1 00:00:00,000 --> 00:00:03,100 [TELEPHONE LINES OPEN] 2 00:00:03,100 --> 00:00:07,970 - HELLO. THIS IS DREW HELMER AT THE WAR RELATED ILLNESS AND INJURY STUDY CENTER. 3 00:00:07,970 --> 00:00:10,040 IN EAST ORANGE, NEW JERSEY. 4 00:00:10,040 --> 00:00:15,540 I AM HERE TO WELCOME EVERYBODY TO THE "AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY: 5 00:00:15,540 --> 00:00:18,550 WHAT PROVIDERS NEED TO KNOW" WEBINAR. 6 00:00:18,550 --> 00:00:23,050 AND I’M GONNA TAKE IT A LITTLE SLOW TO JUST GIVE A FEW OTHER PEOPLE A CHANCE TO JOIN. 7 00:00:23,050 --> 00:00:28,060 WE SEE THE NUMBER OF PARTICIPANTS CONTINUES TO INCREASE. 8 00:00:28,060 --> 00:00:32,060 I WOULD JUST LIKE TO POINT OUT THAT THIS WEBINAR IS ONE OF A SERIES 9 00:00:32,060 --> 00:00:35,560 THAT THE WRIISC PROGRAM OFFERS TO PROVIDERS 10 00:00:35,560 --> 00:00:38,070 AND OTHER INTERESTED PEOPLE 11 00:00:38,070 --> 00:00:40,570 RELATED TO DEPLOYMENT HEALTH ISSUES. 12 00:00:40,570 --> 00:00:46,580 WE HAVE A MONTHLY SERIES THAT IS GONNA BE ADVERTISED TOWARD THE END OF THIS, 13 00:00:46,580 --> 00:00:49,080 AND YOU CAN ALWAYS CHECK OUT OUR WEBSITE 14 00:00:49,080 --> 00:00:56,590 AT THEWARRELATEDILLNESS.VA.GOV. 15 00:00:56,590 --> 00:00:58,090 SO, LET ME SEE. 16 00:00:58,090 --> 00:01:01,460 AT THIS POINT, IT LOOKS LIKE WE HAVE, UH... 17 00:01:01,460 --> 00:01:05,090 OUR NUMBER OF PARTICIPANTS IS MAYBE SLOWING DOWN A LITTLE BIT. 18 00:01:05,090 --> 00:01:08,600 SO, LET ME GO AHEAD AND INTRODUCE TODAY’S SPEAKER. 19 00:01:08,600 --> 00:01:15,100 DR. OMOWUNMI OSINUBI IS AN OCCUPATIONAL AND ENVIRONMENTAL MEDICINE PHYSICIAN. 20 00:01:15,100 --> 00:01:17,110 SHE’S ALSO TRAINED IN ANESTHESIOLOGY 21 00:01:17,110 --> 00:01:19,610 AND INTERVENTIONAL PAIN MANAGEMENT. 22 00:01:19,610 --> 00:01:22,610 SHE GOT BOTH OF HER TRAININGS AT YALE AND AT MT. SINAI. 23 00:01:22,610 --> 00:01:25,110 SHE’S WORKED WITH THE WRIISC AND WITH VETERANS 24 00:01:25,110 --> 00:01:28,620 ON THEIR DEPLOYMENT-RELATED HEALTH CONCERNS SINCE 2008. 25 00:01:28,620 --> 00:01:32,620 AND DR. OSINUBI IS REALLY JUST A GREAT COLLEAGUE. 26 00:01:32,620 --> 00:01:35,620 SHE SEES OUR PATIENTS HERE AT THE WRIISC. 27 00:01:35,620 --> 00:01:37,290 SHE DOES EXPOSURE CONSULTS. 28 00:01:37,290 --> 00:01:40,630 SHE WORKS WITH OUR MULTIDISCIPLINARY TEAM 29 00:01:40,630 --> 00:01:44,130 ON DOING WHAT WE CALL OUR COMPREHENSIVE EVALUATIONS 30 00:01:44,130 --> 00:01:49,640 FOR CHRONIC MEDICALLY UNEXPLAINED SYMPTOMS. 31 00:01:49,640 --> 00:01:53,010 AND NOT ONLY THAT, SHE’S WORTH A MILLION BUCKS. 32 00:01:53,010 --> 00:01:59,150 ONE OF HER MOST RECENT PATIENTS GAVE HER A REPLICA BILL 33 00:01:59,150 --> 00:02:01,420 OF $1 MILLION U.S. DOLLARS. 34 00:02:01,420 --> 00:02:04,650 AND THE QUESTION FOR ANYBODY ON THE CALL IS 35 00:02:04,650 --> 00:02:10,160 IS RUTHERFORD B. HAYES REALLY THE PERSON ON THE MILLION-DOLLAR BILL? 36 00:02:10,160 --> 00:02:13,160 SO, WITH THAT, I’M GONNA HAND IT OVER TO DR. OSINUBI, 37 00:02:13,160 --> 00:02:15,660 AND SHE’S GONNA WALK YOU THROUGH WHAT PROVIDERS NEED TO KNOW 38 00:02:15,660 --> 00:02:18,170 ABOUT THE "AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY." 39 00:02:18,170 --> 00:02:19,600 THANK YOU. 40 00:02:21,170 --> 00:02:23,170 - THANK YOU, DREW, FOR THAT INTRODUCTION, 41 00:02:23,170 --> 00:02:25,170 AND THANK YOU ALL FOR JOINING US THIS AFTERNOON 42 00:02:25,170 --> 00:02:31,180 ON YOUR PRECIOUS LUNCH HOUR TO LISTEN TO THIS WEBINAR. 43 00:02:31,180 --> 00:02:38,190 AND BEFORE WE GET STARTED, JUST A FEW HOUSEKEEPING ANNOUNCEMENTS. 44 00:02:38,190 --> 00:02:45,190 FOR AUDIO, YOU WANT TO CALL 1-855-767-1051. 45 00:02:45,190 --> 00:02:50,600 AGAIN, IT’S 1-855-767-1051. 46 00:02:50,600 --> 00:02:53,270 AND YOU CAN USE THE CONFERENCE CODE ID. 47 00:02:53,270 --> 00:02:57,270 THAT’S 96926984. 48 00:02:57,270 --> 00:02:59,710 IF YOU HAPPEN TO GET DROPPED FROM THE CALL, 49 00:02:59,710 --> 00:03:01,580 JUST TRY THAT NUMBER AGAIN. 50 00:03:01,580 --> 00:03:05,210 OR YOU CAN USE YOUR COMPUTER SPEAKERS OR HEADSET. 51 00:03:05,210 --> 00:03:08,220 JUST SO YOU KNOW THAT WE WILL BE TAKING QUESTIONS. 52 00:03:08,220 --> 00:03:12,720 THROUGHOUT THIS WEBINAR, YOU CAN TYPE IN YOUR QUESTION IN THE CHAT BOX. 53 00:03:12,720 --> 00:03:18,230 AND AT THE END OF THIS SEMINAR, WE WILL READ OUT THOSE QUESTIONS AND ADDRESS THEM. 54 00:03:18,230 --> 00:03:20,730 ALSO, ON THE RIGHT-HAND SIDE OF YOUR SCREEN, 55 00:03:20,730 --> 00:03:24,230 YOU WILL SEE A PAPER CLIP WITH A NUMBER 3 ON THERE. 56 00:03:24,230 --> 00:03:29,240 YOU WILL BE ABLE TO DOWNLOAD THIS WEBINAR IN THE NEXT HOUR, 57 00:03:29,240 --> 00:03:33,240 AND THERE ARE A COUPLE OF FACT SHEETS THAT ARE THERE FOR YOU AS A RESOURCE. 58 00:03:33,240 --> 00:03:37,380 SO, THOSE ARE JUST THE HOUSEKEEPING ANNOUNCEMENTS BEFORE WE GET STARTED. 59 00:03:37,380 --> 00:03:40,250 SO, WHY ARE WE OFFERING THIS SEMINAR? 60 00:03:40,250 --> 00:03:42,750 WELL--OR THIS WEBINAR. 61 00:03:42,750 --> 00:03:47,260 WELL, YOU MAY HAVE HEARD THAT THERE’S THE AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY 62 00:03:47,260 --> 00:03:50,260 THAT IS GOING TO BE LAUNCHED IN APRIL THIS YEAR. 63 00:03:50,260 --> 00:03:52,760 AND THE OBJECTIVES OF THIS PRESENTATION 64 00:03:52,760 --> 00:03:56,260 IS FOR YOU, AS A VA CLINICIAN, 65 00:03:56,260 --> 00:04:02,270 TO BE ABLE TO RECOGNIZE THE MOST COMMON EXPOSURE CONCERNS RELATED TO AIRBORNE HAZARDS. 66 00:04:02,270 --> 00:04:05,270 AT THE END OF THIS PRESENTATION, YOU SHOULD BE ABLE TO PROVIDE 67 00:04:05,270 --> 00:04:09,780 EACH VETERAN WITH THE MOST APPROPRIATE EVIDENCE-BASED DIAGNOSTIC EVALUATION 68 00:04:09,780 --> 00:04:14,280 AND TREATMENT OF THEIR AIRBORNE HAZARD-RELATED SYMPTOMS AND HEALTH CONCERNS. 69 00:04:14,280 --> 00:04:19,790 THE GOAL IS FOR EACH VA CLINICIAN TO BE ABLE TO ENGAGE EVERY VETERAN 70 00:04:19,790 --> 00:04:21,790 IN A THERAPEUTIC RELATIONSHIP 71 00:04:21,790 --> 00:04:26,290 TO OPTIMIZE THEIR MEDICAL MANAGEMENT AND THEIR OVERALL HEALTH. 72 00:04:26,290 --> 00:04:28,300 AND AT THE END OF THIS PRESENTATION, 73 00:04:28,300 --> 00:04:32,800 YOU SHOULD BE ABLE TO USE THE DESIGNATED CLINICAL ASSESSMENT TOOL 74 00:04:32,800 --> 00:04:35,440 TO DOCUMENT THAT EVALUATION AND CARE PLAN 75 00:04:35,440 --> 00:04:40,810 TO ENABLE REGISTRY ANALYSIS AND REPORTING. 76 00:04:40,810 --> 00:04:47,320 SO, WHY IS IT IMPORTANT, THEN, TO FOCUS ON VETERANS’ EXPOSURE CONCERNS? 77 00:04:47,320 --> 00:04:51,820 WELL, IT’S IMPORTANT BECAUSE IT IS VERY COMMON THAT VETERANS 78 00:04:51,820 --> 00:04:54,320 HAVE CONCERNS ABOUT THEIR EXPOSURES. 79 00:04:54,320 --> 00:04:56,590 AT LEAST 1/3 OF DEPLOYED SOLDIERS 80 00:04:56,590 --> 00:05:01,330 REPORT THAT THEY’VE EXPERIENCED DEFINITE OR PROBABLE EXPOSURES TO ENVIRONMENTAL HAZARDS 81 00:05:01,330 --> 00:05:03,700 DURING THEIR MILITARY SERVICE. 82 00:05:03,700 --> 00:05:10,840 FOR EXAMPLE, MORE THAN 1/4 OF SOLDIERS THAT WERE DEPLOYED TO THE JOINT BASE BALAD IN IRAQ 83 00:05:10,840 --> 00:05:14,340 REPORT THAT THEY HAVE PERSISTENT HEALTH CONCERNS 84 00:05:14,340 --> 00:05:20,350 DUE TO DEPLOYMENT EXPOSURES ON THEIR POST-DEPLOYMENT HEALTH REASSESSMENT QUESTIONNAIRE. 85 00:05:20,350 --> 00:05:28,820 AND THE TYPES OF HEALTH EFFECTS THAT THESE VETERANS ARE CONCERNED ABOUT INCLUDE: 86 00:05:28,820 --> 00:05:32,360 RESPIRATORY, CARDIOVASCULAR, GASTROINTESTINAL, 87 00:05:32,360 --> 00:05:35,360 DERMATOLOGIC, AND CANCER CONCERNS. 88 00:05:35,360 --> 00:05:38,370 IT’S THEREFORE IMPORTANT THAT AS A VA CLINICIAN, 89 00:05:38,370 --> 00:05:41,740 THAT WE ADDRESS THESE CONCERNS IN A TIMELY MANNER. 90 00:05:41,740 --> 00:05:44,870 SO, IN THE NEXT FEW SLIDES, WE’RE GOING TO BRIEFLY DISCUSS 91 00:05:44,870 --> 00:05:50,810 WHAT SOME OF THESE EXPOSURES ARE AND WHAT THE POTENTIAL HEALTH EFFECTS MIGHT BE. 92 00:05:52,880 --> 00:05:54,550 SO, WHAT ARE AIRBORNE HAZARDS? 93 00:05:54,550 --> 00:05:58,890 WHEN WE TALK ABOUT AIRBORNE HAZARDS, WE ARE TALKING ABOUT PARTICULATE MATTER 94 00:05:58,890 --> 00:06:02,890 THAT MAY BE EMITTED DIRECTLY FROM A SOURCE OR FROM COMPLEX REACTIONS. 95 00:06:02,890 --> 00:06:08,900 THEY INCLUDE ORGANIC CHEMICALS, METALS, SOIL, DUST PARTICLES, 96 00:06:08,900 --> 00:06:12,400 AND THESE INHALED MATERIALS, ONCE YOU INHALE THEM, 97 00:06:12,400 --> 00:06:16,910 THEY CAN BE TOXIC TO THE LUNGS OR TO OTHER ORGANS. 98 00:06:16,910 --> 00:06:20,910 SOME OF THEM MAY BE GASES, HEAVY METALS, 99 00:06:20,910 --> 00:06:27,580 CHEMICALS SUCH AS PCBs, DIOXINS, AND POLYCYCLIC AROMATIC HYDROCARBONS. 100 00:06:27,580 --> 00:06:30,950 SO, WHAT ARE THE SOURCES OF THESE AIRBORNE HAZARDS? 101 00:06:30,950 --> 00:06:34,420 WELL, YOU’VE PROBABLY HEARD IN THE NEWS THAT BURN PITS, 102 00:06:34,420 --> 00:06:36,930 THE OPEN BURN PITS AND THE BURN PIT SMOKE. 103 00:06:36,930 --> 00:06:40,300 THERE WAS A LOT OF OPEN AIR WASTE INCINERATION, 104 00:06:40,300 --> 00:06:43,930 ESPECIALLY IN IRAQ AND AFGHANISTAN. 105 00:06:43,930 --> 00:06:48,600 AS OF 2010, THERE WERE ABOUT 273 OF THESE OPEN BURN PITS 106 00:06:48,600 --> 00:06:50,440 THAT WERE IN OPERATION. 107 00:06:50,440 --> 00:06:55,280 AND SERVICEMEMBERS MAY HAVE BEEN EXPOSED TO THE SMOKE 108 00:06:55,280 --> 00:06:56,780 ON A DAY-TO-DAY BASIS. 109 00:06:56,780 --> 00:06:59,450 FOR SOME PEOPLE, IT WAS ALMOST 24/7. 110 00:06:59,450 --> 00:07:03,450 AND THE CLOSER THE SERVICEMEMBER IS TO THAT BURN PIT, 111 00:07:03,450 --> 00:07:05,450 THE MORE LIKELY THAT THEY’RE GONNA BE EXPOSED, 112 00:07:05,450 --> 00:07:10,960 ESPECIALLY IF THEY ACTUALLY DID THE BURNING OF THE MATERIALS THEMSELVES 113 00:07:10,960 --> 00:07:15,100 OR THEIR SLEEPING QUARTERS WAS LOCATED CLOSE TO THE BURN PITS. 114 00:07:15,100 --> 00:07:19,970 ANOTHER COMMON SOURCE OF CONCERN IS THE SAND AND DUST STORMS. 115 00:07:19,970 --> 00:07:22,970 THIS HAPPENED-- THEY WERE SEASONAL, 116 00:07:22,970 --> 00:07:25,470 BUT THEY WERE VERY FREQUENT WHEN THEY OCCURRED. 117 00:07:25,470 --> 00:07:27,480 THEY WERE INTENSE. 118 00:07:27,480 --> 00:07:31,480 WHY IS THE SAND DIFFERENT FROM WHAT WE EXPERIENCE HERE 119 00:07:31,480 --> 00:07:33,480 IN THE UNITED STATES? 120 00:07:33,480 --> 00:07:37,490 WELL, THE SAND IS VERY FINE. IT’S TALC-LIKE. 121 00:07:37,490 --> 00:07:44,490 AND IT’S READILY INHALED, BECAUSE THEY’RE RELATIVELY SMALL PARTICLES. 122 00:07:44,490 --> 00:07:50,500 AND THESE PARTICLES CAN ABSORB SOME TOXIC METALS OR BACTERIA 123 00:07:50,500 --> 00:07:53,000 OR VIRAL RNA OR FUNGI. 124 00:07:53,000 --> 00:07:56,000 AND IF YOU INHALE THAT DUST DEEP INTO YOUR LUNGS, 125 00:07:56,000 --> 00:07:59,010 ESPECIALLY FOR VETERANS WHO ARE EXERCISING, 126 00:07:59,010 --> 00:08:03,010 THAT CAN POSE A HEALTH HAZARD. 127 00:08:03,010 --> 00:08:06,010 SO, MANY VETERANS WILL TELL YOU THE SAND WAS SO INTENSE 128 00:08:06,010 --> 00:08:09,520 THAT THEY COULD NOT SEE THEIR HAND IN FRONT OF THEM, 129 00:08:09,520 --> 00:08:13,520 AND SOME OF THEM WERE STANDING IN CONVOY AND COULD NOT GO FOR COVER 130 00:08:13,520 --> 00:08:16,020 WHEN THE SAND AND DUST STORMS HIT. 131 00:08:16,020 --> 00:08:19,030 SO, THAT MAY BE AN ACCOUNT THAT THE VETERAN MAY RELATE TO YOU 132 00:08:19,030 --> 00:08:22,030 AS YOU’RE DOING THESE EVALUATIONS. 