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On this episode of Raise the Line, we’ll introduce you to a relatively new company in the digital health space focused on treatment-resistant mental health patients, which constitute about 30% of people in the US with a mental health diagnosis. Our guest is Jimmy Qian, the co-founder and president of Osmind, who believes mental health practitioners could benefit from a more data-driven approach. “We can't understand the biology of neuropsychiatry unless we get more and more multimodal data and work together as a scientific community to really understand how mental health even works, and that requires rethinking diagnosis and treatments from the ground up using data,” says Qian. As he tells host Shiv Gaglani, Osmind is sharing its data with researchers to help improve scientific understanding of hard-to-treat conditions and has already published two studies with Stanford, including the largest ever real-world analysis of ketamine as a treatment for depression.  Check out this informative conversation to learn how Osmind’s platform is also giving patients the opportunity to provide real-time information on how they're doing between visits and helping providers smooth out their workflow.

Mentioned in this episode: https://www.osmind.org/

This episode of Nursing Australia presents:  

The latest Nursing Australia News (02:36) 

Pharmacists prescribing scope extended, Ballooning demand for Ozempic bites again, and CPR gender bias revealed. 

1. Purple House: Sarah's Story (05:25) 

Meet Sarah Brown, CEO of Purple House. Before the Purple House was established Pintupi people from the Western Desert of Central Australia were forced to leave their country and families to seek treatment for end-stage renal failure in Alice Springs or Darwin. Far from home, they suffered great loneliness and hardship, and weren’t around to pass on cultural knowledge in their communities.  

Discover Purple House  

#yes23

2. Navigating Medical Abortions (20:40) 

In 1996, the Australian government stifled access to RU-486. Despite some eventual revisions, barriers to access still remained, until today. The space around abortion care in Australia continues to evolve. So, what is the latest?  

The Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPs) is an online community of practice interested in increasing women's access to long-acting reversible contraceptives (LARC) and medical abortion. GPs, practice nurses and pharmacists are invited to join. There is no cost to do so. 

 3. Early Detection & Management of CKD (34:38) 

Early detection and management of chronic kidney disease (CKD), so, how can this preserve vital renal function? What can health professionals and patients do to prevent this silent killer? 

Access Chronic Disease Management Tools here 

Kidney Health Australia  
 

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APNA Online Learning Hub  

Astra Zeneca's Chronic Disease Management Tools 

Hosted by: Matthew St Ledger & Mitch Wall
Produced by: Leith Alexander & Matthew St Ledger

If you were to name one thing that could simultaneously increase patient satisfaction and reduce provider burnout, would empathy come to mind? Well, based on research published in peer-reviewed journals, it should, as we’ll learn from our Raise the Line guest Dr. Helen Riess, a clinical professor at Harvard Medical School and author of the book, The Empathy Effect. Trained as a psychiatrist, Riess has built a training program based on the neuroscience of emotion that bucks the prevailing wisdom that empathy is an inborn trait that can’t be taught. “I feel your pain is not just a figure of speech. We actually do feel other people's pain and our very survival depends on it,” Riess explains to host Shiv Gaglani. The company Riess founded and leads, Empathetics, has put thousands of clinicians and frontline staff through its e-learning courses with impressive results including major increases in patient experience scores and improvements in staff retention with the longest follow-up case study showing an 82.9% decrease in turnover among participating clinicians. In a nutshell, the training builds perception of emotion and fosters a deeper understanding of what Riess calls ‘the whole person.’ “You know, not just the broken wrist, but what does the broken wrist mean for a sixty-five-year-old woman who is the only caretaker for her grandchild?” Join us for a fascinating look at the neuroscience of empathy and its role in transforming the culture of healthcare.

