As abortion rights advocates across the country chewed over a leaked U.S. Supreme Court draft opinion that would strike down the 1973 landmark Roe v. Wade decision that legalized abortion, North Carolina Democrats emphasized the importance of the state government’s role in keeping abortion legal.
At a press conference at the North Carolina General Assembly on Wednesday, North Carolina Democrats and abortion rights advocates stressed that the draft opinion is not yet in effect.
Sen. Natalie Murdock (D-Durham), said the future of abortion “will begin in the States.”
“What we now unfortunately know is we cannot depend on the U.S. Supreme Court,” Murdock said. “It is up to us and state legislative bodies to continue to hold the line to say that we will fight to maintain full freedom and autonomy over our bodies so that we can determine our own future and destiny.”
The leaked draft opinion, written by Justice Samuel Alito, would overrule Roe v. Wade, which gave pregnant people the ability to choose to have an abortion without excessive government restriction.
Should the draft become the Supreme Court’s decision, it would throw decisions about abortion access to state governments, instead of being a federally recognized right.
Meanwhile, North Carolina has laws on the books that limit the ability to get an abortion. Some of those statutes pre-date 1973, when Roe went into effect, and some were penned after in attempts to chip away at Roe’s allowances.
But what would happen in North Carolina is far from clear.
Crossing state lines
In the past year, Texas and Oklahoma passed restrictive abortion laws that only allow the procedure for up to six weeks after conception. In the wake of implementation, abortion providers in other states have said they’ve seen patients arriving from Texas.
“We have helped patients come in from as far as the Rio Grande Valley, all the way to our clinic in Minnesota or our clinic in Virginia, or Maryland,” Sonja Miller, head of the Texas-based Whole Woman’s Health Alliance, told a gathering of health care journalists in Austin, Texas this past weekend.
Whole Woman’s Health, which also has clinics in other states, recently opened a clinic south of Minneapolis.
“[We] began serving our first patients with in-clinic surgical procedures at the end of February,” said Miller.
Miller referred to surgical abortions, which tend to take place after about 12 weeks of pregnancy and require a physical procedure done by a health care provider. In recent years, people looking to terminate a pregnancy have also had the option of “medical” abortion, which uses a combination of mifepristone and misoprostol pills to end a pregnancy. Medical abortions can be self-administered by the person seeking an abortion and can only be used for up to about 12 weeks after conception.
Miller said that her organization deliberately situated the Minnesota facility close to the airport.
“We … opened it because we wanted a place that is in a safe state, a haven state,” she said. “Minnesota is such a state where we could take our patients.”
She said that about 30 percent of the patients currently being seen at that clinic are from outside of Minnesota, with many arriving from Texas.
‘Squishy language’
In 2020 in North Carolina (the latest year for state statistics), the state Department of Health and Human Services recorded 25,058 abortions, with 37.4 percent of procedures done surgically, and 59.1 percent of abortions were accomplished using the combination of pills. (DHHS data notes that 3.5 percent of procedures are “unknown.”)
Statistics show of all the procedures taking place in North Carolina in that year, almost 99 percent of procedures were performed on state residents.
That could change, said Meghan Boone, a faculty member at the Wake Forest University law school who specializes in issues of constitutional law and reproductive rights. She said North Carolina could see an influx of people seeking abortion care in the coming months if the Supreme Court strikes down Roe later this summer.
North Carolina is circled by states that have so-called “trigger laws” which go into effect to restrict or ban abortion should the Supreme Court overturn Roe, she explained. And it is likely that South Carolina, Tennessee and West Virginia would all ban abortion as soon as the Supreme Court decision is made.
The laws on North Carolina’s books, however, are less clear.
“There’s a little bit of sort of squishy language in 14-44,” Boone said referring to the North Carolina law written in 1881 that made abortion illegal.
That law was altered in modern times, first by a 1967 law that made abortion legal to preserve the life of the mother, in the case of the pregnancy resulting from rape or incest, or if “the child would be born with grave physical or mental defect.”
All those layers of laws and court decisions make for a murky picture in the absence of Roe, Boone said.
