Research results show that many physicians and other clinicians are hindered from helping patients make these changes.

A survey of 1286 practitioners shows that 55% reported not receiving any reimbursement for lifestyle medicine practices, while 27% reported some reimbursement and 18% being reimbursed for all their lifestyles medicine interventions, according to research results from the American College of Lifestyle Medicine.

The respondents included dietitians, nurse practitioners, physician assistants, physical therapists, and physicians.

The respondents shared specific examples of both clinician and patient barriers, such as a Medicare patient who was denied coverage for a nutrition-focused weight management program in favor of a costly surgical procedure.

“Chronic disease management guidelines clearly recommend health behavior changes, but many reimbursement barriers discourage or prevent health care practitioners from helping patients achieve those lifestyle changes,” study author Kelly Freeman, MSN, AGPCNP-BC, DipACLM said in a statement. “If optimal health outcomes are truly the goal, more resources are needed to best illuminate the most impactful types of lifestyle interventions and how to successfully implement them in a sustainable manner.”

Some survey respondents recommended several changes that would improve their ability to practice lifestyle medicine. The top suggestions included better electronic medical record capabilities, policy changes to incentivize improved health outcomes and lifestyle medicine-specific billing codes, and reimbursement for increased time spent with patients.

The study authors proposed that specific policy changes must change to address the limitations of the payment and reimbursement models. A proposal example is to develop new quality measures that emphasize clinical outcomes and patient experience to address chronic disease remission and reversal.

“Now is the time to acknowledge that lifestyle medicine treatment is high-value care,” Micaela Karlsen, PhD, MSPH, ACLM Director of Research, said in the statement. “Practitioners who are able to achieve outcomes such as type 2 diabetes remission, true improvements in well-being, and reductions in medications, should be paid for their services in a manner that is commensurate with the value they provide.”

Reimbursement struggles for lifestyle medicine interventions pose significant barrier for health care practitioners, study finds. EurekAlert! News release. November 15, 2021. Accessed November 17, 2021. 

https://www.eurekalert.org/news-releases/934904

Articles

The respondents included dietitians, nurse practitioners, physician assistants, physical therapists, and physicians.








Study: Practitioners Face Reimbursement Barriers for Lifestyle Medicine Interventions

 interviewed Rita Wise, DEd, MSN, RN, the program director of the Masters in Nursing Education and Nursing Administration programs at Pennsylvania College of Health Sciences, on the national nurse staffing crisis, which is not only effecting hospitals, but also nursing faculty at academic institutions.

During this discussion, Wise addressed the impact of this staffing crisis on patient health outcomes, as well as how Pennsylvania College of Health Sciences is responding to this crisis within its own faculty.

Videos

Rita Wise, DEd, MSN, RN, program director of the Masters in Nursing Education and Nursing Administration programs at Pennsylvania College of Health Sciences, discusses the impact of this staffing crisis on patient health outcomes.

The Impact of the National Nurse Staffing Crisis on Patient Health Outcomes

The American Association of Critical-Care Nurses (AACN) has developed a guide to help those who have been vaccinated against COVID-19 to engage in constructive conversations with family members and friends who are hesitant about getting the vaccine, according to a press release.

The toolkit is associated with AACN’s Hear Us Out campaign to report nurses’ reality from the front lines of the COVID-19 pandemic and help the unvaccinated reconsider their decisions.

“COVID-19 is still here. The majority of patients with COVID we’re seeing in ICUs haven’t been vaccinated, and their journey often ends with a nurse holding their hand as they die,” said Beth Wathen, AACN president and a clinical practice specialist in Denver, Colorado, in a press release. “Nurses need allies to end this pandemic, and productive conversations about the vaccine among family, friends and those who trust each other can open minds.”

Included in the toolkit are tips to help individuals prepare for potentially challenging conversations with those who are hesitant about getting vaccinated. The toolkit includes resources such as tip sheets, links to trusted information sources, and short videos of nurses sharing profound experiences of taking care of unvaccinated patients with COVID-19.

“This toolkit offers straightforward tips to keep sensitive conversations from becoming confrontational,” said Stephanie Burdick, a community health strategist in Salt Lake City, Utah, in a press release. “It fills a critical gap in community health education as the public prepares to celebrate the upcoming holidays with friends and loved ones.”

