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Radiological imaging is a major and increasing source of radiation exposure worldwide. Computed tomography (CT) is the largest contributor to medical radiation dose patients receive. Typically, CT scans impart doses to organs that are 100 times higher than doses imparted by other lower dose modalities such as chest X-rays. In general, CT examinations may involve doses (typically an average of 8 mSv) which may be equal to the dose received by several hundreds of chest X-rays (about 0.02 mSv/chest X-ray).

During an IAEA consultation on justification in 2007, it was estimated that up to 50% of examinations may not be necessary. It should be anticipated that part of the increase in global annual mean dose that has been observed recently is due to unjustified radiological procedures. Direct epidemiological data suggest that medical exposure to low doses of radiation even as low as 10-50 mSv might be associated with a small risk of cancer induction in the long term. The fact that a considerable percentage of people may undergo repeated high dose examinations , such as CT (sometimes exceeding 10 mSv per examination) dictates that caution should be used when referring a patient for radiological procedures. Health professionals need to make sure the patient benefits from the procedure and risk is kept minimal. 

However, ensuring maximum benefit to risk ratio for the patient is not a trivial task. Referring medical practitioners, in a large part of the world, lack training in radiation protection and in risk estimation. 97% of practitioners who participated in a study underestimated the dose the patient would receive from diagnostic procedures. The average mean dose was about 6 times higher  than the physicians had estimated. The fundamental principles of radiation protection in medicine are justification and optimization of radiological protection. Referring medical practitioners have a major role in justification. They are responsible in terms of weighing the benefit versus the risk of a given radiological procedure.

» What is justification and what is the framework?

Justification requires that the expected net benefit be positive. According to principles established by the International Commission on Radiological Protection (ICRP) and accepted by major international organizations, the principle of justification applies at three levels in the use of radiation in medicine.

» Is the referring medical practitioner responsible for justification of radiological procedures?

Yes, jointly with the radiological practitioner. As stated above, justification at the third level is the responsibility of the referring medical practitioner, as is the awareness about appropriateness criteria for justification at level 2. According to the BSS, the radiological exposure has to be justified through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, or be part of an approved health screening programme.

Since referring medical practitioners usually have the most complete picture of the patient’s health, they should be responsible for the guidance of the patient in undergoing only necessary procedures and benefitting from them. Particularly, this responsibility weighs more on generalists such as primary care providers. In order to facilitate justification in the case of radiological procedures, it is desirable that referring medical practitioners are knowledgeable about radiation effects in regard to the various dose ranges. The referring medical practitioners are responsible for keeping their knowledge about radiation up to date. In support of this, they should be provided education in radiation protection during their medical studies.

» How should justification be practiced and what knowledge is required for proper justification of a radiological procedure?

According to the BSS, the justification of medical exposure for an individual patient shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, with account taken, in particular for patients who are pregnant or breast-feeding or paediatric, of:

  • The appropriateness of the request; 
  • The urgency of the procedure; 
  • The characteristics of the medical exposure; 
  • The characteristics of the individual patient; 
  • Relevant information from the patient’s previous radiological procedures. 

Justification should be patient specific. The referring medical practitioner should take into account all clinical aspects regarding the management of every patient separately. Other possible procedures with lower or no exposure, such as ultrasound or magnetic resonance imaging, should be considered, if and when appropriate, before proceeding to radiological procedures.

» Is the acquisition of patients’ consent important?

According to the BSS, in order for a symptomatic or asymptomatic patient to undergo a medical procedure that involves ionizing radiation, the patient or the patient’s legally authorized representative should be informed in a timely and clear fashion, of the expected diagnostic or therapeutic benefits of the radiological procedure as well as the radiation risks. Thus, the emphasis is on provision of information.

» When is an investigation useful and what are the reasons that cause unnecessary use of radiation?

According to the guidelines published by the Royal College of Radiologists (RCR),  a useful investigation is one in which the result, either positive or negative, will alter a patient’s management or add confidence to the clinician’s diagnosis. According to the RCR guidelines, there are some reasons that lead to wasteful use of radiation. With emphasis on avoiding unjustified irradiation of patients, the RCR report has provided a check list for physicians referring patients for diagnostic radiological procedures:

  • HAS IT BEEN DONE ALREADY? It is important to avoid repeating investigations which have already been performed relatively recently. Sometimes it is not possible to accurately track the procedures history of patients. Furthermore, patients may not be able to inform the practitioner that they had a similar procedure recently. It is important to attempt retrieving previous patient procedures and reports, or at least procedure history when possible. Digital data stored in electronic databases may help in that direction; 
  • To help in avoiding repeating investigations, it is necessary to establish a tracking system for radiological examinations and patient dose. The IAEA has taken steps towards that direction by setting up the “IAEA Smart-Card” project;
  • DO I NEED IT? Performing investigations that are unlikely to produce useful results should be avoided, i.e. request procedures only if they will change patients’ management. It is important for the practitioner to be sure that the finding that the investigation yields is relevant to the case under study;
  • DO I NEED IT NOW? Investigating too quickly should be avoided. The referring medical practitioner should allow enough time to pass so that the disorder or impact of management of the disorder may be sufficiently evident; 
  • IS THIS THE BEST EXAMINATION? Doing the examination without taking into consideration the optimal contributions of safety, resource utilization and diagnostic outcome should be prevented. Discussion with an imaging specialist may help referring medical practitioners decide on proper modality and technique; 
  • HAVE I EXPLAINED THE PROBLEM? Failure to provide appropriate clinical information and address questions that the imaging investigation should answer should be avoided. Deficiencies here may lead to the wrong technique being used (e.g. the omission of an essential view); 
  • ARE TOO MANY INVESTIGATIONS BEING PERFORMED? Over-investigating. Some clinicians tend to rely on investigations more than others. Some patients take comfort in being investigated. 

» What are the reasons for over-investigating?

