Diabetes is related with greater threats of cardiovascular disorder, and nonalcoholic fatty liver sickness and steatohepatitis. It was also approximated to be the seventh leading trigger of death in the U.S. in 2017. But the very good information is that screening sufferers for prediabetes and style 2 diabetes may let for previously detection, diagnosis and treatment to improve overall health outcomes.
Very last calendar year, the U.S. Preventive Services Job Pressure (USPSTF) updated their advice for screening for prediabetes and kind 2 diabetic issues, which was released in JAMA. The advice lowers the screening age for prediabetes from 40 to 35 several years outdated for nonpregnant grownups who have overweight or obesity.
Medical professionals need to also look at screening patients from certain racial and ethnic teams who have greater prevalence and incidence of diabetic issues this kind of as individuals who are of Asian American, Pacific Islander, Black, Hispanic, Alaskan or Native American track record. A brisk, informative JAMA Community™ online video, “Screening for Prediabetes,” specifics the evidence for screening for prediabetes and the updated USPSTF tips.
With the escalating value of diabetes prevention, below are a handful of ideas to hold in head when screening people for prediabetes.
About 15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of U.S. grown ups have diabetes though extra than just one-3rd meet up with standards for prediabetes. However only 19{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of people today with prediabetes report currently being advised by a wellness skilled that they had this issue. That is why physicians need to consider be aware of key improvements in the advice from the USPSTF. These modifications allow for for before detection, analysis and additional treatment method alternatives, in the end strengthening health and fitness results.
Associated Coverage
Of medicine’s skipped prospects, diabetes prevention nears the prime
With well being declining faster and higher charges of form 2 diabetic issues starting at the very least five decades in advance of analysis, prevention is important. But physician practices and wellbeing programs across the region absence a standardized way to measure high quality treatment for prediabetes. To support, the AMA convened a cross-specialty, multidisciplinary technical qualified panel to establish and define quality actions for prediabetes.
These actions goal to assistance the avoidance of style 2 diabetic issues in the U.S., focusing on improved screening and testing for prediabetes, referral for intervention, and observe-up screening.
Through the patient’s take a look at, evaluate related health-related, social and family background, as perfectly as other clinical information, these kinds of as background of gestational diabetes mellitus, prior laboratory exam effects and existing entire body mass index. Medical professionals and health and fitness treatment workforce users ought to also use evidence-based guidelines to detect sufferers at chance for abnormal glucose centered on offered information. Order acceptable laboratory testing to diagnose individuals with prediabetes or abnormal glucose and document the diagnosis.
When the COVID-19 pandemic began, referral of patients to a National Diabetic issues Prevention Application (Nationwide DPP) life-style-adjust software experienced to go digital. Resident medical professionals at Duke Health and fitness designed a new digital referral approach to successfully identify and refer patients at hazard for establishing kind 2 diabetes to a virtual DPP.
With every one in three sufferers maybe acquiring prediabetes, medical professionals may ponder how they will discover time to handle it. That is in which teamwork arrives into enjoy. Regardless of whether it is a diabetic issues educator, nutritionist, pharmacist or professional medical assistant, these wellness gurus can be element of a team that will help educate clients about prediabetes and how to stay clear of type 2 diabetes.
Linked Coverage
Health professionals working with EHRs 2 times as probable to make referrals to Nationwide DPP
In the past 10 years, the incidence and prevalence of style 2 diabetes in the U.S. adolescent populace has elevated. And now with the rise in prediabetes amongst adolescents and younger adults, it is important for medical professionals to progress the discussion. Medical professionals could not routinely monitor for chance in young individuals, but the boost in prediabetes between teens alerts a have to have to monitor before.
The AMA Diabetes Avoidance Tutorial supports physicians and health and fitness care companies in defining and employing evidence-based mostly diabetic issues avoidance procedures. This in depth and custom-made solution can help clinical methods and wellness treatment companies discover sufferers with prediabetes and manage the chance of producing form 2 diabetic issues, which includes referring individuals at danger to a Nationwide DPP life-style-adjust method centered on their specific wants.
