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Delivering Highly Reliable, State-of-the-Art Veteran Care | Sponsored

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Harry S. Truman Memorial Veterans’ Hospital is recognized as a leader in reliability within the US Department of Veterans Affairs for consistently delivering exceptional healthcare. Like other complex high-stakes industries – like commercial aviation – healthcare needs to be both innovative and safety-oriented. Therefore, as an organization, we strive to develop and then implement strategies that consistently lead to excellent results.

There are five strategies we use in health care delivery that enable us to achieve organizational excellence through high reliability. These strategies include:

  • Sensitivity to operations
  • Reluctance to simplify
  • Worry about failure
  • Respect for expertise
  • Commitment to resilience

Operational sensitivity simply means that all employees, not just managers, have constant situational awareness of what works and what doesn’t in our healthcare system. In a highly reliable organization, every employee must understand how their processes and systems affect not just their own work area, but the entire healthcare system. Leadership rounds and monthly employee safety forums are examples of how we create a dialogue that is always open to discussion. If an employee feels that something is not being done right, we want to know.



Dr. Katie Welch is the new Medical Director, Women’s Health at Truman VA.

High reliability organizations seek to simplify procedures to improve patient care. However, they are also reluctant to accept simple explanations for problems that negatively affect outcomes. When we don’t want to simplify an answer, we tend to dig deeper to find the real cause of a particular problem.

Regardless of their role, every employee in a highly reliable company should take a critical look at their operations and try to anticipate potential adverse issues. Dealing with mistakes is a critical strategy in providing safety-focused care. Truman VA’s simulation center is an important tool for minimizing potential risks. Our mobile team of instructors uses advanced technologies and scenarios to simulate unexpected situations away from actual patient care, but in the same environment to avoid process disruptions.

Having a team that leaves the decision-making to expert individuals – regardless of their status within the organization – is another important characteristic of a highly reliable organization. Boots-on-the-ground subject matter experts are essential for urgent situational assessments and responses.

An organization that is committed to resilience is an organization that is able to find the balance between giving meaning to an unexpected but emerging situation, coping with the problem through critical thought processes and integrating the solution into standard work, to prevent this in the future.

In addition to achieving organizational excellence, Truman VA is also focused on improving the services we currently offer and adding new patient care resources that will benefit the veterans we care for. Truman VA recently hired a new Obstetrician and Gynecologist, Katie Welch, MD, to help establish the medical center’s first obstetrics and gynecology division. Dr. Welch also serves as the hospital’s medical director for women’s health.

During the most critical time of the COVID-19 pandemic, when personal patient care had to be curtailed, Truman VA used VA Video Connect to provide healthcare services to veterans in an easy and safe way. When the COVID outbreak first started, Truman VA was already using this technology. By using an Internet-connected computer, tablet, or mobile device, providers have continued to provide personalized, high-quality care to the veterans we care for.

Infrastructure is an important feature in providing highly reliable, state-of-the-art veterinary care. Truman VA recently became the first medical center in central Missouri and the first on VA’s Heartland Network to perform bronchial thermoplastic to treat severe and persistent asthma. The new catheter-based procedure reduces the amount of smooth muscle in the airways and improves breathing capacity.

Truman VA also recently became the first medical facility in Missouri to acquire a robotic Ion platform for minimally invasive pulmonary procedures. The medical center has also just acquired a da Vinci robotic surgical system for treating hernias, prostate and kidney problems.



VA - Innovations_2

Truman VA recently celebrated the completion of the medical center’s new Progressive Care Unit with a ribbon cutting ceremony

Construction is also an important aspect of the infrastructure. Just this month Truman VA celebrated the completion of a new state-of-the-art Progressive Care Unit. The new unit provides providers with the latest technology to monitor and assess acutely ill veterans in an environment designed for this patient population.

Truman VA is also in the process of building a new stand-alone Community Living Center for our long-term patients in care facilities. Our rural veterans will also benefit from two new community-based outpatient clinics located in Sedalia and Camdenton, Missouri.

At Truman VA, our top priority is to provide our nation’s heroes with the care they deserve. If you are a veteran and want to know if you qualify for VA health care, call (573) 814-6535.

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Women’s Health

Menopause: Answering your queries

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Menopause can often be easily dismissed as a hot flash or two. It is so much more, but a serious lack of understanding and awareness can diminish any person’s experience of menopause. This can result in no questions being asked, which limits the ability to make informed decisions. When it comes to menopause, there are no awkward or ridiculous questions. Learning about menopause is crucial. Always ask.