There are various reasons that may lead medical practitioners to refer patients for more procedures than needed. Practitioners should be aware of that and take action to avoid such situations. Some of the reasons that lead to over-investigation are the following:

  • Patient wishes. Patients feel more reassured when they are sure that their practitioner has thoroughly investigated their health condition. Some of them connect the quality of care with the number of procedures they undergo and ask their practitioner to subject them to more procedures. There must be a careful balance between informing patients of risks and benefits and the importance of considering patient desires and needs in the decision making process;
  • Financial. Some organizations or doctors get a direct financial benefit related to conflict of interest (also known as self-referral) from subjecting the patients to various procedures mainly because the services in question are provided by these health care professionals. Such practices are unethical and should not be accepted. Financial reasons may also influence a referring medical practitioner’s equity and also equal access to health services; 
  • Defensive medicine. Some professionals rely far more heavily on investigations including radiological procedures than others, possibly to avoid litigation. In the case of radiological procedures, the risk should also be taken into account and exposure limited to the minimum required for a correct diagnosis;
  • Role of media. The opinion of the public on a subject is shaped by many parameters in a society. Media is one of them. For instance, exaggerated publicity in reporting a medical mistake may lead to increased public sensitivity about the subject. Publicity and increased sensitivity are good things and should be encouraged, but when reporting is not scientific but emotion-driven for audience reasons, as is often the case in mainstream media; this may lead to practitioners practicing defensive medicine and patients refusing indicated procedures; both of these scenarios undermine the appropriate practice of medicine; 
  • Role of industry. The medical industry comprises large corporations that compete with each other for market-share. However, one large problem is that time is needed for new or improved technology, and this must be understood and assessed by the scientific community with regard to the cost-benefit ratio. Studies have to be done and sometimes results take time to come. This creates a window of time when misuse of equipment due to knowledge deficiency is possible;
  • Convenience. Sometimes a practitioner may subject a patient to a procedure that the patient has already undergone when imaging films or discs are unavailable, in order to save personal time, instead of checking the patient’s record. This is not relevant with the specific patient’s well-being, and similar convenience driven prescriptions should be avoided. Such practices are also unethical. 

» Is there any guidance available?

During the last 20 years international and national organizations published guidelines for proper justification of radiological procedures. The UK Royal College of Radiologists (RCR) publication "Making the best use of clinical radiology services " has been in print since 1989. The American College of Radiology (ACR) published its guidelines as Appropriateness Criteria. Similar efforts have been undertaken by the Department of Health of Western Australia in Diagnostic Imaging Pathways. 

For references of publications from national societies in Europe, Oceania, and other regions please see publication from Remedios. These publications constitute guidelines and aim to guide referring medical practitioners in the selection of the optimum procedure for a certain clinical problem. In case there are alternative procedures that do not utilize radiation but yield results of similar clinical value, these guidelines encourage the avoidance of radiological procedures.
The cited publications supply very specific guidance to help practitioners perform justification properly. 

» What if the patient whom I refer for a radiological procedure is pregnant?

The responsibility to identify patients that might be pregnant and are unaware of it is shared by the patient, referring medical practitioner and the imaging service providers. Safeguards to avoid inadvertent exposures of the foetus should be observed at all times. 
The “ten day rule” was postulated by ICRP for women of reproductive age. The more latest “28-day rule” allows radiological procedures throughout the complete menstrual cycle unless there is a missed period. When a woman has a missed period, she is considered pregnant unless proven otherwise. 

Even if safeguards are observed, sometimes a pregnant patient may be exposed to radiation. Depending on the radiation dose and the gestation age of the foetus, radiation effects may differ. Radiation risks are most significant during organogenesis in the early foetal period, somewhat less in the second trimester, and least in the third trimester. 

As a rule of thumb one can assume that properly carried out diagnostic radiological  procedures to any part of the body other than the pelvic region or when the primary X-ray beam is not passing through the foetus can be performed throughout pregnancy without significant foetal risk, if clinically necessary and justified. For radiological procedures where the primary beam intercepts the foetus, advice from the medical physicist should be obtained, who will calculate radiation dose to the foetus and, based on that, the practitioner and patient should make a decision. However, doses associated with radiotherapy procedures and interventional procedures are high and they require the attention of experts (including medical or health physicists, practitioners, and sometimes engineers and epidemiologists). In the case when a practitioner is responsible for a patient who has undergone a radiological procedure inadvertently and has subsequently been found to be pregnant, advice from the individuals listed above is needed. For more information, please click here where comprehensive information is provided not only for diagnostic radiology but also for nuclear medicine and radiotherapy.

Read more:

  • Report of a consultation on justification of patient exposures in medical imaging. Rad. Prot. Dosimetry 135 (2009) 137–144. 
  • Brenner, J.D., Doll, R., Goodhead, D.T., Hall, E.J., et al., Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know. P Natl Acad Sci USA 100 (24) (2003) 13761-13766. 
  • Mettler, F.A., Huda, W., Yoshizumi, T.T., Mahadevappa, M., Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology 248 (2008) 254-263. 
  • Shiralkar, S., Rennie, A., Snow, M., Galland, R.B., Lewis, M.H., Gower-Thomas, K., Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327 (2003) 371–372. 
  • INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION, 2007. Recommendations of the ICRP, Publication 103, Pergamon Press, Oxford (2007). 
  • INTERNATIONAL ATOMIC ENERGY AGENCY. International Basic Safety Standards for protecting people and the environment. Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards. General Safety Requirements Part 3. No. GSR Part3 (Interim), IAEA, Vienna (2011). 
  • Royal College of Radiologists. Making the best use of clinical radiology services. Referral guidelines. Sixth edition, London 2007. 
  • Remedios, D., Justification: how to get referring physicians involved. Rad. Prot. Dosimetry (2011) Epub ahead of print, accessed 21 July 2011. 
Tue, 21 Feb 2012 23:54:00 -0600 en text/html
Killexams : COVID-19 vaccine saved healthcare system $1.2 trillion: study

Children’s hospitals are being pushed to the brink as they confront a surging respiratory disease outbreak in addition to rising COVID-19 cases and a mental health epidemic. It's a multifaceted threat that may recur without policy fixes.

Children’s hospitals were spared from the worst of the pandemic because pediatric COVID-19 case numbers had been low relative to adults. But COVID-19 and respiratory syncytial virus diagnoses among children have climbed in latest months. Those patients are going to hospitals where capacity is already strained by the skyrocketing number of children and young adults with behavioral health conditions.

“Pediatric hospitals are in crisis mode right now,” said Lisa O’Connor, senior managing director at FTI Consulting. “They are pulling out emergency preparedness policies and activating everything functionally possible from a policy and regulatory standpoint.”

Policy experts say it is up to healthcare providers and the government to invest in pediatric care and prevent future crises.

“It has been a perfect storm,” said Dr. Daniel Rauch, a pediatrics professor at Tufts University and chair of the American Academy of Pediatrics committee on hospital care. “If most smaller and safety-net hospitals are, at best, breaking even on Medicaid, they can’t afford to keep pediatric beds open.”

