CVPM approach - Certificate of Veterinary Practice Management Updated: 2023

WEST LAFAYETTE, Ind. – When people think about jobs in the health care industry, they often think about client-facing roles – doctors, nurses, administrative staff and other medical personnel. But beyond the scrubs and lab coats, there are other professionals whose roles, though less visible, are still critical to the success of health care organizations. Medical and health care writers are one such example.

Considered a subfield of technical writing, medical and health care writing is what makes hard-to-understand medical information accessible to a variety of audiences. From writing the informational pamphlets that come with drug prescriptions to preparing the grant applications that sustain medical research facilities, health care writers play an essential role in the function and success of the system.

To help meet the need for skilled medical and health care writers, Purdue University is offering a new 100% online Medical and Healthcare Writing Graduate Certificate. The program consists of three fully online courses, all taught by Richard Johnson-Sheehan, a nationally known expert in scientific, technical, medical and health care writing and a professor of English and professional writing at Purdue.

Purdue’s Medical and Healthcare Writing Graduate Certificate offers students a high-quality, immersive and fast-paced skill-enhancing opportunity that can lead to success in the medical and health care writing industry. The courses cover important skills essential to health care writing areas, including proposal and grant writing. Each course runs for eight weeks. Classes can be taken individually, or students can complete all three to earn the certificate.

"This certificate covers three areas that will get you up and running as a medical and health care writer,” Johnson-Sheehan said “The introduction to medical writing course offers an overview of the career field and several major genres. The proposals and grants course will teach you a fundamental genre that is essential in the health care industry. The editing and publishing course will allow you to collaborate with authors who are experts in their areas but need support with publishing their research, marketing products or services and securing investment for their projects.”

The weekly commitment per class is approximately five hours, making this certificate an accessible option for busy professionals seeking a quick and convenient way to earn a health care writing credential. Courses start in August, October, January and March.

"The certificate offers an asynchronous approach to learning, which means you can complete the courses online and on your own schedule,” Johnson-Sheehan said. “The certificate puts an emphasis on practical communication skills that can be learned with some guidance and practice but are difficult for clients and employers to find among writers and editors.”

Though medical and health care writing has always been a vital component of the health care industry, the field has experienced a lot of growth recently. New tests, drugs and treatments for COVID-19 increased demand for medical writers who can create instruction manuals for patients (for example, the instructions that come with at-home rapid COVID tests). Medical grant writers are also in demand due to the large amount of research being conducted on COVID-19 and variant diseases as well as other diseases.

Demand for medical and health care writers is also on the rise in the medical regulatory compliance industry. Medical writers play a key role in preparing documentation for patents, regulatory filings and grants – particularly in the biopharmaceutical industry.

Because of these factors, medical and health care writers can expect to earn higher wages than other technical writers. According to an American Medical Writers Association salary survey, the median annual salary for medical writers was $144,500 in 2019. The Bureau of Labor Statistics reports that the median annual salary for all technical writers is $78,060. This makes medical and health care writing one of the more lucrative subfields of technical writing.

“Medical and health care writing is a satisfying career for health care professionals who are looking for more flexibility, creativity and well-paid work that can be done from home or other remote locations,” Johnson-Sheehan said. “For professional writers, medical and health care writing is a quickly growing field that pays well and involves intriguing subjects with exciting storylines.”

To learn more about Purdue’s Medical and Healthcare Writing Graduate Certificate, visit the program’s webpage.

Writer: Rachel Barton, barton53@purdue.edu

Source: Richard Johnson-Sheehan, rjohnso@purdue.edu

Starting your own medical practice is hard. In some states, it's almost impossible due to the monopoly power of politically connected hospital associations. Independent doctors and patients tried for 10 years in South Carolina before finally scoring a victory last month.

On May 16, South Carolina Gov. Henry McMaster signed legislation to repeal most of the state's medical certificate of need (CON) laws. A CON is a government permission slip that health care providers must obtain before they can launch or expand services. Spending money to provide safe, affordable care is illegal without this piece of paper.

Big hospitals love the red tape. Instead of competing with would-be rivals on a level playing field, they can claim their turf and defend it using government interference on their behalf. Many states even allow established providers to object to rival CON applications, giving them something like veto power.

If McDonald's had the same authority, local franchisees could block mom-and-pop burger joints from opening nearby. The Home Depot could block family hardware stores. And LA Fitness could block independent gyms.