Disclosures:
Berry reports consulting for Oshi Health. Brenner reports consulting for Allergan and Ironwood Pharmaceuticals. Chey reports no relevant financial disclosures. Keefer reports financial relationships with AbbVie, Lilly, Pfizer, Takeda and Trellus Health. Scarlata reports consulting for Activia, A2 Milk Company, Beckon and Gastro Girl, serving as a paid board member/advisory board member for FODY Food Company and GI OnDemand and holding stock in Epicured LLC and Fody Foods.
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According to the International Foundation for Gastrointestinal Disorders, irritable bowel syndrome is estimated to effect 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the population worldwide, making it the most prevalent functional GI disorder.
While the exact pathogenesis of IBS remains largely unknown, scientific evidence points toward disturbances in gut, brain and nervous system interaction that can cause changes to normal bowel function and produce symptoms ranging from mild inconvenience to severe debilitation.
“IBS care in 2022 and beyond no longer relies on just the gastroenterologist — it is a ‘team sport,’” William D. Chey, MD, FACG, of Michigan Medicine, said at the American College of Gastroenterology Annual Scientific Meeting 2021.
Source: William D. Chey, MD, FACG.
As knowledge of IBS has progressed, the traditional focus on abnormalities in motility and visceral sensation has evolved to include psychosocial distress and food as the most important triggers that worsen symptoms. Although one or more of these factors are demonstrable among most patients with IBS, none can account for symptoms in all.
“The diagnosis of IBS relies on the identification of characteristic symptoms and the exclusion of other organic diseases,” William D. Chey, MD, FACG, of Michigan Medicine, and colleagues wrote in a JAMA IBS clinical review. “Management of patients with IBS is optimized by an individualized, holistic approach that embraces dietary, lifestyle, medical and behavioral interventions.”
The burden of IBS can be measured in a variety of ways with studies consistently demonstrating impairment and decreased quality of life among sufferers with treatment strategies difficult to validate over time due to inconsistent response across the population.
“Though strategies for managing IBS have evolved, one guiding principle remains true: There is no one-size-fits-all treatment strategy. IBS care in 2022 and beyond no longer relies on just the GI doctor but is a ‘team sport’ that involves a multidisciplinary, integrative care team of dietitians, behavioral therapists and maybe even complimentary alternative medicine providers,” Chey said during his J. Edward Berk Distinguished Lecture at the American College of Gastroenterology Annual Scientific Meeting 2021.
In identifying how to best provide care, Healio Gastroenterology spoke with experts across the field on their approach to the treatment of IBS; evolving management strategies, including integrative care; and what advice they give for this special group of patients.
Ask a GI Doctor: Pharmacologic Management
When discussing the pharmacologic management of IBS, the ultimate goal is to target the underlying cause(s) of symptoms.
Darren M. Brenner
“We know that disorders of gut-brain interaction like IBS are biopsychosocial disorders. There are many factors involved in the development of IBS symptoms and these differ between individuals. Thankfully, there are now pharmaceuticals proven to improve multiple symptoms,” Darren M. Brenner, MD, associate professor of medicine and surgery at Northwestern University Feinberg School of Medicine, told Healio Gastroenterology. “I like to say that currently available pharmaceuticals have allowed us to move the needle from treating a predominant symptom to global symptoms. Consequently, we find ourselves for the first time able to recommend against the use of less effective therapies.”
While emerging pharmaceuticals have advanced over time, the next step in pharmacologic treatment progression is precision medicine: identifying the underlying causes of IBS, developing diagnostic biomarkers for them and targeting treatment for these causes rather than the symptoms themselves. Understanding the underlying mechanism of action for treatments, and how they work within the GI tract, also aids in explaining how certain therapies are improving the pathophysiology of each patient’s syndrome course.
Following the need for more precise medicine is the need for more head-to-head trials, as the lack of data can prove to be problematic for making prescription recommendations when there are multiple therapeutics in one class. Often, decisions come down to personal preference and drug cost.
When it comes to Brenner’s usual plan of attack, he often sees pharmacologic interventions as complementary to other tools in the IBS management arsenal.
“I like starting with dietary and behavioral interventions as initial strategies, as IBS is generally a disorder that effects a younger population. If they work, there is the potential for avoiding long-term use of medications. I am a proponent of the low FODMAP diet as a proof-of-concept, not a long-term diet; like all IBS treatment strategies, this diet also requires personalization,” Brenner said. “I am also a firm believer in behavioral interventions, including cognitive behavioral therapy (CBT) and gut-directed hypnosis. However, I am also fully cognizant that behavioral interventions require buy-in from patients: If patients do not believe these treatments are going to be effective, it usually renders them ineffective, and they should be avoided.”
