The Rounds Initiative at XULA (2016)

The Rounds Initiative recently returned to the place where it all began, Xavier University of Louisiana. It was from this initiative that the creator and guest physicians, dentists, nurses, and other healthcare professionals have educated and motivated hundreds of students to continue their pursuits of careers in the medical field.  The 2016 sessions continued to be large successes with many of the students staying after the presentations and question and answer portions were completed to speak with the physicians and dentist who volunteered their time. Efforts such as this can and will effectively change the narrative that young minority students see and understand.  It is for that reason that I want to share a few clips of the 2016 September session, and will continue to promote the conducting of The Rounds Initiative across the country when able to do so. Be sure to check it out below and follow both Dr. Jasper (@drbjasper) and The Round Initiative (@theroundsinitiative) on Instagram to see some motivating and educational posts.

– Supreme Soul

How ironic is it that at the most recent session of #TheRoundsInitiative the topic of how to deal with micro-aggressions while being a minority in the healthcare field was discussed. We believe Dr. Sherman, featured in this clip, and our other guests each gave very poignant answers on different ways to deal with it. We also want to take a moment to say whether it be micro or macro-agressions against minorities in the healthcare field, we all at The Rounds Initiative stand with our sister in medicine, Dr. #TamikaCross in her recent experience dealing with this same subject. Many of us experience this for no other reason than ignorance to idea that if you are of a certain skin tone then you can be that color and be qualified, educated, and smart enough to do a certain job. With that we thank all of our minority doctors, #pharmacists, #nurses, #physicianassistants, #technicians, and anyone else we may have not have mentioned for continuing to remain steadfast despite this logic. Because both @theroundsinitiative and @cmmpmed, on top of the foundation and mission that @drbjasper has established, know #WhatADoctorLooksLike and we will continue to ensure there are plenty more of those same doctors for generations to come. #medicalstudents #medicalschool #medschool #premed #medicaleducation #mentor #mentoring #doctors #blackdoctors #cmmpmed #drbjasper #hbcu #hbcugraduates

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Barriers and Benefits of Palliative Care For Minorities

As the U.S. population becomes increasingly diverse, minorities are strikingly underrepresented in hospice and palliative care programs. Health care disparities are commonly documented for African-Americans, Hispanics, and other groups compared to whites across a range of diseases, including cancer and cardiovascular disease. Similarly, studies have consistently demonstrated a disparity in hospice use of older adults within minority groups than for whites across diagnoses, geographic areas, and settings of care. It is for this reason I wanted to put together something that highlights some of the barriers and benefits of palliative and hospice care among minority groups.

Barriers
While the list of barriers to the use of palliative care by minorities can be extensive, I will try to focus on those that are more prominent and have been researched in some way. Several factors may account for underutilization of hospice care among specific minority groups. Some of these include confusion about terminology (both medical and non-medical), misperception about the intent and scope of care, spiritual and religious beliefs, and mistrust of the motives and services involved.

Studies have commonly shown a disproportionate gap in knowledge about palliative care among minority older adults. Research has shown that many African-Americans often do not have the information they need to make decisions about hospice care. Specifically, they lack knowledge of the nature of hospice services, possible locations where they can receive hospice care, and information on how they can pay for hospice.

Also, the confusion about terminology (e.g. hospice vs. palliative care) and misperceptions about the intent and scope of hospice and palliative care are deep-rooted among minorities. These services are often thought to be for patients with only terminal or malignant diagnoses (such as cancer), or they are believed to only be administered in an inpatient hospital setting.

Other research suggests that within certain cultures, especially within minority communities, spiritual and religious beliefs may conflict with the goals of palliative care. Spirituality is a large component of many cultures. One study found that within African-American culture many families would pray for a miracle rather than accepting death through hospice often because the latter was looked at as “giving up”. Other studies have shown that in many cases African-Americans also value caring for and being cared for by family member. They view this as a way to express respect and dignity for loved ones and for this reason steer clear of hospice and palliative care.

Mistrust of the health care system due to past injustices in research (e.g. The Tuskegee Experiment, Henrietta Lacks, Cold War Radiation Tests, etc.) and ongoing disparities have also led to concerns about forgoing palliative or hospice services. Most cultures trust loved ones to make the best end-of-life decisions on their behalf, and minorities have displayed this concept far more frequently than whites. As a result, many of these cultural groups may use advanced directives less often as well.