133 00:08:22,030 --> 00:08:27,040 ANOTHER SOURCE OF CONCERN IS THE SMOKE FROM BURNING OIL WELL FIRES. 134 00:08:27,040 --> 00:08:34,040 FROM THE FIRST GULF WAR, MORE THAN 600 KUWAITI OIL WELL FIRES WERE SET ABLAZE 135 00:08:34,040 --> 00:08:36,040 BY THE IRAQI TROOPS. 136 00:08:36,040 --> 00:08:43,050 AND MANY TIMES, THE VETERANS WOULD TELL US, IT WAS AS BLACK AS NIGHT DURING THE DAY. 137 00:08:43,050 --> 00:08:46,050 THAT WAS JUST HOW INTENSE THE SMOKE WAS. 138 00:08:46,050 --> 00:08:49,560 AND MANY OF THESE VETERANS, YOU KNOW, BREATHED THIS SMOKE 139 00:08:49,560 --> 00:08:54,560 FOR HOURS ON END AND INHALED COMBUSTION PARTICLES, 140 00:08:54,560 --> 00:08:59,070 AND THESE MAY INCLUDE CARCINOGENS SUCH AS BENZENE, 141 00:08:59,070 --> 00:09:02,040 POLYCYCLIC AROMATIC HYDROCARBONS, 142 00:09:02,040 --> 00:09:04,570 SOOT, ACID, METALS, ET CETERA. 143 00:09:04,570 --> 00:09:12,080 SO, THOSE ARE THE 3 MAJOR AIRBORNE HAZARDS THAT VETERANS TEND TO REPORT TO US. 144 00:09:12,080 --> 00:09:15,080 THERE ARE ALSO OTHER TYPES OF EXPOSURES. 145 00:09:15,080 --> 00:09:19,090 THIS WOULD INCLUDE EXPOSURES FROM INDUSTRIAL EMISSIONS, 146 00:09:19,090 --> 00:09:22,090 AIRCRAFT AND AUTOMATIC ENGINE EXHAUST, 147 00:09:22,090 --> 00:09:28,100 AS WELL AS AEROSOLIZED PARTICLES FROM BLAST EXPLOSIONS AND STRUCTURAL FIRES. 148 00:09:28,100 --> 00:09:33,600 SO, TO SUMMARIZE--I KNOW I’VE SPENT A FEW MINUTES TALKING ABOUT THESE AIRBORNE HAZARDS. 149 00:09:33,600 --> 00:09:37,240 TO SUMMARIZE, THESE AIRBORNE HAZARDS ARE DIVERSE. 150 00:09:37,240 --> 00:09:41,610 THEY ARE COMPLEX. THEY ARE POTENTIALLY HAZARDOUS TO HEALTH. 151 00:09:41,610 --> 00:09:44,110 SO, IT’S IMPORTANT THAT AS A VA CLINICIAN 152 00:09:44,110 --> 00:09:46,110 THAT WE RECOGNIZE AND ACKNOWLEDGE 153 00:09:46,110 --> 00:09:50,120 THAT THESE HAZARDS WERE PRESENT 154 00:09:50,120 --> 00:09:53,120 AND HAVE THE ABILITY TO DISCUSS THAT WITH THE VETERANS 155 00:09:53,120 --> 00:09:56,060 WHO ARE CONCERNED ABOUT THESE EXPOSURES. 156 00:09:59,130 --> 00:10:04,130 SO, NOW WE’RE GOING TO SHIFT GEARS AND TALK ABOUT THE TYPES OF HEALTH EFFECTS 157 00:10:04,130 --> 00:10:09,140 THAT WE MAY SEE FROM THESE TYPES OF AIRBORNE HAZARDS. 158 00:10:09,140 --> 00:10:13,580 LET’S TALK ABOUT WHAT THE SHORT-TERM HEALTH EFFECTS MIGHT BE. 159 00:10:16,640 --> 00:10:21,250 NASAL IRRITATION AND DISCHARGE FROM IRRITATION OF MUCOUS MEMBRANES, 160 00:10:21,250 --> 00:10:25,650 EYE AND THROAT IRRITATION, COUGH AND/OR CHEST CONGESTION, 161 00:10:25,650 --> 00:10:27,660 SHORTNESS OF BREATH-- 162 00:10:27,660 --> 00:10:31,090 SOME OF THE SYMPTOMS THAT THE VETERANS WOULD HAVE EXPERIENCED 163 00:10:31,090 --> 00:10:34,160 OR MAY HAVE EXPERIENCED AT THE TIME THAT THEY WERE EXPOSED. 164 00:10:34,160 --> 00:10:37,670 NOW FOR VETERANS WHO HAD-- OR SERVICEMEMBERS WHO HAD 165 00:10:37,670 --> 00:10:39,170 PREEXISTING RESPIRATORY CONDITIONS, 166 00:10:39,170 --> 00:10:43,670 LIKE A PREEXISTING ASTHMA THAT WAS QUIESCENT FOR MANY YEARS, 167 00:10:43,670 --> 00:10:46,170 THEY MAY ACTUALLY-- 168 00:10:46,170 --> 00:10:49,680 THESE EXPOSURES MAY TRIGGER SUCH ASTHMA ATTACKS, 169 00:10:49,680 --> 00:10:51,180 BRONCHITIS. 170 00:10:51,180 --> 00:10:55,680 IF SOMEONE HAD PREEXISTING COPD, THEN THESE EXPOSURES 171 00:10:55,680 --> 00:10:58,190 MAY CAUSE AN EXACERBATION OF SYMPTOMS. 172 00:10:58,190 --> 00:11:04,190 AND WE HAVE HAD QUITE A NUMBER OF VETERANS COMPLAIN ABOUT SKIN RASHES. 173 00:11:04,190 --> 00:11:07,200 BY AND LARGE, THOUGH, THESE SHORT-TERM HEALTH EFFECTS, 174 00:11:07,200 --> 00:11:11,700 FOR THE MOST PART TEND TO RESOLVE WITHIN A FEW WEEKS, 2 TO 3 WEEKS, 175 00:11:11,700 --> 00:11:15,200 AFTER THE EXPOSURES HAVE BEEN REMOVED 176 00:11:15,200 --> 00:11:18,210 AND THE VETERAN RECOVERS FROM THAT. 177 00:11:18,210 --> 00:11:20,840 BUT IN A SUBSET OF VETERANS, THOUGH, 178 00:11:20,840 --> 00:11:25,710 THOSE WITH PREEXISTING CONDITIONS, AND EVEN SOME WITHOUT PREEXISTING CONDITIONS, 179 00:11:25,710 --> 00:11:30,220 WE ARE FINDING SOME VETERANS ARE COMPLAINING OF ONGOING SYMPTOMS 180 00:11:30,220 --> 00:11:34,720 AFTER THEY’VE BEEN REMOVED FROM EXPOSURE. 181 00:11:34,720 --> 00:11:37,230 WHAT ABOUT LONG-TERM HEALTH EFFECTS, THEN? 182 00:11:37,230 --> 00:11:43,230 IN A SUBSET OF VETERANS, WE HAVE SEEN INCREASED RATES OF SELF- REPORTED PULMONARY SYMPTOMS. 183 00:11:43,230 --> 00:11:48,240 A STUDY BY ... IN 2009 DOCUMENTED THAT. 184 00:11:48,240 --> 00:11:52,240 SOME HIGHER RATES OF ASTHMA HAVE BEEN REPORTED IN THOSE WHO WERE DEPLOYED 185 00:11:52,240 --> 00:11:55,740 VERSUS NON-DEPLOYED VETERANS. 186 00:11:55,740 --> 00:12:00,250 IN SOME VERY RARE CASES, WE HAVE SEEN UNUSUAL OR UNEXPECTED CONDITIONS, 187 00:12:00,250 --> 00:12:03,220 SUCH AS EOSINOPHILIC PNEUMONITIS 188 00:12:03,220 --> 00:12:05,250 OR CONSTRICTIVE BRONCHIOLITIS THAT HAS BEEN REPORTED 189 00:12:05,250 --> 00:12:10,760 IN A SMALL GROUP OF VETERANS WHO WERE DEPLOYED TO IRAQ 190 00:12:10,760 --> 00:12:13,760 AND SOME TO AFGHANISTAN. 191 00:12:13,760 --> 00:12:17,770 THERE ARE SOME STUDIES, THOUGH, THAT DID NOT FIND HIGHER RATES OF CARDIORESPIRATORY DISEASE, 192 00:12:17,770 --> 00:12:20,770 ESPECIALLY WHEN THEY LOOKED AT MODELED EXPOSURES. 193 00:12:20,770 --> 00:12:22,770 SO, THE LITERATURE IS MIXED. 194 00:12:22,770 --> 00:12:27,280 WE DO HAVE SOME CASES WHERE THERE ARE ASSOCIATED 195 00:12:27,280 --> 00:12:28,780 LONG-TERM HEALTH EFFECTS, 196 00:12:28,780 --> 00:12:31,480 AND IN SOME STUDIES THOSE HEALTH EFFECTS 197 00:12:31,480 --> 00:12:34,280 HAVE NOT PANNED OUT. 198 00:12:34,280 --> 00:12:39,290 SO, GIVEN THE CONCERN THAT THE VETERANS HAVE VOICED, 199 00:12:39,290 --> 00:12:42,790 THE PUBLIC HEALTH CONCERN, 200 00:12:42,790 --> 00:12:49,300 THE INSTITUTES OF MEDICINE WAS TASKED BY THE VETERANS’ ADMINISTRATION TO LOOK AT THIS-- 201 00:12:49,300 --> 00:12:53,370 OR THE DEPARTMENT OF VETERANS AFFAIRS TO LOOK INTO THE LONG-TERM HEALTH EFFECTS 202 00:12:53,370 --> 00:12:56,840 OF THESE AIRBORNE HAZARD EXPOSURES. 203 00:12:56,840 --> 00:12:59,810 AND THE INSTITUTES OF MEDICINE DID THE REVIEW OF THE LITERATURE, 204 00:12:59,810 --> 00:13:03,810 AND THEY SUMMARIZED THEIR FINDINGS IN THE REPORT THAT WAS PUBLISHED IN 2011, 205 00:13:03,810 --> 00:13:06,210 WHICH I HAVE THERE ON THIS SCREEN. 206 00:13:06,210 --> 00:13:09,320 THE LONG-TERM HEALTH CONSEQUENCES OF EXPOSURE TO BURN PITS IN IRAQ 207 00:13:09,320 --> 00:13:11,190 AND AFGHANISTAN. 208 00:13:11,190 --> 00:13:13,820 AND WHAT THE INSTITUTES OF MEDICINE DETERMINED 209 00:13:13,820 --> 00:13:17,330 IS THAT THERE IS SOME LIMITED OR SUGGESTED EVIDENCE 210 00:13:17,330 --> 00:13:21,830 OF AN ASSOCIATION BETWEEN EXPOSURES TO COMBUSTION PRODUCTS IN GENERAL 211 00:13:21,830 --> 00:13:25,970 AND REDUCTION IN PULMONARY FUNCTION IN THE POPULATIONS THAT THEY STUDIED. 212 00:13:25,970 --> 00:13:30,970 THAT’S BECAUSE OF THE VERY HIGH LEVELS OF PARTICULATE MATTER THAT WERE IN THE ENVIRONMENT. 213 00:13:30,970 --> 00:13:33,840 SO, THERE MIGHT BE LONG-TERM HEALTH EFFECTS. 214 00:13:33,840 --> 00:13:40,850 HOWEVER, THEY COULD NOT TIE THAT SPECIFICALLY TO BURN PITS OR TO ANY SPECIFIC EXPOSURE, 215 00:13:40,850 --> 00:13:45,850 BUT THEY TALKED ABOUT THAT BEING RELATED TO AIR POLLUTIONS IN GENERAL. 216 00:13:45,850 --> 00:13:47,860 AND THEY COULD NOT, AT THIS POINT, 217 00:13:47,860 --> 00:13:51,860 MAKE A STATEMENT ABOUT ASSOCIATION BETWEEN CANCER 218 00:13:51,860 --> 00:13:55,860 OR SPECIFIC RESPIRATORY DISEASES OR CIRCULATORY DISEASES 219 00:13:55,860 --> 00:13:57,870 OR EVEN NEUROLOGICAL DISEASES. 220 00:13:57,870 --> 00:14:01,870 BUT STUDIES ARE STILL ONGOING, SO YOU NEED TO STAY TUNED 221 00:14:01,870 --> 00:14:06,370 FOR RESEARCH STUDIES AS THEY COME ALONG. 222 00:14:06,370 --> 00:14:11,880 SO, IN RESPONSE TO THE VETERAN CONCERNS 223 00:14:11,880 --> 00:14:16,380 AND THE HEALTH ISSUES THAT COULD POTENTIALLY COME DOWN THE PIKE, 224 00:14:16,380 --> 00:14:24,030 THE CONGRESS PASSED A LAW, THE PUBLIC LAW 112-260, 225 00:14:24,030 --> 00:14:26,760 THAT IS THE... 226 00:14:26,760 --> 00:14:32,270 DIGNIFIED BURIAL AND OTHER VETERANS’ BENEFITS IMPROVEMENT ACT OF 2012. 227 00:14:32,270 --> 00:14:36,040 AND THAT LAW REQUIRED THAT THE VA ESTABLISH A REGISTRY-- 228 00:14:36,040 --> 00:14:38,910 THE AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY. 229 00:14:38,910 --> 00:14:43,410 THE PURPOSE OF THIS REGISTRY IS TO MONITOR AND ASCERTAIN HEALTH EFFECTS 230 00:14:43,410 --> 00:14:45,410 FROM EXPOSURES TO AIRBORNE HAZARDS. 231 00:14:45,410 --> 00:14:48,920 IT’S TO MONITOR THE HEALTH CARE OF THE VETERANS WITH THESE CONCERNS 232 00:14:48,920 --> 00:14:55,920 AND TO ENSURE THAT THE VA PROVIDES HIGH-QUALITY HEALTH SERVICES. 233 00:14:55,920 --> 00:15:00,430 THE VETERANS THAT ARE ELIGIBLE FOR THIS SERVICE 234 00:15:00,430 --> 00:15:02,430 FOR THE BURN PIT REGISTRY 235 00:15:02,430 --> 00:15:06,430 INCLUDE THOSE WHO SERVED IN SOUTHWEST ASIA OF OPERATIONS 236 00:15:06,430 --> 00:15:09,440 AFTER AUGUST 1, 1990, 237 00:15:09,440 --> 00:15:12,070 AND THOSE WHO SERVED IN DJIBOUTI, AFRICA, 238 00:15:12,070 --> 00:15:15,240 AND AFGHANISTAN AFTER SEPTEMBER 2011-- 239 00:15:15,240 --> 00:15:16,980 SEPTEMBER 11, 2011. 240 00:15:16,980 --> 00:15:22,950 SO, THOSE ARE THE VETERANS AND THE SERVICEMEMBERS WHO ARE ELIGIBLE TO PARTICIPATE 241 00:15:22,950 --> 00:15:25,390 IN THIS REGISTRY. 242 00:15:28,320 --> 00:15:29,960 SO, NOW THAT WE HAVE AN UNDERSTANDING 243 00:15:29,960 --> 00:15:33,960 OF WHAT THE POTENTIAL AIRBORNE EXPOSURES AND HEALTH EFFECTS ARE, 244 00:15:33,960 --> 00:15:37,470 WE ARE NOW GOING TO SHIFT OUR ATTENTION 245 00:15:37,470 --> 00:15:41,970 TO THE REGISTRY AND DISCUSS WHAT THIS REGISTRY PROCESS ENTAILS. 246 00:15:41,970 --> 00:15:45,470 THERE ARE 2 MAIN ASPECTS OF THIS REGISTRY. 247 00:15:45,470 --> 00:15:50,580 THERE IS AN ONLINE SELF-ASSESSMENT QUESTIONNAIRE, 248 00:15:50,580 --> 00:15:53,980 AND THEN THE NEXT STEP IS AN OPTIONAL IN-PERSON CLINICAL EVALUATION. 249 00:15:53,980 --> 00:15:57,990 AND ON YOUR SCREEN, YOU CAN SEE ON THE WEBSITE, 250 00:15:57,990 --> 00:16:00,990 THE OFFICE OF PUBLIC HEALTH WEBSITE, 251 00:16:00,990 --> 00:16:03,990 WHAT THE PORTAL IS GOING TO LOOK LIKE. 252 00:16:03,990 --> 00:16:08,000 THE VETERAN HAS THE ABILITY TO SIGN INTO THAT PORTAL 253 00:16:08,000 --> 00:16:10,000 USING A LOG ON NUMBER, 254 00:16:10,000 --> 00:16:14,500 AND THEY WILL BE ABLE TO ACCESS THE REGISTRY THAT WAY. 255 00:16:14,500 --> 00:16:18,840 SO, LET’S TALK A LITTLE BIT ABOUT THIS ONLINE SELF-ASSESSMENT QUESTIONNAIRE. 256 00:16:18,840 --> 00:16:21,010 IT’S THE FIRST TIME THAT THE VA IS DOING THIS, 257 00:16:21,010 --> 00:16:25,350 SO IT IS INNOVATIVE. 258 00:16:25,350 --> 00:16:29,620 THE VETERANS CAN REGISTER AND ACCESS THE ONLINE QUESTIONNAIRE 259 00:16:29,620 --> 00:16:34,560 FROM THEIR PERSONAL COMPUTERS, THEIR SMART PHONE, TABLETS, LAPTOPS, AND MOBILE DEVICES, 260 00:16:34,560 --> 00:16:36,820 SO IT MAKES IT REALLY CONVENIENT. 261 00:16:36,820 --> 00:16:41,030 AND I HAVE THE WEBSITE FOR THE SELF-ASSESSMENT QUESTIONNAIRE 262 00:16:41,030 --> 00:16:43,530 ON THE POWERPOINT PRESENTATION. 