Clinical Education and Training: Putting Clinical Knowledge into Practice
The GWVI-TF Clinical Education and Training effort focused on improving the VA’s ability to put critical clinical knowledge and expertise at the point of care. Where the Clinical Care work was aimed at synchronizing specialty and primary health care, this effort was in direct support, providing necessary clinical education, training, and subject matter expertise. The Veterans health Administration (VHA) Office of Public Health created a series of training modules now universally available online for patients and clinicians. Additionally, VA hosted a series of exposure seminars to enhance clinician knowledge about the health impacts of various environmental exposures. In the coming year, again in direct support of Clinical Care, this effort will publish an environmental health pocket card for primary care providers and collaborate in the formal development/improvement of a three tiered network of care presented in the prototype clinic for Gulf War health care.
<p><strong>Please provide your comments, questions, and suggestion on how we may improve the Clinical Education and Training section of the report.</strong></p>
Angel Warrior 07 commented
The VA hosted a series of exposure semnars but to only 500 people. What about the others? There are a lot more doctors than 500 in the VA system? What is the plan to train others other than what is on the web page? What is the Field Training Plan? Can we Vets view it? Who gets it and when? How can we get a copy of the 2 training letters developed to inform and instruct Regional office personnel? One problem I see with the seperation health assessment is the illness or disease may not show up right away and soldiers always want to get home right away and are gung ho and don't want to admit they have a problem. Then later they do have and the door has been closed to adding there problem when it is service related. On the proactive literature who decides what will be included? Is there any GW Vets working with the VA team on this or has the RAC gotten to approve it?What does environmental scanning consist of? R&D: Encourage targeted efforts - Who decides the targeted efforts? Is the RAC and GWI Vets a part of this process? They should be. Task Force members were ask to ensure that efforts to serve these Veterans werer integrated into institutional practice and lasting VA culture - Who is responsible for follow-up to see this is done at the VA Clinics and hospitals? - Recommending a leadership reporting process to maintain accountability for completion - If they are already too busy to study GWI and don't really care what makes you think this is going to happen. We can't just throw it out there in the air and hope it will get done. There needs to be a continuous training program for all and they initial off when they have completed reading the material within the time given and if they don't they should be documented pay for not doing there required job. We did our job when called and are asking for nothing that shouldn't be expected if they seriously want to be in the position of serving Veterans and not just be there for the good pay and benefits. We need to be taken seriously and treated with respect. We didn't ask for this and we wish things could be different and we could have our good spirits and excellent health back. Thanks to all who really do care!
I remember when you were at Fitz, helping then, Know that MRI w contrast uses GADOLINIUM, rare earth metal, toxic, chelated, but the chelate breaks down, redistributes throughout the body, it accumulates too. gets deep into bones, severe bone pain, rib cage pain, contractures, joint pains, vision affected stars/halos, painful even in daytime, and destroys kidney function. This is a manmade disease, nephrogenic systemic fibrosis, no cure, can't chelate gadolinium or Gd+3 (free element) it goes to the kidneys, it also peneterates dura and gets to cerebellum, mimics neuro/derm diseases, they give to ESRD because they dialyze it out, bypass the kidneys, no reason to give to them either, won't change treatment or outcome. Get DOD records, contact Congressman's VA liaison in home state re VA. Make complaints to medical licensing boards. You have nothing to lose, but check that eGFR test for kidneys, alk Phosphatase, D dimers, calcium, Never get injections for MRI or CT, no need for contrasts with nuclear agents, see TC 99, nuclear waste product, used in bone scans and as a tracer in all new meds, bound to active ingredient in Boniva. search nuclear medicine, notice gadolinium on Wiki is missing. Get book on Element Toxicity by Barnes & Noble online, $20.
Denise Nichols commented
What is utterly frustrating is Dr Haley found neurological tests that prove the damage and yet the VA just throws it in can instead of getting all gulf war vets tested with the diagnostic testing that is available. What the vets want is dang it do the tests the squalene antibody, tests for the neurological damage re Dr Haley, tests for what is being found by the researchers NOW(Dr Klimas, Haley,Barinauck, the Fish Sky Chromosome tests, etc etc.) The Veterans want the right testing NOW, for god sake it has been 20 years! Quit with this insanity...we want the answers of what is wrong in our bodies NOW, compensate automatically. Let me make this simple Make one protocol with standing orders...all Diagnostic tests that should be done for every gulf war vet, blood work (ship to different researchers if needed the results transmitted to the records and sent to vet) then as these are documented in the record immediately put it in for claim update! This is get to be a cat herding episode and is a disservice to all of us that served. You do all the tests for all of us, then immediate connect to claim no need for more C and P exams! Dang it vets can get ss quicker than VA comp this is outrageous and a failed system totally. WE have hundred of thousands of us sick get the system streamlined!! NOW!! If you are ill and the medical tests prove then automatic flow to claim and compensate NOW. Vets need medical care not endless rat mazes!
Denise Nichols commented
The doctors do not know re what the VA themselves have put out much less VARACGWIR reports or research findings to help!!! WE need environmental and integrative medicine to be welcomed into VA now! Do something instead of nothing...try the Myers formula, try COQ10 IV or Gluthatione IV to help us! Check for a standard order sheet for gulf war vets that every doctor must use and all gulf war vets must get testing ie Sleep Study, EMGs, EEGs, MRI and MRI with contrast, vitamin testing, heavy metal testing, testing for ototoxiticy, visual testing, eye testing, assess dental status, check for disc deterioriation, cancer screening complete!!!, viral panels, thyroid testing, adrenal testing, pituitary, parathyroid, Killer cell ratios!!! WE need phase 1-3 of CCEP in one big project updated and done now, we need our gulf war illness clinics we had when we started...we deserve that!
Someone needs to take a good look at each illness, and rewrite things so they are the same across the VA. For instance, the new guideline recently released for treating gulf war vets, says for the docs to not prescribe bed rest for CFS, but the rating guideline says For the purpose of evaluating this disability, the condition will be considered incapacitating only while it requires bed rest and treatment by a physician.
Also the C&P worksheet for CFS, is based off the 1988 case definition, the rest of the world is using the updated 1995 definition.
Look through the many forums, and you will see many cases of a vet having a diagnosis of CFS from their doctor, but the C&P doc will say they do not meet the criteria.
David LaShell commented
Question, where did the critical information, knowledge, and expertise go? I have not talked to anyone at VISN-10 other than a freedom center set up for OIF/OEF veterans. Where do the GW veterans turn when they haven't been informed of exposed hazards? We still don't know the truth and the research may be able to give answers but first we have to have transparency as to where to go for that research.
Your right there needs to be better information dissemination across all VA levels.I have seen providers who are completely unaware GWI even exist. It is sad veterans must bear the brunt on battlefield and then face nearly up hill battle with enemy snipers everywhere to just for care and VA compensation. This is unconscionable/unscrupulous to say the least. Once again VA is failing our veterans and their families. Something needs to be done ASAP to restore VA back to what our founding fathers intended it to be.
I think there is a number of very important issues which are often overlooked when comes to this population of veterans. To begin with I think it would be a good Idea to have all VHA direct clinical practitioners have annual training.(LMS) This would include but not limited to Doctors, PA,NP,Respiratory Therapist, Nurses, and any other direct clinical provider. As a former VHA direct clinical provider and Gulf Veteran it is imperative that VHA and veterans alike are educated on GWI. First and foremost we must ensure those treating our veterans are up to speed with latest information concerning this population.
From my personal expirience I have had to show mediccal and give them the newtraining documents. As a patient I shouldn't have to be the information source. They complain that they don't get the word from the VISN!