Studies also consistently document greater preference for life-sustaining therapies regardless of prognosis among African-Americans and Hispanics compared to whites. So uncertainty of disease prognosis poses an additional barrier for physicians, patients, and families alike. Unpredictable disease courses, physician overestimation of remaining life expectancy, and a lack of familiarity with various prognostic tools can all play a role in the decreased minority utilization of palliative and hospice services.

Other beliefs that may present a barrier to the use of palliative care include less positive attitudes toward disclosure of terminal illness among specific minority groups, concerns about cost and insurance coverage of the services, and the absence of minority staff, interpreters, and community involvement among the organizations providing the services.

Benefits
Palliative care aims to relieve suffering by identifying, assessing, and treating pain and other physical, social, and spiritual problems. It often improves the quality of life for patients with life-threatening illnesses and their families.

Hospice is a type of palliative care that can be provided when curative treatment is no longer found to be beneficial or desired, and when life expectancy is measured to be several months or less. It supports patients and their families while focusing on symptom relief and comfort.

Palliative care can be provided whether an illness is potentially curable, chronic, or life-threatening, and can be administered in conjunction with curative-aimed therapies at any stage of the illness.(6) Both can be provided to patient and families at home or in skilled nursing facilities and studies have shown that patients who receive hospice care have improved quality of life, with less depression and symptom burden.

Patients often feel more in control while receiving these services and are able to avoid risks associated with treatment and hospitalization. Small studies of home-based palliative care and inpatient palliative care consultation have reported favorable outcomes for African-Americans, Hispanics, and Asians/Pacific Islanders, including increased satisfaction, greater rates of home deaths with loved ones present, and increased documentation of patient treatment preferences.(5)

It should also be known that patients with a terminal illness do not usually have to pay for hospice care. These costs are covered by Medicare through the Medicare Hospice Benefit, Medicaid in most states, and The Veteran’s Health Administration.

According to Medicare.gov, depending on the terminal illness and related conditions, the plan of care your hospice team creates can include any or all the following services:

  • Doctor services
  • Nursing care
  • Prescription drugs for symptom control or pain relief
  • Hospice aide and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Short-term inpatient care (for pain and symptom management)
  • Grief and loss counseling for you and your family
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)

What may be even more shocking is that in a study of patients with metastatic lung cancer, those who received palliative care had improved survival rates compared with matched patients (controls) who received standard treatment. So in some instances terminally ill patients survived longer than those who did not go into or receive palliative or hospice care.

That means more time with loved ones, family, and friends during a difficult but important time in life for these terminally ill patients. More time is something that families will not hesitate to have with those they care for deeply which is perhaps the greatest benefit you can gain from all of this. So one can see how these services may be of benefit to people of different cultures, spiritualities, economic standings, and educational levels.

The take home point from the aversions and advantages of using palliative care and hospice services is that this is not just a simple or easy topic to discuss or think about. The studies that were referenced show that because there are a lot of interesting complexities within different cultures it also does not have a one size fits all solution. It will take efforts from the patient, their loved ones, healthcare professionals, and the organizations providing services to address how beneficial palliative or hospice care might be in an individual setting. As this continues to happen, minority cultures can begin to be more educated about, and accepting of, these services on a more consistent basis.

– Supreme Soul

To Be or Not To Be A Gymnast?

With the Olympics in full swing, and U.S. gymnasts racking up gold medal after gold medal you’re probably thinking….”Maybe I should get my kid into gymnastics!” But shortly after that statement you might wonder “what are the benefits of gymnastics?” or better yet “what are the risks?”.

Well it’s those sort of questions that led to me writing about the common benefits that come with gymnastics. Oh, and the risks too!

Benefits
After reviewing a few different sources I found some common themes that benefit those in the world of gymnastics. For starters, participation in weight-bearing activities like gymnastics can help to develop strong, healthy bones. This is important to develop at a young age as we inevitably experience a decrease in bone mass every year the more we age. Building strong, healthy bones when children are young can help reduce the risks of developing osteoporosis later in life.

Another common benefit for gymnasts is something beyond physical gain, and that is the benefit of improving concentration and mental focus. Gymnastics allows children the chance to think for themselves, to stimulate their imaginations, and to determine how to solve problems safely.

