Michael Wade

• U.S. Department of Veterans Affairs

Objective: Describe health service utilization in women veterans with eating disorder symptoms and characterize the nature of mental health services received. Method: Women veterans (N = 191) in a northeastern Veterans Health Administration region completed the Eating Disorders Examination Questionnaire. Health service utilization was then observed...

Background Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed.Objective To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared wi...

Objective: Mild traumatic brain injuries (mTBIs) are common among Veterans. Although the majority of neurobehavioral symptoms resolve following mTBI, studies with Veteran samples demonstrate a high frequency and chronicity of neurobehavioral complaints (e.g., difficulties with attention, frustration tolerance) often attributed to mTBI. Recent opin...

Objective: Individuals with posttraumatic stress disorder (PTSD) symptoms are often reluctant to engage in traditional mental health care but do seek primary care services. Alternative strategies are needed to develop emotional regulation skills among individuals with PTSD symptoms. This study examined the feasibility and effectiveness of Primary C...

Objective: Mild traumatic brain injuries (mTBIs) are common among Veterans. Although the majority of neurobehavioral symptoms resolve following mTBI, studies with Veteran samples demonstrate a high frequency and chronicity of neurobehavioral complaints (e.g., difficulties with attention, frustration tolerance) often attributed to mTBI. Recent opini...

Background: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. Objective: This pilot study aims to test the feasib...

AimTo determine whether statistically distinct classes of smokers exist according to mental health (MH) diagnoses within primary care and to evaluate whether class membership is associated with healthcare utilization.Subject and methodsData were obtained from the US Department of Veterans Affairs (VA) electronic medical record for encounters betwee...

BACKGROUND Electronic health (eHealth) tools have the potential to meet the mental health needs of individuals who have barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase engagement with eHealth. OBJECTIVE This pilot study aimed to 1) test...

Background: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. Objective: This pilot study aims to test the fea...

Background: Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effecti...

This study aimed to validate the factor structure of the expanded Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ-2), which is designed to assess provider fidelity to both the Primary Care Behavioral Health (PCBH) and collaborative care management (CCM) models of integrated primary care. Two-hundred fifty-three integrated care...

Objectives: Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of t...

Introduction: Measurement-based care (MBC) involves the systematic collection of data to inform clinical decision-making and monitor treatment outcomes. In addition to benefitting patients and providers, data on MBC implementation can also be used to inform quality improvement efforts within existing health care systems. Method: Retrospective char...

Objective: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive...

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11...

Negative thoughts about posttraumatic stress disorder (PTSD) treatment are barriers to treatment. This mixed-methods study aims to better understand beliefs about PTSD treatment and their relationship to treatment engagement. Thirty-six primary care veterans with probable PTSD reported treatment-related thoughts during a single-session cognitive be...

Objective: Sleep disturbance crosscuts post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Though previous cross-sectional findings demonstrate a compounding effect of PTSD and TBI comorbidity, relatively little is known about the longitudinal trajectory of sleep-related complaints in veterans with TBI history and current PTSD...

Objectives: Describe outpatient mental health service use in a sample of recent combat Veterans with post-traumatic stress disorder (PTSD) symptoms and hazardous alcohol use and investigate predictors of mental health care utilization. Methods: In this prospective study, 126 Veterans with full or subthreshold PTSD and hazardous alcohol use compl...

Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder (PTSD), the nature of the functional relationship between these problems is not fully understood. Insufficient evidence exists to fully support models commonly used to explain the relationship between hazardous alcohol use and PTSD including the self-medication h...

Objectives: Primary care (PC) patients typically do not receive adequate posttraumatic stress disorder (PTSD) treatment. This study tested if a brief mindfulness training (BMT) offered in PC can decrease PTSD severity. Method: VA PC patients with PTSD (N = 62) were recruited for a randomized clinical trial comparing PCBMT with PC treatment as us...

Introduction Inpatient psychiatric units experience significant pressure from third party payers to keep length of stay (LOS) to a minimum despite having to treat more severely ill patients. However, there is a paucity of empiric data for guiding treatment decisions that maximize therapeutic outcome while minimizing LOS. We therefore endeavored to...

Reports of chronic pain such as headache, back and neck pain, and other musculoskeletal conditions are common among veterans with history of traumatic brain injury (TBI). This pilot study investigates self-reported pain and pain management strategies in a sample of veterans in postacute recovery from TBI. Participants included 24 outpatients with h...

Primary care-mental health integration (PC-MHI) is growing in popularity. To determine program success, it is essential to know if PC-MHI services are being delivered as intended. The investigation examines responses to the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to explore PC-MHI provider practice patterns. Latent cl...

Within the Veterans Health Administration (VHA), Geriatric Evaluation And Management (GEM) clinics are designed specifically to address the needs of older veterans with complex age-related concerns, including dementia and comorbid medical and mental health conditions. Previous literature describes aging veterans as having greater health care needs...

