Category Archives: Internal Medicine

M. Beverly Hosten Dorsey, M.D. Obituary – Press & Sun-Bulletin – Pressconnects

M. Beverly Hosten Dorsey, retired physician, passed away on May 9, 2023 due to gastrointestinal problems. Born April 5, 1925 in Manhattan, NY to the late Edward Rawle Hosten and Frederica Blanche Gittens Hosten. Beverly had three younger brothers who are deceased Edward Bernar Hosten, Gittens Burleigh Hosten, and Edison Rawle Borah Hosten. She spent her childhood in Bedford Stuyvesant, Brooklyn. Their father helped build the Panama Canal as a timekeeper, sold typewriters and zealously invested in the New York Stock Exchange, their mother was a seamstress.

Beverly graduated from Hunter College (Class of 44) where she received her B.A. in chemistry and the sciences. She taught grade school for a few years before entering Howard University Medical School. In the spring of 1950 when she visited Howard for her acceptance interview, Beverly Roscoe Dorsey bounded up and proclaimed, You have my name. Would you like to have lunch with me? Beverly Hosten surveyed the room filled with mostly male prospective classmates and replied, No I am going back to Brooklyn on the train. They started school in the fall, and Beverly did not give back chemistry notes she borrowed for a long time. When Beverly retrieved his notes Beverly reconsidered his lunch invitation, and they became best friends for life. The Bevs were married in 1953 and did their internship at Queens General Hospital. Beverly arrived in Binghamton as a young bride and started her residency along with her husband at Wilson Hospital in 1954.

Beverly was generous giving unconditional love and specific advice to family, patients and community. A high energy person with fierce determination to restore smiles and relief in the many venues she operated in, Beverly was a gifted healer and advocate. She was proud of her West Indian heritage and loved to reminisce about trips to Grenada, Barbados and Jamaica as well as her love of swimming in the ocean. She also traveled to China and France.

Dr. Hosten enjoyed exercising, football, track and other sports in which her husband, brothers, daughters and grandsons have been involved. Years ago, she participated in skating, skiing, and horseback riding.

Her cultural and scientific interests include current events, music, opera, theatre, and visual arts.

She retired in 1997 as a medical doctor and enjoyed her lifestyle living at St. Louis Manor. Beverly used Zoom and YouTube to maintain a very active presence at Trinity Memorial Episcopal Church and worked as a Eucharistic Minister helping the ill and homebound.

Her professional career included working as a Physician for Planned Parenthood, Laboratory Technician in Goldwater Hospital in NYC, Primary Grade School Teacher in Flushing, NY, Medical Advisor for the Broome County Home Care Committee, Medical Staff at Endicott Johnson Corporation and Private Medical Practice Internal Medicine With Dr. Beverly R. Dorsey (husband)

A dedicated community volunteer she formerly served in the following positions: United Health Service Hospitals (Board of Directors), Broome County Medical Society (Board of Directors), Council of Binghamton University (Advisor to President Louis De Fleur), Council of Binghamton University School of Education and Human Development, United Fund (forerunner of United Way), NYC Commission on Human Rights, Physicians for Planned Parenthood, Medical Advisor for Broome County Home Care Commission, the Vestry of Trinity Memorial Episcopal Church and as a Trustee for Childrens Home of Wyoming Conference (Methodist).

Her organization affiliations were: National Medical Association (Black Medical Society), American Medical Association, Medical Society of the State of New York, Broome County Medical Society, Interracial Association (forerunner of the Urban League), Broome County Urban League, NAACP of Broome County, Broome County Martin Luther King, Jr. Commission, Delta Sigma Theta Sorority, Inc. (Apalachin Alumnae Chapter), Charter Life member of Howard University Medical Alumni Association, Inc. (HUMAA)

Her service to the community was recognized with many honors, including Broome County Status of Women Council (Honoree from Delta Sigma Theta Sorority, Inc. (1984), Achievers Award from Utica Consistory of Prince Hall Masonic Affiliation (1998), Paul Harris Fellowship Distinguished Citizen Award (From Rotary in November 1999), Woman of Distinction 2000 Honoree (From Indian Hill Girl Scouts), Chairmans Recognition Award (In appreciation of service to Department of Internal Medicine at United Health Services Hospital in October 2000) and Broome County Council of Churches Honoree (2000).

Beverly is survived by her daughters, Adrienne Celeste Wheeler and Jeannine Michelle Thomas and three grandsons: Zachary Paul Thomas, William Dorsey Wheeler, and Seth Emanual Thomas, sister-in-law, Ann Denise Burt Hosten, nephews, Michael Orlando Hosten, Gregory Rawle Hosten, Terence Borah Hosten, Paul Trestand Hosten, and Joseph Santiago Hosten and a circle of devoted friends.

She will be remembered for her compassionate and caring nature, her intelligence and quick wit, her honesty and integrity, her humor and her knowing smile.

A memorial service will be held at a date to be announced at the Trinity Memorial Episcopal Church, 44 Main St. Binghamton. Those wishing to honor her memory may do so by making a gift in her name to the Howard University Medical School, 520 W Street, NW, Washington, DC 20059. The Hopler & Eschbach Funeral Home is assisting the family. Please sign her guestbook at http://www.HEFUNERALHOME.com

Posted online on May 12, 2023

Published in Press & Sun-Bulletin

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M. Beverly Hosten Dorsey, M.D. Obituary - Press & Sun-Bulletin - Pressconnects

Burnett School of Medicine at TCU Graduates Ready To Break … – Fort Worth Magazine

Ive Avila is the product of immigrants from Mexico, raised with her three siblings in Chicago. Her mother was a janitor at a school and her father worked in construction.

