Tag: care

Transgender patients face discrimination during health care visits

One trans woman recalled a doctor calling her “it.” A nonbinary person was grilled about their use of “they/them” pronouns during an ultrasound. A trans-masculine person moved out of Tennessee, fearing they would lose access to hormone therapy as legislators passed bills restricting gender-affirming care.

Transgender Americans often face subtle discrimination, outright hostility and ill-informed medical professionals in their interactions with the health-care system, according to a poll by The Washington Post and KFF, a nonprofit focused on national health issues.

Challenges arise during routine medical visits as well as when transgender people seek hormone therapy and other forms of gender-affirming care.

Nearly half (47 percent) of trans adults say the health-care providers they have come in contact with know “not too much” or “nothing at all” about providing health care to trans people. Just 10 percent say the health-care providers they have come in contact with know “a lot” about caring for trans people. About 4 in 10 (37 percent) trans adults say it is “somewhat” or “very” difficult to find a health-care provider who treats them with dignity and respect; while about a quarter (24 percent) of cisgender adults say the same. Just over half (53 percent) of trans adults say it is easy to find health care they can afford, less than the 63 percent of cisgender adults who say the same.

Activists say a welcoming health-care system would include affordable access to gender-affirming care from counseling to surgery. Good care also includes professionals treating transgender people with respect, using their preferred pronouns and not being quick to blame hormone treatment for unrelated medical problems.

About 3 in 10 trans adults say they have had to teach a doctor or other health-care provider about trans people so they could get appropriate care, had a doctor or other health-care provider refuse to acknowledge their preferred gender identity and instead refer to their sex assigned at birth, or been asked unnecessary or invasive questions about their gender identity unrelated to the medical reason for their visit. About 1 in 6 trans adults say they have had a doctor or other health-care provider refuse to provide them with gender-affirming care, such as hormone treatments.

The Post-KFF poll is the largest nongovernmental survey of U.S. trans adults to rely on random sampling methods. It builds on a body of research that has often demonstrated poor access to health care for transgender people but with limited data.

“LGBTQ+ people experience high levels of stigma and discrimination and victimization that persists across the lifetime, and this new work amplifies that,” said Lindsey Dawson, director of LGBTQ Health Policy at KFF.

“To have your gender affirmed and to be in an inclusive environment where you have to be quite vulnerable about gender identity can be quite meaningful,” Dawson said. “To have negative experiences might dissuade somebody from accessing health care in the future.”

As Republican state lawmakers mobilize to restrict access to gender-affirming care for children — and in some cases, adults — the poll offers a reminder of the basic struggles transgender adults face in medical environments.

The poll finds trans people’s ease of access to health-care providers who treat them with dignity and respect is not significantly different in states that former president Donald Trump won compared with states President Biden won. The survey also finds that trans adults in urban areas are more likely to report having to educate health-care professionals (38 percent) than those in suburban/rural areas (23 percent) — challenging perceptions that more liberal areas are havens for tolerance and inclusivity.

In follow-up interviews, five transgender and nonbinary Americans who responded to the poll elaborated on their experiences:

Corey Brooks (they/them)

25, Pittsburgh

Even the name of the place Corey Brooks frequented for routine medical care — Magee-Womens Hospital — felt alienating.

Patients donned pink gowns. Cutouts of pink bras were plastered on the walls. A sign urged patients to “fight like a girl.”

“Things like that are just incredibly disorienting for someone going into those spaces who is always being reminded, hey, this wasn’t designed for you,” Brooks said. “You’re not really sure if you should disclose to these people that you’re trans or not.”

Brooks identifies as nonbinary and transgender, but as someone who was assigned female at birth, they share similar health needs as cisgender women for gynecologic care and screenings for chest health as they age.

Brooks was used to uncomfortable visits to the doctor, based on their college experiences when university health services staff peppered them with questions about birth control and sexual activity, assuming they were a cisgender heterosexual woman. They wrote their senior thesis on health access issues for transgender people and avoided the doctor for a few years after graduation.

The worst experience came while undergoing an ultrasound on their chest at the women’s hospital in Pittsburgh. The doctor paused and stared at Brooks’s medical file, spotting a note that they use they/them pronouns.

“What does that even mean?” Brooks recalled the doctor asking in a tone dripping with hostility rather than curiosity.

“As a trans person, that’s unfortunately not uncommon where you’re expected to provide all of this education for your providers,” Brooks said. “You wouldn’t expect a patient who is diagnosed with diabetes to have to educate their doctor on what diabetes is.”

Suzanne Rathburn (she/her)

70, Weed, Calif.

In the 1980s, a psychiatrist pushed his chair away from his desk and abruptly ended a meeting after Suzanne Rathburn explained she was trans. In 2012, a Veterans Affairs doctor referred to her as “it.”

In hundreds of medical visits over decades of navigating gender-affirming care and a rare genetic disease, Rathburn said she’s only had a few doctors she considers “good.”

As she began her transition in the 1980s after leaving the Air Force, Rathburn turned to the library to learn more about gender dysphoria and to find a therapist. She received a vaginoplasty. At the Oakland VA where she underwent hormone therapy, Rathburn said just one of the doctors treated her with respect, while others were dismissive of her medical needs or made negative comments about her gender identity — despite being in the LGBT-friendly San Francisco Bay Area.

Fed up after repeated indignities, Rathburn filed a discrimination complaint against another VA hospital that declined to perform a Pap test after several years of her requests. She said the VA eventually referred her to a doctor outside the system, and her complaint remained unresolved.

It wasn’t until she moved to rural Weed near the Oregon border in 2011 at age 59 that Rathburn experienced some of the best medical care of her life. A medical practice she visited near Medford, Ore., changed its intake forms when she pointed out gender questions were binary. A doctor in the nearby town of Mount Shasta, Calif., treated her trans identity as no big deal and spent time researching her genetic disease. Her therapist, also in Mount Shasta, specializes in supporting trans patients.

“I don’t have to explain it to her,” Rathburn said. “We talked about stuff I haven’t talked about with other therapists or to the psychiatrists I’ve had over 20 years.”

Hans Dirkmaat (they/he)

29, Longmont, Colo.

Hans Dirkmaat knew the nurse practitioner was ill-suited to care for transgender people when they had to explain what top surgery was.

During the primary-care visit, the provider marveled at why someone would want to remove their breasts. She asked, “When are you going to get a penis?”

Another medical professional in the room mouthed, “I’m sorry.”

Dirkmaat, who identifies as trans-masculine and nonbinary, didn’t have many choices for medical care that were in their insurance provider network when they lived in Nashville. They hoped the provider would have been more sensitive because she had mentioned having a lesbian daughter during their first appointment.