“You have one part of the criminal code that says ‘you can’t do this,’ but then other parts of the criminal code that say, ‘you can do this in these sorts of circumstances, situations’” she said. “It’s just not clear that you would be able to criminally prosecute someone under these earlier laws in the face of more modern laws that suggests that legal abortions are legal.”
Enforcement in a post-Roe world
It’s also not clear what would have to happen to make North Carolina’s older laws go into effect.
“You could have a prosecutor who decided to bring charges and then I think in the face of that you would have a criminal defendant who would make an argument that that law was no longer valid in light of the post-Roe subsequent changes to the criminal code, which made their particular circumstance legal,” Boone said.
There’s also the possibility that the legislature could act, she said. But Democratic Gov. Roy Cooper has vetoed several abortion bills passed by the Republican-majority legislature since he was elected in 2016.
Cooper doubled down on his support for abortion in a tweet Monday night, as the Supreme Court leak started to go viral on social media.
Now more than ever, governors and state legislatures must stand up for women’s healthcare. We know the stakes and must stand firm to protect a woman’s choice and access to medical care. – RC
There could be further legislative action to reinstate the 20 week limitation law, but with a Democratic governor and too few Republicans in the legislature to override a gubernatorial veto that seems unlikely.
That reality led Democrats at the press conference in Raleigh to encourage people to go out to vote, even as Republicans circulated talking points about how to encourage voters to adopt their point of view.
Meanwhile, advocates cautioned that the leaked draft is just that — a draft. Abortions remain legal in North Carolina, and nothing has changed yet, said Jillian Riley from Planned Parenthood South Atlantic.
“This is not final,” Riley said. “Abortion is still safe and legal and constitutionally protected in the state of North Carolina.”
Nonetheless, she said abortion providers were getting ready for the actual decision later this year. She said the leaked draft gives providers “a little more time to be able to prepare.”
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by Elizabeth Thompson, North Carolina Health News May 5, 2022
FRIDAY, March 4, 2022 (HealthDay Information) — Are you running a serious wellness issue, be it weight problems or diabetes or coronary heart disease or bronchial asthma?
You will find probably an app for that.
Health apps are getting much more and far more complex, presenting smartphone consumers enable in dealing with long-term ailments, mentioned Dr. David Bates, chief of inner medicine at Brigham and Women’s Hospital in Boston, and an internationally renowned pro in patient basic safety and health care know-how.
“It may differ fairly a ton by application, but some of the apps have been shown to final result in benefits,” Bates stated in the course of a HealthDay Now interview. “Some of the excess weight loss apps actually do assist individuals reduce bodyweight. Similarly, some of the diabetic issues apps can enable you manage your [blood] sugar far more effectively.”
Sad to say, it can be challenging to determine out which application is most effective, supplied the baffling assortment accessible to the regular person.
“There are truly numerous hundred thousand on the marketplace, which is just bewildering as a patient,” Bates stated. That indicates many folks with persistent health problems are not taking benefit of these new tools, according to a current HealthDay/Harris Poll survey.
About 61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of people residing with a chronic issue explained they use some sort of wellness application, but only 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} claimed they are making use of an application exclusively geared in direction of handling or tracking their precise wellbeing problem, the study identified.
A single-third of people with a persistent sickness stated they really don’t bother with an app for the reason that they will not come to feel the want to consistently monitor their well being, the poll outcomes showed. And a quarter of individuals with serious problems stated they are worried about the privacy and safety of professional medical details they share with the application. About 17{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} stated they just are unable to pay for well being apps, and 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} claimed they locate them also sophisticated.
Bates’ very own investigate into wellbeing app use uncovered similar developments.
“There is moderately prevalent use among the a wide variety of age groups, but they’re notably well known among the persons who are younger and tech savvy,” Bates instructed HealthDay Now. Here’s the whole job interview underneath:
Bates pointed to one the latest research amid people today with either language barriers or very little schooling. It located that “most people required to be ready to use the apps, but quite a few people today struggled with accomplishing even very simple jobs, like as a diabetic coming into your blood sugar [numbers],” he mentioned.