She studied molecular biology simply typing that is a dizzying task from Loyola University Chicago, and an MBA from Southern New Hampshire University.

On Saturday, the 32-year-old will be part of the first graduating class of the Anne Burnett Marion School of Medicine at TCU, a groundbreaking moment for all involved, including the school perched on University Drive, celebrating 150 years in 2023.

We are immensely proud of these young doctors. They will forever be a part of TCUs 150th, said Chancellor Victor J. Boschini Jr. This is a day that has been years in the making, and it is only fitting that this special class would be a part of such a celebratory moment in the life of our university.

The 52 graduates, who all placed inresidency programs, will now go out into the world and begin molding the reputation that plays such a critical role ultimately in the formation of the medical school.

Avila is going to serve an OB/GYN four-year residency at Baylor Scott and White in Temple.

I think it's a huge responsibility, honestly, Avila says, Going on to the real world, going into our residency programs as MDs, I think that's an even bigger responsibility because now programs are seeing the product of the school essentially, and, hopefully, we can show them what we've learned throughout the four years, and how our LIC [Longitudinal Integrated Clerkship] program has, I think, prepared us more so than other traditional programs, at least when it comes to patient interaction and practice.

The graduates hooding ceremony will take place at 2 p.m. on Friday at the Van Cliburn Concert Hall. Commencement ceremonies for the med school are scheduled for 9 a.m. on Saturday at Schollmaier Arena.

Briana Collins is another soon-to-be graduate.

Collins grew up in Dallas and attended Ursuline Academy before ultimately earning an undergraduate degree in kinesiology at Louisiana State University.

She will be moving to Palo Alto, California, for a three-year residency in internal medicine at Stanford Health Care. Her plan is to follow that up with a fellowship to train specifically in cardiology for another three years.

Like Avila, Collins didnt hop from undergraduate school to med school. After graduating in 2015, she took the MCAT, the standardized test for prospective med school students, but didnt get the score that I wanted. Not deterred and seeking ways to improve her candidacy, she was accepted into The University of North Texas Health Science Centers masters course of study in medical science.

She worked as an EMT and as-needed emergency technician at UT Southwestern. After graduating with the masters, she dedicated three to four months preparing for the MCAT.

I finally got the score that I was comfortable applying with after my third attempt, Collins says.

Soon, Collins will start a residency in one of the most prestigious programs in the country. More than anything, these professional degrees require incredible work and study habits, and dogged persistence. The whole concept of quitting inspires loathing.

That brings me back to Avila, who had an active young child I could hear in the background as we spoke by phone.

Quin his full name is Quentin, like Quentin Tarantino is 16 months old.

Pregnancy during medical school is not standard operating procedure, but Avila and husband Sam found out they were expecting. Avila and Sam met in Austin on a blind date, though both were working at Lone Star Circle of Care. Avila was an enrollment counselor there, and Sam is still a physician recruiter with the company.

Avila says shes Type-A personality when it comes to scheduling, not spontaneous at all.

I like things to go the way that I plan them. And clearly that did not go that way, Avila says. I did not plan to be pregnant or have a child in medical school. But my husband and I became pregnant and we actually lost our first baby. Here I was freaking out about how [pregnancy] was gonna throw everything off and finally, you accept it, you fall in love, and then you lose your baby.

Now, she had to deal with heartbreak. The couple had made plans to welcome a baby, in their home and their hearts. The experience manifested itself in the couple actually deciding to try to have a baby.

Welcome to the world, Quin.

A tight schedule remained key to handling the newcomer and her studies, plus, she had support from her family, which, by this time,had moved from Chicago to Austin, where her father operates his 23-acre ranch, specializing in sheep and goats. (A little slow cooked, oven braised cabrito would hit the spot about right now.)

As soon as I had him, my mom [Rebeca] retired, and she was like, There's no way we worked so hard to get you here collectively as a family youre going to keep going. So, shemoved in with us. She was our full-time nanny/babysitter. There's no way I could have done it without her.

There's an apothegm or there should be if there's not out there: Its difficult to get through this journey of life without good friends and family, and a bottle of something.

Well, now I'm projecting.

To the inaugural graduating class of the Burnett School of Medicine, we wish you the best. It goes without saying that lots of people will be counting on you.

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Burnett School of Medicine at TCU Graduates Ready To Break ... - Fort Worth Magazine

Internal Medicine Case Challenge: Hallucinations, Moaning, and … – Medscape Reference

Editor's Note:The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

An 88-year-old woman who has had confusion and a decline in mental status over the past 2 weeks is brought to the emergency department by her daughter. The patient's daughter reports that her mother has also had occasional hallucinations for the past week, with associated intermittent moaning. She is unable to provide a history for herself, and all history is gathered from her daughter.

Her past medical history is significant for hypertension and skin and breast cancer; she had a partial mastectomy 10 years ago. The only medication she takes daily is metoprolol for hypertension.

Forty-five days ago, the patient underwent an open reduction and internal fixation of a left femur intertrochanteric fracture. The surgery was uncomplicated, and she was discharged from the hospital to a rehabilitation facility 35 days ago. Before the fracture, the patient was independent; she lived alone and went to a bar every night with her friends. According to her daughter, she does not use tobacco or illicit drugs.

Her daughter noticed that her symptoms of confusion started 2 weeks ago and have progressively worsened. She removed the patient from the rehabilitation facility 5 days ago owing to "improper care." Her daughter also reports that her mother's baseline status is alert and oriented to person, place, time, and event. Her decline in mental status has occurred over the past 2 weeks and has worsened during the past 3 days. The daughter reports that her mother has not had chest pain, shortness of breath, nausea, vomiting, or diarrhea; however, she has had multiple episodes of abdominal pain and deep bone pain over the past 2 weeks.