Mentioned in this episode: https://www.empathetics.com/

The value of early detection is perhaps greater for cancer than many other diseases because it remains the second leading cause of death worldwide. On this episode of Raise the Line we're going to learn about a new testing approach that leverages genomic technology and machine learning to detect signals circulating in the blood across more than 50 types of cancers -- far beyond the number currently screened for -- and helps physicians target locations for diagnostic evaluation. “We can look at this epigenetic pattern on very specific regions of the DNA and say this is only seen in cancer, and make a call,” says Dr. Josh Ofman, the president of GRAIL, a spinoff of the genomic sequencing company Illumina. “We have an opportunity now to dramatically improve the number of cancers found in the population through early detection. We could reduce the death rate over the next five years by almost forty percent,” he tells host Shiv Gaglani. Tune in to find out who qualifies for the test, what obstacles lie ahead and how GRAIL is working to educate physicians about this potentially powerful new option 

Mentioned in this episode: https://grail.com/

On this episode of Raise the Line, we have the privilege of hearing from one of the nation's top healthcare leaders, Dr. Joshua Gordon, who is the director of the National Institute of Mental Health. In that role, he oversees an extensive portfolio of basic and clinical research that seeks to transform the understanding and treatment of mental illnesses, paving the way for prevention, recovery and cure. “Our main role is in trying to make sure that good science is conducted in the service of furthering public mental health,” he tells host Shiv Gaglani. One area of NIMH research that gets less attention than breakthrough medicines is how to make it easier for healthcare systems and practices to adopt best practices and proven treatments. This not only helps improve patient outcomes, but Gordon says it is one element in addressing feelings of a lack of effectiveness that contribute to provider burnout. “If we can increase individuals’ efficacy by ensuring that they are trained in evidence-based approaches, and continue to make new treatments available to help those who aren't responding to the old ones, that's one way we can do that.” This is a rare opportunity to hear from a federal agency executive on some of the most pressing and interesting issues in healthcare including the shortage of providers, health equity, social determinants of health, telemedicine and the potential for psychedelics to treat mental health problems.   

Mentioned in this episode: https://www.nimh.nih.gov/

The Crucial Role of Psychedelic Therapy Guides - Mary Cosimano, Former Director of Guide and Facilitator Services at The Johns Hopkins Center for Psychedelic and Consciousness Research

All of the promising research into the potential benefits of psychedelics in mental health treatment depends on having skilled professionals who can create a therapeutic alliance with participants and guide the sessions in which the compounds are administered. We could not have a betterRaise the Line guest for understanding this role than Mary Cosimano, LMSW, former director of Guide and Facilitator Services at the Johns Hopkins Center for Psychedelics & Consciousness Research. Since the genesis of psychedelic research there two decades ago, she has conducted over 500 sessions herself as well as serving as a research coordinator.  In this fascinating conversation with host Shiv Gaglani, Cosimano discusses how she prepares for and processes the often-taxing sessions, the common themes that emerge from participants, and what qualities effective guides need to have. On that point, she thinks the role needs to be open to chaplains, nurses, hospice care workers, and others with the right combination of experience and personal qualities, not just to licensed medical personnel.  “What’s as important is who they are, what they've done in their life and career, how much work have they done on themselves, do you feel comfortable with them?” This is a fascinating look into the heart of psychedelic-assisted therapy and the meaningful experiences participants can have when they are in the right hands.  

Mentioned in this episode: https://hopkinspsychedelic.org/

“We're really heading to a cliff when it comes to those expressing interest in healthcare careers,” cautions today’s Raise the Line guest Geoffrey Roche, director of Workforce Development in North America for Siemens Healthineers. Unfortunately, this drop-off in interest is happening as statistics on the current and future shortage of healthcare workers seemingly get worse by the day. One strategy the veteran hospital administrator and educator advocates is partnering with the K-12 system to provide early exposure to healthcare careers. “We have to show young people what the possibilities are. We've got to visually help an individual understand ‘this is what your career ladder could be.’ It could also help, he tells host Rishi Desai, if young people understood how much healthcare technology is powered by the same type of systems as video games. Citing the concerns that other industries do a better job of recruiting young people, Roche urges all healthcare organizations to have deep working relationships with educators. “If you’re not working with an academic institution to look at your needs of today and tomorrow proactively, strategically and tactically, then you're behind.” The good news is Roche sees examples of community partnerships and creative approaches to certification and apprenticeships that could yield results. Tune in to find out how bringing healthcare and education together at all levels can help fill the daunting gap in clinical and non-clinical staff that confronts our healthcare system. 

