Comfort care beneficial for hospitalized stroke patients, yet disparities in use persist


Receiving palliative or hospice care services was found to improve quality of life for hospitalized ischemic stroke patients, however, disparities persist in which patients are prescribed or have access to these holistic comfort care options, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Prior to the COVID-19 pandemic, stroke ranked No. 5 among all causes of death in the U.S. Nearly 9 in 10 strokes are ischemic strokes caused by a blockage in a blood vessel that carries blood to the brain. Despite advances in acute stroke treatment and management, stroke remains a leading cause of serious long-term disability in the U.S.

“Stroke death rates have declined over the past decade, however, as more people survive stroke, many face lingering consequences including varying levels of disability,” said lead study author Farhaan S. Vahidy, Ph.D., M.B.B.S., M.P.H., FAHA, an associate professor of outcomes research and the associate director of the Center for Outcomes Research at Houston Methodist, in Houston, Texas. “Many stroke patients are candidates for comfort care, including palliative or hospice care, which can improve outcomes and quality of life. It is important that stroke patients who could benefit with better quality of life from comfort care have these options available.”

Palliative care provides holistic support to patients with stroke and other chronic conditions to relieve symptoms and improve quality of life. Hospice care is end-of-life care and is usually reserved for patients among whom most treatment options are no longer feasible. And like palliative care, hospice care also aims to relieve symptoms and improve quality of life.

To better understand comfort care use among ischemic stroke patients in the U.S., researchers examined hospital patient data from 2006 to 2015 from the Agency for Healthcare Research and Quality. They found:

  • Of the nearly 4.3 million stroke hospital discharges, 3.8% received hospice or palliative care.
  • Prescribing comfort care increased during the 10-year period. Ischemic stroke patients were almost five times more likely to receive a comfort care intervention in 2014 to 2015, compared to 2006 to 2007.
  • The increasing trend in patients’ comfort care use was evident even among patients who had acute stroke treatments, including with intravenous clot busting medications, called thrombolytic therapy, and mechanical clot removal, or endovascular thrombectomy.
  • Some hospital types, including large hospitals and urban teaching hospitals, had higher rates of comfort care.
  • The average length of hospital stays for ischemic stroke patients who received comfort care was longer than stays for patients who did not receive comfort care, yet the average hospitalization costs for patients who received comfort care were lower.
  • Although comfort care continues to be associated with higher in-hospital deaths, 10-year outcome trends among patients receiving the services showed a significant decline in in-hospital deaths and a significant increase in the proportion of patients either discharged home or transferred to long term care facilities.

Comfort care use was notably lower among people who identify with non-white racial and ethnic groups. For example, use was 41% lower among Black stroke patients compared to white patients. Other factors independently associated with higher comfort care utilization were older age, female sex, non-Medicare (private) health insurance and higher incomes.

“Disparities in the prescribing of comfort care interventions among ischemic stroke patients was an important finding that needs to be carefully examined. To our knowledge such disparities have not been previously reported,” Vahidy said. “And, while more stroke patients are getting comfort care, overall use is still low, especially among people from underrepresented racial and ethnic groups.”

A limitation of the study is that the investigators examined information that did not differentiate between palliative care and hospice care usage.

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A pandemic lesson: Older adults must make preventive care a top priority

elderly mask

Older people have borne a higher burden of illness and death from COVID-19, with people 65 and older experiencing higher rates of hospitalization and death. That’s only part of the sad story, however. In many instances, older people stopped seeing their doctors, and standard clinical care for their chronic medical conditions and preventive care was postponed.

When medical clinics reopened, after initial shutdowns in the spring of 2020, many patients didn’t return. National surveys and the Centers for Disease Control and Prevention have shown that nearly a third, or about 32%, of U.S. adults reported delaying routine care because of the pandemic from March to July 2020. In fact, a national survey from the Harvard School of Public Health, the Robert Wood Johnson Foundation and NPR found that one in five U.S. households had trouble getting medical care when they needed it during the coronavirus outbreak. That was most often because of challenges getting an appointment, which resulted in poor health outcomes in more than half, or 57%, of the cases.

While care for medical emergencies is critical, preventive care is also important to optimize health, especially among older adults. As a geriatrician and professor of medicine, I think one of the best things the U.S. health care system could do is to make 2021 the Year of Preventive Care, particularly for older adults.