263 00:16:43,530 --> 00:16:46,170 FOR A VETERAN OR SERVICEMEMBER TO ACCESS THE ..., 264 00:16:46,170 --> 00:16:49,040 THEY MUST HAVE A DS LOG-ON. 265 00:16:49,040 --> 00:16:52,040 THAT’S THE DEPARTMENT OF DEFENSE SELF-SERVICE LOG-ON. 266 00:16:52,040 --> 00:16:58,050 AND THEY CAN GET THAT LOG-ON FROM THE WEBSITE THAT’S LISTED ON THE POWERPOINT. 267 00:16:58,050 --> 00:17:01,550 IT TAKES ABOUT 30 TO 40 MINUTES TO COMPLETE THIS QUESTIONNAIRE, 268 00:17:01,550 --> 00:17:06,050 AND THEY CAN PRINT THE COMPLETED QUESTIONNAIRE WHEN THEY ARE DONE. 269 00:17:06,050 --> 00:17:10,560 A VETERAN WHO HAS COMPLETED THE QUESTIONNAIRE THAT THEY NEED MEDICAL EVALUATION 270 00:17:10,560 --> 00:17:13,060 OR THEY FEEL THAT THEY WANT TO BE ASSESSED, 271 00:17:13,060 --> 00:17:19,500 THEY CAN CONTACT THEIR VA FACILITY TO REQUEST THAT MEDICAL EVALUATION AT NO COST. 272 00:17:21,570 --> 00:17:25,570 SO, WHAT’S IN THE SELF-ASSESSMENT QUESTIONNAIRE? 273 00:17:25,570 --> 00:17:32,580 THE QUESTIONNAIRE WAS DEVELOPED TO ASSESS A BROAD ARRAY 274 00:17:32,580 --> 00:17:35,080 OF EXPOSURE CONCERNS, HEALTH CONCERNS, 275 00:17:35,080 --> 00:17:38,590 SO IT DETAILS THE DEPLOYMENT INFORMATION. 276 00:17:38,590 --> 00:17:43,090 IT DISPLAYS THE NAME OF THE COUNTRY AND THE DATES FROM THE DoD. 277 00:17:43,090 --> 00:17:45,730 THE VETERAN ONLY NEEDS TO VALIDATE THAT INFORMATION. 278 00:17:45,730 --> 00:17:49,200 IT DETAILS THE EXPOSURE AND HEALTH CONCERNS, 279 00:17:49,200 --> 00:17:54,100 WHAT THEY WERE EXPOSED TO, AT WHAT TIME THEY WERE EXPOSED TO, 280 00:17:54,100 --> 00:17:55,970 AND THE LEVEL OF CONCERN-- 281 00:17:55,970 --> 00:17:59,610 WHETHER IT’S A HIGH LEVEL OF CONCERN OR A LOW LEVEL OF CONCERN. 282 00:17:59,610 --> 00:18:02,110 IT DETAILS THE TYPE OF CONCERN THAT THEY HAVE, 283 00:18:02,110 --> 00:18:04,110 WHETHER IT’S THE ILLNESS THEY’VE HAD IN THE PAST, 284 00:18:04,110 --> 00:18:07,450 CURRENT ILLNESS, OR FUTURE ILLNESS THAT THEY’RE WORRIED ABOUT. 285 00:18:07,450 --> 00:18:09,120 IT DETAILS THEIR HEALTH HISTORY, 286 00:18:09,120 --> 00:18:11,390 THEIR ACTIVITY LIMITATIONS, 287 00:18:11,390 --> 00:18:14,620 AND WHETHER OR NOT THE VETERANS ENGAGE IN OTHER RISK FACTORS 288 00:18:14,620 --> 00:18:16,620 THAT MAY AFFECT THEIR HEALTH. 289 00:18:16,620 --> 00:18:20,630 AND IT ALSO ASKS ABOUT THE PREFERRED TYPE OF COMMUNICATION, 290 00:18:20,630 --> 00:18:25,630 WHETHER THE VETERAN WANTS TO BE CONTACTED VIA WEB E-MAIL, REGULAR MAIL, 291 00:18:25,630 --> 00:18:27,400 OR IN PERSON. 292 00:18:29,200 --> 00:18:33,140 SO, WHAT HAPPENS AFTER THE VETERANS COMPLETE THE SELF-ASSESSMENT QUESTIONNAIRES? 293 00:18:33,140 --> 00:18:37,650 SOME VETERANS MIGHT DECIDE THEY’VE DOCUMENTED THEIR EXPOSURE CONCERNS, 294 00:18:37,650 --> 00:18:41,220 AND THEY DON’T NEED TO DO ANYTHING FURTHER IF THEY’RE NOT HAVING ANY SYMPTOMS. 295 00:18:41,220 --> 00:18:42,650 THAT’S FINE. 296 00:18:42,650 --> 00:18:45,650 FOR THOSE WHO CONTINUE TO HAVE SYMPTOMS OR HEALTH CONCERNS, 297 00:18:45,650 --> 00:18:48,660 THEY CAN SEEK MEDICAL EVALUATION. 298 00:18:48,660 --> 00:18:51,160 AND FOR THOSE WHO ENROLLED AT THE VA, 299 00:18:51,160 --> 00:18:54,660 WHAT THEY NEED TO DO IS TO CONTACT THEIR VA PRIMARY CARE PHYSICIAN 300 00:18:54,660 --> 00:18:58,170 OR THE PACT TEAM-- THE PATIENT-ALIGNED CARE TEAM-- 301 00:18:58,170 --> 00:19:00,170 AT THE LOCAL VA FACILITY 302 00:19:00,170 --> 00:19:02,440 TO SCHEDULE A REGISTRY MEDICAL EVALUATION. 303 00:19:02,440 --> 00:19:07,680 AND THAT’S WHERE YOU, AS THE VA CLINICIAN, COMES IN. 304 00:19:07,680 --> 00:19:10,810 YOU WOULD BE THE FIRST LINE OF CONTACT FOR THESE VA ENROLLEES, 305 00:19:10,810 --> 00:19:15,180 WHO ARE SEEKING AN IN-PERSON MEDICAL EVALUATION. 306 00:19:15,180 --> 00:19:18,190 FOR THOSE WHO ARE NOT ENROLLED IN THE VA, 307 00:19:18,190 --> 00:19:22,220 THEY CAN CONTACT THE VA ENVIRONMENTAL HEALTH COORDINATOR 308 00:19:22,220 --> 00:19:24,090 FOR A REGISTRY MEDICAL EVALUATION. 309 00:19:24,090 --> 00:19:28,560 AND THE WEBSITE ON THIS POWERPOINT HAS THE LIST OF THE COORDINATORS 310 00:19:28,560 --> 00:19:30,200 AT EACH VA FACILITY. 311 00:19:30,200 --> 00:19:35,200 SO, THEY JUST NEED TO FIND THE COORDINATORS THAT’S CLOSEST TO THEM 312 00:19:35,200 --> 00:19:37,200 AND ASK FOR A REGISTRY EVALUATION-- 313 00:19:37,200 --> 00:19:39,670 AIRBORNE REGISTRY EVALUATION. 314 00:19:39,670 --> 00:19:42,710 AND THE VETERANS ARE ENCOURAGED TO TAKE PRINTED COPIES 315 00:19:42,710 --> 00:19:44,550 OF THEIR COMPLETED SELF-ASSESSMENT QUESTIONNAIRE 316 00:19:44,550 --> 00:19:47,720 TO THE MEDICAL EVALUATION. 317 00:19:47,720 --> 00:19:51,720 SO, AS VA CLINICIANS, YOU MAY ALREADY BE SEEING VETERANS 318 00:19:51,720 --> 00:19:54,720 WITH AIRBORNE HAZARD HEALTH CONCERNS, 319 00:19:54,720 --> 00:20:00,230 BUT IF A VETERAN CONTACTS YOU AND IS REQUESTING FOR AN IN-PERSON REGISTRY EVALUATION 320 00:20:00,230 --> 00:20:04,730 THEY MAY WANT TO DISCUSS SPECIFIC SYMPTOMS--YOU KNOW, THEIR RESPIRATORY SYMPTOMS, 321 00:20:04,730 --> 00:20:07,740 OR PHYSICAL ACTIVITY LIMITATIONS, 322 00:20:07,740 --> 00:20:11,740 OR OTHER CONCERNS RELATED TO THEIR EXPOSURE. 323 00:20:11,740 --> 00:20:14,410 SOME OF THEM MAY NOT HAVE ANY CURRENT HEALTH PROBLEMS, 324 00:20:14,410 --> 00:20:18,250 BUT THEY’RE CONCERNED ABOUT POSSIBLE FUTURE HEALTH EFFECTS OF EXPOSURES. 325 00:20:18,250 --> 00:20:20,750 THEY ALSO WARRANT A MEDICAL EVALUATION 326 00:20:20,750 --> 00:20:22,620 IF THEY’RE EXPRESSING SUCH CONCERN, 327 00:20:22,620 --> 00:20:26,750 ’CAUSE IT GIVES US AN OPPORTUNITY TO ENGAGE IN DISCUSSIONS WITH THE VETERAN 328 00:20:26,750 --> 00:20:28,690 TO ALLAY THOSE CONCERNS. 329 00:20:30,660 --> 00:20:36,760 NOW, THE REGISTRY HAS DEVELOPED A TEMPLATE IN CPRS 330 00:20:36,760 --> 00:20:43,770 FOR US TO BE ABLE TO DOCUMENT THIS AIRBORNE HAZARDS RATE IN PERSONNEL EVALUATIONS. 331 00:20:43,770 --> 00:20:47,270 SO, THERE IS AN INITIAL ASSESSMENT TEMPLATE IN CPRS. 332 00:20:47,270 --> 00:20:55,780 AND THE NEXT FEW SLIDES IS GOING TO SHOW YOU WHAT THAT TEMPLATE IS LIKE IN CPRS. 333 00:20:55,780 --> 00:21:00,760 WHAT THIS TEMPLATE DOES IS THAT IT FACILITATES A FOCUSED DIALOGUE 334 00:21:00,760 --> 00:21:04,330 AND THOROUGH EVALUATION OF A VETERAN’S AIRBORNE HAZARDS CONCERNS. 335 00:21:04,330 --> 00:21:06,290 AND THAT TEMPLATE MAY BE COMPLETED 336 00:21:06,290 --> 00:21:09,800 BY THE PRIMARY CARE PROVIDER, ENVIRONMENTAL HEALTH CLINICIAN, 337 00:21:09,800 --> 00:21:12,530 OR POST-APPOINTMENT HEALTH CHAMPION, 338 00:21:12,530 --> 00:21:18,740 ’CAUSE YOU WOULD BE THE FIRST LINE CLINICIAN FOR THESE VETERANS. 339 00:21:20,810 --> 00:21:28,820 NOW, THE TEMPLATE ALLOWS YOU TO REVIEW THE COMPLETE SELF-ASSESSMENT QUESTIONNAIRE 340 00:21:28,820 --> 00:21:30,320 USING THE WEB PORTAL. 341 00:21:30,320 --> 00:21:33,320 SO, THAT’S ALREADY EMBEDDED IN THE TEMPLATE, 342 00:21:33,320 --> 00:21:35,960 AND IT GOES THROUGH THE CLINICAL EVALUATION 343 00:21:35,960 --> 00:21:38,830 MUCH AS YOU WOULD DO FOR A REGULAR EVALUATION. 344 00:21:38,830 --> 00:21:40,830 IT’S JUST THAT IN THIS SITUATION, 345 00:21:40,830 --> 00:21:44,330 YOU WILL BE TAKING A DEPLOYMENT HISTORY AND SUMMARIZING IT, 346 00:21:44,330 --> 00:21:47,330 AND THEN YOU’LL REVIEW THEIR SYMPTOMS, HEALTH HISTORY, 347 00:21:47,330 --> 00:21:51,340 GO THROUGH THEIR USUAL RISK FACTORS, 348 00:21:51,340 --> 00:21:55,340 SUCH AS TOBACCO USE, ALCOHOL USE, FUNCTIONAL LIMITATIONS, 349 00:21:55,340 --> 00:21:59,850 SPECIFY WHAT SYMPTOMS THEY ARE CONCERNED ABOUT AT THIS EVALUATION. 350 00:21:59,850 --> 00:22:02,850 YOU’LL COMPLETE A PHYSICAL-- [AUDIO CUTS OUT] 351 00:22:02,850 --> 00:22:05,490 ...DO A DIAGNOSTIC WORKUP, FORM AN ASSESSMENT, 352 00:22:05,490 --> 00:22:06,990 CREATE A CARE PLAN, 353 00:22:06,990 --> 00:22:09,860 AND ENGAGE IN HEALTH RISK COMMUNICATION. 354 00:22:09,860 --> 00:22:12,490 SO, THAT’S REALLY WHAT THE PROCESS ENTAILS, 355 00:22:12,490 --> 00:22:16,360 AND WE’RE GONNA GO THROUGH THIS STEP BY STEP. 356 00:22:16,360 --> 00:22:20,370 OK. SO, THE SCREEN THAT YOU SEE RIGHT IN FRONT OF YOU NOW 357 00:22:20,370 --> 00:22:24,870 IS THE AIRBORNE HAZARD, OPEN BURN PIT REGISTRY 358 00:22:24,870 --> 00:22:27,710 CLINICAL TEMPLATE IN CPRS. 359 00:22:27,710 --> 00:22:32,810 AND THAT’S GONNA BE ACCESSED THROUGH THE NOTES SECTION IN CPRS. 360 00:22:32,810 --> 00:22:34,380 THE BEAUTIFUL THING ABOUT THIS TEMPLATE 361 00:22:34,380 --> 00:22:37,020 IS THAT IT GIVES YOU STEP-BY-STEP INSTRUCTIONS, 362 00:22:37,020 --> 00:22:42,390 AND THOSE INSTRUCTIONS, ALTHOUGH EMBEDDED IN THE NOTES, 363 00:22:42,390 --> 00:22:45,390 THEY WILL NOT PRINT OUT IN YOUR REGULAR NOTES. 364 00:22:45,390 --> 00:22:49,400 SO YOU HAVE A LOT OF INFORMATION ON THE TEMPLATE TO GUIDE YOU, 365 00:22:49,400 --> 00:22:56,900 AND YOU CAN ALSO SEE HYPERLINKS TO THE PATIENT’S RESPONSES TO THE QUESTIONNAIRE. 366 00:22:56,900 --> 00:23:00,910 OR IF YOU HAVE QUESTIONS ABOUT WHAT BURN PITS ARE, 367 00:23:00,910 --> 00:23:02,910 YOU CAN CLICK ON THAT HYPERLINK, 368 00:23:02,910 --> 00:23:06,350 AND YOU, AS A CLINICIAN, CAN GET MORE INFORMATION. 369 00:23:07,780 --> 00:23:10,920 SO, THE NOTE TEMPLATES INCLUDES A CHIEF COMPLAINT, HISTORY, 370 00:23:10,920 --> 00:23:14,920 PHYSICAL EXAMINATION, THE DIAGNOSTIC EVALUATIONS TO DATE, 371 00:23:14,920 --> 00:23:17,420 THE OVERALL ASSESSMENT, RECOMMENDATIONS, 372 00:23:17,420 --> 00:23:20,760 AND QUICK ORDERS. 373 00:23:20,760 --> 00:23:24,930 SO, YOU’RE PROBABLY THINKING, "OK, AS A PRIMARY CARE PHYSICIAN, 374 00:23:24,930 --> 00:23:27,940 WHAT IS EXPECTED OF ME IN COMPLETING THIS TEMPLATE?" 375 00:23:27,940 --> 00:23:31,870 WELL, WHAT WE’RE GOING TO DO IS USE A CLINICAL CASE VIGNETTE 376 00:23:31,870 --> 00:23:35,440 TO ILLUSTRATE HOW A PATIENT MAY PRESENT TO YOU IN THE CLINIC 377 00:23:35,440 --> 00:23:38,450 AND HOW YOU WOULD GO ABOUT COMPLETING THIS TEMPLATE. 378 00:23:38,450 --> 00:23:40,950 SO THE CASE THAT WE HAVE IS VETERAN 00. 379 00:23:40,950 --> 00:23:45,450 SHE’S A 40-YEAR-OLD OEF/OIF AIR FORCE RESERVE VETERAN. 380 00:23:45,450 --> 00:23:47,960 SHE’S COMPLETED THE SELF-ASSESSMENT QUESTIONNAIRE, 381 00:23:47,960 --> 00:23:52,460 AND SHE HAS REQUESTED FOR AN IN-PERSON EVALUATION AT HER LOCAL VA. 382 00:23:52,460 --> 00:23:54,330 SHE PRESENTS WITH CHRONIC COUGH, 383 00:23:54,330 --> 00:23:56,460 ALSO, SHE HAS SAID, WITH THROAT CLOSING, 384 00:23:56,460 --> 00:23:59,500 HOARSENESS, AND DYSPHAGIA. 385 00:23:59,500 --> 00:24:02,970 THESE SYMPTOMS STARTED WHILE SHE WAS IN IRAQ, 386 00:24:02,970 --> 00:24:04,970 AND SHE’S BEEN COUGHING EVER SINCE. 387 00:24:04,970 --> 00:24:07,470 IN FACT, SHE WAS MEDEVACED OUT OF THEATER 388 00:24:07,470 --> 00:24:09,980 BECAUSE OF THE SEVERITY OF HER RESPIRATORY SYMPTOMS. 389 00:24:09,980 --> 00:24:14,380 SHE HAS ONGOING CHRONIC RHINOSINUSITIS, 390 00:24:14,380 --> 00:24:17,990 HER DYSPNEA IS VERY LIMITING WITH MILD TO MODERATE ACTIVITIES. 391 00:24:17,990 --> 00:24:19,850 BEFORE SHE WAS DEPLOYED, 392 00:24:19,850 --> 00:24:22,990 SHE WAS RUNNING 5 TO 10 MILES A DAY, 393 00:24:22,990 --> 00:24:24,490 TRAINING INTENSELY. 