Mentioned in this episode: www.siemens-healthineers.com

Active and fun are rarely the first words associated with medical education, but today’s Raise the Line guest, Dr. Amin Azzam, contends learners get the most value when they can engage with their education rather than passively receive knowledge. As Azzam relates to host Hillary Acer, the vice president of Strategic Operations at Osmosis, he remembers first seeing the power of active learning while observing a class of med students as a psychiatry resident. “I sat behind a one-way mirror and watched these students leading their own small-group learning and it was just palpably infectious how excited they were to learn medicine.” In the ensuing years, Azzam has happily been utilizing and developing active learning strategies as a professor at three Bay Area universities and in his role as Faculty Engagement Coordinator at Osmosis, one of many key roles he has played as a longtime team member. One of his most impactful creative strokes was creating the first medical school course dedicated to improving the quality of health information on Wikipedia, both providing a unique learning experience and improving health content that has been viewed 88 million times by people around the world. Speaking of global impact, he’s also been instrumental in Osmosis initiatives to facilitate learning by medical students in war-torn Syria and refugees seeking medical care. Check out this lively and fascinating look at learner-centric education and the power of providing opportunities for students to do social good while learning. 

Mentioned in this episode:

Osmosis OMEF-ONSA Program

Wikipedia Education Foundation

“When we say ‘treatment for menopause,’ it implies that menopause is a disease, when really it’s a normal and expected time of life,” says Dr. Anna Barbieri, an integrative medicine physician and specialist in menopause certified by the North American Menopause Society. That attentiveness to word choice is reflective of a new perspective that’s driving Dr. Barbieri and her peers to see menopause more holistically than in the past and to forge new approaches to the care they provide. "Menopause care is not checkbox medicine. We have to work with our patients individually," Barbieri shares with special guest host Dr. Deborah Enegess, herself a practicing gynecologist as well as a clinical content writer for Osmosis. A personalized approach involves tailoring care plans that take exercise, nutrition, sleep, stress management and other lifestyle and psychological factors into account in an effort to help patients feel better in the short term and longer term.  Providers also have to contend with a shift in long-held thinking about the use of hormone therapy and a bewildering array of supplements that are touted as effective remedies for various symptoms.  To help sort through all of this complexity, new resources have come on the scene in recent years, including the digital platform Elektra Health -- of which Barbieri is the founding physician -- that describes its mission as “smashing the menopause taboo.” Check out this engaging exploration of what looks to be a promising time for women in search of individualized, integrated and informed care during their menopause journey.

Mentioned in this episode: https://www.elektrahealth.com/

We've been careful on Raise the Line to use the term psychedelic-assisted therapy because, as we've heard from previous guests, these compounds are best administered in the context of a therapeutic relationship in a safe, controlled setting. Today, we're going to focus on the therapy part of the equation with Dr. Mary “Bit” Yaden, an assistant professor of Psychiatry and Behavioral Sciences at Johns Hopkins University. Yaden contends that administering a two-to-three-month course of psychedelic-assisted therapy will be vastly different for professionals used to conventional mental health treatments that involve taking medications daily and which might or might not include long-term courses of talk therapy. “This is taking a pill twice, and participating in psychotherapy is integral to its success. This is not ‘maybe I feel better today taking an SSRI, but I'm not quite sure.’ This is deliberately taking a medicine that changes your mental state in a way that is not ordinary,” she tells host Shiv Gaglani. And while she’s encouraged by growing evidence that psilocybin and other compounds are showing therapeutic promise, she’s concerned about history repeating itself, as reflected in a 2021 article in JAMA Psychiatry she co-authored entitledPsychedelics and Psychiatry, Keeping the Renaissance from Going Off the Rails.  “I think a great tragedy could be if there is so much overblown hype that we become disenchanted too early or that we start allowing for practices that are not safe.” Don’t miss this highly engaging and instructive conversation on the full picture of psychedelic-assisted therapy.

