WyoMed Blog

What is Trauma-Informed Care and Why Does it Matter?

Fri, 21 Mar 2025 23:46:43 GMT

What is Trauma-Informed Care and Why Does it Matter?

The Wyoming Chapter of the American Academy of Pediatrics is passionate about sharing information for pediatric providers and their patients. Our goal is to see every pediatric provider in WY utilizing trauma-informed care.

Are you a primary care provider who would like to learn more about implementing Trauma-Informed Care into your practice?

Join the Wyoming AAP and the Wyoming Medical Society in our 3-part education series this summer!

Medical Coding Challenges for Physicians (and How to Beat Them)

Mon, 17 Mar 2025 20:29:22 GMT

Medical Coding Challenges for Physicians (and How to Beat Them)

By Robert McDermott, President & CEO, iCoreConnect

Medical coding might not be something you think about daily, but it’s the backbone of every successful medical practice. When it’s working smoothly, everything runs as it should. But without it, operations can stop in their tracks.

These codes help document and classify diagnoses, procedures, and treatments, making them essential for billing, insurance claims, and overall practice management. But let’s be honest–medical coding isn’t easy.

What is easy? Using the right technology to simplify the process. That’s where iCoreCodeGenius from Friend of WMS, iCoreConnect, comes in. This software stays up-to-date with coding changes, saving you time and effort. And when it comes to addressing medical coding challenges, the right software makes all the difference. Learn more!

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Links to https://www.icoreconnect.com/wy-enews-0325

Brought to you by Friend of WMS iCoreConnect.

Advocacy Update 2025

Fri, 07 Mar 2025 19:28:17 GMT

Advocacy Updates 2025

If you've missed any of the healthcare legislative action this year, you can catch up by reading the WMS membership and legislative updates below:

If you're a WMS member and would like to voice your opinion on anything related to healthcare policy in Wyoming, please log in to The Wire and make a policy proposal today!

How to use The Wire:

Log on - https://thewire.wyomed.org/
The Wire uses the same username and password as you use to login to the WMS website to manage your membership. If you have forgotten your username or password, you can use the forget password feature on The Wire to reset it.
To view proposals - select "Proposal Feedback" at the top of the screen
Click on "Pre-Board Feedback"
Click on the title link to vote/share your opinion on a topic

Sobering Email Security Stats You Need to Know

Mon, 24 Feb 2025 19:26:31 GMT

Sobering Email Security Stats You Need to Know

By Robert McDermott, President & CEO, iCoreConnect

If you’re following IT or cybersecurity news or groups on social media, it may come as no surprise to you that email is the number one target for cyber attacks. Or perhaps you’ve been on the receiving end of a phishing attack and, given the statistics, the odds are pretty good.

It’s also why you should be paying close attention to your email security and finding ways to limit your risk. Education starts with understanding the threat and understanding how the security measures you employ can help protect you, your patients, and your practice.

Obviously, as with most security plans, layering your defenses is the best move, but the first, and most important, part of your defense is educating yourself and your staff on the threat, potential vulnerabilities, and security measures they can and should employ beyond what’s in place. Read more: https://www.icoreconnect.com/wy-0324

Brought to you by Friend of WMS iCoreConnect.

2025 WMS Annual Conference

Fri, 21 Feb 2025 20:51:20 GMT

Save the Date: 2025 WMS Annual Conference Date Announced

WMS is proud and excited to announce that the 2025 WMS Annual Conference will be held in Laramie, WY, November 14-15, 2025, at the Marian H. Rochelle Gateway Center on the University of Wyoming campus.

Conference information and registrations will be released as soon as possible.

For the most up-to-date conference details, visit the WMS Annual Meeting Website .

WMS - Be The Voice of Medicine

Fri, 17 Jan 2025 19:19:29 GMT

WMS: Be The Voice Of Medicine

UPDATED: WMS Legislative Review Process

The BoT will review, analyze, and debate all bills of relevance to WMS members. Advisory opinions reflecting the expertise of WMS leadership will be established in accordance with the WMS Advocacy Tenets .
WMS advocates will educate and lobby the advisory opinions of the board in the absence of a WMS WIRE position set by the membership.
WMS leadership can vote to require WMS membership engagement on any issue before authorizing public support or opposition of any proposal. The WIRE will be the tool used to gauge WMS member support or opposition.
A minimum of 25% participation from active members is required before the position is communicated openly in advocacy efforts. The result does not necessarily change the WMS Board Advisory Opinion, as those opinions are based objectively on the established WMS Advocacy Tenets.
The WIRE platform will be utilized to calculate engagement on these issues.
The denominator of the required membership participation percentage is based on active WMS members as defined by WMS Bylaws.
Those members with a membership category of associate, affiliate, retired, honorary, or federal employee may participate in all activities on The Wire, but their vote will not count towards or against the required threshold of membership participation.
Any member can submit a policy position for the membership to vote to have WMS advocates engage and testify.
Any member can submit a proposal for review on The Wire.

To cast your vote on either/both of the above proposals, CLICK HERE to access THE WIRE. Members can also access THE WIRE from the WMS website at www.wyomed.org .

 How to use The Wire:

Log on - https://thewire.wyomed.org/
The Wire uses the same username and password as you use to login to the WMS website to manage your membership. If you have forgotten your username or password, you can use the forget password feature on The Wire to reset it.
To view proposals - select "Proposal Feedback" at the top of the screen
Click on "Pre-Board Feedback"
Click on the title link to vote/share your opinion on a topic

Protecting Your Kids from Suburn

Fri, 13 Dec 2024 19:33:49 GMT

What's the best way to protect kids’ skin from sunburn?

Sheilagh M. Maguiness, MD, FAAD, FAAP

As a pediatric dermatologist, I know how important it is to protect children's delicate skin from the sun's harsh rays. As the mom of two boys, I also know how challenging it can be to slather sunscreen on squirmy kids every two hours. It helps to know that sunscreen is only one of several tools you can use together to prevent burns on all those wonderfully sunny summer days.

Cover up for UV protection

Sun protective clothing, for example, is another way to help protect against sunburn . Especially for younger children, it can be easier to keep them covered than to rely on getting the right amount of sunscreen on their skin—especially when they're outside for long periods of time. There are many options today for lightweight sun protection factor (SPF) or ultraviolet protection factor (UPF) hats, shirts, pants and swimsuits. Most are rated UPF 50.

When you don't have access to sun protection clothes, dress your child in clothing made with a tight weave. These will protect them better than clothes with a looser weave, which won't block as many rays. If you're not sure how tight a fabric's weave is, hold it up to see how much light shines through. The less light, the better.

For hats, pick one with a 3-inch brim all around to shield the face, ears and back of the neck. And once your child is about 6 months old, sunglasses can help protect their eyes from the sun. Look for youth-sized sunglasses with at least 99% UV protection.

Peak sunlight hours & when to seek shade

When the UV index is highest, between 11 a.m. and 4 p.m., try to find shade under a tree, an umbrella or the stroller canopy. It is especially important to keep babies younger than 6 months out of direct sunlight as much as you can.

You can also check the UV index on your smartphone to help you decide how much sun protection is needed. Just open your weather app and scan for the UV index number, if it is 3 or higher you and your children need full sun protection. If your older kids complain, tell them they can break out their two piece or remove their sun shirt/rash guard early in the morning or after 4 p.m. when the index is lower.

Don't forget that skin can burn even on cloudy days, since up to 80% of the sun's UV rays can get through the clouds. UV rays can also bounce back from water, sand, snow and concrete, so make sure your child is protected when it's overcast, too.

What to know about sunscreen

Over the past few years there has been a lot of new information and even some controversy surrounding sunscreen ingredients. There have also been large consumer recalls of sunscreens due to contamination concerns. All this has led a lot of parents to question what the safest options are.

Mineral sunscreens

I generally recommend that parents choose sunscreens that contain zinc oxide and titanium dioxide. These are well-known mineral ingredients that are generally recognized as safe and effective (GRASE) by the U.S. Food & Drug Administration. They are broad-spectrum, meaning they block both UVA and UVB rays and are a great choice for children and babies. Zinc oxide and titanium dioxide should be clearly listed on the label as "active ingredients." A zinc oxide-based sunscreen, 20% or higher would give great protection for those exposed areas on babies and children—adults too!

Stick, lotion, cream or spray sunscreen?

For babies and toddlers , the mineral stick sunscreens containing at least 20% zinc oxide are a wonderful choice. Sunscreen in stick form is easy and hassle-free for parents to swipe the stick on the face and hands (and don't forget the ears and the neck, since those areas often get missed!). This is a less messy way to apply the sunscreen and there's no liquid or lotion to run into the baby's eyes and cause irritation.

For older children , a mineral-based cream or lotion, again with 15-20% zinc oxide, is a great option. There are many out on the market now that will rub in nicely, but some will still have a whitish cast. This can be an issue, particularly for anyone with skin of color. Luckily, companies are offering tinted versions for face that can offset that ghost-like appearance. I also recommend choosing a formula that is fragrance-free and hypoallergenic, to avoid possible skin irritation.

As for sprays , this is where things can get complicated. Sunscreen sprays are most often made with the chemical ingredients (read more below). They also contain propellant chemicals, which are irritating and should not be inhaled by babies and children. There was a large recall of various sunscreens due to contamination issues in the summer of 2021. The majority of them were sprays. I view this as another reason to choose a zinc oxide cream when in doubt.

Any type of sunscreen is better than none

For exposed skin on sunny days, using any sunscreen is better than none. However, recent studies have shown that some of the common chemicals found in sunscreens (such as oxybenzone, avobenzone, homosalate and several others) can be absorbed through the skin and found in the blood and body fluids after even one application. This led the FDA to make some changes to sunscreens they accept as GRASE.

The FDA's reasoning is that many of the chemical sunscreen ingredients could use more data to address the potential effects of being absorbed. However, this all must be balanced with the risk of getting a sunburn, since even one severe sunburn increases a child's risk for skin cancer later on.

How much sunscreen to use

Consider that it takes a full ounce (picture a full shot glass) of sunscreen to fully cover an adult's body. That's about two milligrams of sunscreen per square centimeter of skin. Small children may only need about half that amount, but it can be a challenge for them to stay still long enough for you to apply a good layer. Stick sunscreen can be easier to use on areas like the face. With your help, they may even want to "draw" it on.

How often do you need to reapply sunscreen?

No matter what type of sunscreen you use, reapply it every couple of hours and after swimming. You should do this even if the label says "waterproof," because there are no truly waterproof sunscreen formulas.

Remember

Roughly a quarter of lifetime sun exposure happens during childhood and adolescence. Kids spend a lot of time outdoors, especially in the summer, so it's important to build sun-safe habits that don't take away from the fun of outside play . If you have any questions about your child's skin, talk with your pediatrician.

More information

Sheilagh M. Maguiness, MD, FAAD, FAAP

Sheilagh M. Maguiness, MD, FAAD, FAAP , is a past American Academy of Pediatrics (AAP) Section on Dermatology Executive Committee member and Chair of the AAP Section on Dermatology Education Sub-Committee. She is a Professor of Dermatology and Pediatrics at the University of Minnesota.

Last Updated 8/9/2024

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Brought to you by The American Academy of Pediatrics.

AI Advancements in Healthcare

Fri, 29 Nov 2024 20:20:12 GMT

AI Advancements in Healthcare: Physicians are using technology for everything from improving patient care to helping with menial tasks

As published in Wyoming Medicine Fall 2024 - by Ilene Olson

Click here to view the article PDF.

Artificial intelligence and other technological advances are changing the world around us, while expanding the possibilities we see and expect.

Technological innovations in the medical field are prime examples of those changes and advancements, enhancing physicians’ ability to care for their patients and improving patient outcomes. Many of those advancements aim at reducing the administrative burden in hospitals and clinics, while others improve practitioners’ ability to diagnose and treat their patients.

The American Medical Association uses different wording and visualization for AI.

“We talk about augmented intelligence versus artificial intelligence,” said Margaret Lozovatsky, MD, the AMA’s new vice president of digital health innovations, during an AMA podcast interview with Todd Unger, AMA chief experience officer on Feb. 6.

“What we need to understand is that the technology is not going to diagnose the patient,” Lozovatsky continued. “The technology is going to help us in our day-to-day work to be able to do what we love, which is practice medicine.”

Lozovatsky, a pediatrician who also has a computer science degree, said cross-training in both of those fields provides a unique perspective that has allowed her to serve as a liaison between technology teams and clinicians.

“Having that physician voice in how the technology is implemented is absolutely critical,” she said.

She noted that the AMA promoted a playbook for telehealth years ago.

“Now, of course, telehealth has evolved to really move into the entire digital health spectrum,” she said.

Mobile clinics use telehealth

Cheyenne’s HealthWorks utilizes telehealth technology routinely to take medical care to all three of the city’s junior high schools, Alta Head Start, the senior center, the Boys & Girls Club, and more.

“Our mobile clinics can go to where the people are,” Monica Jennings Woodard, operations director for HealthWorks said in August. “We were the provider for the Senior Olympics [and] Pride Weekend downtown.”

Through its mobile clinics and technology, HealthWorks offers every service that is available at its main clinic. That is achieved through iPads, laptops, and phones in the mobile units. “We can use that to be able to communicate with our team here,” she said. “If we need to communicate with each other about non-patient issues, we can use Microsoft Teams to talk to each other.”

Each mobile unit has lab equipment, a printer and everything else needed to care for patients. The mobile clinics also are wheelchair accessible, she said.

If a student needs to be seen and has a consent form, providers in the mobile clinics can care for the child and include the child’s parents at work or home in the visit through a secure HIPAA-compliant telehealth program, Jennings Woodard said.

“We meet you where you are,” she said.

Augmented intelligence in medicine

As augmented intelligence becomes more advanced and available, Dr. Lozovatsky said she envisions it being instrumental in synthesizing and bringing data to physicians, which would allow them to spend more time face-to-face with their patients and less time staring at a computer.

Donald Kirk, MD, of Star Valley Health, uses a note-taking program, Dragon Ambient eXperience, or DAX Copilot, for that reason.

Dragon, a well-known voice-recognition program, was acquired by Microsoft from Nuance in 2022.

Before that, DAX recordings were listened to by Nuance employees, who cleaned up the information and put it into notes within 24 hours, Dr. Kirk said in a July interview.

“DAX ... no longer has a human element,” he said. “It populates a note pretty much when I’m done.”

Dr. Kirk and two other physicians at Star Valley Health began using DAX in June. He said he finds it helpful, even though he must read through and correct every note the program constructs.

The other two doctors, who are family medicine providers, decided not to continue with the notetaker program for now because it is easier for them to use their templates. Those are generally sufficient and faster than using DAX and editing the notes afterward.

Dr. Kirk, who also serves as Chief Medical Officer for Star Valley Health, said he finds it helpful, and, “I’m more invested in trying to make this successful for this institution. I’m more interested in the future and happy to deal with some of the shortcomings at this time. It’s definitely made a difference for me.”

Human scribes can be helpful, but it takes three to six months to fully train them. And after six months, they’re often considering other career options, he said.

“There aren’t a lot of people in high school going, ‘Hey, I think I want to be a scribe for the rest of my life,” he said.

“Humans get sick, need or want time off,” he said. While those absences are usually appropriate and to be expected, they are also inconvenient.

Another option is using virtual scribes, “where you’re outsourced most of the time to folks overseas where they’re listening in, and there have been issues with that,” Dr. Kirk added.

“Basically, DAX is an artificial intelligence scribe that doesn’t want time off, and it isn’t looking for career advancement” he said.

“As long as it’s recording the information, I can parse it out later. I feel like I can spend more time with the patient and less time charting,” he said. “I’ve figured out how to utilize what it can give me and not worry about some of the other issues. ... That said, it’s making a lot of mistakes right now.”

For instance, when a patient was constipated, Dr. Kirk recommended using a colonoscopy bowel prep to relieve the constipation.

“DAX said I ordered a colonoscopy. I didn’t — just the bowel prep. If I don’t read it [the note transcribed by DAX], if I don’t look through it, it will have mistakes like that.”

Despite the need to read through and correct the notes, “it still helps me speed things up,” Dr. Kirk said.

Before he begins notetaking with DAX, Dr. Kirk talks to his patients about the program and asks their permission to record their visit. He has developed an information sheet about the program that his staff gives to his patients before he sees them. In the rare cases when a patient declines, he takes notes himself.

After permission is given, Dr. Kirk opens an app called Haiku and the recording begins, preceded by a prompt to make sure the patient has agreed to being recorded. When the visit is over, he hits the microphone on the app, and it stops recording.

When he’s back in his office, Dr. Kirk hits the microphone again and makes any additions needed to the notes.

“Within about 10 seconds, it’s got everything in the chart,” he said. DAX omits any part of the conversation that is not related to the medical issues discussed during the visit. “It definitely cuts out any unnecessary information,” he said.

An addition can be made within two hours, but is not possible to add to the notes after any editing has taken place, he said. “If

I do any editing, you’re done.”

Dr. Kirk said DAX is reportedly able to separate the voices of 10 different people in a room. While he has never had that many people in a clinical visit at one time, DAX reliably differentiates between people during medical appointments. For instance, the program will note, “Mom says patient has been throwing up. Patient says he had a headache.”

More refinement is needed in the program, Dr. Kirk said.

“One of the issues I’ve had is it’s trying to write a term paper, be a Chat GPT, as compared to a provider who does clinic notes,” he said. “In very rich prose, it said, ‘The patient denies eating causes pain. The patient denies drinking soda causes pain.’ It went on to say four or five things that the patient denies what causes pain. A provider would say those all together.”

A pending update will have an option for bulleted or outlined clinic notes, he said.

Dr. Kirk said that update and other planned upgrades for the DAX software should make the notetaker program more efficient and useful. Among them is a planned reminder function that would prompt providers to follow through on things they discuss with patients. For instance, if a physician said he would order a CBC and a blood chemistry panel in nine months, DAX would remind the provider at that time.

There are cautions to consider, however.

“Can it fail? Yeah. Do you need to be ready for that? Yeah,” he said.

For example, one day when Dr. Kirk sat down to finish some notes recorded a couple of weeks earlier, he hit the button to generate a note about a patient with a complex history, and there wasn’t anything there.

“Thankfully, I remembered it pretty well,” he said.

As with any electronic health information, security is imperative.

“One of the initiatives our hospital is working on is being prepared in case of a cyberattack. We have to be ready for so many reasons. From my perspective, with Microsoft being a major player [with DAX], I’ve got to feel like security would be better than it would be with a smaller player.”

According to an August 2023 AMA survey of physicians about augmented intelligence and its assistive role in healthcare, only 14 percent of doctors were using AI tools to create discharge instructions, care plans or progress notes at that time.

AMA survey results

In a December 14 press release, the AMA summarized the survey results as follows:

41% of physicians were equally excited and concerned about AI in healthcare. Enthusiasm was highest for AI tools that help reduce administrative burdens, including documentation (54%), and prior authorization (48%).
AI tools were most helpful for enhancing diagnostic ability (72%), workflow efficiency (69%), and clinical outcomes (61%).
Concern was highest for AI tools that impact the patient-physician relationship (39%) and patient privacy (41%).
The top attributes required to advance physician adoption of AI tools were data privacy assurances (87%) and not being held liable for AI model errors (87%).
AItoolswereinuseby38%ofphysicianswiththe most common uses including creation of discharge instructions, care plans or progress notes (14%); documentation of billing codes, medical charts or visit notes (13%); translation services (11%); and assistive diagnosis (11%).
TransparencyiskeyforAItools,withabout80%of physicians indicating they want clear information about key characteristics and features regarding the design, development and deployment of AI tools.

Robotic surgery

One of the biggest technological advances in medicine is the advent of robotic surgery, which allows surgeons easier access to small spaces in a patient’s body, reduces post-surgical pain and improves patient outcomes.

Rebecca Deal, MD, a surgeon at Cody Regional Health, said robotic surgery is an advanced form of laparoscopic surgery, with even smaller incisions and greater dexterity. Dr. Deal performs surgery with a Da Vinci robotic surgical system like the ones she used in her residency and at her previous job in Littleton, Colorado.

“The robot can rotate just like a wrist, as opposed to a straight chopstick-like operation as in laparoscopic surgery,” she said. It adds full articulation, which allows us to have similar dexterity to our hands while we’re inside a patient — and that is huge,” Dr. Deal said.

The Da Vinci System has all the tools you would have for laparoscopic surgery — graspers, stapling devices, scissors, needle drivers — “anything you want for any type of case,” Dr. Deal said.

In addition, it has a much better camera that allows surgeons to see everything during the surgery in 3D, she said.

Dr. Deal said robotic surgery is especially helpful in repairing hernias, because they are in confined spaces.

“A lot of surgeons struggle to close the fascia in the abdominal wall,” she said. “It is difficult to do in laparoscopic surgery. With robotic surgery, you can close the inside of a patient without as much difficulty. It makes us much faster, and patients are on the operating table for less time. It’s all done through tiny incisions.”

Dr. Deal said it takes some time to be proficient with robotic surgery, but with experience, it gets much faster.

“I think you need at least 20 cases to really feel comfortable,” she said. “You get good, then you get fast. ... I can do a bilateral

hernia in 30 minutes.”

Surgeons with advanced laparoscopic experience tend to pick up robotic surgery faster, Dr. Deal said.

She cited the example of Thomas Etter, DO, who helped lead the effort to acquire a Da Vinci robotic surgery system for Cody Regional Health.

“He’s doing all sorts of advanced stuff,” she said. “He had so many years of advanced laparoscopy, he just jumped on it and adopted it.”

Forty-five miles away in Lovell, at North Big Horn Hospital (NBHH), Michael Hill, MD, also uses a robotic surgery system. He previously used a Da Vinci robotic surgery system at Billings Clinic in Billings, Montana, beginning in 2017.

Dr. Hill performed traditional laparoscopic surgeries at North Big Horn Hospital on a contract basis, beginning in 2016, while employed at Billings Clinic. He moved to Lovell and began working full-time at NBHH in 2022. The recent acquisition of a robotic surgery system there allowed him to perform robotic-assisted surgery at the Lovell Hospital.

Dr. Hill said the robotic arm’s ability to articulate its movements is a huge improvement over laparoscopic surgery. “If I have a straight stick going into a patient’s abdomen, all the torque of that instrument is going into the patient’s abdominal wall,” he said. “With robotic-assisted surgery, there is no transference of energy or pressure into the patient’s

abdominal wall.”

That results in less trauma to the patient’s tissues, less blood loss, less pain, faster recovery, and shorter hospital stays, he said.

“Normally, after a hernia surgery, a patient goes home with 10 days of prescription-strength medication. Now, they often go home on Tylenol,” he said, adding, “The biggest thing for me is he reduced need for prescription-strength pain medications.”

Dr. Hill also explained some other advantages of robotic surgery.

“If I’m taking out colon cancer, the thing I’m worried about is the ureter. Will I be able to see where the ureter is, and prevent injuring something you don’t want to injure?

The robotic surgery system is designed to work with indocyanine green, or ICG, a chemical dye that the robotic camera picks up, though it can’t be seen with the naked eye. It highlights different things in a patient, depending on how and when it is administered. If administered through a catheter, it highlights the ureters; administering it intravenously an hour before surgery makes the bile ducts glow, Dr. Hill said.

“If all that anatomy glows, you can see the anatomy of the bile ducts,” he said. “Even before you start dissecting, it will show you where the anatomy is. It protects you from injuring structures.”

A surgeon needs to be able to determine exactly where colon cancer ends and healthy tissue begins, ensuring that the remaining tissue is healthy after the cancer is removed, he said.

“You know you put healthy pieces of colon back together. It helps me sleep at night,” knowing the risk of anastomotic breakdown has been minimized, he said.

A planned software upgrade to the robotic surgical system will install an AI component that will overlay information from a patient’s CT scan into the surgeon’s console. The overlay will precisely identify the patient’s anatomy and provide other important information for the surgeon, Dr. Hill said.

For example, when a surgeon is removing a cancer from any organ, “it will be able to highlight where the cancer is, so that the surgeon can allow a margin around that cancer,” he said.