Medscape2023WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Danny Gersowsky.Internal Medicine Case Challenge: Hallucinations, Moaning, and Confusion in an 88-Year-Old-Medscape-May10,2023.

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Internal Medicine Case Challenge: Hallucinations, Moaning, and ... - Medscape Reference

You asked, we answered: Is syncope a symptom of COVID? – Nebraska Medicine

Question: Can COVID cause syncope?

Answered by internal medicine doctor Andrew Vasey, MD

Syncope is the medical term for fainting or passing out. Generally, this condition arises when you have a sudden, temporary decrease in blood flow to your brain. Many syncopal occurrences are benign and result from a short-term cause. Syncope can happen because of the following:

There are a few reports of people presenting post-COVID who experience syncopal issues. Still, the difficult part for health care providers is that various processes can cause syncope, even without post-COVID complications. Similarly, defining a post-COVID symptom versus a symptom from another pre-existing cause is challenging.

Patients with post-COVID issues can have symptoms related to most organ systems. For example, many post-COVID symptoms are believed to be related to autonomic nervous system dysfunction. With autonomic dysfunction, a person can have inappropriate changes in their heart rate such as increasing more than it should with movement or position changes and can feel like they are going to pass out or do pass out. Many medical conditions can cause autonomic dysfunction, not just post-COVID issues.

Given all these factors, the short answer is, it is difficult to determine if syncope is definitively a symptom of COVID-19.

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You asked, we answered: Is syncope a symptom of COVID? - Nebraska Medicine

Penn Medicine Residents Vote to Unionize | MedPage Today – Medpage Today

University of Pennsylvania residents and fellows voted to unionize, with the vast majority green-lighting the historic move.

"With 88% of participants voting in favor, the frontline Penn Medicine doctors are the first statewide to gain union representation," according to the Committee of Interns and Residents/Service Employees International Union (CIR/SEIU), which reported Monday that the vote was 892 to 110.

Specifically, the residents and fellows at the Philadelphia health system "look forward to advocating for the conditions they need to provide top-quality care without compromising their mental, physical, or financial wellbeing," the union stated.

House staff unionization efforts continue to multiply across the country. Just last month, MedPage Today reported that house staff at Mass General Brigham in Boston will proceed with their own unionization efforts despite a salary bump.

Kendall Major, MD, an internal medicine resident at Penn Medicine, told MedPage Today that house staff are thinking about their goals in two ways -- advocating for patients in terms of factors like the design of new buildings and resource allocation, and advocating for themselves when it comes to salaries and benefits.

"We are the ones on the frontlines working 80 hours a week," Major said, adding that it's important "that we have a seat at the negotiating table."

A Penn Medicine spokesperson said in a statement provided to MedPage Today via email that house staff voted for union representation in an election conducted by the National Labor Relations Board (NLRB) on May 3-5. The statement noted that the result has not been certified. Penn Medicine has been informed the process can take up to 7 business days, according to the statement.

"We are proud of Penn Medicine's long history as home to many top residency and fellowship programs, and we have appreciated the ongoing opportunity to hear directly from residents about their concerns during this unionization campaign," the spokesperson said. "We have an obligation to stay true to our shared goals to provide the very best care to our patients, and to ensure that new physicians are able to train in an environment that allows them resources to flourish academically, professionally, and personally."

"We respect our trainees' collective decision and remain committed to continuing our work to improve their training experience and ensure that they are fully supported during these transformative years of their medical careers," the spokesperson added.

"Getting 892 people -- inspiring them to come out and vote -- is really a testament to how much we needed this union at Penn Medicine," Major told MedPage Today, adding that residents and fellows are hopeful that their win will inspire others in what has become a nationwide conversation.

"This is bigger than just the University of Pennsylvania," she said. "I'm hopeful that we will see many, many more to come." she said.

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

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Penn Medicine Residents Vote to Unionize | MedPage Today - Medpage Today

Global Osteoarthritis Leaders Host OA Innovation Shark Tank Meeting at U.S. Congress to Showcase Promise of New Cures Call for Increased Federal…

Rep. Connolly and Congressional Arthritis Caucus Cheer the New Science Salute Innovation and Mark National Arthritis Awareness Month

WASHINGTON, May 12, 2023--(BUSINESS WIRE)--Marking National Arthritis Awareness Month in May, Angry@Arthritis and the Arthritis Foundation yesterday hosted the annual OA Innovation "Shark Tank" meeting on Capitol Hill to spotlight the promise of new treatments to cure osteoarthritis (OA). As researchers and industry demonstrate the success of OA treatments in clinical trials, the arthritis community is saluting innovation and asking Congress for increased OA funding to help cure this disease that afflicts one in seven American adults.

Clinical trials are very expensive. Today, its impossible to see the current level of federal research funding for OA treatments or to understand the impact of the investments Congress is currently making. The community is asking for the Government Accountability Office or the Congressional Research Service to audit current federal OA investment levels and impact, as well as generate an integrated annual report on federal OA research progress.

More than 32.5 million American adults suffer with OA, and more than five percent of the global population are afflicted with the disease. As our population ages, OA is a growing concern 100 percent of people will suffer with OA if we live long enough. OA can afflict any and all joints in the body and today, Americans receive 790,000 knee and 450,000 hip replacements per year, while far larger numbers live with the pain and avoid troublesome joint replacements. There is no effective treatment of OA in the hands and many other joints. Each year, OA costs the U.S. economy $71 billion in lost productivity and inflicts $65.5 billion in medical expenses. While there are a number of treatments in the FDA approval process, currently there is no FDA approved OA treatment. The guidance to lose weight, exercise, and eat healthy is great but this is a much bigger problem.

