A 3-part series on the manifestations of physician burnout, how COVID-19 changed its scope and revealed systemic fractures, and finally, the path towards resolution and reformation. 

Crisis Point: The Physician Burnout Crisis

As disaster-level events become more prevalent globally, a greater proportion of people are being exposed to potential trauma. From this trend has come a growing prevalence of 

—an informal focus of mental health care for decades that is becoming more vital.

American Psychiatric Association (APA) 2022 Annual Meeting

 in New Orleans, Linda Chokroverty, MD, assistant clinical professor of psychiatry and behavioral sciences and pediatrics at Montefiore Health Systems and the Albert Einstein College Of Medicine, discussed the state of disaster psychiatry—a field which emerged about 40 years ago.

“It’s really a subset of psychiatry—but not necessarily so, because it involves regular psychiatrists most of the time,” Chokrovery said. “There’s some people who really become experts in the field and spend more time studying it. They would be more the specialists in the realm, but by and large, disasters are very common and increasing because of the climate situation.”

As Chokroverty explained, psychiatrists are often “inadvertently” providing aide in the event of disasters, which are capable of affecting anyone’s mental health regardless of their location or severity. Though Chokroverty and colleague’s session at APA 2022 focused on disaster psychiatry for children, the role of a family system in addressing pediatric mental health essentially makes the topic applicable to all parties.

Key symptoms of disaster-based psychiatric harm include anxiety, uncertainties about the future, fear, poor sleep health and a general sense of unease, Chokroverty said. “And that’s pretty normal, and part of our job as psychiatrists is to help people understand that…provided we do our best to resume routines and structure,” she said.

On the subject of improving affected children’s sleep, Chokroverty said it’s critical to consider a multitude of factors—from the sleep habits modeled by parents and guardians, to the resources any physician can provide that promote sleep health.

“Sleep is difficult to improve when you’ve had a lot of disruption, especially if you’ve had highly traumatic experiences,” she said. “It’s important still to try and maintain structure in the form of good sleep-promoting habits.”

Videos

Linda Chokroverty, MD, discusses the role psychiatrists play in managing the mental health effects of disasters, and how children specifically may be impacted.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Pediatrics

Pediatrics page, resources on the topics of medical news and expert insight into childhood health care can be found. Content includes articles, interviews, videos, podcasts, and breaking news on pediatric disease research, treatment, and drug development.

Sleep

On the HCPLive sleep page, resources on the topics of medical news and expert insight into sleep medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sleep apnea, insomnia, narcolepsy, and more.

The Need for Disaster Psychiatry Care

. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with 

. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Acid suppression could reduce the mortality risk for patients with 

 (GERD) following lung transplantation in data presented during

A team, led by Wai-Kit Lo, Brigham and Women’s Hospital, examined clinical outcomes in lung transplantation with acid suppression therapy with proton pump inhibitor or histamine-2 receptor antagonist use with a particular focus on early mortality within 1 year.

GERD is often linked to allograft rejection and failure following lung transplantation. This ultimately increases the risk of mortality.

Antireflux surgery is known to modulate GERD-associated risk of poor transplant outcomes, but the role of medical reflux treatment with acid suppression in lung transplant patients is poorly defined and inconsistently applied across different centers.

In the retrospective cohort study, the investigators examined lung transplant recipients at a tertiary care center between 2007-2022. The team excluded patients with pre-transplant antireflux surgery.

The investigators sought outcomes of all-cause mortality and pulmonary mortality within 1 year of transplantation. They also obtained objective reflux data from per0transplant ambulatory reflux monitoring and applied time-to-event analysis using Cox proportional hazards models.

Participants not meeting the outcome were censored at death, last clinic visit, or Nissen fundoplication.

The investigators also assessed differences between treatment cohorts using Fisher’s exact test and student’s t-test.

They identified a total of 467 patients with similar demographics, comorbidities, and pre-transplant cardiopulmonary function.

Overall, 6% (n = 28) of the patients died within 1 year of transplantation, 4.7% (n = 22) because of pulmonary disease, with pneumonia being the most likely cause.

However, both post-transplant PPI and histamine-2 receptor antagonist use were independently associated with reduced risk of 1-year mortality because of pulmonary disease after controlling for confounders, including objective acid and nonacid reflux.

Post-transplant PPI use was associated with reduced all-cause mortality within the first year, but treatment with histamine-2 receptor antagonist was not.

“Acid suppression therapy with PPI or H2RA after lung transplantation was independently associated with decreased 1-year mortality,” the authors wrote. “These findings suggest that pharmacologic treatment of GER may have a role in the management of early mortality following lung transplantation.”