Pediatric care is typically a small element of health system operations so, for units with fewer resources, a viral outbreak can be overwhelming. For instance, Orange County in California declared a health emergency this week as healthcare providers there battle COVID-19, RSV and influenza.

At the same time, hospitals are still struggling to hire workers. Health systems trained lower-level practitioners to treat less-acute patients during the COVID-19 pandemic, but that approach isn’t viable for most pediatric care because it is so specialized.

“Despite the efforts put into place regarding recruitment and retention, we just need a lot more bodies,” said Carrie Kroll, vice president of advocacy, public policy and political strategy at the Texas Hospital Association.

Weathering the ‘perfect storm’

The RSV surge hit earlier than expected this year, which forced hospitals to adapt their operations to accommodate an influx of pediatric patients.

In California, the Santa Barbara area is seeing a striking rise in RSV infections. Cases doubled three weeks ago and have since doubled again, said Dr. Lynn Fitzgibbons, infectious diseases physician at Santa Barbara Cottage Hospital. There have been as many RSV infections in the past week as there were in the preceding month, she said.

Dr. Elizabeth Meade, medical director of quality for pediatrics at Providence Swedish in Seattle, said inpatient pediatric units are at capacity in that region. Between 50% and 75% of the pediatric patients at Providence Swedish are being treated for RSV, which is more than the facility would see in a typical winter.

As a result, the hospital is working on a contingency plan that applies lessons from the pandemic. Shifting workers from adult care to pediatrics is another potential solution, Meade said. And the Providence Swedish emergency department is assessing where to place children when no beds are available, she said.

Hospitals elsewhere have canceled non-urgent procedures and set up outdoor tents to deal with the wave of sick kids.

RSV patients are grouped together at Providence Swedish, where the pediatric and pediatric intensive care units are on the same floor, Meade said. If they require additional space, adolescent patients with non-infectious ailments, such as behavioral health issues or post-surgery needs, would be transferred, she said.

The North Carolina Healthcare Association has deployed a centralized contact system, which it used to facilitate patient transfers before Hurricane Florence hit in 2018 and more recently during COVID-19 surges, to place patients in beds that are harder to find, such as in pediatric ICUs.

Compounding the RSV crisis is the escalating rate of mental health cases among children and young adults, which further strains capacity at children’s hospitals. Kids with mental health issues are staying in hospital emergency departments longer — sometimes for week s— because residential or outpatient services have been cut or facilities are full.

Pediatric providers’ mental health capacity constraints are symptoms of longstanding and often neglected shortfalls. Access to pediatric mental healthcare has historically been limited because of low reimbursement rates, scant financial incentives for students to choose the specialty and narrow insurance networks.

“Part of the solution needs to be upstream. What are we doing on the prevention side and how can we make sure children are getting the appropriate care in the home or outpatient settings, which are not always available?" said Anne Dwyer, associate research professor at the Georgetown University Center for Children and Families.

Policy proposals

Policy experts and healthcare trade associations have proposed short-term solutions to boost capacity and long-term fixes to stabilize the pediatric sector.

The Centers for Medicare and Medicaid Services should codify the looser rules enacted during the coronavirus public health emergency that facilitate telehealth access, such as not requiring clinicians to be licensed in the same states as their patients, Rauch said.

Extending the public health emergency’s facilities waiver would allow hospitals to convert space that is not usually used for patient care, said Bob Garrett, CEO of Edison, New Jersey-based Hackensack Meridian Health. Over the long term, adding more graduate medical education slots for pediatrics and pediatric psychology students would increase the pool of specialists, he said.

The Texas Hospital Association is developing a $65.5 million legislative proposal to increase loan repayments for nursing students, fund training programs to replace retiring nurse professors and increase nursing school capacity. Last year, Texas nursing schools turned away more than 15,000 qualified applicants because of insufficient resources, Kroll said.

“Anytime you are looking for a pediatric specialist, the pool of candidates narrows,” Kroll said. “The only real way to flip the boat around is to put more people into the workforce.”

Congress should lift the caps on graduate medical education payments to teaching hospitals and the federal government and states should raise pediatric Medicaid reimbursements to match Medicare rates, Rauch said. Otherwise, more pediatric beds will disappear, he said.

The number of pediatric inpatient beds declined from 2008 to 2018, according to an analysis of American Hospital Association data published in the journal Pediatrics last year.

CMS notified state Medicaid agencies in August about the Early and Periodic Screening, Diagnostic and Treatment benefit, which funds preventive pediatric mental healthcare. CMS encouraged states to promote prevention by eliminating diagnosis requirements to access treatment, expanding provider capacity by training primary care providers or community health workers in behavioral health, and boosting payment for primary care that integrates behavioral health.

States can also tap into additional funding through the American Rescue Plan Act, which provides $12 billion for home and community-based services under Medicaid. Qualifying states can receive a 10 percentage point increase in the Medicaid matching rate for related services.

“Pediatric care in general is not as profitable as adult care,” said Dr. Larry Kociolek, medical director of infection prevention and control at Lurie Children’s Hospital of Chicago. “Hospitals are businesses and hospitals need a margin to stay open, and so hospitals are making business decisions about how to staff those beds in order for them to be able to recoup the costs of providing healthcare.”

Pediatrics should focus on primary care, which would lighten the burden hospitals bear, said Dr. Keith Jensen, regional medical director of pediatric emergency medicine for the Woman’s Hospital of Texas and HCA Houston Healthcare. Higher pay for primary care also would encourage more people to choose pediatrics as a specialty, he said.

Mon, 12 Dec 2022 20:00:00 -0600 en text/html Killexams : Women not getting equal medical advice when it comes to heart health, study finds

Heart disease is the leading cause of death in the United States for both men and women, but women may not be receiving the same treatment, according to a new study.

Though guidelines for heart disease prevention are gender neutral, researchers report that, in practice, doctors advise less aggressive strategies for women.

Researchers from Massachusetts General Hospital examined the advice doctors gave to patients at high risk for heart disease to help prevent their first cardiac event and found that women were advised more often to make lifestyle changes alone.

"Our study found that women are advised to lose weight, exercise and Excellerate their diet to avoid cardiovascular disease, but men are prescribed lipid-lowering medication," Dr. Prima Wulandari, a cardiology clinical researcher at Massachusetts General Hospital in Boston, said in the study findings. "This is despite the fact that guideline recommendations to prevent heart disease are the same for men and women."

The researchers examined the advice that nearly 3,000 high-risk men and women received for prevention of heart disease, based on participants in the U.S. National Health and Nutrition Examination Study from 2017 to 2020.