Dr. Caoimhe Hartley founded Menopausal Health in 2021 to make menopausal women easier to access to the best advice and care. Dr. Hartley is committed to women’s health and is aware of the difficulties women face in understanding and navigating their menopause. Dr. Deirdre Lundy, of the Bray Women’s Health Center, is a women’s health specialist and leads menopausal training for Irish GPs at the Irish College of General Practitioners.

You are responding to some of our menopause concerns here.

I’m 49, but I’m not going through menopause. Does every woman have menopausal symptoms?

“Most women experience perimenopausal or menopausal symptoms,” says Dr. Hartley. “It can affect their mood, sleep, or physical symptoms such as hot flashes or night sweats. Some women may experience vaginal dryness or bladder symptoms. The loss of bone density that occurs when our estrogen production drops during menopause is largely silent.

“Fortunately, however, there is a percentage of women who have no symptoms at all. Likewise, not all postmenopausal women experience significant loss in bone density. Why some women have symptoms and others don’t may depend on genetic factors. If you have missed your period for more than a year [and you are over the age of 50], you can be sure that you are going through menopause. “

My body aches. Is that a sign of menopause?

“Generalized pain is common during menopause,” advises Dr. Hartley. “This may be due to the loss of estrogen, which has some weak anti-inflammatory properties. Similar symptoms have been seen with aromatase inhibitors, which are anti-estrogen drugs that are sometimes used in patients with breast cancer.

“This pain can have secondary effects, including lack of sleep and decreased ability to exercise or be active. Living with pain can also negatively affect our mood. You may find that an old injury is flaring up again or it is a completely new symptom. Know that you are not alone and that there are ways you can help. Joint pain can also be due to other causes such as osteoarthritis, inflammatory arthritis, and other conditions. It is always a good idea to discuss this with your GP as you may need further tests. “

My symptoms are relentless. What can I do?

“A lot,” says Dr. Hartley. “The first step is to get advice and help. Do not suffer in silence! The route of treatment will depend on what symptoms you are experiencing, what background health risks and levels you may have. I usually start by talking to patients about lifestyle interventions, exercise, CBT. to entertain [cognitive behavioural therapy], Reducing caffeine and alcohol, and a discussion of sleep hygiene, etc.

“There are also non-hormonal and hormonal options for treating menopausal symptoms. estrogen [as part of hormone replacement therapy] is most effective for treating symptoms such as hot flashes and night sweats, as well as vaginal symptoms, and also protects against the development of bone loss and osteoporosis.

“If lifestyle changes do not relieve menopausal symptoms, and this is often the case, we recommend speaking to a doctor who has been trained in menopause,” says Dr. Lundy.

I’m going through menopause and so anxious. Is that normal?

“It is very common for mood swings and anxiety to change during menopause,” says Dr. Hartley. “Many women report a loss of self-confidence, low self-esteem, irritability or loss of motivation. Sometimes these symptoms come and go and can be mild. For others, they can be debilitating.

“Women who have had a history of depression, anxiety, significant premenstrual symptoms, or postnatal depression / anxiety may be at greater risk of developing mood or anxiety disorders at the time of menopause. It is important to speak to your GP about the many options for treating all of these symptoms. “

Menopause ruins my sex life. What can I do?

“It depends on so many factors,” says Dr. Hartley. “What are the underlying problems affecting your sex life? Do you have vaginal dryness that makes sex uncomfortable or painful? Are you suffering from poor sleep or a bad mood? There are many things that can affect sexual desire and function. I would advise you to speak to your family doctor. “

I am full of anger! Why is this happening to me?

“There can be many reasons for this,” says Dr. Hartley. “The fluctuating levels of estrogen that occur during perimenopause [the years of hormonal changes that lead up to menopause, the final period] can have a huge impact on mood, irritability, anxiety, and self-confidence. Estrogen plays an important role in our nervous system and affects the production of neurotransmitters, the expression of hormone receptors in our brain and the protection of our nerve cells from damage.

“Anger is not uncommon during menopause. It has to be tackled with healthcare, ”says Dr. Lundy. “HRT can help, but sometimes hormonal changes during menopause only trigger the onset of underlying mental disorders such as bipolar disorder, severe anxiety, and depression.

“The susceptibility to mood swings or irritability is compounded by poor sleep, fatigue, and other possible symptoms,” advises Dr. Hartley. “Know that you are not alone and that there are many options to help you cope.”

