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House passes bill addressing mental health concerns among students, families, educators




The House passed legislation on Thursday aimed at addressing the mental health problems of students, families and educators, exacerbated by the COVID-19 pandemic, which lawmakers said have had a “severe impact” on those three groups.

The invoice, entitled Mental Health Matters Act., passed in a broadly partisan 220-205 vote. One Republican, Rep. Brian Fitzpatrick (Pa.), joined all of the Democrats in attendance in support.

The bill, if passed by the Senate and enacted into law, would provide grants to establish a pipeline for school-based mental health professionals. Additionally, it would increase the number of mental health professionals in elementary and secondary schools located in high-need locations.

The measure would direct the Department of Education to allocate these grants.

The Department of Education would also be directed to provide grants to state education boards to hire and maintain school-based mental health service providers in public elementary and secondary schools that are deemed to be badly needed.

The passage of the bill comes approximately two and a half years after the start of the COVID-19 pandemic, which has led to the further spread of mental illness.

That World Health Organization unveiled in March that in the first year of the pandemic, the prevalence of anxiety and depression increased by about 25 percent worldwide.

The 2022 KIDS COUNT Data Book, released in August, revealed that about 1.5 million children in the US experienced depression or anxiety in the first year of the pandemic.

Rep. Mark DeSaulnier (D-Calif.), the sponsor of the bill, said his legislation was needed to address the impact of students who have mental health concerns on schools and educators.

“Educators have been forced to play an outsized role in supporting and responding to students’ psychological needs, leading to increased depression and trauma among educators, their students, and the families and community. However, our schools do not have the specialized staff needed to respond to the increasing prevalence and complexity of student mental health needs,” he said.

“Put simply, the Mental Health Matters Act provides the resources students, educators and families need to improve their well-being.” Added DeSaulnier.

Rep. Virginia Foxx (NC), the top Republican on the Education and Labor Committee, said the “country would be better off without” the legislation on the ground.

She specifically criticized the provision that allows the Secretary of Labor to levy civil fines on plan sponsors and administrators of group health plans if they fail to meet parity requirements related to mental health.

“Provide [the Department of Labor] having the power to impose civil fines on plans and increase the risk of litigation will only force the plans to end mental health coverage,” Foxx argued.

“This money should be better spent on helping with compliance rather than targeting employers based on ambiguous standards,” she added.

The law also requires that students arriving at college have access to disabled housing if they have documentation showing their disability, and will introduce a grant program to increase student access to evidence-based trauma support and mental health services through projects that connect schools and local education agencies with trauma-informed support and psychiatric systems.


Specialty Pharma’s Next Big Opportunity: It’s Time for Patient Access to Adopt an Open Protocol




Yishai Knobel, CEO and co-founder of RxWare

In January 2020, the financial conglomerate Visaannouncedit acquired a relatively unknown startup, Plaid, for $5.3 billion. Acquisitions like this are not uncommon, but someone at the US Department of Justice took note of the announcement. Visa had a stranglehold on financial transactions. The Ministry of Justicepostponed to halt takeoverarguing that Plaid “poses a threat to that monopoly: it has developed an innovative new solution that would replace Visa’s online debit services.”

Plaid derives its power not in spite of, but from its invisibility – a visa of power that the government ultimately could not refuse. When a consumer transfers money electronically from one financial platform to another, makes a deposit, or applies for a mortgage, there’s a good chance Plaid is involved. It is the software that enables interoperability between different financial services brokers. It seamlessly stitches together transactions that would otherwise be very complicated. visa at the timeallegedly held around 70 percent of the online direct debit marketShe had every reason to feel threatened. Plaid has discovered a way to charge merchants and consumers less for the convenience of online connectivity.

Ultimately, both parties withdrew from the takeover. Visa’s target purchase price of $5.3 billion looked like a bargain at the timePlaid was valued at approximately $13.4 billion in a Series D funding roundin April 2022.

