People have long believed that eating well-balanced and nutritious meals would lead to a long and healthy life. What does that mean? It is an ever-changing conversation about what is healthy. To help patients make healthier food choices, the School of Medicine and Health Sciences developed a culinary medicine elective that is offered to third- and fourth-year students. The field of culinary medicine combines knowledge of food and cooking with science and medicine. Over 60 academic medical centers use the Health meets Food Culinary Medicine courseware that was created by CulinaryMedicine.org.
Following almost twenty years as a clinician at George Washington University, Dr. Seema Kakar launched culinary medicine education in 2017. She rented a teaching kitchen space and began teaching the Health Meets Food curriculum. The program educates medical students and other healthcare providers to empower their patients on making healthy food choices.
The Seva Culinary Medicine Teaching Kitchen Fund was established by Dr. Kakar and her husband as an endowment for the GW medical school. By establishing this new space, the GW medical community will be able to use food and science to benefit their patients and community. Visit the GW Culinary Medicine Program website for more information.
Cholesterol matters. It may not be the first thing on our mind when it comes to making dietary choices, but it’s an important factor to take into consideration when it comes to dietary decisions. Heart disease remains the number one killer in the United States, and those who have high cholesterol are twice as likely to develop heart disease.
Did you know that 73.5 million adults have an elevated level of low-density lipoprotein (LDL) or “bad” cholesterol? Additionally, only 1 out of every 3 adults that have high LDL actually have it under control. These rates could improve if we all take the time to educate ourselves and our patients about the importance of healthy cholesterol levels, and the impact these levels have on the cardiovascular system.
If you haven’t already, get your cholesterol checked! While some conditions may be out of our control such as family history, knowing your current cholesterol levels can help you to create a plan to maintain a healthy heart. Unchecked hypercholesterolemia can lead to heart conditions including heart attacks and stroke. Additionally, high cholesterol has no noticeable symptoms which makes it difficult to diagnose without a blood test (lipid panel/lipid profile). All the more reason to get it checked! To learn more about high cholesterol and caring for your patients, check out the CDC’s guidelines and tools.
Talking to your patients about their cholesterol may not be easy. Even if the topic falls into a category that is outside your field of expertise, the CDC has a communications kit filled with resources to help you to better educate patients on the benefits of monitoring and managing cholesterol.
Lastly, World Heart day is on September 29th. Visit this website to find out more about how you can get involved to spread the message about how critical heart health is to us all.
Sickle Cell Disease Awareness Month occurs in September and it is a great opportunity to learn more about this inherited blood disorder that affects approximately 100,000 people in the United States and millions more across the world.
Sickle cell disease is a blood disorder where red blood cells develop a distinct ‘sickle’ shape instead of the normal disc shape. These unusually shaped red blood cells are not flexible, thus making it difficult for the cells to travel through blood vessels. Because of the potential for blood vessels to get clogged, people living with sickle cell disease may experience extreme pain crises, strokes or other severe health complications. Sickle-shaped red blood cells usually last in the body between ten to twenty days and the body cannot quickly add new blood cells to replace the lost cells, thus people with this disorder are also likely to develop anemia.
This disorder can affect anyone, but it is mostly commonly found in people of African descent and within the United States this disorder occurs in approximately one in every 365 African American children. There are also high concentrations of this disorder within Hispanic populations, where it is estimated that one in every 1,000-1,400 Hispanics Americans live with sickle cell disease. (MedlinePlus, 2020)
Testing is available to determine if someone has sickle cell disease or if they carry the trait. If a person has sickle cell disease, there are treatment plans to help manage pain, prevent red blood cells from taking on the sickle shape and prevent blood vessel clogs, but unfortunately the only potentially curative intervention for this disorder is a blood and bone marrow transplant.
Researchers at the National Health, Lung and Blood Institute are actively looking for new treatment options and cures. The Center of Disease Control also has a Sickle Cell Data Collection program that tracks the disease in the country “to study long-term trends in diagnosis, treatment, and healthcare access for people with SCD (sickle cell disease)...The program helps to inform policy and healthcare standards that improve and extend the lives of people with SCD.) (Centers for Disease Control and Prevention, 2021, para. 1) Data from California and Georgia are currently available, while data from other several states will be made available in the future.