Also, gymnasts have been known not react with as large of a “startle response” to sudden changes in balance as non-gymnasts. By applying their conditioning outside the sport, those people become better equipped to avoid hazardous situations by quickly identifying them and naturally correcting body alignment when walking, standing, or jumping. In other words, they are less likely to fall when the stumble of something that was unexpected.

An additional advantage in gymnastics is an increasing level of flexibility. This can be an effective aid in the reduction of injury by preventing people from forcing a limb to an overextended position. By learning movements and combining them in a routine, gymnasts often attain greater flexibility and greater control of the body.

To add to all of that, a 2001 study conducted by researchers at the Robert Wood Johnson Medical School and the University of Medicine & Dentistry of New Jersey also indicated that children who participated in physical activity like gymnastics were likely to have better self-esteem and self-efficacy. They found that the more time children ages 10 to 16 spent being active, the higher they reported having self-efficacy and self-esteem.

The American Heart Association recommends children take part in 60 minutes of physical activity per day. Therefore, participating in gymnastics would help kids meet these exercise recommendations and will likely raise those kids’ feelings of being amazing! Gymnastics can help maintain a healthy body weight, which is also key to preventing many health conditions such as asthma, cancer, obesity, heart disease and diabetes.

Those are just some of the benefits kids get with the gymnast life, but let’s not forget about the other side of this discussion. Many people who have been around gymnastics can also attest to the negatives that come with the lifestyle as much as they can about the positives. So let us mention those so we have a full picture.

Risks

Right from the beginning it must be mentioned that sustaining an injury is one of the largest cons of participating in gymnastics. A study, conducted by researchers in the Center for Injury Research and Policy (CIRP) at The Research Institute at Nationwide Children’s Hospital, examined information on children 6 to 17 years of age who were treated in hospital emergency departments for gymnastics-related injuries between 1990 and 2005. According to its findings, on average nearly 27,000 injuries are reported each year. To go one step further, the likelihood of being injured while doing gymnastics is 4.8% per 1,000 gymnasts, and those between the ages of 12 and 17 had the highest rate of injury at 7.4% per 1,000 gymnasts.

Another reported issue was that children who take gymnastics training at a young age are no longer allowed to simply be children. Training can take up a good deal of their time so they don’t often have the luxury of free play. According to the American Academy of Pediatrics, a child may experience feelings of failure and frustration when the demands of the sport exceed their cognitive and physical development.

Extreme dieting may be another serious hazard to young children due to the pressure to stay small in gymnastics. This can lead to eating disorders and stunted growth which can also have lasting, psychological effects on preteen and teen. In a 1992 NCAA survey, 51% of the gymnastics programs that responded reported eating disorders among its team members, a far greater percentage than in any other sport.

Parents who may be considering gymnastics for their children often worry that there may be a relationship between gymnastics and delayed physical development. The International Gymnastics Federation believes that if there is a relationship between gymnastics and delayed growth, it is likely related to intense and repeated physical effort.
Many studies have shown that intense physical activity causes changes in the release of hormones that control growth. Physical signs of this include small stature, delayed bone growth, delayed onset of menses, and menstrual disorders.

However, while some studies have focused specifically on gymnastics, others have not found any difference between the effects of gymnastics and other sports in general. Although gymnastics is often singled out, any sport can cause growth delays and postpone maturity, depending on the intensity at which the child trains.

So there you have it. As always please consult with a health care professional before making any medically related decisions and good luck on creating the next or first Olympic gymnast in the family.

– Supreme Soul

Which Gynecological Disease Increases Risk of Heart Disease in Young Women?

Nausea.

Painful periods.

Excessive bleeding.

Pain with intercourse.

Fatigue.

Pain with bowel movements or urination.

These are just some of the symptoms associated with a disorder that has been found to occur in 7-10% of US women in the general population and found in 50% of teenagers with extremely painful periods. Things found to increase the risk of this condition are very common in a number of women and include stuff like beginning menses at an early age, extended menstrual flow (>7 days), delay in pregnancy, and heavy bleeding during the menstrual cycle.

What’s probably the most concerning is that if it is left untreated this same disorder can lead to infertility and even ovarian cancer. That is, until a study was published in an American Heart Association Journal (Circulation: Cardiovascular Quality and Outcomes) stating that women age 40 or younger were at a disproportionately higher risk to suffer cardiovascular symptoms and disease if they were confirmed to have this issue laparoscopically.