But tolerance for gay people does not mean a medical provider is attuned to the health-care needs of trans people. Transgender people weigh the risks and benefits of different aspects of gender-affirming medical care, and most have not received hormone therapy or transition-related surgeries.

Dirkmaat was wary of taking testosterone because of a heightened risk of cardiovascular complications. Their mother had died of heart disease at 41.

But that same nurse practitioner declined to prescribe medication to treat their high cholesterol because it could create pregnancy complications. The fact that Dirkmaat is married to a cisgender woman and has no plans to have children did not sway the provider. She said she would only authorize the pills if Dirkmaat were to undergo testosterone treatment.

“It’s very frustrating,” Dirkmaat said. “Like I can’t make decisions for me.”

The climate for transgender people in Nashville was starting to feel more unsafe, they said. The clinic specializing in transgender care where they received chest masculinization surgery became a magnet for right-wing protests, forcing the clinic to close on some days to protect patients. They drew more disgusted looks on the streets.

Tennessee GOP lawmakers joined the vanguard of a national movement to restrict care for transgender people, passing legislation to ban gender-affirming care for minors. Activists fear care for adults is next, noting legislation introduced to prohibit the state Medicaid program from working with insurers that cover gender-affirming care.

As Dirkmaat weighed whether to take hormones, they feared such therapy could be banned next.

So they moved to a suburb of Boulder, Colo., where a doctor who specializes in hormone therapy and its effects on the cardiovascular system is just an hour drive away.

Ezekiel Scott (he/they)

31, Columbus, Ohio

When Ezekiel Scott left Minnesota to attend college in Ohio last year, he brought six months’ worth of hormone medication just in case he ran into trouble resuming care. It wasn’t enough.

Administrators at Ohio State University assured Scott, who identifies as transgender and nonbinary, that hormone therapy would be covered under student health insurance. But first he needed to reestablish care with a doctor — and that proved to be a challenge.

He didn’t want to go to just any doctor, but one familiar with treating transgender patients. He had had negative experiences with doctors who were quick to blame the hormone therapy for mundane medical conditions, including one who suggested ending it to address a rash on his arm.

“That’s the first thing we’re going to try? Not like, I don’t know, a skin cream?” Scott said.

The hormones were essential to feeling comfortable in his own skin and affirming his gender identity, but the treatment was cast as cosmetic and unnecessary. “It’s like being told to stop having your own face,” he said.

It took four months to get an appointment at a university health clinic. After obtaining authorization to receive testosterone, a national shortage of the intramuscular injections further delayed his access to treatment as he exhausted his previous supply.

For several months, he had to ration weekly hormone injections that helped him develop facial hair and a deeper voice in line with his gender identity. And because he had had his ovaries removed, the absence of natural hormones risked his heart health.

His depression and anxiety grew worse, and he experienced suicidal ideations. Medication management for ADHD, once balanced with the hormone therapy, became complicated. He experienced hot flashes, an apparent result of early menopause caused by hormones not coming in properly.

Months later, he found a walk-in clinic recommended by a nonbinary friend. He got hormones that same day, eight months after he moved. His mental health improved, he could focus in school again, and the hot flashes ended.

“All of it is back in balance,” Scott said.

Richael Faithful (they/them)

37, Washington, D.C.

Richael Faithful is no stranger to cringeworthy moments during visits to the doctor.

Staff at some offices would misgender them. The first dermatologist they saw appeared nervous and avoided eye contact after Faithful disclosed being trans. One lung specialist they saw for breathing issues who seemed well-meaning shared a story about knowing “a transgender.”

“Once folks have bad experiences, it’s really hard to trust the health-care system again,” said Faithful, a D.C. resident who identifies as nonbinary and trans-masculine. “But I do want other trans folks and other cis folks to know there are good providers out there providing high-quality care.”

Faithful does not identify as a woman but is not transitioning to be a man either. For them, gender-affirming care means presenting more masculine to the world.

Faithful considers themselves part of the top 1 percent in being able to access gender-affirming care because they have the financial means and emotional support network to do so.

Faithful sought hormone therapy through a nurse practitioner at a medical concierge service with a reputation for being trans friendly and where membership costs $300 a year. They pay $265 every month and a half for hormones. They were able to travel with their partner to Florida for two weeks to undergo chest reconstruction surgery from a well-known plastic surgeon who does not accept health insurance and charges $15,000, paid in advance.

The staff at another dermatology practice where Faithful received acne treatment used the correct pronouns and showed a nuanced understanding of the relationship between hormone treatment and acne.

Faithful said they could afford these services as a consultant for social justice organizations who receives health insurance through their partner’s plan — while other Black transgender people living in the poorest parts of the city struggle to access basic gender-affirming care.

“My stress level is just kind of lower because I notice I’m not navigating even seemingly small things that just are distracting or annoying when they continue to happen,” Faithful said.

Scott Clement and Emily Guskin contributed to this report.

Puget Sound-area health care facilities will continue requiring masks

Patients, staffers and visitors will continue to be required to mask up inside many health care clinics and facilities throughout the Puget Sound region, a group of Washington hospital and public health leaders decided Friday.

About 20 public health departments and health care systems around the region made the announcement a couple weeks before the state’s remaining indoor masking requirements are set to come to an end on April 3. Most of the Department of Health’s masking mandates have expired, except those in health care or correctional facilities.

Now, the organizations are “working together to establish an approach for continued masking in health care facilities” to prevent the spread of COVID-19, the statement said.

Health departments from King, Snohomish, Tacoma, Kitsap, San Juan, Clallam and Jefferson counties have signed on to support the recommendation, in addition to hospital leaders from UW Medicine, Seattle Children’s, Virginia Mason Franciscan Health, MultiCare Health System and Kaiser Permanente Washington.

“This is important and appropriate because the current community burden of COVID-19 remains substantial and is underestimated by case reporting,” Public Health – Seattle & King County said.

The department added that the risk for developing severe COVID symptoms remains high for those who are older, those with underlying health conditions and those who are pregnant — who all might visit health care settings on a more regular basis.

“Unlike many other activities, health care is not optional, but essential; and every patient deserves to feel safe from acquiring a preventable infection when seeking health care,” the organizations wrote.

In addition, patient care areas often “bring people close together leading to increased exposure risk and transmission of COVID-19,” the statement said. “Masks mitigate the spread of infection in these settings, including when people have minimal or no symptoms.”

Because there are no available preventive COVID treatments for immunocompromised patients, public health leaders felt it was important to extend the requirement.

“A regional consensus ensures a consistent and clear message that these healthcare facilities prioritize the health and safety of both their patients and employees,” the statement said.

The organizations said masking recommendations and requirements for health care facilities should be reevaluated from time to time as scientists continue to learn about the spread of the disease. They plan to determine new recommendations by early July.