They found that though both men and women were eligible, men were 20% more likely to be prescribed statins. Women, on the other hand, were almost 40% more likely to receive recommendations for behavioral modifications, like losing weight, exercising more and stopping smoking.

The study was presented Dec. 3 at a medical conference in Singapore.

Close to 700,000 people die of heart disease in the U.S. every year making it the most common cause of death, according to the Centers for Disease Control and Prevention.

Among women, heart disease causes 1 in 5 deaths, and around 1 in 16 women over 20 years of age have coronary heart disease, the most common type of heart disease, according to the CDC.

Coronary heart disease can present with chest pain, nausea, and breathlessness, among other symptoms. However, typical symptoms are mostly seen in men.

Women tend to experience less chest pain than men. Instead, they experience more pain in the middle or upper back, neck or jaw, more dizziness, extreme tiredness, pressure in chest and stomach pain -- all symptoms that can easily lead to misdiagnosis.

Multiple studies have shown that in health care overall, inherent biases among doctors lead to women not being diagnosed or having a delay in diagnosis.

When it comes to why the prevention of heart disease in women is sub-optimal, according to the study, the reasons vary.

One reason, according to Wulandari, is that heart disease may still be seen as something that predominantly impacts men, despite the statistics showing women are also affected.

The rate of coronary heart disease is higher in men until 75 years of age, and women present with more atypical symptoms which could lead to misdiagnosis of their disease.

"A potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men," said Wulandari. "Our findings highlight the need for greater awareness among health professionals to ensure that both women and men receive the most up-to-date information on how to maintain heart health."

Another potential reason for the treatment bias is that there is an underrepresentation of women in research studies that can lead to practitioners being cautious of generalization of the heart disease management to both genders.

In addition, women themselves may underestimate their own risk of heart disease, and for other chronic health care conditions, it has been consistently shown that women prefer lifestyle intervention over medications.

According to ABC News chief medical correspondent Dr. Jennifer Ashton, in addition to a greater awareness among health care professionals, there are prevention strategies of which patients themselves should be aware.

Around 80% of heart disease can be prevented, Ashton said Tuesday on "Good Morning America," citing American Heart Association data.

Some health changes that can help prevent heart disease include weight management, exercise, eating more fiber and less saturated fat, consuming less alcohol, monitoring blood glucose and not smoking cigarettes.

Ashton, a board-certified OB-GYN, said it is also important to take prescribed medications if indicated.

"If indicated, blood pressure medication, cholesterol-lowering medication for both men and women have been shown to save lives," she said.

Dr. Sristi Sharma is a preventive medicine physician and is a member of the ABC News Medical Unit.

Tue, 06 Dec 2022 06:58:00 -0600 en text/html
Killexams : Work-life balance key for struggling general practitioners

Overloaded Australian general practitioners (GPs) have such poor work-life balances they no longer feel in control of their own lives, a new analysis has found.

Alongside inadequate support and unrealistic patient expectations, the new study from Flinders University highlights the growing issues within Australia's field, which continues to experience increasing costs and a shrinking workforce, especially in regional and remote communities.

"General practitioner doctors can work very long hours, some as much as 70 hours per week, with regional doctors likely to work even more hours if they service a small community," says study senior author Dr. Vivian Isaac, from Flinders University Rural and Remote Health SA.

"These long hours contribute to fatigue, reduced well-being, and poor mental health, which alongside maintaining patient and colleague relationships and workforce shortages is increasingly leading to burnout and depression.

"We know that feeling in control of one's life can help mitigate occupational stress, but this had yet to be investigated in relation to Australian doctors."

Using data from a survey of more than 3,600 GPs, the team investigated what factors negatively impacted their internal "locus of control" (LoC)—the sense that they themselves, and not external forces, were in control over the outcome of events in their lives.

"Studies have shown that individuals with a high locus of control are more resilient, cope better under stressful conditions, have higher job satisfaction and in the case of health care workers, cope better with ," says Dr. Isaac.

"On the other hand, having a low LoC is associated with depression, anxiety and stress."

The study found gender didn't impact LoC, while GPs aged between 40 and 60 years reported a lower internal LoC than those below 40 or older than 60 years. Other factors that contributed to a lower LoC included being overseas trained, not having a spouse and self-reporting poor health.

Working long hours and having inadequate mentoring or supervision, running a stressful practice, and overall job dissatisfaction were all also contributing factors to a low LoC.

On the social side of things, work life balance was key, with low LoC linked to limited opportunities for and an imbalance of personal and professional commitments.

"We found over half of all GPs surveyed were dissatisfied with their social network, which was then negatively affecting their sense of control," says Dr. Isaac.

"This clearly highlights that the work-life imbalance has tended to become normalized for GPs and they struggle with work overload, which has a negative impact on their ability to do their job.

"Another key factor that reduced GPs internal LoC was from their patients. This indicates more formal training of doctors in improving communication skills is necessary, which could lead to an improved sense of control and overall well-being."

The authors say the study highlights the importance of fostering , building support systems and adequate training to manage patient expectation among Australian GPs to Excellerate their LoC and thereby their well-being.

"As the data was collected in 2010 we must be cautious of the immense changes that have since occurred in the sector, but the issues identified have not gone away," says Dr. Isaac.

"In that time there have been some noticeable changes in general practice include a decrease in younger GPs, a decline in small practices and the proliferation of telemedicine and , so it's importance we continue to understand how to help this vital medical field."

The paper, "Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners," by Daya Ram Parajuli, Shahid Ullah, Matthew McGrail, Craig S. McLachlan and Vivian Isaac, is published in the Journal of Psychiatric Research.

More information: Daya Ram Parajuli et al, Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners, Journal of Psychiatric Research (2022). DOI: 10.1016/j.jpsychires.2022.09.048

Citation: Work-life balance key for struggling general practitioners (2022, November 16) retrieved 13 December 2022 from

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Wed, 16 Nov 2022 03:23:00 -0600 en text/html
Killexams : Behavioral Health Treatment was Associated with Lower Healthcare Costs No result found, try new keyword!Having one or more outpatient behavioral health treatment (OPBHT) visits was associated with lower healthcare costs among patients with newly diagnosed behavioral health conditions, a study found. Tue, 06 Dec 2022 02:59:00 -0600 en-US text/html Killexams : Ideas conversation: Has public health gotten too political? Natalia Linos (left) and Benjamin Mazer. © handout Natalia Linos (left) and Benjamin Mazer.