A key finding was the protective effects were independent of evidence of the disease, which shows the potential mechanisms beyond acid suppression alone, such as possible direct anti-inflammatory effect by PPI as suggested in prior in vitro studies.

“Further investigations are needed on more standard applications of acid suppression therapy in this patient population to improve outcomes,” the authors wrote.

Sa1189: ACID SUPPRESSION THERAPY IS INDEPENDENTLY ASSOCIATED WITH REDUCED RISK OF 1-YEAR MORTALITY FOLLOWING LUNG TRANSPLANTATION

Articles

Both post-transplant PPI and histamine-2 receptor antagonist use were independently associated with reduced risk of 1-year mortality.

Gastroesophageal Reflux Disease (GERD)

The HCPLive gastroesophageal reflux disease page is a comprehensive resource for clinical news and insights on GERD. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for reflux disease, and more.

Acid Suppression Results in a Decrease in Mortality for GERD Patients Following Lung Transplantation

Like many public health crises, climate change does not affect all Americans equally. In fact, as 2 collaborating psychiatrists discussed with 

, the most historically oppressed populations are facing a greater—and more diverse—brunt of the 

 in New Orleans this weekend, a pair of New Mexico psychiatrists discussed the relationship between social determinants of mental health and climate change—particularly among Black, Indigenous and people of color (BIPOC).

Edward J. Neidhardt, MD, a psychiatrist with Christus St. Vincent Regional Medical Center, discussed the burden of “eco-anxiety” in younger US generations; as he noted, long-term decisions like whether to start a family, or even their perspective on the future itself, can be severely impacted by the psychological effect of environmental crisis.

“Many of them have eco-anxiety, and that amount of anxiety has been increasing over the last few years—a lot of it because of climate change and our political situation as well,” Neidhardt said. “As you get anxious, you tend to see things in a more negative way.”

Neidhardt emphasized the need to “empower” affected patients to contribute to solutions against their greatest worries; a solution to eco-anxiety can be as simple as being more active in environmental protection or rehabilitation.

But the issue may be greater in BIPOC communities, where outside contributing factors to mental health—such as poverty rates or lacking resources to care—are coupled with generally worse exposure to climate change.

Mary Hasbah Roessel, MD, a psychiatrist with Santa Fe Indian Hospital, is Navajo. She discussed how she has observed the impact of “historical trauma” on mental health outcomes among BIPOC in both her personal experiences and as a practicing psychiatrist.

“When you have indigenous people who have been displaced, forcibly removed from their homes to go to boarding or residential schools…you have the impact of having to deal with regaining your culture, your values, your family systems again,” she explained.

And, many of the reservations or regions where these populations have been settled into are more adversely impacted by climate change. “It’s a really devastating combination of circumstances,” Roessel said.

Roessel also discussed the unique impact of climate change on the mental wellbeing of indigenous people who historically practiced “living within the land” in their culture.

“Adverse weather events, climate change, all of these issues become more pertinent and devastating for us, in terms of poverty and food insecurity especially,” she said.

Neidhardt discussed the need for broadened perspective on the contributing factors to mental health.

“In dealing with this, we really need to take a broad look at how we cope, and how we teach our patients, both dealing with acute symptoms of anxiety but also if they have PTSD, taking more active treatments…and looking at the other factors such as housing, employment, and all the things that impact people as well,” he said.

A pair of psychiatrists discuss how climate change and other social determinants of health are affecting the mental wellbeing of indigenous people.

Eco-Anxiety and Contributing Mental Health Factors Among BIPOC

Connor Iapoce is an assistant editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

New findings suggest a higher adherence to the Dietary Approach to Stop Hypertension (DASH) diet had strong protection against 

incident non-alcoholic fatty liver disease (NAFLD)

 risk. On the other hand, higher scores in the Mediterranean diet study cohort had a weak, but inverse association with this same outcome.

“In the entire cohort, 18.6% developed NAFLD, and on average, liver fat increased for all participants,” wrote study author Ioanna Yiannakou, MS, Department of Medicine, Preventive Medicine and Epidemiology, Boston University School of Medicine. 

2022 Digestive Disease Week Meeting in San Diego, California

Although diet is essential for treatment of NAFLD, particularly in the early stages of the disease course, the optimal diet remains to be known, according to investigators. The current study investigated whether adherence to a specific diet was associated with changes in liver fat or incident NAFLD in the Framingham Heart Study.

Yiannakou and colleagues additionally investigated whether these associations were modifiedby cardiometabolic dysfunction. They included individuals who had undergone an abdominal computed tomography scan and were found free of NAFLD, for the incident NAFLD analyses.