Until then, public health leaders reminded residents to use high-quality and well-fitting masks that can fit around your nose and mouth, particularly N95, KN95 and KF94 masks.

“Masking is an important way we can help make visiting healthcare facilities safer for the many people in our community of all ages who are at increased risk for severe infections,” Dr. Jeff Duchin, King County’s public health officer, said in the statement.

What we’ve gained from the Affordable Care Act, 13 years later

Do you remember when some senior citizens had to ration their medications due to the fact their prescription drug expenses would triple each 12 months soon after they entered the Medicare protection gap identified as the “donut hole”? I do.

Do you recall when turning 19 intended getting kicked off your parents’ overall health insurance plan plan, regardless of your dwelling circumstance? I do.

Do you keep in mind when insurance policy firms could refuse to pay for preventive treatment options — vaccinations, mammograms, colonoscopies or a great number of other necessary products and services — for any motive, or maybe no purpose at all? I do.

Do you remember insurance plan corporations refusing coverage to pregnant females or many others with “preexisting conditions”? Or when they could cost you what they wished, for no matter what reason they wished, and you seriously had no selection but to accept that due to the fact there was no Patient’s Bill of Rights? I do.

But those times were being relegated to the dustbin of historical past on March 23, 2010, when President Obama signed the Economical Treatment Act (ACA) into regulation. Of class, as we mark the ACA’s 13th anniversary, it’s simple to ignore the political costs of that “miracle” laws. 

To start off with, it took a long time for Congress to draft and vote on the wellness treatment regulation. Then, the GOP built repealing the ACA its priority in the 2010 midterm elections. They demonized the law — labeled as “ObamaCare” — threw in a few of racist pet whistles and, with a nationwide disinformation campaign, rode a wave that received them back again manage of the Property of Associates and flipped 12 governor’s workplaces, together with Ohio, Pennsylvania, New Mexico and Michigan. This ushered in an era of obstructionism that described Congress for numerous decades.

In point, the GOP-managed Household voted a lot more than 50 times to repeal the ACA, disregarding the tens of hundreds of thousands of People in america who received health and fitness insurance coverage, and numerous others who have benefitted from the Patient’s Bill of Rights. Ironically, the one-minded devotion that won Republicans the Home greater part in 2010 would expense them that vast majority in 2018, adhering to a systematic schooling campaign that took the debate from abstract political philosophy to 1 centered on concrete truth.

A noted 13.6 million Individuals received insurance in 2021 by itself through that ACA marketplaces. Closing the prescription drug “donut hole” saved millions of Medicare recipients billions of bucks, and 2022 surveys by the Kaiser Family members Foundation and Morning Talk to uncovered that a bulk of Us citizens approve of the ACA. Staunch Republican opposition is shrinking.

It turns out that public feeling is even a lot more placing when you inquire people about distinct ACA provisions. For instance:

  • 90 per cent of People assist prohibiting wellbeing insurance policies companies from denying coverage for people today with preexisting problems
  • 89 per cent support demanding well being insurance coverage providers to deal with the cost for most preventive services
  • 88 {bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} aid prohibiting wellbeing insurance companies from denying protection to pregnant ladies
  • 87 per cent aid prohibiting wellbeing insurance coverage corporations from charging ill people today extra, and the very same share support providing states the alternative to increase Medicaid
  • 85 per cent assist providing economical enable to reduced- and average-cash flow People to buy coverage and
  • 78 per cent aid allowing younger grownups to keep on their parents’ insurance plan ideas until age 26.

Additional than 35 million Americans have well being insurance policies currently for the reason that of the ACA — guys, gals and young children who are benefiting from reduced charge and increased good quality wellbeing treatment coverage. They can thank the eyesight and bravery of leaders such as former Residence Speaker Nancy Pelosi (D-Calif.), former The vast majority Leader Steny Hoyer (D-Md.) and previous The vast majority Whip Jim Clyburn (D-S.C.), who socialized the concern and worked to safe the history-making votes in Congress.

These males and girls of conscience knew that “an ounce of avoidance is worthy of a pound of heal,” as the aged Ben Franklin declaring goes. They passed the most consequential overall health treatment legislation of my lifetime, proving that the age of heroes has not handed and that, in the words and phrases of Abraham Lincoln, our “government of the men and women, by the folks and for the people today shall not perish from the earth.”

Do you believe that in miracles? I do.

Antjuan Seawright is a Democratic political strategist, founder and CEO of Blueprint Strategy LLC, a CBS News political contributor, and a senior going to fellow at 3rd Way. Abide by him on Twitter @antjuansea.

Copyright 2023 Nexstar Media Inc. All rights reserved. This content may possibly not be published, broadcast, rewritten, or redistributed.

Parenting advice from Care and Feeding.

Care and Feeding is Slate’s parenting advice column. Have a question for Care and Feeding? Submit it here or post it in the Slate Parenting Facebook group.

Dear Care and Feeding,

My husband and I taught our children about eating healthily, but we’ve never tried to demonize any foods, focusing on how anything can be healthy if eaten in moderation. We don’t tend to keep a lot of sweets in our house. I’m an immigrant from a country noted for its sweets, but diabetes runs in both my husband’s and my own family, so we keep such things to a minimum.

Recently, my daughter fell ill and had to stay at home for a few days. She had a high fever and was bedridden. I work from home, so I was checking up on her whenever I had free time. While I was bringing her lunch up to her room, I saw her eating chocolate. I was curious as to where the chocolate came from, and I eventually discovered that she had chocolate everywhere in her room. There were chocolate and candy wrappers in her sock drawer and under her bed, and in her glasses case, in her tablet case, and everywhere else.

When I found this, she broke down crying. She said that her brother was getting paid by our neighbor to feed and walk her dog whenever she left town. He was using the money from his raise to buy candy and chocolate every week. When my daughter found the candy, she asked for a bribe to keep quiet.

I have no idea how to proceed now. We said that we weren’t happy that they were eating this much chocolate, but we were much more upset that they were trying to hide it. I don’t want to become authoritarian and check up on their rooms at random times to make sure they aren’t sneaking chocolate, but the fact that they’re sneaking chocolates at all is a bad sign, right? How should we proceed?

— Stopping the Chocolate

Dear Stopping the Chocolate,

Your impulse to avoid the “good food-bad food” dichotomy and teach that all food can be enjoyed in moderation is right on, according to nutritionists. But it seems like you sent your kids a different message when it comes to sweets. And by restricting them, you may have made them seem even more appealing. The research in fact shows that restricting a particular food leads instead to increased consumption of that food whenever kids can get it.

And let’s be real—sugar consumption alone is not a cause of diabetes, and having sweets from time to time is unlikely to lead your otherwise healthy kids to develop it. In fact, even people with diabetes are able to have sweets in moderation.