In a recent AACN survey of more than 6500 acute and critical care nurses, 76% of respondents claim that people who have yet to be vaccinated threaten nurses’ physical and mental well-being. Additionally, 92% of nurses surveyed said they think that the COVID-19 pandemic has depleted nurses at their hospitals and has led to the shortening of their careers than intended.

“We know that people in communities with low vaccination rates are at greater risk for becoming seriously ill with COVID-19 and dying from what is now largely a preventable disease,” said Amanda Bettencourt, AACN president-elect and an assistant professor in Philadelphia, Pennsylvania, in a press release. “The pandemic has brought the nursing profession into crisis, and the public is a critical part of the solution. The fastest way out of this is by more people getting vaccinated.”

Toolkit provides tips for COVID vaccination conversations. American Association of Critical-Care Nurses. Published November 9, 2021. Accessed November 15, 2021. 

https://www.aacn.org/newsroom/toolkit-provides-tips-for-covid-vaccination-conversations

Included in the toolkit are tips to help individuals prepare for potentially challenging conversations with those who are hesitant about getting vaccinated. 

New Toolkit Provides Tips for COVID-19 Vaccination Conversations

During this discussion, Wise addressed the extent of the nurse staffing crisis occurring across the country and what the possible causes of the crisis may be.

Rita Wise, DEd, MSN, RN, program director of the Masters in Nursing Education and Nursing Administration programs at Pennsylvania College of Health Sciences, discusses the national nurse staffing crisis and its possible causes.

Assessing the Extent of the National Nurse Staffing Crisis, Possible Causes

About 1 in 4 individuals, aged 20 to 39 years, with attention-deficit/hyperactivity disorder (ADHD) have generalized anxiety disorder (GAD), the results of a study show.

“There are many studies linking adult ADHD to depression and suicidality, but less attention has been paid to generalized activity disorders and other adverse outcomes across the life course,” Esme Fuller-Thomson, professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and director of the Institute for Life Course & Aging, said in a statement.

Individuals with ADHD are 4 times more likely to have GAD at some point in their lives than those who do not have the disorder.

Even after controlling for other relevant factors, such as adverse childhood experiences, a history of major depressive disorders or substance use disorder, or sociodemographic factors, individuals with ADHD still had more than double the risk of developing GAD than those who do not have the disorder.

The results also show that females with ADHD were nearly 5 times more likely to develop GAD.

Individuals who had experienced adverse childhood experiences, such as chronic parental violence or physical or sexual abuse, were 3 times more likely to develop GAD.

In addition, 60% of those with ADHD with anxiety disorders had experienced at least 1 of these adverse childhood experiences.

“It is crucial that those with ADHD who are struggling with mental health issues reach out for help from their family doctor or other mental health professional, including social workers, psychologists, and psychiatrists. Effective treatments, such as [cognitive behavioral therapy], are available, and these can dramatically improve one’s quality of life,” Fuller-Thomson said.

Other factors that were associated with GAD included having an income below $40,000, fewer close relationships, and a lifetime history of major depressive disorder. The odds of individuals with ADHD developing GAD were 6-fold for those with a history of major depressive disorder.

Investigators examined a sample of 6898 individuals from the Canadian Community Health Survey-Mental Health, aged 20 to 30 years.

The investigators did not have access to information on what treatments respondents were receiving to address their anxiety.

Adults with ADHD four times more likely to have generalized anxiety disorder. EurekAlert. News release. November 18, 2021. Accessed November 18, 2021. 

https://www.eurekalert.org/news-releases/935302

Those with attention-deficit/hyperactivity disorder are much more likely to have GAD at some point in their lives than others who do not have it.

1 in 4 Individuals With ADHD Have a Generalized Anxiety Disorder

The FDA has approved a varenicline solution (Tyrvaya, Oyster Point Pharma) nasal spray 0.03 mg1 as the first and only nasal spray approved for the treatment of the signs and symptoms of dry eye disease, according to a press release.

Dry eye is a chronic disease of the ocular surface characterized by a loss of homeostasis of the tear film, which can result in a multitude of symptoms. The condition impacts more than 340 million adults globally.

Varenicline solution is the first pharmaceutical therapy approved by the FDA to treat the signs and symptoms of dry eye disease. Additionally, the Aptar Cartridge Pump System (CPS) will be the first and only FDA-approved treatment for dry eye disease via the nasal route, according to the press release.

CPS has been in the process of development for more than 15 years and is specifically designed to enable reliable, exact dosing and targeted medication delivery to the nasal mucosa.