394 00:24:24,490 --> 00:24:27,730 AND WHILE SHE WAS DEPLOYED, SHE DID THAT UNTIL SHE GOT SICK. 395 00:24:27,730 --> 00:24:30,000 SHE CARRIED A LOT OF HEAVY GEAR, 396 00:24:30,000 --> 00:24:33,430 BUT NOW HER ACTIVITY LIMITATION IN TERMS OF EXERCISE, 397 00:24:33,430 --> 00:24:37,500 SHE CAN ONLY EXERCISE 30 TO 45 MINUTES A DAY. 398 00:24:37,500 --> 00:24:39,510 AND ON TOP OF HER RESPIRATORY SYMPTOMS, 399 00:24:39,510 --> 00:24:44,510 SHE ALSO HAS GASTROESOPHAGEAL REFLUX DISEASE. 400 00:24:44,510 --> 00:24:47,510 NOW, HOW DO WE EVALUATE THIS PATIENT? 401 00:24:47,510 --> 00:24:52,020 WELL, IN THE TEMPLATE THAT YOU HAVE IN CPRS, 402 00:24:52,020 --> 00:24:56,520 IN YOUR INITIAL NOTE, YOU HAVE A CHECKLIST OF SYMPTOMS. 403 00:24:56,520 --> 00:25:01,530 AND WHAT YOU NEED TO DO IS TO CHECK THOSE SYMPTOMS THAT THE PATIENT PRESENTED WITH. 404 00:25:01,530 --> 00:25:04,670 SO, IN THIS CASE, YOU WOULD CHECK OFF RUNNY NOSE, 405 00:25:04,670 --> 00:25:08,040 CHRONIC SINUS CONGESTION, SORE THROAT, COUGH FOR MORE THAN 3 WEEKS, 406 00:25:08,040 --> 00:25:11,540 SHORTNESS OF BREATH, AND GASTROINTESTINAL PROBLEMS. 407 00:25:11,540 --> 00:25:14,040 NOW, AT THE END OF THAT CHECKLIST, 408 00:25:14,040 --> 00:25:16,540 YOU CAN SEE A BOX THAT YOU CAN CLICK 409 00:25:16,540 --> 00:25:20,050 TO BE ABLE TO WRITE IN TEXT FORMAT 410 00:25:20,050 --> 00:25:24,050 WHAT THE VETERAN COMPLAINED ABOUT IN THEIR OWN WORDS. 411 00:25:24,050 --> 00:25:27,550 SO THIS IS A VERY FLEXIBLE TEMPLATE TO USE. 412 00:25:27,550 --> 00:25:31,490 IT HELPS YOU DOCUMENT THE SYMPTOMS VERY QUICKLY, 413 00:25:31,490 --> 00:25:35,060 AND THEN YOU ALSO HAVE A TEXT OPTION 414 00:25:35,060 --> 00:25:40,570 TO BE ABLE TO PUT THE CLINICAL INFORMATION IN AS YOU DEEM APPROPRIATE. 415 00:25:40,570 --> 00:25:43,570 SO LET’S SHIFT GEARS AND TALK ABOUT VET OO’S 416 00:25:43,570 --> 00:25:47,570 DEPLOYMENT--RELATED HISTORY & EXPOSURES. 417 00:25:47,570 --> 00:25:49,580 SO, SHE’S A COMBAT ENGINEER. 418 00:25:49,580 --> 00:25:57,080 SHE SERVED IN TOLEDO, OHIO, BEFORE SHE WAS DEPLOYED TO AFGHANISTAN IN 2003-2004 419 00:25:57,080 --> 00:26:03,620 AND TO IRAQ IN FEBRUARY 2011 TO OCTOBER 2011. 420 00:26:03,620 --> 00:26:06,590 NOW, IN THE COURSE OF HER JOB AS A COMBAT ENGINEER, 421 00:26:06,590 --> 00:26:11,100 SHE WAS INVOLVED IN PULLING DOWN ALL BUILDINGS THAT HAD ASBESTOS IN THEM, 422 00:26:11,100 --> 00:26:13,670 SO SHE WAS EXPOSED TO ASBESTOS FIBERS. 423 00:26:13,670 --> 00:26:17,100 SHE SUPERVISED POURING CONCRETE, 424 00:26:17,100 --> 00:26:20,640 SO SHE WAS EXPOSED TO CEMENT DUST AND CONCRETE DUST. 425 00:26:20,640 --> 00:26:23,110 WHEN SHE WAS DEPLOYED, 426 00:26:23,110 --> 00:26:26,480 HER WORKSITE WAS LOCATED CLOSE TO A BURN PIT, 427 00:26:26,480 --> 00:26:31,550 AND SHE BREATHED IN THE SMOKE PRETTY MUCH ALL OF THE TIME SHE WAS THERE. 428 00:26:31,550 --> 00:26:35,620 THEY HAD A LOT OF SAND AND DUST STORMS THAT WERE SEVERE. 429 00:26:35,620 --> 00:26:37,890 AND TO TOP ALL OF THIS, 430 00:26:37,890 --> 00:26:40,130 SHE WAS LOCATED NEXT TO AN AIRFIELD, 431 00:26:40,130 --> 00:26:44,630 SO SHE WAS EXPOSED TO JET ENGINE EXHAUST 432 00:26:44,630 --> 00:26:50,140 AND AIRCRAFT NOISE AS THE PLANES AND HELICOPTERS LANDED AND TOOK OFF. 433 00:26:50,140 --> 00:26:54,140 SHE ALSO DID MISSIONS OUTSIDE OF HER DAYS 434 00:26:54,140 --> 00:26:57,140 DURING WHICH SHE WAS EXPOSED TO SAND AND DUST STORMS. 435 00:26:57,140 --> 00:26:59,650 SHE DID CARRY A LOT OF WEIGHT, 436 00:26:59,650 --> 00:27:02,650 BUT SHE DID NOT HAVE ANY COMBAT EXPOSURE. 437 00:27:02,650 --> 00:27:06,150 SHE WAS NOT DIRECTLY ENGAGED IN COMBAT. 438 00:27:06,150 --> 00:27:08,160 NOW, THAT’S A LOT OF INFORMATION. 439 00:27:08,160 --> 00:27:11,160 HOW WOULD YOU AS A PRIMARY CARE PHYSICIAN 440 00:27:11,160 --> 00:27:13,660 CAPTURE ALL OF THAT INFORMATION? 441 00:27:13,660 --> 00:27:18,730 WELL, THE TEMPLATE IN CPRS 442 00:27:18,730 --> 00:27:22,170 HELPS YOU TO ACTUALLY CATEGORIZE THOSE EXPOSURES. 443 00:27:22,170 --> 00:27:28,180 AND IF YOU CAN SEE ON THE LOWER PORTION OF THIS TEMPLATE, 444 00:27:28,180 --> 00:27:32,680 YES, YOU WOULD CHECK OFF THAT SHE HAD OFF-BASE AIR POLLUTION DURING HER DEPLOYMENT, 445 00:27:32,680 --> 00:27:34,950 BECAUSE SHE WAS OUTSIDE THE BASE, 446 00:27:34,950 --> 00:27:37,680 AND SHE WAS EXPOSED TO SAND AND DUST STORMS, 447 00:27:37,680 --> 00:27:40,190 ON-BASE AIR POLLUTION DURING HER DEPLOYMENT-- 448 00:27:40,190 --> 00:27:42,060 YOU WOULD CHECK THAT OFF-- 449 00:27:42,060 --> 00:27:45,190 AS WELL AS MILITARY JOBS WHILE SHE WAS NOT DEPLOYED. 450 00:27:45,190 --> 00:27:51,200 AND THERE’S ALSO AN OPPORTUNITY FOR YOU TO INPUT INFORMATION IN THE TEXT. 451 00:27:51,200 --> 00:27:56,700 SO THAT WAY, YOU CAN STREAMLINE THE DEPLOYMENT-RELATED HISTORY 452 00:27:56,700 --> 00:28:00,210 AND CAPTURE AS MUCH INFORMATION AS YOU WANT TO 453 00:28:00,210 --> 00:28:02,810 IN THAT ENCOUNTER. 454 00:28:04,780 --> 00:28:08,220 NOW THE NEXT PHASE OF DOING THE EVALUATION 455 00:28:08,220 --> 00:28:10,850 IS ONCE YOU’VE COMPLETED THE PHYSICAL EXAM-- 456 00:28:10,850 --> 00:28:12,720 AND YOU WOULD DOCUMENT THAT AS YOU NORMALLY WOULD 457 00:28:12,720 --> 00:28:14,720 FOR ANY PHYSICAL EXAMINATION-- 458 00:28:14,720 --> 00:28:18,730 THE NEXT PHASE IS TO LOOK AT THE DIAGNOSTIC WORKUP FOR THIS PATIENT. 459 00:28:18,730 --> 00:28:23,230 SO, FOR OUR VET OO, BEFORE SHE CAME TO SEE US IN THE CLINIC, 460 00:28:23,230 --> 00:28:25,870 SHE ACTUALLY HAD GOTTEN SOME TESTS DONE AT THE VA. 461 00:28:25,870 --> 00:28:28,240 SHE’D HAD SPIROMETRY, CHEST X-RAY, 462 00:28:28,240 --> 00:28:30,240 AN ECHOCARDIOGRAM, PULMONARY ANGIOGRAM, 463 00:28:30,240 --> 00:28:35,740 AND ALLERGY SKIN TESTS HAD BEEN ORDERED BY VARIOUS CLINICIANS 464 00:28:35,740 --> 00:28:37,740 WITHIN THE VA SYSTEM. 465 00:28:37,740 --> 00:28:42,250 THE BEAUTY ABOUT THIS TEMPLATE IS THAT THE TEMPLATE IS GOING TO PREPOPULATE 466 00:28:42,250 --> 00:28:47,790 ALL THE DIAGNOSTIC TESTS THAT HAVE BEEN DONE WITHIN THE VA IN THE LAST 2 YEARS 467 00:28:47,790 --> 00:28:53,260 WITHIN THAT TEMPLATE, AND YOU CAN SEE THAT INFORMATION. 468 00:28:53,260 --> 00:28:57,260 THEN, AS A CLINICIAN, YOU DECIDE, "OK, WHAT’S THE NEXT STEP FOR THIS VETERAN?" 469 00:28:57,260 --> 00:28:59,270 AND IF THEY HAVEN’T HAD ANY DIAGNOSTIC WORKUP, 470 00:28:59,270 --> 00:29:04,770 YOU HAVE THE ABILITY TO ORDER THOSE TESTS IN THE ORDER SECTION. 471 00:29:04,770 --> 00:29:07,770 SO, WHAT’S NEXT FOR OUR VETERAN? 472 00:29:07,770 --> 00:29:09,980 WELL, SHE’S HAD A NUMBER OF TESTS DONE, 473 00:29:09,980 --> 00:29:14,780 BUT MAYBE THERE ARE SOME SPECIALTY CONSULTS THAT YOU WANT TO CONSIDER. 474 00:29:14,780 --> 00:29:20,290 AND FOR ANY VET WHO PRESENTS WITH YOU WITH AIRBORNE, HAS THAT CONCERN, 475 00:29:20,290 --> 00:29:25,290 YOUR CONSULTATION IS GONNA VARY DEPENDING ON WHAT YOUR CLINICAL FINDINGS ARE 476 00:29:25,290 --> 00:29:28,800 AND HOW SERIOUS THE PATIENT’S CONCERN IS. 477 00:29:28,800 --> 00:29:32,230 SO YOU MAY WANT TO ORDER A PULMONARY CONSULT-- 478 00:29:32,230 --> 00:29:36,800 EAR, NOSE, AND THROAT, IF THEY HAVE PROBLEMS WITH DYSPHAGIA OR HOARSENESS, 479 00:29:36,800 --> 00:29:39,810 LIKE IN THE CASE OF VETERAN OO. 480 00:29:39,810 --> 00:29:42,810 SOME OF THEM PRESENT WITH NEW-ONSET ALLERGY CONDITIONS, 481 00:29:42,810 --> 00:29:45,310 SO YOU MAY WANT TO ORDER ALLERGY/IMMUNOLOGY. 482 00:29:45,310 --> 00:29:47,310 AND THEN FOR GASTRO-- 483 00:29:47,310 --> 00:29:54,320 YOU MAY ORDER A GASTROENTEROLOGY CONSULT AS NEEDED. 484 00:29:54,320 --> 00:29:58,330 AND THESE CONSULTS ARE PART OF THE REGISTRY, 485 00:29:58,330 --> 00:30:02,260 AND THEY ARE PROVIDED TO THE VETERAN AT NO COST. 486 00:30:04,830 --> 00:30:09,840 FOR PULMONARY CONCERNS, THERE ARE SPECIALTY DIAGNOSTIC ASSESSMENTS 487 00:30:09,840 --> 00:30:12,470 THAT MAY BE ORDERED FOR THE VETERANS. 488 00:30:12,470 --> 00:30:16,340 SO WE MAY DECIDE TO DO FULL PULMONARY FUNCTION TESTS, 489 00:30:16,340 --> 00:30:20,110 WITH OR WITHOUT BRONCHODILATOR METHACHOLINE CHALLENGE TEST; 490 00:30:20,110 --> 00:30:22,350 HIGH-RESOLUTION CT SCANS; 491 00:30:22,350 --> 00:30:25,220 A CARDIOPULMONARY EXERCISE STRESS TEST; 492 00:30:25,220 --> 00:30:28,360 AND BRONCHOSCOPY AND LUNG BIOPSY IN SELECTED CASES. 493 00:30:28,360 --> 00:30:34,360 NOW, THESE ARE SPECIALIZED TESTS THAT A PULMONARY SPECIALIST MAY ORDER 494 00:30:34,360 --> 00:30:37,360 AFTER THE PATIENT HAS BEEN REFERRED ONTO PULMONARY. 495 00:30:37,360 --> 00:30:41,870 AND ALSO, ENT MAY ORDER SPECIFIC DIAGNOSTIC ASSESSMENTS 496 00:30:41,870 --> 00:30:45,810 OF THEIR VOCAL CORDS TO LOOK FOR VOCAL CORD DYSFUNCTION. 497 00:30:47,370 --> 00:30:50,010 SO THE TEMPLATE GIVES YOU THE OPPORTUNITY 498 00:30:50,010 --> 00:30:53,380 TO CHECK OFF WHAT TESTS THAT NEED TO BE ORDERED 499 00:30:53,380 --> 00:30:56,380 SO THAT THAT GOES OFF AS A CONSULT. 500 00:30:56,380 --> 00:31:00,450 THAT STREAMLINES THE PROCESS FOR THE PATIENT AND FOR THE PROVIDER. 501 00:31:01,890 --> 00:31:05,890 SO, FOR OUR VETERAN OO, WHAT DID HER TESTS SHOW? 502 00:31:05,890 --> 00:31:09,400 WELL, HER PFTs WERE NORMAL. 503 00:31:09,400 --> 00:31:12,400 THE HIGH-RESOLUTION CHEST CT WAS NORMAL, 504 00:31:12,400 --> 00:31:15,770 BUT THEN SHE HAD A POSITIVE METHACHOLINE CHALLENGE TEST, 505 00:31:15,770 --> 00:31:18,770 WHICH CONFIRMED THAT SHE HAD REACTIVE AIRWAYS DISEASE, 506 00:31:18,770 --> 00:31:22,540 SO NOW SHE’S SEEING A PULMONOLOGIST AT HER LOCAL VA 507 00:31:22,540 --> 00:31:27,410 WHO HAS AN INTEREST IN TREATING DEPLOYMENT- RELATED LUNG INJURY. 508 00:31:27,410 --> 00:31:29,680 SHE DID HAVE AN ENT CONSULT, 509 00:31:29,680 --> 00:31:32,350 AND THAT CONFIRMED VOCAL CORD DYSFUNCTION. 510 00:31:32,350 --> 00:31:37,420 SO NOW SHE’S IN THE PROCESS OF GETTING SPEECH THERAPY 511 00:31:37,420 --> 00:31:39,430 FOR HER CHRONIC RHINOSINUSITIS. 512 00:31:39,430 --> 00:31:42,430 SHE WAS FOUND TO HAVE A DEVIATED NASAL SEPTUM, 513 00:31:42,430 --> 00:31:45,170 AND SURGERY’S PLANNED FOR THAT. 514 00:31:45,170 --> 00:31:48,170 AND FOR HER GERD, IT WAS CONFIRMED THAT 515 00:31:48,170 --> 00:31:51,440 SHE HAD H. PYLORIC GASTRITIS, 516 00:31:51,440 --> 00:31:54,810 AND SHE WAS STARTED ON MEDICAL TREATMENT. 517 00:31:54,810 --> 00:31:58,180 SO YOU CAN SEE THAT FOR OUR VETERAN OO, 518 00:31:58,180 --> 00:32:03,450 THIS EVALUATION ALLOWED US TO FIGURE OUT WHAT HER MAIN HEALTH CONCERNS WERE, 519 00:32:03,450 --> 00:32:08,960 AND WE WERE ABLE TO TREAT HER TO THE VARIOUS SPECIALISTS THAT SHE NEEDED, 520 00:32:08,960 --> 00:32:14,960 AND SO SHE’S NOW GETTING MULTI-SPECIALTY CARE FOR HER AIRBORNE HAZARD HEALTH CONCERNS 521 00:32:14,960 --> 00:32:17,460 AND CONDITIONS. 522 00:32:17,460 --> 00:32:19,730 SO, WHEN YOU’VE COMPLETED YOUR EVALUATION WITH THE VETERAN, 523 00:32:19,730 --> 00:32:21,970 YOU’VE DEVELOPED A CARE PLAN, 524 00:32:21,970 --> 00:32:24,470 IT’S REALLY IMPORTANT TO HAVE A DISCUSSION 525 00:32:24,470 --> 00:32:26,470 AND COMMUNICATE WITH YOUR VETERAN 526 00:32:26,470 --> 00:32:28,740 IN TERMS OF THE EXPOSURE CONCERNS 527 00:32:28,740 --> 00:32:31,010 AND THE FINDINGS OF YOUR EVALUATION. 528 00:32:31,010 --> 00:32:33,350 FIRST AND FOREMOST, IT’S REALLY IMPORTANT 529 00:32:33,350 --> 00:32:35,980 IN TERMS OF COMMUNICATING WITH THE VETERAN 530 00:32:35,980 --> 00:32:38,250 TO LISTEN AND RESPECT THEIR CONCERNS. 531 00:32:38,250 --> 00:32:41,990 IT’S IMPORTANT BECAUSE THIS HELPS YOU TO ESTABLISH TRUST AND RAPPORT 532 00:32:41,990 --> 00:32:43,990 WITH YOUR PATIENTS. 