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This annual OA Innovation Shark Tank program brings together the leading minds in OA research and clinical disciplines from across America and around the world to present their treatments, opinions, research, and human clinical trial data. The treatments target OA in a series of different joints. The program puts a spotlight on the promise of cures and makes the case for additional investment from government and the pharmaceutical industry. In addition to opening remarks from Rep. Gerry Connolly (D-VA), the program featured:

Dr. Elizabeth "Blair" Solow, M.D., Associate Professor of Rheumatology, Department of Internal Medicine at University of Texas Southwestern Medical Center; and chair of the America College of Rheumatology Government Affairs Committee. Dr. Solow provided a rheumatologists clinician perspective and spoke to the disease modifying OA treatment desert in patient care. She underlined the urgent need for new innovation and increased federal research and development funding to improve patient care and outcomes.

Dr. Ivan Martin, Chair of the Department of Biomedicine at the University of Basel, Switzerland. Dr. Martin reviewed his teams Nasal Tissue Engineered Cartilage (N-TEC) treatment that harvests cells from nasal cartilage and grows them into cartilage patches which are surgically inserted into cartilage defects and damaged OA joints. His team has treated more than 100 human patients knees, shoulders, and ankles with N-TEC.

Dr. Jennifer Elisseeff, Director of the Translational Tissue Engineering Center at Johns Hopkins University. Dr. Elisseeff is a pioneer in regenerative immunology treatments that empower patients bodies to repair their joints themselves. She created the original recipe for the anti-aging, senolytic OA drug UBX0101 that recently exited FDA clinical trials. Dr. Elisseeff talked about the promise of regenerative immunology and senoyltics.

Dr. Brad Estes, CEO and founder, CytexOrtho, in North Carolina. Dr. Estes reviewed his teams work restoring damaged joints using a cutting-edge regenerative medical implant designed to mimic native tissues. CytexOrtho recently received Breakthrough Device Designation for its joint repair product and is currently in the process of entering human clinical trials in the hip later this year.

Dr. Yusuf Yazici, Chief Medical Officer at Biosplice Therapeutics Inc. based in San Diego, California. Dr. Yazici presented data on Lorecivivint, an injectable CLK/DYRK inhibitor thought to modulate Wnt and inflammatory pathways, in development as a potential pain and disease-modifying treatment for knee osteoarthritis. Lorecivivint is currently in phase 3 clinical trials.

"Osteoarthritis is crippling Americans and our economy," said Steve OKeeffe, founder, Angry@Arthritis. "But it is not inevitable and its not incurable. To steal a line from CytexOrtho, people dont want to replace their joints they want to renew them. We need to disrupt the inevitability of the failing status quo. We have many innovative new treatments that are proving effective in clinical trials America needs to know. Our government and industry players need to jump into this fight and invest in osteoarthritis research and cures. We encourage you to contact your Congressional representative 32.5 million Americans thats a powerful voting block."

"Scientific advancements are moving at a lightning speed, and they can really make a difference in OA treatment but were disappointed that the funding and support just dont add up," said Anna Hyde, Vice President of Advocacy and Access for the Arthritis Foundation. "As part of our commitment to leading the way to scientific breakthroughs, were pushing for lawmakers to increase the federal investment in arthritis research and help make real progress in helping millions of Americans live free from OA pain."

About Angry@Arthritis

Angry@Arthritis is a new 501(c)(3) focused on attacking and eliminating osteoarthritis http://www.angryarthritis.org. Angry@Arthritis provides the patients guide to OA, raises money to fund new cures, and advocates for OA to the U.S. Congress.

About the Arthritis Foundation

The Arthritis Foundation is fighting for all people who live with arthritis. As Champions of Yes, the Arthritis Foundations mission is to turn the obstacles arthritis causes into opportunities. The Arthritis Foundation champions life-changing solutions and medical advancements, and it also provides ways for people to connect, break down barriers in health care and join the fight to conquer arthritis uniting hearts, minds and resources to change the future of arthritis. To join the fight to conquer arthritis, visit arthritis.org.

View source version on businesswire.com: https://www.businesswire.com/news/home/20230512005358/en/

Contacts

Whitley TaylorOKeeffe & Companywtaylor@okco.com (757) 287-2167

Marlena ReedArthritis Foundationmreed@arthritis.org (470) 588-9755

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Global Osteoarthritis Leaders Host OA Innovation Shark Tank Meeting at U.S. Congress to Showcase Promise of New Cures Call for Increased Federal...

Can Digital Psychiatry Really Fill the Mental Health Care Gap? – Smithsonian Magazine

Many new digital psychiatry solutions have attracted funding in recent years, and experts have questions about how helpful or harmful they will be. Illustration by Emily Lankiewicz / Public Domain

Imagine youre in a room with a hundred American young adults, bright-eyed and bushy-tailed. Over their lifetimes, about 25 of them will have a stroke; 40 will get cancer. And an astounding half the room will develop a mental illness, if they havent done so already.

The United States mental health epidemic has been simmering for decades, with Covid-19 both illuminating and exacerbating the crisis. Given the social isolation, job insecurity and weakened support systems over the past few years, the World Health Organization estimated a 25 percent increase in anxiety and depression worldwide, with women and young people worst hit.