Mentioned in this episode: https://hopkinspsychedelic.org/

“I really have challenged the students that have graduated from Duke the last couple of years to consider being ambassadors for science and for communication of what is good science,” says Dr. Mary Klotman, executive vice president for Health Affairs and dean of the School of Medicine at Duke University.  She notes that the stakes of disinformation are too high to do otherwise, as up to 300,000 COVID-19 deaths can be attributed to unfounded fears about one of the safest vaccines ever produced. It's just one of many educational imperatives Klotman is pursuing to prepare future clinicians for a constantly changing healthcare landscape. Others include helping students put new tools such as AI in the context of patient care, creating more opportunities to learn in ambulatory settings where 90% of healthcare is now delivered, and more multidisciplinary training to reflect a growing team approach to medical care. To help develop those interprofessional habits, Klotman has championed a “One Duke” approach. “Whether you're a student, senior investigator or a clinician, take advantage of the broad expertise here to solve a problem whether it's engineering in medicine, or it's data science. That is the nature of scientific problem solving today.” Join host Shiv Gaglani on this episode of Raise the Line for a wide-ranging look at how a leading academic center is innovating to adjust to dynamic changes in society, technology and healthcare.

Mentioned in this episode: 

Duke University School of Medicine

Duke's Program on Medical Misinformation

Instead of fretting about AI replacing jobs humans currently do, Dr. Nigam Shah is urging people to adopt a perspective about the technology that echoes President John Kennedy’s famous charge in his inaugural address: ‘ask not what this technology can do to you, ask what you can do with this technology.’ “If medicine simply automated everything we were doing 200 years ago, we’d have a machine that would do bloodletting. But we didn't fall into that trap,” says Shah, the chief data scientist at Stanford University. Instead, he suggests, people in the healthcare arena should think about what a human and a computer can do together that neither of them could do alone. In this fascinating episode of Raise the Line with host Shiv Gaglani, Shah also issues a call to action to the medical community about training AI for medical purposes. “If you really want to use these things, we have to create the instruction-tuning data so that they produce the output that we expect.” As for predictions of AI being the author of our salvation or doom, count him as skeptical. “I'm quite sure both sides are overblowing it for different reasons, and the truth will land somewhere in the middle. We’ve got to proactively pick the amazing and stay away from all the fearmongering.” There is much to be learned in this engaging conversation about the history of AI hype cycles, how to use AI to maximize productivity and the challenges inherent in AI-human interaction. 

“What's really exciting and scary in medical education right now is we're seeing large language models enter the scene,” says today’s Raise the Line guest Dr. Adam Rodman, who is well-placed to make such an assessment. As co-director of the Innovations in Media and Education Delivery Initiative (iMED) at the Beth Israel Deaconess Medical Center, Rodman is witnessing, and influencing, how new technologies are shaping both medical education and the future of healthcare.  In his view, AI can’t replace a doctor right now, but it can make remarkable insights into how humans think. “We need to start to grapple with what it means when a lot of these cognitive processes that medical education is designed to train for get offloaded to a machine,” he tells host Shiv Gaglani. He summarized his thoughts on AI, with co-author Dr. Avraham Cooper, in a piece for the August issue of the New England Journal of Medicineentitled “AI and Medical Education: A 21st-Century Pandora's Box” and invokes another concept rooted in ancient Greece as he describes AI as a ‘pharmakon.’ “There really is a way these technologies could dramatically improve what it means to be a patient -- and hopefully what it means to be a physician -- but the same technologies could be used to make things worse.” The ancient references are not surprising coming from Rodman, a medical historian who enjoys exploring the roots and evolution of the field on his long-running podcast Bedside Rounds. Don’t miss this richly informed conversation on how humans perform when interacting with AI, the advent of virtual tutors, and how AI might be used to improve student assessments and enhance the doctor-patient relationship.