So rather than “stopping the chocolate,” I’d start incorporating sweets into the family diet, like offering a serving of dessert at dinner or including them as an option in scheduled snack times. Let your kids know that they do not have to hide to eat sweets or keep it a secret. It might make you feel uncomfortable, but you have to treat these foods neutrally and avoid managing your children’s portions or making comments or reacting nonverbally to their consumption of them. This will take the power away from sweets and teach your kids to regard them as they would any other food.

Most of all, remain calm and don’t shame your kids for what you found. The last thing you want is for your kids to associate any kind of food with shame or punishment. This may all feel counterintuitive given what society teaches us about food and health, but as you saw firsthand, restricting food simply does not work and in fact has the opposite of its intended result. If you truly want to teach moderation, you have to start by removing the value judgments from food.

Want Advice From Care and Feeding?

Submit your questions about parenting and family life here. It’s anonymous! (Questions may be edited for publication.)

Dear Care and Feeding,

I have three kids—an 8-year-old and 6-year-old twins. Their father is my ex-husband, who abandoned them after we divorced in 2020. The last the kids saw him was at his wedding to a woman who made it clear she wouldn’t be their stepmother. He’s since left the state, and it’s a struggle to get child support. I didn’t have family left when we married, and I became very close to my ex-husband’s family.

During and after the divorce, my ex-husband’s parents and sisters all took my side. None of them attended his wedding, causing a major argument, and now none of them talk to him.

I’m struggling a lot as a single mother. My kids fight all the time. I’m stretched financially. All three of my kids need glasses. One of my kids has a condition that causes her to need regular physical therapy. Knowing that I’m stretched pretty thin, my in-laws often help me out. They subsidize our apartment, and they help with childcare, and all the healthcare costs. They’ve basically adopted me into the family.

I feel so guilty, because I know that without their generosity I wouldn’t be able to afford any of this. I’ve been able to enjoy my divorced life only because of my ex-husband’s family. I can’t ever think of a way to repay them. When I brought up my feelings of endless gratitude to my sister in-laws, they told me I am their sister and I never need to repay them, and I’m sure my mother and father in-law would say the same thing if I asked. How can I stop beating myself up over this?

— Overwhelmed By Help

Dear Overwhelmed By Help,

Asking for and accepting help can be a very vulnerable thing to do, especially for those of us with the internalized belief that our needs are a burden on others. But one single mom to another: learning to do so is, in my experience, the only way to make it work. Now I accept help from everybody: family, friends, other moms in the neighborhood, people who look nice enough on the bus (jk on that last one). I try to trust that others will not offer help they don’t want to or can’t afford to give.

When I told a friend I was struggling to manage the household laundry, and she sent over a hefty gift card for a wash-and-fold with home delivery, I felt guilty. But it helped me to think about how I would feel (and want her to feel) if the roles were reversed. I hope anyone I love would know that I am there and ready to support them if they need anything.

I’ll take it a step farther and say: When someone asks me for help, I truly feel that they are giving me a gift because they are allowing me to be of service to someone I love. It makes people feel good to help! When you allow your in-laws to help you, you are giving them something as well, and you are deepening your relationship and connection. Generosity is a two-way street.

And while you are currently the one in need, that may not always be the case. When the time comes for you to show up for them as they have for you, you’ll be ready to do so. In the meantime, look for little ways to reciprocate, even if it’s as small as washing a dish or sending a loving note.

It’s incredible that your ex’s family shows up for you and your kids in this way, so try to redirect your guilty feelings back to your deep feelings of gratitude and simply thank them and the universe for helping to provide for you. And remember: You and your children are more than worthy of this help.

Dear Care and Feeding,

I don’t have any children of my own, but I’m the honorary aunt to my friend’s awesome daughter, Gabby. She just turned 9, and I’m probably biased, but she’s remarkably curious, social, and empathetic for her age. Her parents emigrated here in their teens, and English is not their first language, so occasionally they’ll ask me for help with answering complicated questions she poses that they aren’t quite sure how to explain in English.

Recently, I’ve noticed Gabby’s questions are becoming more anxious. She’s asked me about car accidents, animal attacks, and some scars I have from various surgeries. Each time, it seems like she’s trying to figure out what somebody did that caused it, or what she can do to prevent it. Her mom told me that after she heard about a school shooting, Gabby asked if the children were bad or misbehaving, and was worried that someone would come to school and shoot her if she was “bad.”

When Gabby asks me these kinds of questions, how do I balance explaining that sometimes bad things just happen, and it’s not your fault, but also, there are things you can do to protect yourself, like wearing a seatbelt, or not feeding wild animals? How do you teach kids that sometimes the world is a scary place, but that doesn’t mean you have to live being scared of everything?

— Sometimes I’m Scared Too

Dear Sometimes I’m Scared Too,

These are super tough topics to tackle and while I’m sure you’re an amazing aunt, they may be best handled by Gabby’s parents. Can you touch base with them and let them know what you’ve observed about the nature of Gabby’s questions? Ask them if they feel comfortable with you having these discussions with her, and if so, how they’d like you to handle these big questions. If you feel comfortable doing so and think they’ll be open to hearing it, let them know that you’ve noticed Gabby seeming increasingly anxious. They may want to have her screened for clinical anxiety, which current guidelines recommend doing at age 8 anyway.

If you do continue these conversations with Gabby, you can start by validating her feelings, encouraging her to talk about them, and letting her know that you also feel scared and sad sometimes. Explain scary events in age-appropriate language, and correct her misconceptions, like the idea that school shootings happen if you are bad. Reassure her that she is safe and that her parents are here to protect her. Remind her of the precautions we take to help us stay safe, such as wearing our seat belts in the car. When relevant, you can remind her or go over the plans and procedures in place at home or school to respond to the event. And let her know that these events like school shootings are very rare, and that there is more good in the world than bad.

It’s been recommended a million times, but Mister Rogers’ quote about “looking for the helpers” is a classic for a reason. It reads: “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of ‘disaster,’ I remember my mother’s words, and I am always comforted by realizing that there are still so many helpers – so many caring people in this world. Talk about the first responders like firemen and EMTs who charge in to help and get scary situations under control. It’s clear each time these words of wisdom go viral that they provide comfort for all of us, kids and adults alike.

Catch Up on Care and Feeding

• If you missed Monday’s column, read it here.
• Discuss this column in the Slate Parenting Facebook group!

Dear Care and Feeding,

My second-grade daughter, “Libby,” has a classmate who regularly exhibits classic “mean girl” behavior. Anna lies, accuses other kids of doing things they haven’t done (like cheating or pushing her), and has even gotten physically pushy with other girls before. I’ve talked to my daughter about how to deal with this classmate, “Anna,” and for the most part, Libby isn’t too bothered by it. She has plenty of other friends and just sort of avoids Anna.