“The privateness issues are a real problem, and the applications are not executing as good a position as they might in conditions of preserving our privateness,” Bates mentioned. “Which is a little something we have to have to continue to target on. Substantially of this variety of knowledge is not that private, but some of it is.”
Folks in the marketplace for a wellness application ought to know that on-line ratings in the app retailers “are not always a seriously very good predictor of how fantastic the app is likely to be for you,” Bates said.
Bates and his colleagues have suggested that an independent 3rd bash start out score wellness apps, so people today will be ready to uncover top quality items that go well with their wants.
“We have to have to do a little something to restrict the quantity of decision, for the reason that when you have that quite a few choices folks frequently just won’t be able to choose. It really is also hard,” Bates claimed.
Limiting the quantity to some degree would be really useful, he proposed. “For illustration, in England they have about 60 applications that are endorsed nationally and promoted. There is certainly a good deal of competitors to get into that team, but that helps make it a lot less complicated to choose which types may well be pertinent for you,” he discussed.
With the advent of telemedicine, apps are getting to be even additional crucial, Bates included.
People usually have to get their possess essential indications and observe their personal wellbeing details, so they can report their conclusions to their health practitioner throughout a telemedicine visit.
“Ordinarily, you will find a lot more responsibility positioned on the individual to deal with things them selves, and an app can help you a whole lot,” Bates claimed. “It can aid you observe some of the numerous matters you should be viewing,” like your daily blood sugar levels or your weekly work out periods.
Sooner or later, Bates believes that wellbeing gurus will start off “essentially prescribing applications. You’ll go to your health care provider and they’ll suggest that you use an app. Points will be established up so that the facts can appear back again to them, and they can see how you’re accomplishing. If you are doing effectively, they will congratulate you, and if you’re struggling a little bit they can support you out.”
But for now, he warns that there are drawbacks to some applications out there. In individual, Bates is concerned that applications are not terrific at notifying people today of life-threatening conditions.
“For several applications you can say your blood sugar is 10, which is existence-threateningly lower, and the application will not essentially tell you that you need to have to do anything urgently,” he mentioned. “I might like to see the apps do a better task all-around warning you if there is a major situation.”
Supply: David Bates, MD, chief, inside medication, Brigham and Women’s Clinic, Boston
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).
From the Alpha variant to Delta to Omicron, the COVID-19 virus is changing, but it doesn’t seem to be going anywhere. Incarcerated people and their families wonder what the future of COVID means for them.
Incarcerated people have been acutely impacted by the highs and lows of the pandemic. Not only must they cope with the fear of getting ill and dying, or suffering from long-term COVID symptoms, but the pandemic has meant periodically losing much of the few freedoms they still have, such as outdoor recreation time and family calls and visits.
For incarcerated people, frequent lockdowns have meant more time in a cell, sometimes with other people, some of whom are sick, sometimes all alone, often for 23 hours a day.
Researchers argue that these experiences are adding to the trauma that already exists from spending time behind bars.
To prevent widespread illness and additional trauma, advocates for incarcerated people have called for decarceration. This means reforms that would limit the number of people sent to jails and prisons in the first place and reforms that would allow certain people to exit prisons early.
As it becomes clearer that quick fixes will continue to be Band-Aids on the larger problem, advocates press for long-term solutions.
COVID and incarceration
The United States prison system is not built for a pandemic.
“In addition to everyone being on top of each other, there are too many of them in the space allotted,” Finholt said. “The prisons generally have one sort of air circulation system that is common to the whole prison. And so if you get a lot of virus in the air, it’s just going to be in the air everywhere in the prison.”
Additionally, staff move in and out of the prison, making the prison far from a closed bubble.
“Prisons are ongoing, constant mass gatherings,” Finholt said.
One study using mortality records from the Florida State Department of Corrections found that COVID-19 led to a four-year decline in life expectancy in Florida’s prison population.
The North Carolina Department of Public Safety (DPS) has reported that 57 incarcerated people have died of COVID in North Carolina’s prisons. It is possible that more people have died of COVID, but their deaths have not been properly reported, a North Carolina Health News/ VICE News investigation showed.