Care beyond COVID-19 vaccines

Because of their vulnerability to COVID-19, older Americans were first in line for COVID-19 vaccines as they became available to the public. That aligned perfectly with public health prevention strategies. Vaccination for older adults, including those for influenza, shingles and pneumonia, is a key component of preventive care.

For older adults, though, there’s more to preventive care than vaccination. Preventive care is an important piece of health care, in keeping with the patient’s other medical conditions and goals of care.

Preventive screening in older adults should be based on a personalized prevention plan between the patient and their doctor. Preventive screenings ideally identify issues before problems occur—talking about living alone, change in memory, any falls and who is around to help out when needed.

For people over 65 years old who have Medicare Part B for 12 months, Medicare allows for an annual wellness visit once every 12 months, often at no cost.

The Medicare annual wellness visit differs from a regular follow-up appointment for chronic medical conditions. This visit is fully focused on health risk and prevention. With the changes from the COVID-19 pandemic, your doctor or health care provider can even do it as a telemedicine video visit.

The focus of this visit is on preventive care and health. It includes:

  • A review of your medical and family history
  • Development or updating of a list of current providers and prescriptions
  • Height, weight, blood pressure and other routine measurements
  • Detection of any cognitive impairment
  • Personalized health advice
  • Assessment of risk factors and treatment options
  • Advance care planning
  • A schedule or checklist for appropriate preventive services, such as screenings and vaccines

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Homemade Substitutes for Skin Care Beauty Products You Use Daily

Many people believe that buying expensive branded skin care products will guarantee them good looks. This might be true to some extent, but these products also contain a ton of chemicals that do more harm than good. We believe that natural products are always better and you’ll be shocked to discover how many homemade products can get you fast results and will cost you a fraction of what you spend on skin care and beauty products.

1. Homemade Blackhead Remover

This is something everyone has to deal with at least once a month. Skin exfoliation is important to remove blackheads and dead layers of skin. All you need is 1 tablespoon of baking soda and clean water. Mix the ingredients together until the mixture has a paste-like consistency. After that, apply the mixture to your nose and cheeks and leave it on for 10-15 minutes so it to dries completely. Rinse with water and you’ll instantly see the positive results. Seems like a better option than buying expensive skin care creams, doesn’t it?

2. Homemade Skin Toner

As you already know, skin toner is used to remove oil and dirt from your skin. If you have an aloe vera plant at home, you can create a homemade skin toner with magical effects. Cut a thick aloe vera leaf and carefully scoop out the fresh aloe vera gel inside. Apply this gel to your face and neck, then sit back and relax for 15 minutes until it dries. Use lukewarm water to rinse your face. After a couple of uses, people around you will start noticing the glow on your skin.

3. Homemade Face Pack for Glowing Skin

What if we told you that you won’t need to sit at your skin care center for hours and get an expensive facial anymore? Just take 2 tablespoons of chickpea flour and 1 tablespoon of raw milk and mix them together to make a slightly thick paste. Chickpea flour improves the uneven skin tone and has magical effects on the oily skin. Milk, as we know, makes the skin smoother and brighter. Once the mixture is prepared, apply it to your face and leave the mask on for 15-20 minutes. Once it dries completely, rinse the face with lukewarm water.

4. Homemade Teeth Whitener

Having pearly white teeth is just as important as having a beautiful glowing skin. Baking soda is a common household kitchen item. Take 1 tablespoon of baking soda and mix it with 1/2 tablespoon lime juice. Apply the paste to your teeth with a brush or even your finger and let it rest there for a couple of minutes and then rinse. If you do this for a week, your dentist will start missing you soon. Whether you save a few bucks on skin care products or dental bills, it’s a saving.

5. Homemade Makeup Remover

Forget about all the expensive makeup removing products if you have coconut oil in your home. Give yourself a sublime skin treatment by applying a dab of coconut oil to your cheeks. Unlike some makeup removing products and anti-aging creams, coconut oil is a natural moisturizer and gives your face a radiant glow. If you develop a habit of massaging your face with coconut oil before going to bed daily, you’ll start noticing the glow on your skin in a matter of days.

6. Homemade Eye Lash and Eye Brow Enhancer

Of course, fake eyelashes and mascara can give your eyelashes a fuller and definitive look, but those beauty products don’t come cheap. The natural, homemade solution to this problem is castor oil. Just apply 2 drops to your eyebrows and lashes before going to sleep each night and you’ll have thick and strong ones by the end of the week. Castor oil has remarkable properties when it comes to hair growth.