Many times, smaller health care providers provide up without applying for a CON application because the process is expensive, cumbersome, and rigged. North Carolina, for example, uses a formula that counts doctors and patients like data points on a spreadsheet. "Need" is not based on what will save people time or money but on how many nearby providers already exist.

Ophthalmologist Jay Singleton got trapped in this environment. He owns a state-of-the-art vision center in New Bern, North Carolina, where he can treat patients at a fraction of big hospital costs. But the state blocked him from using his space for certain procedures because he lacked a CON. 

Application would have been futile for Singleton. Regulators decided in advance that CarolinaEast Health System, a $1.2 billion hospital network, could not handle more competition.

Singleton refused to submit the paperwork for formal denial. Why bother? Yet the North Carolina Court of Appeals faulted him for not trying when he sued to break up the CON monopoly with representation from our public interest law firm, the Institute for Justice.

Independent doctors and investors with Danbury Proton took a different approach in Connecticut. They played by the CON rules and asked for permission to open a proton therapy center to treat cancer patients. More than three years later, they are still waiting. The state denied their initial application, denied their appeal, and is now forcing them to watch from the sidelines while the state's two largest health care networks team up to open a proton therapy center 45 miles away.

Singleton tried litigation. Danbury Proton tried compliance. Neither approach worked to tear down the CON barriers. A third option is legislative reform.

Many states have considered repeals, but victories like the one in South Carolina are rare. Part of the reason is opposition from the American Hospital Association and its affiliates, which began pushing for CON laws in the 1960s and have defended them ever since.

These groups are well-funded and good at what they do. They knock on lawmakers' doors, describe alarmist scenarios, and provide talking points. They claim CON laws are necessary to prevent redundant investment, which they say would drive up costs and lower quality. Sometimes they even claim existing hospitals would close or be ruined without CON protectionism.

What these groups don't provide is evidence to back up their claims. They can't. "By their very nature, CON laws create barriers to entry and expansion to the detriment of health care competition and consumers," the U.S. Department of Justice and Federal Trade Commission concluded in a 2008 joint report.

Decades of real-world experience confirm this finding. California, Texas, and 10 other states eliminated their CON laws years ago with good results. Elsewhere, lawmakers passed substantial CON repeals in Arizona, Ohio, Indiana, and Montana.

CON monopolies took more hits in 2023. Besides South Carolina, which will soon require a CON only for long-term care facilities, North Carolina and West Virginia passed recent CON reforms. Iowa almost joined this list with a repeal package that advanced out of the state Senate before dying. Kentucky and Georgia, meanwhile, approved task forces to study CON repeal.

Beating a hospital monopoly is difficult. But these states show it's possible.

Executives looking for a way to enhance their own leadership style need look no further than Apple TV's Ted Lasso. Disguised as a show about a British football team, the series just might be a master class in leadership and management that could up any healthcare C-suite member's game.

Ted Lasso chronicles the roller coaster of wins and losses of a soccer team managed by a very unlikely fish-out-of-water guy from Kansas. He doesn't like tea and gets constantly hung up on the differences between American and U.K. English. He's not even a great soccer team manager; the team loses far more than it wins.

But a closer look and listen to the show, which also follows the ups and downs of the team's back office and characters' personal lives, reveals that game-changing leadership lessons can come from those you would least expect.

For example, how often do you find yourself frustrated with something or someone and ruminate about it for far too long? Ted Lasso's advice? Be a goldfish. Don't allow one bad deed to define who you are. Think about it for less than 10 seconds and then forget about it — like a goldfish.

Becker's spoke with several hospital executives — not all of whom watch the show, but it doesn't matter — who said "Ted Lasso's Lessons in Leadership" truly resonate with them.

Here, 16 healthcare leaders comment on Ted Lasso lessons they believe has affected their own leadership style.

Editor's note: Responses have been edited for clarity and brevity.

Lesson 1: Lead with empathy.

Christine Albert. Chief Experience Officer at LCMC Health (New Orleans): Empathetic leaders encourage diverse viewpoints, promote open communication and ensure that everyone's voice is heard. 

By incorporating empathy into our culture, our leaders create a positive and inclusive work environment, foster strong relationships and, ultimately, enhance the experiences of our patients. This approach improves teamwork, creativity, innovation and drives greater engagement, productivity and success within our organization. It enables us to deliver better services and better experiences to our patients, their families and the communities we serve.