However, they excluded those with heavy alcohol intake, which they defined as >7 drinks a week for women or >14 drinks a week for men. Investigators then calculated the liver fat attenuation on a CT scan to determine liver fat and derived dietary data from food frequency questionnaires for both DASH and Mediterranean Diet adherence scores.

Further, they used modified poisson regression models to compute incidence NAFLD risk ratios (RR) and 95% confidence intervals (CI) associated with score categories after adjustment for age, sex, educational status, alchol intake, current cigarette smoking, physical activity, and multivitamin use. Linear regression models computed the adjusted means of liver fat change over 6 years of median follow-up, according to the study authors.

The data show participants with higher DASH or Mediterranean Diet scores were mostly women with a mean age of 51 ± 9 years and were less likely to be current smokers, with lower BMI and abdominal adiposity at baseline.

A higher adherence to the DASH diet compared to a lower one was associated with 37% reduced risk of incident NAFLD (95% CI, 0.43 - 0.92) and a statistically significantly less increase in liver fat over study follow-up, investigators found.

They additionally observed anthropometric and medical-related factors modified the protective effects of the DASH score. They exemplified this findings by showing participants with a higher DASH score who had lower abdominal adiposity had a lower NAFLD risk (RR: 0.15; 95% CI, 0.07 - 0.32) than those with either the risk factor alone (RR for higher DASH scores: 0.82, 95% CI: 0.56 - 1.19; RR for lower adiposity: 0.30, 95% CI, 0.21 - 0.43).

Meanwhile, a higher DASH score combined with no prevalent hypertension or diabetes had the lowest NAFLD risk. Additionally, the association with higher Mediterranean diet adherence score was weaker except in those with a lower ratio of fasting triglyceride to high-density lipoprotein (RR: 0.51, 95% CI, 0.37 - 0.71).

The study, “Higher Diet Quality is Associated with Lower Non-Alcoholic Fatty Liver Disease in the Framingham Heart Study,” was presented at 

DASH diet was inversely associated with NAFLD risk, independent of BMI changes. 

Hepatitis C

Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Higher Adherence to DASH Diet Linked to Stronger Protection Against NAFLD Risk 

Digestive Disease Week (DDW) 2022 Meeting

 in San Diego, investigators find that ribavirin is not a suitable option for patients with genotype 3 hepatitis C virus (HCV) and compensated cirrhosis.

A team, led by Wen Xin Flora Xu, National University of Singapore, evaluated the efficacy and safety of sofosbuvir/velpatasvir with or without ribavirin in genotype 3 compensated patients with cirrhosis.

The current guidelines for genotype 3 HCV care for patients with compensated cirrhosisthat were treated with 12 weeks of Sofosbuvir/Velpatasvir call for the use of ribavirin for unless baseline resistant-associated substitution mutations were excluded.

However, this testing is not yet widely available and the clinical differentiation between compensated cirrhosis from advanced fibrosis is challenging in the primary care setting.

“A safe and simplified regimen is crucial for global hepatitis C Virus (HCV) elimination,” the authors wrote.

The investigators suggest balancing the risk of treatment-related adverse events and the need for closer monitoring in adding ribavirin to a sofosbuvir/velpatasvir regimen.

In the systematic review and analysis, the investigators identified studies from inception to June 2021 involving HCV genotype 3 compensated patients with cirrhosis treated with sofosbuvir/velpatasvir with and without ribavirin.

The team sought secondary outcomes of treatment-related adverse events, defined by symptomatic anemia requiring transfusion or a drop in hemoglobin beyond 2 g/dL.

Overall, the final analysis included 7 studies involving 1088 patients.

Sustained virologic response at 12 weeks was similar in both intention-to-treat (RR, 1.03; 95%CI, 0.99-1.07; I

= 0%) and per-protocol analysis (RR, 1.03; 95%CI, 0.99-1.07; I

= 48%) of patients treated with sofosbuvir/velpatasvir.

The overall pooled rate of treatment-related adverse events was 7.2%.

In addition, ribavirin use increased the overall pooled risk of treatment-related adverse events (RR, 4.20; 95%CI, 1.29-13.68; I

= 0%). In the subgroup analysis, the investigators found ribavirin wax related to an increased sustained virologic response at weeks in patients with baseline resistant-associated substation mutation, but it did not significantly increase the sustained virologic response at 12 weeks among treatment-experienced patients.

“In GT3 compensated cirrhosis patients treated with 12 weeks of SOF/VEL, RBV was associated with higher adverse events without significant improvement in SVR12,” the authors wrote. “Our findings suggest routine RBV is not mandatory for GT3 compensated cirrhosis patients treated with SOF/VEL.”