If you are interested in spreading awareness about sickle cell disease, the National Heart, Lung, and Blood Institute has created a social media toolkit with infographics, hashtags and sample posts that can be shared online. You can also help by donating blood. The American Red Cross is particularly interested in African American blood donors who can donate their blood to people living with sickle cell disease. Visit the American Red Cross website to find a local blood donation center or blood donation drive. If you’re interested in hearing the personal stories of people living with sickle cell disease, then visit the Stories of Sickle Cell which features stories, videos and a photoblog of life with this blood disorder.
Himmelfarb also has resources to help you better understand this blood disorder. Some titles that may be of interest include:
Sickle cell disease is the most common inherited disorder and impacts the quality of life for millions of people around the world. With current treatment options, people who live with sickle cell disease can manage their symptoms, while researchers continue to learn more about this disorder and search for additional cures.
In the year 2020, nearly 46 thousand people took their own lives. That is roughly one suicide every 11 minutes. September is National Suicide Awareness Month and is a good time to reflect, educate, and to encourage every patient in need to seek mental help.
Where to begin: reflect. Ask yourself: do I, or have I known anyone who has struggled with suicidal ideations? If you answered yes, how did this affect you? Regardless of your healthcare speciality, it is important to remember that mental health plays a critical role in a person's overall health and well-being.
Educate. Suicide can be a difficult topic to address, but it is one that should not be ignored, especially when warning signs are present. Understanding the risk factors of suicide paired with action can save a life. Know that there is no qualification or degree needed to see that someone needs help. If you are uncertain of common behaviors of someone who may be feeling overwhelmed by stress or depression, the National Alliance on Mental Awareness (NAMI) provides guidelines for identifying risk factors, as well as articles on personal experiences, mindfulness, and how to prevent suicide.
Lastly, encourage. Even if you may not feel qualified to help someone personally, you can connect them to nationally available resources, such as the Suicide Crisis Lifeline, by calling or texting 988.This lifeline is available 24/7, and connects people in need to a trained counselor who will not only listen and provide support, but offer assistance and resources that may be needed. You can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.
There is national help available even to those who do not have access to healthcare options.
While we continue to endure the ongoing pandemic, it is more important than ever to stay aware of emerging health threats. The following are some recommended websites for staying current..
The CDC newsroom provides information on regional outbreaks such as salmonella and monkeypox, vaccine effectiveness, and a plethora of COVID resources as part of their COVID-19 Digital Press Kit. They also have a digital archive that contains the previous three years of their news releases.
Remember that the source of your information matters. Many popular resources today are misleading in their facts, and are tailored specifically to extract a response from you, not to inform you.
In a developing situation where every minute counts; ensure that your sources are based on credible sources. Your time and your research matters. If you need support from the Himmelfarb library, remember to ask a librarian! We are here to assist in your medical research endeavors.
On June 24, 2022, The Supreme Court announced a 6-3 ruling on the Dobbs v. Jackson Women’s Health Organization case that overturned the 1973 Roe v. Wade decision and ended the constitutional right to obtain an abortion. As a result of this ruling, individual states can now decide whether or not abortion access will remain legal, and what restrictions can be placed on abortion care within their state.
Following the news of this decision, GW health leaders and experts released statements and responses that expressed deep concern for the implications this decision will have on medicine and public health. Barbara Bass (Dean of the GW School of Medicine and Health Sciences and CEO of the GW Medical Faculty Associates), Lynn Goldman (Dean of the GW Milken Institute School of Public Health), and Pamela Slaven-Lee (Interim Dean of the GW School of Nursing) released a joint statement in response to this decision. The statement highlighted the health ramifications of carrying an unintended pregnancy to term, including “a higher risk of maternal death, preterm birth, and other serious health problems” (Bass et al., 2022). The statement went on to assert that the decision “disrupts the oath of physicians and health care providers to provide care that, first and foremost, honors personal autonomy and the unwavering commitment to provide care with safe and effective therapies” (Bass et al., 2022).
Amita Vyas, Director of the GW Maternal and Child Health Center told GW Today that “every single adult and child in this country will be affected by this decision” (GW Today, 2022). Vyas went on to express concern based on evidence-based studies that have shown that abortion restrictions lead to higher maternal mortality rates.