This is not to say that Brenner does not believe in the benefits of traditional therapeutics; the treatment decision should be agreed upon by the practitioner and patient after an educated discussion. Though dietary and behavioral management strategies have been highly effective in most, some patients will still opt for medication.
Despite the lack of direct comparison and need for more head-to-head drug trials, there are many different therapeutics to choose from. The decision is typically made based on the IBS subtype.
“At times this can be frustrating for patients, as symptom improvement may require cycling though one or a combination of treatments until the right ones are identified,” he added. “It is key to educate your patients on the benefits and risks of each therapeutic and to explain the educated trial and error process. Knowing this in advance reduces patient frustration when initial interventions are ineffective.”
The future of care relies on precision and designing an algorithm for medication choice based on a patient’s personal indications.
“Don’t get frustrated. When it comes to pharmaceuticals, we are not yet as precise as we would like to be,” Brenner concluded. “Believe that your practitioner has a method to their madness.”
Ask a GI Dietitian: Dietary and Nutritional IBS Management
The convoluted and highly individualized nature of an IBS diagnosis has made management more difficult. In past scenarios, where pharmacological intervention has faltered, the offerings for patients have been scarce — until now.
Kate Scarlata
“IBS is a complex condition and patients are really suffering,” Kate Scarlata, MPH, RDN, founder of For a Digestive Peace of Mind, said. “Having evidence-based diet interventions for IBS symptom management is relatively new in clinical practice. It is utilizing nutrition to help manage symptoms, which may include the three-phase low FODMAP diet or modifying other digestive system triggers, such as excess alcohol or fat or adjusting fiber intake.”
Like IBS management strategies as a whole, dietary intervention must be chosen carefully with each individual’s best interests and health history in mind. Though there are a plethora of dietary intervention strategies to choose from, the effectiveness and popularity of the low FODMAP diet has been proven time and time again, while also being backed by robust research and evidence.
According to results from a network meta-analysis, Christopher J. Black, MBBS, MRCP, and colleagues found the low FODMAP diet correlated with a reduced failure to improve global IBS symptom occurrence compared with all other intervention strategies (RR = 0.97; 95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, 0.48-0.91). Further, it was also most effective for combatting abdominal pain, bloating or distension severity. Additional research from the Domino study reported on by Karen Van Den Houte, PhD, at Digestive Disease Week 2021 found app-based, low FODMAP intervention was significantly more likely to lead to an improvement in overall IBS symptoms (> 50 point reduction in IBS symptom severity score) at 8 weeks compared with otilonium 60 mg (71{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs. 61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) with durable benefits seen at 6 months.
“If you’re using the low FODMAP diet, remember that elimination is the beginning not the end,” Chey said at ACG. “If they do not respond to FODMAP elimination, you should take them off the diet and move on to some alternative strategy. On the other hand, if the patients do experience improvement, they should undergo a systematic reintroduction of foods containing individual FODMAPs. This process allows a provider to customize and liberalize a low FODMAP diet plan for each individual patient.”
Initial assessment for dietetics looks at a wide range of factors, Scarlata said, noting the importance of asking about a patient’s relationship with food. Additional assessments include screening for malnutrition and food insecurity, self-identified food triggers, disordered eating and practicality. The main goal is to provide quality, evidence-based interventions based off particular diagnoses, taking into account potential overlapping conditions and IBS mimickers.
“GI dietitians provide tailored nutrition interventions that incorporate the patient’s clinical data, nutritional intake, socioeconomics and lifestyle to ensure a feasible and nutritionally adequate plan to manage GI symptoms,” Scarlata previously wrote for Healio Gastroenterology. “A collaborative care process in treating patients with GI disorders allows the dietitian to fulfill gaps in the patient’s medical history that may or may not have been divulged or missed in the GI visit. Together, providers can piece together the patient’s full clinical picture to provide a better assessment and multifaceted approach to care.”