Anna has a birthday party coming up in a couple weeks, and apparently it’s all she’s been talking about. She has a limit of 12 people she can invite, but there are 15 girls in their entire grade, so that leaves out only a few girls. Anna has been very vocal about the party, explicitly telling kids that she’s not inviting them. Libby was a bit upset, but considering she doesn’t really like Anna, she moved on pretty quickly.

Today, Anna told Libby that she is now going to invite her to the party, but only because a couple other girls can’t attend, so now she has room for more. Basically, my kid was Anna’s 12th choice, and she knows she’s only invited because two other friends can’t attend.

I really, really don’t want Libby to go to the party. I feel like if I did, I’d be teaching her that it’s okay to let people treat you like this. But I also don’t want to force her to miss out. Her preference is to go—not because she likes Anna, but because she is social and wants to be with her friends. However, she’s really mature, so I’m confident she wouldn’t put up a fuss if I said no and explained my reasoning.

Any advice?

— Unsure Mama

Dear Unsure Mama,

I want to give Anna and her parents the benefit of the doubt and assume there is a valid reason they capped the guest list at 12, but either way it certainly sounds like Anna is lording the invites over the other girls in the class. Here’s my take on birthday party etiquette: It’s OK to invite just a few people from the class, but if you’re going to invite most of the class, you’ve gotta invite everybody. It’s not fair to exclude just a few people.

But kudos to Libby for not getting involved in the drama and just wanting to scope the party scene. Since it seems as if the whole thing is bothering you more than it is her, I don’t think you should push the issue. You may end up making her feel bad about herself where she didn’t before, and it sounds like her self-esteem is currently pretty solid.

My only real concern is for the (one?) kid in the class who is still not invited to the party. Can you ask Libby for the deets on who is still being excluded and why, and if she knows how that student feels about the situation? Depending on what you find out, the bigger issue at play may be whether Libby wants to attend the party while someone is still actively being excluded, or if that feels like participation in the mean girl culture you both dislike.

—Emily

More Advice From Slate

A distant relative who is close to my age works at a day care center several states away from me. We follow each other on social media, and she frequently shares things that really make me uncomfortable. For example, she often posts pictures or takes Snaps of kids crying in a way that’s shaming them, like “He was hungry, so I gave him a snack” or “She wanted to go outside, but it’s not time.” (Think of the “Why my toddler is crying?” meme, only they’re not her kids.) She and her co-workers also appear to play a game where they hide the head of a decapitated baby doll around the center, in view of the children, in order to scare one another…

How to ensure social determinants of health actually improve health care

Presented 80 p.c of a person’s health is affected by non-healthcare variables, it is no surprise that the two overall health treatment companies and well being strategies are on the lookout for means to superior deal with the broader established of social and economic disorders that influence wellbeing. Emblematic of the ongoing shift from quantity to value, an escalating quantity of Medicaid-managed care contracts are requiring health plans to measure and handle the social determinants of overall health (SDoH), with the final objective of lowering well being disparities and escalating overall health and fitness. Although relocating in the suitable way, the means for wellbeing options to employ evidence-centered interventions to increase health and fitness fairness is significantly hampered by a absence of provider Z code utilization. If you can not measure it, you can’t handle it.

In 2016, diagnosis codes Z55-Z65 were launched to the healthcare coding system to permit vendors to report the presence of non-scientific factors that are recognised to affect well being results (this sort of as employment, housing, foodstuff insecurity, etcetera.). When properly documented, these Z codes are an powerful way for vendors and wellness strategies to coordinate care and to establish qualified group-centered interventions. Even so, uptake has been sluggish thanks to administrative load, a lack of benchmarks, a lack of service provider consciousness, as effectively as vendors remaining unwell-geared up to handle these wants.

Learning from Z code utilization

In Oct 2021, Centers for Medicare and Medicaid Companies (CMS) launched a report, which shown that Z codes are mostly unreported in Medicare rate-for-support promises. By 2019, homelessness was the most regularly used Z code, on the other hand Z codes have been only documented on .11 {bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of all promises.

We analyzed details by way of 2022 and observed that the use of Z codes throughout commercially insured, Medicare Edge and Medicaid populations carries on to stall. On a yearly basis, the proportion of individuals with a Z code ranges from .13 percent in 2017 to .15 per cent in 2019 and 2020. In major metropolitan parts, the proportion of sufferers with a Z code is as low as .03 p.c in Atlanta, Georgia to .17 percent in San Francisco, California.

Even with the present state of very low adoption, federal and state policy efforts go on to double down on the importance of improving upon documentation and measurement of social things, ranging from the Medicaid and CHIP Payment and Access Commission’s (MACPAC) most current recommendations to Congress, to Centers for Illness Management and Prevention’s (CDC) release of extra Z codes, which go into effect April 1, 2023. The exacerbation of well being inequities on full screen for the duration of the COVID-19 pandemic without doubt supports the rationale driving these coverage initiatives and the ongoing concentrate on enhanced measurement. Even so, policymakers keep on to overlook a significant place: Facilitating access does not guarantee adoption.

As we have witnessed numerous situations before (which include with COVID-19 telehealth growth), procedures that just make a thing obtainable, unbiased of how precious that company or item is, do not always translate to significant use or adoption. If utilization of Z Codes from 2017 to 2022 is only a tenth of a percent, what is to say that introducing more codes will increase adoption of current codes, let by yourself new codes? If the priority is to maximize measurement, and hence, provide additional qualified social care, then should not plan attempts be targeted on overcoming present barriers to use?

Driving Z code adoption

Very well-intentioned policies like The American Rescue Approach Act of 2021 involved efforts to deal with food and housing insecurity, these types of as developing a standard method to measuring and accumulating results linked to overall health equity. Having said that, equally federal and state procedures similar to this situation proceed to overlook the concentrate on — while delivering a course of action in which to obtain the intended consequence, they do not alter the system that sales opportunities to the wished-for behavior, which is greater documentation. Illustrating this disconnect, researchers have identified that even among the minority of providers that doc social needs via clinical notes, an even more compact share of all those providers are translating these notes into Z codes.

Many levers need to be pulled to meaningfully spur Z code adoption on a national stage. The aforementioned CMS report from 2021 acknowledges the absence of money incentives and providers’ perceived skill to handle SDOH-linked problems as remaining persistent limitations to greater adoption of Z coding in clinical practices.

Ultimately, screening for health and fitness-relevant social complications is essentially diverse from screening for healthcare issues, which raises the query: What policies are becoming carried out to present instruction for both equally the screening and “treatment” of SDoH? The option needs recognition of the truth that major care suppliers are at the “front lines” of wellness care and are progressively screening and dealing with patients for a lot more specialised disorders, like despair. In a well being financial state wherever supplier provide is currently substantially constrained, policymakers should consider the evolving (and at any time-expanding) responsibilities of companies and what that usually means for their capacity to get on added social screening tasks.