7. Homemade Wax for Facial Hair

The chemicals in bleach and other hair removal products can do a great deal of damage to the skin cells. Instead of buying expensive hair removal and skin care products, this homemade natural wax can do the same trick. Just take 2 1/2 cups of powdered sugar, 2 cups of water, and 1/2 cup of lemon juice (without the seeds) and mix the ingredients together. Next, heat up this mixture for 10-15 minutes until the color turns golden-brown. Turn off the stove and let the mixture cool down a bit. Upon cooling down it will become sticky, just like wax. Apply it to your skin, pull it gently, and voila! You can even store the mixture in your icebox to heat it up and reuse it next time.

These homemade and completely natural skin care treatments are perfect substitutes to the expensive beauty and skin products on the market. Enjoy!

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Pay for elderly to live in care homes in lower income countries, rich nations advised


Rich nations should consider paying for elderly people to live in care homes in lower income countries in a bid to ease the pressure on domestic residential and nursing care provision, argues an ethicist in the Journal of Medical Ethics.

Providing such a move wouldn’t disadvantage local residents, and that appropriate quality checks could be made, this policy would enable older citizens to access affordable and decent care when they need it, contends Dr. Bouke de Vries, University of Umeå, Sweden.

The reality is that many higher-income countries are struggling to provide affordable and decent care for their relatively old and ageing populations, says De Vries.

Something has to be done, and there are already examples of German and Swiss citizens who have opted to live in care homes in Eastern Europe and South East Asia, he points out.

Paying for provision in lower income countries would be morally acceptable if five criteria are met he suggests:

a significant proportion of citizens don’t currently have access to adequate residential or nursing carethe care in homes abroad isn’t worse than that provided in domestic care homessending states conduct regular quality checks or delegate this to reliable local monitoring bodiesappropriate steps are taken to ensure that this type of migration doesn’t disadvantage local residents in the receiving countriesthe public money allocated for this isn’t better spent on other ways of easing the pressure on domestic care/nursing homes

How much a richer nation should pay will depend on several factors, he suggests. These include its wealth; the magnitude of the strain on domestic provision; and how much the public purse will save, as well as the amount of taxpayers’ money needed to convince citizens to make the move, to monitor the quality of those care homes, and to offset any disadvantage to local citizens.

This disadvantage might include fierce competition for care home places that would otherwise be available to locals and/or increasing the costs of residential care, because of the ability of migrants from richer countries to afford higher prices.

But this could be overcome by the sending countries subsidising the construction of affordable care homes for local people or building care homes within the receiving countries that partly if not wholly accommodate their own citizens, suggests De Vries.

In a linked blog, De Vries acknowledges that this migration policy is not the only solution to the crisis facing elderly care.

Others include paying formal caregivers more; providing better support to informal caregivers; and investing in robot caregivers and other forms of assistive technology. But he nevertheless believes his solution shows “great promise.”

Some people might object on the grounds that the policy might put undue pressure on people on lower incomes to migrate while others might simply feel that it is unpalatable.

“My proposal for higher-income countries to pay their residents to move to care homes within lower-income countries will undoubtedly prove controversial,” he accepts.

But should it, if the eligibility criteria are strictly adhered to? he asks.

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More burnout among pregnancy, newborn care providers during pandemic, study finds

More burnout among pregnancy, newborn care providers during pandemic, study finds

Medical professionals who care for pregnant women and newborns experienced greatly increased rates of burnout during the early days of the COVID-19 pandemic, according to a small study led by Stanford University School of Medicine researchers.

The results was published online March 16 in the Journal of Perinatology.

Among the 288 people, mostly nurses and physicians, from across the United States who responded to a June 2020 survey, 66% reported symptoms of burnout. In addition, 73% felt that their co-workers were showing more burnout. The findings raise concerns for patient safety, according to the study’s authors.

“The levels of burnout are about 2.5 times the rates we observed in pre-pandemic samples,” said Jochen Profit, MD, the study’s senior author and an associate professor of pediatrics at Stanford. The extent of caregiver burnout his team documented was equivalent to implementing new electronic medical records systems—an event widely recognized as stressful—twice in a row, Profit said. The study’s lead author is Eman Haidari, MD, medical fellow in pediatrics at Stanford.