A large part of the challenge are the cavernous gaps in care: 158 million Americans live in an area with a shortage of mental health workers. And while the rise of telehealth and creation of the 988 suicide and crisis lifeline have helped, they are only Band-Aids, barely holding together a system failing at its seams. Were at a point in the U.S. where it almost couldnt get worse, says Kenneth Pages, a Florida doctor and former chief of psychiatry at Tampa General Hospital. Describe worse to me at this point.

Daunting as they may be, these challenges have inspired a new wave of digital psychiatry solutions, offering automated promise where humans have fallen short. Largely developed by computer scientists and consumer tech entrepreneurs, the new field leverages smartphones and wearable sensors to provide mental health insights, attracting more than $10 billion in funding worldwide between 2020 and 2022, according to technology market intelligence firm CB Insights. John Torous, director of the Digital Psychiatry Division at Beth Israel Deaconess Medical Center in Boston, argues that the mental health crisis were all talking about really requires more transformative solutions.

Left open are broad questions over this nascent field and the trend toward shifting health care into a digital-first field. What does it mean to remove humans from something as fundamentally interpersonal as our mental health? And is digital psychiatry worth all the hype?

When you first consider digital psychiatry, you might think about the laundry list of apps ready to download on your smartphone: Calm, Headspace, Sanvello, Bearable, Happify and many others with similarly cheery names. These apps are personal assistants of sorts, helping users engage in guided meditations, mindfulness exercises, anxiety management and other activities, with customized wellness plans based on user preferences and lifestyles. While most of these apps offer free versions, accessing the full range of contentparticularly the personalized toolsrequires subscriptions ranging between $27.99 to $350 per year.

These companies advertise slogans like Become the architect of your health, and they say that Youll be surprised at how soon youll start feeling a positive change, but they are also quick to note that the apps are not meant for clinical use. We are not a health care or medical device provider, nor should our products be considered medical advice, Headspace emphasizes, before adding that its app makes no claims, representations or guarantees that the Products provide a physical or therapeutic benefit. Most others offer similar disclaimers.

That being said, some of these apps can be helpful. Recent data from nonclinical participants suggest that Calm and Headspace offer modest improvements across mindfulness, well-being, stress, anxiety and depression. Clinical psychologist Vara Saripalli says a lot of her patients already use these apps, and she even recommends some of them for patients who are anxious or want practice sorting through their thoughts and feelings. As an adjunct where your provider is checking in about your use of one of these tools, she continues, that can be helpful.

Beyond the consumer-facing apps, firms also offer software to help clinicians better care for their patients. The TrakStar platform, for instance, helps clinicians manage transcranial magnetic stimulation, an FDA-approved therapy for major depressive disorder, obsessive-compulsive disorder, migraines and smoking addiction. More specifically, TrakStar helps determine patient eligibility and insurance coverage, tracks patient-reported outcomes during treatment to assess efficacy and adverse events, and continues to monitor patients post-treatment through questionnaires in case they relapse. The platform notifies a provider if a patient gets worse so the provider can reengage with the patient.

Many of our patients waited until they completely crashed into a deep depression in order to seek help, even if they had previously recovered, says Cory Anderson, the companys vice president of clinical affairs and medical operations. What TrakStar is doing is monitoring these patients after their treatment to make sure they dont crash. He calls it an early warning system, with the ultimate goal being to expand health care capacity. In Andersons ideal world, mental health providers could quickly divert their attention to patients experiencing severe crises rather than being spread thin across all patients.

This mission to use digital tools to augment professional care is shared by academic researchers. Beth Israels Torous, for instance, invented MindLAMP, a digital psychiatry platform that collects info on sleep patterns, physical activities, physiological symptoms and call and text logs to offer patients customized mindfulness, meditation and breathing interventions. Although the app can take in data across wearable technology, surveys and GPS tracking, Torous emphasizes that clinicians and patients collaboratively decide which particular data streams to collect and then interpret them together in the clinic. We built it to be a more customizable, flexible way to use smartphones to augment care, Torous says.

So far, this approach appears promising: Across India, China, Australia, Canada and the U.S., MindLAMP has been used to digitally provide therapy to patients with schizophrenia, track memory loss in patients with Alzheimers, and understand differences in the disease trajectories of bipolar disorder and depression. If we can, in the future, start using algorithmsones that are evidence-basedI think we can begin to offer people a lot more responsiveness and features on LAMP to help them feel better quicker, says Torous.

Right now, MindLAMP is run by a research protocol without any investors, and there are no plans currently to spin the platform out into a business. Wed like to keep it as a common tool that people can use, Torous continues. They can do replicable science in this spacethey can add to it, augment it. He wants to provide a free platform for other researchers to validate and build off, in a field sometimes devoid of data-driven solutions.

Like Torous, Paola Pedrelli, associate director of the Depression Clinical and Research Program at Massachusetts General Hospital, and Judith Law, CEO of Anxiety Canada, value these types of academia-led innovations in digital psychiatry. For the past seven years, Pedrelli has been working with Rosalind Picard at MIT to develop machine learning algorithms that detect the severity of depressive symptoms among patients. And since 2012, Law has been collaborating with Mayo Clinic, University of British Columbia, University of Waterloo and other institutions on MindShift CBT, an anxiety management coaching app. Based on cognitive behavioral therapy, the goal is to challenge patients thoughts, beliefs and attitudes to improve their emotional well-being.