Policymakers will require to calibrate their investment in growing provider capability (which include social personnel) to fulfill the requires of populace-based mostly screening and documentation. Ultimately, as the health treatment industry has found with the adoption of other novel CMS steps, incentivizing the use of Z codes as a aspect of price-based mostly care arrangements may be the finest way to integrate them into a portion of day-to-day apply.

In the meantime, if the goal is to connect patients promptly and competently to social treatment methods, policymakers and payers can concentrate on non-personal steps to predict unique requires. Although not ideal, econometrics have demonstrated that Z codes are associated with a large Area Deprivation Index, and there is plenty of Zip Code-unique overall health treatment utilization, demographic and behavioral information now offered to use. If analyzed appropriately, the want for Z codes could develop into significantly less salient.

To make significant and lasting transform in well being equity, and, in turn, health outcomes, by improved coordination and connectivity in between social and professional medical care, CMS really should not simply make new prognosis codes, but thoughtfully incentivize the behaviors needed to make adoption.

Allison Oakes, Ph.D., is the director of exploration at health care analytics corporation Trilliant Wellness.

Sanjula Jain, Ph.D., is the senior vice president of market method and main exploration officer at Trilliant Health.

Copyright 2023 Nexstar Media Inc. All legal rights reserved. This content might not be published, broadcast, rewritten, or redistributed.