To Dr. Benjamin Mazer, a pathologist and medical writer in Baltimore, a paper in the Nov. 24 issue of the New England Journal of Medicine was “the perfect study for Substack.” That’s the online platform where he has just begun a newsletter about, as he puts it, “diagnostics, medical evidence, and the media.”

The paper he was describing was written by public health researchers in Boston. By analyzing data from schools that dropped mask mandates at different times last winter, the scientists determined that in the first 15 weeks after the state allowed the policy change, Boston-area schools without mandates had 45 more COVID cases per 1,000 students and staff than they otherwise would have had. That amounted to 29 percent of the COVID cases in these schools in that time period.

Some critics questioned the validity of comparing case counts across districts, given that other factors — including levels of COVID immunity and testing — were also fluctuating. But Mazer thought the study’s statistical methods seemed solid. What concerned him was the commentary accompanying the data. The researchers wrote that school masking policies should also be considered matters of health equity for “students and staff already made vulnerable by historical and contemporary systems of oppression (e.g., racism, capitalism, xenophobia, and ableism).”

To Mazer, this and other references in the paper to oppression and capitalism crossed a line. “The authors shoot themselves in the foot,” he wrote on Substack. “Public health has already become so politicized during the pandemic. Why would you want to further contribute to that, undermining your own credibility as a scientific actor? . . . A well-designed study might help convince political leaders and regular Americans that mask mandates are effective, but positioning masks as anti-capitalist is going to cancel that right out.”

I relayed Mazer’s criticism to one of the authors of the paper, Natalia Linos, a social epidemiologist who is the executive director of the FXB Center for Health and Human Rights at Harvard. She suggested that Globe Ideas host a conversation between her and Mazer. So I introduced them on a video call in November, and edited and condensed highlights of the discussion follow.

Linos: By definition, COVID policy is political. We wanted to be open about that and also to make clear that COVID policy has a differential impact for different groups. I was very proud that the paper addressed politics, power, and economic inequities. Because the doctors who read the New England Journal of Medicine, who are in the clinic seeing patients, maybe they’re not thinking, “Why am I seeing more patients of color in my clinic with COVID?” Research on public health requires attention to the why. We see these different patterns in COVID rates, not because of genetics or biology but because of structures that we have put in place. And therefore the optimist in me says there’s something we can do about it.

Mazer: I’m kind of the target audience for the New England Journal of Medicine. I’m a medical practitioner who wants to keep up on the big advances of the field. And so I was excited to read this paper specifically because of its high-quality natural experimental methods. I saw this was a really good methodology. And then I get to the discussion section, and I found it both interesting and a little jarring. It didn’t necessarily seem to connect very much to the purpose of the paper, which is to evaluate the impact of a particular social intervention on rates of COVID.

I was really struck by the references to capitalism. Masks don’t really have to do with capitalism. I could tell from the discussion that it was really sincere and erudite, but I think it will end up being provocative. I want politicians to be able to take a step back from some of the political division and say, “Can we use good evidence to guide us in our decisionmaking?” Some Republican governors did that with COVID interventions, and I think that is the kind of person you should be targeting. Because you’re revving up some of these political divisions in the discussion, that message might get lost on people who otherwise would be receptive to it.

Linos: That’s a helpful point, and it’s one that we considered. There’s also the other argument, which is: You get a chance to put something in front of all of these doctors at a moment in time. After George Floyd’s killing, all the world is having these debates of, How are we thinking about racism? And in this country, unfortunately, racism and racial capitalism go hand in hand. It’s not by chance that the vast majority of poor people in our cities are also people of color. And so if you have an opportunity to supply doctors and an audience that doesn’t get trained in social epidemiology a flavor of that conversation, the hope isn’t to close down the conversation. I hear your point that at times it could be jarring. I just think that when the COVID pandemic has unequivocally shown that our country does worse than other countries because of structural issues — the way that we don’t supply low-wage workers the protection of sick leave, for example — these are debates that doctors should be having. If we’re not having the debates in medical journals, then we miss an entire audience that I’d like to invite into the conversation. And we need to be able to say the word “racism” in order to start dealing with it.

Mazer: In that sense, it’s to be applauded that you brought those issues to the fore, because here we are having this conversation. I think unfortunately you didn’t supply yourself the room to really bring people on board and explain it. There are conservative doctors, Republican doctors, there are doctors who maybe don’t understand how a particular word is being used in a particular academic context. There was a focus on capitalism, on racism, on these unequal structures, but there was very little interrogation of our governmental systems, our policy systems. A lot of these inequalities are being produced by our democratic institutions, not by the free market. You guys brought up the very different quality of school infrastructure, classroom size, these kinds of well-known inequalities in education, and that’s a failure of government. I mean, these are government-run public schools.

Linos: Yeah, exactly. When we talk about structural racism, it’s around institutions and policies and government. Should public health be political? My answer is: Of course. Because government has the opportunity to solve a lot of these public health issues. And if we pretend that public health is not political and that scientific knowledge can happen in a neutral way, then we’re not interrogating the status quo, which has allowed the pandemic to have very different impacts on different people.

Mazer: I think the important distinction to make is between being political and being partisan. And I think much of public health has started to be seen as partisan, and I think that’s where public health has lost some people. You lost some trust. And it enabled political partisans to say, “Hey, the science is wrong because they’re just Democratic stooges and they’re not thoughtful, careful scientists.”

The pandemic does bring a lot of these structural inequalities to the forefront, but I think the idea that we were going to have a massive political change maybe pushed people to be more partisan — even on some of the measures where there could have been more agreement.

Ideas: Ben, you’re saying it’s one thing to identify the structural and thus political causes of health disparities, but it’s quite another to go down the road of suggesting policy prescriptions that are overwhelmingly or entirely Democratic policy goals. Natalia, do you think it’s possible for the public health profession to stop short of advocacy while being effective in the way you intend?

Linos: I don’t know if it’s possible. I’m very comfortable talking about issues that are unfortunately seen as partisan, like sick leave or maternity leave, which I don’t think are that controversial. Similarly on climate change, there’s a lot of data now around how fossil fuels and air pollution are bad for health. We can’t stay silent. I think it’s our responsibility to use our data and our institutions to show how different policies could be.

Now, you could accuse people like me of going too far. For example, we had a symposium at the FXB Center that asked: Could reparations close the white-Black health divide? Reparations are being discussed by economists, by historians, by others. A lot of people in public health may think, “This has nothing to do with us.” But part of me wonders, if you’ve dedicated your life to health and you’re seeing these health inequities, you can’t not be part of those conversations. Yes, at this moment in time, that is an issue that is unlikely to be supported by Republicans, but I’m hoping to normalize some of these conversations across different political viewpoints.