These statements from GW experts are grounded in evidence-based research. This post will examine what the evidence-based research says about abortion-related morbidity and mortality rates, and how restrictive abortion laws affect health disparities and health outcomes. This post will also explore what the evidence shows about whether or not restrictive abortion laws prevent or reduce abortion rates, the impacts of restrictive abortion laws on patient care, and how health care providers can prepare for the consequences of this ruling in their practices.
Abortion and Morbidity and Mortality
Numerous studies have examined the rates of morbidity (an illness or disease) and mortality (death) related to abortion. Stevenson’s 2021 study investigated the impact of a total abortion ban in the United States on pregnancy-related mortality. This study estimated that a total abortion ban would result in a 7% increase in pregnancy-related deaths during the first year of the ban, and a 21% increase in subsequent years (Stevenson, 2021). Black, Indigenous, and people of color populations would likely experience even higher rates of mortality: an estimated first-year pregnancy-related death increase of 12% among Non-Hispanic Black people and a 6% increase among Hispanic people, followed by subsequent year increases of 33% among Non-Hispanic Black people and 18% among Hispanic people (Stevenson, 2021).
Despite the 1973 Roe decision, access to abortion care has steadily become more restrictive in the United States since the mid-1990s. Addante et al. published a retrospective study examining maternal mortality rates in the United States between 1995 and 2017, during which time, the number of states with restrictive abortion laws rose from 13 states to 29 states. (Addante et al., 2021). States with neutral abortion laws decreased from 32 states to only 12 states, while states with protective abortion laws rose slightly from 5 states to 9 states during this time period (Addante et al., 2021). The mean maternal mortality rates in 1995 were similar across states with restrictive, neutral, and protective abortion laws, but by 2017, maternal mortality rates in states with restrictive abortion laws were 70% higher than in states with protective abortion laws (Addante et al., 2021).
Restrictive abortion laws can contribute to increased maternal mortality rates in a variety of ways. Women who have high-risk pregnancies, which increase the risk of poor obstetrical outcomes, may be less able to terminate a pregnancy for medical reasons in states with restrictive abortion laws (Addante et al., 2021). Additionally, there is often a reduction in sexual and reproductive healthcare services, such as access to contraception, that are provided by abortion clinics when clinics are forced to close due to restrictive abortion laws (Addante et al., 2021). Verma and Shainker’s 2020 study found that a 20% reduction in Planned Parenthood clinics resulted in an 8% increase in the maternal mortality rate (Verma & Shainker, 2020).
Karletsos et al.’s 2021 study explored whether states with gestational age limit abortion laws experienced changes in infant mortality rates. Between 2005 and 2017, 13 states passed gestational age limit laws (Karletsos et al., 2021). The study found that infants born as a result of gestational age laws had a 3.6% increased infant mortality rate (Karletsos et al., 2021). The Turnaway Study by Foster and Kimport in 2013 found that people who sought an abortion after the gestational age of 20 weeks experienced difficulty in finding a provider, as well as financial hardships associated with the cost of the procedure and travel-related costs (Foster & Kimport, 2013).
Abortion Access and Health Disparities
Studies have shown that limiting access to abortions has a disproportionally negative impact on underserved groups, thus exacerbating already existing health disparities. Low-income populations and those experiencing poverty are the most at risk of being impacted by the negative effects of anti-abortion laws. Many people who seek abortions cite not being able to afford a child (or another child), negative impacts on work, school, and/or the ability to care for other children among the factors influencing their decision (Boonstra, 2016). In addition, low-income individuals seeking an abortion may “delay or forgo paying utility bills or rent, or buying food for themselves and their children” in order to afford the procedure (Boonstra, 2016).
According to 2014 data from the Guttmacher Institute, 75% of patients who seek abortions were poor or low-income (Verma & Shainker, 2020). The 1976 Hyde Amendment, which restricted access to reproductive healthcare by banning federal funding for abortions under Medicaid, the Indian Health Service, and the Children’s Health Insurance Program, had a disproportionately negative impact on Black women (Salganicoff et al., 2020). 30% of black women and 24% of Hispanic women between the ages of 15 and 44 have Medicaid coverage, compared to only 14% of their white counterparts (Boonstra, 2016).