Ask a Therapist: Behavioral Management
According to the American Journal of Gastroenterology, advances in the understanding of the brain-gut-microbiome axis, as well as behavioral intervention science, have shown that psychotherapies effective for the treatment of depression, anxiety and chronic pain can be adapted to specifically manage IBS symptoms, including abdominal pain, altered bowel habits and quality of life. These advances, coupled with real-world data, supported the latest ACG guideline which recommended the use of brain-gut behavior therapies for the management of IBS.
Laurie Keefer
“This was a huge accomplishment [for the ACG] to recommend the use of behavioral therapies earlier on in the care pathway,” Laurie Keefer, PhD, director of psychobehavioral research in gastroenterology at Mount Sinai in New York City, said. “We call them brain-gut behavior therapies because they target the cause of IBS or one of the main causes of IBS: brain-gut dysregulation. We are talking about managing IBS from the gut to the brain, that is what these behavioral therapies are focused on.”
In conjunction with pharmacology or dietary intervention, the benefits of behavioral therapy for the management of IBS outweigh the costs, Keefer continued. Adding a behavioral specialist to the medical care team allows for more succinct collaboration for the patient without referring them to community mental health providers without explanation.
The evaluation and application of which behavior therapy to use relies first on the extent of brain-gut dysregulation; how deeply rooted unhelpful coping strategies are indicates how much effort is needed to alter behaviors. While digital therapeutics may be an efficient route to take for newly diagnosed, highly motivated or symptomatically mild patients, those with increased brain involvement with evidence of pain catastrophizing, fear of symptoms or avoidance behaviors may require more personalized cognitive behavior therapy (CBT) to challenge their beliefs, build back self-confidence and reframe ideas about their symptoms.
“Patients have to understand that the brain-gut pathway is not just the gut, and it is not just the brain; there are things they can do in the brain that help with the gut and vice versa,” Keefer said. “They have to really buy into that before we even introduce the concept of changing their thoughts, behaviors or feelings.”
Keefer’s main ingredient for therapeutic management is piecing together each individual patient’s story to understand the context of their symptoms in day-to-day life, acknowledging how the problems started, why they continue and how to make improvements. Rather than simply going through common CBT exercises blindly, a GI psychologist provides insight into how these factors come together and which approach will best aid in alleviating the underlying brain-gut issue.
“It is the integration — it is the doctor and dietitian talking with the behaviorist that, in my opinion, drives the outcomes,” Keefer concluded. “The behavior change techniques themselves don’t drive the outcomes; it is looking at the patient in context together through the same lens as a care team. That is the point of integrated care.”
The Integrative Care Model
Although proven to be effective, psychological, behavioral and dietary therapies in an integrated approach have not routinely been provided to patients with IBS or functional GI disorders.
The MANTRA study, an open-label, single-center, pragmatic trial, found that the integrative care model improved symptom severity, psychological state and quality of life among 188 patients with functional GI disorders compared with standard care alone (84{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} responders vs. 57{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} responders; P = .001). Specifically, among patients with IBS (n= 65{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), integrated care correlated with a greater reduction in IBS symptom severity score (> 50 point reduction: 66{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs. 38{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; P = .017) and a lower cost per successful outcome.
“The biggest attractors for integrated care are two main things: one, it tremendously expands the number of treatment options and increases the likelihood that you are going to be able to find something that is effective for that individual patient,” Chey said. “The second thing, which we have not done a good job at until recently, is it meets the patient where they are. If patients want a diet solution or they want a behavioral solution, we should have evidence-based options to satisfy those requests.”
Like other approaches to management, Chey’s first step in implementing integrative care is verification that a patient’s most troublesome symptoms line up with an IBS diagnosis. From understanding the individual phenotype, he identifies whether symptoms most closely relate with either food or stress and anxiety; the choice of one over the other guides the specific approach to care he employs sooner rather than later.
“The notion of integrated care really embraces the fact that IBS treatment extends beyond just medications. For years, gastroenterologists have focused on identifying patients’ predominant symptoms and then choosing medical therapy based upon the clinical phenotype,” Chey said. “While that is still relevant and the medications are still very useful, we figured out over time that the medications don’t work for everybody, and a growing number of patients are looking for solutions that extend beyond medications.”
The Future of IBS Management
While the data shows that an integrated team of dietitians and psychologists working alongside gastroenterologists significantly improves outcomes in IBS, the vast majority of patients are still unable to access these services.