Caregivers in the survey did not encounter high rates of COVID-19 infection among the pregnant women and newborns they cared for. However, they had to adjust to a large number of quickly changing medical protocols, to the general stressors of the pandemic and to greater levels of worry among their patients.

“In maternal and neonatal medicine, we’re on the front line, but we haven’t been hit by the hardest part of this pandemic,” Profit said. “It tells you what must be going on with the folks out there who are in other areas of medicine, such as those working in adult intensive care units.” Helping health care providers deal with burnout from the pandemic will require a large national response, he added.

Burnout linked to emotional exhaustion

Burnout among health care providers is characterized by feelings of emotional exhaustion and depersonalization. Individuals experiencing burnout also have increased rates of depression, alcoholism and suicidal ideation, as well as worse relationships with people in their lives. Prior studies have shown that health care workplaces with higher burnout levels have more problems with patient safety.

The study was conducted via an online survey offered to 673 health care workers who had participated in a webinar about mental health during the COVID-19 pandemic. The survey consisted of 13 questions about participants’ well-being and about patient safety in their workplaces. Participants’ level of emotional exhaustion was assessed using a previously validated five-question scale. The participants provided demographic information, including job title.

In total, 288 participants completed the survey. About one-third were from California. The rest were from other parts of the United States. The majority of responses (58.7%) came from nurses, with the rest from physicians (11.8%) and other health care professionals (29.5%).

Many elements of the responses indicated the toll of the pandemic: Besides the 66% of respondents who were emotionally exhausted and the 73% who felt their co-workers were increasingly burned out, 58% saw co-workers struggling to focus on work, 59% were themselves struggling to meet work and home responsibilities, 33% reported more unprofessional behavior, and 12% reported more medical errors. However, 70% were hopeful about the future, and 83% felt lifted up by their colleagues. In general, nurses reported more struggles than physicians.

Readying a response

More research is needed to understand how recent stages of the pandemic are affecting the well-being of health care providers, Profit said. Larger studies and data collected at multiple time points would help, he added. Neonatal intensive care units in California already have efforts underway to improve workplace culture. Such efforts previously have been shown to reduce burnout. But more will be needed to deal with the effects of the pandemic, Profit said.

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Medical workforce data shortage hampering access to care


Challenges with data collection and infrastructure are affecting medical workforce research and access to medical care, particularly in rural and regional Australia, according to the authors of a Perspective published by the Medical Journal of Australia.

Dr. Grant Russell, Professor of Primary Care Research at Monash University’s School of Primary and Allied Health Care, and colleagues wrote that “for many years the development of the medical workforce has been shaped by self-regulation and market forces.”

“Short term and uncoordinated workforce planning has generated cycles of contraction and expansion of training places, sporadic regulation, and recent policy dilemmas,” they wrote.

“Most recently, the dramatic increase in numbers of graduates from Australian medical schools has occurred in the absence of clear plans as to how to use these additional doctors to optimally meet community need.

“Flooding the market with more graduates has not addressed persistent rural shortages, with insufficient numbers either willing to or able to navigate a career pathway to work in areas of need.

“Oversupply continues to be an issue in some specialties (eg, emergency medicine or cardiothoracic surgery) while shortages persist in others such as general practice and psychiatry.

“Over-reliance on international medical graduates continues in many rural communities, while the fierce competition for accredited training places in some specialties leaves many junior doctors caught in the middle.”

Russell and colleagues said more high-quality longitudinal and linkable across different doctor groups and doctor characteristics was vital, but not currently available for a variety of reasons.

“The availability of administrative medical workforce data to researchers is at an all-time low,” they wrote.

“There was a reduction in funding of the Medical Schools Outcomes Database in 2015 and the withdrawal of funding (from 2016) for the Australian Institute of Health and Welfare to produce health workforce statistics.

“The Bettering the Evaluation and Care of Health (BEACH) study was also discontinued as the only data on the clinical activities of general practitioners.

“Adding to the challenge, the internationally unique Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of 9–10 000 doctors per year ceased in 2019 after 11 annual waves of data collection.”

Russell and colleagues concluded that the development of the new National Medical Workforce Strategy and the National Health Information Strategy needed to be informed by “robust evidence.”