DPS spokesperson Brad Deen said that as the Omicron variant surges across North Carolina’s prisons, most cases “are asymptomatic or manifest mild symptoms in the vaccinated, and that unvaccinated offenders with underlying medical issues are the most at risk of this variant.”
Incarcerated people who died of COVID are not the only casualty. Three incarcerated people have died by suicide just this calendar year, according to DPS press releases.
COVID has been and continues to be a problem for incarcerated people, even as the world tries to move on, said Wanda Bertram, communications strategist at the Prison Policy Initiative, which researches the harms of mass incarcerations.
Public officials who have declared COVID endemic are “basically admitting that prisons are going to be more dangerous in terms of health risks than they’ve been before,” Bertram said.
The way prisons have handled COVID thus far is likely to have a lasting effect on incarcerated people. Some people who contracted COVID while they were incarcerated will experience long COVID, but even if they didn’t get sick, the pandemic “absolutely makes it worse in terms of just the trauma of prison,” Finholt said.
Addressing the dangers of COVID through decarceration
As COVID-19 continues to evolve, so will DPS, Deen said.
“DPS will continue to be adaptable and resilient and will continue to follow the science and do what is possible to prevent COVID-19 from getting into the facilities, to help prevent it from spreading to other facilities and to confine it within a facility if it does get in,” Deen said.
To combat deaths in state prisons, some advocates have called for large-scale decarceration, which would reduce the prison population and create more space.
It has been almost a year since 3,500 incarcerated people were released early from state prisons following a legal settlement between a number of advocacy groups and the state (NAACP v. Cooper) that aimed to decrease the harms of COVID against vulnerable incarcerated people.
C. Daniel Bowes, director of policy and advocacy for the ACLU of North Carolina, says it wasn’t enough.
“Obviously the problem has not been solved,” Bowes said.
The ACLU of North Carolina is part of a coalition of North Carolinians who have called on the state to address the COVID-19 crisis behind bars through the Vigil for Freedom and Racial Justice, a month-long demonstration outside the North Carolina Executive Mansion.
Bertram said now is the time for governments to pursue criminal justice reforms that make sentencing reforms retroactive. She also believes states need “any kind of plan” to release older incarcerated people and incarcerated people who are immune-compromised, especially if they are getting close to the end of their sentence.
“The Department wound down the ELC initiative in late 2021, and there are no plans to reactivate it at this time,” Deen said.
Finholt said if the pandemic continues to pose a public safety threat to the prisons, officials will have two options to make them safer: mass decarceration or vastly increasing funds to prisons to properly staff them.
The state budget that Gov. Roy Cooper signed into law in November includes a provision that sets aside $3 million to make the adult corrections of DPS a standalone department by 2023.
One proponent for prison reform, Sen. Bob Steinburg, R-Chowan, told the Daily Advance this move will give the state’s prisons a “seat at the table.”
Advocates for incarcerated fear it might be too little too late.
Impact upon reentry
Almost all incarcerated people in North Carolina will return to society. About 98 percent of people who are incarcerated in North Carolina will be released in the future.
However, many Americans tend to ignore the health of incarcerated people.
“They just stop at ‘they’re criminals and whatever they get, they deserve,’” Bowes said.
As the pandemic caused lockdowns and shut down visitation to prisons periodically, that means communication from inside prison to the outside world has also suffered.
“I think the problem with the way we use incarceration is that it disappears people,” Finholt said.
“In turn, disappearing people makes it so that the problems those people face are not visible.”
But those people will return and when they do, they are likely to have more health problems than they entered prison with, said Eric Reinhart, resident physician in the Physician Scientist Training Program at Northwestern University’s Department of Psychiatry and Behavioral Sciences.
More people will be reentering society with long COVID, Reinhart said, and many people will be reentering traumatized from the conditions they’ve lived with.
“I think there is a multi-generational burden of care that we are producing now by subjecting people to horrific conditions in U.S. jails and prisons during the pandemic,” Reinhart said, “before as well, and especially now during the pandemic.”
There are things that states can do to make reentry more successful, Bertram said.
Researchers at the Prison Policy Initiative found that simply facilitating contact between incarcerated people and their family and friends on the outside world could improve the mental health of incarcerated people and reduce recidivism.