“This approval further demonstrates the broad potential for Aptar’s drug delivery solutions and the continued market opportunities for nasal drug delivery,” said Stephan B. Tanda, Aptar President and CEO, in a press release. “We are pleased that our proven CPS nasal system is now a multidose delivery option for patients suffering from dry eye disease.”

First Nasally-Administered Pharmaceutical Treatment for Dry Eye Disease Approved by US FDA with Aptar’s Nasal Pump System. BusinessWire. October 25, 2021. Accessed October 26, 2021. https://www.businesswire.com/news/home/20211025005101/en

Varenicline solution is the first pharmaceutical therapy approved by the FDA to treat the signs and symptoms of dry eye disease. 

FDA Approves Aptar Nasal Pump System as First Nasally-Administered Pharmaceutical Treatment for Dry Eye Disease

Red blood cells function as immune sensors by binding cell-free DNA called nucleic acid, which is present in the body's circulation during sepsis and COVID-19, according to a study published by 

. The study found that this DNA-binding capability triggers removal of the cells from circulation, driving inflammation and anemia during severe illness, meaning that red blood cells play a larger role in the immune system than previously thought.

“Anemia is common, affecting about a quarter of the world's population. Acute inflammatory anemia is often seen early after an infection such as parasitic infections that cause malaria,” said Nilam Mangalmurti, MD, assistant professor of Medicine at the University of Pennsylvania, in a press release. "For a long time, we haven't known why people—when they are critically ill from sepsis, trauma, COVID-19, a bacterial infection, or parasite infection—develop an acute anemia. These findings explain one of the mechanisms for the development of acute inflammatory anemia for the first time.”

Toll-like receptors (TLRs) are a class of proteins that play a key role in the immune system, activating immune responses, such as cytokine production. According to the study, during sepsis and COVID-19, red blood cells express an increased amount of the TLR protein TLR9 on their surface. When these cells bind too much to inflammation-causing nucleic acid, they lose their normal structure, causing the body to cease recognizing them. Macrophages then remove these blood cells from circulation, causing the immune system to become activated in otherwise unaffected organs, resulting in inflammation, according to the study.

“Right now, when patients in the ICU become anemic, which is almost all of our critically ill patients, the standard is to give them blood transfusions, which has long been known to be accompanied by a host of issues including acute lung injury and increased risk of death,” Mangalmurti said in the release. “Now that we know more about the mechanism of anemia, it allows us to look at new therapies for treating acute inflammatory anemia without transfusions, such as blocking TLR9 on the red blood cells. Targeting this TLR9 may also be a way to dampen some of the innate immune activation without blocking this receptor in immune cells, which are very important for the host when fighting a pathogen or injury.”

According to Mangalmurti, this discovery could have implications for using red blood cells as diagnostic tools. As an example, a physician may be able to take red blood cells from a patient with pneumonia, sequence the nucleic acid that has been soaked up from the infection, and identify the specific kind of pathogen to better determine what kind of antibiotic to prescribe.

Red blood cells play much larger role in immune system through discovery of DNA-binding capability, study finds [news release]. ScienceDaily; October 20, 2021. Accessed October 25, 2021. 

https://www.sciencedaily.com/releases/2021/10/211020150401.htm

The study found that this DNA-binding capability triggers removal of the cells from circulation, driving inflammation and anemia during severe illness, meaning that red blood cells play a larger role in the immune system than previously thought.

Red Blood Cells Play Significant Role in Immune System, Bind Cell-Free DNA

 interviewed Nate Royster, RN, an emergency department (ED) charge nurse at Ohio State, on how to encourage vaccinations without offending patients or making them feel belittled to help address disparities and hesitancy around COVID-19 immunizations.

During the interview, Royster addressed what some of the causes for vaccine hesitancy in his ED have been, how he responded to patients expressing their concerns around the safety of the COVID-19 vaccines, and what some of the current disparities are relating to COVID-19 vaccinations that nurses can help to address.

Nate Royster, RN, an emergency department charge nurse at Ohio State, discusses how to encourage vaccinations with empathy to help address disparities and hesitancy around COVID-19 vaccinations.

How to Encourage COVID-19 Vaccinations With Empathy to Help Address Disparities, Hesitancy

Individuals with anemia, which is blood with low oxygen levels, can be treated with transfusions of blood substitutes, a new mathematical model of the body's physiological and biochemical processes shows.