Bay Pines VA Research Program | VA Bay Pines Health Care

Study Area Psoriasis Title/BP Study Number A Multicenter, Open Registry of Patients with Psoriasis who are Candidates for Systemic Therapy Including Biologics “PSOLAR” Study #1573980 Synopsis Observational Study collecting information related to the treatment of psoriasis and evaluates patient and disease characteristics, patient-reported assessments and clinical and quality of life outcomes. Clinical Trials: NCT00508547 Study Team Local PI: Daniel Hogan, MD Lori Sisler lorine.sisler@va.gov 727-385-0223 Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Status Enrolling Study Area Genetics Title/BP Study Number Million Veteran Program “MVP” Study #1612959 Synopsis A national research program to learn how genes, lifestyle, and military exposures affect health and illness. All Veterans can participate in this one-time blood collection project. Study Team Local PI: Allison Williams, RN, Ph.D., ND Gary Smith gary.smith@va.gov 727-398-6661, ext.17284 Lori Sisler lorine.sisler@va.gov 727-385-0223 Status Enrolling Study Area Opioid Abuse Title/BP Study Number Comparative Effectiveness of Two Formulations of Buprenorphine for Treating Opioid Use Disorder in Veterans “VA BRAVE” CSP 2014 Study #1612560 Synopsis Treat Veterans with Opioid Use Disorder (OUD) to understand whether Buprenorphine a medication to treat OUD, given in a monthly injection form works similarly to or better than buprenorphine oral form. Participation in the study will last 1 year. Clinical Trials: NCT04375033 Study Team Local PI: Maha Lahoud-Bladykas, MD Chris Vallanat christopher.vallanat@va.gov 727-398-6661, ext. 15992 Mariah Alexis mariah.alexis@va.gov 727-398-6661, ext. 10152 Status Enrolling Study Area Opioid Abuse Title/BP Study Number A Randomized, Double-Blind Study Comparing 2 Maintenance Dosing Regimens of Buprenorphine Extended-Release Subcutaneous Injection (RBP-6000) in Treatment-Seeking Adult Participants with Opioid Use Disorder and High-risk Opioid Use ”INDIVIOR” Study #1651131 Synopsis The primary objective of the maintenance phase is to compare the efficacy of 100 mg and 300 mg maintenance doses of extended-release buprenorphine administered every 4 weeks. Clinical Trials: NCT04995029 Study Team Local PI: Maha Lahoud-Bladykas, MD Mariah Alexis mariah.alexis@va.gov 727-398-6661, ext. 10152 Chayla Lee Chayla.lee@va.gov 727-398-6661, ext. 10111 Status To be launched Study Area Lung Cancer Title/BP Study Number Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy Trial “VALOR” CSP 2005 Study #1573963 Synopsis Veterans diagnosed with stage I non-small cell lung cancer who are healthy enough to have surgery, agree to be randomized to either surgery (standard of care treatment) or an alternative non-surgical treatment – Stereotactic Radiotherapy (SBRT). Clinical Trials: NCT02984761 Study Team Local PIs: Edward Hong, MD Ryan Burri, MD Marlena Kern, RN marlene.kern@va.gov (VA cell) 727-219-7174 Status Enrolling Study Area PTSD/Mental Health Title/BP Study Number Veteran Health Behavior Study (Wave 2) Study #1573969 Synopsis Observational trial recruiting Veterans who were deployed to Iraq or Afghanistan to learn more about the bidirectional relationships between sleep quality, PTSD symptoms and Alcohol Use Disorder symptoms. Clinical Trials: NCT04552782 Study Team Local PI: Jessica Keith, PhD Anna Rosenblatt Anna.Rosenblatt2@va.gov 727-398-6661, ext.14728 or 727-317-7361 Camille Compton Lori.Compton@va.gov 727-398-6661, ext. 14728 or 10151 Status Enrolling Study Area Infectious Disease Title/BP Study Number Randomized, Double-blind, Placebo-controlled, Multicenter Phase 3 Study to Assess the Efficacy, Safety And Immunogenicity of Vaccination With ExPEC9V Study #1624732 Synopsis Phase III clinical trial to evaluate the safety and efficacy of Vaccination With ExPEC9V in the Prevention of Invasive Extraintestinal Pathogenic Escherichia coli Disease in Adults Aged 60 Years And Older with a History of Urinary Tract Infection in the Past 2 Years. Clinical Trials: NCT04899336 Study Team Local PI: Kaley Tash, MD Anna Rosenblatt Anna.Rosenblatt2@va.gov 727-398-6661, ext.17051 or 727-317-7361 Cortny Withee Cortny.Withee@va.gov 727-398-6661, ext.15900 Status Enrolling Study Area PTSD/Insomnia Title/BP Study Number CSP #2016 National Adaptive Trial for PTSD related Insomnia (NAP) Study #1612520 Synopsis A clinical trial to compare the efficacy of trazodone hydrochloride, eszopiclone, and gabapentin to placebo, as adjunctive therapies in the treatment of insomnia symptoms among Veterans with military related PTSD. Study Team Local PI: Ateiat Philips, MD Stella Inting-Toothman 727-398-6661, ext. 17184 727-776-8687 Stella.inting-toothman@va.gov Status Enrolling Study Area Psoriatic Arthritis Title/BP Study Number Solstice- Guselkumab therapy in patients with active Psoraitic Arthritis (PsA) Study #1634796 Synopsis For Veterans with active psoriatic arthritis who have failed a prior anti-TNF (Humira, Enbrel, etc.) The primary objective is to evaluate the efficacy of guselkumab. Study Team Local PI: Priyanka Murali, MD Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Camille Compton Camille.compton@va.gov 727-398-6661, ext. 14728 or 10151 Status Enrolling Study Area Psoriatic Arthritis Title/BP Study Number Star- Guselkumab therapy in patients with Psoraitic Arthritis (PsA) who have never been treated with a biologic before Study #1634798 Synopsis For bionaive Veterans who have never been treated with a biologic participants with psoriatic arthritis axial disease. The goal is to evaluate the efficacy of guselkumab by assessing reduction in axial symptoms. Study Team Local PI: Priyanka Murali, MD Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Camille Compton Camille.compton@va.gov 727-398-6661, ext. 14728 or 10151 Status Enrolling Study Area Psoriatic Arthritis Title/BP Study Number Affinity- Combination therapy with guselkumab and golimumab in patients with Psoriatic Arthritis (PsA) Study #1634801 Synopsis For Veterans with active psoriatic arthritis, who have failed prior treatment of anti-TNF (Humira, Enbrel, etc.) and are interested in a dual therapy of guselkumab AND golimumab. Study Team Local PI: Priyanka Murali, MD Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Camille Compton Camille.compton@va.gov 727-398-6661, ext. 14728 or 10151 Status Enrolling Study Area Cardiology Title/BP Study Number Pragmatic Evaluation of Events and Benefits of Lipid-Lowering in Older Adults (PREVENTABLE) Trial Study #1612747 Synopsis PREVENTABLE is a multi-center, randomized, parallel group, placebo-controlled superiority study that will evaluate if taking a statin could help older adults live independently for longer by preventing dementia, disability, or heart disease. PREVENTABLE will randomly assign Atorvastatin 40 mg daily or matching placebo once daily to 20,000 community-dwelling adults ≥75 years of age without clinically evident cardiovascular disease, significant disability, or dementia, and follow them for up to 5 years. Clinical Trials: NCT04262206 Study Team Local PI: Dennis Hall Chayla Lee Chayla.lee@va.gov 727-398-6661, ext. 10111 Cortny Withee Cortny.Withee@va.gov 727-398-6661, ext. 15900 Status Enrolling Study Area Infectious Disease Title/BP Study Number CSP #2001 Investigation of Rifampin to Reduce Pedal Amputations for Osteomyelitis in Diabetics (VA INTREPID) Study #1613455 Synopsis VA Cooperative Study #2001 is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for Diabetic Foot Osteomyelitis. The primary endpoint is amputation-free survival. Clinical Trials: NCT03012529 Study Team Local PI: Melissa Abercrombie, MD Cortny Withee Cortny.Withee@va.gov 727-398-6661, ext. 15900 Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Status Enrolling Study Area Infectious Disease Title/BP Study Number CSP #596 Optimal Treatment for Recurrent Clostridium difficile Infection (OpTION) Study #1613094 Synopsis The primary objective of this study is to determine whether 1) standard fidaxomicin treatment and 2) standard vancomycin treatment followed by taper and pulse vancomycin treatment are superior to standard vancomycin treatment alone for sustained clinical response at day 59 for all treatments, for participants with either their first or second recurrence of C. difficile infection. Clinical Trials: NCT02667418 Study Team Local PI: Kaley Tash, MD Cortny Withee Cortny.Withee@va.gov 727-398-6661, ext. 15900 Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Status Enrolling Study Area Cardiology Title/BP Study Number CSP2002 VA-IMPACT Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular OuTcomes Study #TBD Synopsis VA Cooperative Studies Program #2002 will determine whether treatment with metformin, compared with placebo, reduces the risk of major adverse cardiovascular events (MACE) in patients with pre-diabetes and established atherosclerotic cardiovascular disease (ASCVD). Study Team Local PI: Manjunath Harlapur, MD Stella Inting-Toothman (727) 398-6661, ext. 17184 (727) 776-8687 Stella.inting-toothman@va.gov Sarah Crim sarah.crim@va.gov 727-398-6661, ext. 17975 Status To be launched Study Area Lung Cancer Title/BP