Is Hormone Replacement Therapy Right For Me?

“This question is very difficult to answer because it depends on so many different factors,” says Dr. Hartley. “Hormone Therapy in Menopause” [HRT] is one of several different treatment options that we have to help women relieve symptoms of menopause. HRT also protects against bone density loss and can reduce the risk of cardiovascular disease in some women. It depends on your own background risk and the symptoms you are trying to treat. It depends on your own health values ​​and goals.

“For the majority of women, the benefits of hormone therapy for both symptom relief and health improvement outweigh the potential marginally increased risks. The type of HRT, what hormones are prescribed, and how long you take them are also important when considering the risk. Again, for most women, the benefits outweigh the risks. How long you take HRT is also very individual and there is no arbitrary age or how long you need to stop taking your medication.

“It is important to consider lifestyle factors such as smoking, physical activity, alcohol consumption and diet that can affect the long-term risk of developing osteoporosis or bone density loss and cardiovascular disease.

“It’s also important to have your blood pressure and cholesterol checked annually, and to keep up to date with breast and cervical checkups. There are many alternatives to HRT, but these depend on the symptoms affecting your quality of life and thus the goal of treatment. Whichever treatment path you choose, you should be well informed and discuss in detail with your doctor what is the best option for you. “

How long until I feel like myself again?

“This question is difficult to answer,” replies Dr. Hartley. “The duration and severity of the symptoms depend on many factors and are very individual. The average duration of hot flashes and night sweats is five to seven years. Most symptoms will improve over time, but some problems, such as vaginal dryness and discomfort, may get worse over time. “

Dr. Lunday says, “Most women between the ages of 55 and 60 feel a lift. Others can be stressed for much longer and remember that some women have no symptoms at all. “

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Vaccine hesitancy, S-equol, and women’s health in rural Africa

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Michael Krychman, MD, is a sexual health specialist and survival medicine expert at the Southern California Center for Sexual Health and Survivorship Medicine.

Barb Dehn, NP, is a Women’s Health Nurse for El Camino Women’s Group and a nationally recognized health professional specializing in pregnancy, breastfeeding, fertility, menopause, and sexual health.

MK: Hello i’m dr Michael Krychman here with Contemporary OB / GYN®. We’re at the North American Menopause Society’s annual meeting in Washington [D.C.], and I’m so excited to have Sister Barb Dehn here. She’s a regular medical reporter, she’s on NBC California Live, she wears a million different hats. We’re going to try to pick out your brain a little for the next little while.

Tell us what’s wrong? What did you do on your show?

Address vaccine hesitation

BD: We talked a lot about COVID. We talked about how to get people from being hesitant to vaccinate to being ready to vaccinate. And guess what? Trusted Ob-Gyn are some of the people that make the most difference in people’s lives because women love Ob-Gyn. They gave birth to their babies, they are always there for them. So women have a lot more influence than they might think when it comes to helping people make decisions about getting vaccinated.

MK: It’s a very sensitive subject. I know where I am in Orange County, it’s a very sensitive issue where people get their information or their misinformation. We need really good resources and how to communicate with our patients. Because I agree with you, we have influence and now we are all asking, ‘Did you get the vaccine?’ And if not, what are you hesitating about? Where do you get information from? How can we educate you to make informed decisions based on fact, not fiction, right?

BD: Exactly. And we don’t want to shame or blame. What I always say is that we have two ears and one mouth so we can listen twice as much as we can talk. By listening you can really go deeper into the real reasons, and sometimes it really comes as a surprise. And then, if possible, you can break myths, but not shame or blame them because people already feel anchored in their positions.

MK: I have to tell you the truth I have children. Your teams and I use this line all the time: ‘Two ears, one mouth, make me listen more than speak.’ And I think this is a really good clinical bead for almost everything we do, right?

BD: Especially for sex. And you are an expert in sexual medicine. No matter who I talk to about sex with, especially teenagers, I always say, ‘It’s not about the birds and the bees. It’s really about listening and asking open-ended questions. Sometimes just what-if questions, right, when you’re talking to a teenager? Or, ‘When do you think people want to have sex and you know what needs to happen in a relationship before you make that decision?’ So I like to ask a lot of questions.

Myths and Misconceptions About Soy

MK: I know you have been very busy here and I was lucky enough to only attend one session today that you presented at 1. Tell me what are the highlights and the take-home messages, because I find it really exciting and new.