A similar turning point is now upon us for the specialty pharmaceutical industry. Along the way, specialty pharma patients interact with a number of siled institutions: clinics, specialty pharmacies, copay program providers, patient assistance programs, nurses, etc. Similar to the financial industry, these institutions still exchange patient information via fax machines. Facilitating digital interoperability between these different stakeholders is paramount. So what lessons can be learned from the story of Plaid’s meteoric rise?

To diagnose the problem that specialty pharmaceuticals face, a brief history lesson is in order. The healthcare industry began its first major digital transformation in earnest in the 1990s whenthe large-scale conversion to electronic recordsstarted. The industry’s preference for paper did not disappear overnight. Healthcare systems have been slow to digitize their filing cabinets full of charts and other patient data. The Institute of Medicine initially advocated a switch from paper-based to electronic patient records1992however, only 13 percent of US healthcare facilitieswere foundto have a fully implemented EHR system by 2004.Many are yet to make the transition.

Today sale of specialty drugsaccount for more than half of all drug expenditure. This sector of the healthcare industry has both the incentive – and the financial means – to make the patient experience as seamless as possible. However, in many ways it is more backward than the fintech industry before Plaid. When Plaid effectively forced financial institutions to adopt an open protocol approach to digital interoperability, “every bank took their five-year digitization strategy and whittled it down to a year or two,” said CEO Zach Perretsaid in an interview with Fortune magazine.

In healthcare in general, and in patient services in particular, the transition to an open protocol approach has been slow and uneven. Open protocol, put simply, is a digital language that facilitates electronic transactions between prescribers, pharmacies, patient support providers, data aggregators, insurers, and other stakeholders in the specialty pharmaceutical patient journey. Taking an “open protocol approach” means standardizing the open and shared application programming interfaces (APIs) within an industry or a sub-sector of a larger industry. The widespread adoption of these protocols allows all participants in the environment to expect a well-defined behavior when communicating digitally with each other.

The power of the open protocol approach has been recognized across many industries. Check out Twilio’s example. In 2008, the startup launched its first API to make and receive calls entirely in the cloud. Now, six years after going public, the company is worth billions. The suite of related tools includes platforms for data security, language analysis and customer relationship management.

If the healthtech and pharmatech industries can take this opportunity to standardize their most common digital tasks, the integration of records and transactions between the different parties will be lightning fast compared to today. This is the key lesson that pharmatech and healthtech companies can learn from what Plaid has done for the fintech industry.

If an open protocol approach facilitates convenience, what’s the downside? As in finance, traditional healthcare players tend not to share information very efficiently with their competitors. Interoperability has never been an explicit goal of the industry. However, for patients with specialty pharmaceuticals, interacting with stakeholders across multiple silos is the norm. Typically, these patients require at least one transaction to receive their prescriptions from the prescribing physician, then another with the office to provide their HIPAA, TCPA, and Hub consent, then interact with the Hub regarding their coverage, and then again with a specialty pharmacy regarding their shipments and out-of-pocket payments, then another to handle the co-payment, another with a patient assistance program, another to support compliance, etc. The patient journey is usually long and complicated – not to mention of his own recovery from the illness for which she is being treated.

You may be wondering: can an open protocol be HIPAA compliant? HIPAA does not specifically prohibit the use and sharing of Open Protocol-based software. “Open protocol” does not automatically mean “unsafe” either. While the industry’s reluctance to share back-end software protocols is understandable, there is nothing standing in the way of collaborative problem solving to ensure that all private healthcare data transmitted over open protocols remains secure. On the contrary, an open protocol can easily allow such monitoring of the data passed, much better than fax machines and FTP transmissions. At the moment, this reluctance is making life more complicated for patients. Your patient journey usually requires working with discreet service providers who often use outdated means of communication.

The discussion of how to integrate an open protocol approach into a complicated system governed by HIPAAhas been running for years. Yet many key players in the industry are still at the bottom: moving their primary means of communication from paper to digital.

The time to cross that bridge has passed. As Plaid’s case study makes clear, now is the time for the industry to embrace open protocols.