Both Dr. Hill and Dr. Deal said it is often difficult for patients to wrap their minds around how robotic-assisted surgery works.

“It’s hard for patients to grasp,” Dr. Hill said.

When Cody Regional Health introduced its Da Vinci System to the public, an ad campaign named it “Leo.” While that was a good attention-grabber, Dr. Deal said it gives some people the impression that the robot is doing the surgery independently. She assures them that’s not the case.

“I tell them, ‘I am in your room; I am at your bedside. It is only listening to my inputs and my movements.’”

A video showing Cody Regional Health’s Da Vinci System can be viewed at https://www.youtube.com/watch?v=_ EtAWWX1Tbg/ .

The American Medical Association does not endorse any brand of AI technical advances or medical equipment.

Dr. Tina Stanco

Fri, 15 Nov 2024 20:09:58 GMT

Dr. Tina Stanco: Recent geriatric fellowship graduate and former Navy corpsman accepts role as Casper residency faculty member

As published in Wyoming Medicine Fall 2024 - by Gayle M. Irwin

Click here to view the article PDF.

Tina Stanco, MD, spent more than two decades in the military striving toward her dream career – to become a doctor. In July she completed her geriatric fellowship at the University of Wyoming Family Medicine Residency Program in Casper and this fall she will serve as a new faculty member for the program.

Dr. Stanco began her Casper residency in 2020, after completing a rotation in Wyoming five months before. She selected the state’s residency program as her first choice after that month-long stay in Wyoming.

“I absolutely fell in love with the program and family medicine,” she said. “I fell in love with the state and people in Casper as well. It was an ‘aha moment’ for me.”

She wanted to pursue rural family medicine.

“I thought I was going to be a full-spectrum, rural medicine doc, which was the original dream when I started, but ... my husband, unfortunately, had to have some medical stenting, and that kind of changed how rural I thought we could be,” Dr. Stanco said.

A new opportunity arose – the geriatric fellowship program. She applied and was accepted.

“They [program leaders and faculty] will probably say they knew I was a geriatrician before I knew I was a geriatrician, and they are probably right,” she said. “It’s the best decision I ever made. It’s the exact right population for me, and I couldn’t be happier.”

Her rotations focused on older adults in Casper and Laramie as well as out-of-state. She spent time at the Alzheimer’s Institute in Arizona and at a palliative care center in Salt Lake City.

“I’ve had the opportunity to get exposure to things that we don’t necessarily have in town,” she said. “That’s a great thing to bring back to offer our population here.”

Dr. Stanco credits the program faculty with “helping me grow into a geriatrician that I want to be.”

She added, “I think I connected here for the same reasons I connected with residency – I very much like the population [and] the faculty that I have the amazing opportunity to work with.”

Originally from New Jersey, Dr. Stanco entered military service to help pursue her dream of becoming a doctor and to ensure medicine was the right career path.

“The only thing I wanted to do in the military was be a hospital corpsman,” she said. “I wanted to make sure that’s where I really wanted to be.”

She spent 21 years as a hospital corpsman in the Navy. She learned vital lessons as she served aboard the USS Enterprise, was deployed twice, and spent time in various foreign ports. Three of those lessons were; take advantage of every opportunity to learn, teamwork, and leadership. However, one lesson eclipsed all others.

“To be forever grateful and thankful for the opportunities that I had because lots of folks I met through my travels had much less opportunity in the world than I did,” she said.

She spent nine months in Sierra Leone and time in Zambia. Both countries were “eye-opening,” she said.

“Those were truly opportunities to know just how incredibly blessed and lucky I am to have all that I did have,” Dr. Stanco said. “It was incredible to see the lack of facilities in those countries while I was there. Unfortunately, folks not having the services they need for things that we would consider very basic in a healthcare setting.”

While serving aboard ship, she assisted her fellow sailors.

“I got to see the differences in coordinating care for our service members when there were instances,” she said. “That gave me a good look at some of the different experiences that people have trying to coordinate care back at stateside facilities, because they didn’t have some of the specialties we needed when we were overseas.”

Those experiences led her to consider rural medicine in the United States.

“I think that may have given me a better understanding of rural medicine here in the states because you have to do a lot of the coordination of care – you don’t have every subspecialty that you need everywhere that you go,” Dr. Stanco said.

She received her bachelor’s and master’s degrees while on active duty, and she retired as a senior chief petty officer. Also while serving, she met her husband, a retired British Army official. The pair enjoy residing in Wyoming after having lived throughout the world.

“We’re both very outdoorsy,” Dr. Stanco said. “We love hiking, we both love fishing – we’re figuring out the flyfishing thing. Mostly we enjoy being in nature.”

After retiring from the Navy, Dr. Stanco continued to pursue her dream. She attended medical school on the island of St. Vincent in the Caribbean, at St. James School of Medicine. She described that experience as “incredibly formative” in shaping her career.

“I was a very non-traditional student,” she said. “The island was beautiful, the people were fantastic! I very much enjoyed my time there.”

She conducted her clinicals primarily in Chicago, at which point she knew the big city was not the place for her. Visiting Wyoming and experiencing a smaller, rural area with warm and welcoming faculty and residents drew her to apply for the University of Wyoming Family Medicine Residency Program in Casper. After acceptance, one of the physicians she met was Michael Jording, MD, a family practice physician in Newcastle, who serves as a guest attending physician at the Casper residency program.

“I’ve known him for a few years now,” Dr. Stanco said. “I’ve had interactions with him both as a resident and as a fellow. He’s just a fantastic teacher, very patient, always helping you to think and to grow. He brings different insight and experiences.”

Dr. Jording expressed admiration for her as well.

“I had opportunity to visit with Dr. Stanco when she was interned and the last two years of the family medicine residency. She would present patients to me and I would judge her abilities. She was always very strong in knowledge, and I thought her care plans were well developed and showed a lot of insight,” he said.

Dr. Jording has served as a guest attending physician at the Casper program for 30 years. He travels from Newcastle once a month. He said he considered her above average in skill and knowledge, that she was mature and stood out from the rest of the residents. He attributes all that to her time as a corpsman in the military.

“She developed a great skill ... and a great knowledge base for medicine. Her experience in the military gave her a wonderful foundation for family medicine,” Dr. Jording said.

As she steps into her new role as faculty member at the Casper residency program, Dr. Stanco said she feels grateful for all of her experiences and for this new opportunity.

“It was always my dream to be a doctor. I could not be more grateful and thankful for this opportunity ... it’s been just the right fit,” she said. “Geriatrics is awesome, and the perfect fit for me. I love the population and I love to serve the underserved.”

Dr. Stanco offered encouraging words for those who also dream about their future.

“You’re never too old [to learn],” she said. “Never give up on your dream.”

Dr. Monica Bertagnolli

Fri, 01 Nov 2024 20:06:00 GMT

Dr. Monica Bertagnolli: National Institutes of Health director embraces Wyoming roots, focuses on rural medicine

As published in Wyoming Medicine Fall 2024 - by Gayle M. Irwin

Click here to view the article PDF.

Monica Bertagnolli, MD, director of the National Institutes of Health, remains rooted in Wyoming personally and professionally. She returns to the Cowboy State for visits and also seeks to improve medical information and access in rural areas.

“I grew up on the western slope of the Wind River Range – that’s where the ranch is,” Dr. Bertagnolli said. “It’s 98 miles to Rock Springs – that’s where I went to school – [and] I understand what it’s like to be 100 miles from the doctor’s office.”

She was bucked off a horse as a child and broke her arm. A full day passed before she went to a medical clinic in Rock Springs. That difficult access to medical services and the life and career of an uncle who worked in family practice were two motivators for Dr. Bertagnolli’s decision to become a physician and to focus on helping people living in rural areas.

“He was the VA doctor,” Dr. Bertagnolli said of her uncle, Pierre Carricaburu, MD. “He used to care for veterans over the whole state ... and did a lot of work on the reservation, taking care of the Shoshone and Arapahoe veterans. He was a big inspiration to me when I was a kid. He was the first one in my family to go to medical school, and I so admired how he took care of people.”

She said she was always interested in math and science and really wanted to help people.

“The best way to use science and help people is to go into medicine,” Dr. Bertagnolli said. “There were so many directions I could go. It’s a very broad field, and I could find my place there.”

She discovered a strong interest in research and immunology while attending the University of Utah medical school. However, her direction changed course her senior year.

“One day I walked into an operating room ... and just felt that I belonged there,” she said.

She moved to Boston and served as a surgeon but also had a research laboratory. She specialized in cancer surgery and was “heavily involved in research,” including clinical research.

“I didn’t want to only be a mouse doctor, I wanted to be a person doctor,” Dr. Bertagnolli stated.

She spent more than 35 years in the fields of surgery and research, including running a large clinical group that focused studies in rural and remote areas, including Billings. That is the type of work she deeply enjoys, she said.

Nominated by President Joe Biden to oversee the National Institutes of Health (NIH) in May 2023, the U.S. Senate confirmed Dr. Bertagnolli last November. She is the first surgeon and only the second woman to hold this position.

According to Dr. Bertagnolli, NIH is the largest supporter of biomedical research in the world and has a $47-plus billion- dollar budget, allowing the organization to help find answers to society’s biggest medical issues.

“It’s just a delight to be in this job,” Dr. Bertagnolli said. “It’s such an honor and a privilege to be in that environment. We can do a tremendous amount of what people really need and that’s what we’re going to do.”

She previously served as the director of the National Cancer Institute (NCI), an organization within NIH. The NCI research studies the causes of cancer, and also develops effective treatments and possible cures. She said steady progress has been made, and survival of different cancer types, such as breast cancer, has vastly improved.

“The death rate from breast cancer has decreased tremendously even though the incidence is going up,” she said. A breast cancer survivor, Dr. Bertagnolli understands the necessity for such research and treatment advances.

“My prognosis is excellent,” she said. “That wasn’t true a number of years ago, and it’s getting better and better

every day.”

Another important NIH research program is exploring new gene therapies which will be used to move closer to a cure for rare diseases such as sickle cell and hemophilia.

“It’s really going to take the National Institutes of Health to tackle these diseases because they’re not something the pharmaceutical companies are going to naturally gravitate toward – even though they help – because so many of the diseases that can be treated with gene therapies are rare,” she said.

New project for rural communities

A $30 million project was recently announced and ties back to Dr. Bertagnolli’s desire to help rural communities. Called Communities Advancing Research Equity (CARE) for Health, the pilot program seeks to integrate clinical research with community-based primary care in order to improve access to such research to medical providers in underrepresented and underserved communities.

“We have to learn two things: what do rural communities need? And how do we make it possible for those communities to contribute to our learning?” Dr. Bertagnolli explained. “We have to know what kind of resources we need to bring and what kind of research is relevant to them.”

The point is not telling people what they need, but instead, listening to them and learning what they need.

“We’re big, we’re the whole NIH," she said, "so we’re going to have some programs that will help us deliver, or learn how to deliver, what [those communities] need. We need to get people access to research that will benefit them. And even if we think we know what might benefit different communities, we won’t succeed without going into communities, asking what [they] need and then inviting [them] to participate in research programs that we have that are of the community’s choice.”

The CARE pilot program covers 2024 and 2025. As of July 2024, no announcement had been made as to how many communities will participate or the locations. Dr. Bertagnolli said she hopes some in Wyoming will be part of the study.

She returned to her home state this summer, spending time at the family ranch and visiting Fort Washakie, where she learned more about a substance abuse program at the Warm Valley Health Care clinic.

“They are bringing the Native culture into helping people recover and helping people live a full, complete, and healthy life, and they’ve had some great success so far,” Dr. Bertagnolli said. “It’s heartwarming to see. And it was also heartwarming to see a community so absolutely dedicated to the well-being of its people.”

A partnership between the clinic and NIH may develop.

“I got great feedback from the Warm Valley clinic that they were willing to bring a lot to any partnership we could develop there, and that’s exactly what we’re looking for,” she said, adding that partnerships are crucial to NIH projects.

She and her NIH team look forward to implementing the CARE program, Dr. Bertagnolli said.

“This is a very ambitious program [but] I can tell you, everyone at NIH is so excited,” she said. “They care so much about people and about doing what’s right for people. They’re very excited about understanding and addressing the needs of rural Wyoming, rural Alabama, rural Maine, and rural Alaska – to name a few locations already engaged.

Projects like CARE for Health bring her back to her rural roots.

“A lot of our [medical] research is done at big, academic medical centers. I want to see it reach rural America ... and we can do that,” she said. “That’s one of my biggest priorities. We need our research to learn from the wonderful environment of Wyoming so that we learn better how to serve people in all rural communities. And, most of all, we want to help everyone in Wyoming live long and healthy lives.”

She added, “I mean it seriously – we really need to serve every community, and we’ve got a lot of learning to do to know how to deliver what people really need.”

From Wyoming to Washington, D.C., Dr. Bertagnolli remains focused on helping rural communities from Acadia to Alaska and all areas in between.

“I deeply care for communities like we see in Wyoming where it’s a long way to a doctor or a long way to a specialist,” she said. “My guiding principle when I became NIH director was this: our work at NIH is not done when we deliver new discoveries; our work is only done when all people are living long and healthy lives.”

She maintains a Wyoming physician’s license.

“I am a Wyoming girl still [and] I am proud, proud, proud to be from Wyoming,” she said. “I bring my Wyoming heritage to everything I do.”

Too Young to Be Diagnosed

Fri, 18 Oct 2024 20:00:27 GMT

Too Young to be Diagnosed: Aaron Booker Firefighter Cancer Screening Act highlights prevalence of early cancer
in firefighters

As published in Wyoming Medicine Fall 2024 - by Elizabeth Sampson

Click here to view the article PDF.

As a young fireman, Kevin Reddy was supposed to receive a prostate cancer screening as part of an annual physical, but his screening doctor refused, saying there was no reason to examine anyone under the age of 35 for prostate cancer.

Luckily, Reddy did not have cancer, but he now knows firefighters face constant exposure to chemicals that lead to cancer diagnoses earlier than the rest of the population. Working to make sure no other firefighter is refused a cancer screening, Reddy, who is president of Federated Firefighters of Wyoming and a Cheyenne firefighting veteran with more than 20 years of experience, testified before the Wyoming Legislature on behalf of the Aaron Booker Firefighter Cancer Screening Act.

The act, which was sponsored by Rep. Landon Brown, R-Cheyenne, ensures no other firefighter misses out on what could potentially be a lifesaving cancer screening. After going into effect July 1, any employed or volunteer firefighter in Wyoming with at least 10 years of experience can have cancer screening tests covered by the state’s workers’ compensation fund. Firefighters are eligible for the screenings 10 full years after retirement as well.

“The medical providers who deal with these patients can rest assured that their bills are going to get paid, especially if they have any indication that there may be some level of cancer anywhere in these individuals’ bodies,” Brown said. “The state of Wyoming has billions of dollars in our state workers’ comp account, and that is where the claims will be paid from. That was a big portion of why I developed this law the way I did – to ensure that the bills will be paid. There is zero concern about that. We want these providers to know they have every tool and every resource available to them to save these people’s lives earlier and earlier and reduce the cost of expensive treatment for late diagnoses and late treatment plans.”

Brown also wanted to make sure doctors and their patients are not hindered by yearly testing time limitations, meaning if a test is medically indicated, it will be covered by workers’ compensation. He said that was important to include in the act because of the experience his friend Aaron Booker went through.

Booker was a Cheyenne firefighter who died from job- related colon cancer at the age of 47 in 2023. Brown met him at church on the day Booker had been diagnosed with stage IV colon cancer.

Brown noted his friend had a colonoscopy early in the year where polyps were removed, but when symptoms continued he had to fight against the notion that a young man is not a likely candidate for colon cancer – and thereby did not qualify for a second colonoscopy in a single calendar year. When he did finally get a second colonoscopy, his doctors found another polyp and realized his cancer had spread.

“He had gone through the rigmarole of being too young to be diagnosed in most medicinal processes with colon cancer,” Brown said. “Once they found that polyp and realized his cancer had spread, it was already too late.”

During one of Booker’s last days, Brown was sitting with him out on his porch.

“He told me, ‘Do me a favor, and make sure that this never happens to anyone else,” Brown said.

That's when Brown got to work pushing for legislation that would help protect the firefighters who protect others. In 2017, former governor Matt Mead signed into law the presumptive disability for firefighters bill. The bill guaranteed that if a firefighter gets one of a specific list of diseases or conditions, it is presumed it was caused by his work. Brown expanded on that language to ensure these conditions can be caught early and treated effectively, thereby saving money and lives and making sure firefighters can return to the workforce.

He said the legislation received incredible support in both houses of the legislature. It passed out of the house with a 62-0 vote in favor of the bill and passed through the senate with 28 ayes, 2 excused and only one nay.

“It was the most amazing thing I’ve ever experienced,” Brown said. “For me being as polarizing of a figure as I have been in the legislature, I’ve never had a bill pass out of the house with a 60-plus vote majority.”

Firefighters face cancer earlier and more frequently than the general population

According to Reddy, cancer is the leading cause of line-of- duty death across the world for firefighters. Colon, bladder, testicular, ovarian and various skin cancers are common in firefighters, as are brain, lung, throat and esophageal cancer.

"The list is quite extensive—it’s pretty wide open,” Reddy said. “Just the occupation of firefighters is considered a class 1 carcinogen,” Reddy said. Today’s firefighters are exposed to many more petroleum-based chemicals than previous generations face. While in the past building and furnishings were made mostly of natural materials like wood, cotton and wool, now many items are made with synthetic materials and then are laced with flame retardant chemicals which become highly toxic once they eventually start to burn.

“Everything you can imagine is filled with petroleum- based chemicals, and to keep the volatility of these petroleum products from starting on fire, they lace them with more chemicals in the flame retardants,” Reddy said. “All of these combined, once they start on fire, form this toxic soup that firefighters are exposed to when they go into these superheated

environments.”

The extreme heat makes their pores open up trying to cool them down, which makes the firefighters even more susceptible to absorbing the chemicals into their bodies. Even their protective gear absorbs the toxic chemicals during a fire and may continue to off-gas chemicals for several days after a fire, Reddy indicated.

Paul Juergens, Wyoming state director of the Firefighter Cancer Support Network, said that in the last year, he has heard of three Wyoming firefighters who died from cancer. He said firefighters are nine percent more likely than the general population to get cancer, and have a 14 percent higher mortality rate. Additionally, they are 129 percent more likely than the average person to get mesothelioma, 102 percent more likely to get testicular cancer and 62 percent higher than average to get esophageal cancer. He said a recent study of women firefighters in San Fransisco – a department with the nation’s highest percentage of women on their force – showed they had a breast cancer rate six times higher than the national average.

Juergens said while the pool of women studied was a small sample of 300, it’s still a frightening statistic.

He knows doctors probably don’t see firefighters every day in their practice, and they often come in appearing to be healthy and fit. But that can be deceptive.

“It’s easy to say, ‘I see him running down at the park or at the gym working out, so he’s healthy,’” Juergens said. “But that same person has a high risk of cancer. Almost be a hypochondriac in a way. If they have something weird, dig a little deeper.” Knowing that the Aaron Booker Firefighter Cancer Screening Act covers the cost of any testing, Juergens hopes doctors lean in to additional testing if something seems off.

While fire departments are now encouraging their employees to quickly shower off when they return from a fire, and then making an effort to wash down their gear and their trucks as well, they are still facing health threats each time they go to work. Juergens explained that beyond the carcinogens they face from smoke and burning chemicals, they face additional risk that means their cancer risk goes up.

“Firefighters don’t get good sleep – we don’t get that REM sleep so we don’t get a chance for our body to boost our immune system, and the stress that comes with our job,” Juergens said. “These three factors compound and give firefighters a greater cancer risk.”

Harnessing the Power of Technology

Fri, 04 Oct 2024 19:50:52 GMT

Harnessing the power of technology

As published in Wyoming Medicine Fall 2024 - by Spencer Weston, MD

Click here to view the article PDF.

When you think of Wyoming, technology is probably not the first thing that comes to mind. However, in today's rapidly advancing world, technology is deeply woven into the fabric of our daily lives, even on the high plains. Its impacts are far-reaching, touching nearly every sector, and Wyoming healthcare is no exception. While the use of technology in urban areas is widely recognized, we often overlook its potential in rural medicine. However, there is a growing community of healthcare professionals in Wyoming who are passionate about practicing medicine in rural areas and harnessing technology's power to bridge the healthcare access gap. The feature article in this issue of Wyoming Medicine explores the ways rural healthcare providers are using technology to increase their connection with patients and amplify the quality of care provided.

Passion for rural medicine

Rural medicine attracts a special breed of healthcare professionals who possess a deep passion for helping underserved communities, especially here in the Cowboy State. Often involving a broader scope of practice, which requires physicians to be versatile, adaptable, and resourceful, rural healthcare attracts doctors who are seeking to make a genuine difference in the lives of small-town patients. Rural medicine may not be for every practitioner, but with the help of technology we can try to ensure that rural healthcare is for all patients in need.

Challenges in rural healthcare

In rural areas, there is no shortage of challenges facing both patients and providers. One of the most significant patient disparities is the limited access to specialized medical care. Rural areas often lack the infrastructure to support comprehensive healthcare services, leading to long travel distances for patients seeking specialized treatment, with the scarcity of primary healthcare providers further exacerbating the issue. Without funding from larger healthcare systems, practices are often under utilizing available advanced technologies. All of these challenges result in limitations on care available to patients, longer wait times and ultimately compromised patient outcomes. Wyoming has an opportunity to use technology to do better by our patients.

The role of technology

Before the COVID-19 pandemic, the idea of telemedicine produced a sizable amount of skepticism from both doctors and patients, but during the pandemic its use became regular practice for many, completely revolutionizing healthcare.

Telemedicine allows healthcare providers to remotely diagnose and treat patients, eliminating the need for long-distance travel, proving particularly beneficial in areas where access to specialists is limited. Virtually overnight, many Wyoming patients were receiving expert medical care with the use of video consultations, portable medical devices, and upgraded electronic health records (EHR)s without ever leaving their communities, all while local healthcare providers were able to collaborate and seek guidance from specialists, improving the quality of care provided in even the most rural areas of our state.

Doctors and patients weren’t the only ones excited about the possibilities for increasing healthcare access in rural Wyoming; we also saw a number of community organizations make it their mission to help expand access via tech. Wyoming Frontier Information (WYFI) began providing no-cost, HIPAA- compliant Zoom accounts to any physician practicing in Wyoming and the Wyoming Institute for Disabilities (WIND) partnered with several libraries on the placement of telehealth booths with computers and remote patient monitoring devicesfor patient use. The Wyoming Medical Society has consistently worked to ensure that our members and their patients have access to these important programs.

Preservation of quality care

The WMS Board of Trustees and Wyoming Leaders in Medicine alumni held a retreat in Saratoga over the summer. During leadership sessions, there were several discussions about the use of telemedicine in individual practices amongst attendees. One of the key takeaways from these conversations was that while technology offers immense potential in rural medicine, it is crucial to find a balance in its use to preserve the human side of care and maintain the quality of care expected by our patients. I’ve practiced medicine in a small town long enough to realize the importance of personal connections with patients, but technology can and should be used as a tool to enhance these connections, rather than replace them. Our patients must still feel valued, heard, and cared for, even in the virtual realm.

Passion for rural medicine and the use of technology are not mutually exclusive concepts. By harnessing the power of technology, its integration in rural healthcare has the potential to completely change Wyoming’s healthcare landscape. By keeping an open mind, staying informed and continuing to try new ways to connect with and monitor our patients, we can change lives for the better and make a lasting impact on the lives of our patients.

Students Up-To-Date on Vaccines?

Fri, 20 Sep 2024 19:45:26 GMT

Are Your Family’s Students Up to Date on Vaccines?

Wyoming Department of Health Press Release

The Wyoming Department of Health (WDH) encourages parents to remember important vaccinations for their children along with lunches, notebooks and backpacks as students begin a new school year.

