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

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

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

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

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

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

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

A Message From the Chief

The State of VA Research /2009-2011

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

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

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

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

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

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

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

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

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

ConTenTS

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For questions or additional copies contact:

R&D Communications (12)

103 South Gay Street, Ste. 517

Baltimore, MD 21202

(410) 962-1800 x223

research.publications@va.gov

The State of VA Research /2009-2011

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Overview

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

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

This report highlights some of VA’s major research accom-plishments, with an emphasis on 2010 progress. As such, the report presents a snapshot of the types of research that

make VA Research an acclaimed model for conducting bench-to-bedside research.

Value of an intramural research program with price-less partnerships

One major advantage of VA R&D is that it is an intra-mural program where clinical care and research occur together within the VA system. Because of this, VA can bring scientific discovery from the patient’s bedside to the laboratory and back, making this program one of VA’s most effect tools for improving care for Veterans. Embed-ding research within an integrated health care system, with a state-of-the-art electronic health record, creates a national laboratory for the discovery of new medical knowledge and the translation of that knowledge into improved health. The fundamental goal is to address the needs of the entire Veteran population from the recruit who returns with inju-ries from recent a conflict to the aging Veteran. Ultimately, this research can benefit all those who receive health care in the United States .

VA is able to conduct innovative trials across multiple VA

VA Research plays key role in advancing health care for Veterans

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

At the same time VA embraces the advantages of an intra-mural program, VA R&D also embraces its close ties to academic affiliates and fosters dynamic collaborations with other federal agencies, nonprofit organizations, and private industry—thus magnifying the program’s impact on the health of our Veterans and the nation. Among VA’s committed partners in health care research are federal agencies such as the Department of Defense (DoD) and the Department of Health and Human Services (HHS). Combined, the agencies’ resources and unique strengths have produced powerful results and offer great promise for future improvements in Veterans’ health care.

VA’s Centers of Excellence—some associated with VA’s Health Services R&D Service and others with its Reha-bilitation R&D Service— attract the brightest minds from academia, industry, and medicine into the VA to collaborate on research solutions that respond to Veterans’ pressing health needs.

Trials bring much-needed hope to wounded VeteransAt the same time VA embraces the advantages of an intramural program, VA R&D also embraces its close ties to academic affiliates and fosters dy-namic collaborations with other federal agencies, nonprofit organizations, and private industry—thus magnifying the program’s impact on the health of our Veterans and the nation. Among VA’s committed partners in health care research are federal agencies such as the Depart-ment of Defense (DoD) and the Department of Health and Human Services (HHS). Combined, the agencies’ resources and unique strengths have produced powerful results and offer great promise for future improvements in Veterans’ health care.

VA’s Centers of Excellence—some associated with VA’s Health Services R&D Service and others with its Rehabilitation R&D Service— attract the brightest minds from academia, industry, and medicine into the VA to collaborate on research

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

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

near the collarbone.

Electrical stimulation from the battery-operated device

aims to jam the brain signals causing the

symptoms.

Research Spotlight

CSP Trial Looks at Brain Stimulation for Parkinson’s

Caption (top): this would be a creative caption, It would state something like the place, subject, and other important informa-tion the ready may want

to know. (Right) A VA employee interacts

with a Veteran.

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

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

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

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