“Future medical workforce data strategies need to be institutionally neutral, guided by a research strategy including agreed priority research questions with resources to conduct the research, and underpinned by openness and data sharing.

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Provider teams outperform solo care for new-onset chronic disease

Provider teams outperform solo care for new-onset chronic disease

(HealthDay)—Provider teams outperform solo providers for management of three new-onset chronic diseases, while among solo providers, care management and outcome differ little between physicians and nonphysicians, according to a report published in the March issue of Health Affairs.

Maximilian J. Pany, from Harvard Medical School in Boston, and colleagues used electronic health record data from U.S. primary care practices to examine how care management and biomarker outcomes after new onset of three chronic diseases (type 2 diabetes mellitus, hyperlipidemia, and hypertension) differed by team-based versus solo care and by care from a physician versus nonphysician (nurse practitioner and physician assistant).

The researchers found that irrespective of the team composition, provider teams outperformed solo providers. When receiving an abnormal biomarker result, provider teams submitted diagnostic claims at significantly higher rates than solo providers for type 2 diabetes mellitus and hypertension, but at similar rates for hyperlipidemia. Provider teams were also more likely than solo providers to have patients whose disease was under control for all three chronic diseases. Among solo providers, there was little meaningful difference in performance for physicians and nonphysicians.

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Harnessing the power of machine learning to improve urology care

Harnessing the power of machine learning to improve urology care

Urodynamics—a group of tests that evaluate how well the body collects, and then releases, urine—can be crucial for diagnosing urologic problems, particularly in children with spinal cord defects and other neurologic conditions. While urodynamics can provide clinicians with a rich set of data, the interpretation of these tests remains unstandardized. That can make it challenging for urologists to reliably read and analyze the results, says Hsin-Hsiao Scott Wang, MD, MPH, MBAn, a urologist in the Urodynamics Program at Boston Children’s Hospital.

To address this issue, Wang and his colleagues have developed a predictive model based on machine learning algorithms. This approach promises to improve physicians’ ability to accurately identify detrusor overactivity (DO), a urodynamics finding in which the bladder’s detrusor muscle contracts uncontrollably. Drawing from an archive of 799 urodynamics studies performed at Boston Children’s between 2013 and 2019, they identified five representative patterns of DO. They then created an algorithm and evaluated its performance in predicting DO.

Their results, published November 18, 2020, in Neurourology and Urodynamics, show that this predictive model had great performance with area under the curve over 0.8 and an overall accuracy of 81.35 percent, a sensitivity of 76.92 percent, and a specificity of detecting DO events of 81.41 percent. “We hope this can serve as the cornerstone and basis for future research marrying artificial intelligence (AI) and urodynamics,” says Wang.

Personalizing UTI workups in children

Machine learning also shows promise for helping to personalize the evaluation and treatment of children with urinary tract infections (UTIs). Children with febrile UTIs are at increased risk for anatomical abnormalities, including vesicoureteral reflux (VUR), which in turn is associated with recurrent pyelonephritis and renal scarring. However, it can be challenging to determine which children with UTIs should undergo further evaluation with a voiding cystourethrogram.

For a July 2019 study, Wang and his colleagues in Boston Children’s Department of Urology developed and applied a predictive model to data from 500 pediatric UTI patients. They found that this model predicted recurrent UTIs associated with VUR with very robust performance. The novel machine learning algorithm has the potential to further personalize the treatment of children with an initial UTI and identify those most likely to benefit from further evaluation. The model is now available as a free app called PredictVUR. Preliminary analysis shows that this model has helped tremendously for patient counsel and shared decision making in UTI children management.

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Trump’s Pardons Included Health Care Execs Behind Massive Frauds

At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers.

“These aren’t just technical financial crimes. These were major, major crimes,” said Louis Saccoccio, chief executive officer of the National Health Care Anti-Fraud Association, an advocacy group.

The list of some 200 Trump pardons or commutations, most issued as he vacated the White House this week, included at least seven doctors or health care entrepreneurs who ran discredited health care enterprises, from nursing homes to pain clinics. One is a former doctor and California hospital owner embroiled in a massive workers’ compensation kickback scheme that prosecutors alleged prompted more than 14,000 dubious spinal surgeries. Another was in prison after prosecutors accused him of ripping off more than $1 billion from Medicare and Medicaid through nursing homes and other senior care facilities, among the largest frauds in U.S. history.