“Children have returned to schools, where they are in close contact with each other all day. It doesn’t take much to spread illness,” said Dr. Alexia Harrist, state health officer and state epidemiologist with WDH. “We are thankful to have vaccines to help protect our kids from many life-threatening diseases such as measles and whooping cough.”

Some vaccines are required for attendance at public and private schools and child care facilities in Wyoming. Kindergarteners should be up-to-date on DTaP, MMR, hepatitis B, polio and varicella vaccinations. Children who are 11 through 12 years old should receive a Tdap vaccination. Depending on individual school rules, children who have not completed their required vaccinations may be put on conditional enrollment or be excluded from school.

“We encourage parents to keep their children up-to-date on required immunizations, as well as others we recommend such as for flu, HPV, meningococcal, hepatitis A and COVID-19,” Harrist said. “These are all great tools to help keep Wyoming kids healthy.”

Harrist noted cost should not be a barrier to vaccinations for Wyoming’s children.

“For children with health insurance, vaccination costs are covered by most policies,” she said. “In addition, more than 100 Wyoming providers offer low-cost vaccines for qualifying children who may need help paying for vaccinations through the Vaccines for Children program.”

WDH suggests families look up their children’s vaccination records in Docket, a secure website and smartphone app offered by the department. Docket can be used to create an official record of vaccinations that have been reported to the Wyoming Immunization Registry and can notify users when vaccinations are due. Docket is also available for adults in Wyoming.

For more information about vaccine records, visit immunizewyoming.com and look for the “Vaccine Records and Docket” tab. Residents may also visit immunizewyoming.com and click on the “Find a Provider” tab to find nearby vaccine providers and more information about programs in Wyoming offering financial help for vaccinations.

Brought to you by The Wyoming Department of Health.

Changes Underway for Wyoming's Behavioral Health System

Fri, 16 Aug 2024 19:38:53 GMT

Changes Underway for Wyoming’s Behavioral Health System

Wyoming Department of Health Press Release

After several years of planning and coordination with partners across the state, changes to Wyoming’s behavioral health system are underway, according to the Wyoming Department of Health (WDH).

“For many years, our department has paid millions of state dollars to community mental health centers to help ensure access for Wyoming residents who sought care for mental health and substance use related issues regardless of their ability to pay,” said Stefan Johansson, WDH director. “It’s one of our largest budget items and is clearly important, but there have been challenges.”

A significant new law passed in 2021 by the Wyoming Legislature supported efforts to strengthen Wyoming’s behavioral health system. A chief goal is focusing state resources on those who need them most: acute psychiatric adults, criminal justice involved clients, high needs children and families and low income and indigent general access populations.

Johansson said, “We really want to help ensure high-needs people facing serious mental illness do not fall through the cracks before their needs grow. As we have carefully prepared for these changes, a focus for our department and our partners has been to help answer the question of ‘What is state government’s role?’”

To help direct the state dollars toward where and when they are needed most, the redesigned process is meant to help ensure people seeking services who could qualify for financial help from other sources such as Wyoming Medicaid or private insurance are supported through those sources rather than through state funding alone.

“When Wyoming’s community mental health system was designed, there was less financial support available for behavioral health services through options such as private insurance. But that has since changed, which presents an opportunity to potentially share the financial load,” Johansson said.

Franz Fuchs, senior policy analyst with WDH, said “One thing people will notice is all residents seeking state-paid behavioral health services must now submit an application through Wyoming Medicaid. While this does not mean you have to be eligible for Medicaid to be helped, this step will check for other potential pay sources beyond state general funds and verify income, citizenship and residency.”

Without an application on file, WDH will not be able to pay for services received after July 1. “The community health centers and organizations such as Enroll Wyoming can help people complete the needed application,” Fuchs said.

Because Wyoming Medicaid is also part of WDH, using existing systems to check eligibility and to manage payments to the community mental health centers is an efficient solution.

Fuchs acknowledged some individuals will no longer be eligible for state-supported services from the community mental health center network. These include people with incomes over 200 percent of the Federal Poverty Level (FPL) who do not have significant behavioral health needs. For those in this group who do not already have insurance, heavily subsidized insurance is likely available through the federal marketplace .

There are also changes to provider payments. “We’re moving from block grants to a mix of block grants, service payments and outcome payments,” Fuchs said.

“The hope for many involved in this redesign effort is that focusing the state’s resources on high-needs clients may eventually lead to cost-savings and reduced pressure on other elements of Wyoming’s behavioral health system such as frustrating waiting lists,” Fuchs said. “If we can reduce repeated hospitalizations or divert people from institutional settings in the first place, that’s a win for both clients and for our state facilities.”

Matt Petry, Behavioral Health Division senior administrator with WDH, said, “We are making big changes and we certainly recognize that change isn’t always easy. We are truly grateful and want to thank our partners in Wyoming’s community mental health centers, law enforcement personnel, leaders in local and state correctional facilities, judicial system representatives, Department of Family Services staff and the state’s policymakers for their participation and willingness to work with us.”

Brought to you by The Wyoming Department of Health.

The Importance of Family Routines

Fri, 19 Jul 2024 18:58:05 GMT

The Importance of Family Routines

Content brought to you by the American Academy of Pediatrics

The Importance of Family Routines

By: Shelly Vaziri Flais, MD, FAAP

Every family needs routines. They help to organize life and keep it from becoming too chaotic. Children do best when routines are regular, predictable and consistent.

Finding a flexible balance

One of a family's greatest challenges is establishing comfortable, effective routines. Ideally, they should achieve a happy compromise between the disorder and confusion that can arise without them, and boredom that can come with too rigid a structure that offers children no choice and little flexibility.

As a parent, it helps to review the routines in your household to ensure that they accomplish what you want. Here are some tips.

Weekday mornings

To help mornings go more smoothly, put as many things in order as possible the night before.
Keep wake-up routines cheerful and positive. If your child just isn't a "morning person," consider some upbeat music to help get the household going. Music is a natural mood lifter .
Encourage your child to eat breakfast, even if they are not hungry in the morning. See Breakfast for Learning .
Help avoid last-minute squabbles by offering kids a choice when possible. For example: "It chilly out, so you should wear a jacket. Would you like to wear the blue one or the red one?"
Finally, round out each morning by saying goodbye to your young child. A simple hug and a wave as they head out the front door or slides out of the car are very important. They will give your child a positive feeling as they begin the day's activities. See How to Ease Your Child's Separation Anxiety .

After school

During middle childhood, children need adult supervision. Many schools offer excellent after-care options for working parents, or transportation to reliable child care organizations.
Healthy after-school routines may include a snack, exercise, relaxation, and study, in whatever order works best for your child. In general, after 6 to 8 hours of school, children need time for active play .
Active play lets them better able to complete the tasks before them, to get their energy out, and to help them get the physical activity they need to stay healthy and fit.

Evenings

Dinner should be an important time for your family. As often as possible, all family members should eat together at the dinner table, without the distraction of electronic devices or television . See Benefits of Family Meals: Eat Together, Thrive Together .
During dinner the family can share the day's activities and participate in enjoyable conversation . Everyone should be encouraged to take part. Discourage negative comments and criticism. Conversation starter card decks encourage positive communication.
After dinner, your kids can help clean up, do other chores such as emptying the garbage, and finish their homework. Once these are done, they can relax by reading , having a conversation, playing games or limited screen time.

Bedtime

On school nights, children need a regular time to go to sleep. Lights can go out at different times for different children in the family, depending on how much sleep each child should get based on their age. See Healthy Sleep Habits: How Many Hours Does your Child Need?
Nighttime rituals can help ease a child to sleep. These rituals can include storytelling, reading aloud, conversation, and songs. Try to avoid exciting play and activities before bedtime. See Brush, Book, Bed: How to Structure Your Child's Nighttime Routine .

Weekends

Although weekend schedules are different for different families, they can be good times for family togetherness. You might go grocery shopping as a family, visit museums and zoos, tackle chores that everyone participates in, or go on family hikes or bike rides .
Especially for elementary school-age children, who may be forming social bonds outside the family, consider inviting special friends to visit . You can share some family time and also get to know your child’s friends better. Simple is best—your child can invite a friend for dinner with your family followed by board games or a movie .
Keep in mind that while family time is essential, it is equally important for parents to set aside some time just for themselves, too. This can strengthen parents’ bonds with each other and sends a positive message to the children. Kids will enjoy their time with a trusted sitter while parents reconnect.

More information

About Dr. Flais

Shelly Vaziri Flais, MD, FAAP , is a board-certified practicing pediatrician and mother of 4 children. An assistant professor of clinical pediatrics with Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, she is the author of the American Academy of Pediatrics books,Nurturing Boys to Be Better Men: Gender Equality Starts at Home and Raising Twins. Dr. Flais is also editor-in-chief of Caring for Your School-Age Child, 3rd Edition , and a contributor for Sleep: What Every Parent Needs to Know. She has shared her reality-based parenting approach with national and local television, radio, online, and print news outlets.

Last Updated 6/28/2024

Source American Academy of Pediatrics (Copyright @ 2024)

Brought to you by The American Academy of Pediatrics.

The City and the Psychiatric Hospital

Mon, 24 Jun 2024 20:39:50 GMT

The City and the Psychiatric Hospital

As published in Wyoming Medicine Spring 2024 - by Byron Glathar

Click here to view the article PDF.

#WEAREFIRSTLINE

Wed, 19 Jun 2024 21:20:09 GMT

#WEAREFIRSTLINE

Content brought to you by the American Academy of Pediatrics

The newly added video, Introduction to Infection Control , deepens the conversation in the series by identifying the four pathways for spread and eight common reservoirs for germs, and discusses strategies for minimizing the spread of germs in healthcare settings.

Wrapping up the video series is Source Control in Health Care . This module supports team members in identifying how to use source control in healthcare settings, knowing the difference between source control and personal protective equipment (PPE), and demonstrating their role in reducing the risk of spreading disease.

The full series of informative videos is now available!

Brought to you by The American Academy of Pediatrics.

Gaining Ground: Wyoming combats high suicide rates, but there's still a big climb ahead

Mon, 17 Jun 2024 20:34:59 GMT

Gaining ground: Wyoming combats high suicide rates, but there's still a big climb ahead

As published in Wyoming Medicine Spring 2024 - by Elizabeth Sampson

Click here to view the article PDF.

People Matter, Words Matter

Wed, 12 Jun 2024 20:58:27 GMT

People Matter, Words Matter

Content brought to you by The American Hospital Association

Words can transmit stigma. Studies have shown that people with psychiatric and/or substance use disorders often feel judged, outside and inside the health care system. This can lead them to avoid, delay or stop seeking treatment. The way we talk about people with a behavioral disorder can change lives – in either a positive or negative manner.

The AHA, together with behavioral health and language experts from member hospitals and partner organizations, will release a series of downloadable posters to help your employees adopt patient-centered, respectful language. Please consider downloading, printing and sharing each poster with your team members and encourage them to use this language both in front of patients and when talking to colleagues. People matter and the words we use to describe them or the disorders they have matter.

Brought to you by The American Hospital Association.

Gun-Free Zones: What almost was and what remains after the veto of HB125

Mon, 10 Jun 2024 20:30:52 GMT

Gun-free zones: What almost was and what remains after the veto of HB125

As published in Wyoming Medicine Spring 2024 - by Nick Healey, JD, Claire Postman, JD

Click here to view the article PDF.

Three R's of Trauma-Informed Care

Wed, 05 Jun 2024 07:23:34 GMT

Three R's of Trauma-Informed Care

Content brought to you by the American Academy of Pediatrics

Brought to you by The American Academy of Pediatrics.

Mental Health Care and the Ability to Practice Safe Medicine

Mon, 03 Jun 2024 20:26:59 GMT

Mental Health Care and the Ability to Practice Safe Medicine

As published in Wyoming Medicine Spring 2024 - by Kevin Bohnenblust, JD

Click here to view the article PDF.

2024 WMS Annual Conference

Wed, 29 May 2024 20:17:49 GMT

2024 WMS Annual Conference

Content brought to you by The Wyoming Medical Society

WMS Annual Conference

October 25-26, 2024

Laramie, WY

University of Wyoming

Marian H. Rochelle Gateway Center

The Wyoming Medical Society invites you to attend the 2024 Annual Conference.

New this year...

The 2024 WMS Annual Meeting will be held the same weekend that the University of Wyoming Cowboys football team takes on Utah State at home! GO POKES!

We are thrilled to provide our members with the opportunity to gather with colleagues from across the state for learning, networking and fellowship AND a fun WMS tailgate and game day experience!

Conference Information

Brought to you by The Wyoming Medical Society.

Prioritizing Mental Health and Well-Being

Mon, 27 May 2024 20:23:33 GMT

Prioritizing mental health and well-being

As published in Wyoming Medicine Spring 2024 - by Sheila Bush

Click here to view the article PDF.

What U.S. Healthcare Will Look Like In 2033

Wed, 15 May 2024 19:53:24 GMT

What U.S. Healthcare Will Look Like In 2033

Content brought to you by The Doctors Company

Executive Summary

Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group

American healthcare faces persistent issues with consolidation, workforce shortages, integration of new technologies, and unrelenting economic pressure. In 2023, technologies such as clinical decision support (CDS) and other artificial intelligence (AI) tools have continued to emerge, offering both promise and risk. Meanwhile, even as long-standing care and business models are upended, the ripple effects of COVID-19 continue. Physician shortages are growing, especially in primary care, though advanced practice clinicians (APCs) are filling many of the gaps.

Healthcare organizations are looking to their vast wealth of data for insights that can be harnessed to improve care for patients, promote professional satisfaction for clinicians, mitigate liability, and streamline medical practice.

Each year, TDC Group looks ahead to healthcare trends over the next decade, focusing on challenges, key lessons, and emerging risks. We remain committed to serving those who provide care by delivering insights into healthcare’s evolution to help guide the actions of medical leaders making critical decisions. This examination, though certainly not exhaustive, lays out some of the most pressing issues medical professionals must address as we look ahead. Our 2022 analysis examined the impacts of the pandemic, health equity challenges, and healthcare costs on the changing landscape.

What Will Healthcare Look Like in a Decade?

Here are TDC's 2023 predictions for how U.S. healthcare will change over the next 10 years:

Prediction One: The shadow of the pandemic will still fall over healthcare, as physicians face continuing pandemic-related lawsuits, unanswered questions around care for long COVID patients, and delayed diagnoses stemming from COVID-19 disruptions.

New research suggests that health risks can persist at least two years after COVID-19 . For a large swath of long COVID sufferers, regular appointments with one or more specialists like pulmonologists, respiratory therapists, endocrinologists, cardiologists, urologists, and gastroenterologists is an inevitability. There are still many unanswered questions around long COVID, not only in terms of its symptoms and treatment, but also in terms of liability for physicians.

During the pandemic, shield laws enacted by many states created qualified immunities from certain types of liability . These protected medical professionals against medical malpractice claims relating to the prevention and treatment of acute COVID-19, but those same protections may not exist for those treating patients with long COVID. Among other complicating factors, says Peter Kolbert, JD, Senior Vice President for Claim and Litigation Services for Healthcare Risk Advisors (HRA), part of TDC Group, long COVID is still something of a “ diagnosis of exclusion .” Therefore, the strength of relationships and clear communication between physicians and patients are crucial. In malpractice claims involving COVID-19, “the very first piece of evidence is the medical record,” which becomes a time capsule, containing efforts to rule in, rule out, and follow up.

“There is still a lack of full societal acceptance of long COVID,” Mr. Kolbert says. “But claims alleging delay in the treatment or recognition of long COVID are starting to trickle in.”

Prediction Two: Healthcare consolidation will continue unabated and continue to be a driver of increasing healthcare costs.

Healthcare consolidation is often promoted for its ability to access economies of scale and cost reductions, but this benefit rarely reaches patients. A recent study from JAMA found that consolidation among physicians produced medical charges that were 12 to 26 percent higher than they had been before consolidation . And for hospitals, the average increase in pricing was about 31 percent.

“The study showed some positive quality differentials were achieved, but they were quite small,” says Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer of The Doctors Company and TDC Group. “Consolidation is not providing the level of improvement that we’d hoped.”

At the same time, tech giants and private equity funds—who secure distressed specialty practices—have continued to tighten their grip on the U.S. healthcare market. According to the American Hospital Association’s Health Care Disruption 2023 Outlook, nontraditional providers will capture one-third of the healthcare market by 2030 .

“The venture capital model is, ‘Buy it, increase profitability, and sell it in three to five years,’” Dr. Anderson explains. “That’s a very disruptive model for healthcare. When I say disruptive, I don’t mean disruptive innovation. I mean it can disrupt the continuity of care in a profound way.”

From 2014 to 2021, the volume of private-equity and venture-capital deals in healthcare grew at a 29 percent annualized rate—compared to only about 2 percent overall. In 2022, healthcare merger and acquisition revenues totaled a record-breaking $45 billion , and the pace of such transactions was picking up; the pace stayed strong through the first half of 2023 .

Prediction Three: Nuclear malpractice verdicts—driven by social inflation—will continue to push insurance rates and healthcare costs higher.

A notable difference between the U.S. and similar countries is the rising cost of malpractice litigation. Numerous factors contribute, including the consolidation of healthcare, which creates large corporate healthcare systems that make attractive targets to plaintiffs’ attorneys, hold little appeal for juries sympathetic to injured patients, and often wish to avoid the uncertainty of extended litigation, which may incline them to settle. Social media and nuclear verdicts remain powerful influences .

Healthcare practices and institutions, as business organizations, are affected by the same economic forces that impact the communities and business climates in which they operate. Social inflation, which occurs when an insurer’s average claim amount grows faster than the overall inflation rate, has reshaped numerous markets, but its effect on healthcare has been outsized.

“People are, understandably, sympathetic to injured patients,” says Robert E. White, Jr., President of TDC Group. “Jurors can also form emotional bonds with credible, empathetic medical professionals, but it’s harder to be sympathetic to a hospital—if jurors perceive a healthcare organization as a faceless but deep-pocketed entity, then an enormous award may be easier for the plaintiff’s attorney to inspire.”

Over the decade ending in 2021, social inflation has increased losses incurred by physician-focused insurers by between $2.4 and $3.5 billion—8 to 11 percent. By creating pressure to increase insurance premiums, social inflation increases healthcare costs and can make care less accessible.

From 2013 through 2018, liability premiums were relatively stable. In 2019, a rapid uptick began , culminating in roughly 30 percent of policyholders nationwide experiencing an increase in their medical malpractice premiums in 2022. These increases are not due to social inflation alone, but they are connected.

“As these cost trends continue, medical professional liability carriers will have to increase their rates to keep up with the losses,” Mr. White says. “Therefore, although social inflation hits insurers first, it ultimately affects practices’ premiums.”

In this short video, Mr. White explains more about social inflation.

Prediction Four: Patient use of retail healthcare clinics like CVS will increase—forcing a serious re-examination of “patient-centered care.”

For a patient’s routine care needs, traditional practices are now competing with the ease of access that large retail pharmacies like CVS provided during the pandemic. Retail healthcare clinics can often offer appointments sooner than traditional physician practices, making them appealing to patients who want or need rapid help with medical concerns. Retail clinic billing volumes are up 200 percent since 2017 , outpacing urgent care centers, emergency departments, and physicians’ offices. This means that retail medicine providers like pharmacy clinics present business competition to traditional practices.

“During the pandemic, millions and millions of patients started to use retail clinics for the first time, because they could get their immunizations there,” Dr. Anderson says. “In today’s society, where 24/7 service is available for virtually anything and there are many metrics for the quality of the service, people know what good customer service looks like. Despite two decades promoting patient-centered care, access to prompt convenient care has not generally improved among traditional providers.”

Patients can book their retail healthcare clinic appointments using a customized app. The patient encounter begins long before the visit and continues after through communications regarding testing and follow-up.

Faced with the ease of access provided by retail medicine, traditional healthcare practices are expanding their focus beyond the point of care, pushed to rethink the patient’s entire journey. However, practices face obligations that retail medicine providers do not.

“Retail companies can make profits by driving traffic to their stores, with medical care serving as a loss leader,” Dr. Anderson says. “Retail medicine is going to harvest the low-hanging fruit in American healthcare with routine things like school physicals, immunizations, and prescription pick-up. And they’re doing this unencumbered by any responsibility for the overall healthcare system.”

Prediction Five: APCs and alternative models of care will be two keys to alleviating the primary care and elder care crisis.

The Association of American Medical Colleges predicts that demand for medical services in the U.S. will grow much faster than physician supply , leading to an estimated physician shortage of between 54,100 and 139,000 by 2033. In primary care, specifically, relief is coming for overburdened physicians, as APCs, including nurse practitioners (NPs) and physician assistants (PAs), are among the fastest growing professions. Through 2030, strategic studies show that the total of practicing physicians is projected to grow at a compound annual growth rate (CAGR) of less than 1 percent, vs. 6.8 percent and 4.3 percent for NPs and PAs respectively.

“Increasingly, APCs will become accessible care providers for many Americans seeking routine and preventative care, as well as entry into traditional care delivery,” says Laura Kline, MBA, CPCU, Senior Vice President of Business Development, The Doctors Company, part of TDC Group.

Leaders in primary care emphasize the importance of role definition, so physicians and APCs can collaborate effectively within state-based scope-of-practice limitations. This will broaden access to care while helping team members practice at the tops of their licenses.

According to census estimates, by 2050, the population of Americans 65 and older is projected to increase by more than 50 percent . More of this population is choosing to age at home, creating a need not only to develop a care model but also to work with patients to modify their environments to support that choice. “Nurse practitioners are providing much-needed in-home care and community-based options for elder care,” says Paul Romano, President of TDC Specialty Underwriters, part of TDC Group. “These models are alternatives to healthcare’s traditional heavy reliance on the current institutional model and focus not only on caring for a patient’s health but ensuring they can manage and even thrive in their home environment.”

Outpatient primary care models can reduce cost and suffering. This approach is growing, with “hospital at home” programs offering inpatient-style care for serious health issues at home.

“The expansion of care in home settings will continue as more routine procedures are approved for outpatient care settings,” Mr. Romano says. “With better reimbursement rates, lower costs, quicker recovery times, and a better overall patient experience, more care will be administered this way. The role of APCs will continue to expand to handle this shift of exposure to outpatient settings.”

In a time of worsening physician shortages, new approaches to primary care, home care, and elder care are essential. Thoughtful structuring of care teams can assist many specialties in maintaining or expanding access to care while containing costs, relieving burdens for physicians, and continuing to provide high-quality and attentive care.

Prediction Six: AI-powered clinical decision support tools will help reduce administrative burdens to free up more time for patient care—but present new risks in the process.

For physicians in fields requiring the interpretation and assimilation of vast amounts of data, AI has become a critical technological tool—albeit one that is still in its earliest stages. Many healthcare practitioners say they welcome AI-powered assistance in lifting administrative burdens, but few healthcare systems have developed a plan for using AI tools in scheduling and billing—much less for diagnosis or other phases of patient care.

AI-powered CDS tools have shown promise for analyzing images (e.g., masses, skin lesions, or moles) to augment clinicians’ judgment in separating what is normal from what is cause for concern. Radiologists have led the way in seeking workflows by which AI-powered tools could reliably enhance detection and decision-making—as opposed to bogging down in false alarms or otherwise creating as many burdens as they relieve , as often happens with new technology.

AI-powered tools are being implemented in more medical specialties, and they are being deployed to provide administrative support that allows medical professionals to focus directly on patients.

Medicine is seeing an increase among prospective research studies examining a variety of AI-powered CDS tools in practice, evaluating their ability to provide evidence-based recommendations for diagnosis and treatment, improving care quality, and reducing adverse events.

“Even when using valid clinical decision support tools, medical professionals must apply critical thinking, clinical judgment, and additional diagnostic testing as needed to validate CDS recommendations,” Mr. Kolbert says. For instance, though an algorithm anticipates a patient’s active myocardial infarction, the emergency department physician must still secure additional evidence or confirming test results prior to sending the patient for stenting or an angioplasty—or risk a subsequent medical malpractice claim of misdiagnosis if the procedures were unnecessary. Even as CDS can streamline clinicians’ workflows, it does present additional patient safety and litigation risks , if not applied with caution and in the context of documented clinical judgment and physical findings.