533 00:32:43,990 --> 00:32:47,490 YOU SHOULD IDENTIFY ANY GAPS IN KNOWLEDGE 534 00:32:47,490 --> 00:32:49,760 ABOUT THE EXPOSURE THAT YOU IDENTIFY, 535 00:32:49,760 --> 00:32:55,000 SO WE KNOW THAT, YES, THERE ARE ACUTE HEALTH SYMPTOMS THAT PEOPLE HAVE, 536 00:32:55,000 --> 00:32:58,000 THERE ARE SOME LONG-TERM HEALTH CONDITIONS 537 00:32:58,000 --> 00:33:00,510 THAT HAVE BEEN REPORTED IN THE MEDICAL LITERATURE, 538 00:33:00,510 --> 00:33:03,010 BUT WE DON’T HAVE THE FULL PICTURE YET. 539 00:33:03,010 --> 00:33:08,420 IT DOES TAKE A WHILE FOR SCIENCE TO CATCH UP WITH... 540 00:33:08,420 --> 00:33:11,520 GIVE US ENOUGH INFORMATION TO BE ABLE TO SHARE WITH THE VETERAN. 541 00:33:11,520 --> 00:33:14,520 SO, WE KNOW THAT PEOPLE MAY HAVE ASTHMA, 542 00:33:14,520 --> 00:33:18,020 AND THERE ARE PEOPLE WHO HAVE ONGOING RESPIRATORY SYMPTOMS WITH THIS, 543 00:33:18,020 --> 00:33:23,030 BUT THERE’S SOME CONDITIONS THAT WE STILL CAN’T SAY, ONE WAY OR THE OTHER, 544 00:33:23,030 --> 00:33:25,200 WHETHER IT’S GONNA BE A PROBLEM IN THE FUTURE. 545 00:33:25,200 --> 00:33:27,530 SO, FOR EXAMPLE, MAYBE LUNG CANCER 546 00:33:27,530 --> 00:33:29,540 IS WHAT THE VETERAN IS CONCERNED ABOUT. 547 00:33:29,540 --> 00:33:32,470 WE JUST DON’T HAVE THAT KIND OF INFORMATION YET. 548 00:33:32,470 --> 00:33:35,540 SO WE’RE GONNA DISCUSS THESE TYPES OF-- 549 00:33:35,540 --> 00:33:38,040 WOULD HAVE THOSE KINDS OF DISCUSSIONS WITH THE VETERAN 550 00:33:38,040 --> 00:33:41,550 AND THEN TALK TO THE VETERAN ABOUT THEIR WORKUP 551 00:33:41,550 --> 00:33:43,820 AND CHECK BACK ON THEIR UNDERSTANDING 552 00:33:43,820 --> 00:33:46,020 OF WHAT THE NEXT STEPS ARE. 553 00:33:49,060 --> 00:33:52,560 SO, IN TERMS OF COMMUNICATION WITH THE VETERAN, 554 00:33:52,560 --> 00:33:57,560 IT’S IMPORTANT THAT WE DISCUSS WITH THE VETERAN 555 00:33:57,560 --> 00:34:00,570 THAT, YES, WE HAVE SOME INFORMATION ABOUT THEIR AIRBORNE EXPOSURES, 556 00:34:00,570 --> 00:34:03,570 AND THE HEALTH CONDITIONS RELATED TO THESE ARE COMPLEX. 557 00:34:03,570 --> 00:34:06,570 WE DON’T NECESSARILY HAVE ALL THE ANSWERS. 558 00:34:06,570 --> 00:34:11,580 WHAT THIS EVALUATION ALLOWS US TO DO IS TO GATHER THE NECESSARY INFORMATION 559 00:34:11,580 --> 00:34:14,580 AND HAVE A DISCUSSION WITH THE VETERAN ABOUT THEIR CURRENT HEALTH 560 00:34:14,580 --> 00:34:16,580 AND THEIR FUTURE HEALTH CONCERNS. 561 00:34:16,580 --> 00:34:19,090 BUT MORE IMPORTANTLY, THOUGH, WHAT WE WANT TO DO 562 00:34:19,090 --> 00:34:22,090 IS FOCUS OUR MANAGEMENT ON SPECIFIC ACTION STEPS 563 00:34:22,090 --> 00:34:25,590 THAT WE CAN TAKE RIGHT NOW TO REDUCE THEIR HEALTH RISKS 564 00:34:25,590 --> 00:34:27,590 TO OPTIMIZE THEIR HEALTH AND FUNCTION. 565 00:34:27,590 --> 00:34:30,230 SO, IF THEY’RE HAVING SYMPTOMS OF ASTHMA, 566 00:34:30,230 --> 00:34:32,100 THEY NEED TO BE TREATED. 567 00:34:32,100 --> 00:34:36,600 IF THEY ARE HAVING OTHER HEALTH CONDITIONS THAT YOU IDENTIFIED, 568 00:34:36,600 --> 00:34:39,240 MAYBE NOT EVEN RELATED TO AIRBORNE HAZARDS, 569 00:34:39,240 --> 00:34:42,540 THEN THAT NEEDS TO BE TREATED AS WELL. 570 00:34:45,110 --> 00:34:49,250 SO, IT’S POSSIBLE, THEN, THAT THE VETERAN GOES THROUGH YOUR EVALUATION 571 00:34:49,250 --> 00:34:51,120 AS A PRIMARY CARE PHYSICIAN, 572 00:34:51,120 --> 00:34:53,620 AND THEY’VE GONE THROUGH THE SPECIALTY CONSULT AT YOUR VA, 573 00:34:53,620 --> 00:34:56,620 AND YOU’VE EXHAUSTED YOUR LOCAL RESOURCES 574 00:34:56,620 --> 00:34:58,630 IN TERMS OF SPECIALTY EVALUATION 575 00:34:58,630 --> 00:35:00,630 AND THEY’RE STILL HIGHLY SYMPTOMATIC 576 00:35:00,630 --> 00:35:04,630 OR THEY HAVE SIGNIFICANT FUNCTIONAL IMPAIRMENTS. 577 00:35:04,630 --> 00:35:06,630 SO, WHAT’S THE NEXT STEP? 578 00:35:06,630 --> 00:35:10,640 WELL, YOU CAN REFER TO THE WAR RELATED ILLNESS AND INJURY STUDY CENTERS. 579 00:35:10,640 --> 00:35:12,640 THERE ARE 3 OF US IN THE NATION, 580 00:35:12,640 --> 00:35:15,640 AND OUR WEBSITE IS RIGHT THERE ON YOUR SCREEN. 581 00:35:15,640 --> 00:35:22,650 AT THE WRIISC, WE HAVE EXPERTISE IN POST-DEPLOYMENT HEALTH AND AIRBORNE HAZARD EXPOSURES. 582 00:35:22,650 --> 00:35:26,650 AND FOR VETERANS WHO HAVE THE MOST COMPLEX AND DIFFICULT-TO-DIAGNOSE 583 00:35:26,650 --> 00:35:30,160 OR MEDICALLY UNEXPLAINED HEALTH CONCERNS, 584 00:35:30,160 --> 00:35:36,200 THOSE ARE THE VETERANS THAT YOU CAN REFER TO THE WRIISC. 585 00:35:36,200 --> 00:35:40,670 OUR ASSESSMENTS AT THE WRIISC ARE INDIVIDUALIZED FOR EACH PATIENT, 586 00:35:40,670 --> 00:35:47,670 AND THEY ARE APPROPRIATE TO THE PRESENTING COMPLAINT OF THE PATIENT. 587 00:35:47,670 --> 00:35:49,680 SO, FOR EXAMPLE, 588 00:35:49,680 --> 00:35:54,680 WE ARE ABLE TO DO EXTENDED PULMONARY EVALUATIONS AT THE WRIISC 589 00:35:54,680 --> 00:36:00,190 TO INCLUDE THE LUNG FUNCTION TESTS WITH DIFFUSING CAPACITY. 590 00:36:00,190 --> 00:36:03,190 WE’RE ABLE TO PERFORM FORCED OSCILLOMETRY, 591 00:36:03,190 --> 00:36:05,260 EXHALED NITRIC OXIDE LEVELS, 592 00:36:05,260 --> 00:36:10,700 AS WELL AS BRONCHOPROVOCATION CHALLENGE TESTING. 593 00:36:10,700 --> 00:36:13,700 WE ALSO ARE ABLE TO TAKE IT A STEP FURTHER, 594 00:36:13,700 --> 00:36:15,700 BECAUSE MANY VETERANS HAVE SYMPTOMS 595 00:36:15,700 --> 00:36:17,700 WHEN THEY ARE EXERCISING, 596 00:36:17,700 --> 00:36:22,540 SO WE HAVE THE ABILITY TO DO CARDIOPULMONARY EXERCISE FUNCTION TESTS 597 00:36:22,540 --> 00:36:26,210 TO DETERMINE WHETHER THERE’S A LIMITATION WITH THE LUNG FUNCTION 598 00:36:26,210 --> 00:36:31,720 OR IF IT’S THE CARDIAC OR ACTUALLY IT’S THE MUSCLES THAT’S IMPAIRING EXERCISE 599 00:36:31,720 --> 00:36:34,790 IN THE VETERANS-- WE’RE ABLE TO DETERMINE THAT. 600 00:36:34,790 --> 00:36:38,220 AND AT THE END OF THE EVALUATION, 601 00:36:38,220 --> 00:36:41,730 WE GIVE THE VETERAN PRETTY MUCH A ROADMAP 602 00:36:41,730 --> 00:36:47,730 OR A CARE PLAN THAT THEY CAN TAKE BACK TO THEIR REFERRING VA PCP 603 00:36:47,730 --> 00:36:53,240 OR PACT TEAM, FOR THEM TO BE ABLE TO MOVE FORWARD WITH THEIR CARE. 604 00:36:53,240 --> 00:36:55,110 SO, THAT TYPE OF EVOLUTION-- 605 00:36:55,110 --> 00:36:58,240 IT’S TYPICALLY DONE OVER 2 TO 3 DAYS AT THE WRIISC. 606 00:36:58,240 --> 00:37:02,380 AND THEN THE VETERAN RETURNS TO THEIR HOME VA FOR IMPLEMENTATION 607 00:37:02,380 --> 00:37:05,190 OF THE CARE PLAN THAT WE PROPOSE. 608 00:37:07,750 --> 00:37:14,260 SO, NOW THAT WE’VE SUMMARIZED WHAT A CLINICAL EVALUATION IS GONNA BE LIKE 609 00:37:14,260 --> 00:37:18,260 FOR A VETERAN WHO WANTS AN IN-PERSON EVALUATION, 610 00:37:18,260 --> 00:37:21,770 AND WE’VE TALKED ABOUT WHAT THIS REGISTRY ENTAILS, 611 00:37:21,770 --> 00:37:24,270 HOW ARE WE GETTING THE WORD OUT TO THE VETERANS? 612 00:37:24,270 --> 00:37:28,270 WELL, THE VA PLANS TO INFORM VETERANS ABOUT THE REGISTRY 613 00:37:28,270 --> 00:37:30,780 BY USING A NUMBER OF MECHANISMS. 614 00:37:30,780 --> 00:37:33,280 THAT WOULD INCLUDE POST CARD MAILINGS; 615 00:37:33,280 --> 00:37:37,780 FACT SHEETS; SOCIAL MEDIA, USING FACEBOOK AND TWITTER. 616 00:37:37,780 --> 00:37:41,790 THEY ARE COMMUNICATING WITH VETERAN SERVICE ORGANIZATIONS. 617 00:37:41,790 --> 00:37:44,790 DEPARTMENT OF DEFENSE IS ON BOARD WITH THIS, 618 00:37:44,790 --> 00:37:48,800 SO THAT SERVICEMEMBERS WHO ARE STILL ACTIVE DUTY 619 00:37:48,800 --> 00:37:50,800 HAVE THE ABILITY TO PARTICIPATE. 620 00:37:50,800 --> 00:37:56,800 THE VET CENTERS ARE GONNA BE PROVIDED INFORMATION ABOUT THE BURN PIT REGISTRY. 621 00:37:56,800 --> 00:37:58,670 AND THEN THERE ARE INTERNAL COMMUNICATIONS, 622 00:37:58,670 --> 00:38:04,740 SUCH AS STAFF NOTES AND THE "HEY VA" REMINDERS. 623 00:38:06,310 --> 00:38:09,820 WHAT ABOUT FOR VA PROVIDERS? HOW ARE WE GETTING THE WORD OUT? 624 00:38:09,820 --> 00:38:16,820 WELL, THIS WEBINAR IS ONE WAY OF GETTING THE INFORMATION OUT TO YOU AS A VA CLINICIAN. 625 00:38:16,820 --> 00:38:21,330 WE’RE HOPING THAT YOU WILL USE THE INFORMATION THAT YOU GET FROM THIS WEBINAR. 626 00:38:21,330 --> 00:38:26,330 IT’S AVAILABLE TO YOU AS A DOWNLOAD, AS I INDICATED TO YOU EARLIER ON. 627 00:38:26,330 --> 00:38:29,340 ON THAT CLIP--IT’S RIGHT THERE, THE PAPER CLIP. 628 00:38:29,340 --> 00:38:32,840 YOU CAN DOWNLOAD 3 DOCUMENTS WITHIN THE HOUR-- 629 00:38:32,840 --> 00:38:35,840 HOPEFULLY, AFTER THIS PRESENTATION IS COMPLETED-- 630 00:38:35,840 --> 00:38:38,340 SO YOU HAVE THIS WEBINAR TO REFER TO, 631 00:38:38,340 --> 00:38:40,850 AND YOU CAN SHARE IT WITH YOUR COLLEAGUES AS WELL. 632 00:38:40,850 --> 00:38:45,850 WE HAVE PROVIDER FACT SHEETS SPECIFIC FOR AIRBORNE HAZARD CONCERNS, 633 00:38:45,850 --> 00:38:49,860 SO THAT WILL BE AVAILABLE ON THE SHAREPOINT SITE 634 00:38:49,860 --> 00:38:51,520 AS WELL AS THE WRIISC WEBSITE 635 00:38:51,520 --> 00:38:53,860 AND THE OFFICE OF PUBLIC HEALTH WEBSITE. 636 00:38:53,860 --> 00:38:58,870 THERE’S GONNA BE A VHA INFORMATIONAL LETTER THAT GOES OUT TO THE CLINICIANS. 637 00:38:58,870 --> 00:39:01,870 THE WRIISC--WAR RELATED ILLNESS AND INJURY STUDY CENTER 638 00:39:01,870 --> 00:39:04,870 IS PUTTING OUT A NEWSLETTER IN APRIL, 639 00:39:04,870 --> 00:39:07,140 AND THAT WOULD FEATURE AIRBORNE HAZARDS 640 00:39:07,140 --> 00:39:10,380 AND THE AIRBORNE HAZARDS & OPEN BURN PIT REGISTRY. 641 00:39:10,380 --> 00:39:14,380 AND THEN THERE’S THE PDICI COMMUNITY OF PRACTICE CALL-- 642 00:39:14,380 --> 00:39:20,490 THE POST-DEPLOYMENT INTEGRATIVE CARE INITIATIVE COMMUNITY OF PRACTICE CALL. 643 00:39:20,490 --> 00:39:24,890 WE’LL BE GIVING A PRESENTATION OF THAT CALL AS WELL. 644 00:39:24,890 --> 00:39:29,400 SO, THIS IS THE INFORMATION THAT WILL BE AVAILABLE TO ALL VA CLINICIANS, 645 00:39:29,400 --> 00:39:35,400 AND WE’RE HOPING THAT EACH PERSON WOULD HAVE ACCESS TO THIS INFORMATION 646 00:39:35,400 --> 00:39:40,410 SO THAT THEY ARE WELL-EQUIPPED TO EVALUATE VETERANS 647 00:39:40,410 --> 00:39:42,740 THAT HAVE AIRBORNE HAZARD CONCERNS. 648 00:39:44,440 --> 00:39:49,920 SO, IN SUMMARY, BASED ON WHAT WE’VE DISCUSSED TODAY AS A VA CLINICIAN, 649 00:39:49,920 --> 00:39:53,920 YOU MAY BE THINKING, "WELL, WHAT’S MY ROLE? WHAT DO I NEED TO DO WITH THIS?" 650 00:39:53,920 --> 00:39:58,930 WELL, YOU NEED TO BE FAMILIAR WITH THE EXPOSURE CONCERNS THAT THE VETERANS HAVE, 651 00:39:58,930 --> 00:40:00,930 SPECIFICALLY RELATED TO AIRBORNE HAZARDS, 652 00:40:00,930 --> 00:40:04,430 ’CAUSE THEY WILL BE COMING TO THE VA FOR EVALUATION 653 00:40:04,430 --> 00:40:08,430 AFTER THEY’VE COMPLETED THEIR SELF-ASSESSMENT QUESTIONNAIRE. 654 00:40:08,430 --> 00:40:12,440 YOU SHOULD KNOW THAT THERE ARE NO SPECIFIC BIOMARKERS OF EXPOSURES 655 00:40:12,440 --> 00:40:14,140 OF THESE AIRBORNE HAZARDS 656 00:40:14,140 --> 00:40:17,940 OR EVEN BIOMARKERS OF DISEASE RELATED TO THESE AIRBORNE EXPOSURES 657 00:40:17,940 --> 00:40:19,780 AT THIS PRESENT TIME. 658 00:40:19,780 --> 00:40:22,450 SO, IT’S IMPORTANT THAT YOU, AS A VA CLINICIAN, 659 00:40:22,450 --> 00:40:24,950 THAT YOU HAVE A HIGH INDEX OF CLINICAL SUSPICION 660 00:40:24,950 --> 00:40:29,960 FOR RESPIRATORY CONDITIONS AND HAVE A LOW BAR FOR FURTHER EVALUATION. 661 00:40:29,960 --> 00:40:34,460 IT’S IMPORTANT THAT YOU PERFORM THE APPROPRIATE WORKUP FOR EACH PATIENT 662 00:40:34,460 --> 00:40:36,460 IN A TIMELY MANNER AND EXPEDITIOUSLY. 