States-level gestational age laws also tend to negatively impact lower-income people who “were unable to obtain earlier care owing to a lack of financial resources, transportation, child care, and other constraints” (Karletsos et al., 2021, p.788). Forced maternity only enhances these hardships as low-income individuals often experience barriers to “adequate prenatal, postpartum, and other health care for themselves and their infants” in addition to the barriers experienced in affording living expenses and access to resources to keep their newborns healthy (Karletsos et al., 2021, p.791).
According to Verma and Shainker, “unintended pregnancy rates remain highest among Black women, Hispanic women, and women of lower socioeconomic status, comprising the same groups with the highest abortion rates” (Verma & Shainker, 2020, p. 4). The article goes on to point out that these are also the groups facing the greatest risk of maternal mortality since they tend to be less likely to have health insurance, further limiting access to family planning and preventive health care services (Verma & Shainker, 2020).
Increased Rates of Abortion
While anti-abortion advocates often seek abortion bans in an effort to deter abortions, evidence shows that legal restrictions on abortions do not eliminate abortions or result in decreased abortion rates. Instead, legal restrictions simply “increase the likelihood that abortions will be performed unsafely, as they compel women to seek clandestine procedures” (Fathalla, 2020, p. 8). Latin American countries have the world’s strictest abortion bans but have the highest rates of abortion in the world at 32 abortions for every 1,000 women (Oberman, 2022). In contrast, Western Europe has the world’s lowest abortion rates (12 abortions per 1,000 women), with some of the world's most liberal abortion laws that provide easy access to safe abortions (Oberman, 2022).
The largest predictor of abortion rates is the percentage of unwanted or unintended pregnancies - not the legal status of abortion (Oberman, 2022). Western Europe not only provides easy and legal access to safe abortions, but modern contraception use is high, thus diminishing unintended and unwanted pregnancies and the need for abortions (Fathalla, 2020). “Public health experience has demonstrated that women’s need for abortion can be reduced by making contraceptive information and services available, accessible, and affordable” (Fathalla, 2020, p. 6). When the Affordable Care Act was passed mandating health insurance coverage for contraception in 2010, unintended pregnancy rates dropped by 15% (Obermann, 2022).
Complications of Unsafe and Unmanaged Abortions
“When abortion is legally restricted or otherwise inaccessible, girls, women, and those who care about them look outside formal medical care to end pregnancies” (Harris & Grossman, 2020, p. 1,029). This can often end in unsafe or self-managed abortions, often through medication.
According to the World Health Organization (WHO), abortion is considered safe when it is “done with a method recommended by the WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained” (Fathalla, 2020, p. 3). Abortions are considered less safe if it meets one of the criteria (method or trained provider), but not both (Fathalla, 2020). WHO estimates that between 4.7% and 13.2% of maternal deaths each year are a result of unsafe abortions worldwide (WHO, 2021). The health risks resulting from unsafe abortions can include incomplete abortion, hemorrhage, infection, uterine perforation, and genital tract and/or internal organ damage (WHO, 2021). Unsafe abortions are a leading cause of maternal morbidity resulting in almost 300,000 maternal deaths per year worldwide (Rodgers et al., 2021).
Aside from the very real health risks associated with unsafe abortions, there is also a significant financial cost. A 2020 systematic review found that the annual cost of abortion care in the United States was $134 million (Soleimani et al., 2020, p. 63). WHO estimated that the financial burden on health care systems from complications of unsafe abortions in developing countries was $553 million per year not including a loss of $922 million in household income that is lost due to long-term disability resulting from unsafe abortions (WHO, 2021). By comparison, for patients requiring post-abortion care for unsafe abortions, the yearly cost of contraception supplies and services amounts to just 3% to 12% of the cost of providing post-abortion care (Rogers et al., 2021).