Sameer K. Berry
“Patients with IBS routinely undergo repeated endoscopy and imaging without access issues, yet most have no way to see a dietitian or psychologist,” Sameer K. Berry, MD, MBA, a fellow in gastroenterology at the University of Michigan, said. “We need to flip this paradigm.”
Operationalizing different treatments for IBS and scaling integrated care relies on reducing access barriers. Much of this is already happening by supplementing face-to-face care with digital health. Digital health tools in IBS can include mobile apps that track diet and symptoms; FDA-approved digital therapeutics that provide app-guided behavioral interventions, such as CBT; at-home diagnostics for bloodwork, stool and breath testing; and virtual-care delivery platforms that connect patients to a multidisciplinary care team from the comfort of their home. These digital health tools are being designed to address access problems, including improved convenience and significantly reduced cost to patients.
As these tools continue to evolve, the benefits extend beyond the individual patient and reduce total cost to the health care system. “Those of us studying the development and implementation of digital health tools in IBS have started to realize that the direct and indirect cost of IBS in the United States has likely been grossly underestimated,” Berry said. “A significant portion of care utilization by these patients may not be associated with an ICD code for IBS. For example, colonoscopies may be ordered as ‘screening’ to avoid patient copay, when in reality they are being ordered to work up symptoms of IBS.”
The lack of access to evidenced-based interventions, such as dietitians and psychologists, also leads to overutilization of expensive medications and even unnecessary surgery in some patients. The suffering these patients endure also impacts the workplace.
“IBS is the second leading cause of workplace absenteeism, after the common cold,” Berry noted. “And patients do not always feel comfortable discussing this disease with their employer.”
Digital health interventions are quickly supplementing in-person care delivered by gastroenterologists and will need continued collaboration with physicians. “Twenty-five percent of the U.S. population struggles with a GI condition,” Berry added. “They are suffering and seeing a gastroenterologist once every three months is not the solution.
“However one feels about digital health, whether skeptical or incredibly supportive, I would argue we all need to be on the same page about trying novel approaches, because the status quo is not working. As gastroenterologists, it is our responsibility to rigorously evaluate and study these new tools and work with these companies to help improve care for our patients.”
References:
Basnayake C, et al. Lancet Gastroenterol Hepatol. 2020;doi:10.1016/S2468-1253(20)30215-6.
Black C, et al. Gut. 2021;doi:10.1136/gutjnl-2021-325214.
Chey W, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2020.06.099.
Chey W, et al. JAMA. 2015;doi:10.1001/jama.2015.0954.
Chey W. The end of the geginning: Megatrends in gastroenterology. Presented at: ACG Annual Scientific Meeting; Oct. 22-27; Las Vegas (hybrid meeting).
Ford AC, et al. Am J Gastroenterol. 2018;doi:10.1038/s41395-018-0084-x.
International Foundation for Gastrointestinal Disorders. Facts about IBS. Available at: https://aboutibs.org/. Accessed: December 06, 2021.
Lacy BE, et al. Am J Gastroenterol. 2020;doi:10.14309/ajg.0000000000001036.
Van Den Houte K, et al. Abstract 512. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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“Family and friends say I look exhausted all of the time.”
“Some days I absolutely dread going to work.”
“I started having to take an (antidepressant) in order to function without breaking down every day.”
These were just some of the dozens of responses to an anonymous survey in which the North Carolina Nurses Association queried registered nurses across the state on how they were doing two years into the pandemic. The survey, conducted last month, found that nurses continue to be affected by the effects of the pandemic. Many of the 229 nurses who responded to the questionnaire described themselves as experiencing burnout.
Those results really trouble Erin Fraher, a researcher on North Carolina’s health care workforce at the Sheps Center for Health Services Research at UNC Chapel Hill. Fraher has been watching trends in the nursing workforce in the state for the better part of three decades and last month, she told lawmakers that she’s “never been so worried about a workforce in my life based on the data.”
Fraher went on to tell lawmakers that before the COVID-19 pandemic, her data were telling her that the state faced a probable shortage of about 12,500 nurses in the coming decade. But since the pandemic has stretched nurses to their limit, leading many to consider and take early retirement, the state could have something closer to 21,00 too few nurses by 2033.
Even as nurses were willing to cut loose anonymously, many are still reticent about speaking ill of their institutions for fear of retaliation by employers, said nurses reached by NC Health News. But surveys and data show that the health care workforce is likely to lose some of the most experienced staffers.