663 00:40:36,460 --> 00:40:40,970 REMEMBER, THAT THESE MEN AND WOMEN WERE EXPOSED MANY YEARS AGO. 664 00:40:40,970 --> 00:40:43,470 THEY’VE LIVED WITH THESE SYMPTOMS FOR QUITE A WHILE. 665 00:40:43,470 --> 00:40:47,970 MANY OF THEM ARE ALREADY FRUSTRATED WITH THEIR HEALTH CONDITION 666 00:40:47,970 --> 00:40:52,980 AND SOMETIMES WITH THE CARE THAT THEY’VE GOTTEN SO FAR 667 00:40:52,980 --> 00:40:57,980 IN THE SENSE THAT THERE HASN’T BEEN A LOT OF ATTENTION FOCUSED ON THIS. 668 00:40:57,980 --> 00:41:01,990 SO, IT’S IMPORTANT THAT WE EXPEDITE THEIR CLINICAL EVALUATION 669 00:41:01,990 --> 00:41:03,990 TO THE EXTENT POSSIBLE, 670 00:41:03,990 --> 00:41:08,930 AND YOU WANT TO REFER THEM FOR SPECIALTY CONSULTATIONS AS INDICATED. 671 00:41:10,500 --> 00:41:16,500 SO I HAVE REFERENCES LISTED AS WELL IN THE PRESENTATION. 672 00:41:16,500 --> 00:41:22,010 AND THE WEBINAR WILL BE AVAILABLE 673 00:41:22,010 --> 00:41:26,010 AT THE END OF THIS PRESENTATION AS A DOWNLOAD, 674 00:41:26,010 --> 00:41:31,520 AND THERE IS A WEBSITE THERE FOR YOU TO ACCESS THE WEBINAR. 675 00:41:31,520 --> 00:41:34,520 AND NOW WE WILL TAKE QUESTIONS. 676 00:41:34,520 --> 00:41:38,020 ’CAUSE I SEE THAT THERE HAVE BEEN QUITE A NUMBER OF QUESTIONS 677 00:41:38,020 --> 00:41:40,530 COMING UP ON THE SCREEN. 678 00:41:40,530 --> 00:41:43,530 - THANK YOU, DR. OSINUBI. THIS IS DR. SANCHEZ. 679 00:41:43,530 --> 00:41:47,530 I’VE BEEN TRYING TO ANSWER SOME OF THE QUESTIONS, AS HAS DR. HELMER, 680 00:41:47,530 --> 00:41:50,540 BUT I THOUGHT WE SHOULD GO THROUGH A COUPLE CATEGORIES OF QUESTIONS 681 00:41:50,540 --> 00:41:53,040 THAT SEEM TO BE COMING UP FREQUENTLY. 682 00:41:53,040 --> 00:42:00,050 THE FIRST ONE IS "HOW MUCH TIME SHOULD A PROVIDER ALLOT FOR THE EXAM?" 683 00:42:00,050 --> 00:42:04,050 - THAT’S A VERY GOOD QUESTION AND A REALLY PERTINENT QUESTION. 684 00:42:04,050 --> 00:42:06,050 IT HAS BEEN FIELD-TESTED, 685 00:42:06,050 --> 00:42:08,050 AND THE UNDERSTANDING THAT WE HAVE 686 00:42:08,050 --> 00:42:14,060 IS THAT IT COULD TAKE BETWEEN 30 TO 40 MINUTES, ON THE AVERAGE, 687 00:42:14,060 --> 00:42:18,060 BUT I WOULD SAY ABOUT AN HOUR AT THE MOST. 688 00:42:18,060 --> 00:42:23,070 BUT I THINK 30 TO 40 MINUTES, IT’S ABOUT REALISTIC TIMEFRAME. 689 00:42:23,070 --> 00:42:26,070 AGAIN, IT’S GONNA DEPEND IN PART, THOUGH, ON, YOU KNOW, 690 00:42:26,070 --> 00:42:31,580 THE CONSENT OF THE VETERAN AND THE TIME THEY TAKE TO DESCRIBE THE EXPOSURES. 691 00:42:31,580 --> 00:42:35,580 BUT ON THE WHOLE, WE’RE THINKING THIS WOULD BE WITHIN 30 TO 40 MINUTES 692 00:42:35,580 --> 00:42:38,220 OR MAYBE AN HOUR AT THE MOST. 693 00:42:38,220 --> 00:42:43,590 - AND CAN YOU ALSO JUST REITERATE EXACTLY WHERE THE TEMPLATE WILL BE FOUND IN CPRS 694 00:42:43,590 --> 00:42:47,090 AND RECONFIRM THAT THE TEMPLATE WILL BE AVAILABLE 695 00:42:47,090 --> 00:42:50,600 BEFORE THE REGISTRY GETS ADVERTISED? 696 00:42:50,600 --> 00:42:56,600 - YES, MY UNDERSTANDING IS THAT IT WILL BE AVAILABLE EFFECTIVE APRIL 1st. 697 00:42:56,600 --> 00:43:01,110 DR. HELMER, IS THAT YOUR UNDERSTANDING? 698 00:43:01,110 --> 00:43:04,110 OK, HE’S NOT COMING ON. 699 00:43:04,110 --> 00:43:05,610 - CAN YOU HEAR ME? 700 00:43:05,610 --> 00:43:07,110 - YES, WE CAN. 701 00:43:07,110 --> 00:43:11,620 - SO, THE TEMPLATE SHOULD BE READY FOR INSTALLATION THROUGH A PATCH 702 00:43:11,620 --> 00:43:13,120 BY THE END OF MARCH. 703 00:43:13,120 --> 00:43:16,120 AND MY UNDERSTANDING IS THAT THE VETERAN SELF-ASSESSMENT 704 00:43:16,120 --> 00:43:19,130 WILL BE ROLLED OUT AFTER THAT. 705 00:43:19,130 --> 00:43:23,130 - OK, AND PERHAPS AGAIN, WE CAN JUST CLARIFY THE EXPECTATIONS. 706 00:43:23,130 --> 00:43:26,130 WE’VE GOT A LOT OF QUESTIONS ABOUT, YOU KNOW... 707 00:43:26,130 --> 00:43:29,140 "WHAT AM I RESPONSIBLE FOR AS A PCP?" 708 00:43:29,140 --> 00:43:31,640 AND "SHOULD THE ENVIRONMENTAL HEALTH CLINICIAN DO THIS, 709 00:43:31,640 --> 00:43:33,640 OR SHOULD THE PCP?" 710 00:43:33,640 --> 00:43:35,640 SO, DR. HELMER, I KNOW YOU TYPED YOUR RESPONSE TO THIS, 711 00:43:35,640 --> 00:43:38,580 BUT COULD YOU AGAIN REITERATE WHAT THE ANSWER IS TO THAT? 712 00:43:40,980 --> 00:43:42,650 - I’M SORRY. SUSIE, CAN YOU REPEAT THAT? 713 00:43:42,650 --> 00:43:45,150 - WHO’S RESPONSIBLE FOR CONDUCTING THE EVALUATIONS? 714 00:43:45,150 --> 00:43:47,150 - OH, YEAH. 715 00:43:47,150 --> 00:43:52,160 SO, THE IDEA--ONE OF THE NEW THINGS ABOUT THIS REGISTRY 716 00:43:52,160 --> 00:43:58,160 IS THAT WE WERE TRYING TO PROMOTE THE INTEGRATION OF THE INITIAL EVALUATION 717 00:43:58,160 --> 00:44:00,800 INTO THE REGULAR CARE OF THE PATIENT. 718 00:44:00,800 --> 00:44:06,170 AND SO, IN SOME WAYS, THE DEFAULT IS THAT THIS WOULD BE AN EXAM, 719 00:44:06,170 --> 00:44:10,680 AN ENCOUNTER BETWEEN A PATIENT, A VETERAN, AND A PRIMARY CARE PROVIDER. 720 00:44:10,680 --> 00:44:13,680 IF THE VETERAN DOES NOT HAVE A PRIMARY CARE PROVIDER, 721 00:44:13,680 --> 00:44:18,680 THEN THE SECOND CHOICE WOULD THEN BE AN ENVIRONMENTAL HEALTH CLINICIAN. 722 00:44:18,680 --> 00:44:24,690 NOW, THAT CAN VARY DEPENDING ON THE LOCATION AND THE SPECIFIC EXPERTISE 723 00:44:24,690 --> 00:44:26,690 AND AVAILABILITY, WAIT TIMES. 724 00:44:26,690 --> 00:44:31,600 ALL THOSE SORTS OF THINGS MAY DRIVE DIFFERENT SOLUTIONS, 725 00:44:31,600 --> 00:44:33,170 AND THAT FLEXIBILITY IS GONNA BE THERE. 726 00:44:33,170 --> 00:44:39,710 THE TEMPLATE IS ACTUALLY ABLE TO BE USED BY LOTS OF DIFFERENT PEOPLE. 727 00:44:39,710 --> 00:44:44,710 I THINK ONE OF THE OTHER QUESTIONS THAT FLASHED THROUGH HERE WAS-- 728 00:44:44,710 --> 00:44:47,210 A PROVIDER, I GUESS, SAID, "YOU KNOW, IT TAKES ME-- 729 00:44:47,210 --> 00:44:50,220 "I HAVE AN HOUR TO DO AN INITIAL EVALUATION WITH A PATIENT. 730 00:44:50,220 --> 00:44:54,220 IS THIS SUPPOSED TO BE PART OF THAT EVALUATION, OR IS IT SUPPOSED TO BE SEPARATE?" 731 00:44:54,220 --> 00:44:56,720 YOU KNOW, I THINK IT DEPENDS ON THE PATIENT. 732 00:44:56,720 --> 00:44:59,730 CERTAINLY, WE’D LIKE YOU TO DOCUMENT THE ASSESSMENT 733 00:44:59,730 --> 00:45:01,990 FOR THE AIRBORNE HAZARD CONCERNS SEPARATELY, 734 00:45:01,990 --> 00:45:08,730 BECAUSE THAT NOTE TAIL GIVES US THE ABILITY TO TRACK RESPONSES 735 00:45:08,730 --> 00:45:14,740 AND KEEP AN EYE ON WHAT’S HAPPENING WITH PATIENTS WITH AIRBORNE HAZARD CONCERNS. 736 00:45:14,740 --> 00:45:21,250 AND IT MAY OR MAY NOT FIT INTO THE FLOW OF YOUR REGULAR INITIAL HISTORY 737 00:45:21,250 --> 00:45:23,750 AND PHYSICAL WITH THE PATIENT. 738 00:45:23,750 --> 00:45:26,750 BUT I THINK IT DOES DEPEND, I THINK--YOU KNOW, THE IDEA IS THAT THE PATIENT 739 00:45:26,750 --> 00:45:29,260 MAY BE COMING AND SAYING, "I’M HERE FOR MY INITIAL EVALUATION, 740 00:45:29,260 --> 00:45:31,260 AND I HAVE AIRBORNE HAZARDS CONCERNS." 741 00:45:31,260 --> 00:45:33,190 YOU DON’T WANT TO IGNORE THAT. 742 00:45:33,190 --> 00:45:35,260 BUT IF YOU THINK IT’S GONNA TAKE A LOT OF TIME, 743 00:45:35,260 --> 00:45:37,330 YOU MAY SAY, "WELL, LET’S FOCUS ON SOME OTHER THINGS, 744 00:45:37,330 --> 00:45:40,700 AND LET’S SCHEDULE A SEPARATE VISIT TO DISCUSS THAT." 745 00:45:40,700 --> 00:45:42,770 AND OMOWUNMI, I WAS HAVING SOME ISSUES WITH THE SOUND, 746 00:45:42,770 --> 00:45:45,200 AND SO I’M NOT SURE IF YOU SAID THIS. 747 00:45:45,200 --> 00:45:48,270 BUT THE ESTIMATE RIGHT NOW IS THAT THE VA OVERALL 748 00:45:48,270 --> 00:45:51,780 WILL ONLY SEE AN INCREASE OF ABOUT 26,000 VISITS. 749 00:45:51,780 --> 00:45:53,750 AND WHILE THAT MIGHT SOUND LIKE A LARGE NUMBER, 750 00:45:53,750 --> 00:45:59,290 WHEN YOU THINK ABOUT THAT SPREAD ACROSS 154 DIFFERENT FACILITIES AND EVEN MORE CBOCs, 751 00:45:59,290 --> 00:46:04,920 ANY GIVEN PROVIDER IS PROBABLY NOT GOING TO SEE A LARGE NUMBER OF EXTRA VISITS 752 00:46:04,920 --> 00:46:07,790 BECAUSE OF THIS PARTICULAR REGISTRY. 753 00:46:07,790 --> 00:46:12,300 AND LIKE I SAID, OFTEN TIMES, YOUR PATIENTS ARE ASKING ABOUT THESE SYMPTOMS 754 00:46:12,300 --> 00:46:14,930 THAT THEY’RE EXPERIENCING OR EVEN BRINGING UP 755 00:46:14,930 --> 00:46:17,800 THE CONCERN ABOUT THE EXPOSURE WHEN THEY COME AND SEE YOU. 756 00:46:17,800 --> 00:46:20,810 - DR. HELMER, THAT JUST FALLS ONTO A QUESTION THAT WAS ASKED JUST A MINUTE AGO 757 00:46:20,810 --> 00:46:22,810 ABOUT WHETHER OR NOT THE IMPACT HAS BEEN ASSESSED 758 00:46:22,810 --> 00:46:24,810 RELATIVE TO THE PACTs AND PCPs. 759 00:46:24,810 --> 00:46:27,310 SO I THINK YOU’VE ANSWERED THAT. 760 00:46:27,310 --> 00:46:29,650 CAN WE JUST GIVE AGAIN THE NAME OF THE TEMPLATE 761 00:46:29,650 --> 00:46:31,820 AND EXACTLY WHERE IT WILL BE LOCATED? 762 00:46:31,820 --> 00:46:34,920 WE’VE HAD A NUMBER OF QUESTIONS ABOUT THAT. 763 00:46:34,920 --> 00:46:37,920 - WELL, THE NAME OF THE TEMPLATE IS ACTUALLY 764 00:46:37,920 --> 00:46:45,330 "THE BURN PIT AIRBORNE HAZARDS INITIAL EVALUATION NOTE." 765 00:46:45,330 --> 00:46:48,670 BUT THE BEST THING ABOUT IT IS WHEN YOU GO TO OPEN A NEW NOTE-- 766 00:46:48,670 --> 00:46:51,840 LIKE YOU DO WITH ANY PATIENT, YOU OPEN THE ENCOUNTER 767 00:46:51,840 --> 00:46:53,840 AND GO IN AND TYPE A NEW NOTE. 768 00:46:53,840 --> 00:46:57,340 IF YOU TYPE IN "BURN PIT" OR "AIRBORNE HAZARDS," IT POPS UP. 769 00:46:57,340 --> 00:46:59,350 RIGHT NOW, IT’S THE ONLY ONE IN THERE. 770 00:46:59,350 --> 00:47:01,980 AND WHEN THE NOTE TEMPLATE IS INSTALLED-- 771 00:47:01,980 --> 00:47:05,750 SO, IT’S NOT INSTALLED-- IT’S ONLY INSTALLED IN EAST ORANGE, DETROIT, 772 00:47:05,750 --> 00:47:07,250 AND INDIANAPOLIS RIGHT NOW. 773 00:47:07,250 --> 00:47:09,360 BUT WHEN IT IS INSTALLED AT YOUR SITE, 774 00:47:09,360 --> 00:47:10,860 ALL YOU HAVE TO DO IS TYPE IN "BURN PIT," 775 00:47:10,860 --> 00:47:14,390 AND THAT NOTE TEMPLATE WILL POP UP FOR YOU. 776 00:47:14,390 --> 00:47:18,200 - GREAT. AND SIMILARLY, WE’VE HAD SEVERAL QUESTIONS ABOUT WHAT GETS AUTOPOPULATED 777 00:47:18,200 --> 00:47:19,630 INTO THE TEMPLATE. 778 00:47:19,630 --> 00:47:21,700 AND I KNOW, DR. HELMER, YOU ANSWERED THAT, 779 00:47:21,700 --> 00:47:26,340 THAT ESSENTIALLY WOULD NOT INCLUDE DoD INFORMATION 780 00:47:26,340 --> 00:47:28,040 OR DoD STUDIES, 781 00:47:28,040 --> 00:47:29,810 BUT IT COULD INCLUDE INFORMATION 782 00:47:29,810 --> 00:47:33,180 IF IT WAS PART OF, AGAIN, CPRS OR VISTA. 783 00:47:33,180 --> 00:47:35,280 SO IT MIGHT INCLUDE IT FROM OUTSIDE YOUR OWN FACILITY, 784 00:47:35,280 --> 00:47:38,180 DEPENDING ON IF IT WAS CPRS OR VISTA, IS THAT CORRECT? 785 00:47:38,180 --> 00:47:43,390 - YEAH, SO IT’S GONNA INPUT THE VITAL SIGNS. 786 00:47:43,390 --> 00:47:47,190 IT’S GONNA TAKE SOME OF THE CLINICAL REMINDERS THAT MAY HAVE BEEN ANSWERED RECENTLY. 787 00:47:47,190 --> 00:47:50,160 IT’S GOING TO PULL SOME OF THE RECENT DIAGNOSTIC WORKUP 788 00:47:50,160 --> 00:47:54,230 THAT’S ACCESSIBLE IN YOUR SYSTEM. 789 00:47:54,230 --> 00:47:57,000 AND IT WILL PULL ALL THOSE IN. 790 00:47:57,000 --> 00:48:00,140 IN A WAY, IT PULLS IN THE PROBLEM LIST, IT PULLS IN THE MEDICATIONS. 791 00:48:00,140 --> 00:48:03,840 SO, JUST LIKE WITH A LOT OF OUR TEMPLATES AND PRIMARY CARE, 792 00:48:03,840 --> 00:48:06,650 YOU GET A LOT OF THAT INFORMATION RIGHT THERE 793 00:48:06,650 --> 00:48:11,920 WHEN YOU’RE SEEING THE PATIENT ALREADY POPULATED INTO THE NOTE TEMPLATE. 