“It’s one of the cheapest ‘programs’ that you can have,” Bertram said.
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by Elizabeth Thompson, North Carolina Health News February 10, 2022
COLUMBUS, Ohio (WCMH) — Musical artist and Ohio native Nightbirde appeared on CNN with Chris Cuomo to talk about her health, the holidays, what she’s working on and maintaining a positive attitude while battling cancer.
Cuomo introduced Zanesville native Jane Marczewski with one of her famous quotes, “You can’t wait until life isn’t hard anymore before you decide to be happy,” adding that she walks “the walk” when it comes to being happy in the face of adversity.
Then a clip was played of her shining moment this summer when she auditioned for “America’s Got Talent” while struggling with her cancer, earning Simon Cowell’s Golden Buzzer for her performance.
Since that performance, Nightbirde has kept a low profile, stepping aside from the “America’s Got Talent” competition to focus on fighting her life-threatening illness.
“Well, you know what, I wish we would get a faster miracle, but it’s happening slow, little by little day-by-day I’m getting a little better,” Nightbirde told Cuomo when asked about how she is doing. “I did get a scan result back and a bunch of stuff that was there has now disappeared and a bunch of the really big stuff has gone down in size so, we’re on the way.”
Cuomo then asked if she was comfortable enough with her struggle “to continue to dare to dream about what happens next?”
“I think life sometimes is a game of, choose your pain, so the pain of continuing or the pain of giving up. So, the pain of continuing, there’s a lot more uncertainty that way, but I think the pain of giving up is so much worse.”
The conversation also touched on Nighbirde’s holiday plans when Cuomo asked her to reflect on what Thanksgiving means to her this year.
“Every year that I get to gather around the table with people that I love, it’s such a — it’s such an honor and a gift,” she responded. “I shouldn’t, I should not be alive right now based on the usual statistics. So every year when this time comes around, it’s special for the whole family.”
Nightbirde went on to describe her attitude toward life when Cuomo pressed about her “heavy truth.”
“Well, I think every, every moment that we breathe is a miracle and a gift,” she said. “Most people don’t know what a joy it is to wake up in the morning without pain, ’cause they’ve just experienced, you know, maybe a normal life. But those like me who face death on a day-to-day basis.
“Sometimes I think we’re the luckier ones because if we get to really see the sweetness of life and the miracle is to love and be loved. And to, to dream and to have a, you know, the chance at a future. I don’t know if I’ll ever get used to the weight of that, or I don’t know if I’ll ever, I don’t know if it’ll ever become casual to me again, just to live.”
Near the end of the interview, Nightbirde discussed her current plans when it comes to making music and what is happening in her life professionally.
“I am so proud of everything I’m writing right now,” she said. “Uhm again, pain can be a gift because it really, really drives you to deep places to, to dig for gold. Sometimes you gotta dig really, really deep for gold. And, and that’s, that’s what I’ve been doing. I’m really proud of the stuff that I’m, I’m working on. And the voice is getting there. Today I actually sang a lot and even it, even though it’s not up to 100{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, I am just so happy to be singing. I could not stop smiling today.”
This post is introduced to you by nVoq. This interview took location during a live Q&A session with nVoq’s Senior Director of Post-Acute Product sales, Jason Financial institutions, at the HHCN Upcoming function in Chicago held on September 30, 2021. The interview has been edited for clarity, Home Garden USA.
Home Overall health Treatment News: Jason, previously right now we talked about the operational side of operating a significant submit-acute service provider. For the far better aspect of two a long time, this has been your encounter. What do you see as some of the major trends influencing dwelling health and your clients in the following few of many years?
Jason Banking companies: Specially now with COVID, there are three main themes in a ton of the shows that we go to, and in our conversations with possible providers or clientele. I imagine the workforce lack is initial and foremost on a ton of the providers’ minds.
The next factor is regulatory, and the regulatory stress that will come alongside with functioning a post-acute treatment firm, and we’ll speak much more about that, but it is considerable. Then, the 3rd is the change to worth-dependent care. We’ll listen to a ton about this all all through the working day — the clinic, the home, ER diversion, SNF-at-property and all the other models and flavors coming out.