The reasons are many. They include:
The stress that comes from working in a pandemic for two years with overextended personnel;
Financial woes besetting some health care systems and providers;
The ire at disparities in pay; and
More recently, animosity from the public.
“The level of exhaustion is so real,” said Lisa Harrison, health director for Granville and Vance counties.
“No more meditation or pizza parties… We need real concrete help.” – anonymous response
At the beginning of the pandemic, restaurants provided free meals to nurses and other health care workers, hospitals put up billboards praising their staffers, and members of the public offered applause every night. But as COVID-19 cases rose and fell, and the public became tired of mask mandates and infection-control measures, health care personnel grew wearier while also taking more of the brunt of the public’s frustration.
Some hospitals have done a better job than others at mitigating the burnout that’s come with the two years of surging workloads. Those hospitals that have taken the time and expense to prevent burnout likely saved money, according to Jane Muir, a nurse researcher from the University of Virginia. For her doctoral research, she did an economic analysis of the costs of burnout to hospitals.
Hospitals looking to prevent such fatigue among their staff nurses spend on average $11,592 per nurse per year to prevent the exhaustion, Muir found. Those costs include measures such as spending more on full-time staff to share the load, creating programs to improve patient safety and the quality so nurses feel like they’re providing better care, providing opportunities for professional development for nurses and increased vacation time.
But doing nothing actually costs hospitals more, Muir’s analysis found. She calculated that when hospitals simply stayed with the status quo, they ended up spending about $16,736 per nurse per year on their nurses. That’s because they had higher turnover rates and incurred costs to recruit new nurses, get them up to speed and hire expensive fill-in nurses to pick up the slack.
“A lot of pretty raw feelings”
People in all professions have left their jobs as the pandemic has spooled out, and nurses have been a part of the so-called “great resignation.”
Frustrated RNs may not have quit the profession completely, Fraher told lawmakers, but many have left their staff jobs for travel assignments that became more lucrative as the pandemic extended from weeks to months to years. “Travelers” have long provided temporary fill-in for busy hospital units. They work for temporary staffing agencies who recruit and place them. Often travelers make a lot more than the staff nurses they work alongside, something that was a frustration even before the pandemic.
“It used to be when someone decided they wanted to do travel nursing, it was to take a job across the country somewhere, not across the street to the competitor,” said Dennis Taylor, the immediate past president of the North Carolina Nurses Association.
As a traveling nurse, Taylor explained, “you could go make sometimes triple or quadruple your hourly rate, and then turn around and either come back to your original organization because they need people, or decide to stay on at that new organization.”
During the pandemic, those frustrations have at times boiled over, Taylor said.
“I think that has led to a lot of pretty raw feelings among folks who had been working at institutions for 10, 12, 15, 20 years,” he said.
Those kinds of rewards, Taylor said, pushed some nurses who were close to retirement to jump ship.
“I think that, unfortunately, the signal that it sent to them was that we don’t value your tenure, your experience or your loyalty to the organization,” he said.
“I gladly left my job due to dissatisfaction and frustration with a broken healthcare system” – anonymous response
Those are the kinds of retirees that really have Fraher worried, she told lawmakers. They are the more experienced nurses bailing out of bedside care.
Four years ago, Fraher’s center published data showing that the average age of nurses in the state was 45 for metro-area nurses and 46 in rural parts of the state. Now, that average has crept upward as the entire workforce has aged. Many of those older nurses can find different jobs with less stress.
Before the pandemic, Fraher projected the state would need about 125,726 nurses by 2033, but would only have 113,277 available, leaving a deficit of 12,500. If nurses within five years of retirement age decide to jump ship early, that would almost double the deficit to 21,032.
Fraher told lawmakers that pre-COVID, NC was forecasted to face an estimated shortage of 12,500 RNs by 2033. If burnout or other factors cause nurses to exit the workforce five years earlier, that shortage nearly doubles, she said. Image courtesy: Erin Fraher/ Sheps Center for Health Services Research, NurseCast
Taylor was one of those people. After years of critical care nursing and leading the state nursing association during the pandemic, he also decided to leave his position, for now.