About Yishai Knobel

Yishai is co-founder and CEO of RxWare. Before HelpAround, Knobel was Head of Mobile at AgaMatrix Diabetes, the manufacturer of the world’s first smartphone blood glucose meter. He also served at Microsoft’s Startup Labs in Cambridge and as an officer in an elite Israeli Army R&D unit.

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When your letter to the editor is rejected or ignored




Dear Doctor. El Dalati,

I am sorry that we are unable to publish your recent letter to the editor regarding the Chowdhury article of September 16, 2021. The space available for correspondence is very limited and we must use our judgment to present a representative sample of the material received. Many meaningful messages have to be rejected due to lack of space.

The answer from the New England Journal of Medicine (NEJM) seemed simple and straightforward enough on the surface. A closer look, however, highlighted a troubling feature of medical publishing: journals can publish virtually anything they choose, through an ambiguous peer-review process with no governing board to review the quality of the research or the validity of the claims. The only option most people have when they discover a serious error in a published article is to send a letter to the editor, the editor who published a potentially misleading manuscript.

The article highlighted above entitled “Oral versus intravenous antibiotics for endocarditis‘, was published in September 2021 and presented itself as a point-counterpoint discussing the management of endocarditis in patients with substance use disorders. One author wrote an article in favor of intravenous (IV) antibiotic therapy and the other outlined an argument for using partial oral antibiotic treatment. However, both authors excluded relevant literature and indicated a general lack of interest in the patient’s experience. The pro-IV author emphasized keeping the patient hospitalized and did not consider alternative methods to intravenous treatment, although the literature supports that people who inject drugs (PWIDs) can do so successfully complete IV therapy on an outpatient basis at home or at medical recreation facilities. There was no acknowledgment of how the healthcare system discriminates against PWIDs, including Refusal to be admitted to nursing facilities to receive antibiotics. While the author explored the need for an interdisciplinary approach to the management of endocarditis, there was no discussion as to whether the patient had access to a multidisciplinary endocarditis team. There was also no discussion as to why the patient wanted to leave the hospital. An investigation into this could have led to a safe medical solution. While the rebuttal touched on these issues in passing, it focused primarily on the medicinal value of oral versus intravenous antibiotics, rather than addressing how stigma from the healthcare system impacted patient treatment. Ultimately, both opinions placed the provider perspective ahead of the patient perspective without fully considering the available evidence. I set out all of these concerns in my letter, which conforms to the very specific standards required by NEJM, and received the response at the beginning of this article.

Fast forward a year to September 2022, when the American Heart Association (AHA) published a scientific statement entitled Circulation in its journal “Management of infective endocarditis in people who inject drugs.” The document specifically addresses the role of partial oral antibiotic therapy for patients with Staphylococcal aureus endocarditis. More specifically, the authors include a recommendation for the use of linezolid and rifampin to treat methicillin-resistant Staphylococcus aureus (MRSA) endocarditis and attribute this specific treatment to it POET study published by Iversen et al. in 2018. However, no cases of MRSA endocarditis were included in this study. Iversen et al. included patients with endocarditis caused by methicillin-resistant coagulase-negative staphylococci (MRCoNS), and linezolid and rifampin were among the antibiotics used to treat these cases. There is little evidence that using this regimen to treat MRCoNS-related endocarditis can be extrapolated to treating MRSA endocarditis. In addition, although the POET study included 201 patients in the oral therapy arm, only four patients with CoNS endocarditis were treated with linezolid and rifampin. In summary, the POET study was incorrectly cited in the most recent scientific statement and advocated the use of an antibiotic combination for the treatment of MRSA endocarditis, which was actually only examined in 4 patients with CoNS endocarditis.

In addition, recent literature has demonstrated this Staphylococcus aureus can account for up to 75 percent of cases of endocarditis associated with injecting drug use (IDU-IE), other studies have suggested so Streptococci and enterococci can be seen in about 40 percent of patients with IDU-IE. Notably, only 21.8 percent of the patients examined in POET had Staphylococcus aureus as the etiologic agent. In contrast, 73.3 percent of patients in POET had endocarditis caused by either streptococci or enterococci. However, the scientific explanation makes no comment on the role of partial oral antibiotic treatment for these pathogens, despite the larger sample size examined.