Pedrelli hopes that eventually, by collecting heart rate, sweat gland activity, temperature and movement from wearables, she and Picard will be able to prioritize patients experiencing acute relapses and proactively modify treatments before they fall into a deep depression. But in the meantime, MindShift CBT doesnt collect physiological data and instead contains modules to educate users on anxiety and engage them in skill-building exercises to support coping. A distinctive aspect of this free app is its community forum where users can learn from others experiences in a moderated space, providing and receiving peer-to-peer support. According to Lance Rappaport, a clinical psychologist at the University of Windsor and senior author of an upcoming study on MindShift CBT, anxiety, depressive symptoms and functional impairment decreased and quality of life increased among a cohort of more than 200 people who used the app for 16 weeks.

For digital psychiatry to succeed, Law says, the field will need to build its evidence base, actually proving that these tools have a clinical benefit in users. And if they dont, regulators may need to step in and hold companies accountable to produce the evidence. If Calm, Headspace and all these other products, ultimately, are more interested in the evidence base versus profitability, then I think were headed in the right direction, says Law.

Unfortunately, with billions of dollars of investor funding, some companies have tested ethical and legal boundaries in how they offer patient care. The platform Koko recently admitted to using artificial intelligence chatbots in place of humans to provide emotional support to customers without their consent. And last year, mental health telemedicine company Cerebral was placed under investigation by the Department of Justice for overprescribing the controlled substances Adderall and Xanax without requiring in-person evaluations. Companies that are for-profit are going to cut corners, says Saripalli. Im really concerned about the lack of quality of care that is going to proliferate the more these apps proliferate.

Vanderbilt Universitys Bradley Malin, an expert in biomedical informatics, offers similar concerns: With VC support behind it, theres this push toward quick return as fast as possiblegrow, grow, grow. With around 20,000 mental health apps currently available on the marketplace, ensuring these technologies are validated and demonstrate tangible benefit is thus of utmost importance. And doing this properly requires a lot of data collection, independent studies and replicated results.

But how much data is too much? Malin says, Its this push forward toward, We dont know what were looking for. And therefore, were just going to blitz it and collect as much as we want, and then were going to let the computer figure out the answer.

With this shotgun approach to data collection, data breaches, either because of internal mistakes or external hacking, become increasingly risky. Cerebral had been using pixel trackerscode that collects activity datato monitor user engagement for the past four years. And only in 2023 did the company realize that this data was being shared with Meta, TikTok and Google in a breach affecting 3.2 million patients. Similarly, a security flaw in the IT systems of Vastaamo, referred to as the McDonalds of psychotherapy, led to its entire patient database being leaked to the internet, including email addresses, social security numbers and therapists notes. Around 30,000 people received ransom demands from hackers threatening to publish their private information.

And some companies have even shared data willfully. The Federal Trade Commission went after the online counseling service BetterHelp for pushing people to give sensitive health information while promising absolute privacybut then BetterHelp handed that data over to Facebook, Pinterest, Snapchat, Criteo and other advertisers. BetterHelp has since agreed to a $7.8 million settlement for alleged data misuse. Digital psychiatry may promise mental health care from the privacy of peoples homes, but what does that privacy mean in a world of seemingly endless leaks?

According to Malin, any health care provider can search a patients physical informationlab tests, imaging, vitals. But mental health information is only known to those doctors whom it is shared with in consult. And our thoughts are sensitivethey concern other people, about things that have yet to happen, about the world that only we can see. It does make it very juicy information, for lack of a better term, Malin adds. The question is: How much support are you going to provide for personal rights and protection versus the end application?

Such sensitive information leaves little room for error. The penalties of being wrong are severe, says Colin Walsh, an internal medicine physician at Vanderbilt. If an algorithm says an individual is high-risk and they arent, they may receive an intervention that they dont need. Walsh brings up the example of the military, where these kinds of false positives can be career altering: A commander might take that information and not want to send them on deployment.

Already were seeing students forced to withdraw from college after university medical staff inform administrators of their conditionsand workers are getting fired from their jobs after voluntarily disclosing their mental illnesses. With the propagation of digital psychiatry, providers, supervisors and administrators could get access to even richer personalized data, collected through routine onboarding processes or employer-provided mental health services. While these data usually tend to be de-identified, Walsh notes that they can always be re-identified. In his eyes, the rise of digital psychiatry could bring a rise in stigma and discrimination against those with psychiatric conditions.

For the time being, medical health professionals think its unlikely that digital psychiatry will fully replace human clinicians. Apart from the lack of scientific evidence to support these technologies, apps are simply unable to provide a humanistic experience. One of the biggest factors in successful therapy is the quality of the relationship between the individual and the therapist, says Saripalli. I dont think youre going to get a human personalized touch if this is your primary provision of treatment.

If anything, digital psychiatry might exacerbate the very inequities it hoped to address. Indeed, left unregulated, mental health companies can profit off those who cant afford traditional care by offering cheap, ineffective treatments. At the higher end of the income spectrum, people are going to pay for a premium product, and theres no question that in-person, one-on-one individualized attention is going to be superior, Saripalli adds.

Nonetheless, everyone interviewed for this story believes that the digital psychiatry movement is far from slowing downand that providers need to actively participate to ensure it doesnt harm patients. While part of this movement is undoubtedly driven by hype and feckless profiteering, real potential exists for digital solutions to alleviate the burdens of a mental health care system on the brink of collapse. The question becomes how to identify these promising use-cases and bring together mental health providers, data privacy officials and patients to ensure that we are progressing in an evidence-based, secure way.

Theres this idea, move fast and break thingsthat old Silicon Valley mantra, says Walsh. In health care, that means people get hurt.

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Can Digital Psychiatry Really Fill the Mental Health Care Gap? - Smithsonian Magazine

Consistent poverty linked to higher mortality rates – Healio

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Poverty should be considered a major risk factor for death in the United States, according to the results of research published in JAMA Internal Medicine.