Even for someone seasoned like me, I’ve brought a lot of clinical gems with me and I’m really excited about new innovations that come on the market so I know you are on the cutting edge. So tell us what’s going on.

S-Equol and Estrogen Receptors

BD: I’ve always been interested in soy because it’s a phytoestrogen. There is so much conflicting data on this, and we talk about myths and misconceptions when it comes to soy. So many people fear it because rodent studies have shown hyperplasia in the chest, but it turns out that some people metabolize soy for its natural metabolite, S-equol. But S-Equal – take this – it only works on estrogen receptor beta.

It has a 13-fold higher affinity for the estrogen receptor beta than alpha, which means that sometimes it acts like an estrogen and sometimes like a sirmaur, an antagonist, or an antagonist.

MK: Back to the basics, a lot of clinicians don’t even know. All you think about is estrogen receptors, don’t you? And you are [thinking]”All estrogen receptors are the same and they do the same thing.” We know it now and they [inaudible] really taught us that cells are sometimes turned on, sometimes turned off, and this adds another layer.

I find the alpha and beta receptors really exciting and I think it’s important to remember that not all soybeans are created equal. There are different qualities. It’s really exciting because you gave us some statistics about women and what they want, and it really opened my eyes.

BD: As a result, 2 million women go through menopause each year – and yet – only one in four uses some type of treatment, whether it is over-the-counter or prescription. But 50% – and I actually think that’s a little low – 50% of women want to use some type of dietary supplement or natural product.

Now they come to us with a lot of crazy ideas that they hear from an online influencer. It’s really up to us to look at the data and say, ‘Look, is that evidence-based?’ And: “Does it hold up against placebos?” And as it turns out, S-Equol has great data and it has great security, great security profile.

MK: I think that’s really important. Because there are many snake oil remedies out there. We see it all the time. Every day they put some strange thing in their vagina or they take this strange product that comes in a brown paper bag and we don’t know what it is. Then they have complications.

It’s really exciting that some of these companies are taking the extra step to do this research. It is very reassuring for us as clinicians to implement this. Where do you see the future of that?

Increasing knowledge of receptors for tailor-made care

BD: I am very excited. I just did a literature review of ovarian cancer cells inhibited by beta activation of the estrogen receptor, and it was recent research from the University of Texas.

I think as clinicians we will not only pay more attention to whether like breast cancer are estrogen receptor positive or negative, but if it is an alpha receptor if they are estrogen receptor positive? Is It a Beta Receptor? And how do we use this knowledge about receptors to better tailor or individualize the treatment options we have for women? You and I both know that one size never fits all. That is why we are always looking for a tool in our menopause toolbox to offer patients different things, because every woman wants different things.

MK: Or sometimes even stratify. Very often I will be doing behavioral things and I will incorporate a nutraceutical or dietary supplement. Even with estrogen, people want to stick to a lower dose, but they still want an extra boost. So sometimes you have to layer it. And I think your concept is right, precision medicine. Are you doing any other events here? Any posters, other exciting things?

Foundation for African Medical Education (FAME)

I know you genuinely care about health and health inequalities. I cannot have you interviewed without talking about your commitment to FAME. I find it really amazing so I think people want to know about it. Tell us about fame and how you started, where we are and where we need to be.

BD: That’s very nice of you, because I’ve been going to Karatu, Tanzania, that’s sub-Saharan Africa for about six years – very close to the Serengeti, very close to the wildebeest migration. I became a board member, but here I am challenged [and] loaded with.

I built our Global Fellowship program specifically for ob-gyn.

FAME is a non-denominational hospital. There is no religion involved. It’s sustainable. Really sustainable. They are all Tanzanian doctors, all Tanzanian nurses and experts like you. We’re getting the Penn neuroteam that’s coming, and we had a global colleague. I am actually recruiting post-residency fellows who come to FAME for at least three months. Our last mate liked it so much that he stayed for nine months.

We are looking for people who would like to complete their training or do a scholarship with us at FAME. It’s an amazing, amazing process and you can see a whole different part of the world. That’s why I was charged.

We have anesthesia fellows from Stanford, we have the neuro team from Penn, we had a surgeon from Creighton [University], University of Arizona for our Ob Scholar, and I would like to welcome everyone else. You can find me at NurseBarb.com if you are interested. I think I’m trying to get you to come over, right?

MK: I think I have to do this trip. What about clinicians? How can you help?

BD: If a doctor wants to come, we want you to come for at least three weeks. You would come in, you would look after your Tanzanian colleagues, you would act like a visitor. You would learn a lot about infectious diseases. We learn from each other.