“Instead of real blood, we can use a substitute that can lower the costs and eliminate blood transfusion's negative effects,” Weiyu Li, a PhD student in energy resources engineering at Stanford's School of Earth, Energy & Environmental Sciences, said in a statement.

Results show that low-cost and safe blood substitutes can decrease the overall cost of blood transfusions by 10 times, while lowering the negative aspects of the process as well, investigators said.

The new model shows that during transfusion, some of the individuals’ blood vessels did not dilate and thickens the blood. Therefore, it was not as easy to deliver oxygen in the blood.

“Our mathematical model identifies natural physiological processes that explain the conclusion of multiple observational studies: People can get the benefit of blood transfusion without using blood,” Daniel Tartakovsky, PhD, a professor of energy resources engineering at Stanford Earth, said in the statement.

“But nothing really comes out of modeling alone; it has to be grounded in observations, investigational studies and experience,” he said.

The model also shows that abstaining from transfusion or transfusing alternative fluids, or plasma expanders, promotes blood vessels dilating more, increasing oxygen delivery.

Plasma expanders consist of high-molecular-weight starch dissolved in normal saline, which has been used in transfusion medication and is proven to be effective.

Transfusions are common procedures for transferring blood to the circulation of individuals with anemia, which helps the red blood cells carry more oxygen. However, the process is costly and intensive, because it must be obtained, stored, delivered, and sanitized.

New model points to solution to global blood shortage. ScienceDaily. News release. October 19, 2021. Accessed on October 19, 2021. 

https://www.sciencedaily.com/releases/2021/10/211019110513.htm

A new mathematical model shows that low-cost and safe plasma expanders for transfusion can decrease the overall cost by 10 times, while also lowering the negative aspects of the process.

Blood Transfusions With Substitutes Prove Beneficial for Individuals With Anemia

Contemporary Clinic spoke with Dr. Sara Hunt, DNP, FNP-C, about wellness and safety tips for the upcoming Halloween holiday.

Hunt covered trick-or-treating tips, costume safety, how to celebrate while staying safe from COVID-19, and more. 

Maintaining Wellness and Safety for Halloween 2021

Factors such as climate change, widening distributions of host populations, and better clinician awareness are some of the main reasons for the geographic spread of Lyme disease over the past few months, according to recent data from epocrates.

Acey Albert, MD, director of clinical content at epocrates, is board certified in internal medicine and pediatrics with 15 years of experience in outpatient primary care and medical group leadership. He was able to combine his interest of technology, medicine, and physician leadership as a part of the epocrates team.

Albert explained how there was an increased interest in Lyme disease incidence compared to 2020 among clinicians who use epocrates’ medical application this summer, which measured at a 90% increase YoY.

“This was surprising because, while we know Lyme disease is becoming more common, this was a much steeper increase than we expected,” Albert said in an interview with 

. “For comparison, CDC data showed a doubling of Lyme disease cases between 1991 and 2018, while cases over the last 3 years of data (most recently, 2019) remained relatively flat.”

The increase in Americans traveling again this year and predictions of a warmer, wetter weather pattern could have also played a major factor in the uptick of Lyme disease this past summer, according to Albert.

As for the main implications that both providers and patients should know about in the spread of Lyme disease, Albert said diagnosis of the disease is highly dependent on the patient’s location and travel history.

“By current CDC and IDSA guidelines, patients with the pathognomonic rash, erythema migrans (EM), and tick exposure in an area where Lyme disease is common can be diagnosed and treated without further testing,” Albert said in an interview with 

. “Those exposed in areas with Lyme who don’t have EM but have other symptoms require testing.”

These guidelines also focus on when to empirically treat asymptomatic patients with tick bites in areas where Lyme disease is endemic, according to Albert.

“For clinicians, the possible geographic expansion of Lyme means that more of us might need to include it in the differential diagnoses of patients experiencing a fever, headache, myalgia, and joint pain. For patients, it means that more of us should take vital protective measures when venturing outdoors,” Albert said in an interview with 

At epocrates, an issue that was addressed in the summary of Lyme guidelines was how clinicians are often confronted by patients with concerns about chronic Lyme disease at the point-of-care. This term is not usually acknowledged by gold-standard medical organizations, but clinicians are still being asked about it, according to Albert.

Symptoms such as fatigue, pain, and “brain fog” are usually seen in 10% to 15% of patients who are fully treated for the disease, according to the CDC, which is also known as post-treatment Lyme disease syndrome. However, Albert said there have been some controversies around this condition. The society that promotes “Lyme literate” clinicians who believe the condition represents chronic, persistent 

 infection, despite a scarcity of evidence supporting this assertion is an example of this issue.