“All of us are shaking our heads with these insurance fraud criminals just walking free,” said Matthew Smith, executive director of the Coalition Against Insurance Fraud. The White House argued all deserved a second chance. One man was said to have devoted himself to prayer, while another planned to resume charity work or other community service. Others won clemency at the request of prominent Republican ex-attorneys general or others who argued their crimes were victimless or said critical errors by prosecutors had led to improper convictions.

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Trump commuted the sentence of former nursing home magnate Philip Esformes in late December. He was serving a 20-year sentence for bilking $1 billion from Medicare and Medicaid. An FBI agent called him “a man driven by almost unbounded greed.” Prosecutors said that Esformes used proceeds from his crimes to make a series of “extravagant purchases, including luxury automobiles and a $360,000 watch.”

Esformes also bribed the basketball coach at the University of Pennsylvania “in exchange for his assistance in gaining admission for his son into the university,” according to prosecutors.

Fraud investigators had cheered the conviction. In 2019, the National Health Care Anti-Fraud Association gave its annual award to the team responsible for making the case. Saccoccio said that such cases are complex and that investigators sometimes spend years and put their “heart and soul” into them. “They get a conviction and then they see this happen. It has to be somewhat demoralizing.”

Tim McCormack, a Maine lawyer who represented a whistleblower in a 2007 kickback case involving Esformes, said these cases “are not just about stealing money.”

“This is about betraying their duty to their patients. This is about using their vulnerable, sick and trusting patients as an ATM to line their already rich pockets,” he said. He added: “These pardons send the message that if you are rich and connected and powerful enough, then you are above the law.”

The Trump White House saw things much differently.

“While in prison, Mr. Esformes, who is 52, has been devoted to prayer and repentance and is in declining health,” the White House pardon statement said.

The White House said the action was backed by former Attorneys General Edwin Meese and Michael Mukasey, while Ken Starr, one of Trump’s lawyers in his first impeachment trial, filed briefs in support of his appeal claiming prosecutorial misconduct related to violating attorney-client privilege.

Trump also commuted the sentence of Salomon Melgen, a Florida eye doctor who had served four years in federal prison for fraud. That case also ensnared U.S. Sen. Robert Menendez (D-N.J.), who was acquitted in the case and helped seek the action for his friend, according to the White House.

Prosecutors had accused Melgen of endangering patients with needless injections to treat macular degeneration and other unnecessary medical care, describing his actions as “truly horrific” and “barbaric and inhumane,” according to a court filing.

Melgen “not only defrauded the Medicare program of tens of millions of dollars, but he abused his patients — who were elderly, infirm, and often disabled — in the process,” prosecutors wrote.

Prosecutors said the scheme raked in “a staggering amount of money.” Between 2008 and 2013, Medicare paid the solo practitioner about $100 million. He took in an additional $10 million from Medicaid, the government health care program for low-income people, $62 million from private insurance, and approximately $3 million in patients’ payments, prosecutors said.

In commuting Melgen’s sentence, Trump cited support from Menendez and U.S. Rep. Mario Diaz-Balart (R-Fla.). “Numerous patients and friends testify to his generosity in treating all patients, especially those unable to pay or unable to afford healthcare insurance,” the statement said.

In a statement, Melgen, 66, thanked Trump and said his decision ended “a serious miscarriage of justice.”

“Throughout this ordeal, I have come to realize the very deep flaws in our justice system and how people are at the complete mercy of prosecutors and judges. As of today, I am committed to fighting for unjustly incarcerated people,” Melgen said. He denied harming any patients.

Faustino Bernadett, a former California anesthesiologist and hospital owner, received a full pardon. He had been sentenced to 15 months in prison in connection with a scheme that paid kickbacks to doctors for admitting patients to Pacific Hospital of Long Beach for spinal surgery and other treatments.

“As a physician himself, defendant knew that exchanging thousands of dollars in kickbacks in return for spinal surgery services was illegal and unethical,” prosecutors wrote.

Many of the spinal surgery patients “were injured workers covered by workers’ compensation insurance. Those patient-victims were often blue-collar workers who were especially vulnerable as a result of their injuries,” according to prosecutors.

The White House said the conviction “was the only major blemish” on the doctor’s record. While Bernadett failed to report the kickback scheme, “he was not part of the underlying scheme itself,” according to the White House.