“I see health systems being systematically disintermediated by certain payers and some tech companies who are eager to take the easy stuff and leave health systems with really complex, sick and often very poor patients,” says veteran healthcare executive Dr. Marc Harrison. “I need a speedboat to change that.” He’s building that speedboat in partnership with venture capital firm General Catalyst, and will leverage his deep experience -- most recently as CEO of Intermountain Healthcare -- to set a new course for healthcare in the US. “Healthcare should be accessible, affordable, of high quality, consumer-centric and a combination of the digital and legacy world,” he tells host Shiv Gaglani.  “A ‘clicks & mortar’ future, as we like to say.” In this thoughtful episode of Raise the Line, Harrison also touches on his own health struggles and discusses his book Possibility Unleashed which examines how to create environments where people get to do their very best work. “How do they get to run hard, run fast, be collaborative and do more in that context than they could ever do on their own?” Don’t miss this wisdom drop from one of the country’s leading figures in healthcare reform.

Mentioned in this episode: Dr. Marc Harrison’s book, Possibility Unleashed.

 

Twenty years ago, health outcomes in Eastern North Carolina lagged behind state averages but those deficits have largely been erased, and Dr. Mike Waldrum, Dean of the Brody School of Medicine at East Carolina University, thinks he knows why. “We’ve done it primarily with a community-based focus and taking students only from North Carolina that we know have a propensity to want to practice medicine in the environments that we're here to serve. That's kind of our sauce,” he tells host Shiv Gaglani. Building on that approach, the university started a rural residency program in recent years, and out of four graduates in its first cohort, two have agreed to stay in the communities in which they trained. And while that kind of incremental progress on the ground level is important, Dr. Waldrum knows change is needed at the system level as well. Some things ECU Health can do on its own, such as implementing a unified electronic medical record across all of its care sites that allows it to model where health needs are and intervene early. But what he sees as the necessary restructuring of how the healthcare system is organized and financed will take a group effort. “We need Medicare, Medicaid, the insurance industry and others as partners in how we transform the system.” Tune in for a thoughtful look at the challenges of improving healthcare in rural communities, and the special role academic “safety-net” health systems play in that effort. 

Mentioned in this episode: https://medicine.ecu.edu/

The failure of patients to take their medications as prescribed costs the U.S. healthcare system more than $500 billion a year, not to mention the adverse health outcomes it causes. Today’s Raise the Line guest, Sebastian Seiguer, co-founded and leads a company called Scene Health that is tackling this problem with a system that combines video technology, clinical coaching and validated interventions to improve medication adherence rates. Based on evidence gathered in multiple clinical trials, the Centers for Disease Control recently concluded that using asynchronous video is equivalent to an in-person Directly Observed Therapy - the current gold standard for adherence. “It’s an incredible thing. It's the first time in healthcare that an asynchronous video appointment is being treated the same as an in-person appointment,” Seiguer tells host Shiv Gaglani. Scene Health is currently supporting patients across multiple chronic and infectious conditions, including diabetes, asthma, opioid use disorder, tuberculosis and hypertension. Check out this enlightening conversation to learn why adherence is so low in the first place, how Scene Health is educating patients on how and why their medications work, and other applications for this approach.