“Unsurprisingly, these tests and treatment aren’t typically covered by insurance, and they’re administered in the offices of those ‘Lyme literate’ providers on a cash-pay basis. (National Institutes of Health)-funded studies show this approach is no better than placebo, and that fatal complications of long-term antibiotic treatment have been observed,” Albert said in an interview with 

. “Nonetheless, this group is surrounded by large patient advocacy groups with scientific-sounding websites, aggressive social media campaigns, legislative lobbyists, and celebrity spokespeople. As we’ve seen in COVID-19, anti-science disinformation abounds and shapes patient interactions with health care.”

As for suggestions to know about combatting Lyme disease, Albert recommends knowing the evidence-based guidelines for treatment or having a quick, point-of-care reference that summarizes this guidance. Further, keeping an eye out for newer evidence in areas that are more generalized to the rest of the country is also highly recommended. 

 in ticks around the San Francisco Bay area doesn’t necessarily mean that clinicians in Denver need to think about Lyme disease right now. That said, the study is likely to raise interest in broader investigations of the current geographic range of the disease, and clinicians should be ready to adapt,” Albert said in an interview with 

Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

 interviewed Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and the medical director of the blood bank, on the national blood shortage in the United States. As the national inventory was beginning to recover toward the end of this summer, COVID-19 cases began to significantly increase as a result of the Delta variant, directly impacting donor turnout.

During the discussion, Andrews addressed what this blood shortage may mean for health systems, how this shortage may affect patient care and outcomes throughout the country, how the shortage may impact nurses caring for patients in health care settings, what nurses can do to help encourage patients to donate blood while receiving other health care services, and what health systems can do to further address this issue and increase blood donations.

Jennifer Andrews, MD, pediatric hematologist-oncologist at Vanderbilt University Medical and medical director of Vanderbilt University Medical’s blood bank, discusses the national blood shortage and its impact on health systems and patient care.

During National Blood Shortage, Nurses’ Efforts Can Make All the Difference

For a Contemporary Clinic interview, Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discussed Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

She talked about what parents should know, the benefits of the vaccine for children this young, and why the FDA proceeds with extreme caution when considering the approval for the 5 to 11 age group.

Anna Legreid-Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists discusses Pfizer’s request to approve their COVID-19 vaccine for children 5 to 11.

Expert: Pfizer Requests the Approval of COVID-19 Vaccine for Ages 5 to 11

New research has found that ketone supplements may be a novel strategy for protecting and improving brain health in people with obesity, according to a study published in 

Because those with obesity are known to be at a higher risk of developing cognitive impairment and neurodegenerative diseases, this study found that giving a ketone supplement 3 times a day for 14 days improves blood flow to the brain and enhanced aspects of cognitive function, such as working memory and processing speed.

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment, according to the researchers.

Volunteers included adults with obesity who consumed either a ketone supplement or a taste-matched placebo supplement 3 times per day 15 minutes before breakfast, lunch, and dinner. The participants were randomly assigned to take the supplement or the placebo for the first 14-day period before switching to the other condition for another 14-day period. All meals and snacks were provided by the researchers for both 14-day intervention periods.

Cognitive function was measured using validated tests via an iPad application and brain blood flow was measured using a duplex ultrasound of neck arteries. Following this, blood samples were taken to measure hormones that the study authors likened to fertilizer for the brain, helping neurons grow and improving cognitive function.

“Once validated with a larger group of people, we expect that these supplements can be used to protect and improve brain health in people with obesity,” said first study author Jeremy Walsh, MD, in the press release.

Ketone supplement might be a novel therapeutic for boosting brain function in obesity. EurekAlert! October 4, 2021. Accessed October 5, 2021. 

https://www.eurekalert.org/news-releases/930078

The researchers also demonstrated that ketone supplements may be a novel therapy for protecting and improving brain health in people with obesity who are at risk of developing neurocognitive impairment.

Study: Ketone Supplement May Be Therapeutic for Boosting Brain Function in Obesity

interviewed Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

 on the epidemiology of functional seizures among adults treated at a university hospital.

During the discussion, Davis explained why women have a higher statistical likelihood of experiencing functional seizures than men.

Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, explained why women have a higher statistical likelihood of experiencing functional seizures than men. 

News

All Content