794 00:48:11,920 --> 00:48:14,450 - WE’VE HAD MORE QUESTIONS ON TRAINING. 795 00:48:14,450 --> 00:48:18,090 AGAIN, THIS WAS ACTUALLY CONSIDERED INITIAL TRAINING FOR PROVIDERS. 796 00:48:18,090 --> 00:48:20,960 IF PEOPLE FEEL THAT THERE’S ADDITIONAL INFORMATION THAT THEY NEED, 797 00:48:20,960 --> 00:48:22,760 IT WOULD BE GOOD TO KNOW WHAT THAT IS. 798 00:48:22,760 --> 00:48:25,900 WE HAVE HAD SOME DISCUSSIONS ABOUT OTHER THINGS THAT WE MIGHT DO, 799 00:48:25,900 --> 00:48:29,400 ALONG WITH OFFICE OF PUBLIC HEALTH TO PROVIDE SOME ADDITIONAL TRAINING, 800 00:48:29,400 --> 00:48:32,540 WHETHER IT’S SOMETHING IN ...OR ADDITIONAL WEBINARS LIKE THIS. 801 00:48:32,540 --> 00:48:36,310 WE’RE LOOKING AT PERHAPS MAYBE A WEBINAR TAILORED WITH PULMONOLOGISTS. 802 00:48:36,310 --> 00:48:38,580 AGAIN, IT’S ANOTHER EXAMPLE OF A TIER TRAINING, 803 00:48:38,580 --> 00:48:42,110 AND WE’RE GONNA HAVE THIS SERIES OF FACT SHEETS THAT WILL BE AVAILABLE. 804 00:48:42,110 --> 00:48:45,350 WE HAVE GOTTEN A QUESTION ABOUT WHAT IF WE WANT TO REFER SOMEBODY TO THE WRIISC, 805 00:48:45,350 --> 00:48:46,650 HOW DO WE DO THAT. 806 00:48:46,650 --> 00:48:48,490 SO, EITHER DR. OSINUBI OR DR. HELMER, 807 00:48:48,490 --> 00:48:51,590 WOULD YOU LIKE TO DISCUSS THAT? 808 00:48:51,590 --> 00:48:52,960 - YEAH, I CAN TAKE THAT QUESTION-- 809 00:48:52,960 --> 00:48:55,530 - SURE. - IF YOU GO TO-- GO AHEAD, DREW. 810 00:48:55,530 --> 00:48:58,000 - NO, GO AHEAD. 811 00:48:58,000 --> 00:49:04,940 - OK, SO IF YOU GO TO THE WEBSITE, WARRELATEDILLNESS.GOV, 812 00:49:04,940 --> 00:49:08,870 THERE IS--SORRY. LET ME GET THAT. 813 00:49:08,870 --> 00:49:14,110 WWW.WARRELATEDILLNESS.VA.G-O-V, OR DOT.GOV. 814 00:49:14,110 --> 00:49:18,480 THE INFORMATION IS THERE AS TO HOW TO REFER THE PATIENT TO THE WRIISC. 815 00:49:18,480 --> 00:49:21,990 YOU HAVE TO PUT IN A REFERRAL THROUGH CPRS, 816 00:49:21,990 --> 00:49:23,460 BUT IT WILL GUIDE YOU. 817 00:49:23,460 --> 00:49:27,530 THERE ARE SPECIFIC INSTRUCTIONS ON THE WEBSITE. 818 00:49:27,530 --> 00:49:29,260 - AND I WILL SAY THAT WE’RE IN THE PROCESS RIGHT NOW 819 00:49:29,260 --> 00:49:32,770 OF ACTUALLY PUTTING TOGETHER A BROCHURE FOR PROVIDERS 820 00:49:32,770 --> 00:49:36,500 THAT WILL EXPLAIN, AGAIN, WHAT WE DO IN TERMS OF AIRBORNE HAZARDS AT THE WRIISC 821 00:49:36,500 --> 00:49:38,500 AND, AGAIN, HOW TO GET THAT REFERRAL. 822 00:49:38,500 --> 00:49:42,540 SO, THAT’S A PRODUCT THAT WILL BE FORTHCOMING. 823 00:49:42,540 --> 00:49:47,510 WE ALSO HAD A QUESTION ABOUT WHO’S COVERED. 824 00:49:47,510 --> 00:49:50,220 AND I THINK DR. ... HAS JUST ANSWERED THAT, 825 00:49:50,220 --> 00:49:52,720 WHETHER OR NOT DoD CIVILIAN EMPLOYEES ARE COVERED, 826 00:49:52,720 --> 00:49:56,520 AND ESSENTIALLY, WE HAD A SLIDE EARLIER THAT TALKED ABOUT WHO IS ELIGIBLE 827 00:49:56,520 --> 00:49:58,460 FOR THE REGISTRY, 828 00:49:58,460 --> 00:50:02,460 AND IT WOULD NOT INCLUDE DoD OR CIVILIAN EMPLOYEES. 829 00:50:06,200 --> 00:50:08,100 LET’S SEE... 830 00:50:08,100 --> 00:50:15,410 AGAIN, WE GOT ANOTHER QUESTION ABOUT CAN ANY PCP DO THE EVALUATION? 831 00:50:15,410 --> 00:50:17,410 - YES. 832 00:50:17,410 --> 00:50:21,010 - I’LL ANSWER THAT, BECAUSE NOT ONLY IS THE ANSWER YES, 833 00:50:21,010 --> 00:50:25,680 BUT I SUSPECT THAT IF YOU HAD A PATIENT WALK INTO YOUR OFFICE SAYING, 834 00:50:25,680 --> 00:50:28,550 "I’M HERE FOR A CHRONIC COUGH, AND I THINK IT’S RELATED TO THE BURN PIT," 835 00:50:28,550 --> 00:50:30,360 YOU WOULD ADDRESS IT. 836 00:50:30,360 --> 00:50:37,960 AND I THINK IN SOME WAYS, CALLING IT A REGISTRY MAKES IT SOUND DIFFERENT AND UNUSUAL, 837 00:50:37,960 --> 00:50:41,000 BUT IT REALLY IS A LOT OF PRIMARY CARE, 838 00:50:41,000 --> 00:50:46,110 AND WHEN YOU GET TO THE POINT WHERE YOU DON’T KNOW THE NEXT STEP, YOU ASK FOR HELP. 839 00:50:46,110 --> 00:50:49,610 YOU GET THE PULMONOLOGIST INVOLVED, MAYBE GET YOUR ENVIRONMENTAL HEALTH CLINICIAN. 840 00:50:49,610 --> 00:50:53,550 MAYBE AFTER YOU’VE TAPPED INTO THOSE LOCAL RESOURCES, 841 00:50:53,550 --> 00:50:58,120 YOU COME TO THE WRIISC AND SAY, "HEY, GOT THIS REALLY UNUSUAL CASE. 842 00:50:58,120 --> 00:51:02,150 "THIS GUY HAS... HE’S HAD A COUGH. HE’S GOT WEIGHT LOSS. 843 00:51:02,150 --> 00:51:04,620 "CAN’T FIND ANYTHING WRONG WITH HIM. 844 00:51:04,620 --> 00:51:08,590 "PULMONARY FUNCTION TESTS AREN’T DEFINITIVE. 845 00:51:08,590 --> 00:51:10,200 WHAT DO YOU GUYS THINK IS GOING ON?" 846 00:51:10,200 --> 00:51:15,030 SO, I THINK ANY PCP CAN CERTAINLY START THE CONVERSATION WITH A PATIENT 847 00:51:15,030 --> 00:51:17,000 AND SAY, "LET’S LOOK AT YOUR HEALTH, 848 00:51:17,000 --> 00:51:21,070 LET’S LOOK AT YOUR CONCERNS, WHAT’S GOING ON HERE, AND LET’S MAKE A PLAN." 849 00:51:21,070 --> 00:51:24,540 - 2 LATE-BREAKING QUESTIONS WITH REGARD TO ELIGIBILITY, 850 00:51:24,540 --> 00:51:26,510 ALSO WHO CAN REFER. 851 00:51:26,510 --> 00:51:29,050 "CAN A PRIVATE PHYSICIAN REFER THEIR PATIENTS 852 00:51:29,050 --> 00:51:33,290 IF THE PATIENT IS A VET WHO REFUSES TO USE VA SERVICES?" 853 00:51:33,290 --> 00:51:35,820 - I THINK THE ANSWER TO THAT IS NO. 854 00:51:35,820 --> 00:51:39,120 WE REALLY NEED A REFERRAL TO COME FROM A VA PROVIDER. 855 00:51:39,120 --> 00:51:40,930 THAT’S HOW WE COMMUNICATE. 856 00:51:40,930 --> 00:51:46,800 WE’RE A SYSTEM OF CARE, AND I WILL SAY, THOUGH, 857 00:51:46,800 --> 00:51:50,140 WE OFTEN GET PATIENTS WHO PRIMARILY SEE OUTSIDE PROVIDERS, 858 00:51:50,140 --> 00:51:52,670 BUT IN TERMS OF THE ACTUAL REFERRAL TO THE WRIISC, 859 00:51:52,670 --> 00:51:57,210 WE REALLY NEED A VA PROVIDER TO MAKE THAT REFERRAL. 860 00:51:57,210 --> 00:52:00,080 - AND "DOES THE REGISTRY INCLUDE DUAL STATUS PERSONNEL 861 00:52:00,080 --> 00:52:03,950 FOR A RESERVIST WHO MIGHT ALSO BE A CONTRACTOR?" 862 00:52:03,950 --> 00:52:05,650 - A RESERVIST? 863 00:52:05,650 --> 00:52:07,290 - DR. ... JUST ANSWERED THAT. 864 00:52:07,290 --> 00:52:13,560 RESERVISTS ARE ELIGIBLE IF THEY ARE DEPLOYED WHILE CALLED TO ACTIVE DUTY. 865 00:52:13,560 --> 00:52:17,930 ANOTHER QUESTION ABOUT WHETHER OR NOT A FEE-BASIS PROVIDER THAT’S CONTRACTED BY THE VA 866 00:52:17,930 --> 00:52:19,670 CAN REFER. 867 00:52:19,670 --> 00:52:22,570 - YES, I THINK THAT WOULD BE ACCEPTABLE. 868 00:52:22,570 --> 00:52:28,710 - OK. AND BEFORE WE END THIS, WE WILL PUT UP THE URL FOR OUR SHAREPOINT SITE, 869 00:52:28,710 --> 00:52:30,380 WHICH IS WHERE A RECORDING IS. 870 00:52:30,380 --> 00:52:33,610 YOU CAN TELL YOUR COLLEAGUES, WE GOT TAPPED, EVIDENTLY, AT 400, 871 00:52:33,610 --> 00:52:35,480 IN TERMS OF THE AUDIO FOR THIS. 872 00:52:35,480 --> 00:52:40,690 SO THE RECORDING WILL GO UP ON OUR WRIISC SHAREPOINT SITE. 873 00:52:40,690 --> 00:52:45,020 QUESTION: "CAN COMP AND PEN DO THIS REGISTRY EXAM?" 874 00:52:45,020 --> 00:52:47,690 - THAT’S AN INTERESTING ONE. 875 00:52:47,690 --> 00:52:50,300 I GUESS--THIS IS DREW AGAIN. 876 00:52:50,300 --> 00:52:52,360 I THINK--AHEM-- 877 00:52:52,360 --> 00:52:56,700 I WOULD SAY IT’S PROBABLY NOT WHAT WE WOULD PREFER. 878 00:52:56,700 --> 00:52:58,970 NOW, I KNOW A LOT OF PROVIDERS DO COMP AND PEN 879 00:52:58,970 --> 00:53:04,580 AND ALSO DO PRIMARY CARE OR ALSO DO SOME OF THE OTHER REGISTRY EXAMS. 880 00:53:04,580 --> 00:53:08,150 SO, THIS IS NOT A COMP AND PEN EXAM. 881 00:53:08,150 --> 00:53:12,080 IT WOULD HAVE TO BE CONSIDERED CLINICAL CARE. 882 00:53:12,080 --> 00:53:15,790 SO, CAN A COMP AND PEN PROVIDER DO IT? ABSOLUTELY. 883 00:53:15,790 --> 00:53:19,860 IS IT A COMP AND PEN EXAMINATION? THE ANSWER IS NO. 884 00:53:22,230 --> 00:53:25,100 - AND I’M TRYING TO SEE IF THERE ARE ANY OTHER QUESTIONS FROM FOLKS. 885 00:53:25,100 --> 00:53:29,200 WE HAVE A COUPLE MORE PEOPLE WHO ARE TYPING. 886 00:53:29,200 --> 00:53:31,470 - YES, THERE’S A QUESTION HERE, SUSAN, THAT SAYS, 887 00:53:31,470 --> 00:53:35,770 "IF A VET IS REGISTERED AND EXAMINED PREVIOUSLY IN THE 1990s 888 00:53:35,770 --> 00:53:37,140 "AND WAS NOT OFFERED CARE, 889 00:53:37,140 --> 00:53:42,380 SHOULD THEY FILL OUT THE SELF-ASSESSMENT QUESTIONNAIRE?" 890 00:53:42,380 --> 00:53:45,420 - I THINK THE ANSWER TO THAT IS PROBABLY YES. 891 00:53:45,420 --> 00:53:50,820 SO, THIS IS DIFFERENT FROM THE GULF WAR REGISTRY. 892 00:53:50,820 --> 00:53:53,860 THIS IS THE SEPARATE REGISTRY, AS DR. OSINUBI MENTIONED. 893 00:53:53,860 --> 00:54:00,530 THE PERSONNEL WHO WERE DEPLOYED TO THE GULF REGION IN 1990 AND 1991 894 00:54:00,530 --> 00:54:03,770 ARE ELIGIBLE FOR THIS REGISTRY AS WELL, 895 00:54:03,770 --> 00:54:09,780 BUT THE SELF-ASSESSMENT QUESTIONNAIRE ASKS DIFFERENT QUESTIONS. 896 00:54:09,780 --> 00:54:12,950 ENROLLMENT IN THE REGISTRY IS GONNA BE TRACKED SEPARATELY, 897 00:54:12,950 --> 00:54:15,710 SO IF SOMEBODY HAS AN AIRBORNE HAZARDS CONCERN, 898 00:54:15,710 --> 00:54:19,250 I WOULD ENCOURAGE THEM TO COMPLETE THIS SELF-ASSESSMENT, 899 00:54:19,250 --> 00:54:24,290 EVEN IF THEY COMPLETED A GULF WAR REGISTRY EXAM IN THE PAST. 900 00:54:24,290 --> 00:54:26,290 - SO, WE HAVE THE WEBSITE TYPED UP THERE. 901 00:54:26,290 --> 00:54:28,130 I’M GONNA ASK FOR THE URL. 902 00:54:28,130 --> 00:54:31,930 IS THAT THE SAME AS OUR URL FOR OUR SHAREPOINT FOR THEM TO GET THE RECORDING? 903 00:54:31,930 --> 00:54:35,330 - NO. THAT’S FOR THE WRIISC. 904 00:54:35,330 --> 00:54:39,240 - CAN WE TYPE ALSO THE SHAREPOINT FOR WHERE THE RECORDING IS? 905 00:54:41,840 --> 00:54:44,010 I KNOW FLORENCE IS THERE WITH YOU. 906 00:54:44,010 --> 00:54:47,210 PERHAPS YOU CAN JUST HAVE HER TYPE IN THAT SHAREPOINT. 907 00:54:47,210 --> 00:54:50,250 - OK. WE’LL DO THAT IN A MINUTE. WE’RE JUST GETTING INFORMATION. 908 00:54:50,250 --> 00:54:52,350 - OK, THERE IS ANOTHER QUESTION THERE. 909 00:54:52,350 --> 00:54:54,090 "A STUDY IN THE "NEW ENGLAND JOURNAL OF MEDICINE" 910 00:54:54,090 --> 00:54:56,990 "ON RETURNING COMBAT VETS WITH DYSPNEA 911 00:54:56,990 --> 00:54:58,460 "HAD OPEN LUNG BIOPSY, 912 00:54:58,460 --> 00:55:00,230 "FINDING OF CONSTRICTIVE BRONCHIOLITIS. 913 00:55:00,230 --> 00:55:03,200 CAN YOU COMMENT ON THIS?" 914 00:55:03,200 --> 00:55:06,230 - THAT’S AN OMOWUNMI QUESTION. - YES, IT IS. 915 00:55:06,230 --> 00:55:08,930 - YES, YES. 916 00:55:08,930 --> 00:55:12,100 YES, CONSTRICTIVE BRONCHIOLITIS HAS BEEN DESCRIBED 917 00:55:12,100 --> 00:55:16,910 IN A SUBGROUP OF VETERANS WHO WERE DEPLOYED TO IRAQ, 918 00:55:16,910 --> 00:55:19,180 MOSTLY TO IRAQ. 919 00:55:19,180 --> 00:55:24,080 MANY OF THEM WERE EXPOSED TO THE SULFUR FIRE INCIDENT IN MAZRAA, 920 00:55:24,080 --> 00:55:29,760 ALTHOUGH THERE HAVE BEEN VETERANS WHO WERE NOT EXPOSED TO THE SULFUR FIRE INCIDENT 921 00:55:29,760 --> 00:55:34,090 AND THEY HAVE FOUND CONSTRICTIVE BRONCHIOLITIS ON THEIR LUNG PATHOLOGY. 922 00:55:34,090 --> 00:55:36,800 SO THAT STUDY HAS BEEN PUBLISHED. 923 00:55:42,470 --> 00:55:45,400 DID I ANSWER THE QUESTION? 924 00:55:45,400 --> 00:55:48,210 - WE DON’T HAVE A WAY FOR PEOPLE TO-- 925 00:55:48,210 --> 00:55:50,180 I GUESS WE COULD HAVE THEM TYPE IT IN. 926 00:55:50,180 --> 00:55:54,410 - YES. SO, THERE HAS BEEN-- THAT STUDY-- 927 00:55:54,410 --> 00:55:58,250 THAT HAS BEEN REPORTED IN THE MEDICAL LITERATURE. 