Again I wrote a letter to the editor of the AHA and the principal authors of the statement. Instead of a polite declination for publication, this time I heard nothing. In both cases, these major medical publications chose to ignore reasonable criticism of their work. In the first case, NEJM continued to promote the biases that PWIDs face through the healthcare system. In the second case, the AHA miscited existing literature and consequently made incorrect recommendations. Both NEJM and Circulation are among the most widely read medical journals in the world, and their articles have the potential to influence clinical decision-making for a large number of providers. As an infectious disease physician primarily caring for patients with substance use disorders and endocarditis, I witness daily the adverse effects of poor quality literature and guidelines that miscite existing evidence. be clear I am a proponent of oral antibiotic therapy for all patients with endocarditis and have published articles to support it. However, without the opportunity for appropriate discourse, these journals make it difficult for providers who actually care about patients to provide quality patient-centred care.

Perhaps we can start an evidence-based discourse outside the walls of these powerful institutions to transform the conversations about patient care and most importantly, put the right information in the hands of medical providers.

Sami El Dalati is a specialist in infectious diseases.

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Boy with heart failure saved by doctor who revolutionised transplants




Nine-year-old Rafi is just a child who is now thriving thanks to Richard’s research (Image: Richard Issitt/Katy Levett)

“One reason for our work is to give away a future,” explains Dr. Richard Issitt, whose pioneering research in pediatric heart transplantation has already helped save dozens of lives.

dr Richard, senior pediatric perfusionist at Great Ormond Street Hospital for Children, knew that young children awaiting heart transplants face many obstacles.

In particular, when a child receives a heart from a donor who does not match their blood type, it takes many liters of donor blood products to flush out their own. If not, the child’s blood would attack the new mismatched organ.

This meant that unfortunately only very young children could receive mismatched hearts – to reduce the amount of blood lost and discarded – and older children had to wait for life-saving transplants.

And so one night in the pub in 2014, with colleagues Alex Robertson and Richard Crook, he came up with a revolutionary idea that would change the future of pediatric heart transplants – with an original sketch drawn on the back of a beer mat.

Richard explains his work in more detail: “We don’t have that many hearts, especially for children, which is obviously a good thing (because it means children don’t die). But alas, for people waiting for a heart, it’s bittersweet. So we need to maximize the use of the donors we have.’

Richard emphasizes that in adult heart transplants, it is crucial to match a patient with a donor of the right blood type. However, this is not the case for children – they can be given a heart of a different blood group as a gift.

He says: “As we age, our immune system builds up the ability to distinguish between blood groups.

“For example, if you’re a type A and I’m a type B and your heart beat to me, my body would realize it was the wrong blood type and start attacking it; it behaves as if it encountered a virus and can’t really tell the difference. Of course, that can lead to rejection.”

The blood filter device developed by Richard and his team (Image: Richard Issitt)

This previously meant mismatched heart transplants were limited to smaller children up to four years old – to reduce the amount of blood lost and discarded.

For decades, this was a major stumbling block faced by the medical world.

But that night in the pub, Richard and his colleagues found a solution. The antibodies that cause rejection are removed during the transplantation with a special blood filter device – which drastically reduces the amount of donor blood required.

“Part of the reason we do our work is to give away a future” (Photo: Richard Issitt)

He explains: “We actually thought well, rather than just throwing away everything related to the blood surrounding the patient, why don’t we see if we can start targeting the actual antibodies that are causing the problem of rejection.”

Richard and his team experimented with specific antibody targets so that antibodies would stick to them – and not to the donated heart. After successful testing in a laboratory, it was adopted in a clinical setting.

Now, seven years later, the practice is being adopted by more and more hospitals around the world, and it also means transplants can be performed on older children too.

One of those children who received a transplant thanks to Richard’s research – which was funded by the British Heart Foundation – is nine-year-old Rafi, who was diagnosed with a heart murmur at just six weeks old.

Rafi spent much of his childhood in hospital (Image: Katy Levett)

After having open-heart surgery at the age of one and receiving a HeartWare – a mechanical pump – at the age of five, Rafi was still in need of a heart transplant at the age of six.

