What needs to change about the way we conduct research so as to better serve female patients? How might we move away from the templated responses in post acute care? What treatments in the ED need to change to better serve women?
What have you found in the literature about how hormonal birth control impacts a woman’s holistic health? How might women’s health specialists be more coordinated? What are some of the risk factors women face in caring for their skin that differ from male patients?
Great question Laura, I always try to stay in my lane, which is stroke and cardiovascular care. Here is a link to a recent story about an actress that had a stroke/ TIA attributed to birth control. I dug a little deeper and the American Heart Association lists birth control has the potential to increase stroke risk (link below). The association is women with migraines has higher incidence of stroke, birth control increases migraines, but the link between the two is not well understood.
https://www.today.com/health/health/can-birth-control-pills-lead-stroke…
https://www.goredforwomen.org/en/know-your-risk/risk-factors/risk-of-st…
Women’s health is defined by one source as the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman's physical and emotional well-being. So as Nada Hanafi shared with me ahead of this discussion, it’s so much more than “bikini medicine”. What gaps do you see in women’s holistic health and how might we band together to address those concerns?
My answer to the question is I'm not sure, but hopefully I can add to this topic. In stroke and cardiovascular care, there is an understanding that there are factors that drive strokes and outcomes in women, but also contradictory research (article below on factors).
What I see on the emotional wellbeing side, is that women are more likely to be receiving treatment for depression at the time of stroke than men (link).
I think one solution on banding together is to recognize interdisciplinary approached to women's health, that considers nonobvious factors, in this case stroke + depression.
https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.117.018415
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282882/
How might we make policy changes that improve maternal and fetal wellbeing in an efficient, equitably, and holistic way in this country (we'll get to global in a couple of days)?
Equity in access. Increasing access to care at all stages of the pregnancy and post-partum. Expanding care to include multiple modalities to support maternal wellbeing. Extending postpartum support further than the usual 6-8 weeks.
What is the impact of the Supreme Court’s recent decision on Roe v Wade from your perspective?
What I can say is, as a Canadian, it really shows us that the WORLD is vulnerable to a Roe v Wade decision. We cannot just sitback in other countries and watch with blind eyes. We are already seeing this impact with the Italian election a couple days ago. If you think "this cant happen in my country", think again!
How does burnout impact the care team members involved in women’s reproductive health? Can you share any lessons learned?
What healthcare technology innovations are most impactful for women’s breast health?
What healthcare technology innovations are most impactful for women in labor and delivery?
What can we learn from team-based care in women’s reproductive health specifically and how might we apply that to other specialties?
Promoting team-based care is such an important aspect of patient-centered care in general. What can be better as a patient than having a coordinated team of providers, across multiple disciplines (primary care, nurses, dieticians, therapists, acupuncturists, social workers, etc.), working together with a shared goal of delivering individualized quality care to you. Not only are patients are cared for during their treatment but also in their wellness and prevention stages. It’s also great for clinicians- increasing communication and symmetrical information, as well as professional support and helping with burn-out.
Happy Tuesday everyone! Today we want to focus on improving outcomes in women’s reproductive health today. From your perspective, what differentiates the leaders in women’s reproductive health from the rest? What are they doing differently, what can we learn from them?
Leaders in reproductive heath, research and health policy are moving the needle in the understanding of the unmet needs and future treatments that are necessary to advance innovation. These leaders often work as catalysts and thought leaders bridging key strategic partnerships to create improvement in public health focused on women.
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First, we need to understand drivers of the disparity in care. For example, 1 in 5 women are likely to experience a stroke that will be more massive and debilitating that a man experiencing a stroke. This is a solid premise to conduct meaningful research. I work in women and stroke research and would welcome any follow-on questions.
Second, in the ED we may need to think about how guidelines drive care. Sometimes the criteria do not intend to bias, but it does. For example, it was recently found that the criteria to screen for atrial fibrillation includes BMI but substituting height and weight would flip the script on AF risk towards women. While this seems nonbiased on the surface (BMI), it biases towards more men than women being screened. So, in answer to your question, we need to think (rethink) standard ED care and objectives in high volume environments (ED). The ED professional care givers are great people motivated by patient outcomes, but they are screening high volumes and rules driven by downstream specialties (vs admit/ not admit) need to be explored to better understand unintentional disparity.
https://www.tctmd.com/news/vital-rhythm-data-may-flip-script-af-screeni…
Pending
Life Sciences research needs to recognize that women are not little men, and include sex as a biological variable from the benchtop/pre-clinical testing phase of research, so as to better inform clinical study design and translate research into more meaningful medical therapies and technologies that allow for the promise of personalized medicine - https://orwh.od.nih.gov/sex-gender/nih-policy-sex-biological-variable
Pending
I also would add, that the default or status quo of excluding women fo child bearing potential (WOCBP) or pregnant/lactating women from clinical studies needs to be challenged. We can develop adaptive clinical studies and we can safely include this patient population in clinical studies once we establish a baseline safety profile, because we know that these patient groups will likely need to use or be exposed to the medical product (drug, device, biologic) that is the subject of the clinical research at some point after it receives regulatory body approval, so let's collectively work to study the product and provide meaningful data to inform decision making for this subpopulation of pregame/lactating or WOCBP.
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Agree with what's been said below. Technology and innovation often exclude women and people from racial and ethnic minority groups at the development stage, so it's no surprise when the technologies then fail to perform well clinically in real practice. The same goes for clinical rules, guidelines, algorithms, etc. -- all bring efficiencies, but have the potential to reinforce biases and health disparities rather than minimize them.