"Medical record documentation of human judgment in response to AI guidance will be essential to patient safety and mitigating the risks of allegations of negligence,” Mr. Kolbert says.

Prediction Seven: AI tools will “listen” to patient-clinician interactions to reduce the burden of documentation—a top driver of clinician burnout.

The recording of physician-patient interactions via natural language processing (NLP) shows promise in freeing clinicians from EHR documentation to focus on patients, not computer screens. A recent study found that physicians spent more than 16 minutes per outpatient encounter using EHRs, with chart review, documentation, and ordering accounting for most of that time. These ambient listening and charting tools could reduce clinicians’ “ pajama time ” with their EHRs—relieving a major contributor to burnout.

AI’s ability to synthesize incalculable amounts of data grabs headlines and imaginations, but some of the finest AI-powered tools so far have been those that relieve administrative burdens, such as scheduling, coding, and billing. This assistance can be transformative for an organization when it frees up human attention for direct patient care.

ChatGPT can be used to assist in drafting prior authorization letters for medical insurance. Large language models are also being tested to auto-draft responses to common and time-intensive patient messages in practitioner portals.

Integrating technologies like ChatGPT into the clinical process requires guardrails. “Although AI-driven tools are capable of providing valuable information and guidance, they are not infallible,” says Deepika Srivastava, MBA, PMP, Executive Vice President of Medical Professional Liability and Shared Services, The Doctors Company and TDC Group. “There is the possibility of generating inaccurate or outdated information.”

Hospitals are implementing guidelines, policies, and restrictions that caution physicians about the potential inaccuracy of ChatGPT-generated information and about auto-drafted responses to prompts that sound plausible but are in fact nonsensical. Because AI-powered tools are trained on large datasets, the content of those datasets, if not carefully considered, can produce skewed results, with the potential for results that are inaccurate, unfair, or even dangerous for some patient groups.

Early examples include a COVID-19 vaccine distribution algorithm prioritizing university trustees over medical residents performing frontline patient care and a racially biased healthcare access algorithm . The algorithm prioritized enrollment by healthcare utilization as opposed to underlying conditions. Utilization was driven by insurance status, and sicker Black patients were less likely to have insurance in the dataset used. As these examples demonstrate, addressing algorithmic bias is vital to achieve credibility and safety for AI-powered tools in healthcare.

“AI relies on good data, and a data governance strategy is a key component to understanding where the data is coming from, how accurate it is, if it’s reproduceable, what controls are in place to ensure the right people have the right access, and, if we’re starting to use it to build algorithms, that it’s deidentified,” Ms. Srivastava says.

Prediction Eight: AI tools will increase HIPAA and cybersecurity risks for healthcare.

Healthcare practices and organizations are entrusted with large quantities of confidential, valuable patient data. Unfortunately, this makes healthcare organizations choice targets for cybercriminals—the frequency of cyberattacks on hospitals and health systems more than doubled between 2016 and 2021 . During that period, nearly 42 million patients had their protected health information (PHI) exposed. The attractiveness of healthcare organizations to cybercriminals only grows as AI-powered tools for scheduling, billing, and other administrative tasks permeate the healthcare space. And with AI-powered tools for CDS continuing to develop, concerns around privacy and security increase as well.

Given the risks to patient safety and the threat of fines and litigation costs, the incentive to prevent cyberattacks could hardly be greater.

“With sensitive patient data being processed and stored by these systems, it is imperative to maintain strict security measures to prevent potential data breaches,” says Richard F. Cahill, JD, Vice President and Associate General Counsel for The Doctors Company, part of TDC Group. “Healthcare providers must prioritize cybersecurity by implementing multifactor authentication, encryption, and regular security audits.”

For healthcare organizations, the HIPAA implications of a cyberattack are top of mind, because recovery from a data breach can mean substantial fines from the Department of Health and Human Services (HHS) Office for Civil Rights (OCR). Healthcare organizations have often been slower to detect, respond to, and recover from breaches than businesses in other industries, which also increases costs. Moreover, the costs of a breach go beyond direct monetary costs.

Lengthy administrative disruptions are not merely inconvenient or expensive, but potentially dangerous to patients. Interruptions in hospital workflows can lead to delayed tests or procedures, to longer hospital stays—and even to increased mortality . Further, because disruptions at one regional healthcare facility can lead to changes at others nearby, even nontargeted hospitals in an area may be affected when a local institution is attacked, leading some to suggest that cyberattacks against hospitals be treated as regional emergencies . These dangers and disruptions obviously take a personal toll on patients and practitioners, as well as contributing to litigation risks.

Prediction Nine: The flood of data from patient wearables will continue to overwhelm clinicians.

The prepandemic increase in the use of wearables was spurred by new needs for remote care, and that pace has not flagged: The global wearables market could reach $415.12 billion by 2029 . Yet from the perspective of medical professionals, the picture is mixed. Many consumer-market (as opposed to research-grade) devices show promise, and many are helpful to some limited extent. That said, the accuracy of consumer-market wearable tech devices remains much lower than desired, leading to a variety of liability concerns for medical professionals .

This influx of questionable, spurious, or irrelevant data from patient wearables can overwhelm clinicians. Who owns and is responsible for analyzing all this information remains unclear. AI-powered tools may be able to sort, prioritize, or help triage some of the information flow.

“Real-time patient data analysis can improve patient safety and mitigate morbidity by searching for specific indications of sepsis or patient decline requiring rapid response and alerting appropriate personnel,” Mr. Cahill says. “As telehealth-based interventions such as remote patient monitoring gain traction in acute home care, the constant data streams overwhelm clinicians. Artificial intelligence is a potential solution for converting the data flood to prioritized actionable information and communicating it to the appropriate care team members.”

Prediction Ten: Big data will pay off—but only for those organizations that successfully harness it.

The volume of data in healthcare today is unprecedented. Healthcare organizations need better tools to help sort, prioritize, and analyze this incoming tide.

“It is crucial for any hospital or healthcare institution to improve care and minimize future risk; the answer to decreasing liability risks and improving overall patient safety may be found within the data they own,” says Veronique Grenon, FCAS, Vice President of Data Strategy at HRA, part of TDC Group. “Their data holds the key to understanding patterns and trends that can drive risk reduction strategies.”

Healthcare professionals have faced unrelenting pressure in recent years, but data analysis can help identify systemic issues contributing to liability risks for healthcare practitioners and organizations. The prediction of staffing needs is an example of how an organization’s own data can assist in improving both patient safety and practitioner experience, while mitigating liability.

Eye-catching increases in nursing turnover have been especially well reported. Workload and staffing ratios have been a frequently cited culprit. Organizations that can access, organize, and aggregate their own staffing-relevant data will be better able to meet patients’ needs in ways that improve safety and satisfaction while reducing staff turnover.

Similarly, hospitals and healthcare organizations have the opportunity to use data analysis to ameliorate system issues contributing to patient safety risks. This process could take various forms, including analyses of practitioner-reported safety events such as near misses, and data-driven approaches to managing both current and closed medical malpractice claims. Attending to actionable items discovered through these quantitative evaluations should produce improvements that foster better outcomes for patients, while providing healthcare practitioners with reductions in liability and increases in professional satisfaction.

“Healthcare organizations need support while facing consolidation, competition, staffing shortages, and more,” says Mr. Romano. “The healthcare industry is evolving rapidly, and to help them keep pace, organizations need partners that can offer specialized and responsible insurance programs that support them as they meet these challenges.”

Over time, organizations that doggedly pursue a data-driven approach and the recommendations they derive from their own data will not only improve outcomes for individuals—they will build a stronger organization, one that may be more resilient in the face of change and challenge.

Brought to you by The Doctors Company.

PATTeR Child Health Advice for Trauma (CHAT)

Wed, 01 May 2024 19:33:38 GMT

PATTeR Child Health Advice for Trauma (CHAT)

Content brought to you by AAP - PATTeR

Trauma-informed care (TIC) is defined by the  National Child Traumatic Stress Network as medical care in which all parties involved assess, recognize and respond to the effects of traumatic stress on children, caregivers and healthcare providers.

The resources below, including resources from the AAP Pediatric Approach to Trauma, Treatment, and Resilience (PATTeR) project, provide information and guidance on implementing TIC in pediatric settings.

Check out updated resources to hang up in your clinic or share with families and caregivers, including new infographics now available in Spanish.

PATTeR Child Health Advice for Trauma (CHAT) Manual Level 1

PATTeR Child Health Advice for Trauma (CHAT) Manual Level 2

PATTeR Video Case Vignette Series

The Pediatric Approach to Trauma, Treatment and Resilience (PATTeR) video case vignette series below demonstrate an effective workflow for screening, referral, and follow-up for trauma. The series is broken into three videos; 1) Attachment, Resilience, and Trauma; 2) Shared Power and Difficult Conversations; and 3) Talking to Teens About Trauma. Each full video is further broken down in shorter clips for teaching points.

Video 1: Attachment, Resilience and Trauma

In this video you will see how the pediatrician engages with his 9-year-old patient Jake and his mom and demonstrates predictable compassionate availability, allowing the family to feel safe to express their distress and helping them regulate that distress. The pediatrician models surveillance, screening, and resilience by asking open ended questions and starting from a resiliency approach.

Section 1 – Engagement
Section 2 – Attachment
Section 3 – Surveillance
Section 4 – Screening
Section 5 – Resilience
Section 6 – Trauma reactions
Section 7 – Naming feelings
Section 8 – Setting up the framework

Video 2: Shared Power and Difficult Conversations

In this video the pediatrician reengages with his 9-year-old patient Jake and his mom and demonstrates how nonverbal communication can help regulate and help promote healing. The pediatrician explains the concept of the “invisible suitcase” and refers to a trauma informed mental health provider for therapy.

Section 1 – Reengagement
Section 2 – Nonverbal communication
Section 3 – Matching affect
Section 4 – Invisible suitcase
Section 5 – Regulating emotions
Section 6 – Referral
Section 7 – Wrapping up

Video 3: Talking to Teens About Trauma

In this video the pediatrician engages with his teen patient, demonstrates the steps in talking with teens about trauma and explains the importance of displaying acceptance, curiosity, and empathy.

Section 1 – Steps in talking to teens
Section 2 – Acceptance
Section 3 – Curiosity
Section 4 – Empathy

Brought to you by the AAP - PATTeR.

WY Dept. of Health - Childhood and Teen Vaccines

Thu, 18 Apr 2024 00:29:51 GMT

Childhood and Teen Vaccines

Content brought to you by the Immunization Unit of the Wyoming Department of Health

Vaccination is one of the best ways parents can protect infants, children, and teens from many serious diseases. Vaccine-preventable diseases can require hospitalization, or even be deadly— especially to infants and young children.

Which vaccines does your child need? Visit the Centers for Disease Control and Prevention web page for a vaccine scheduling tool.

Worried about paying for vaccines? Visit the Find a Vaccine Provider web page .

Recommended Vaccinations for Children and Teens

Click on a disease name to learn more about the diseases and the vaccines that prevent them on the Centers for Disease Control and Prevention website .

Brought to you by the Immunization Unit of the Wyoming Department of Health.

When Things Aren't Perfect: Caring for Yourself and Your Children

Thu, 04 Apr 2024 00:00:06 GMT

When Things aren't perfect: caring for yourself and your children

Content provided by HealthyChildren.org

We hear this message a lot: "Kids are resilient ." We usually hear it when hard things have happened:

These events can cause a lot of stress for some children, and when kids don't have the right amount of support, the events can cause damage.

As we learn more about how children's brains develop, we understand that ongoing stressful experiences can cause real damage to the brain and to children's overall physical and mental health and well-being—even into adulthood. The Adverse Childhood Experiences Study (ACE Study) , shows us that diseases like diabetes , high blood pressure , obesity , substance abuse , and others are much more common in adults who experienced serious adversity when they were children.

The greater number of adverse childhood experiences (ACEs), the more likely adults will develop poor health outcomes. There are a number of different factors that play a role in how children will respond to the stress .

Stress & the body

The human body is designed to handle some stress. Some stress, like the first day of kindergarten or working on a big school project, can actually be positive and help kids develop resilience. Resilience means being able to adapt and cope with stress in a way that helps you get better at handling stressful situations in the future.

Sometimes children's stress responses can be very harmful, especially without the presence of caring and supportive adults in their lives. When children experience a very stressful situation once or are exposed to a chronically stressful environment, the body's natural way of dealing with stress (the fight, flight, or freeze response) can become harmful. When this happens, it results in something we call toxic stress —which can lead to behavior challenges, sickness, and mental health issues.

Children can be protected from this toxic stress through the loving and supportive adults around them, especially parents or caregivers, who can reassure them and help them heal after they have experienced something traumatic. Safe, stable, nurturing relationships counteract the effects of toxic stress.

Parents were kids once, too!

What happened to parents when they were children can affect their health now as adults. Parents' memories of how they were raised can shape the way they raise their own children. Sometimes parents who have experienced ACEs have trouble when stressful situations occur. They might lose their temper more quickly or have more health problems, or they may struggle with depression. Many people, including parents, may use unhealthy ways to help calm down— yelling at partners or children, smoking , drinking alcohol or using drugs .

Parents can instead learn healthy ways to cope. Mental health treatment , physical exercise, exercises to help improve self-regulation and keep a positive mental attitude, meditation, and talking to peers can help parents protect their children from also having ACEs.

Helping kids: strong & healthy parents

Parents and other loving adults are very important in helping children practice resiliency. Parents need to take care of themselves before they will be able to help their children, similar to the instructions heard on an airplane—"Put on your own oxygen mask before assisting others."

What does this mean?

Identify your circle of support. Parenting is hard, especially when families have experienced difficult times. No one should try to do it alone. Who do you turn to for advice or help or just to talk about what's going on in your parenting? Seek support from counselors, physicians, family and friends, faith communities, and others who can help you see what you are doing well and to connect you with more support when needed.
Take care of yourself physically. Eat healthy, get enough sleep, practice an exercise routine, take care of your medical needs and give yourself some child-free time to relax.
Identify things you love to do and make time for them.
Identify ways that help you calm down or handle stress when it happens. Take a walk, practice deep breathing, talk to friends, or meditate or pray.
Take time to think about what happened in your own childhood and how it could be affecting you now. If this is difficult or painful, consider getting support from a counselor or simply ask someone you trust for help.

Once parents have found ways to stay healthy even in stressful times, they can provide support to their children. What does this support look like?

Be a positive influence in your children's lives. Your children need to know that you love them and believe in them. Ordinary things like playing together and spending time together can help with this.
Learn about what you can and cannot expect from your children at different ages. Use this knowledge to plan your activities. For example, a 2-year-old is not going to be able to sit still for long. When you need to bring your children to the grocery store, involve them:
"Do you see anything red?" "Please help me put the cans into the cart." Or, if possible, consider going to the grocery store on your own, without your children, or going with a friend who can help.
Model good behavior for your children. They look up to you and will try to do what you do.
A good parenting practice is to stay as positive as possible. For example, give your children praise ; try to notice the good things you see them doing each day.
Be aware of what ACEs and other hard times can do to your children's brain development and overall health. If something traumatic happens to your children or family, share that information with your pediatrician. Medical professionals can help you and your children get the support you need. The earlier you get support for your children, the easier it will be for them to heal quickly and continue living healthy and less stressful lives.

More information

Last Updated 2/14/2024

Source Trauma Tool Box for Primary Care (Copyright © 2014 American Academy of Pediatrics). Project funded through a grant (UC4MC21534) from the Health Resources and Services Administration, Maternal and Child Health Bureau.

Content provided by the American Academy of Pediatrics in partnership with the Wyoming Chapter of the American Academy of Pediatrics - trauma-informed care initiative

Sobering Email Security Stats You Need To Know

Wed, 20 Mar 2024 21:40:24 GMT

Sobering Email Security Stats You Need To Know

Content brought to you by Robert McDermott - President & CEO iCoreConnect

If you’re following IT or cybersecurity news or groups on social media, it may come as no

surprise to you that email is the number one target for cyber attacks. Or perhaps you’ve been on

the receiving end of a phishing attack and, given the statistics, the odds are pretty good.

It’s also why you should be paying close attention to your email security and finding ways to limit

your risk. Education starts with understanding the threat and understanding how the security

measures you employ can help protect you, your patients, and your practice.

Obviously, as with most security plans, layering your defenses is the best move, but the first,

and most important, part of your defense is educating yourself and your staff on the threat,

potential vulnerabilities, and security measures they can and should employ beyond what’s in

place.

How to Support Neurodivergent Kids

Wed, 06 Mar 2024 21:48:36 GMT

How to Support Neurodivergent Kids: A Parents Guide to Neurodiversity

Content brought to you by Children's Hospital Colorado

If it seems like the idea of neurodiversity only recently went mainstream, that’s because it did. The term was first coined by Australian sociologist Judy Singer in 1998 to highlight one essential truth: No two human minds are exactly alike. Driven by the autism community’s self-advocacy in the early 1990s, Singer imagined a new movement where people with autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD) and other conditions could come together to advocate for their common interests.

Neurodiversity itself is not a medical diagnosis. It’s an umbrella term that encompasses a range of neurodevelopmental disabilities and other conditions that impact brain function. The term has gained widespread use as an identifier for people of all ages. According to research published in the British Medical Bulletin , approximately 15% to 20% of people globally are considered neurodiverse.

But what is neurodiversity, exactly? And how can caregivers recognize if their child is neurodivergent? Our pediatric experts share everything you need to know about neurodiversity, including tips on how to support a neurodivergent child.

What does it mean to be neurodivergent?

Put simply: “It's just saying, the way you approach things, the way you think, is different,” says Sandra Friedman, MD , an expert in developmental pediatrics at Children’s Hospital Colorado. But just because a person’s brain works differently doesn’t mean it’s “bad” or “wrong.” In fact, it’s just the opposite. Neurodiversity is a celebration of the fact that no two brains — or people — are alike.

“Neurodivergence is a form of human diversity,” says Julia Barnes, PhD , a child and adolescent psychologist at the Pediatric Mental Health Institute at Children's Hospital Colorado. “Just like there's no normal, correct or superior race, gender, ethnicity or culture, there's no one normal, right or superior type of brain.”

Neurotypical, on the other hand, broadly refers to people who are not neurodivergent. Their brain functions and behaviors are often considered the norm in our society, and as such, our environments, like schools and workplaces, tend to accommodate this group of people. That’s part of the reason that the neurodiversity movement exists — to shift perspectives about what is considered “normal.”

Instead of focusing on “dysfunctions” or “deficits,” neurodiversity encourages tapping into a person’s unique strengths to fill in the gaps and help them adapt to their environment, whether that's school, social settings or at work. Oftentimes, people who are neurodiverse need special accommodations to help them succeed. For kids in the classroom, this could mean allowing noise-canceling headphones, providing more opportunities for movement or extra time for test-taking and other changes to the classroom environment.

What conditions fall under the term “neurodiversity”?

Because neurodiversity is not a medical diagnosis, there is not one definitive list of conditions that are included under this umbrella term. Typically, individuals who identify as neurodiverse may have one or more of the following diagnoses:

Autism spectrum disorder
Attention deficit/hyperactivity disorder
Learning disabilities , such as dyslexia, dyscalculia, dysgraphia and dyspraxia
Tourette syndrome and other tic disorders
Sensory processing issues

People who have certain mental health conditions, such as bipolar disorder , obsessive-compulsive disorder and anxiety disorders, or intellectual disability such as Down syndrome might also identify as neurodiverse.

It's common for neurodivergent people to have co-occurring conditions, or more than one diagnosis. Also, Dr. Barnes says that as a child grows up and faces new challenges, it’s possible that their initial diagnosis might change, or they might receive additional diagnoses.

How can I tell if my child is neurodivergent?

Like many things in parenting, it often starts with a gut feeling. "Red flags are probably going to go up in any parent's heart when they recognize that their child isn't thriving in a way that they expected or hoped,” says Dr. Barnes. While some signs might be apparent when a child is as young as 9 to 12 months old, such as not making eye contact or responding to their name, many parents first recognize concerns in social settings when their child is in preschool or kindergarten. Is your child making friends or getting along with other kids on the playground? At home, you might notice that your child isn’t picking up on social norms, is lacking empathy or has a hard time understanding or managing their emotions.

As a child begins navigating the demands of school, a caregiver or teacher might note that they’re not performing well academically, are easily distracted, are noticeably distressed or simply acting differently than neurotypical children. “If a child is just not clicking with their environment, then I think it's totally reasonable to have them evaluated to figure out what this kiddo needs to help them thrive in school,” Barnes says.

My child has sensory processing issues. Does that mean they’re neurodivergent?

Not necessarily. Many children, but not all, who are diagnosed with autism spectrum disorder and ADHD experience some sensory difficulties. This means that they are over-responsive (hypersensitive) or under-responsive (hyposensitive) to sensory stimulation, such as bright overhead lights or loud street noises. Oftentimes, a child might be hypersensitive in one area, but hyposensitive in another. Sensory processing challenges can impact a child’s five senses — sight, hearing, touch, smell or taste — as well as their balance and coordination (vestibular), external body awareness (proprioception) and internal cues and signals (interoception).

Children with sensory processing sensitivities showcase a wide range of reactions and behaviors that can be confusing for parents. Some of these behaviors include:

Excessive movement, including running, jumping, spinning or purposely crashing into things
Hand-flapping or rocking back and forth
Covering ears or eyes to reduce external stimuli
Frequent touching or discomfort with being touched
Dislike of certain items of clothing or textures (or even tags or seams inside of clothing)
Meltdowns in response to disliked sensory stimulation

What should I do if I think my child might be neurodivergent?

Our experts always recommend starting with your child’s primary care provider. Autism and ADHD can have similar characteristics and also regularly occur together, so it is always important to bring your concerns to a trusted medical professional for discussion and evaluation.

Screening for neurodiverse conditions

If your child is still young, your provider should be regularly tracking their general development at their well-child visits through the Ages and Stages Questionnaires. If your child is between 16 and 30 months of age and you think they should be screened for autism , you can request an M-CHAT evaluation, or Modified Checklist for Autism in Toddlers. For older children, you can ask for a CAST screening, or Childhood Autism Spectrum Test.

Screenings for ADHD can vary by provider and a child’s symptoms, but often includes a combination of interviews with caregivers and teachers, reviews of school and medical records, vision and hearing screenings and observation time with the child. For more information and additional resources, check out Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) .

Make sure you come to your appointment prepared with notes about behaviors or challenges that you and other caregivers or teachers have noticed. Your provider should be able to initially evaluate your child in their office before referring you to specialists for further evaluation and discussion.

At what age are children typically diagnosed with one of these conditions?

It depends on the child and the condition. Dr. Barnes says children can be diagnosed with autism before they reach preschool, with some signs being detected by 18 months old in some children. According to the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring (ADDM) report, children are diagnosed on average at about 4 years of age. In other cases, a child might effectively adapt to their environment up to a certain point in time, until the gap between their skills and the expectations of their environment widens too far. This often happens around middle school, when the social environment becomes more complex and the schoolwork is more challenging. In general, the earlier the diagnosis is made and services begin, the better the outcomes.

Other conditions, like ADHD and learning disabilities, typically become apparent after a child starts school, although ADHD can be diagnosed in preschool. While some behaviors associated with these conditions might be noticeable at a younger age, such as hyperactivity or difficulty recognizing letters or numbers, they might initially be dismissed as developmentally appropriate. If these concerns persist, seek out an evaluation.

How can parents support their neurodivergent child?

Every child is different, so the support that one child needs might differ from what another kid needs. Dr. Friedman says it’s important for parents to work with their providers to get the right screenings and ask plenty of questions to help them understand both the diagnosis and the provider’s recommended treatments and therapies. “Parents know their children better than anyone, so they should not be reluctant to ask questions and express their concerns and opinions,” she says. While some parents feel relieved to get an official diagnosis for their child, Dr. Friedman says it can take years for others to come to terms with it. Both reactions are totally normal.