928 00:55:58,250 --> 00:56:01,720 AND IT’S NOT UNIQUE JUST TO THIS TYPE OF EXPOSURE, 929 00:56:01,720 --> 00:56:04,020 IN OTHER OCCUPATIONAL SETTINGS AS WELL 930 00:56:04,020 --> 00:56:09,560 WHEN THEY HAVE HAD AIRBORNE HAZARDS EXPOSURES OF A DIFFERENT TYPE. 931 00:56:09,560 --> 00:56:14,000 THERE HAVE BEEN CASES OF WHAT LOOKS LIKE A CONSTRICTIVE BRONCHIOLITIS 932 00:56:14,000 --> 00:56:18,600 OR BRONCHIOLITIS OBLITERANS, FOR EXAMPLE, 933 00:56:18,600 --> 00:56:21,610 IN POPCORN WORKERS LUNG. 934 00:56:21,610 --> 00:56:27,550 SO, THESE ARE LUNG PATHOLOGIES IN RESPONSE TO TOXIC INSULTS. 935 00:56:27,550 --> 00:56:29,880 - WE’RE GETTING A LOT OF LATE-BREAKING QUESTIONS. 936 00:56:29,880 --> 00:56:31,850 WE HAD A QUESTION EARLIER THAT I FAILED TO SAY 937 00:56:31,850 --> 00:56:34,890 ABOUT WHETHER THE STUDY LOOKED AT AMMO DEPOTS THAT WERE BLOWN UP 938 00:56:34,890 --> 00:56:36,390 CREATING AIRBORNE HAZARDS. 939 00:56:36,390 --> 00:56:38,490 WE JUST GOT ANOTHER QUESTION ON THE SULFUR FIRES 940 00:56:38,490 --> 00:56:41,260 AND IF YOU COULD PROVIDE SOME MORE INFORMATION OR A REFERENCE 941 00:56:41,260 --> 00:56:44,430 WHERE PEOPLE COULD GET THAT. 942 00:56:44,430 --> 00:56:49,940 - OK. THE U.S. ARMY PUBLIC HEALTH COMMAND 943 00:56:49,940 --> 00:56:56,440 ALSO HAS--THEY HAVE FACT SHEETS ON THOSE SPECIFIC EXPOSURES. 944 00:56:56,440 --> 00:56:59,080 THE WRIISC WEBSITE ALSO HAS FACT SHEETS 945 00:56:59,080 --> 00:57:01,450 ON SOME OF THOSE SPECIFIC EXPOSURES, 946 00:57:01,450 --> 00:57:06,390 SO WE CAN UPDATE WEBSITES IF THAT INFORMATION IS NOT ALREADY THERE. 947 00:57:08,220 --> 00:57:12,460 - I’D LIKE TO ANSWER THE QUESTION ABOUT "IS THERE GOING TO BE A REPORTING FORM, 948 00:57:12,460 --> 00:57:14,960 LIKE THE AGENT ORANGE AND PERSIAN GULF WAR REGISTRIES?" 949 00:57:14,960 --> 00:57:18,330 THE ANSWER IS NO. THAT’S THE BEAUTY OF THIS. 950 00:57:18,330 --> 00:57:23,970 THE VETERAN IS RESPONSIBLE FOR ENTERING THEIR SELF-ASSESSMENT INFORMATION ON THE WEB, 951 00:57:23,970 --> 00:57:28,470 AND THAT FORMS THE BASIS FOR PARTICIPATION IN THE REGISTRY. 952 00:57:28,470 --> 00:57:33,410 AND THEN THE IN-PERSON EVALUATION IS CONSIDERED OPTIONAL. 953 00:57:33,410 --> 00:57:36,480 BUT IF YOU USE THE NOTE TEMPLATE THAT WE’VE DEVELOPED, 954 00:57:36,480 --> 00:57:39,480 THAT’S IT--THERE’S NO OTHER DOCUMENTATION REQUIRED. 955 00:57:39,480 --> 00:57:43,490 WE’LL USE SOME OF THE DATA MINING TECHNOLOGIES 956 00:57:43,490 --> 00:57:46,490 TO PULL OUT SOME OF THE HEALTH FACTORS 957 00:57:46,490 --> 00:57:49,130 OR THE DATA OBJECTS FROM THAT NOTE 958 00:57:49,130 --> 00:57:53,000 TO TRACK THE HEALTH STATUS AND THE CONCERNS OF THE PATIENTS, 959 00:57:53,000 --> 00:57:56,500 AS WELL AS THE PATTERNS OF THEIR WORKUP. 960 00:57:56,500 --> 00:58:01,010 SO, ONCE YOU DOCUMENT-- ONCE YOU SIGN THAT NOTE TEMPLATE, YOU’RE DONE. 961 00:58:01,010 --> 00:58:05,140 YOU DON’T HAVE TO DO ANYTHING ELSE FROM A DOCUMENTATION STANDPOINT. 962 00:58:05,140 --> 00:58:07,180 YOU HAVE TO TAKE CARE OF THE PATIENT, OF COURSE, 963 00:58:07,180 --> 00:58:10,020 BUT THAT’S WHY WE DID IT THAT WAY. 964 00:58:10,020 --> 00:58:12,650 - JUST ONE THING WE SHOULD POINT OUT. 965 00:58:12,650 --> 00:58:15,520 WE’VE BEEN TELLING ALL OF YOU THAT YOU CAN GO TO SHAREPOINT FOR THE RECORDING. 966 00:58:15,520 --> 00:58:18,020 I GUESS TO GET ACCESS TO THAT SHAREPOINT, 967 00:58:18,020 --> 00:58:19,520 WE’LL HAVE TO GIVE YOU ACCESS. 968 00:58:19,520 --> 00:58:21,790 SO IF YOU’RE INTERESTED IN THAT, 969 00:58:21,790 --> 00:58:25,530 E-MAIL FLORENCE.CHUA@VA.GOV. 970 00:58:25,530 --> 00:58:29,030 AND WE’LL HAVE TO PUT THAT INFORMATION SOMEHOW OUT MORE BROADLY 971 00:58:29,030 --> 00:58:34,970 SO THAT FOLKS WILL KNOW THAT TO GET ACCESS TO THAT SHAREPOINT SITE. 972 00:58:38,040 --> 00:58:41,050 WE HAD ANOTHER QUESTION ABOUT "ANY ADDITIONAL INFORMATION 973 00:58:41,050 --> 00:58:45,550 REGARDING SKIN DISORDERS WITH EXPOSURE?" 974 00:58:45,550 --> 00:58:47,890 - YEAH, I WAS JUST GONNA RESPOND TO THAT. 975 00:58:47,890 --> 00:58:49,550 SO THERE HAVE BEEN A COUPLE QUESTIONS 976 00:58:49,550 --> 00:58:52,060 ABOUT OTHER EXPOSURE CONCERNS AND OTHER HEALTH CONDITIONS 977 00:58:52,060 --> 00:58:55,060 THAT MIGHT BE RELATED TO DEPLOYMENT. 978 00:58:55,060 --> 00:58:57,560 IF YOU HAVEN’T DONE IT, CHECK OUT THE WRIISC WEBSITE, 979 00:58:57,560 --> 00:59:02,070 BECAUSE WE DO ADDRESS A COUPLE OF THE MORE COMMON DEPLOYMENT- RELATED HEALTH CONCERNS, 980 00:59:02,070 --> 00:59:04,570 AND SO DOES THE OFFICE OF PUBLIC HEALTH WEBSITE. 981 00:59:04,570 --> 00:59:09,070 I’LL PULL THAT UP AND TYPE IT IN THERE. 982 00:59:09,070 --> 00:59:14,080 BUT THERE ARE SOME REALLY NICE MATERIALS ALREADY DEVELOPED 983 00:59:14,080 --> 00:59:17,080 THAT DESCRIBE A LOT OF THE COMMON EXPOSURE CONCERNS 984 00:59:17,080 --> 00:59:21,090 AND THE WORK THAT’S BEEN DONE TO UNDERSTAND THOSE. 985 00:59:21,090 --> 00:59:24,590 - NOW, THERE’S ONE OTHER QUESTION THAT I WANTED TO ANSWER, FROM PORTLAND, 986 00:59:24,590 --> 00:59:28,990 THE QUESTION IS: "THE GULF WAR REGISTRY EVALUATIONS AT THE PORTLAND VA MEDICAL CENTER 987 00:59:28,990 --> 00:59:32,100 "INCLUDE ALL THE INFORMATION FOR THE AIRBORNE HAZARDS TEMPLATE. 988 00:59:32,100 --> 00:59:36,030 WHY ARE WE HAVING TO DO THIS TEMPLATE WHEN THIS IS AVAILABLE?" 989 00:59:38,100 --> 00:59:40,110 ANYONE WANT TO TACKLE THAT ONE? HA HA! 990 00:59:40,110 --> 00:59:44,110 - WELL, THERE’S A NEW LAW REQUIRING AN AIRBORNE HAZARDS REGISTRY, 991 00:59:44,110 --> 00:59:46,610 SO THAT’S PART OF THE ANSWER. 992 00:59:46,610 --> 00:59:48,610 UM... 993 00:59:48,610 --> 00:59:54,620 I THINK, IN SOME WAYS, THE NEW PROCESS OF DOING THIS-- 994 00:59:54,620 --> 00:59:59,620 AND SO, ALSO THERE ARE PEOPLE WHO ARE NOT ELIGIBLE FOR THE GULF WAR REGISTRY 995 00:59:59,620 --> 01:00:03,130 WHO ARE ELIGIBLE FOR THE AIRBORNE HAZARDS REGISTRY. 996 01:00:03,130 --> 01:00:11,140 AND I DO THINK THAT, YOU KNOW, BY INTEGRATING IT INTO THE CLINICAL CARE, 997 01:00:11,140 --> 01:00:13,140 PARTICULARLY INTO PRIMARY CARE, 998 01:00:13,140 --> 01:00:15,140 INTO THE PRIMARY CARE OF THE PATIENT, 999 01:00:15,140 --> 01:00:19,640 THAT YOU’RE POTENTIALLY DOING SOMETHING BETTER FOR THE PATIENT. 1000 01:00:19,640 --> 01:00:21,650 UM... 1001 01:00:21,650 --> 01:00:27,150 BUT IF YOU HAVE THAT TEMPLATE AVAILABLE AND PREFER TO USE THAT, 1002 01:00:27,150 --> 01:00:32,660 I WOULD JUST ASK THAT YOU CUT-AND-PASTE IT INTO THE NOTE TITLE FOR THE AIRBORNE HAZARDS. 1003 01:00:32,660 --> 01:00:35,160 I MEAN, IF YOU’VE ALREADY COLLECTED THAT INFORMATION. 1004 01:00:35,160 --> 01:00:40,670 YOU KNOW, SO, IT WOULDN’T MAKE SENSE TO DO 2 DIFFERENT REGISTRIES NECESSARILY, 1005 01:00:40,670 --> 01:00:44,170 BUT THAT’S A QUESTION THAT PROBABLY NEEDS TO BE ADDRESSED WITH THE PATIENT, 1006 01:00:44,170 --> 01:00:47,170 BECAUSE BOTH OF THESE ARE CONSIDERED VOLUNTARY. 1007 01:00:47,170 --> 01:00:51,180 THEY’RE SUPPOSED TO WANT TO PARTICIPATE IN THE REGISTRY. 1008 01:00:51,180 --> 01:00:53,680 - JUST TO POINT OUT, THERE’S SOME TYPING THAT’S GOING ON 1009 01:00:53,680 --> 01:00:55,680 ON THE QUESTIONS SLIDE RIGHT NOW, 1010 01:00:55,680 --> 01:01:00,690 SO DR. OSINUBI OR FLORENCE, YOU PROBABLY DON’T WANT THAT THERE. 1011 01:01:00,690 --> 01:01:02,690 SO, THERE IS SOME TYPING THAT’S-- 1012 01:01:02,690 --> 01:01:06,190 - YEAH, I DON’T KNOW WHO’S-- IT’S AN UNUSUAL THING. 1013 01:01:06,190 --> 01:01:10,700 SOMEONE IS PUTTING THIS ON, AND IT’S NOT FROM US HERE. 1014 01:01:10,700 --> 01:01:12,200 IT’S KIND OF RANDOM. 1015 01:01:12,200 --> 01:01:14,700 - YEP. THERE WAS SOME OTHER WRITING THERE BEFORE-- 1016 01:01:14,700 --> 01:01:16,840 - DON’T KNOW HOW IT GOT ON THERE. 1017 01:01:16,840 --> 01:01:19,700 THAT’LL HAVE TO BE SOMETHING WE HAVE TO LOOK AT FOR LINK. 1018 01:01:19,700 --> 01:01:22,710 SO, THERE WAS A QUESTION ABOUT WHETHER OR NOT THERE’LL BE A MASS MAILING 1019 01:01:22,710 --> 01:01:24,710 TO ALL VETERANS ABOUT THE REGISTRY. 1020 01:01:24,710 --> 01:01:28,210 AGAIN, I THINK THAT WAS POINTED OUT ON AN EARLIER SLIDE 1021 01:01:28,210 --> 01:01:30,720 WHAT THE COMMUNICATION PLAN IS. 1022 01:01:30,720 --> 01:01:33,150 AND, SO...YES, 1023 01:01:33,150 --> 01:01:35,720 THERE WILL BE A MAILING. 1024 01:01:35,720 --> 01:01:40,730 THERE’LL BE LOTS OF WAYS THAT VETERANS WILL BE INFORMED ABOUT THE REGISTRY. 1025 01:01:40,730 --> 01:01:43,230 AND JUST A POINT OF INFORMATION 1026 01:01:43,230 --> 01:01:45,860 THAT THERE WILL BE MORE INFORMATION, AGAIN, 1027 01:01:45,860 --> 01:01:48,230 AT THE NEXT ENVIRONMENTAL HEALTH QUARTERLY PROGRAM CALL. 1028 01:01:48,230 --> 01:01:50,240 THAT’S SCHEDULED FOR WEDNESDAY. 1029 01:01:50,240 --> 01:01:53,240 I DON’T KNOW IF THAT WAS A QUESTION TO DR. ..., 1030 01:01:53,240 --> 01:01:55,740 WOULD THIS BE DISCUSSED OR NOT. 1031 01:01:55,740 --> 01:01:59,240 AND WE CAN ALSO PROVIDE INFORMATION OR DO A WEBINAR 1032 01:01:59,240 --> 01:02:01,250 FOR THAT GROUP IF NEEDED, 1033 01:02:01,250 --> 01:02:05,250 IF PEOPLE THINK THAT THAT’S NEEDED. 1034 01:02:05,250 --> 01:02:10,260 SO, I KNOW WE WERE SUPPOSED TO GO TO 1:00, AND IT IS A LITTLE AFTER 1:00. 1035 01:02:10,260 --> 01:02:13,260 DR. ... IS TYPING. GREAT. 1036 01:02:13,260 --> 01:02:15,760 WE’LL LET THAT ANSWER COME UP. 1037 01:02:15,760 --> 01:02:18,260 BUT AGAIN, WE HOPE THAT THIS INFORMATION WAS USEFUL, 1038 01:02:18,260 --> 01:02:20,270 AND IT GAVE YOU AT LEAST A STARTING POINT 1039 01:02:20,270 --> 01:02:22,270 FOR UNDERSTANDING WHAT THE REGISTRY IS, 1040 01:02:22,270 --> 01:02:24,770 WHAT YOUR ROLE WILL BE AS A PROVIDER. 1041 01:02:24,770 --> 01:02:28,770 AND I WOULD AGAIN REMIND PEOPLE TO GO UP TO THAT PAPER CLIP 1042 01:02:28,770 --> 01:02:30,780 AND DOWNLOAD THE INFORMATION THAT’S THERE, 1043 01:02:30,780 --> 01:02:32,780 CHECK OUT THE SHAREPOINT FOR THE RECORDING 1044 01:02:32,780 --> 01:02:35,850 AND CONTINUE TO LOOK AT THE WRIISC WEBSITE, 1045 01:02:35,850 --> 01:02:39,780 ’CAUSE AS WE MAKE NEW PRODUCTS, WE’LL CONTINUE TO GET THAT OUT TO THE FIELD. 1046 01:02:39,780 --> 01:02:42,790 OUR GOAL IS TO DISSEMINATE INFORMATION THAT WILL ASSIST YOU 1047 01:02:42,790 --> 01:02:45,220 IN RESPONDING TO THE REGISTRY. 1048 01:02:47,290 --> 01:02:50,800 AND DR. HELMER, DR. OSINUBI, ANY LAST WORDS? 1049 01:02:50,800 --> 01:02:53,300 - YEAH, THANK YOU SO MUCH FOR YOUR ATTENTION. 1050 01:02:53,300 --> 01:02:55,800 AND THERE HAVE BEEN QUESTIONS AS TO WHEN THIS IS GONNA HAPPEN. 1051 01:02:55,800 --> 01:02:58,800 AFTER MARCH 31, 2014. 1052 01:02:58,800 --> 01:03:01,440 SO THAT HAS BEEN A RECURRING QUESTION. 1053 01:03:01,440 --> 01:03:05,310 SO, LOOK OUT FOR THIS APRIL 1, 2014, 1054 01:03:05,310 --> 01:03:08,250 IS WHEN THIS IS GONNA GO LIVE. 1055 01:03:09,810 --> 01:03:11,320 THANK YOU. 1056 01:03:11,320 --> 01:03:12,820 - DREW? 1057 01:03:12,820 --> 01:03:14,250 - THANK YOU, EVERYBODY. 1058 01:03:15,820 --> 01:03:18,820 - THANKS. - OK, BYE-BYE. 1059 01:03:18,820 --> 01:03:21,830 - AND DR. OSINUBI AND FLORENCE, EITHER, 1060 01:03:21,830 --> 01:03:26,330 IF YOU CAN JUST CALL ME BACK, PERHAPS RIGHT AFTER THIS, THAT WOULD BE GREAT. 1061 01:03:26,330 --> 01:03:29,270 - WILL DO. THANK YOU. - THANK YOU. 1062 01:03:31,340 --> 01:03:35,270 [WOMAN WHISPERING]