Mazer: I think there are two ways you could maintain a political aspect to public health without being seen as partisan.

One is the way policies are packaged. Many different ideas were put forth during the pandemic that started to hit on longtime Democratic goals. Many of which I agree with. But, you know, things like single-payer health care are not necessarily completely related to the pandemic, whereas something like sick leave — I think you would actually find a lot of agreement on finding some way of providing more sick leave to people. You may actually bring some Republicans over, at least at the state level.

And I think the other way public health could be political while being less partisan is to look at the outcome you want to change, some kind of disparity you want to close. Like with paid sick leave — there are different ways in practice to implement that policy along every kind of political philosophy, and they’ve been implemented differently around the world. Same thing with various public health interventions. Perhaps you could have given people a menu of choices and said, “Here’s a more conservative approach. Here’s a classically liberal approach. All working toward this outcome we think is important.”

Doctors are a very powerful political group. They are engaged in massive amounts of lobbying and fundraising and donations to political leaders. They speak out as a group, for important public health and medical issues, and of course for their own self-interest. So I’d like us to be able to use the political power of physicians to promote people’s health. And so I think if you want to better bring doctors into the public health realm as the political force that they can be, then you need to do what you can to remove those partisan signifiers and to find common ground.

Tue, 06 Dec 2022 00:48:00 -0600 en-US text/html
Killexams : NPs Can Offset Psychiatry Shortage, Tackle Mental Health Crisis

With many psychiatrists not accepting insurance, and fewer psychiatrists billing Medicare due to reimbursement cuts, psychiatric mental health nurse practitioners (PMHNPs) are seen lately as part of the solution to the shortage of mental healthcare providers in the United States. In many states, these specialized nurse practitioners can prescribe medication, unlike psychologists and other therapists, and their services are less expensive than doctors.

A recent report by Health Affairs indicates that the mental healthcare system relies more on PMHNPs to fill in the gap of Medicare patients with mental health needs. The study showed that from 2011 to 2019, PMHNPs provided almost one in three psychiatric visits to Medicare patients. While there was a 6% decrease in the number of psychiatrists billing Medicare, the number of PMHNPs increased by 162%, the report showed.

Study authors estimated there would be a 30% decline in mental health specialist visits in Medicare patients if not for PMHNPs. Because of the specially trained nurses, that decrease ended up being only 12%.

“Nurse practitioners (NPs) are often being relied on to fill in gaps due to the shortage of psychiatrists across the country and they are often less expensive,” Kristin Kroeger, chief of Policy, Programs, and Partnerships with the American Psychiatric Association (APA) told Medscape. Medicare reimburses NPs and other advanced practice providers at 85% the rate of doctors.

“APA supports direct supervision of NPs as they often do not have the training to treat people with mental health or substance use disorders.”

To become a PMHNP, nurses go through the same training as their peers. After a bachelor of science in nursing degree, PMHNPs can progress through master’s or doctoral paths (3 to 5 years, depending) which then leads to certification through the American Nurses Credentialing Center (ANCC). After academic requirements are fulfilled, students must take the ANCC certification exam. Certifications are valid for 5 years and professional continuing education is required for recertification.

Kathleen McCoy, PMHNP-BC

PMHNPs are trained to treat a wide variety of mental health disorders regardless of age, setting, or culture, said Kathleen McCoy, PMHNP-BC, associate professor at the University of South Alabama, Mobile, told Medscape Medical News. But PMHNPs will also refer to more appropriate specialists, services, and levels of care when these are available, she said.

The competency-based standards of today’s NP program accreditation requirements ensure NPs can provide high-quality patient care, according to Pamela Lusk, DNP, RN, FAANP, clinical associate professor of practice at The Ohio State University College of Nursing, Columbus.

Pamela Lusk, DNP, RN, FAANP

Independent Practice

To date, half of the states and US territories have given NPs full practice authority (FPA). In FPA states, there is no need for a collaborative practice agreement between NPs and physicians to provide care. As defined by the American Association of Nurse Practitioners (AANP), FPA gives NPs the authority to evaluate, diagnose, and treat patients, as well as order and interpret diagnostic tests under the state board of nursing.

Wait times for appointments are also believed to be shorter for NPs than doctors.

During the pandemic, PMHNPs were providing comprehensive mental health services on the frontlines to all populations, especially in rural areas with populations who are underserved, explained Lusk.

In states where NPs don’t have FPA, they are required to work with a collaborating physician. This becomes trickier when there’s a lack of these psychiatric clinicians to provide oversight. More than one third of Americans live in areas the US Department of Health and Human Services deems to have a mental health professional shortage.

Susanne Astrab Fogger, DNP, CRNP, PMHNP-BC

“Managed care has made psychiatry a particularly challenging field, as visits are often time-driven. It’s difficult to connect to patients when the visit is only 15 minutes in length,” said Susanne Astrab Fogger, DNP, CRNP, PMHNP-BC, a professor at the School of Nursing at the University of Alabama at Birmingham. “There just aren't enough psychiatrists to care for the volume of patients who need treatment.”

Burnout and retirement are also factors affecting the psychiatrist shortage. Nearly 40% of psychiatrists are experiencing burnout.

Collaboration Is Key

The demand for PMHNPs can be seen in their earnings growth. PMHNPs earned the highest income among advanced practice registered nurses (APRNs), $132,000, according to Medscape’s 2022 APRN compensation report. That figure shows growth over the past 2 years, during which time those in the specialty also earned more than their APRN peers. The specialty is not the largest among APRNs surveyed, but it saw growth from 8% of those surveyed in 2021 to 9% in the latest report.

Despite the increased earnings, there’s a need for more PMHNPs to replenish those leaving the workforce, according to the American Psychiatric Nurses Association (APNA). More than half of PMHNPs are in their 50s and 60s, nearing retirement age, and the APNA is keeping an eye on whether the number of younger nurses entering the mental health nursing practice, which is increasing, is enough to balance those leaving it.  

“The growing field certainly presents an opportunity for registered nurses to pursue additional education and training to obtain advanced licensure as a PMHNP,” said Chizimuzo Okoli, PhD, APRN, PMHNP-BC, president of the APNA. He added that PMHNP programs have almost doubled in the last 8 years — from 114 programs in 2015 to 208 in 2021.