How to advocate for your neurodivergent child

It’s crucial that caregivers advocate for their child to ensure they're getting the support they need, both in healthcare and educational settings. Just because a child has a medical diagnosis of a certain condition doesn’t mean they’ll automatically receive the support they need at school. Oftentimes, a child will need to undergo additional screening at their school to be considered for an Individualized Education Plan (IEP) or 504 education plan, which allows for accommodations to help them succeed in the classroom.

Supporting your neurodivergent child at home and in school

At home, parents can support their neurodivergent child by giving them a safe space to be themselves and meeting their unique needs, whatever that might mean. Give them plenty of time to explore their interests and plan activities that suit their sensory preferences. For example, if you know your kid needs plenty of physical play, designate an area where they can run, jump, spin or wrestle without harming themselves or others. If your child has sensitivities to light or sound, consider using dimmable lightbulbs or limiting how loudly you play music or the television. In school or social settings, you might decide to send packed lunches or bring your child’s preferred foods so they feel more comfortable. You can also work with your child’s teacher to see if your child can utilize a fidget toy during class to help them concentrate or wear earplugs or headphones to reduce noise.

In general, Dr. Friedman recommends that parents not focus on a child’s unique challenges, but instead recognize their strengths. Work with your child’s care team and teachers to determine how those positive attributes can boost the areas that need further development.

What treatments and therapies are available for neurodivergent children?

Your provider’s recommended treatments and therapies will depend on your child’s unique needs. For some conditions, like ADHD, a combination of medication and behavioral therapy can improve your child’s symptoms and allow them to function more effectively . Your provider might also recommend parent training to help caregivers manage their kid’s behavior. Many children and teens with learning disabilities may benefit from additional tutoring, occupational therapy or speech-language therapy , or by accessing various resources in the classroom.

Support for children with autism

For kids with autism, treatment plans are always tailored to an individual’s specific needs and any other conditions they may have. A doctor might recommend applied behavioral analysis (ABA), occupational therapy or speech-language therapy or other treatments . Your provider might also recommend medications to ease some of the challenging behaviors associated with autism. If you’re unsure whether to add medication to your child’s care plan, Dr. Friedman recommends Autism Speaks’ Medication Decision Aid to help guide you.

Children with autism are also more likely to have other medical or mental health conditions that could require treatment, such as:

Epilepsy : One-third of people with autism have this seizure disorder.
Stomach issues: Constipation , acid reflux , bowel inflammation and abdominal pain are nearly eight times more common in children with autism.
Sleep issues: Over half of children with autism experience disrupted sleep .
ADHD: Up to 60% of people with autism have ADHD.
Anxiety: 42% of people with autism experience anxiety.

Is it OK if my child or young adult self-identifies as neurodivergent?

How a person identifies is deeply personal. As children get older, they might decide to adopt “neurodivergent” or “neurodiverse” as identifiers, or they may shy away from these terms altogether. Similarly, someone might prefer to use person-first language to identify themselves, such as “a person with autism,” while others might identify as an “autistic person” or “neurodiverse individual.” Some people may choose to adopt no labels that recognize their diagnosis. It’s also possible that the way a person identifies may change over time. That’s why Dr. Friedman recommends asking your child what their preference is and never assuming.

Research has shown that children start developing self-awareness by the age of 2 and can recognize differences in themselves and their peers by age 5. Many kids who are diagnosed with neurodevelopmental conditions already know they think or function differently.

How to talk to a neurodivergent child about their condition

When talking to your child about their diagnosis, it’s important to stay positive and highlight their unique strengths, as well as their challenges. Point out that everyone has areas where they struggle or succeed, and that by knowing more about how their brain functions, you will be able to get them the resources they need.

Remember: When a child feels secure in their self-identity, it strengthens their confidence and sense of belonging, which has a direct impact on their physical and mental health.

Brought to you by Children's Hospital Colorado.

Top Things Parents Need to Know About Measles

Wed, 28 Feb 2024 21:04:24 GMT

Top Things Parents Need to Know About Measles

Content brought to you by the Centers for Disease Control

You may be wondering what you as a parent really need to know about measles. CDC has put together a list of the most important facts about measles for parents like you.

Brought to you by the C enters for Disease Control in partnership with the Wyoming Chapter of the American Academy of Pediatrics and Project Firstline.

Physicians and nonphysicians: What are the differences?

Thu, 22 Feb 2024 01:21:34 GMT

Physicians and nonphysicians: What are the differences?

Content brought to you by the American Medical Association

hat is especially the case given the relentless efforts to expand the scope of practice for nonphysician providers—dubbed scope creep. Such legislative or regulatory changes would inappropriately permit nonphysician providers to deliver care without doctor supervision, which can increase patient safety risks and health care costs .

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians .

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

Physicians are trained to lead, and the AMA stands in strong support of physician-led health care teams. More than 90% of patients say that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency. Patients also deserve to know who is providing their health care and the education and training of their health care professional.

To help set the record straight, the AMA is publishing a series of news articles outlining the key differences between various types of physician specialists and nonphysician providers.

Physicians and nurses practitioners .
Nurse-practitioner (NP) programs generally last two to four years, however, some nurse practitioners can get their degree in as little as 18 months after becoming an RN. Online-only programs are allowed. Physicians, by contrast, must complete four years of medical school to earn a degree as an MD (a doctor of medicine) or a DO (doctor of osteopathic medicine). There are no online medical schools.
Meanwhile, nurse practitioners have no residency training requirement, whereas physicians must complete three to seven years of residency and fellowship training depending on which specialty they pursue. Nurse practitioners will tally just 500–750 patient-care hours in training. By comparison, physicians get between 12,000 and 16,000 hours of patient-care experience.
Physician assistants and physicians .
Physician assistant (PA) programs usually run about two years long, or perhaps two and a half. In addition, physician assistants have no residency-training requirement. Compare that with physicians’ training, which includes four years at a medical school—none of which are online-only—along with three to seven years of residency and fellowship training, depending on the physician specialty they pursue.
Optometrists and ophthalmologists .
All optometrists have completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (OD) degree. Some also complete an optional residency in a specific area of practice, but there is no mandatory postgraduate training in optometry.
By contrast, ophthalmologists are physicians—either medical doctors, MDs, or doctors of osteopathic medicine, DOs—whose education and training consists of pre-professional undergraduate education in a college or university, four years of medical school, four years of residency training, and about 40% of ophthalmology residents go on to do an additional one- or two-year fellowship in a subspecialty.
In addition, whereas optometrists receive about one-year in clinical rotations, ophthalmologists get more than 12,000–16,000 hours during their training.
Psychiatrists and psychologists .
Doctors of psychology and doctors of philosophy in psychology—who earn PsyD degrees and PhDs, respectively—get four to six years of graduate-level education plus a one-year internship. Moreover, psychologists complete a one-year internship while psychiatrists get between 12,000 and 16,000 hours of patient care during their four- to six-year residency program.
More important even than years of training, however, is the nature of the education these two types of health professionals get. The core issue is that, while psychologists may be well-equipped behavioral experts, their educational requirements include zero training in medicine. While psychologists provide care for emotional and behavioral issues, they are not equipped to provide the medical care psychiatrists provide.

Find out in detail why education matters to medical scope of practice , with information on:

Nurse practitioners compared with physicians.
Physician assistants compared with physicians.
Nurse anesthetists (CRNAs) compared with anesthesiologists.
Psychologists compared with psychiatrists.
Naturopaths compared with physicians.

Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.

Brought to you by the American Medical Association

Put your medicines up and away and out of sight

Wed, 14 Feb 2024 22:50:28 GMT

Keep your children safe - put medicine up and away and out of sight

Content brought to you by upandaway.org

Brought to you by upandaway.org

The ABCs of Continuous Glucose Monitoring

Thu, 08 Feb 2024 03:03:52 GMT

The ABCs of CGM: Implementing Continuous Glucose Monitoring

By Tamara Oser, M.D., and Sean Oser, M.D., M.P.H., from the AAFP Blog

Nov. 14, 2023

We were introduced to continuous glucose monitoring when it was recommended for our 8-year-old daughter a year after she had been diagnosed with type 1 diabetes. CGM gave us much more context about her health: We could now see not only when her glucose level was 130 mg/dL just before a soccer game, but also which direction it was headed — and without yanking her away from her teammates for a finger stick before kickoff. And thanks to trend arrows displayed next to her glucose levels, we could also send her to bed knowing whether she needed a snack or not, because we could see whether her glucose level was steady, rising or falling.

We quickly grew to appreciate the ways CGM transformed living with diabetes. We could also easily see how it might be helpful for our patients, too, including those with type 2 diabetes, although research at that point had focused almost entirely on type 1 diabetes.

The evidence for using CGM in type 2 diabetes has mounted since then — first for individuals on intensive insulin therapy regimens, then for people using any insulin therapy at all, and still more recently for some who don’t even take insulin.

Personal CGM became available to many more patients this past spring when Medicare expanded coverage criteria , in line with growing evidence supporting its use and updated standards of care . Now any Medicare beneficiary with diabetes whose therapy includes insulin (even basal insulin) can qualify, as can those who have problematic hypoglycemia but do not use insulin.

For many of our patients, this puts a greater understanding of their glucose patterns within easy reach. It also allows them to trade those hated finger sticks for a simple click that applies their CGM device. “That’s it?” they commonly ask, surprised about the simple application process.

For physicians and other members of the diabetes care team, CGM is like turning on a light in a dark room. We can see patterns and pictures that make it much easier to confidently make medication adjustments, compared to using finger-stick data points or fasting morning glucose readings.

Deciding Together

Whether CGM is right for a particular patient comes down to patient-clinician conversations that enable shared decision-making. Pointing out the ways it could be helpful for patient and physician alike is a great way to start, followed by answering the patient’s questions.

It’s crucial not to let your implicit biases affect which patients you have these conversations with or to make assumptions about which ones will be interested in the technology. We have seen that even patients who face insurance barriers may want to use CGM intermittently to assess medication effects or behavior changes.

Patients should know that trying CGM does not require a lifetime commitment. Vouchers and samples can allow for a short, or even a one-time, trial, and these programs may also help with insurance authorization.

Unfortunately, CGM often requires such authorization. Fortunately, we’ve gotten pretty good at getting approval by understanding Medicare’s coverage criteria, our local Medicaid coverage criteria (which differs among states and can change over time as states add or expand coverage) and knowing what information many commercial payers ask for.

For patients who have tried CGM and want to continue, we’ve found it particularly helpful during the authorization process to be able to tell the payer how their glucose patterns improved, including specific improvements in their CGM metrics. Patients who have tried CGM routinely tell us how much they have learned about the effects of different foods on their glucose levels, and about their experiences of watching changes occur in real time and how they have changed their eating habits in response. Behavior change is hard and we previously spent hours trying to help empower people. But this technology is a powerful motivator that lets us have these conversations in only a fraction of the time.

CGM has also allowed us to adjust patients’ medications more easily and confidently. Instead of trying to piece together a handful of fingerstick data points or fasting glucose readings, we now see a full picture and important patterns. It can be a powerful tool to adjust the therapeutic inertia that is known to be prevalent in primary care.

Integrating CGM Into Practice

So, how can you incorporate CGM into your practice?

First, think about where it might fit in your workflow.

You can gather patients’ CGM data by asking them to share it with you on the cloud, or by looking at it on their smartphones or devices. We like to ask patients not to make any big changes at first, but to start by observing their data and seeing what they learn. Once we have two weeks of data, we discuss the findings together in person or by telehealth.

Using CGM can also help us decrease the stigma many people with diabetes feel by allowing more opportunities to emphasize where patients are achieving their goals. It’s important not to label CGM data as good or bad, controlled or uncontrolled, because language matters.

If this sounds like a lot of work, remember we’ve found that it makes diabetes care take less work. In fact, we published research that found primary care clinicians who had prescribed CGM even once were seven times more likely to prescribe in the future. To put it simply: Try it; you’ll like it.

Billing for CGM

CPT codes 95249 (for starting a patient on a personal CGM system) and 95251 (for interpreting CGM data, which can be done as often as every 30 days for most payers) ensure you’re compensated for your work. Code 95249 may be billed only once during the time the patient owns the receiver. Codes for remote patient monitoring may also apply.

Further, CGM has been shown to improve glycemic metrics, which can increase payment for practices that use value-based payment models.

Tools for Family Physicians

If our experience with CGM has piqued your interest, you can dive deeper with AAFP resources, starting with a webpage focused on what family physicians need to know . The Academy also offers a detailed CME course (on which we served as faculty) that’s available through Dec. 21 and is set to be updated for 2024; and FPM blog posts on workflow, billing and coding and on this year’s Medicare coverage updates.

We encourage you to give CGM a try, perhaps with just one patient if you’re unsure about adopting it at the practice level. Data continues to demonstrate clinical, psychosocial and behavioral benefits of CGM, and broadening insurance coverage is making it available to more and more patients.

We have found CGM incredibly helpful in improving our patients’ understanding of their glucose levels and patterns, and in adding value to our practice.

Tamara Oser, M.D., is an associate professor in the Department of Family Medicine, founder and director of the Primary Care Diabetes Lab, and associate director of the Practice Innovation Program at the University of Colorado Anschutz Medical Campus.

Sean Oser, M.D., M.P.H., is an associate professor in the Department of Family Medicine, director of the Practice Innovation Program and associate director of the Primary Care Diabetes Lab at the University of Colorado Anschutz Medical Campus.

Governor's Mental Health Road Map

Thu, 01 Feb 2024 02:55:19 GMT

Governor Gordon Announces Roadmap to Improve Mental Health Care in Wyoming

By Michael Pearlman

Governor Gordon Announces Roadmap to Improve Mental Health Care in Wyoming

Governor of Wyoming sent this bulletin at 01/29/2024 04:18 PM MST

FOR IMMEDIATE RELEASE

January 29, 2024

CONTACT: Michael Pearlman, Communications Director

Michael.Pearlman@wyo.gov

Governor Gordon Announces Roadmap to Improve Mental Health Care in Wyoming

Priorities will build and expand on existing efforts

CHEYENNE, Wyo. – Governor Mark Gordon today announced the launch of an initiative to address Wyoming’s ongoing mental health crisis. The Governor’s “Mental Health Roadmap” takes steps to advancing systemic behavioral health reform in Wyoming, identifying five pillars that are critical to improving outcomes for those who are battling mental health issues. The strategy builds and expands upon existing programs and reflects the ongoing work of many people across Wyoming, as well as the Legislature.

The five pillars are:

Access to Care-- Ensuring residents have access to the continuum of behavioral health services.
Affordability of Care-- Ensuring cost is not a barrier to accessing services in Wyoming.
Quality of Care-- Delivering the highest quality of service based on best practices and evidence-based research.
Innovation--Constantly thinking of ways to improve our system based on new research and information.
Suicide Prevention and Anti-Stigma efforts

Each pillar has priorities and key strategies to achieve those priorities.

“The community engagement that we’ve had, including the recent mental health town halls, along with the work of the legislative and judicial branches have led us to identify our priorities and our most significant challenges,” Governor Gordon said. “We know how critical it is to Wyoming’s future to address the mental healthcare needs of our residents.”

Some of the priority strategies identified in the mental health roadmap incorporate work that is already underway. This includes the Mental Health Diversion Court Pilot Project in Campbell County; healthcare workforce development efforts through the Wyoming Innovation Partnership and Veterans Talking to Veterans .

Other strategies are included in the Governor’s budget proposal, including full funding for the Wyoming 988 suicide prevention hotline, along with the addition of text and chat services; redesign of community behavioral health services; funding for pediatric virtual mental health services; and funding for mobile crisis services to support first responders when they respond to behavioral health crises.

A copy of the Mental Health Roadmap may be found here . The complete Wyoming Behavioral Health Reform Report can be found through a link on the Governor’s Mental Health website .

-END-

Measles reported in multiple states; be prepared to take infection-control steps

Thu, 25 Jan 2024 05:12:50 GMT

Measles reported in multiple states; be prepared to take infection-control steps

Content provided by American Academy of Pediatrics

Clinicians should be prepared to identify a possible case of measles and take infection-control measures as cases have been reported in at least six states.

Measles is a highly contagious disease and can be especially dangerous in young children. Symptoms include fever, cough, runny nose and watery eyes followed by a maculopapular rash that begins on the head and face and spreads downward. The disease can result in complications like pneumonia, brain damage and deafness, and can be fatal.

Cases have been reported recently in Delaware , Georgia , New Jersey , Pennsylvania , Virginia , and Washington state . In Virginia, officials warned that a traveler with measles may have exposed people at Dulles International Airport and Ronald Reagan Washington National Airport.

Measles is transmitted through contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes, according to the Centers for Disease Control and Prevention (CDC). The virus can remain in the air for up to two hours.

The AAP and CDC have guidance on preventing the disease from spreading in health care settings when there is a known or suspected case of measles. Health care personnel should have presumptive evidence of immunity from the disease through vaccination, laboratory evidence or birth before 1957. They also should take standard and airborne precautions, including wearing a fit-tested National Institute for Occupational Safety & Health-approved N95 or higher-level respirator.

Patients with a known or suspected case of measles should be placed in an airborne infection isolation room (AIIR). If one is not available, they should be in a private room with the door closed until they can be transferred to an AIIR. Patients 2 years and older and their family should wear well-fitting masks.

Clinicians also should routinely promote respiratory hygiene and cough etiquette, appropriately manage exposed and sick health care providers and implement environmental infection control. The AAP and CDC resources below have additional details.

When a patient is suspected of having measles, the CDC recommends clinicians collect a throat or nasopharyngeal swab and a blood sample for testing and report suspected measles cases to their local and/or state health department.

Measles vaccines are highly effective at preventing illness. Children should receive their first dose of measles, mumps and rubella (MMR) vaccine between 12 and 15 months of age and a second dose between 4 and 6 years. If traveling abroad, infants ages 6 months through 11 months should have one dose of MMR, and children 12 months and older should receive two doses at least 28 days apart.

A recent CDC study found 93% of kindergartners were fully vaccinated against measles during the 2022-’23 school year, ranging from 81% in Idaho to at least 98% in Mississippi. It was the third consecutive year the vaccination rate was below the Healthy People 2030 target of 95%, and officials estimated about 250,000 kindergartners remain at risk.

Other countries also have been grappling with measles cases and inadequate vaccination rates. In the United Kingdom, health officials issued a warning last week about rising cases in some areas and said more than 3 million unvaccinated children in England are at risk. The World Health Organization’s European Region recently reported there were more than 42,000 cases in 2023, a 45-fold increase compared to 2022, and attributed the spike to decreased measles vaccine coverage during the COVID-19 pandemic.

Resources

How to Protect Kids From Tobacco Product Use and Exposure

Wed, 17 Jan 2024 18:47:47 GMT

How to Protect Kids From Tobacco Product Use and Exposure

Content provided by HealthyChildren.org

Tobacco use remains the leading preventable cause of disease and death for U.S. adults—and 90% of tobacco users began using the substance before age 18, when the body and brain are especially vulnerable to addiction. The direct and indirect harms of tobacco and nicotine use and tobacco smoke exposure are well-documented and require urgent action to protect children, who can be harmed by exposure even before birth.

That is the message of the American Academy of Pediatrics within a new policy statement, " Protecting Children and Adolescents From Tobacco and Nicotine ." Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. The tobacco policy statement, accompanied by a clinical and a technical report , marks the first update in recommendations since 2015. The articles will be published in the May 2023 Pediatrics.

"More than 16% of high school students report current use of a tobacco product, such as e-cigarettes, cigars or cigarettes—and many use more than one kind," said Brian P. Jenssen, MD, FAAP, lead author of the statement, written by the Section on Nicotine and Tobacco Prevention and Treatment and Committee on Substance Use Prevention. "There are multiple evidence-based clinical and policy approaches that pediatricians and pediatric clinicians can take to protect children, adolescents, and their families from the harms of tobacco and nicotine. Pediatricians are uniquely positioned to help them live tobacco-free lives."

Start tobacco prevention messaging early

Tobacco prevention messaging should start no later than 11 or 12 years of age, as approximately 3% to 7% of middle school students report current tobacco or nicotine product use, according to research cited. Messages that focus on how the tobacco industry deceives and tries to manipulate youth have been shown to resonate more with children and adolescents.

Prenatal exposure to tobacco has been shown to affect lung development and increases risks and severity of respiratory illness, with effects that may have consequences that last beyond childhood, according to research. Almost 40% of children ages 3-11 are regularly exposed to secondhand tobacco smoke, as well. Rates of secondhand exposure to e-cigarette aerosol have increased over the last decade.

"One of the most important things a child can do to prepare for a healthy life is not use nicotine or tobacco," said Susan Walley, MD, MHCM, FAAP, co-author of the reports. "Children from communities that have historically experienced high levels of discrimination and stigma are disproportionately affected by tobacco and nicotine use and tobacco smoke exposure. There are actionable steps pediatricians, parents, and communities can take to break this cycle and protect children and families."

The AAP calls for heightened prevention efforts, early intervention and federal regulations to reduce tobacco use and nicotine exposure in children and adolescents.

AAP public policy recommendations include:

The FDA should regulate all tobacco and nicotine products to protect public health.
Tobacco use prevention, screening, and treatment should be adequately funded and specifically designated for pediatric populations. Tobacco control research should be considered a high priority and funded accordingly from both government and private sources.
Tobacco and nicotine product prices should be increased to reduce child and adolescent tobacco use initiation.
Enforce the tobacco product sales age of 21 years.
All flavor ingredients, including menthol, should be prohibited in all tobacco and nicotine products.
All tobacco and nicotine product advertising and promotion in forms that are accessible to children and adolescents should be prohibited.
Depictions of tobacco and nicotine products in movies and other media, such as content through streaming platforms that can be viewed by children and adolescents, should be restricted.
Tobacco industry-sponsored mass-media and school-based tobacco control programs should be prohibited.

For pediatricians and clinicians, AAP recommends:

Screen all adolescents for tobacco and nicotine use as part of health supervision visits.
Include tobacco and nicotine use prevention as part of anticipatory guidance for children and adolescents.
Refer youth who want to quit using nicotine and tobacco to behavioral interventions. Given the safety profile of nicotine replacement therapy (NRT) and the well-known consequences of untreated tobacco use, it is also reasonable to recommend and prescribe NRT to adolescents with moderate or severe tobacco use disorder.
Inquire about parents' use of nicotine and tobacco. When parents quit tobacco use, they eliminate the majority of their children's secondhand smoke exposure and decrease the risk of smoking initiation among their children.
Implement systems to identify, counsel, treat, and refer caregivers who smoke or use other tobacco products. Pediatricians can also recommend and prescribe FDA approved medications, including NRT, as part of a treatment plan for parental tobacco cessation.

A technical report details the evidence base for each recommendation. One strong and consistent finding is that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes.

"Though the promotion of evidence-based clinical and policy strategies, pediatricians, pediatric clinicians, and the AAP have pushed back against tobacco companies to help children, adolescents, and their families live tobacco-free lives," Dr. Jenssen said. "Continued clinical and policy advocacy can help prevent new addiction, end the tobacco epidemic, and promote a nicotine and tobacco-free future."

More information

Published 4/11/2023 12:00 AMSource American Academy of Pediatrics (Copyright @ 2023)

Cleaning and disinfection are important in health care because they keep germs away from people and keep infections from spreading.

Thu, 11 Jan 2024 06:45:08 GMT

Cleaning and disinfection are important in health care because they keep germs away from people and keep infections from spreading.

Content provided by Centers for Disease Control

Cleaning and disinfection are important in health care because they keep germs away from people and keep infections from spreading.

Cleaning vs. Disinfecting – What’s the Difference?

Cleaning removes the visible dirt, dust, spills, smears, and grime, as well as some germs, from surfaces. This is accomplished by washing the surface using a cleaning product and water. Cleaning products include liquid soap, enzymatic cleaners, and detergents. High-touch surfaces should be cleaned regularly. Some examples of high-touch surfaces include tables, door handles, and keyboards.

Disinfecting kills germs on surfaces or objects. This is accomplished by cleaning an area with soap, water, or any additional detergent; then using an EPA-registered household disinfectant. Disinfectants are only for disinfecting after cleaning and are not substitutes for cleaning unless they are a combined detergent-disinfectant product. For effective use of the disinfecting product, follow the instructions on the label.