The White House also said Bernadett was involved in numerous charitable activities, including “helping protect his community from COVID-19.” “President Trump determined that it is in the interests of justice and Dr. Bernadett’s community that he may continue his volunteer and charitable work,” the White House statement read.

Others who received pardons or commutations included Sholam Weiss, who was said to have been issued the longest sentence ever for a white collar crime — 835 years. “Mr. Weiss was convicted of racketeering, wire fraud, money laundering, and obstruction of justice, for which he has already served over 18 years and paid substantial restitution. He is 66 years old and suffers from chronic health conditions,” according to the White House.

John Davis, the former CEO of Comprehensive Pain Specialists, the Tennessee-based chain of pain management clinics, had spent four months in prison. Federal prosecutors charged Davis with accepting more than $750,000 in illegal bribes and kickbacks in a scheme that billed Medicare $4.6 million for durable medical equipment.

Trump’s pardon statement cited support from country singer Luke Bryan, said to be a friend of Davis’.

These treatments “involved sticking needles in their eyes, burning their retinas with a laser, and injecting dyes into their bloodstream.”

“Notably, no one suffered financially as a result of his crime and he has no other criminal record,” the White House statement reads.

“Prior to his conviction, Mr. Davis was well known in his community as an active supporter of local charities. He is described as hardworking and deeply committed to his family and country. Mr. Davis and his wife have been married for 15 years, and he is the father of three young children.”

CPS was the subject of a November 2017 investigation by KHN that scrutinized its Medicare billings for urine drug testing. Medicare paid the company at least $11 million for urine screenings and related tests in 2014, when five of CPS’ medical professionals stood among the nation’s top such Medicare billers.

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Amid COVID and Racial Unrest, Black Churches Put Faith in Mental Health Care

Wilma Mayfield used to visit a senior center in Durham, North Carolina, four days a week and attend Lincoln Memorial Baptist Church on Sundays, a ritual she’s maintained for nearly half a century. But over the past 10 months, she’s seen only the inside of her home, the grocery store and the pharmacy. Most of her days are spent worrying about COVID-19 and watching TV.

It’s isolating, but she doesn’t talk about it much.

When Mayfield’s church invited a psychologist to give a virtual presentation on mental health during the pandemic, she decided to tune in.

The hourlong discussion covered COVID’s disproportionate toll on communities of color, rising rates of depression and anxiety, and the trauma caused by police killings of Black Americans. What stuck with Mayfield were the tools to improve her own mental health.

“They said to get up and get out,” she said. “So I did.”

The next morning, Mayfield, 67, got into her car and drove around town, listening to 103.9 gospel radio and noting new businesses that had opened and old ones that had closed. She felt so energized that she bought chicken, squash and greens, and began her Thanksgiving cooking early.

“It was wonderful,” she said. “The stuff that lady talked about [in the presentation], it opened up doors for me.”

As Black people face an onslaught of grief, stress and isolation triggered by a devastating pandemic and repeated instances of racial injustice, churches play a crucial role in addressing the mental health of their members and the greater community. Religious institutions have long been havens for emotional support. But faith leaders say the challenges of this year have catapulted mental health efforts to the forefront of their mission.

Some are preaching about mental health from the pulpit for the first time. Others are inviting mental health professionals to speak to their congregations, undergoing mental health training themselves or adding more therapists to the church staff.

“COVID undoubtedly has escalated this conversation in great ways,” said Keon Gerow, senior pastor at Catalyst Church in West Philadelphia. “It has forced Black churches — some of which have been older, traditional and did not want to have this conversation — to actually now have this conversation in a very real way.”

At Lincoln Memorial Baptist, leaders who organized the virtual presentation with the psychologist knew that people like Mayfield were struggling but might be reluctant to seek help. They thought members might be more open to sensitive discussions if they took place in a safe, comfortable setting like church.

It’s a trend that psychologist Alfiee Breland-Noble, who gave the presentation, has noticed for years.

Through her nonprofit organization, the AAKOMA Project, Breland-Noble and her colleagues often speak to church groups about depression, recognizing it as one of the best ways to reach a diverse segment of the Black community and raise mental health awareness.

This year, the AAKOMA Project has received clergy requests that are increasingly urgent, asking to focus on coping skills and tools people can use immediately, Breland-Noble said.