There is a volunteer house and it is a safe area. We learn from each other, we work together and there is a great need for women’s health. Because – obviously – everything is created, right? You are going to see this kind of crazy stuff that you would never see in the United States. It’s an amazing experience, but we expect people to give something back. You have to pay yourself, but after that you can go on safari!

MK: Barb, I really want to thank you today for your time. It was wonderful to see you in person. I know we have been challenged by Zoom meetings and everything else. I am sure the future will be on Zoom again and in person. I know you are very busy here at the conference, but I really want to thank you for your time and insight, especially for your commitment to women’s health.

BD: Oh thank you. What a pleasure. Thank you very much.

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Women’s Health

Democrats Erase Women Through Budget “Reconciliation”

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According to the rules of the Senate, a reconciliation package should be limited to budgetary issues. But in 2021, the $ 3.5 trillion tax and spending bill that the Democrats are trying to enforce through the reconciliation process offers an opportunity for radical gender activists to infuse the language and assumptions of their ideology into federal law permit.

For example, the text on ‘Maternal Mortality’ (Part 4 of Subtitle J of Title III) consists of 15 sections providing funding for a range of grants and programs for research and education on women’s health.

And yet, in those sections that discuss mothers who may be confronted with high-risk birth-related illnesses, we find gender-neutral terminology that is repeated 18 times in more than half of the 15 sections: “Pregnant women, breastfeeding women and the puerperium “.

While “individual” or “person” is common in legal documents when the speaker can be male or female, that doesn’t explain what’s going on here. The use of vague, insignificant terms is an attempt to reconcile legal language with an ideology that denies the innate duality of male and female.

The use of the generic “persons” in subtitle J with “pregnant”, “breastfeeding” or “after childbirth” is even different from the rest of the calculation. For example, a separate section on Medicaid refers to “Pregnant and Postpartum Women”. But in such cases the bill refers to past laws that already use the word “women”, such as the 1994 Law on Violence Against Women.

Often these are direct quotations from laws that are already in the books, so gender editors have to keep the “offensive” words.

The career path is unmistakable: Wherever possible, references to women are castrated. We have seen this Congress’s commitment to the radical gender ideology of the awakened left since its inauguration days. In early January, House Speaker Nancy Pelosi, D-California, made gender-neutral language standard practice for Congress.

This approach remains in place even if the draft law deals exclusively with issues specific to women. In 2021, the decision to refer to a woman as a “pregnant, breastfeeding, and postpartum person” suggests that someone does not need to be a woman to be pregnant, breastfeeding, or experience postpartum health complications.

That, of course, is exactly the point. For some radical gender activists, being a woman is more a function of education and self-determination than nature and biology. This language reflects that belief.

Unfortunately, this lively language isn’t just kept in federal filing cabinets as an artifact of history. It will drive hundreds of millions of dollars in spending. This direction can be painfully specific.

For example, Part 4 of Subtitle J provides resources that can be used to train America’s healthcare professionals. Section 31046 provides competitive grants of $ 85 million to eligible, accredited medical schools and programs that seek to study the health effects of climate change on maternal mortality.

The scholarship holders must use these funds for curricula and training. These programs need to focus on “identifying and addressing health risks and inequalities related to climate change, providing advice and strategies to mitigate these risks and inequalities”.

But there is an option for those less concerned about the role of changing global temperature averages on lactation. Medical schools can also use the funds to examine “implicit and explicit prejudice, racism and discrimination in the care of pregnant, breastfeeding, postpartum and those intending to become pregnant”.

In abstract terms, funding the development of curricula on discrimination and bias against “pregnant, breastfeeding and postpartum people” may of course sound good. But let’s not be naive about its effect, which is to impose curricula committed to gender ideology through the power of the federal treasury. It would do this under the guise of preventing “discrimination”.

Whether this promotion could improve the well-being of pregnant women or mothers, the inclusion of such gender-neutral language signals that this is about much more than supporting mothers. Rather, it is about smuggling an ideology that destroys women into society from the federal level.

Activists have tried to advance this cause through the comprehensive equality law that enshrines gender ideology in the Civil Rights Act. But they also take every opportunity to erase references to women – from civil society to the classroom to the executive branch.

Cautious lawmakers and legislatures should reject these efforts to gradually advance radical gender ideology – and bring them to light before it finds its way into the language of our laws.

This piece originally appeared in The Daily Signal

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