PPE should be worn while cleaning or disinfecting, such as wearing disposable gloves. Additional personal protective equipment might be required based on the cleaning/disinfectant products being used and whether there is a risk of splash.

Please note, these checklists are intended to be samples.

Cleaning Procedure Summaries for Spills of Blood or Body Fluids

1. Wear appropriate PPE
2. Confine the spill and wipe it up immediately with absorbent

(paper) towels, cloths, or absorbent granules (if available) that are spread over the spill to solidify the blood or body fluid (all should then be disposed as infectious waste).

3. Clean (neutral detergent and water)
4. Disinfect using a facility-approved intermediate-level disinfectant. 5. Immediately clean/disinfect all reusable supplies and equipment

(e.g., cleaning cloths, mops) after the spill is cleaned up.

To learn more about healthcare environmental infection prevention and control, visit cdc.gov/hai/prevent/environment

To learn more about disinfection and sterilization, visit cdc.gov/infectioncontrol/guidelines/disinfection

Support for Ukraine Wyoming doctors find a way to help kids in a country at war

Thu, 04 Jan 2024 06:01:04 GMT

Support for Ukraine: Wyoming doctors find a way to help kids in a country at war

As published in Wyoming Medicine Fall 2023 - by Rachel Girt

Click here to view the article PDF.

Get To Know Wyoming 211

Sat, 30 Dec 2023 06:12:14 GMT

Get To Know Wyoming 211

Content provided by Wyoming 211

Help Starts at Wyoming 211

Serving 100% of Wyoming’s population, Wyoming 211 connects people with community, health and disaster services through a free phone service and searchable online database. Using the power of technology and innovation, we connect people to the help they need. Learn more about our services below.

About 211

Wyoming 211 provides every person in communities across the state with a place to turn when they need answers to life’s challenges, big or small. 211 is a free, anonymous, helpline offering listening support, information and referral.

Our professional, trained staff connects people in need with nearly 2,800 programs and services that are available to help them. Bilingual staff and telephone interpreter services make sure that callers can talk with us in the language of their choice.

When Is Wyoming 211 Available?

211 is available Monday – Thursday 8AM to 6PM, and Friday 8AM to 5PM. Callers outside standard business hours will receive a follow-up call the next business day.

Service is available statewide by dialing 211 or 888-425- 7138 during normal business hours and online anytime at wyoming211.org .

Rodeo Medicine: Even the toughest cowboys need doctors

Sat, 16 Dec 2023 04:45:14 GMT

Rodeo Medicine: Even the toughest cowboys need doctors

As published in Wyoming Medicine Fall 2023 - by Whitney Harmon

Click here to view the article PDF.

Handwashing in Communities: Clean Hands Save Lives

Fri, 01 Dec 2023 05:30:12 GMT

Handwashing: A Family Activity

Content provided by Centers for Disease Control

Handwashing can prevent 1 in 3 diarrhea-related sicknesses and 1 in 5 respiratory infections, such as a cold or the flu.

Handwashing is an easy, cheap, and effective way to prevent the spread of germs and keep kids and adults healthy. When your family is healthy, you don’t have to worry about missing school, work, or other activities.

Help your child develop handwashing skills

Parents and caretakers play an important role in teaching children to wash their hands. Handwashing can become a lifelong healthy habit if you start teaching it at an early age. Teach kids the five easy steps for handwashing —wet, lather, scrub, rinse and dry—and the key times to wash hands, such as after using the bathroom or before eating. You can find ways to make it fun, like making up your own handwashing song or turning it into a game.

Give frequent reminders

Building handwashing skills takes time. At first, your child will need regular reminders of how and when to wash hands. It is especially important to remind children to wash their hands after using the bathroom, before eating, after touching pets, after playing outside, and after coughing, sneezing, or blowing their nose. But once handwashing becomes a habit and a regular part of your child’s day, they will practice it throughout their lives.

Lead by example by washing your hands

Young children learn by imitating the behaviors of adults in their lives. When you make handwashing part of your routine, you’re setting an example for your children to follow.

What if soap and water aren’t available?

Washing hands with soap and water is the best way to get rid of germs. If soap and water are not available, use an alcohol-based hand sanitizer that has at least 60% alcohol, and wash your hands with soap and water as soon as you can.

Baby Wipes

Baby wipes may make your hands look clean, but they’re not designed to remove germs from your hands. CDC recommends washing hands with soap and water when possible.

Remember to make handwashing a healthy habit at home, school, and at play!

Important Oversight or Delay Tactics? Doctors push back against prior authorization complications

Sat, 18 Nov 2023 03:43:09 GMT

Important Oversight or Delay Tactics? Doctors push back against prior authorization complications

As published in Wyoming Medicine Fall 2023 - by Elizabeth Sampson

Click here to view the article PDF.

Parenting After Trauma: Understanding Your Child's Needs

Wed, 01 Nov 2023 03:17:44 GMT

Parenting After Trauma: Understanding Your Child's Needs

Content provided by Healthychildren.org

Parenting After Trauma: Understanding Your Child's Needs

All children need homes that are safe and full of love. This is especially true for children who have experienced severe trauma. Early, hurtful experiences can cause children to see the world differently and react in different ways. Some children who have been adopted or placed into foster care need help to cope with what happened to them in the past. Knowing what experts say about early trauma can help you work with your child.

Forms of trauma

An event is traumatic when it threatens the child or someone the child depends on for safety and love. Abuse may be traumatic, but trauma may take many forms. It includes:

Neglect
Separations
Violence between caregivers
Natural disasters
Accidents

The body's fight or flight response

A frightened child may feel out-of-control and helpless. When this happens, the body's protective reflexes set off a “fight or flight" panic response that can make a child's heart pound, blood pressure rise and lead to emotional outbursts or aggressive behavior.

Some children are more sensitive than others. What is traumatic for one child may not be seen as traumatic for another child. Fear responses are based on a child's sense of what is frightening. It might be hardest for children who are neglected, even if they don't have signs of physical injury like bruises. These children worry about having their basic needs met, like food, love, or safety.

Trauma has more severe effects when...

it happens again and again.
different stresses add up.
it happens to a younger child.
the child has fewer social supports (healthy personal relationships).
the child has fewer coping skills (language skills, intelligence, good health, and self-esteem).

How the brain reacts to trauma

When something scary happens, the brain makes sure you do not forget it. Traumatic events are remembered by the body, not just through memories. Traumas are experienced as a pattern of sensations with sounds, smells, and feelings mixed together. They can rush into the present without a child realizing they are experiencing a memory, and they can be remembered that way, too. Any one of these things can make a child feel like the whole event is happening again. These reminders or sensations are called "triggers."

Triggers

Triggers can be smells or sounds. They can be places, postures, or tones of voice. Even emotions can be a trigger. For example, being anxious about school may be related to being anxious about violence at home. This can cause dramatic and unexpected behaviors like physical aggression or withdrawal. Triggers can be hard to identify, even for a child. If a child knows what a trigger is, the child will try hard to avoid it.

Remembering a traumatic event can cause some of the original fight-or-flight reaction to return. This might look like a “ tantrum " or overreaction. Sometimes anxiety can cause a child to “freeze" or blankly stare as if they are in their own world. This may look like defiance or “zoning out." A child who sees the world as a place full of danger may do this. Many children who have been abused or neglected go through life always on edge, and have difficulty maintaining control of their emotions because their body is ready to freeze, flee or run away from what frightens them, or to fight in self-defense.

Associated disorders

Being ready to flee or fight shows up in many ways. Children who are always on guard may have trouble concentrating. This is called “hyperarousal" or “hypervigilance." These effects of past trauma can be easily confused with hyperactivity and inattention, classic signs of attention deficit hyperactivity disorder (ADHD), and children may incorrectly receive this diagnosis if caregivers and doctors do not realize the effects of trauma on development.

Children who have experienced trauma may also be overwhelmed with emotions and have trouble with the unexpected. Their need for control may be seen as “manipulative" or as always wanting things done their way. Going from one activity to another may be hard. When these aggressive responses are extreme and trauma reactions are not considered, it can be labeled "oppositional defiant disorder" or "intermittent explosive disorder." These terms do not recognize that a child's reactions might have been appropriate at the time they experienced a trauma, though they may be no longer appropriate now.

What foster and adoptive parents can do to help

Children who have been adopted or are in foster care have often suffered trauma. They may see and respond to threats that others do not, and their brains may always be “on guard." Many children have never learned to depend on consistent, reliable adults, and usual parenting practices may not work. It can be hard to remember that these emotions may happen with you, but are not about you. These strong feelings are in response to the traumas that happened before. Some helpful tips:

Strategies that can help you and your child adjust to trauma's effects

Learn to notice and avoid (or lessen) “triggers." Find out what distracts or makes your child anxious. Work to lessen these things.
Set up routines for your child (for the day, for meals, for bedtime) so they know what to expect.
Give your child a sense of control through simple choices. Respect your child's decisions.
Do not take your child's behaviors personally.
Try to stay calm. Find ways to respond to outbursts that do not make things worse. Lower your voice. Do not yell or show aggression. Do not stare or look directly at your child for too long. Some children see this as a threat.
Remain available and responsive when your child keeps you at a distance.
Avoid discipline that uses physical punishment . For a child who was abused, this may cause panic and out-of-control behavior.
Let your child feel the way they feel. Teach your child words to describe their feelings when they are calm, words they can use when they get upset. Show acceptable ways for them to deal with feelings. Then, praise them for expressing their feelings or calming down.
Be consistent, predictable, caring, and patient. Over time, this shows your child that others can be trusted to stay with them and help them. It may have taken years of trauma or abuse to get the child in their current state of mind. Learning to trust again is not likely to happen overnight—or anytime soon.
Ask for help whenever you have concerns, questions, or are struggling. There are proven therapies to help children and parents adjust to the effects of trauma. Pediatricians, developmental specialists, and therapists can suggest ideas why your child reacts certain ways, and effective responses. Sometimes medications, used appropriately, will help to manage symptoms and make learning new ways possible.

Learning to trust after trauma

All newborn babies are helpless and dependent. Consistent and loving caregivers help babies learn to trust others, and to feel valuable and worthy of love. This is important for healthy development. We cannot thrive without the help of others. This is most true when times are hard.

Supportive, caring adults can help a child recover from traumatic experiences. Some children may not have had adults help them before, and may not know that adults can help or that they can be trusted. They may resist the help of others. Not trusting adults can be mistaken as disrespect for authority. This can cause problems at home and school. It can also make learning harder.

It can be hard to tell who is affected by trauma. Mistreated children may withdraw from people and seem shy and fearful. They may also be very friendly with everyone they meet. They may cross personal boundaries and put themselves at risk for more abuse. They are choosing between “trust no one" and “trust everybody, but not very much."

Remember

Children are remarkedly resilient and do the best they can with what they have been given. It is our job to provide them with the tools they need and to guide them as they grow. It may be a slow process with many setbacks, but the rewards are worth the effort. By understanding that your child's past experiences have affected the way they see and responds to their world, you have taken the first steps to building a safer, healthier world for you child.

More information

Last Updated 11/23/2020

A Higher Power Physician obligations to report another physician’s conduct under Wyoming law

Fri, 13 Oct 2023 23:52:59 GMT

A Higher Power: Physician obligations to report another physician's conduct under Wyoming law

As published in Wyoming Medicine Fall 2023

Click here to view the article PDF.

Safe and Sound: Helping Children Who Have Experienced Trauma and Adversity

Sun, 01 Oct 2023 03:00:43 GMT

Safe and Sound: Helping Children Who Have Experienced Trauma and Adversity

Content provided by American Academy of Pediatrics

Created with support from the Dave Thomas Foundation for Adoption and Jockey Being Family, this series of resources is designed to help children who have experienced trauma and adversity, by helping their parents, caregivers, and other adults in their lives understand how that early trauma may have affected them. Each guide can be downloaded and shared to provide ideas for how to help children, and links to additional information and resources.

A Guide for Parents

Parents are encouraged to read this guide first to get acclimated to the various resources within this series. This first guide explains how trauma can affect a child’s development and behavior, and offers practical strategies for trauma-informed parenting that promote healing and make a family’s day-to-day life less stressful.

Important Information to Share With My Child’s Pediatrician

Parents can complete, print, and share this form with their child’s pediatrician. It is important that their child’s pediatrician be aware of the child’s past experiences, so that they can understand any current struggles in light of those past traumas. This will allow the child’s parents and pediatrician to work together to find resources that can support the family in caring for the child, as well as obtain evidence-based treatments for the child.

A Guide for Adults Involved in My Child's Life

Parents can share this 1-page guide with other adults involved in their child’s life. This may include coaches, dance teachers, parents of the child’s friends, etc. It can be helpful for these other adults to understand why a child might have certain fears or behavioral struggles, and understand helpful and unhelpful ways to respond. These adults can learn more and become allies for the child.

A Guide for Caseworkers

This guide is specifically designed to help child welfare workers better understand the effects of early adversity and trauma on the children and youth they serve. When caseworkers better understand the emotional, developmental, and behavioral needs of the children and youth they serve, they are better equipped to help the caregivers and other adults in the lives of those children and youth understand and meet those needs. This guide can also be used for training and professional development.

A Guide for Early Education and Child Care Providers

Parents can share this resource with their child’s early education and child care providers. Like the other guides, this guide explains how early adversity and trauma can affect young children and offers early education and child care providers specific ways they can help children heal. This guide can also be used for training and professional development.

A Guide for Teachers, Counselors, and Other School Professionals Working With School-Age Children and Youth

Parents can share this resource with their child’s school and teachers. Like the other guides, this guide explains how early adversity and trauma can affect children and youth, and offers educators specific ways they can promote healing. This guide can also be used for training and professional development.

Talk with your child's pediatrician for more parenting tips on helping your child cope after trauma.

Last Updated 07/21/2021

Source American Academy of Pediatrics

Not Just Politics: Wyoming Medical Society offers members connections and support

Fri, 15 Sep 2023 21:14:55 GMT

Not Just Politics: Wyoming Medical Society offers members connections and support

As published in Wyoming Medicine Fall 2023

Click here to view the article PDF.

Five Key Concerns of Medical Professionals Post-Roe

Thu, 31 Aug 2023 19:34:51 GMT

Five Key Concerns of Medical Professionals Post-Roe

Content provided by The Doctors Company

Jackson , which overturned Roe v. Wade , state restrictions are colliding with clinical judgment in ways unfamiliar to

many medical professionals. Physicians and other healthcare providers are facing confusion and concern about how recent legal shifts affect them and their patients.

In this volatile legal landscape, The Doctors Company has gathered experts to present frontline clinician perspectives and to discuss approaches to medical providers’ shared dilemmas. During a recent discussion with three prominent OB/GYNs about the pressure that the Dobbs decision has placed on clinicians, five top concerns emerged:

1. Telemedicine, Patient Access, and Legal Issues

Daniel Grossman, MD, of the University of California, San Francisco, proposes that in states where prescribing for medication abortions via telemedicine has become a standard of care, offering telemedicine appointments to the appropriate patients could increase clinic capacity to serve patients who must travel for care. Sheila Dejbakhsh, MD, MPH, speaking from Orange Coast Women’s Medical Group in Southern California, made a similar point, noting that offering telemedicine pre-procedure and post-procedure consultations for some patients helps those patients minimize time away from work and family.

2. Healthcare Access Inequities

Increasingly, patients who travel for care must cover enormous distances. A patient in Houston, Texas, who needs access to a first-trimester abortion is now looking at a 700-mile drive, roughly nine-and-a-half hours each way, to Wichita, Kansas, as their closest care option. If that clinic is booked, then the next-closest option is 800-plus miles away. These vast distances impose cost and time burdens, the brunt of which will be borne by patients who are already economically struggling. Though we sometimes turn to telehealth to overcome physical distance, Ghazaleh Moayedi, DO, MPH, speaking from Pegasus Health Justice Center in Texas, points out that even when telehealth is an appropriate option, it may be the most marginalized patients who have least access to it.

3. A Critical Shortage of Training Venues

“I work at a training institution,” Dr. Grossman says, “and I’m really concerned about, particularly, the OB/GYN residents, for whom abortion training is mandatory.” However, training venues are in increasingly short supply, and are wildly insufficient for OB/GYN trainees already. Soon, it may be that only roughly half of OB/GYN residents have access to this required training.

4. Emergencies and the Risks of Delayed Care

All healthcare providers know that, as Dr. Moayedi says, “Nobody’s body read the textbook.” There is no standard medical definition of “emergency.” Yet laws restricting abortion access may not reflect this complex reality, and can seem to expect people’s bodies to follow a simple course.

5. Finding the Physician Voice

All panelists recognized that clinicians are generally snowed under by their daily work with patients. Still, during this high-stakes period, as organizational conversations unfold at institutions around the country, Dr. Dejbakhsh says, “It is very important that we take a more active role in stepping up.” Along those lines, Dr. Moayedi emphasizes the clinical expertise that physicians bring to institutional planning.

Gender-Affirming Care: Providers and advocates navigate the needs of a small community

Fri, 18 Aug 2023 19:21:10 GMT

Gender-Affirming Care: Providers and advocates navigate the needs of a small community

Originally published in Wyoming Medicine Spring 2023

In January and February, physicians, psychologists, and advocates appeared at the Capitol to testify about two bills that sought to limit gender-affirming care for people under the age of 18 in the state. While Senate File 111, Child abuse– change of sex, and Senate File 144, Chloe's law– children gender change prohibition, both failed to become law, the topic reflected confusion, fear, and anxiety among those on all sides of the issue.

Legislators sponsoring the bills sought to control what they worried would harm children, and physicians were fearful they would face criminal charges for their work to provide the best care possible for their patients. Mental health professionals were anxious about the potential harm to transgender children who watched, listened, or read about the legislative action. The Wyoming Medical Society had opposed both bills as they stood.

Identifying as a different gender

Transgender is an adjective describing people whose gender identification does not match the sex they were assigned at

birth. A transgender man is someone who was assigned female at birth but now identifies and lives as a man. A transgender woman is someone who was assigned male at birth but identifies and lives as a woman. Nonbinary people identify as a gender that’s not exclusively male or female. Together, lesbian, gay, bisexual, transgender, and queer and/or questioning, plus other sexual and gender minorities are commonly known as LGBTQ+.

A 2021 Pew research study found that 20% of Americans say they know someone who identifies as transgender.1 A 2022 UCLA Williams Institute research study2 found that nationally, 1.4% of youth ages 13-17, and 0.6% of adults age 18 and older, identify as transgender. The same study estimates that 0.6% of youth ages 13-17 in Wyoming identify as transgender.

“Before about 10 years ago it would be pretty rare. Now it’s routine,” said Wyoming Behavioral Institute Medical Director Stephen Brown, MD, who specializes in child and adolescent psychiatry. He is also a member of the Wyoming Medical Society board. Dr. Brown has practiced psychiatry in Wyoming for 33 years. He said he isn’t sure why he is seeing more cases of patients identifying as a different gender, but it may be that it’s more acceptable socially. He is still concerned for them.

“A lot of these kids are under immense pressure. The adults don’t understand.” Dr. Brown said that it’s not just bullying at school; many adults haven’t met a transgender person before and have trouble with the concept.

The needs of children and adolescents struggling with mental health issues have changed over time in concert with shifts in the environment in which they live. Dr. Brown is seeing more patients identifying as a different gender, and Wyoming Behavioral Institute has added an LGBTQ+ group as part of its residential treatment model to give patients a safe place to talk about their feelings. Dr. Brown offers clinical rotations for family practice residents and physician assistant students to observe and understand the issues today’s youth are facing. He advises his students to treat people as they are, where they are. “It is important to recognize that trauma may result from rejection, particularly when adult decision-makers in children’s lives are unable to accept them,” he said.

Mental health

Mental health is a common topic of discussion among caregivers of transgender children. They may suffer from depression, eating disorders, and be at elevated risk for suicide.

Caroline Kirsch, DO, associate program director and director of Osteopathic Education at the University of Wyoming Family Medicine Residency Program in Casper, cited statistics from the 2022 Trevor Project National Survey.3 The survey found that nearly one in five transgender and nonbinary people ages 13-24 had attempted suicide during the past year. Of all surveyed LGBTQ+ teens aged 13-17, 18% had attempted suicide, and 50% had considered suicide. This is all higher than the national averages.

“Research shows this is a result of trauma from social stigma,” Dr. Kirsch said, citing findings by the Trevor Project survey. She noted that transgender people weren’t experiencing trauma just because they felt uncomfortable in their body, they were also experiencing trauma because of the way they were treated by others.

The Trevor Project survey identified three support categories that decrease suicide risk for transgender people; 1) social support from family, which cut the attempted suicide reporting in the group to less than half, 2) gender accepting schools, and 3) community support. "Each step of support adds another level of affirmation for that person," Dr. Kirsch said.

“I think the mental health part is important for skills to cope with the trauma that comes from being stigmatized,” Dr. Kirsch said. “How do you navigate in a society that’s not accepting?”

What is gender-affirming care?

Gender-affirming care can be a number of actions that support a person’s gender identity. This can be social affirmation, such as addressing a person by the name and pronouns they prefer. It can be supporting a child who dresses and acts in the manner of the gender they prefer. It can be mental health care and counseling in a way that addresses and acknowledges the person as they want to be seen.

Beyond mental healthcare, gender-affirming care might be the use of puberty blockers to slow down puberty for a child who experiences genuine and long-held distress related to gender, which can be reversed. In some cases, which are overwhelmingly for adults, it can also be hormonal or surgical intervention.

Core curriculum

“It’s something that I never dealt with growing up, the medical school never talked about it. I’m sure they’re talking about it a whole lot now in medical school,” Dr. Brown said.

Gender identity is now part of the core curriculum in Wyoming’s medical school. Doctors who earn their MD through the Wyoming, Washington, Alaska, Montana, and Idaho (WWAMI) medical school program can also take an LGBTQ+ pathway. The LGBTQ+ pathway is one of six pathways the school offers for students who would like to help underserved populations. Other available pathways are: Indian Health, Global Health, Latinx, Black Health Justice, and Underserved.

“WWAMI first years [medical students] learn to provide an affirming environment for LGBTQ+ patients, because it’s something that providers are starting to see,” Dr. Kirsch said. “They are entering clinical rotations understanding how to approach LGBTQ+ patients in a positive, affirming way.”

“I’m of the belief that everyone needs the very best healthcare they can get. This is one space. So many groups need better health and better access,” Dr. Kirsch said.

Healthcare access

Wyoming Equality, a nonprofit dedicated to improving the lives of LGBTQ+ people, is working on resources at a local level. “It’s really interesting what good data can do,” said Sara Burlingame, executive director of Wyoming Equality. Two years ago, the nonprofit asked the LGBTQ+ community to share feedback to help inform its policy. Burlingame expected the community to say they needed help with acceptance and hate crimes. Instead they identified healthcare needs.

“Folks were going out of state. Healthcare providers didn’t know what was needed. It was a much more complex issue

than we anticipated,” Burlingame said.

The Wyoming Equality Healthcare Access Project, or WEHAP, committee formed, and made a plan to help the LGBTQ+ community access healthcare.

Wyoming Equality Healthcare Organizer Kota Babcock is one of two Wyoming Equality employees assigned to WEHAP. Babcock said that first, WEHAP identified two main barriers to healthcare access for LGBTQ+ people: 1) access to affordable healthcare, and 2) access to supportive providers. Then they began finding solutions.

WEHAP has compiled a list of almost 50 supportive providers in Wyoming, from primary care physicians to naturopaths. Babcock is working to add affordable payment options, including for those without insurance, to the list. Patients are able to reach out to Wyoming Equality for this information, but it’s kept from public view after a provider in Colorado received threats.

To create the list, Wyoming Equality representatives meet with providers for a one-on-one session. “We’re really open to what that person has to say about LGBTQ issues,” Babcock said. “We are not abandoning people for being behind on the information. We want to be properly cared for, and we want doctors to be able to ask questions. We are looking for people who are open to learning, who are showing dedication and interest in caring for patients. We are a small community and want as many allies as we can find.”