There is little known regarding the typical trajectory of alcohol use following a positive screen for hazardous alcohol use. This information would help primary care providers as they attempt to determine the best use of patient visits that might include brief alcohol interventions versus other competing medical demands. This longitudinal observati...

Traumatic brain injury (TBI) in Iraq and Afghanistan war veterans is frequently associated with a variety of complaints, including cognitive problems and posttraumatic stress disorder. In this study, the authors explored the predictive impact of premilitary cognitive abilities on postdeployment cognitive functioning, as mitigated by posttraumatic s...

Persistent postconcussive symptoms (PPCS) are noted when a series of cognitive, emotional, and somatosensory complaints persist for months after a concussion. Clinical management of PPCS can be challenging in the veteran population because of the nonspecific nature of symptoms and co-occurrence with affective disturbances such as posttraumatic stre...

Alzheimer's disease and related dementias are common and costly, with increased healthcare utilization for patients with these disorders. The current study describes a novel dementia detection program for veterans and examines whether program-eligible patients have higher healthcare utilization than age-matched comparison patients. Using a telephon...

Traumatic brain injury (TBI) is a prevalent and costly condition among U.S. veterans. We used a case-controlled review of Veterans Affairs (VA) administrative data to describe outpatient health care utilization (HCU) in a sample of 780 veterans with history of closed TBI and an equivalent number of controls. Results suggest higher rates of HCU in v...

Ultraporous β-tricalcium phosphate (TCP) synthetic graft material (Vitoss; Orthovita) persists for a year or longer in some cases. In this study, we prospectively examined healing of cavitary defects filled with TCP versus TCP and bone marrow aspirate (TCP/BM) with the hypothesis that bone-marrow aspirate speeds incorporation of bone graft substitu...

PTSD symptoms and substance use commonly co-occur, but information is limited regarding their interplay. We used ecological momentary assessment (EMA) to capture fluctuations in PTSD symptoms and drinking within and across days. Fifty Iraq and Afghanistan War veterans completed four daily Interactive Voice Response (IVR) assessments of PTSD and sub...

To describe the use of telemedicine for teaching group diabetes education classes to individuals with diabetes mellitus in a rural medically underserved area. Adults with diabetes from a rural area served by Oswego Hospital in upstate New York were asked to participate in this study. Volunteers received diabetes education through real-time teleconf...

Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been d...

To improve nutrition and physical activity of county employees and promote weight loss. Random assignment to begin the program when first offered or after 3 months ("wait control" group). Worksite. Onondaga County employees (n = 45) at risk for diabetes (n = 35) or with diabetes (n = 10). Mean (±SD) age = 51.2 (± 8.0) years and body mass index (BMI...

Posttraumatic stress disorder (PTSD) is common among Veterans Affairs (VA) primary care patients and may be managed via multiple treatment pathways. Using the Behavioral Model of Health Service Use (Anderson, 1995), this retrospective study based on medical chart review examined factors associated with three types of mental health treatment: interv...

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD...

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur. Methods that can map symptom occurrences over time may shed light on the potential etiological and maintaining factors of such complex symptom presentations. The Longitudinal Follow-Up Evaluation (LIFE) is an assessment method that has been used to characterize...

Cancer survivors are advised to maintain a healthy BMI to optimize quality of life. In the VA healthcare system, multidisciplinary primary care clinics are responsible for screening and management of overweight or obesity, but it is unclear if cancer survivors are accessing or benefiting from these services. This study aimed to determine if primary...

To determine if a diagnosis of posttraumatic stress disorder (PTSD) was associated with primary care provider-diagnosed physical disease in the first 5 years post deployment. An examination of medical records of 4416 veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) was conducted. Participants were veterans who served between Sept...

Comorbid substance use and posttraumatic stress disorders (SUD-PTSD) predict poorer treatment outcomes. Self-medication has been forwarded as a symptom-level explanatory model. However, research has yet to be conducted that can provide detailed examination of SUD and PTSD symptom fluctuations over time as posited by such a process. This pilot study...

The use of androgen deprivation therapy (ADT) for prostate cancer is on the rise, but its adverse side effects may include increased fat mass and decreased lean muscle mass. The net effect of ADT on BMI is unknown. Primary, incident cases of early stage prostate cancer (n = 473) were identified from the Buffalo VA Medical Center tumor registry and...

To test the feasibility and effectiveness of telemedicine to improve care of children with type 1 diabetes in schools. Subjects, ages 5 to 14 years (grades kindergarten through eighth) were randomized to usual care (18 students; 13 schools) or intervention (23 students; 12 schools). Usual care included medical visits every 3 months and communicatio...

There is a need to advance the quality of healthcare by increasing knowledge about multiple risk factors and how to intervene to improve health outcomes. In an effort to better describe the presentation of multiple risks, this study involved a database review to describe the prevalence and covariation of multiple risk factors in individuals present...