How disproportionate? Well the women in the study that were confirmed to have this disease were three times as likely to develop heart attack, chest pain, or need treatment for blocked arteries, compared to women without the condition. Researchers from Brigham and Women’s Hospital followed 120,000 women over 20 years for this data and found that nearly 12,000 participants had suffered with this condition. So compared to women without it, women with the condition experienced:

  • 52% increased risk of heart attack
    (myocardial infarction)
  • 91% increased risk of developing chest pain(angina)
  • 35% increased risk of needing surgery or stinting to open blocked arteries (coronary artery bypass grafting or CABG)

So enough about all the numbers. The most important question on your mind now is what is the condition causing all these symptoms and complications? Better yet, what can I do to make sure that this isn’t something me or my loved one is going to deal with or has already had at some point? Well this infamous disorder is called endometriosis and it occurs when there is a growth of the tissue that lines the uterus (endometrial tissue) in other places within the body.

This misplaced tissue responds to changes in women’s hormone levels much like it would if it remained in the uterus. To put it more plainly, imagine the tissue that should be in the uterus causing a “period” (and all the things that go along with it) wherever it’s located in the body. This can lead to a large amount of damage via an inflammatory response consisting of neovascularization and fibrosis formation.

Just about any organ system within the body can be affected by this misplaced tissue, and the exact cause of endometriosis is poorly understood. One of the most likely causes is something called retrograde menstruation, which is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. Other possible causes include surgical scar implantation (after a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision) and endometrial cells transport (blood vessels or the lymphatic system transports endometrial cells to other parts of the body).

So now you have your answer to the first question we can now go back to the second question, and that is what can be done about this condition? Well there is an extensive list of potential ways to treat endometriosis and that list includes things like different hormone therapies (birth control medication or medication that halts the growth of the endometrium). If those don’t work then you may have to move to more invasive alternatives like surgery on the endometrial tissue directly or removal of the uterus altogether (hysterectomy).

Yet, another interesting fact about the study that was mentioned earlier was that having had a hysterectomy was also found to have an association with higher risk of cardiovascular disease compared with not having had a hysterectomy. (Now ain’t that something!) Since treatment may be as much of an issue as the condition itself I must mention another type of way to deal with some of these issues. That method is called prevention.

The recommendations for prevention are usually a lot cheaper and offer less potential complications than medications and surgeries. So please don’t be surprised that they are things like eating a healthy diet and staying active by doing at least 30 minutes of moderate to rigorous physical activity per day. Physical activity can help to improve pain symptoms associated with heart disease and in some cases endometriosis. It’s also recommended to maintain a healthy weight and losing weight since the latter can decrease chronic inflammation, which is one of the key issues with both endometriosis and cardiovascular disease. Other things include quitting (or do not start) smoking and taking warm baths which can help relax pelvic muscles, reducing cramping, and improve pain.

In all, you should consult with a doctor or healthcare provider about any questions, symptoms, treatments, or prevention measures before beginning them. I hope this has been a helpful post and thanks for reading.

– Supreme Soul

James Derham


James Derham was the first Black person to receive a certificate to practice medicine in the U.S. He won his freedom and set up his own practice in New Orleans. He was the first African-American to formally practice medicine in the United States though he never received an M.D. degree. Derham was born into slavery in Philadelphia, Pennsylvania. He was owned by several doctors and by working as a nurse/medical assistant, he saved enough money to purchase his freedom by 1783. In the same year he ended up in New Orleans with a Scottish physician, to perform medical services. He opened his own medical practice, and by age 26 his annual earnings exceeded $3,000. He was a popular and distinguished doctor in New Orleans, at least in part for his knowledge of English, French, and Spanish. In 1789, Durham saved more yellow fever victims in New Orleans than any other physician in colonial Philadelphia.

Supreme Soul

Dr. Solomon Carter Fuller

Here at 3GW, it was decided to give readers some information about influential African-Americans for Black History Month. I will try to keep it brief and informative and hope you all enjoy.

Solomon Carter Fuller, M.D.

Solomon Carter Fuller, M.D. was the nation’s first African-American psychiatrist and a neurologist who made significant contributions to the study of Alzheimer’s disease. He also focused his research on the organic causes of disorders such as schizophrenia and bipolar disorder. Fuller’s knowledge of venereal disease later helped diagnose syphilis in black World War II veterans who had been previously misdiagnosed with behavioral disorders. The mental health facility at Boston University is now officially known as the Dr. Solomon Carter Fuller Mental Health Center.

Supreme Soul