Dr. Kirsch also wants both patients and providers to feel comfortable. “The whole idea is that we have a place where people can get healthcare, not be turned away—which has happened—or laughed at,” she said. “I think some providers are afraid and don’t want to do anything. Most of us are here because we want to provide healthcare, if you don’t know what to do, you freeze.”

“Honestly, caring for most human beings is the same,” Dr. Kirsch said. “If it’s an upper respiratory infection, gender doesn’t matter.”

How would Dr. Brown recommend providers understand gender identity when caring for patients? “You can emphasize the desire–of people being happy. They need compassionate support,” he said. “The political environment complicates their world. It’s just this: how do you get good care to people who identify as a different gender?”

Wyoming Equality Executive Director Sara Burlingame would like providers to know that her organization would like to have a dialogue, even when it’s difficult to know where to start.

“We could have a better conversation here in Wyoming. We’ll meet you where you are,” she said.

Resources

If a provider is looking for more information, Dr. Kirsch recommends reading publications from sources such
as the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the Fenway Institute.

Resources accessed for this article include:

American Association of Pediatrics (AAP) policy statement. “Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents.” Pediatrics, October 2018.
AAP publication. “Developing Parenting Guidelines to Support Transgender and Gender Diverse Children's Well-being.” Pediatrics, September 2022.
AAP’s HealthyChildren.org website, offering plain language guidance for parents of transgender youth.
American Medical Association (AMA) Education Hub, lgbtqiahealtheducation.org.
The Endocrine Society. “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons:
An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism, November 2017.
San Francisco State University’s Family Acceptance Project.
Wyoming Equality Healthcare Access Project (WEHAP), wyomingequality.org.
World Professional Association for Transgender Health (WPATH), “Standards of care for the health of transgender and gender diverse people, version 8.” Int J Transgend Health. 2022, wpath .org.

1 Minkin, R., Brown, A. “Rising shares of U.S. adults know someone who is transgender or goes by gender-neutral pronouns.” Pew Research Center, 2021, pewresearch.org.

2 Herman, J.L., Flores, A.R., O’Neill, K.K. “How Many Adults and Youth Identify as Transgender in the United States?” The Williams Institute, UCLA School of Law, 2022, williamsinstitute.law. ucla.edu.

3 “2022 National Survey on LGBTQ Youth Mental Health,” 2022, thetrevorproject.org.

Childhood Trauma: 3 Ways to Help Kids Cope

Mon, 31 Jul 2023 18:51:49 GMT

Childhood Trauma: 3 Ways to Help Kids Cope

Content provided by Healthychildren.org

There are many important ways parents and caregivers can help children who have had traumatic experiences. Some of the most important ones are helping them to feel safe, learn healthy routines, identify and manage their emotions and behavior, and build resilience .

To help your child cope after troubling events, it helps to remember the 3 Rs: reassure, return to routine, and regulate .

1. Reassure

Remind your child that they are safe and loved.

Use words and touch (high fives, for example, or hugs if appropriate), and extra one-on-one time.
Reflect with the child and let them know that it's OK to feel what they're feeling. Try to see the world through their eyes.
Create safe spaces in the home. Let them make a tent in their bedroom or designate a "safe chair" just for them.

2. Return to routine

Try to maintain regular daily routines. These can promote a sense of safety and normalcy for your child and let them know what to expect.

Keep dependable routines for meals, bedtime , and time for homework or chores. Depending on age, creating visual schedules and prompts can help. Try to build in time for relaxing activities, such as family walks.
Explain any changes in the schedule ahead of time. Consider having special routines before and after schedule changes, such as reading the same story, playing the same game, or eating the same meal.

3. Regulate

Help your child learn " self-regulation " skills to calm themselves and manage their emotions and behaviors.

Consider relaxation techniques such as belly breathing, stretching, and yoga poses, and tensing and releasing muscles.
In times of calm, play feeling charades—acting out being hungry, proud, or disappointed, for example.
Talk about where in the body your child feels the emotion, such as the chest, stomach or head. Name different feelings with different colors.
Practice skills to use when they get upset or angry, such as deep breathing, seeking an adult, or taking a break for active play or exercise.

Helping your child heal from trauma

It may take your child time to learn to identify and manage feelings after a scary or upsetting event. When your child is having a hard time or strong reactions, try to talk with them at eye level. Stay calm and speak in a relaxed tone. Stay close until your child is calmer and able to connect. Remember not to take their actions personally.

Talk with your child's pediatrician for more parenting tips on helping your child cope after trauma.

Last Updated 6/2/2023

Wyoming Medical Society Mission: Advocating for doctors and their patients since 1903

Fri, 16 Jun 2023 19:06:05 GMT

Wyoming Medical Society Mission: Advocating for doctors and their patients since 1903

Originally published in Wyoming Medicine Spring 2023

Support. Oppose. Neutral.

These are the available single- Simple, right? These are the available single-word responses to any piece of legislation or policy that

comes across our board table. Simple, right? Actually, quite the dramatic opposite. The process is complex and nuanced. As one side perceives it: we didn’t fight hard enough, we gave up, we lost. And on the other side: the same. With any bill, and in particular for those with very strong convictions on either side, a single-word response has limited meaning, and should be taken in context of the entirety of a bill, including its intent, the precedent it may set, and potential ramifications. These responses cannot, and should not, be taken as an absolute decree. Indeed, many pieces of legislation in the past five years have had damning consequences for patients, physicians, and medical practice, beyond their purported intent. It is this uphill battle that we fight constantly at the Wyoming Medical Society.

So how do we ultimately get to one of those one-word responses on any given piece of legislation? The Wyoming Medical Society board of trustees meets quarterly, either in person, or via teleconference. In addition to the business of the society, including the budget and other matters, we discuss legislative policy. Our executive director compiles a list of all medically relevant topics for discussion, including upcoming proposed legislation, requests from various legislators and organizations, and topics brought forth by board members, society members, and others. The board then discusses the topics, develops an action plan, and renders a stance by board vote with a simple majority as directed by our bylaws, which are governed by state statute. The information is then presented to society members via regular email updates and through their county or regional society representative. Any member is allowed to attend any board meeting.

The Wyoming Medical Society is a political advocacy organization, whose mission is, as stated above, “Advocating for doctors and their patients since 1903.” Political advocacy is messy. Ideology often butts heads with pragmatism. We must not let fervent ideology control the conversation, lest we wish to lose more control of our profession. Plainly spoken, we must play the game. This means give and take. In pragmatic terms, this looks like supporting a bill we don’t like if certain legislators agree to take out the really bad stuff, or if they support us on another bill. If we go hardline in any direction, we risk a worse version of a given bill, or losing support entirely on future legislation.

Society members have a number of ways in which they can influence WMS policy and positions. This includes communication through their county trustee who holds voting power on the board, appealing decisions of the board as outlined in our bylaws, and using The Wire, our new member engagement tool designed specifically for members to communicate anything of importance to all society members.

Because many of the topics as of late have fervent supporters on either side, within and outside of medicine, we must work with our mission ever in the forefront. With our mission as a beacon, our advocacy work for medicine in Wyoming is centered on a few tenets.

These are as follows:

We oppose any legislation that seeks to criminalize physicians, PAs, or the practice of medicine. We believe that the tort system effectively and appropriately punishes providers in cases of negligence.
We believe the legislature has NO business dictating the practice of medicine. Indeed, there have been various members of the legislature in the past five years who have made this assertion, claiming to not have enough expertise to legislate the practice of medicine (e.g., optometry scope of practice expansion).
We believe in physician, PA, and medical practice autonomy (see below).
Our advocacy work is, and should be, nonpartisan.
Our advocacy work should not be bounded by our own personal beliefs.

Regarding evidence-based medicine, the Wyoming Medical Society does not set medical guidelines, direct the practice of medicine, or otherwise tell physicians or PAs how to practice. We believe strongly in physician autonomy, individually and as a profession. There is a great breadth of medicine across all specialties. Even within a given specialty, practices vary greatly. We believe physicians are, and should be, stewards of evidence-based medicine, with flexibility to adjust practice based on the available evidence. Again, we do not believe the legislature is capable of deciphering what is, or is not, good evidence, and therefore should not be legislating based on their perceptions of such evidence.

Our own personal beliefs are important, but should not be taken as a referendum for the whole of medicine. We all took variations of the Hippocratic Oath when we became physicians. Among many very important details, a personal or political guide to our profession is not included. The oath is people- centric, including both individuals and populations. Similarly, the American Medical Association Code of Ethics contains many virtuous principles. Among others, it advocates that we “regard responsibility to the patient as paramount,” and allows physicians freedom “to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” But this does not give that same physician allowance to limit care for an individual or a population. I mention these principles not to diminish anyone’s personal beliefs, but as a reminder of how we conduct ourselves professionally, and in advocacy work, the mission of which is to support physicians and their patients. Though difficult at times, WMS policy decisions should be based on how they will impact physician and PA medical practice and the physician/patient relationship,and not partisan politics or personal beliefs.

For 120 years the WMS board and staff have been proudly and vigorously fighting every day for each of you, our patients, and our profession. Each position will certainly not be agreeable to every member, though I am confident that regardless of any divergent beliefs, we still have common interests in a profession that is far bigger than any one of us.

Saddle Up and Get Screened

Wed, 31 May 2023 22:45:25 GMT

Cancer screening is cancer prevention

Cancer is the second leading cause of death in Wyoming. It’s simple: cancer screening is cancer prevention.

Don’t be all hat and no health. Catch cancer before symptoms even begin by getting regular screenings.

Screenings help detect cancers at an early stage, significantly improving survival. Be your own advocate for your health and ask your healthcare provider if you are due for any cancer screenings.

It only takes a minute to ask and could add years to your life. Wyomingites can get cancer screenings at no charge with or without insurance with the resources provided on this page.

Don’t let the sun go down on the things you should’ve done. Schedule that appointment! Learn about cancer screenings and find local Wyoming resources all in one place.

Article source: https://cancerscreeningwy.org

THE SHIELD BECOMES A SWORD - WYOMING’S CONSTITUTIONAL RIGHT TO MAKE HEALTHCARE DECISIONS

Fri, 12 May 2023 18:32:27 GMT

The Shield Becomes a Sword - Wyoming’s constitutional right to make healthcare decisions

Originally published in Wyoming Medicine Spring 2023

In 2010, a debate about the proper role of government in invalidate the “trigger ban” on abortion; in 2023, against the healthcare roiled the country, as Democrats sought to pass the Patient Protection and Affordable Care Act–popularly known as the ACA or Obamacare–federal legislation they claimed would provide greater access to healthcare. Federal and state-level Republicans claimed the ACA would limit patient choice in both healthcare services and in how to payfor those services. The ACA passed, and several years later, in 2012, Wyoming’s Republican-led Legislature proposed a constitutional amendment to shield its citizens’ ability to make their own healthcare decisions, subject to reasonable restrictions, which Wyoming’s voters approved–Article I,section 38 of the Wyoming Constitution.

In 2023, Wyoming’s Republican-led Legislature finds section 38 used as a sword against its efforts to restrict Wyoming’s citizens’ ability to make certain healthcare decisions, such as within the realms of abortion and gender- affirming medical care. In 2022, the U.S. Supreme Court (or SCOTUS) set the stage for this debate by ruling in Dobbs v. Jackson Women’s Health Organization , that the U.S. Constitution did not guarantee the right to abortion, and in the process overturned 49 years of precedent that began with Roe v. Wade in 1973. In the process, the SCOTUS gaveindividual states the right to regulate abortion.

Opponents of the Legislature’s efforts have sued in the Wyoming District Court for Teton County: in 2022, to Life is a Human Right Act (the “Life Act”), claiming these are illegal restrictions on their rights under section 38. Whether the Life Act, and similar laws, survive those challenges will ultimately turn on what the Wyoming Supreme Court finds that section 38 really means.

The genesis of section 38: The healthcare decisions amendment

Article I, § 38 of the Wyoming Constitution was passed by the Wyoming Legislature in 2011, and approved overwhelmingly in 2012 by Wyoming’s citizens. Section 38 states, in its entirety:

a. Each competent adult shall have the right to make his or her own healthcare decisions. The parent, guardian or legal representative of any other natural person shall have the right to make healthcare decisions for that person.

b. Any person may pay, and a healthcare provider may accept, direct payment for healthcare without imposition of penalties or fines for doing so.

c. The legislature may determine reasonable and necessary restrictions on the rights granted under this section to protect the health and general welfare of the people or to accomplish the other purposes set forth in the Wyoming Constitution.

d . The State of Wyoming shall act to preserve these rights from undue governmental infringement.

Section 38 does not explicitly mention the ACA, but there is little doubt it was intended as a direct response. 1 In fact, Wyoming’s response to the ACA was not unique– between 2010 and 2015, 22 state legislatures enacted measures relating to challenging or opting out of the ACA, and five states–Alabama, Arizona, Ohio, Oklahoma, and Wyoming–amended their constitutions to prevent or inhibit the application of the ACA. All of these state constitutional amendments, like Wyoming’s, explicitly guaranteed the right not to be compelled to participate in a healthcare system. However, Wyoming went further, guaranteeing the right of every competent adult to make their own healthcare decisions. 2 In fact, the Wyoming Legislature strengthened this protection by stating that the State itself was required to protect this right from “undue governmental infringement.”SCOTUS has given the term “infringement” particular significance in the Second Amendment context, essentially holding that it means the Second Amendment protects a right that pre-existed the federal Constitution. 3 In Second Amendment cases, SCOTUS has held that the burden is on the government to show that the governmental infringement is justified, and will grant “substantial deference” to protecting the preexisting right. The Wyoming Supreme Court has likewise held that, where fundamental rights are involved, the government bears the burden of proof, not thechallenger. 4 Therefore, the Wyoming Legislature seems to have set itself a high bar in seeking to constrain Wyoming citizens’ rights to make healthcare decisions–the State has the burden of showing that a restriction is justified. That may, given the circumstances, be an uphill battle.

When passed, section 38 seems to have been a specific response to two aspects of the ACA. Section 38: (a) addressed the belief that the ACA would restrict a patient’s rights to choose their own physician and course of care (including so- called “death panels”, which would supposedly deny care toolder or disabled patients in the name of cost containment) 5 and (b), addressed the concern that Wyomingites would be compelled to participate in a single-payer healthcare system. The Wyoming Attorney General argued in Johnson I that section 38 was only intended as a “message” amendment, “expressing the state's displeasure with the controversial federal Affordable Care Act.” 6 That may be true–however, the way the Wyoming Legislature and voting public chose to express that displeasure seems to have been by guaranteeing the right to make healthcare decisions.

Wyoming courts are already grappling with these issues

Fast-forwarding just 10 years since the passage of section 38; Wyoming’s “abortion trigger ban,” Wyo. Stat. § 35-6-102, went into effect soon after the ink was dry on the SCOTUS’ Dobbs decision. The “trigger ban” prohibited abortion except in very limited circumstances:

When necessary to preserve the woman from a serious risk of death or of substantial and irreversible physical impairment of a major bodily function, not including any psychological or emotional conditions;
the pregnancy is the result of incest; or
sexual assault.

Almost immediately after the “trigger ban” went into effect, in 2022, several individuals and organizations filed suit in state court in Jackson, seeking to prevent the State (and county and town law enforcement) from enforcing the “trigger ban” ( Johnson v. State of Wyoming , or “ Johnson I ”), claiming that the “trigger ban” violated section 38’s guarantee of the right to make healthcare decisions. Judge Owens temporarily granted the plaintiff’s requested injunction against enforcement of the “trigger ban,” finding a substantial likelihood that the “trigger ban” was unconstitutional. Judge Owens then certified the question to the Wyoming Supreme Court for a final decision. The Wyoming Supreme Court, however, refused to decide the question at that time, sending the case back to Judge Owens for further development of the facts. Johnson I has been overtaken by events on the ground, as the Wyoming Legislature passed the Life Act in 2023, seeking to further refine the abortion ban, and remove some of the grounds on which the “trigger ban” had been challenged. Immediately after the Life Act became effective, the plaintiffs in Johnson I filed a new lawsuit before Judge Owens ( Johnson II ), claiming that the Life Act also violated the section 38’s guarantee of the right to make healthcare decisions. 7

Section 38’s inherent tension; the right to make healthcare decisions vs. “reasonable restrictions”

Section 38 contains an inherent tension–on the one hand, subsection (b) guarantees the right to make healthcare decisions (which subsection (d) says must be protected from “undue governmental infringement”) 8 , and on the other, subsection (c) permits the State to restrict that right. It is almost inevitable that a court would be called on to resolve that tension, which would require the court to answer several questions:

Is the treatment (such as gender-affirming care) or procedure (such as surgical abortion) “healthcare,” so that the decision to undergo that treatment or procedure is a “healthcare decision”?
If the State has restricted an individual’s right to receive the treatment or procedure, is that restriction both “reasonable” and “necessary,” and specifically, both reasonable and necessary “to protect the health and general welfare of the people” or “to accomplish the other purposes set forth in the Wyoming Constitution”?

The Wyoming Legislature attempted an end-run around the first question, by making a Legislative finding in the Life Act that abortion is not healthcare. This attempt is unlikely to be successful–under the Constitution’s “separation of powers” principle, interpreting the laws (including the constitution), it is the exclusive job of the courts, not the legislature (as both Judge Owens and Governor Gordon have pointed out). While the Wyoming Supreme Court has acknowledged that it must give “great deference” to Legislative pronouncements, it has also acknowledged that the Court has an “equally imperative duty to declare a legislative enactment invalid if it transgresses the state constitution ... We must look behind the name to the thing named.” 9 Therefore, the Legislature’s declaration does not bind Wyoming’s courts, and this issue will have to be addressed.

The Wyoming Supreme Court will instead look to the “plain language” of section 38 itself, following the time-honored rule that “[i]n cases of constitutional interpretation, a court is guided primarily by the intent of the drafters; in determining that intent, the court looks first to the plain and unambiguous language used in the text of the Constitution.” 10 Further, “[i] n cases of constitutional interpretation, courts are not at liberty to depart from a meaning that is plainly declared.” 11 But if a court determines that the language of section 38 is ambiguous, then a court may consider the legislative history of section 38; 12 along with the historical context in which section 38 was passed.

Abortion and gender-affirming care under section 38

Section 38 does not define “healthcare decision,” giving few textual clues as to the intent of the drafters. However, as described above, the intent of section 38 appears to have been, at least in part, a direct response to fears that the ACA would limit patient choice, indicating that laws doing the same thing, i.e. limiting patient choice, are specifically within its scope of protection. While the Wyoming Attorney General has argued in Johnson I and II that the proper question is whether the Wyoming Constitution guarantees the right to abortion, the proper question is more likely whether abortion is a healthcare decision. The Legislature itself has spoken to the “plain meaning” of the term “healthcare decision” in the 2005 Wyoming Healthcare Decisions Act , defining it as:

[A] decision made by an individual or the individual's agent, guardian, or surrogate, regarding the individual's healthcare, including:

(A) Selection and discharge of healthcare providers and institutions;

(B) Approval or disapproval of diagnostic tests, surgical procedures, programs of medication and orders not to resuscitate; and (C) Directions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of healthcare.13

“Healthcare,” in turn, is defined as “any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual’s physical or mental condition.” 14

Using these definitions to interpret section 38, the Wyoming Supreme Court could find that both the decision to terminate a pregnancy, and to receive gender-affirming care, are “healthcare decisions” protected by Article 1, section 38. Pregnancy is a physical condition, and which is clearly affected by termination (usually through a “surgical procedure” or “programs of medication”). Likewise, gender dysphoria is a recognized “mental condition” (in the DSM-5), which either “programs of medication” or a “surgical procedure” can treat. Using the definitions the Legislature has already created, the Wyoming Supreme Court could easily find that both the decision to terminate a pregnancy, and to receive gender-affirming care, are “healthcare decisions,” protected by section 38.

The question then becomes whether Wyoming’s restrictions on abortion, and proposed restrictions on gender-affirming care, are “reasonable and necessary restrictions to protect the health and general welfare of the people.” It’s unclear how a Wyoming court would judge the reasonableness or necessity of restrictions on section 38’s right to make healthcare decisions. Generally, restrictions on constitutional rights are reviewed by courts under a “strict scrutiny,” “intermediate scrutiny,” or “rational basis” standard. Strict scrutiny is generally applied to governmental restrictions on fundamental rights; it is the highest bar a governmental restriction must overcome, and such restrictions will only be upheld if they serve a compelling state interest, and are narrowly tailored to serve that compelling interest. Judge Owens in Johnson II found that section 38 protected a fundamental right when she granted a temporary restraining order (TRO) against enforcement of the Life Act, stating that:

Wyomingites voted into law that they have a fundamental right to make their own healthcare decisions, and, by doing so, they also agreed that the state can put reasonable and necessary restrictions on that, as long as there is no undue government infringement. The Legislature declaring that abortion is not healthcare takes away from the duty of this court to decide constitutional questions of law, and that violates the separation of powers.15

At the trial court level, at least, it appears that the State of Wyoming will have to identify a compelling state interest that the Life Act was narrowly tailored to protect. That phase of Johnson II has not yet begun, but will be a heavily fact- intensive inquiry, and is unlikely to be over soon. Again,the Legislature appears in the Life Act to have pointed to its interest in protecting life, which it contends begins at conception, as the interest it seeks to protect. However, it remains to be seen whether Wyoming courts are willing to accept the Legislature’s contention. Likewise, the State of Wyoming will have to explain why the Life Act is “necessary” to protect life, when it has already passed statutes that resolve conflicts between a child’s right to life and a parent’s right to the free exercise of religion (another fundamental right) against the child. Wyoming law (Wyo. Stat. 14-3-202(a)(vii)) excepts from the definition of “neglect” of a child's treatment of medical conditions solely with prayer, presumably even if it results in the child’s death. These difficult questions will likely be part of Judge Owens’ (and the Wyoming Supreme Court’s) decision-making process as Johnson II progresses.

Conclusion

Section 38 was a direct response by the Wyoming Legislature and citizens to the passage of the ACA; however, the Wyoming Legislature and citizens may have inadvertently opened the door for a person to claim that their “healthcare decisions,” whatever they may be, are now protected by the Wyoming Constitution. The reasonableness of any restrictions on the rights guaranteed by section 38 is a matter the courts are now wrestling with, and likely will for years to come.

1 See Asay, Meredith, The Affordable Care Act: Expanding Healthcare Coverage and Wyoming’s Response To It, 36 Wyoming Lawyer 20 (October 2013)(“In 2011, in response to the passing of the Affordable Care Act, the Wyoming Legislature passed Original Senate Joint Resolution No. 0002 (SEJR0002) which proposed to amend the Wyoming Constitution to include the rights to make healthcare decisions; pay directly for healthcare without penalties or fines; and preserve the right to healthcare access from undue governmental infringement.”)

2 Compare Ala. Const. art. I, § 36.04(a) (“In order to preserve the freedom of all residents of Alabama to provide for their own healthcare, a law or rule shall not compel, directly or indirectly, any person, employer, or healthcare provider to participate in any healthcare system.”); and Ariz. Const. art. XXVII § 2(A), preempted by Coons v. Lew, 762 F.3d 891 (9th Cir. 2014) (“A. To preserve the freedom of Arizonans to provide for their healthcare: 1. A law or rule shall not compel, directly or indirectly, any person, employer or healthcare provider to participate in any healthcare system.”); and Ohio Const. art. I, § 21 (“(A) No federal, state, or local law or rule shall compel, directly or indirectly, any person, employer, or healthcare provider to participate in a healthcare system. (B) No federal, state, or local law or rule shall prohibit the purchase or sale of healthcare or health insurance. (C) No federal, state, or local law or rule shall impose a penalty or fine for the sale or purchase of healthcare or health insurance.”); and Okla. Const. art. 2, § 37(B) (“To preserve the freedom of Oklahomans to provide for their healthcare: 1. A law or rule shall not compel, directly or indirectly, any person, employer or healthcare provider to participate in any healthcare system . . . .”); with Wyo. Const. art. I, § 38 (“(a) Each competent adult shall have the right to make his or her own healthcare decisions. The parent, guardian or legal representative of any other natural person shall have the right to make healthcare decisions for that person. (b) Any person may pay, and a healthcare provider may accept, direct payment for healthcare without imposition of penalties or fines for doing so.”). See Justice Brennan’s Call to Arms-What Has Happened Since 1977?, 77 Ohio St. L.J. 387 (2016)

3 See New York State Rifle & Pistol Association, Inc. v. Bruen, 142 S.Ct. 2111, 2129-30 (2022); see also District of Columbia v. Heller, 554 U.S. 570, 592 (2008).