EP1198: EFFICACY AND SAFETY OF ADDING RIBAVIRIN FOR GENOTYPE 3 HCV COMPENSATED CIRRHOSIS RECEIVING 12-WEEKS OF SOFOSBUVIR/VELPATASVIR: A META-ANALYSIS

The treatment did not improve sustained virologic response but did increase the rate of treatment-related adverse events.

Ribavirin Not Effective, Safe for Genotype 3 HCV

There remains a need for longer-term observational studies comparing the 2 treatments. 

Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Anti-TNF, Ustekinumab Have Similar Efficacies Against Crohn’s Disease

It takes even more than a village to provide the comprehensive care needed for aging, neurocognitive patients, says Rajesh R. Tampi, MD, MS.

Geriatrics

Geriatric medicine condition center page is a comprehensive resource for clinical news and insights on frequent geriatric-related diseases and conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for sleep disorder, dementia, Alzheimer's disease, and more.

Who Makes Up the Modern Dementia Care Team?

A 6-year mirror analysis of risperidone, once-monthly paliperidone palmitate or once-monthly aripiprazole concludes suggesting the regimens may serve as an alternative to clozapine.

Schizophrenia

The HCPLive schizophrenia page is a resource for medical news and expert insights on the mental disorder. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for schizophrenia, and more.

Second-Generation Long-Acting Injectables Significantly Improve Long-Term Severe Schizophrenia Outcomes

Rajesh R. Tampi, MD, MS, discusses the evolved interpretation of neurocognition, and how its spectrum of symptoms impact clinical development.

Alzheimer Disease

Alzheimer Disease condition center page, resources on the topics of medical news and expert insight into Alzheimer's can be found. Content includes articles, interviews, videos, podcasts, and breaking news on Alzheimer disease research, treatment, and drug development.

Neurology

Neurology condition center page is a comprehensive resource for clinical news and insights on nervous system disorders. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for Alzheimer's disease, brain injury, PTSD, and more.

The Developing Dementia Definition, Treatment Field

Sarcoidosis expert Dr. Wonder Drake got into the field after diagnosing a patient with the disease early in her career. In this interview she explains the best way to approach a suspected case of sarcoidosis. 

Rare Disease Report®

The Rare Disease Report page is a resource for medical news and expert insights on rare diseases. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for sickle cell disease, multiple myeloma, and more.

Family Medicine

Family Medicine condition center page, resources on the topics of medical news and expert insight into family care can be found. Content includes articles, interviews, videos, podcasts, and breaking news on Family medicine research, treatment, and drug development.

Wonder Drake, MD: Sarcoidosis is a Disease of Exclusion

Armand Butera is the assistant editor for 

. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining 

. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at 

Dupilumab is the first treatment in the US indicated for adults and pediatric patients over 12 years with EoE. 

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

FDA Approves Dupilumab for Eosinophilic Esophagitis 

Guselkumab was effective in patients with previous biologic therapies, comorbidities or psoriasis manifestation in difficult-to-treat areas.

Atopic Dermatitis

Atopic Dermatitis condition center page, resources on the topics of medical news and expert insight into eczema can be found. Content includes articles, interviews, videos, podcasts, and breaking news on dermatitis research, treatment, and drug development.

New 52-Week Data Finds Guselkumab Well Tolerated in Moderate to Severe Psoriasis

Despite being one of the most common dermatologic conditions, the etiology of chronic pruritis is still unknown, and conventional medication may not always result in a good therapeutic response.

Study Finds Limited Evidence Regarding Herbal Remedies for Chronic Pruritus

Dr. Carolyn Rowley talks about the Cayenne Wellness Center's mental health initiative for individuals with sickle cell disease and shares the story of one of her first patients.

Sickle Cell

Sickle Cell condition center page, resources on the topics of medical news and expert insight into sickle cell disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sickle cell research, treatment, and drug development.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

Carolyn Rowley, PhD: Patients with Sickle Cell Disease are Born into Pain

A significant decrease in SII, SIRI, CRP, and UAS-7 was observed in the third month of omalizumab treatment, and the responder groups at 3 and 6 months of treatment had significantly higher baseline SII and SIRI levels than non-responders.

Latest News

The Need for Disaster Psychiatry Care

Acid Suppression Results in a Decrease in Mortality for GERD Patients Following Lung Transplantation

Eco-Anxiety and Contributing Mental Health Factors Among BIPOC

Higher Adherence to DASH Diet Linked to Stronger Protection Against NAFLD Risk

Ribavirin Not Effective, Safe for Genotype 3 HCV