It would seem like overnight, I was just entering into put up-acute care, and now I have been in the field for more than 20 several years. We have been conversing about, “Hey, we can in all probability do a lot more with these remarkable men and gals that go to people’s properties and just take care of them.” It’s amazing that write-up-acute treatment has grow to be the taste of the day when it arrives to offering care for continual care management, stop-of-lifetime treatment and those kinds of factors in the dwelling.
Above the past 7 years, I have been imagining about, “What are some of the root will cause of these chances or challenges that providers are dealing with?” One particular of the root triggers or prevalent threads all through are the documentation prerequisites or the challenges affiliated with documentation. Clinicians are expending amongst 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of their time documenting.
If you have observed other environments or explored house treatment and hospice outside of the U.S., you’ve likely identified that the selection drastically decreases for numerous reasons, no matter whether regulatory compliance or other elements. You’ll also discover that the treatment actually is amazing in those environments, the clients are content and the clinicians are pleased.
A widespread topic that’s been running by my head for perfectly above a decade now is, “How do we get to palms-cost-free documentation?” chiseling absent at some of the issues clinicians are undertaking that really don’t include worth to the affected individual expertise — which is what nVoq does. nVoq is speech-to-text at a 30,000-foot amount, but deep beneath the handles, we’re addressing alternatives these vendors are encountering on a every day foundation with income optimization and earning certain that they’re recruiting and retaining the proper talent.
I got the cell phone call from Chris Moran, who’s in the audience, and Debbi Gillotti, our COO, about 6 months back, and they stated, “Hey, we’re getting curiosity from these article-acute care providers all over bringing speech-to-textual content to not just the physicians, but also to the frontline clinicians supplying care. The interest is across the board from massive providers, medium, compact companies, nonprofit, for-profit, hospital-based mostly, non-hospital based mostly. We imagine there’s one thing in this article, would you be interested in checking out this?” I stated, “Absolutely. This is accurately what I imagine the field requires.”
HHCN: That is great. A single of the themes a ton of our purchasers are talking to us about as properly is that shift to price-primarily based care I simply call it every little thing at-property. Converse to us about how you men are positioning what you do in conditions of value-based care from a risk standpoint, and how you are laying the groundwork for price-based care in the extensive phrase.
Banking institutions: I was told not to say what I’m about to say, but I’m likely to say it in any case in my legitimate mother nature. Some of the people who have labored with me in the past will think this is amusing mainly because I have stated this for a even though. Article-acute, above the earlier 20 many years that I’ve been associated, is related to AA, Alcoholics Nameless. This means, I’ve in no way fulfilled any person going to submit-acute treatment that claimed, “I had a amazing working day. I require submit-acute care.” It’s, “I had a seriously bad working day.” Often the worst day of their lives.
If medical professionals come in and convey to them there’s absolutely nothing much more they can do and they require to search for out hospice care, it is at times the worst working day of their life. I’ve equated it to AA for the previous five or six a long time in that you have to have a little something bad to come about to go to publish-acute care. Why does it have to be that way? Loads of men and women are dwelling with chronic treatment conditions who can be serviced to prevent people acute events from taking place. In purchase to do that, those people companies will need to operate at the greatest degree of their licensure.
Advisable HHCN+ Exclusives
You need to have to have cross-self-control features inside of the home to make confident you’re addressing every little thing from the bodily requirements to the non secular and emotional requirements, to the social determinants of overall health. I often chat about affected person tax. Patient tax, in my head, is anything at all that doesn’t increase value to the client encounter. In value-dependent treatment and the at-dwelling models, the medical center-at-residence, the ER diversion, the SNF-at-house versions — you are seeing a great deal of these affected person taxes being removed.
Client tax, in my brain, would be doubled documentation. I had the satisfaction of serving in a hospice and palliative treatment organization here in Chicago. I ran the business for about two and a 50 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} decades. We would have our nurses documenting two or three occasions in a solitary take a look at. Did it increase value to the individual or loved ones? Completely not. Was it regulatory-compliant? Certainly. There are a thousand of all those points across any service provider organization that you can strip out of the procedure. And by new innovative programs, you will see much more businesses strip people out of the method and include worth to the affected individual expertise.