4 Hardison v. State, 507 P.3d 36, 39 (Wyo. 2022)

5 Gonyea, Don, “From the Start, Obamacare Struggled With Fallout From a Kind of Fake News”, NPR
(January 10, 2017 (https://www.npr.org/2017/01/10/509164679/from-the-start-obama-struggled-with-fallout-from-a-kind-of-fake-news)

6 2022 WL 3009976 (Wyo.Dist.) (Trial Motion, Memorandum and Affidavit), District Court of Wyoming, Ninth Judicial District, Teton County

7 The plaintiffs’ claims in both Johnson I and Johnson II do not rely on section 38 alone, and also include challenges on other grounds, including the constitutional right to free expression of religion. However, this article focuses on section 38.

8 The State has argued in Johnson II that “government infringement”, in this context, means the federal government, since the concern section 38 was meant to address was federal restrictions on patient choice in the ACA.

9 Witzenberger v. State ex rel Wyoming Community Development Authority, 575 P.2d 1100, 1114 (Wyo. 1978) (“While it is our duty to give great deference to legislative pronouncements and uphold constitutionality when possible, it is likewise our equally imperative duty to declare a legislative enactment invalid if it transgresses the state constitution. We cannot, in good conscience, call the Authority a political subdivision when it is clear by the terms of the act itself that it is not. We must look behind the name to the thing named. Its character, its relations and its functions determine its position, not the sobriquet it carries.”)

10 Powers v. State, 2014 WY 15, Hd. 3, 318 P.3d 300 (2014)

11 Id.

12 Id. at ft.n. 12 citing Geringer v. Bebout, 10 P.3d 514, 521 (Wyo. 2000).

13 Wyo. Stat. 35-22-402(a)(ix)
14 Wyo. Stat. 35-22-402(a)(viii)

Manage Your Time

Sun, 30 Apr 2023 22:45:29 GMT

An important life skill for college students to learn
Content provided by Intelligent

What is time management?

Time management is the practice of organizing and planning your time to fulfill obligations and accomplish tasks. Whether you are a college freshman creating your own schedule for the first time, or an adult learner juggling work and family obligations, effective time management is essential to your success in college. However, many individuals struggle with time management. This page offers strategies for managing your time and incorporating studying into your other school and life commitments.

Why is time management important?

As a college student, you must devote a significant amount of time to attending class, studying, and doing homework, but you also likely have personal commitments like work, family, and friends that you need to consider.

While it may be tempting to cut out all other activities in favor of studying, and there will certainly be times when you have to forgo a work shift or social event to complete a school assignment, striking a healthy school-life balance is critical to your long-term success and quality of life in college. Neglecting relationships, personal interests, and self-care is a recipe for burnout.

Time management is all about organizing your life so you can have an optimal balance between school and life. If you are prepared for tests and project deadlines, you won’t have to miss hanging out with friends to pull an all-nighter, and if you know when your life obligations are, you won’t have to be studying at your cousin’s wedding.

8 Tips for Good Time Management

Follow the tips below to start developing good time management skills!

Tip #1 : Keep a detailed schedule for school and life commitments

As discussed in the last section, having a detailed study plan is key in committing time to studying. Part of creating the study plan is mapping out important dates for school work, like tests, exams, and project due dates. Do this at the start of each term; each course instructor should give you a syllabus detailing all of this information within the first few days of class.

You should also include life commitments, like work deadlines and social events, on this calendar. This long-term planning may feel like a drag, but it will save you time and stress when you don’t have assignments or obligations sneaking up on you.

Tip #2: Write down your study plan

Instead of just planning study sessions in your head, include them on your calendar so you are reminded every time you look at it. You will be more likely to follow through with your study plan if it is clearly marked on your calendar. If you use a calendar app, set reminders for what you should be studying, and when. Making a schedule and sticking to it will allow you to develop a routine that you can easily follow.

Tip #3: Prioritize your assignments

When you are juggling a multitude of tasks, as most college students are, prioritization is very important.

You can prioritize based on the urgency of assignments – reading a chapter that will be discussed in class tomorrow should be prioritized higher than studying for midterms in two weeks. But be sure not to de-prioritize things too much – the purpose of a study plan is to avoid putting off studying and assignments until the last minute.

Another way to prioritize is by assessing the difficulty of the subject or assignment. You may want to devote more time to studying subjects that are new to you, or those in which your grade needs improvement. Also, remember to study the harder subjects first so that you tackle them with a fresh mind.

Whichever way you decide to prioritize, write down your tasks in the order in which you plan to complete them. Not only will this provide a visual reminder of what you plan to accomplish, but crossing items off your check-list can provide a motivation boost.

Tip #4: Break down big assignments into smaller chunks

Few things can be more intimidating than having to complete a large assignment, like a term paper, all at once. Avoid this by breaking the work into smaller, more manageable tasks. For example, if you are writing a term paper, the steps could be:

Doing research and taking notes
Writing an outline
Writing the introduction and thesis statement
Writing the body
Writing the conclusion
Revising

These tasks can be spread out over the course of several days or weeks, so you’re not sitting down in front of a blank screen right before the paper is due

Tip #5: Be realistic about how much time assignments will take

A big part of time management is understanding how long it takes you to complete tasks. It’s common for people to underestimate how much time they will need to complete a task (a phenomenon called “the planning fallacy”), so try to avoid this pitfall by trying different time-tracking techniques, and being honest with yourself about your productivity.

Tip #6: Avoid distractions and time-wasters

Distractions and disorganization can significantly undermine your time management skills. An hour of study time is not nearly as effective if you spend thirty minutes checking your email, responding to texts, or browsing social media. Cut down on distractions as much as possible by:

Finding a quiet, private place to study
Asking roommates to not interrupt you when studying
Putting your phone on silent, and stashing it out of sight
Using apps that block social media, messages, and other distractions on your phone or computer

Staying organized will also help you to avoid wasting valuable time. Since you will be enrolled in several classes at a time, it is important that you organize your study materials in an easily accessible way. Find an organization method that works for you, such as using a separate binder or folder for each class. Also, when going into a study session, make sure you have anything you need. You don’t want to interrupt your study session by searching your room for flash cards or notes. If you are taking online courses, learn how to organize files in the most efficient way possible to avoid wasting time sifting through your hard drive for course materials.

Tip #7: Minimize multitasking

When you have multiple tasks to accomplish, it can be tempting to try to address them all simultaneously, in the practice known as multitasking. However, there is evidence that multi-tasking can actually decrease humans’ productivity, and that it lowers students’ retention of material and impacts grades negatively.

Make the most of your study sessions by focusing on one subject or assignment at a time. This will help you finish tasks faster, improve the quality of your work, and ensure you retain more of what you have studied

Tip #8: Reward yourself

The purpose of time management is to ensure that you don’t need to spend every waking moment studying or doing homework. It’s easier to stay on track and stick to your study plan when you reward yourself for accomplishing your study goals. This can mean taking a short walk to break up a study session, or treating yourself to a movie after you finish a large project. Take time to practice self-care, whether it’s eating a healthy meal, meditating for a few minutes a day, or getting a full night’s sleep.

Article source: https://www.intelligent.com/manage-your-time/

Violence Against Healthcare Workers

Sat, 15 Apr 2023 02:00:48 GMT

Violence Against Healthcare Workers

As published in Wyoming Medicine Spring 2023

In September 2022, a new report revealed that 5,217 nurses to service is what makes nurses and other healthcare providers were assaulted on the job in this country in just three months in 2022. These are staggering numbers and far exceed the experience

of workers in any other profession.

This equates to more than two nurses assaulted every hour, 57 every day, and 1,739 every month. Bureau of Labor Statistics data show workers in healthcare and social services experience the highest rates of violence and are 5 times as likely to be injured at work than workers overall. Rates of violence against healthcare workers have risen every year since 2011. Right here in Wyoming, between January 1, 2021, and June 21, 2022, violence impacted 121 healthcare workers—with injuries extreme enough to result in workers' compensation claims. It is important to note these are only workers' compensation claims and not the total number of assaults on healthcare staff. The total number of attacks is, without question, dramatically higher.

While this commitment to service is what makes nurses and other healthcare providers heroes in their communities, it also makes them extremely vulnerable. The question of “how high” is difficult to pin down. Many times, attacks go unreported, and the reasons are varied. Healthcare workers are often, by nature and by training, helpers. They are in this field to care for people. They have been trained to treat the patient in front of them—even in the face of threats and physical violence. While this commitment heroes in their communities, it also makes them extremely vulnerable.

Further adding to the risk, they have no ability to pick and choose who they serve. In a hospital setting, federal law requires all patients who walk through the door be treated. For example, a patient may enter the emergency room of a hospital on Monday and assault a nurse. This same patient could return to the same emergency room on Friday, and the hospital staff must treat that patient - regardless of the threat they pose.

State legislators across the country have decided they have an important role to play in addressing this violence. Nebraska, Louisiana, Wisconsin, and Oklahoma have all passed laws which consider assault of a medical professional or provider a felony. The passage of such legislation makes a strong statement about how healthcare workers are valued, and how the abuse they suffer in the workplace is unacceptable.

There is precedent for this in Wyoming law: The state of Wyoming has enhanced penalties when it comes to corrections and detention officers. Federal law acknowledges attacks against flight attendants as a more serious crime than a “regular” assault. Hospitals and other healthcare facilities are intended to be places of healing. The harm caused by attacks on healthcare professionals extends beyond the individual(s) assaulted. It interferes with the care of other patients, some who may require lifesaving measures. Interfering with the delivery of healthcare is a serious public safety issue, and Wyoming law should be updated to recognize this reality.

Healthcare providers, particularly nurses, have been leaving the profession at an alarming rate over the past several years. Burnout is one driver of this exodus, and Wyoming has suffered a lack of workforce more than most states. The market for recruiting healthcare professionals is a national one and Wyoming must compete in that market for nurses and other providers who are in high demand everywhere. It is critical for Wyoming to make itself as inviting as possible to attract and retain the best talent. While states across the country continue to pass laws enhancing penalties for these crimes, Wyoming places itself at a further competitive disadvantage without addressing this growing issue.

Does Teletherapy Really Work?

Sat, 01 Apr 2023 01:16:08 GMT

Tele-mental health services have been around a lot longer than COVID
Content provided by Wyoming Behavioral Institute

Teletherapy is now available from mental health providers who also see people in person, and some mental health professionals only work remotely. But some people question whether teletherapy is the same as in person therapy and if youth, in particular, get any benefit from seeing a therapist remotely.

The Proof is in the Research

The Agency for Healthcare Research and Quality (AHRQ) did a comprehensive study lasting nearly 10 years, exploring more than 950 studies. The AHRQ reported that telehealth is beneficial for specific uses and populations. In fact, there is a large volume of research reporting that teletherapy clinical outcomes are as good as OR BETTER than usual care and that mental health services delivered remotely can improve intermediate outcomes and satisfaction.[1]

The Canadian Medical Association also completed a study lasting nearly 10 years that explored the impact of online cognitive behavioral therapy (CBT).[2] Research found online CBT – which is the most common type of therapy available — could effectively reduce the symptoms of depression and other mental health issues. In some cases, online CBT was even MORE EFFECTIVE than traditional in-person therapy.

Dr. David Mohr, Director of the Center for Behavioral Health Intervention Technologies at Northwestern University School of Medicine, has spent his career studying the impact of teletherapy. He reports video conferencing for therapy has proven to be effective for depression, anxiety, adjustment disorder, substance use, eating disorders and other problems in children and adolescents. According to Dr. Mohr, “what we’ve seen is that telehealth is essentially just as effective as face-to-face psychotherapy, with better retention.”[3]

[1] The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic | Effective Health Care (EHC) Program (ahrq.gov)

[2] Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness – PMC (nih.gov)

[3] How well is telepsychology working? (apa.org)

What Is Teletherapy, exactly?

Simply put, telehealth enables child, adolescents, adults and seniors to remotely connect with clinicians for healthcare services and information by phone, tablet or computer. Utilizing user-friendly, HIPAA-compliant video and communications technology, this service allows our clients to see and speak with a therapist just as they would during an in-person consultation — all in real time, respectful of social distancing practices and from home, school or another location.

Several different types of therapy services may be available virtually, via videoconferencing.

Individual Teletherapy

Individual teletherapy provides support that inspires change and promotes a better quality of life. Individual therapy can help individuals overcome obstacles impacting their wellbeing. Youth learn coping skills, improve their decision-making ability and self-awareness, work toward recovery from trauma and grief, improve their ability to manage their mental health, learn to set and achieve goals and improve their overall function.

Family Teletherapy

Family teletherapy helps families address specific issues affecting their health and functioning. Family therapy provides support for children or parents suffering from mental illness, assists in the development of problem-solving, communication, and coping skills and promotes the development of strengths families need to overcome challenges such as trauma, grief and loss, anger and stress.

Group Teletherapy

Group teletherapy is designed to help with mental illness, trauma, impulse control, self-harm, grief and loss and other challenges by working with others who are experiencing similar life challenges.

Adolescent Mental Health Intensive Outpatient Programming

Adolescent Mental Health Intensive Outpatient Treatment (MH-IOP) services are designed to support patients experiencing a variety of mental and behavioral health care challenges. Patients struggling with depression, anxiety, trauma, impulse control, eating disorders, bipolar disorder, panic disorder, self-harm and other diagnosable mental health concerns or challenges will participate in nine hours of group therapy a week, usually for 4-6 weeks. Participants may also attend individual and family therapy outside of MH-IOP services.

MH-IOP supports the patient in an outpatient setting enabling them to attend school and participate in work or other activities while receiving structured support. IOP uses Expressive Art Therapy, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy and other skills-based treatment methods to develop a goal-directed treatment plan to increase each patient’s functioning and ability to find joy in life.

Participation in IOP will require attendance and participation in all weekly sessions, a complete intake/clinical assessment and telehealth orientation, and may require a referral from a physician/psychiatrist as well as a completed medical assessment (with physical/health screening by a physician if indicated).

Step Down

Telehealth intensive outpatient programming can help teens discharging from inpatient and residential treatment continue to recover with group, individual and family counseling, without having to leave home.

Step In

Telehealth intensive outpatient programming can help teens struggling at home or in school who are not yet in need of acute inpatient psychiatric care or residential treatment.

Want to Know More?

To speak with a member of our outpatient telehealth clinic team, give us a call at 307-439-2139 or you can reach us via email at wbioutpatient@uhsinc.com .

Article source: https://wbihelp.com/2022/09/01/does-teletherapy-really-work/

What Parents Need to Know About Mental Health Care and Teens

Wed, 01 Mar 2023 02:16:36 GMT

Child and adolescent mental health
Content provided by Wyoming Behavioral Institute

New Paragraph

Parents may be among the first to notice when a teen starts to suffer with depression, anxiety and other mental health issues. Whether it is loss of interest in normal activities, lack of enthusiasm, irritability, anxiety, poor concentration or another warning sign, these clues can alert adults that a teen is distressed.

Many concerned adults want to do something to help struggling teens, and this guide can help concerned parents know whether they should take their teen to therapy, the nearest emergency room for another treatment level.

Wyoming Behavioral Institute has been serving children and adolescents experiencing mental health crises for more than 20 years, and we have compiled a list of important things to know about mental health inpatient care, therapy and crisis care for teens. Although you may feel like this is new territory, our mental health professionals are very familiar with adolescent mental health and can help.

IT IS COMMON FOR TEENS TO FEEL THIS WAY

Many parents worry about their teens and feel overwhelmed by trying to get mental health treatment with and for them. What parents sometimes do not realize is that though their teen may be experiencing these symptoms for the first time, and it may seem scary, mental health issues in teens are extremely common and our mental health professionals specialize in caring for youth.

The CDC outlined figures for common mental health problems in youth:

ADHD, anxiety problems, behavior problems, and depression are the most commonly diagnosed mental disorders in children. Estimates for ever having a diagnosis among children aged 3-17 years, in 2016-19, are below.

ADHD 9.8% (approximately 6.0 million)
Anxiety 9.4% (approximately 5.8 million)
Behavior problems 8.9% (approximately 5.5 million)
Depression 4.4% (approximately 2.7 million)

Source: Centers for Disease Control

What Are the Levels of Care for Mental Health?

Something that can help parents decide what level of mental health care is appropriate for their teen is understanding the different tiers and admission criteria for each level of care. There are four levels of treatment available at Wyoming Behavioral Institute:

Outpatient Teletherapy
Intensive Outpatient Teletherapy (IOP)
Acute Psychiatric Hospitalization
Residential Treatment Program

Outpatient Teletherapy

Most parents know about therapy and its potential benefits. Outpatient therapy can be used for anyone who needs support for mental health issues. Frequency can be low, once a month, or quite frequently, weekly or twice weekly. The admission criteria are low so anyone who feels they would benefit from therapy is invited to try a few sessions.

For parents who know their teen needs help but do not know where to start, setting them up with a therapist is recommended.

Intensive Outpatient Teletherapy

Treatment is three times a week for three hours. This is for teens who need more support than weekly visits with a therapist, but who do not meet criteria for a higher level of care.

Acute Psychiatric Hospitalization

When a teen is in crisis, it may become necessary to admit them to a psychiatric unit for a short stay to stabilize. Psychiatric stays are normally only five to eight days. Outpatient care is recommended after inpatient care.

Residential Treatment

Residential treatment is when the patient resides in a treatment program for a matter of weeks, and sometimes months. Programs vary in length. Residential programs can address behavioral issues, addictions, mental health problems, and a host of other issues. School also is a priority.

Teens Are Influenced by Their Friends

Although many parents are aware, it is important to remember that teens are highly susceptible to pressure from their peers. Penn State University researchers studied teen behaviors, and “compared to boys, girls tend to be more influenced by their friends to engage in delinquent behavior, which includes skipping class and fighting.”[1]

[1] How winning friends may influence adolescent behaviors | Penn State University (psu.edu)

Parents Can Encourage Health Habits and Coping Skills

Parents can have a major impact on their teens’ mental health. Praise and encouragement for positive behaviors and healthy habits, as well as providing opportunities for their teens to have healthy experiences can help teens develop a healthy self-image and lifestyle.

WBI Can Help

If your teen is in crisis, do not hesitate to get help.

Wyoming Behavioral Institute can provide a no-cost level of care recommendation, available by simply calling 800-457-9312.

Article source: https://wbihelp.com/2022/09/01/what-parents-need-to-know-about-mental-health-care-and-teens/

Learn to Recognize the Signs of a Drug or Alcohol Problem

Wed, 01 Feb 2023 02:16:39 GMT

Signs of a problem
content provided to WMS by Start Your Recovery

Drinking and drug use can be common in many settings. For many people, their use of one or both might be casual, and they are aware of their limits. But when drugs or alcohol become engrained into or interfere with your daily life, it may be time to reassess your dependency. Whether you or someone you care about has transitioned from an occasional or social drinker to binge drinking regularly, increased dosage of prescribed opioid medication, or progressed to harder drugs like heroin and methamphetamine, it’s important to seek help and take control of substance use.

It’s not easy to recognize whether someone you know is experiencing problems with substances, much less yourself. Learning how to recognize the signs of addiction can help you determine whether you or a loved one should reach out for support. Doing so is often the first step on the path to recovery.

Signs of a problem with alcohol

When drinking casually with friends, we may not look for or recognize signs of alcoholism. Alcohol consumption is so common that addiction and abuse can be difficult to identify, especially in ourselves. There are many ways to enjoy a healthy relationship with alcohol; it’s when drinking starts to interfere with your everyday life that there may be a problem.

Drinking may be a problem if you …

Drink to forget something in your life or past.
Seek out alcohol when you’re feeling down or worried.
Can’t sleep or wake up without a drink.
Cope with emotions by drinking.
Have a hard time managing stress without alcohol.
Engage in “binge drinking,” having five or more drinks on a single occasion.
Have trouble maintaining relationships, hobbies, or activities because of your drinking habits.
Consistently go over limits on drinking that you set for yourself.
Find yourself in dangerous situations or experiencing thoughts of suicide because of drinking.
Using alcohol as a tool to manage emotions or moods can seem like a good way to cope. But over time, drinking can affect the rest of your life, including your:
Relationships
Career
Finances
Physical health
Mental health

And since our bodies are wired to seek pleasure and relief, you may find it hard to cut down on your own.

If you’re concerned about your drinking habits or you’d like to know more, a confidential self-assessment can help you figure out whether you could benefit from treatment and support.

Knowing the risk factors

Many of us drink alcohol on a regular basis, but some of us are more likely to develop problems with alcohol than others. If we’re aware of our risk factors, we can take steps to reduce the likelihood of developing an addiction.

Risk factors you need to know:

Genetics : If someone in your family has an alcohol use disorder, you may be more likely to develop one, too.
Age of initial alcohol use : If you started drinking when you were very young, you may have a higher risk of developing an alcohol use disorder.
Mental health disorder : Individuals with anxiety, mood, and other psychiatric illnesses have higher rates of substance use disorders. Combined, substance misuse and mental health disorders can increase risk for suicide.

Situational factors you can control:

Friends : When you’re surrounded by people who regularly drink heavily, it can be hard not to join in.
Environment : Some areas of the country have higher rates of alcohol consumption than others, creating a culture of heavy drinking that can increase the risk for alcohol problems.

Signs of a problem with drug use

People use prescription or recreational drugs for a variety of reasons: out of curiosity, to relax or socialize, or because a family member or loved one also uses drugs. However, when drug use interferes with your daily life, there may be a problem. If you notice that your use, or a family member’s or friend’s use, gets in the way of sleep, relationships, work, or fulfilling responsibilities — or if it’s significantly affecting your mood — then it may be time to reach out for support. If you’re ready, taking that first step can get you on a path to recovery.

Have you noticed that you …

Use drugs to forget something in your life or past?
Find yourself longing for the drug or feeling strong urges?
Experience symptoms of withdrawal — like muscle pain, nausea, or anxiety — when you don’t use?
Act unlike yourself to get access to the drug?
Have a hard time managing stress without using?
Have trouble maintaining relationships, hobbies, or activities because of your drug habits?
Consistently go over limits you set for yourself?
Have found yourself in dangerous situations or experiencing thoughts of suicide because of your use?

Many people use drugs to cope with tough situations, and they can provide temporary relief. However, over time, using drugs can affect your work, your finances, your relationships, and your physical health — and the problem can be difficult to control on your own.

If you’re concerned about your drug use, or that of someone you care about, and you’d like more information, Mayo Clinic provides a detailed breakdown of signs and symptoms of drug use by type of substance.

Knowing the risk factors

Many people have participated in recreational drug use at some point in their lives, but some of us are more likely than others to develop problems with drugs. Some risk factors may be beyond your control, but knowing the factors that can contribute to substance use problems can empower you to take steps toward reducing your likelihood of developing an addiction.

Risk factors you need to know:

Gender: Studies show that people of different genders use drugs in different ways. Women may develop an addiction earlier in their drug use than men.
Genetics: If you know that someone in your family has a substance use problem, you may be more likely to develop one, too.
Method of use: Injecting or smoking drugs like cocaine, opiates, heroin, or opioid painkillers can increase the risk of developing an addiction.

Situational factors you can control:

Friends: When you spend a lot of time with people who regularly use drugs, you tend to adopt their habits.
Environment: Some areas of the country have higher rates of drug use than others do, creating a culture of drug use that can increase the risk for drug-related problems.

Article source: https://startyourrecovery.org/signs

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