One response to the increase in restrictive abortion laws has been self-induced or self-managed abortions, often through medications obtained outside of a medical setting (Conti, & Cahill, 2019). Medication-based abortions have made finding an abortion both easier and safer (Oberman, 2022, p. 6). Misoprostol is the most common and most widely available abortion medicine and is classified as an “essential medicine” by WHO for its “vital role in reducing deaths from postpartum hemorrhages, miscarriages, and illegal abortions” (Oberman, 2022, p. 7). Patients managing abortion through medications such as mifepristone and misoprostol can experience bleeding, cramping, and expulsion of pregnancy tissue at home (Harris & Grossman, 2020).
Pregnancies ended through medications are often “clinically indistinguishable from those who have had uncomplicated spontaneous pregnancy loss” (Harris & Grossman, 2020, p. 1,029). Telemedicine could be an essential tool in enabling patients experiencing financial or geographical difficulties when seeking an abortion to receive medication abortions (Verma & Shainker, 2020). Unfortunately, “abortion pill” bans have also become a target for states that seek to pass restrictive abortion laws.
Physician Preparedness for Restricted Abortion Access
As states pass more restrictive abortion laws following the recent Supreme Court decision, health care providers are faced with helping patients navigate the new abortion landscape and “must become familiar with the normal course of self-managed abortion with medications and its rare complications, as well as complications of unsafe abortions” (Harris & Grossman, 2020, p. 1,029).
In Harris and Grossman’s 2020 review article, they explore potential circumstances physicians and health care providers may be facing as abortion laws become more restrictive. While many patients who seek care will only require confirmation that a medication-induced abortion is complete, others will require outpatient interventions for incomplete abortions (Harris & Grossman, 2020). “In contrast, those using unsafe methods may need lifesaving critical care for sepsis, hemorrhage, pelvic-organ injury, or toxic exposures” (Harris & Grossman, 2020, p. 1,029). Patients managing abortion through a clinically supervised combination of mifepristone and misoprostol rarely experience major complications that require hospitalization, surgery, or blood transfusions, which occur in only 0.3% of cases (Harris & Grossman, 2020). However, physicians should be aware of other ineffective and less safe methods of self-managed abortions, such as herbal remedies that are not only ineffective but can cause toxic reactions and even death (Harris & Grossman, 2020).
Physicians and healthcare professionals need to be increasingly prepared to provide “prompt, nonjudgmental, evidence-based care” when patients present after self-managed abortions or following unsafe abortions (Harris & Grossman, 2020, p. 1,037). Additionally, health care facilities need to develop policies and care protocols that prioritize the safety of pregnant patients (Harris & Grossman, 2020).
Summary
The evidence shows that restrictive abortion laws not only fail to eliminate abortions or decrease the number of abortions taking place but instead increase the rate of abortions. In addition, the evidence demonstrates that morbidity and mortality rates related to abortion increase as a result of more restrictive abortion laws, having a disproportionate effect on Black, Indigenous, and people of color communities, including a 33% increase in pregnancy-related death among Black people. Limits on abortion access disproportionately negatively impact low-income groups by increasing barriers to necessary healthcare services, thus exacerbating already existing health disparities.
References:
Addante, A. N., Eisenberg, D. L., Valentine, M. C., Leonard, J., Maddox, K., & Hoofnagle, M. H. (2021). The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017. Contraception, 104(5), 496–501. https://doi.org/10.1016/j.contraception.2021.03.018
Council on Community Pediatrics (2016). Poverty and Child Health in the United States. Pediatrics, 137(4), e20160339. https://doi.org/10.1542/peds.2016-0339
Fathalla M. F. (2020). Safe abortion: The public health rationale. Best practice & research. Clinical Obstetrics & Gynaecology, 63, 2–12. https://doi.org/10.1016/j.bpobgyn.2019.03.010
Foster, D. G., & Kimport, K. (2013). Who seeks abortions at or after 20 weeks?. Perspectives on Sexual and Reproductive Health, 45(4), 210–218. https://doi.org/10.1363/4521013
Harris, L. H., & Grossman, D. (2020). Complications of unsafe and self-managed abortion. The New England Journal of Medicine, 382(11), 1029–1040. https://doi.org/10.1056/NEJMra1908412