The aim of this study was to compare the PC-PTSD and GHQ-12 in detecting new cases of PTSD among primary care patients. Data on the PC-PTSD, GHQ-12 and psychiatric diagnoses was extracted from clinical databases for 11,230 VA primary care patients. Signal detection analyses and likelihood ratios were used to compare screens. Logistic regression ana...

Patients with substance use (SUD) and posttraumatic stress disorders (PTSD) are at high risk for relapse. This study examined the reasons patients identify for their first substance use following discharge from SUD treatment. A total of 65 patients with and without PTSD completed clinical interviews, including an adapted version of the Relapse Inte...

This clinical trial assessed the effects of monitored naltrexone treatment in 19 subjects with schizophrenia spectrum and alcohol use disorders in an eight-week prospective open pilot study. Naltrexone was directly administered to subjects in oral doses of 100 mg on Mondays and Wednesdays, and 150 mg on Fridays. Subjects received reimbursement for...

The purpose of this study was to assess the prevalence and correlates of comorbid diabetes and Post-Traumatic Stress disorder(PTSD)and potential relationships between PTSD and diabetes outcomes. Male patients enrolled in a VA primary care database (N = 73,270) were classified as having diabetes from pharmacy records (N = 14,438) and grouped into th...

The authors endeavored to determine if there is significant weight gain during acute psychiatric inpatient hospitalization for adults and, if so, what are the contributing factors. A retrospective chart review was conducted of all patients admitted to the psychiatric inpatient unit of a University Hospital in the year 2001. The study was approved b...

Previous research has yielded inconsistent findings on the relationship between personality characteristics and chronic pain. The present study examines measures of alexithymia, somatosensory amplification, attachment, counterdependency, and emotional distress in 140 consecutive general medical outpatients seen in psychiatric consultation. Forty-fi...

The aim of this study was to evaluate current prescribing patterns of outpatient child psychiatrists in central New York. Data were drawn from all active files of 1- to 18-year-olds (n = 1292) at eight outpatient treatment locations in central New York on one day in 2002. Age, race, gender, diagnoses, current medications, and doses were recorded. D...

This study attempted to determine if extended-release venlafaxine is safe for use in severely medically and surgically ill depressed patients. The charts of 16 patients who were admitted to medical and surgical inpatient services and given extended-release venlafaxine were retrospectively evaluated for dose and duration of drug treatment, blood pre...

diabetes is a significant disease of elderly people, an age group whose numbers will double over the next 20-30 years. Yet studies which assess diabetes-related quality of life have rarely included elderly participants. to compare and contrast the health-related quality of life of elderly (> or = 65 years) and younger individuals with diabetes usin...

We sought to test the validity and clinical utility of the Thrombolysis In Myocardial Infarction (TIMI) risk score for patients who have non-Q-wave myocardial infarction. A post hoc analysis of the Veterans Affairs Non-Q-Wave Infarction Strategies In-Hospital (VANQWISH) Trial was performed, wherein patients were assigned a TIMI risk score from whic...

To prospectively assess the relation between marital relationship domains (i.e., intimacy and adjustment) and health-related quality of life (HRQoL) and glycemic control of individuals with diabetes. A previous cross-sectional study assessed the relationship between marital quality and adaptation to diabetes for 78 insulin-treated adults. Each part...

We sought to determine whether the stringent stress test criteria for crossover to cardiac catheterization in the conservative arm of the Fast Revascularization During Instability in Coronary Artery Disease (FRISC-II) trial subjected this strategy to a disadvantage by failing to identify patients with surgical coronary artery disease (CAD). In FRIS...

We sought to determine the underlying coronary anatomy and characterize the culprit lesion after non-Q-wave myocardial infarction (NQWMI). Although the culprit lesion and infarct-related artery often are easily identified with coronary angiography after Q-wave MI, the culprit lesion after NQWMI has not been well characterized. Small retrospective s...

There is much literature regarding the interaction of pharmaceutical sales representatives and physicians. However, there is little information available regarding their interactions with psychiatric residents. This paper attempts to quantify the impact of pharmaceutical sales visits upon prescriptions written for newly admitted patients in a psych...

We wished to determine the effect of post-infarct management strategy on event rates (death or recurrent nonfatal myocardial infarction [MI]) in patients who evolved non-Q-wave MI (NQMI) following thrombolytic therapy. Patients who evolve NQMI following thrombolytic therapy are often considered to be at high risk and are frequently managed with rou...

To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction. In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in...

Human immunodeficiency virus (HIV)-1 infection is associated with progressive cell-mediated immune deficiency and abnormal immune activation. Although highly active antiretroviral therapy regimens can increase circulating CD4 T lymphocyte counts and decrease the risk of opportunistic complications, the effects of these treatments on immune reconsti...

Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expendit...