“The opportunity to obtain further specialization as a PMHNP is quite appealing to both nursing students and professional, or clinical, nurses who would like to advance their careers.” To attract more nursing students into the specialty, APNA offers advantages such as discounted student memberships and conference scholarships.

In terms of training more psychiatrists, APA continues to advocate for more federal funding for residency programs, Kroeger said. “However, even with that funding, it takes years to train a psychiatrist.”

The APA supports a collaborative care model to deliver mental health services into primary care. “The model provides early intervention of mental health and substance use disorders through screening in a primary care office,” she said. If a patient needs care, they’ll be treated by primary care in consultation with psychiatry and case management.

This collaborative care approach not only helps patients have better access to care, but insurance, including Medicare, is more likely to reimburse for it, compared to psychiatric care alone, the APA reported.

Receiving psychiatric care in a behavioral health integrated primary care clinic can help make it less stigmatizing to the patient, said Fogger. But she cautions that having too many psychiatrists in this type of setting might make integration too costly.

Risa Kerslake, RN, BSN, is a freelance writer living in the Midwest. She specializes in health, parenting, and education.

For more news, follow Medscape on  Facebook,   Twitter,   Instagram, and  YouTube.

Thu, 08 Dec 2022 02:33:00 -0600 en text/html
Killexams : As student mental health needs soar, schools turn to telehealth


In the southwestern suburbs of Denver, the Cherry Creek school system has been tackling the mental health crisis gripping students here, as in the rest of the country. Social workers and psychologists are based in schools to help. But this month, the district debuted a new option: telehealth therapy for children.

A growing number of public schools across the country are following the same path — turning to remote health care when the demand for aid has spiked and the supply of practitioners has not. To pay for it, some school districts are using federal covid relief money, as studies show rising depression, anxiety and suspected suicide attempts among adolescents.

Some of the contracts are going to private companies. Other districts are working with local health-care providers, nonprofits or state programs. In Texas, state officials recruited help from providers at medical schools, a collaboration that served more than 13,300 Texan students last school year. “It’s provided a lot of kids the support they needed,” said David Lakey, administrator and presiding officer of the Texas Child Mental Health Care Consortium.

Telehealth services more generally soared during the pandemic, as people sought to minimize in-person contact and embraced the convenience. Over almost three years of pandemic life, families and providers have grown comfortable with remote medical visits.

Federal data shows that 17 percent of public schools reported having telehealth services in the spring, with a greater concentration in rural areas and middle and high schools. Seventy percent of schools said the percentage of students seeking mental health services had increased during the pandemic.

“I don’t know one kid who wasn’t affected by this,” said Michelle Weinraub, chief health officer for 55,000-student Cherry Creek district, recalling that students lost relatives or homes during the pandemic, and many were isolated at home learning remotely.

In many schools, students may see a telehealth therapist by using an iPad or other device in a quiet office away from classmates. In Cherry Creek, they will do so from home, before or after school. Some school systems offer both options.

For schools that host the digital therapy sessions, it is not enough to simply outfit a room for appointments and send students in, said Sharon Hoover, a professor of child and adolescent psychiatry at the University of Maryland’s School of Medicine and co-director of the National Center for School Mental Health. “Most schools will need to provide staffing to support safety and privacy issues,” she said. Services are free to families in many cases, covered through school systems, government grants or insurance reimbursements.

Hoover said the trend in virtual mental health care owes partly to more providers offering remote sessions and a loosening of strict regulations that prohibit delivery and billing across state lines.

In Colorado’s Aurora Public Schools, which began to focus on mental health efforts after the 2018 school shooting in Parkland, Fla., Superintendent Rico Munn said several hundred of his students have benefited from a contract for telehealth services, including a number of children in crisis. More than 1,800 therapy sessions were held remotely last spring, thanks to federal covid relief funds. “The need was there, obviously, and it was important to be there to serve that need,” Munn said.

Virginia Garcia’s daughter was among those struggling in Aurora schools. The 17-year-old was at first distressed by family issues but while she was in treatment, a close friend was killed, her mother said. “The therapy helped a lot at that time, because the situation was terrible,” Garcia said. Her daughter began to learn strategies to help her cope with her sadness and anger and be more forthcoming with her feelings, her mother said. “I saw the change.”

Garcia said her daughter continues to work with a private therapist. Still, she was grateful when the school checked back in to see if her daughter needed more help.

According research published by the American Psychological Association, no-show rates for therapy visits for underserved families and children were significantly lower with telehealth programs than with in-person care before the pandemic. But the paper also noted some challenges unique to this format, including patients who don’t have the right tech to log in or enough privacy at home. Other research also has broadly pointed to telehealth benefits for children.

While some schools used virtual mental health services before covid-19, particularly in rural areas, researchers at the nonprofit Child Trends said the pandemic showed “proof of concept” to many more people.

The Colorado school districts in Aurora and Cherry Creek hired Hazel Health, a San Francisco-based company that started with virtual health services in schools in 2015 and expanded to mental health in May 2021.

It now has telehealth in 80 school districts, including in Florida, California, Georgia, Maryland and Hawaii; 20 other districts have signed contracts. The company said students are seen in relatively short order, and sessions are held in the familiar settings of school or home. Parent permission is required, and referrals are made by school staff or families.

Hazel Health CEO Josh Golomb said children often receive to six to 10 sessions, meeting the clinical needs of most students. For longer-term cases, Hazel connects patients to community clinicians. Some advocates have raised concerns that telehealth could mean a different practitioner from one session to the next. Hazel said children primarily keep to the same therapist.

Hazel therapists, who combined speak 10 languages, work from their homes, Golomb said. All are clinical mental health professionals who are licensed to practice in the state where their patients receive therapy.

The company plans to work with school districts to study whether Hazel’s mental health services also help reduce absenteeism, Golomb said.

Reducing absenteeism was one major incentive for Maryland’s second-largest school system, in Prince George’s County. If appointments are at school, many students will be able to return to class and miss less instruction, said Doreen Hogans, supervisor of school counseling.

Schools are already using Hazel for physical health services and will launch mental health services for high schools, middle schools and k-8 schools before winter break. Elementary schools will come sometime during or after January. Students across k-12 may request home-based telehealth.

Students will be able to go to the nurse’s office, where the nurse will find a quiet place to set the student up on an iPad with a practitioner, Hogans said. “The benefit is that the student is not going home and we can retain the student right there in school,” she said. The school system, like others around the country, has a number of vacancies in mental health-related positions, she said.