Karletsos, D., Stoecker, C., Vilda, D., Theall, K. P., & Wallace, M. E. (2021). Association of state gestational age limit abortion laws with infant mortality. American Journal of Preventive Medicine, 61(6), 787–794. https://doi.org/10.1016/j.amepre.2021.05.022
Oberman M. (2022). What will and won't happen when abortion is banned. Journal of Law and the Biosciences, 9(1), lsac011. https://doi.org/10.1093/jlb/lsac011
Rodgers, Y., Coast, E., Lattof, S. R., Poss, C., & Moore, B. (2021). The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PloS One, 16(5), e0250692. https://doi.org/10.1371/journal.pone.0250692
Soleimani Movahed, M., Husseini Barghazan, S., Askari, F., & Arab Zozani, M. (2020). The Economic Burden of Abortion and Its Complication Treatment Cares: A Systematic Review. Journal of Family & Reproductive Health, 14(2), 60–67. https://doi.org/10.18502/jfrh.v14i2.4354
Stevenson A. J. (2021). The pregnancy-related mortality impact of a total abortion ban in the United States: A research note on increased deaths due to remaining pregnant. Demography, 58(6), 2019–2028. https://doi.org/10.1215/00703370-9585908
Verma, N., & Shainker, S. A. (2020). Maternal mortality, abortion access, and optimizing care in an increasingly restrictive United States: A review of the current climate. Seminars in Perinatology, 44(5), 151269. https://doi.org/10.1016/j.semperi.2020.151269
June 27th is National HIV Testing Day! First observed in 1997, this is a day intended to encourage people to get tested for HIV. This year's theme is “HIV Testing is Self-care.” Many of us have become more aware of the importance of self-care during the COVID-19 pandemic, and continue to focus on self-care as we navigate our current daily lives. But self-care is more than just enjoying some quiet time with a good book, going for a walk in nature, or taking a relaxing bath to unwind after a stressful day. Self-care is also about taking care of all aspects of your health. By getting tested for HIV, you are taking the first step towards knowing your HIV status and learning more about HIV prevention or pursuing treatment.
HIV, the virus that can cause AIDS if left untreated, can only be detected and diagnosed through testing. It’s recommended that everyone between the ages of 15 and 65 years old gets tested for HIV at least once. Pregnant people should also be tested as proper diagnosis and treatment can not only improve the health of the pregnant person but can also reduce the risk of transmitting HIV to the infant during pregnancy, childbirth, and breastfeeding. Individuals who are at a higher risk of contracting HIV (individuals who share needles or have sex without a condom) should consider being tested frequently.
HIV tests detect antibodies to HIV. Antibodies typically appear within 3-12 weeks after an individual is infected with HIV (Fauci, Folkers, & Lane, 2022). The most commonly used HIV tests are enzyme-linked immunosorbent assay tests, also known as EIA or ELISA tests (Adams & Woelk, 2014). ELISA tests are more than 99.9% accurate and are available as saliva tests (Adams & Woelk, 2014). Nucleic Acid Tests (NAT) look for the HIV virus in the blood and can detect HIV sooner than other types of tests (CDC, 2022). While many self-tests and rapid antibody tests can provide results within 20-30 minutes, NAT or antigen/antibody lab tests can take a few days to receive results (CDC, 2022).
Getting tested is as easy as going to your doctor’s office. Physicians and health care providers should consider including conversations about HIV testing with patients as part of providing regular routine care.
Fauci A.S., & Folkers G.K., & Lane H (2022). Human immunodeficiency virus disease: aids and related disorders. Loscalzo J, & Fauci A, & Kasper D, & Hauser S, & Longo D, & Jameson J(Eds.), Harrison's Principles of Internal Medicine 21e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3095§ionid=265434013
On June 19th, look for buildings lit in red to raise awareness of sickle cell disease and the challenges experienced by patients, their families and caregivers. The inherited blood disorder occurs in more than 100,000 people in the US, resulting in serious chronic disease and 75,000 hospitalizations annually.
The Sickle Cell Anemia Act of 1972 raised awareness of the disease and increased screening so that early intervention is now common. 20 years ago the introduction of the pneumococcal vaccine helped to reduce the mortality rate for children under 4 with sickle cell disease by 42%. Today, patients are best managed in a comprehensive multidisciplinary program of care that can include penicillin prophylaxis in those under 5, hydroxyurea, blood transfusions and opioids for pain management. Since 2017, three additional medications are now available to help manage symptoms: L-glutamine, crizanlizumab and voxelotor. Still most management of sickle cell disease is palliative and not a cure.