The United States consistently has a poverty rate much higher than similarly wealthy countries, which presents an enormous challenge to population health, given that considerable research demonstrates that being in poverty is bad for ones health, David Brady, PhD, a professor of public policy at University of California, Riverside, and colleagues wrote.

Although previous research has offered valuable contributions on income and mortality, the researchers wrote that the quantity of mortality connected with U.S. poverty is unknown. So, they conducted a cohort study to estimate the associations between mortality and poverty and quantify the proportion of deaths linked to poverty.

Brady and colleagues evaluated the Panel Study of Income Dynamics 1997 to 2019 data merged with the Cross-National Equivalent File, ultimately including 18,995 respondents aged 15 years or older. The survey observed mortality from surviving family members and validated with the National Death Index. When it came to measuring socioeconomic status, the higher quality household income measure included all income sources and taxes and was adjusted for household size.

Brady and colleagues found that poverty was linked to a greater mortality hazard of 1.42 (95% CI, 1.26-1.6). Consistently being in poverty referred to as cumulative poverty was linked to a greater mortality hazard of 1.71 (95% CI, 1.45-2.02).

Current poverty was associated with 6.5% of deaths (95% CI, 4.1-9) among those aged 15 years or older in 2019. Among that same demographic, cumulative poverty was linked to 10.5% of deaths (95% CI, 6.9-14.4).

Current poverty was connected to higher mortality than major causes like stroke, accidents and lower respiratory diseases, according to the researchers. It was also linked to higher mortality than far more visible causes, they wrote. For instance, current poverty mortality was responsible for 2.6 times as many deaths as drug overdose, 3.9 times as many deaths as suicide, 4.7 times as many deaths as firearms and 10 times as many homicides.

However, cumulative poverty was linked to approximately 60% greater mortality than current poverty and higher mortality than obesity and dementia. The researchers wrote that the only causes or risks with greater mortality than cumulative poverty were cancer, smoking and heart disease.

Because the U.S. consistently has high poverty rates, these estimates can contribute to understanding why the U.S. has comparatively lower life expectancy, Brady and colleagues wrote. Because certain ethnic and racial minority groups are far more likely to be in poverty, our estimates can improve understanding of ethnic and racial inequalities in life expectancy.

Brady and colleagues additionally noted that disparities in survival between those in poverty and those not in poverty begin to emerge at around 40 years of age. The gap peaks around 70 years of age, they wrote, and then begins to converge again.

The mortality associated with poverty is also associated with enormous economic costs, the researchers wrote. Therefore, benefit-cost calculations of poverty-reducing social policies should incorporate the benefits of lower mortality.

Brady and colleagues also noted that poverty likely aggravated the mortality impact of COVID-19, which occurred after our analyses ended in 2019.

Therefore, one limitation of this study is that our estimates may be conservative about the number of deaths associated with poverty, they wrote. Ultimately, we propose that poverty should be considered a major risk factor for death in the U.S.

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Consistent poverty linked to higher mortality rates - Healio

Poor performance in non-lame Standardbreds often involves several … – Horsetalk

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Poor performance in Standardbred racehorses without lameness issues often involves multiple problems, researchers in Italy report.

Chiara Lo Feudo and her fellow researchers, writing in the Journal of Veterinary Internal Medicine, said poor performance is a common and complex condition of racehorses, usually associated with subclinical disorders.

In addition to musculoskeletal conditions, medical disorders are common, and their identification can be challenging for veterinarians.

In fact, poorly performing horses are mostly normal on physical examination, and the identification of underlying medical diseases often requires dynamic tests. Multiple disorders can affect horses at the same time, and it can be difficult to determine the contribution of each to impaired racing performance.

The study team, with the University of Milan, set out to describe the prevalence and distribution of medical disorders diagnosed in a population of poorly performing Standardbred trotters and their associations with fitness variables measured during a standardized treadmill test.

In addition, the associations between simultaneously encountered diseases was evaluated, and the contribution of each disorder on changes in fitness-related variables in a multifactorial setting was determined.

The medical records of Standardbred trotters referred for poor performance to the Equine Sports Medicine Unit of the Veterinary Teaching Hospital at the University of Milan between 2002 and 2021 were reviewed.

All of the 259 non-lame horses identified were in full training upon admission. The age of the horses varied from 2 to 9years. They were made up of 93 females, 146 stallions and 20 geldings.

All underwent a standard diagnostic evaluation for poor performance, with identification of subclinical causes.

The diagnostic protocol included a resting examination, plasma lactate concentration, a treadmill test with continuous heart monitoring and assessment of fitness variables, creatine kinase activity, a treadmill endoscopy, postexercise tracheobronchoscopy, bronchoalveolar lavage, and gastroscopy.

The prevalence of different disorders was evaluated, including cardiac arrhythmias, exertional myopathies, dynamic upper airway obstructions, exercise-induced pulmonary hemorrhage (bleeding from the lungs), moderate equine asthma and gastric ulcers.

Moderate equine asthma and gastric ulcers were the most common disorders identified, followed by bleeding from the lungs, dynamic upper airway obstructions, cardiac arrhythmias, and exertional myopathies diseases that affect the muscles that control voluntary movement.

Hemosiderin scores were positively correlated with levels of neutrophils, eosinophils, and mast cells in lavage fluid. Increased creatine kinase activity was linked with neutrophilia in lavage fluid, dynamic upper airway obstructions, premature complexes (when the lower chambers of the heart contract before they should), and gastric disease affecting the upper squamous portion of the stomach.