Study Number LungLife AI Inc. Study #1651410 Synopsis The objective of this study is to use blood draws to validate a device developed by LungLife AI Inc in detecting circulating tumor cells for patients presenting with pulmonary nodules. The test aims to aid in the detection of early-stage lung cancer. Clinical Trials: NCT05171491 Study Team Local PI: Stephen Clum, MD Camille Compton Lori.compton@va.gov 727-398-6661, ext. 10151 Mariah Alexis Mariah.alexis@va.gov 727-398-6661, ext. 10152 Kameron Wheelock Kameron.wheelock@va.gov 727-398-6661, ext. 17842 Status Enrolling Study Area Prostate Cancer Title/BP Study Number Identification of Targetable Prostate Cancer Alterations Through Tumor DNA Screening Study #1573965 Synopsis This is an observational, non-interventional study of screening veterans receiving care within Bay Pines VA Healthcare System who carry the diagnosis of advanced prostate cancer, metastatic or recurrent, for the presence of DNA mutations in tumor or germline DNA which could provide access to therapies with potential to significantly prolong survival. Study Team Local PI: Ryan Burri, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Mariah Alexis Mariah.Alexis@va.gov 727-398-6661, ext. 10152 Status Enrolling Study Area Prostate Cancer Title/BP Study Number VA STARPORT: Veterans Affairs Seamless Phase II/III Randomized Trial of Standard Systemic Therapy with or without PET-directed Local Therapy for Oligorecurrent Prostate Cancer Study #1616760 Synopsis This is an interventional study for patients with oligorecurrent prostate cancer to determine whether adding metastasis-directed therapy to standard systemic therapy improves disease outcomes further. This study also determines if certain mutations present in tumor DNA can predict if Veterans will benefit from PET-directed local therapy. Study Team Local PI: Ryan Burri, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Status Enrolling Study Area Lung Cancer Title/BP Study Number A Phase III, Randomized, Placebo-controlled, Double-blind, Multi-center, International Study of Durvalumab with Stereotactic Body Radiation Therapy (SBRT) for the Treatment of Patients with unresected Stage I/II, lymph-node negative Non-small Cell Lung Cancer (PACIFIC-4/RTOG-3515) Study #1600510 Synopsis This is a study assessing the efficacy and safety of durvalumab versus placebo with standard of care Stereotactic Body Radiation Therapy (SBRT) in patients with unresected clinical Stage I/II lymph node-negative (T1 to T3N0M0) Non-Small Cell Lung Cancer. Study Team Local PI: Ryan Burri, MD Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Status Enrolling Study Area Bladder Cancer Title/BP Study Number A Phase 3, Randomized, Double-blind, Placebo-controlled Clinical Trial to Study the Efficacy and Safety of Pembrolizumab (MK-3475) in Combination With Chemoradiotherapy (CRT) versus CRT Alone in Participants with Muscle-invasive Bladder Cancer (MIBC). Study #1573968 Synopsis This is a trial for muscle-invasive bladder cancer to compare intact event-free survival in participants from Arm A (pembrolizumab + chemoradiotherapy) and Arm B (placebo + chemoradiotherapy). Study Team Local PI: Andrew Leone, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Status Enrolling Study Area Lung Cancer Title/BP Study Number A Phase 2 Trial of MRTX849 Monotherapy and in Combination with Pembrolizumab in Patients with Advanced Non-Small Cell Lung Cancer with KRAS G12C Mutation Study #1679339 Synopsis This is a study assessing the efficacy and safety of MRTX849 alone and in combination with Pembrolizumab as a first-line treatment in patients with Advanced Non-Small Cell Lung Cancer with a KRAS G12C mutation. Patients will be randomized to different arms depending on their Tumor Progression Score (TPS). Study Team Local PI: Ryan Burri, MD Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Mariah Alexis Mariah.Alexis@va.gov 727-398-6661, ext. 10152 Status Enrolling Study Area Bladder Cancer Title/BP Study Number An observational study of efficacy and utility of Cxbladder tests in the identification of low vs high risk patients and the detection of urothelial carcinoma in patients presenting with hematuria Study #1683093 Synopsis This is an observational study recruiting patients presenting with blood in the urine, who are undergoing investigation for the presence of Urothelial Carcinoma. This study is designed to compare the Cxbladder tests versus standard of care procedures. Study Team Local PI: Andrew Leone, MD Mariah Alexis Mariah.Alexis@va.gov 727-398-6661, ext. 10152 Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Status To be launched Study Area Head and Neck Cancer Title/BP Study Number Randomized Phase II/III Trial of Radiation with High-Dose Cisplatin (100 mg/m2) Every Three Weeks versus Radiation with Low-Dose Weekly Cisplatin (40 mg/m2) for Patients with Locoregionally Advanced Squamous Cell Carcinoma of the Head and Neck (SCCHN) Clinical Trials: NCT05050162. Study #1682403 Synopsis This study for patients with locoregionally advanced squamous cell carcinoma of the head and neck is to determine whether radiation with low-dose cisplatin weekly is superior in terms of acute toxicity to radiation with high-dose cisplatin every 3 weeks. Study Team Local PI: Ryan Burri, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Mariah Alexis Mariah.Alexis@va.gov 727-398-6661, ext. 10152 Status Enrolling Study Area Prostate Cancer Title/BP Study Number A Single-arm, Open-label, Phase II Study of Checkpoint Inhibitors in Men with Progressive Metastatic Castrate Prostate Cancer (mCRPC) Characterized by a Mismatch Repair Deficiency or Biallelic CDK12 Inactivation (CHOMP). Study #1612473 Synopsis The purpose of this study is to determine the response rate to the anti-PD1 antibody, pembrolizumab in Veterans with mCRPC characterized by either mismatch repair deficiency (dMMR) or biallelic inactivation of CDK12. Study Team Local PI: Ryan Burri, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Status Enrolling Study Area Prostate Cancer Title/BP Study Number An open-label, multicenter phase II study to compare the efficacy of carboplatin as first-line followed by second-line olaparib versus olaparib as first-line followed by second-line carboplatin in the treatment of patients with castration resistant prostate cancer containing homologous recombination deficiency (COBRA). Study #1612483 Synopsis To determine progression free survival (PFS) to initial therapy (PFS-1L) with carboplatin vs. olaparib in the treatment of patients with metastatic castration resistant prostate cancer (mCRPC) containing inactivation of the homologous DNA repair pathway, including BRCA1, BRCA2, PALB2, BARD1, BRIP1, CHEK1, FANCL, RAD51B, RAD51C, and RAD54L. Study Team Local PI: Ryan Burri, MD Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Status Enrolling Study Area Prostate Cancer Title/BP Study Number VA Multi-Omics Analysis Platform for Prostate Cancer and Sequencing (VA MAPP-SEQ) Biorepository Study #1713735 Synopsis Biorepository for men with the potential to be diagnosed with prostate cancer or having a diagnosis of prostate cancer scheduled to undergo surgical/non-surgical procedure on the prostate gland or metastatic tissue. The purpose of this study is to create a centralized biorepository for future research for Veterans with prostate cancer. Study Team Local PI: Andrew Leone, MD Hayley Maither Hayley.maither@va.gov 727-398-6661, ext. 15925 Kameron Wheelock Kameron.Wheelock@va.gov 727-398-6661, ext. 17842 Mariah Alexis Mariah.Alexis@va.gov 727-398-6661, ext. 10152 Status Enrolling Study Area Pulmonary/COPD Title/BP Study Number A Phase III, Multicenter, Randomized, Double-blind, Chronic-dosing, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy and Safety to Two Dose Regimens of MEDI3506 in Participants with Symptomatic Chronic Obstructive Pulmonary Disease (COPD) with a History of COPD Exacerbations (TITANIA). Study #1672631 Synopsis For Veterans 40 years and older with a diagnosis of COPD who have a history of exacerbations within the past year. The goal is to evaluate the efficacy and safety of MEDI3506 300 mg every 8 weeks and 300 mg every 4 weeks dose regimens. The study is to be conducted. Study Team Local PI: Ravi Patel, MD Sarah Crim Sarah.Crim@va.gov 727-398-6661, ext. 17975 Lori Camille Compton Lori.Compton@va.gov 727-398-6661, ext. 10151 Chayla Lee Chayla.Lee@va.gov 727-398-6661, ext. 10111 Status Enrolling Study Area Cardiology Title/BP Study Number A Multi-Center Study Evaluating Participants who Received CanGaroo® Envelope, TYRX™ Envelope, or No Envelope During CIED Implantation. Study #1605396 Synopsis The purpose of this study is to look at the differences of healing and complications in patients who have had previous heart device procedures done. The study will compare the results of the previous procedure (a type of envelope used or no envelope used). Clinical Trials: NCT04645173 Study Team Local PI: Afolabi Sangosanya, MD Cortny Withee Cortny.Withee@va.gov 727-398-6661, ext. 15900 Lori Camille Compton Lori.Compton@va.gov 727-398-6661, ext. 10151 Chayla Lee Chayla.Lee@va.gov 727-398-6661, ext. 10111 Status Enrolling