“After George Floyd’s death, it became: ‘Please talk to us about exposure to racial trauma and how we can help congregations deal with this,’” she said. “‘Because this is a lot.’”

Across the country, mental health needs are soaring. And Black Americans are experiencing significant strain: A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days and 18% had started or increased their use of substances to cope with pandemic-related stress.

Yet national data shows Blacks are less likely to receive mental health treatment than the overall population. A memo released by the Substance Abuse and Mental Health Services Administration this spring lists engaging faith leaders as one way to close this gap.

Two congregants expressed suicidal thoughts to Carl Lucas, pastor at God First Church in northern St. Louis County. “The pandemic has definitely put us in a place where we’re looking for answers and looking for other avenues to help our members,” he says. (Evelyn Lucas)

The Potter’s House in Dallas has been trying to do that for years. A megachurch with more than 30,000 members, it runs a counseling center with eight licensed clinicians, open to congregants and the local community to receive counseling at no cost, though donations are accepted.

Since the pandemic began, the center has seen a 30% increase in monthly appointments compared with previous years, said center director Natasha Stewart. During the summer, when protests over race and policing were at their height, more Black men came to therapy for the first time, she said.

Recently, there’s been a surge in families seeking services. Staying home together has brought up conflicts previously ignored, Stewart said.

“Before, people had ways to escape,” she said, referring to work or school. “With some of those escapes not available anymore, counseling has become a more viable option.”

To meet the growing demand, Stewart is adding a new counselor position for the first time in eight years.

At smaller churches, where funding a counseling center is unrealistic, clergy are instead turning to members of the congregation to address growing mental health needs.

At Catalyst Church, a member with a background in crisis management has begun leading monthly COVID conversations online. A deacon has been sharing his own experience getting therapy to encourage others to do the same. And Gerow, the senior pastor, talks openly about mental health.

Recognizing his power as a pastor, Gerow hopes his words on Sunday morning and in one-on-one conversations will help congregants seek the help they need. Doing so could reduce substance use and gun violence in the community, he said. Perhaps it would even lower the number of mental health crises that lead to police involvement, like the October death of Walter Wallace Jr., whose family said he was struggling with mental health issues when Philadelphia police shot him.

“If folks had the proper tools, they’d be able to deal with their grief and stress in different ways,” Gerow said. “Prayer alone is not always enough.”

Laverne Williams got worried when she heard pastors tell people they could pray away mental illness. She created a multimedia presentation to educate faith leaders about mental health ― to show that faith and mental health can coexist. (Laverne Williams)

Laverne Williams recognized that back in the ’90s. She believed prayer was powerful, but as an employee of the Mental Health Association in New Jersey, she knew there was a need for treatment too.

When she heard pastors tell people they could pray away mental illness or use blessed oil to cure what seemed like symptoms of schizophrenia, she worried. And she knew many people of color were not seeing professionals, often due to barriers of cost, transportation, stigma and distrust of the medical system.

To address this disconnect, Williams created a video and PowerPoint presentation and tried to educate faith leaders.

At first, many clergy turned her away. People thought seeking mental health treatment meant your faith wasn’t strong enough, Williams said.

But over time, some members of the clergy have come to realize the two can coexist, said Williams, adding that being a deacon herself has helped her gain their trust. This year alone, she’s trained 20 faith leaders in mental health topics.

A program run by the Behavioral Health Network of Greater St. Louis is taking a similar approach. The Bridges to Care and Recovery program trains faith leaders in “mental health first aid,” suicide prevention, substance use and more, through a 20-hour course.

The training builds on the work faith leaders are already doing to support their communities, said senior program manager Rose Jackson-Beavers. In addition to the tools of faith and prayer, clergy can now offer resources, education and awareness, and refer people to professional therapists in the network.

Since 2015, the program has trained 261 people from 78 churches, Jackson-Beavers said.

Among them is Carl Lucas, pastor of God First Church in northern St. Louis County who graduated this July — just in time, by his account.

Since the start of the pandemic, he has encountered two congregants who expressed suicidal thoughts. In one case, church leaders referred the person to counseling and followed up to ensure they attended therapy sessions. In the other, the root concern was isolation, so the person was paired with church members who could touch base regularly, Lucas said.

“The pandemic has definitely put us in a place where we’re looking for answers and looking for other avenues to help our members,” he said. “It has opened our eyes to the reality of mental health needs.”

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