEBINAR
FOR THAT GROUP IF NEEDED,
IF PEOPLE THINK THAT THAT’S NEEDED.
SO, I KNOW WE WERE SUPPOSED TO GO TO 1:00, AND IT IS A LITTLE AFTER 1:00.
DR. ... IS TYPING. GREAT.
WE’LL LET THAT ANSWER COME UP.
BUT AGAIN, WE HOPE THAT THIS INFORMATION WAS USEFUL,
AND IT GAVE YOU AT LEAST A STARTING POINT
FOR UNDERSTANDING WHAT THE REGISTRY IS,
WHAT YOUR ROLE WILL BE AS A PROVIDER.
AND I WOULD AGAIN REMIND PEOPLE TO GO UP TO THAT PAPER CLIP
AND DOWNLOAD THE INFORMATION THAT’S THERE,
CHECK OUT THE SHAREPOINT FOR THE RECORDING
AND CONTINUE TO LOOK AT THE WRIISC WEBSITE,
’CAUSE AS WE MAKE NEW PRODUCTS, WE’LL CONTINUE TO GET THAT OUT TO THE FIELD.
OUR GOAL IS TO DISSEMINATE INFORMATION THAT WILL ASSIST YOU
IN RESPONDING TO THE REGISTRY.
AND DR. HELMER, DR. OSINUBI, ANY LAST WORDS?
- YEAH, THANK YOU SO MUCH FOR YOUR ATTENTION.
AND THERE HAVE BEEN QUESTIONS AS TO WHEN THIS IS GONNA HAPPEN.
AFTER MARCH 31, 2014.
SO THAT HAS BEEN A RECURRING QUESTION.
SO, LOOK OUT FOR THIS APRIL 1, 2014,
IS WHEN THIS IS GONNA GO LIVE.
THANK YOU.
- DREW?
- THANK YOU, EVERYBODY.
- THANKS. - OK, BYE-BYE.
- AND DR. OSINUBI AND FLORENCE, EITHER,
IF YOU CAN JUST CALL ME BACK, PERHAPS RIGHT AFTER THIS, THAT WOULD BE GREAT.
- WILL DO. THANK YOU. - THANK YOU.
[WOMAN WHISPERING]