Various complications caused Rafi’s health to deteriorate rapidly and his mother, Katy Levett, was told in 2019 that (thanks to the team’s new technique) her son could receive a mismatched transplant of a different blood type as his only real option for survival.

By this point, Rafi had spent so much of his childhood in the hospital that Katy was willing to try anything to improve his deteriorating condition.

“If that heart hadn’t come along, he wouldn’t have made it” (Image: Katy Levett)

Katy says: “Before his transplant he had no hope. If that heart hadn’t come along, he wouldn’t have made it.

“Rafi was in the hospital for so long he couldn’t live his life and if he hadn’t gotten the heart his life would never have started.”

In a strange twist of fate, Richard himself was also involved in Rafi’s Great Ormond Street transplant on December 29, 2019 – with Katy calling it “the best Christmas present ever”.

Luckily the transplant was a success and now Rafi is a thriving little boy who has his life back.

Katy adds: “He can now do all these normal things: he can go to school, he can play football and he’s learning to swim – which he couldn’t do before.

“He’s a kid now and that’s all I ever wanted.”

“If he hadn’t got the heart, his life would never have started” (Image: Katy Levett)
Rafi is now thriving and loves to play football (Image: Katy Levett)

When we see a kid running around and making absolute havoc on the parents after a transplant, that’s my goal.

Richard and his colleague’s work means they have doubled the age group of children eligible for patients with a mismatched heart transplant – and significantly reduced the amount of blood used during those surgeries.

“Rafi was kind of a trailblazer in a lot of ways, actually due to the fact that Katy was willing to help us push the boundaries of what was possible,” explains Richard.

“It’s nice to know we’re making a difference – so when we see a kid running around and causing absolute chaos for the parents after a transplant, that’s my goal.

“There is no greater reward to see someone come out on the other side and be full of life.”

Were it not for Richard and the team’s novel idea in 2014, Rafi would likely still have been waiting for a blood-group-matched donor heart — more than a year after his mismatched transplant.

“You never think you’ll be able to need an organ, let alone your child need a heart.” (Image: Katy Levett)

Both Katy and Richard also hope their story sheds light on the importance of organ donation and blood donation – and encourage parents to have more open discussions about donating their children’s organs.

Katy adds: “None of this would have been possible without a heart donation and it’s such a taboo subject – especially with children. It is important to emphasize that without donated organs none of this can happen.

“Rafi has probably had 10 blood transfusions in total, including the blood he needed for his transplant.

“We tend to think something for old people when it comes to organ donation, but what we don’t think is a one-year-old who hasn’t lived a life.

“You never think you’ll be able to need an organ, let alone your child need a heart.”

While Richard adds, “The parents who are able to put other children first at such a devastating point in their lives are undoubtedly the unsung heroes of this. Your selflessness and generosity have made it possible for a seriously ill child somewhere to have a chance at life thanks to you.”

More at Centre County The Heart Hero Awards 2022 campaign can be found here.

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Get in touch via email Centre County [email protected] County

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The British Heart Foundation Heart Hero Awards 2022

A BHF heart herowith Centre County as a media partner this year, anyone can be, from a healthcare professional doing exceptional work, to a young person with heart disease who has shown incredible courage and determination, to an inspirational fundraiser who is creative found ways to fund research.

Those shortlisted will be invited to an awards ceremony hosted by Vernon Kay at Glaziers Hall in London on December 1, where the winners will be announced.

You can Register to watch the celebration online via live stream in the evening from 8 p.m. Guest stars will announce some of the winners.

Category judging is now complete, with Scottish footballer Scott Allan and TV and radio presenter Will Njobvu among this year’s celebrity judges.

But the Young Heart Hero and CPR Hero categories remain open for nominations throughout the year.

The awards raise awareness of the continued need for funding for the groundbreaking research that is turning science fiction into reality and bringing hope to more than seven million people in the UK living with cardiovascular problems.

To find out more about the categories or to make a nomination, Visit the British Heart Foundation website.

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