This week, Hugh Tilson, head of the North Carolina Area Health Education Centers, told lawmakers that his organization had surveyed employers to find that they were already having trouble recruiting and retaining staff to fill vacancies, especially for nurses.
In November, AHEC found that many facilities reported “exceptionally long” vacancies for open positions. When it came to RN positions, responses from 19 types of facilities – from nursing homes to hospitals – reported long periods where they couldn’t fill vacant jobs, including 31 of 35 hospitals surveyed. RN retention was also an issue.
“The important thing about our study is that it confirmed that these problems existed in the past, and COVID made it worse,” Tilson said. He said there needs to be coordination at the state level to consistently monitor, track and report to the legislature where the needs are in the health care workforce, otherwise, “we’ll be in the same place 10 years from now as we are now.”
Tilson also noted that health care institutions can’t “solve the nursing problem in isolation, but only if they work with the larger health care ecosystem and with other professions within health care.
Public health workforce also stressed
In the public eye, the image of nurses in the pandemic has been that of someone covered head to toe in protective gear, hovering at the bedside of an ICU patient. But Lisa Harrison, the public health director in Vance and Granville counties, pointed out that her public health nurses have been just as much on the front lines, maybe more so, as they’ve been outside the bubble of a hospital and confronting an often angry public.
“Communicable disease nurses in local health departments, so many people forget the roles and responsibilities they bear in the case investigation and the contact tracing,” Harrison said last week. “The abuse they’ve received in these last two years doing their jobs has been profound and their exhaustion is also profound.”
Many public health nurses across the state have been “holding the line because they feel this just overwhelming dedication to community and public,” Harrison added. “The public heart thing is ‘I’m not going to leave here in the middle of a crisis, but as soon as the crisis abates, phew, I need a vacation badly and it needs to be a two-year vacation.”
Those public health nurses often are confronted with anger from people who were pro-mask, anti-mask, pro-vaccine, anti-social distancing, Harrison added, saying you name the position, they’ve heard criticism about it.
“Seeing the abuse they’ve received in these last two years doing their jobs has been profound and their exhaustion is also profound,” she said.
Harrison predicted that many public health nurses might look for an exit ramp soon, some temporarily, some permanently.
“We’re gonna lose a lot.”
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by Rose Hoban, North Carolina Health News March 2, 2022
We’re about to enter into March, which means that people have now spent almost two months trying to keep up with their new year’s resolutions.
One of the most popular yet difficult ones that people choose to give up is smoking.
A study conducted by by the Royal Society of Public Health (RSPH) found that three in five people that chose to give up the habit in 2016 started smoking again by January 31.
Only 13 per cent of those remained smoke three a year later.
It is believed that a third of UK’s ten million smokers make at least one attempt to quit every year, often driven by key life events or milestones such as new year.
Only four per cent of those who pledge to give up smoking remain smoke free one year later.
Understanding the challenges that are faced by smokers, NHS Scotland has given pointers on how to make succeeding in your pledge that little bit easier.
Understand why you smoke
Some people may have started in their teens, maybe because their friends smoke or because they want to look grown up.
For other, it could be during college or university, starting a job or being in a social circle where everyone smokes.
You may have started for no reason at all.
Understanding why you have started smoking and the reasons for continuing the habit is crucial in weaning yourself off it – what first introduced you to smoking may no longer be part of your life now.
The NHS says that this can help you prepare for those moments when you might miss smoking, and deal with withdrawal symptoms and cravings.
The reasons for which you started smoking may no longer be there anymore (Image: Getty Images/EyeEm)
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Planning
People are more likely to be successful in their journey if they plan ahead in advance – this includes preparing and working towards a specific end date.
The NHS has highlighted the importance of picking a day that you pledge to stop and marking it on the calendar. Sometimes the transition period is best started over a holiday or somewhere that is not in the usual routine.
They continue: “If you stop smoking for just a month, you’re already on track to stopping smoking for good. Pick a time when you aren’t too stressed. Take one step at a time, give yourself small goals, and don’t think too far ahead.
“Tell your friends and family the day you’ve chosen to stop smoking. Letting them know your plans allows them to help you to stop.
“Think about how you’ll deal with tempting situations and what you’ll say if a friend, relative or colleague invites you to have a cigarette. You could say, “No, thanks, I don’t smoke,” or “I’ve given up!””