Treadmill velocity at a plasma lactate concentration of 4mmol/L and at a heart rate of 200 beats per minute was negatively affected by neutrophilia in lavage fluid, multiple dynamic upper airway obstructions, exertional myopathies, and squamous gastric disease.

The multifactorial nature of poor performance was confirmed, the researchers said, with moderate equine asthma, dynamic upper airway obstructions, myopathies and equine gastric ulcer syndrome representing the main diseases involved in fitness impairment.

Two or more disorders were simultaneously observed in almost 90% of the horses.

The most commonly diagnosed disorders were gastric ulcer syndrome and moderate equine asthma, followed by bleeding in the lungs, equine glandular gastric disease and dynamic upper airway obstructions.

All disorders, except for premature complexes, were associated with one or more fitness variables.

The greatest impairment of fitness was related to the diagnosis of exertional myopathies, severe and multiple dynamic upper airway obstructions, neutrophilic inflammation of the lower airway, and severe grades of squamous gastric disease.

A definitive diagnosis was reached for 254 of 255 horses, which suggests that the diagnostic protocol performed in our study was comprehensive enough to evaluate the most common subclinical non-orthopedic causes of racing poor performance.

Gastric ulcers were diagnosed in almost all horses, with severe squamous gastric disease (grade 3 or 4) detected in 87% of the horses, whereas the prevalence of glandular gastric disease was approximately 58%.

Respiratory diseases represented an equally common cause of poor performance among the study horses. A diagnosis of mild to moderate asthma was made in 97% of the horses, with the majority of them affected by a mixed inflammatory form.

The authors noted that mild to moderate asthma is universally recognized as one of the most common causes of impaired athletic capacity in horses.

Based on endoscopy, around 60% of the horses had blood in the trachea, but only 17% were positive for exercise-induced pulmonary hemorrhage (EIPH) based on their total hemosiderin score and could therefore be considered bleeders.

Clinically relevant premature complexes were detected in 18% of the horses during treadmill exercise.

Finally, post-exercise creatine-kinase activity was higher than normal in 11% of the horses, whereas clinical myopathies (observed during hospitalization or inferred by history) affected 17% of the horses.

Exertional rhabdomyolysis is reported to have a prevalence of 6% among Standardbred racehorses, which may be higher in our study because of the inclusion of only poorly performing horses.

The researchers said the horses in the study came from different training centers over a period of 20years. Therefore, different training techniques may have influenced the results.

Finally, because our study was performed retrospectively and only included poorly performing Standardbred racehorses, future studies should verify whether or not the identified associations are found in a mixed population, including a control group of well-performing horses.

The study team comprised Lo Feudo, Luca Stucchi, Bianca Conturba, Giovanni Stancari, Enrica Zucca and Francesco Ferrucci, all with the University of Milan.

Lo Feudo, CM, Stucchi, L, Conturba, B, Stancari, G, Zucca, E, Ferrucci, F. Medical causes of poor performance and their associations with fitness in Standardbred racehorses. J Vet Intern Med. 2023; 1- 14. doi:10.1111/jvim.16734

The study, published under a Creative Commons License, can be read here.

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Poor performance in non-lame Standardbreds often involves several ... - Horsetalk

Q&A: What impact did ID experts have on the COVID-19 pandemic? – Healio

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Throughout the COVID-19 pandemic, infectious disease experts made contributions to help control the outbreak and improve public understanding of the new disease.

Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, and colleagues wrote in a recent paper that these efforts went well beyond their usual responsibilities and often led to hours of additional work without additional compensation.

We spoke with Adalja about the impacts infectious disease (ID) experts had and what they mean for the future for both ID experts and potential pandemics.

Healio: What prompted this paper?

Adalja: The prompt for this paper which is a distillation of a larger report was the tremendous ID expertise the nation relied upon throughout the pandemic. This expertise was not just in-hospital treatment of patients but extended far outside hospital walls into communities and added much resiliency to communities and organizations. Often, this work was voluntary and uncompensated but so vital.

Healio: What were some of the most notable contributions the ID workforce made to the COVID-19 response?

Adalja: The ID workforce helped reopen schools, gyms and workplaces. Some ID physicians even helped sports teams, entertainment venues, consulted on movie filming and provided expert forecasting to financial firms.

Healio: What were the impacts of these contributions?

Adalja: Its hard to quantify the impact, but it was core to resiliency and recovery of many communities and organizations.

Healio: What recommendations does the paper suggest to help fortify the ID workforce for future pandemics, and why is it important to do so?

Adalja: The recommendations are to recognize the enormous value that ID physicians provide to communities by making the specialty attractive to training physicians. ID is not a highly compensated subspeciality paradoxically because it is a cognitive specialty and not one that is procedure based. The extra training, for example, an internal medicine physician undergoes to become an ID physician will actually lower their salary. The formula that the government and other payers employ undervalues mental effort and must change. Loan repayment programs can also play a role.

Healio: Do you think the U.S. is in better shape for the next pandemic than it was before COVID-19?

Adalja: Although I think the pandemic opened peoples eyes to how calamitous and deadly a pandemic could be in the 21st century, complacency is already setting in. This is just not a priority for political leaders whose time horizon is just the next election. The missteps that occurred in the early mpox response illustrate this. However, there is hope that the public will demand competence in this field from governments because the pandemics toll was magnified by government failures at all levels.

Healio: What is the main take away from this paper?

Adalja: ID physicians are on all the front lines protecting individuals and society from the threat of infectious diseases. The modern human way of life is one in which an individual benefits from much that ID physicians do, even if they have never seen one for medical care.

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Q&A: What impact did ID experts have on the COVID-19 pandemic? - Healio