It is paid for through a $4 million federal grant, according to a spokesman for the Prince George’s County Health Department.

The big question for some districts is what to do when their federal relief money runs out in the next couple of years — whether they will find other dollars for telehealth.


Thu, 08 Dec 2022 15:01:00 -0600 Donna St. George en text/html
Killexams : AI technology to help reduce risk of vision loss: Monash study
HCMC – New artificial intelligence (AI) technology that detects subtle changes in the retina could prove a game-changer in helping millions of people avoid vision loss or blindness, according to a latest study conducted by Monash University.

The retinal deep learning model, developed during a three-year study, can help general practitioners and healthcare professionals detect and predict the risk of retinal vein occlusion (RVO), which occurs when a blood clot blocks a vein in the eye’s retina.

The technology also has the potential to predict the risk of heart attacks and strokes as the retina is closely connected to other parts of the body through the central nervous system.

The study, published in the prestigious journal, Eye, was carried out by the Monash Medical AI Group, which sits within the university’s Monash eResearch Center, in partnership with its philanthropic industry sponsor, Airdoc.

Study author Associate Professor Zongyuan Ge, also an adjunct senior research fellow in the Department of Electrical and Computer Systems Engineering, said RVO is the second most common retinal vascular disease in the world, affecting an estimated 16 million people. If diagnosed too late or left untreated, it can lead to vision loss or, in serious cases, blindness.

RVO can occur if the veins of the eyes are too narrow and is more likely to occur in people with diabetes, high blood pressure or high cholesterol levels.

During the study, researchers trained an AI model to distinguish between more than 10,500 fundus images collected from the West China Hospital of Sichuan University. Some of the patients captured in the photos had retinal vein occlusion, while others did not.

“We believe our study enhances our understanding of what AI can really do in disease diagnosis and management,” said Associate Professor Ge.

Hundreds of thousands of pieces of data were used to train the AI model, and enable highly accurate predictions.

“The ability of AI to perform massive calculations and capture unknown and seemingly unrelated factors for classification is far beyond human thinking and capabilities,” Associate Professor Ge noted.

The algorithm tool will likely be a powerful tool to help doctors and clinicians predict the risk of RVO and other cardiovascular and cerebrovascular diseases, such as stroke, in the future – even if they don’t specialize in that area.

All they will need is a smart fundus camera and a cloud computing platform integrated with the AI algorithm.

Led by Ge, the Monash Medical AI Group is one of the world’s leading research groups focusing on medical applications for artificial intelligence.

Sun, 11 Dec 2022 18:06:00 -0600 en text/html
Killexams : Stirling CBD Shares How Chiropractors Are Using CBD Gummies to Help Their Clients Sleep Better

Press release content from Globe Newswire. The AP news staff was not involved in its creation.

CARY, N.C., Dec. 12, 2022 (GLOBE NEWSWIRE) -- Sleep is so vital to human health that the  NIH says lack of it can lead to chronic illnesses. Most Americans  don’t get enough sleep - despite knowing how important rest is to one’s health. One group of health practitioners can help - Chiropractors are doing their part to ensure their patients sleep better, and one tool they are using is Stirling CBD.

Chiropractic care, in general, has been  studied for its positive impact on insomnia and other sleep problems. Aside from alignment and overall chiro care, chiropractors are turning to CBD products to Excellerate their patients’ sleep patterns. According to preliminary research, CBD has shown positive effects on sleep disorders. In a 2019 research study, 66% of people who took CBD reported better sleep.

With the power of CBD and chiropractic care combined, chiropractors across the nation can help reduce sleep deprivation among their patients.

Reasons Why Chiropractors Recommend Stirling Professional CBD Gummies to Their Patients

1. Natural & Organic  - Compared to prescription drugs,  Delta 8 Sleep Gummies offer a natural way to Excellerate sleep. These CBD Sleep Gummies include CBN and low doses of THC - both compounds help the mind and body relax. Aside from being organic, Stirling’s Delta 8 and  Delta 9 Sleep Gummies are made from pectin derived from apple fiber, making them organic. Most other companies sell gelatin gummies made from animal cartilage.

Stirling Professional CBD has some major advantages for Chiropractors who want to Excellerate their patients’ sleep. Stirling offers Pure.Proven.Tested.TM  CBD for Chiropractors. It sources its hemp from U.S.-grown plants; this ensures strict agriculture standards are adhered to. The company can oversee the plants’ growth, ensuring only organic fertilizers and pesticides are used.  

2. They’re convenient - Compared to other CBD products, gummies are easy to integrate into people’s routines. Patients should take the sleep gummies 45 minutes before going to bed. This will allow the body to digest the gummy and carry the CBD throughout the system. 

3. They have a lot of varieties - Unlike capsules, gummies are available in different flavors. Since they can be naturally flavored, patients can pick their favorite flavors, like mango and strawberry-watermelon.  CBD gummies can also be formulated with additional ingredients, like CBN.

4. They taste great - Another added plus of gummies over other CBD products is their taste. Patients with sensitive stomachs and even picky eaters can enjoy taking the gummies before sleep. Most gummies are formulated to be either full or broad spectrum, which generally includes other compounds like terpenes. 

Terpenes are full of flavonoids that add depth and flavor to each gummy. CBD gummies can also include other flavor enhancements. Take Stirling’s  mango sleep gummies, for example, which blend the taste of mangoes with other flavonoids. 

The overall appeal of CBD gummies can encourage even the pickiest adult to consider taking sleep gummies as a treat.

5. They can be taken by adults of any age range - Sleep gummies can be recommended to any adult as long as they don’t have any sensitive medical conditions. Even those who struggle swallowing capsules or taking liquid medicine won’t have difficulty integrating gummies into their diet since they are easy to swallow and don’t taste like medicine.

The five reasons mentioned above are why many chiropractors prefer Stirlings Sleep gummies over other products. CBD gummies offer more than just sleep improvement; they make it easy for even the busiest adult to integrate them into their diets. 

About Stirling CBD 

Founded in 2014 in Santa Cruz, California, as a premium cannabis flower company, Stirling launched its first CBD products in 2018. Stirling continues to lead in new product innovation and quality and sells a full lineup of Hemp-Based CBD, Delta 8 THC, and Delta 9 THC Products. In addition, Stirling launched its Professional Brand -  Stirling Professional CBD - which is sold exclusively to Chiropractors, Gyms, CrossFit Boxes, PTs, and Massage Therapists.

Contact Information:
Mike Albanese

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Mon, 12 Dec 2022 01:02:00 -0600 en text/html
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