Look into alternatives
Consider looking into certain medications to help you on the way as nicotine is an addictive drug, and willpower alone might not be enough to kick the habit.
Using medication designed to prevent you from smoking is much better alongside intensive support such as group or one to one support than simply using the medication alone.
The NHS has said that you are more likely to succeed with the help of nicotine replacement therapy and the support of a local smoking cessation group.
“If you’re taking any other medication, you must speak to a health professional who provides your prescription”, they add.
“This is to ensure they monitor your medication levels during your quit attempt.”
E-cigarettes are another way to help you on your journey to quit as they are similar in shape and appearance to the real deal.
They are also an alternative to cigarettes for nicotine.
The NHS has said that e-cigarettes are not without their risks, but they will “almost certainly benefit your health”.
Think about the benefits of stopping
The reasons for which you are choosing to stop can be a great source of motivation.
Some personal reasons can include trying to get pregnant, wanting to get into shape or you could be going into hospital.
The NHS recommends listing your top three reasons for quitting, write them down and keep them handy where you can see them everyday – such as on the fridge, phone or in your wallet.
“Think about the financial, physical and health benefits you’ll get from stopping smoking”, the NHS says.
“You could keep a diary to track your progress. This could record how long you’ve gone without a cigarette, how much money you’ve saved or improvements you’ve noticed in your health. This will help keep you motivated during your quit attempt.”
NHS Scotland has also produced a cost calculator, to help people realise how much they could save by giving up smoking.
Scots should consider alternatives such as medication or e-cigarettes (Image: Getty Images)
Consider reducing the amount of smoke
While the NHS has said that there is “no safe level of cigarette use”, it can also be a good way to get you started on the road to stopping long term.
“This is provided that you plan well, set the quit date and see it through to stopping and staying stopped.”
They recommend that you set a quit date within six weeks or your plan to cut down and reduce the number of cigarettes you smoke every day/week/fortnight.
SPRINGFIELD, Mass. (WGGB/WSHM) – A new breakthrough for prostate most cancers people involves prostate-particular membrane antigen-dependent imaging. Lou Masella, vice president of PET and CT imaging at Shields Health and fitness Care, spoke with Western Mass News about the technological know-how.
What just is PSMA for PET/CT?
Masella: “PET CT is a radiology-based tool that does a whole lot of very good do the job at analyzing a amount of distinct cancers. When we use the PSMA, we are concentrating on the prostate and not only remaining capable to glance at the prostate organ alone, but to examine if the cancer has most likely left the prostate and absent to other places like lymph nodes of the bones.”
Generally, we hear about acquiring analyzed in your 50s for prostate cancer, who would you advise is a superior candidate for this scan?
Masella: “We know by now as guys start out to age, they have conversations with their main health practitioner about urinary health and that’s an essential discussion for all of us that as we age. We know factors change in our prostate. If pretreatment or staging is a little something that is important for your conversation, then you could advance to some kinds of imaging to assess how that cancer is behaving in your system. Now, there are actually two sets of clients that are important to advance to PSMA and PET/CT. One particular is if in the course of early dialogue you are obtaining that you may possibly be at superior chance for the condition to escaped your prostate and long gone elsewhere. The next team that is significant is that I may well have now had most cancers and could have presently been addressed for it and my medical professional is following my procedure post with a blood examination and if that blood test variations, then it could be indicative that cancer has reoccurred, and we are likely to want to seem all over again and see if it is escaped the prostate and has attached itself to other regions like the lymph nodes or the bones.
Would you suggest this for an preliminary screening of prostate most cancers?
Masella: “It is not a screening software and it is not a self-referral resource. This is an essential aspect of the dialogue with your main treatment medical professional or if you have been referred to urologist for evaluation, but it will become incredibly significant when there is suspect condition that’s at an superior phase or if it has recurred since a lot of of these scenarios can be a minimal elusive and they may set them selves in a put distant from a regular imaging place that you would choose photos by MRI or PET/CT and having the total picture to be ready to recognize to most effective treat you gets to be extremely significant as you are produced that procedure program.”
Copyright 2022. Western Mass News (WGGB/WSHM). All rights reserved.
/cloudfront-us-east-1.images.arcpublishing.com/gray/EFTSRZMADBBV7M6ZPYJ6VAXGVY.jpg "breakthroughs in prostate cancer imaging")