HHCN: Let’s commit a moment talking about that regulatory natural environment mainly because it’s transforming. With COVID and the pandemic, new matters have appear about and we’ve experienced some independence and adaptability in specified parts. What does that seem like for you going ahead, and how does that effect companies now?
Banking institutions: I study an AMA post that reported hospitals have about 96 steady finding out points (CLPs) when article-acute has 288, and they have to comply with all the other complex needs linked with information stability, HIPAA compliance and every thing else. When you are supplying either at-property treatment or treatment in a facility location, there are so a lot of regulatory requirements to take into consideration.
1 of the points we’re hunting to do is alleviate some of that stress of the regulatory prerequisites by letting the clinicians to be with the individual to choose treatment of them. Then, we’re in fact taking some of those people parts of regulatory compliance off their hands and saying, “Hey here’s anything you could want to add to the note that is both regulatory compliant or likely to include to the individual encounter.” Which is one particular of the issues that we do with nVoq as properly.
HHCN: Let us converse about workforce shortages. I consider which is permeating into almost everything we include nationwide. How can your voice tech help clinicians and frontline team battle the scarcity concern?
Banking institutions: This is likely one particular of the strongest worth propositions, albeit not the only for nVoq, but it is a single we’re laser-focused on. At the starting, we talked about three main challenges that vendors are facing with workforce lack, regulatory compliance and the change towards price-based mostly care. The workforce shortage is selection a single, two and a few. You have outstanding leaders in this place that have different degrees of participation in, “How do we remedy for that workforce lack?”
Factors like choosing. I know there are a variety of corporations in the place that can enable you find and stand out amongst prospective recruits. There are also signal-on bonuses, hiring bonuses, referral bonuses, retention bonuses, increased pay back and cultural points you can do as a company. All those all perform a element, but I consider there’s an fundamental problem with the workforce lack.
That is, why do clinicians leave companies? Why do they decide on companies? What’s distinct about home overall health and hospice from other configurations they might observe in? A single of the issues I consider a good deal about is, “Why do clinicians find property overall health and hospice as a occupation?” One particular issue jumps correct out to me, and it is that they desire relationships. They like associations with the client and spouse and children about transactional care.
Once more, the popular thread which is a barrier to relationships are the documentation needs. If they are spending 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of their time documenting, either because of regulatory specifications or other explanations, and the full explanation they obtained into write-up-acute treatment in the to start with place was because of that romantic relationship ingredient, that is what is driving them out.
I’ve noticed that in exit interviews in excess of and around and above once more. “We’re leaving mainly because of the documentation demands. We’re leaving due to the fact of the regulatory burden. We’re not leaving due to the fact of the group, and we’re not leaving due to the fact we never care for clients or families.” These are extraordinary adult men and women of all ages serving our principally elderly population. We’re laser-targeted on assuaging that documentation load for them.
HHCN: I have just one last issue for you. A person of the matters I like to study about is engineering. Amazon just came out with some new Alexa gadgets and Siri is permeating every little thing that we do. How do you see the proliferation of buyer voice tech have an effect on these who are doing the job with your computer software today?
Financial institutions: I believe it is great simply because I use voice tech in my personal home. We have Alexa in the home today. I use an Iphone, so I use Siri especially when I’m in a cellular setting in which I want to shoot a quick text or a thing like that. When I’m riding in the passenger seat and I want to shoot a quick textual content, I’ll use voice-to-textual content. We’re viewing that capacity far more and a lot more, and I feel it’s heading to grow to be 2nd mother nature for these clinicians.
This write-up is sponsored by nVoq. nVoq Integrated delivers a HIPAA and PCI-DSS compliant, cloud-primarily based speech recognition system supporting a wide wide range of health care shipping scenarios which includes put up-acute treatment with an emphasis on property health care and hospice. nVoq’s speech recognition answers convert speech to textual content in seconds and are hugely accurate for most health-related specialties. To learn extra, stop by sayit.nVoq.com