Mentioned in this episode: https://www.scene.health/

“I think we're doing something really special here to change the way healthcare is delivered in South Florida, so keep an eye on us,” says Dr. Julie Pilitsis, dean of the Charles E. Schmidt College of Medicine and Vice President of Medical Affairs at Florida Atlantic University. For one thing, class sizes in the medical and nursing programs are both increasing to tackle less than ideal access to health services. “If you get diagnosed with a lump on your breast in Florida, it takes you thirty days on average to see a doctor, while the national average is three to five days,” she notes. And just as FAU’s educational and clinical programs are supporting the communities they serve, Pilitsis tells host Shiv Gaglani that they need support in return.  “I think academic medicine and academic hospitals are essential. Everybody wants good healthcare, but I think sometimes they don't understand the economic impact that good healthcare brings to the area.” Shiv and Dr. Pilitsis also explore advancements in functional neurosurgery, the role of artificial intelligence in reducing burnout and her landmark career as the first female neurosurgeon to become a dean in this enlightening episode.

Mentioned in this episode: https://www.fau.edu/medicine/

One challenge in developing treatments for rare diseases is finding enough people with the condition to mount valid clinical trials.  Databases that contain diagnostic codes for specific conditions can help, but those miss people who may have the condition but have yet to be conclusively diagnosed.  That’s where Verana Health comes in, a digital health company that uses AI to mine its data network of more than 20,000 healthcare providers and the clinic notes they make about patient encounters. “If you wanted to find somebody with a specific genetic defect, or a specific condition for which a diagnostic code doesn't even exist, clinic notes represent really the only place you could discover that information,” explains Dr. Michael Mbagwu, an ophthalmologist and Verana’s Senior Medical Director. Verana partners with the American Academy of Ophthalmology, the American Academy of Neurology and the American Urologic Association to manage their clinical registries which were built to improve quality of care, answer research questions and help physicians report quality metrics. Join host Michael Carrese for an exploration of the ways medicine is being changed by the ever-growing amount of data available and the new technologies which allow clinicians and others to analyze and use all of that information. “Some of the things that we just assumed were never possible or were kind of hopeless endeavors are now possible for the first time thanks to AI.” 

Mentioned in this episode: https://www.veranahealth.com/

“I noticed early on in my academic career that the traditional methods of engagement and the lecture was no longer working for millennials and Gen Z, which is the first generation to completely grow up being immersed in technology,” says Dr. Nicolene “Nikki” Lottering of Bond University in Queensland. That set the assistant professor of anatomy and forensic anthropologist on the path of determining how to use technology effectively without going too far. “For me, it's about the responsible use of technology to meet students halfway and harness that power to engage them and make them excited about what they're learning.” This thoughtful approach is one of the reasons Lottering is the winner of the 2022 Osmosis Raise the Line Faculty Award in the Anatomy and Physiology category. Another, according to her student nominators, is her compassion for her students. This became particularly pronounced during COVID which presented enormous challenges to educators and students alike. “I believe good education comes from a place of genuinely caring about your students,” she tells host Michael Carrese. “We can learn as a community and we can, through learning, find coping strategies as well. It's not always about the content, but it's actually about the community.” Don’t miss this inspiring conversation from an educator with many insights on how to connect students to their learning and to each other. 

Mentioned in this episode: www.Osmosis.org/faculty-awards

What if your vibrator not only brought you pleasure but also provided valuable health data? That's precisely what Anna Lee, co-founder of Lioness, is striving to achieve. In this episode of Raise the Line, our host Shiv Gaglani sits down with Anna to discuss her journey from being an engineer at Amazon to starting a company focused on women's sexual pleasure and health. Despite the stigma around female pleasure, Lioness is dedicated to serving an underserved community, and the data they've collected is shedding light on the importance of sexual wellness. As Anna puts it, "Orgasms are the canary in the coal mine for healthcare implications and overall health." Join us to hear Anna's inspiring story and learn about the challenges of creating a smart vibrator in a male-dominated industry.

Mentioned in this episode: https://lioness.io/