“…unfortunately, patients still have a poor quality of life because of extreme pain episodes, end-organ damage, and also a reduced life expectancy.”1
Starting in 1984, bone marrow transplant has been used as a therapy in patients with disease serious enough to outweigh the risks of the procedure, and for whom a good donor match can be found. About 1,200 of these procedures have been reported. In 2018, the National Heart Lung and Blood Institute at NIH launched the Cure Sickle Cell Initiative to advance gene therapy for sickle cell disease; a number of clinical trials are currently underway. The CEDAR study in phase 1 clinical trials uses gene correction, a combination of gene editing and addition. You can learn more about current therapies, including gene therapies, in this article from the American Society of Hematology Education Program.2
Rates of physician and nurse burnout have risen dramatically during the COVID-19 pandemic. There are multiple causes including chaotic and emotionally draining work environments and high work loads exacerbated by staffing shortages. But another contributing factor predates the pandemic, excessive documentation burden.
Excessive documentation is a byproduct of electronic health record (EHR) systems. And it may be particularly burdensome in the US healthcare system. A 2018 article by Downing, et al in the Annals of Internal Medicine noted:
“The highly trained U.S. physician…has become a data-entry clerk, required to document not only diagnoses, physician orders, and patient visit notes but also an increasing amount of low-value administrative data. To justify billing to such payers as the Centers for Medicare & Medicaid Services, physicians must specify diagnoses from long and confusing arrays of choices relating to each test or procedure and document a clinically irrelevant number of elements for the history of present illness, review of systems, and physical examination.“1
Along with complex documentation requirements, high email message volume and poor usability of EHRs are other factors in clinician frustration with the systems.2
This past year the American Medical Informatics Association (AMIA) launched an initiative with Columbia and Vanderbilt Universities funded by the National Library of Medicine to reduce clinician documentation burdens by 75% in five years. A virtual symposium of experts was held in January and February of 2021 and this spring they released their 25x5 Symposium Summary Report. The report identified over 80 action items to streamline workflows and eliminate or automate wherever possible billing, legal issues, and regulatory requirements. “The Symposium activities were informed by one key theme: clinician documentation is for patient care delivery and clinician-patient communication.”3 Confirming the 2018 Annals paper, the symposium found that US clinicians spend 75% more time with EHR documentation than clinicians in other economically developed nations.
The report includes calls to action for providers/health systems, policy/advocacy groups, and vendors. Each will play a role in finding solutions. For example, providers and health systems are tasked with providing better training and supporting real-time information retrieval, while vendors are asked to promote an ecosystem of interoperable systems. The action items will be divided into short, intermediate, and long-term goals that will be implemented by a network of allies and working groups. You can follow developments in the 25x5 effort on the AMIA web page.
Downing, N. L., Bates, D. W., & Longhurst, C. A. (2018). Physician burnout in the electronic health record era: are we ignoring the real cause?. Annals of Internal Medicine, 169(1), 50-51. https://doi.org/10.7326/M18-0139
Poon, E. G., Trent Rosenbloom, S., & Zheng, K. (2021). Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. Journal of the American Medical Informatics Association, 28(5), 895-898.https://doi.org/10.1093/jamia/ocab058
Did you know that April is National Autism Awareness month? Regardless of how much you understand about the Autism Spectrum Disorder, there are available resources that can help to expand your current perspective, which may be helpful in making appropriate treatment decisions for Autistic patients
For an introduction to the Autism Spectrum, Autism.org has a 30 minute 101 course designed to increase your knowledge on what it is and the early signs of Autism. Additionally, the CDC has resources available on their website appropriate for families of autistic children and others providing care for them.
Over the past twenty years, Autism Spectrum Disorder (ASD) cases have been on the rise. According to the CDC, in 2000, it was estimated that 1 in 150 children developed ASD. By 2018, that number increased significantly to 1 in every 44. As Autism Spectrum Disorder becomes more prevalent in the population, physicians will be more likely to provide medical care to Autistic patients during their medical career.