Lesson 2: Being vulnerable doesn't make you weak.

Frank Beaman. CEO of Faith Community Hospital (Jacksboro, Texas): When I started at this hospital, the place was in bad shape. The community had a love/hate relationship with both the hospital and the only doctor in town. But it was all they had. I knew that if we were going to change things, I'd have to be the frontman. Many people didn't want anything to change. They didn't want a new leader and they were negative about everything. I faced considerable skepticism from many in the community.

I became vulnerable in an effort to prove change was necessary. To the extent of making myself vulnerable, I actually published my cell phone number. And I told people, "I'm the guy. If you have a problem, you need to call me."

If you are vulnerable, you're willing to take responsibility. If you have a weak personality and you are not an optimist, you may not be able to handle the vulnerability. It might make you curl up in a corner or make you hide from the situation. That's a recipe for disaster. On the contrary, if you make yourself vulnerable and embrace the challenges, you're going to come out on top.

Lesson 3: Optimism is infectious.

Michael Dowling. President and CEO of Northwell Health (New Hyde Park, N.Y.): I'm an eternal optimist by nature. Being positive isn’t a skill that you learn; it's a lifestyle. Positivity and optimism stem from leadership. As a leader, you must exude genuine confidence about the future. You need to have the courage to persistently believe tomorrow will be better. Resolve to beat the odds. Have hope that is not bashful, conditional or manufactured. 

You have to be realistic; you can't go around with a religious fervor. You have to balance reality with optimism. Yes, today's tough, but tomorrow will be better. You don't provide oxygen to despair. Who wants to follow someone like that? You need to provide oxygen to hope.

Lesson 4: Doing the right thing is never the wrong thing.

Greg Feirn. CEO of LCMC Health (New Orleans): At LCMC Health, doing the right thing is essential to our mission and we take pride in leading with health, care and education beyond extraordinary. We emphasize treating people like family — allowing us to show true compassion and providing that little something extra to our patients and families in the communities we serve. 

When making decisions, I am always mindful and take accountability in asking myself, "Is this the right thing?" That thought process allows me to take ownership of tough decisions and set a positive example for others. As healthcare leaders, it is critical that we always consider the potential long-term consequences of our actions, rather than focusing solely on short-term gains. 

Lesson 5: Winning and losing aren't everything.

Patrick Frias, MD. President and CEO of Rady Children's Hospital-San Diego: There's little room for egos when you are making decisions that impact the lives of children. While "winning" a debate with your colleagues may seem satisfying at the moment, it may ultimately be a hollow victory if the children in your care don't benefit. 

My leadership style looks at every decision through the lens of "what is best for the kids?" I'm happy to adjust my point of view if it becomes clear that a different approach better serves our patients and families. 

An example of this comes from the pandemic. Like most healthcare systems, our finances were under pressure and the future was uncertain. Could we afford to continue staffing our hospital and clinics and provide the highest level of care? We considered a number of options, but ultimately settled on the approach that was summed up best by our board chair: "Just remember these two things: Take care of the kids in our community and take care of our employees. Everything else will work out after it's done." We didn't cut staff or services; we weathered the storm, and in the end, we were all winners.

Lesson 6: Optimists take more chances.

Robert Garrett. President and CEO of Hackensack Meridian Health (Edison, N.J.): I definitely believe optimists take more chances and their attitude can inspire others. Being an optimist is especially helpful in times of uncertainty, such as during the COVID pandemic. As a leader, it was imperative to have hope and confidence about the future, especially when our teams were challenged like never before. 

With a positive outlook and vision, you can see the big picture and remain focused regardless of challenges or roadblocks that can seem insurmountable at times. 

A great example of this is my dream of opening a school of medicine. Why? You can't make all improvements necessary to remodel a flawed American healthcare system at the point of care. You have to instill a new way of learning with a far more expansive view of health and healthcare. It took more than a dozen years for my dream to reach fruition — and a few harrowing moments to keep on course — but it has been one of the most satisfying and epic gambles I have ever taken. 

Lesson 7: Everyone differs from everyone else.

Sonja LaBarbera. President and CEO at Gaylord Specialty Healthcare (Wallingford, Conn.): As a practicing speech-language pathologist for nearly two decades, I have had the pleasure of getting to know my patients — their families, their hobbies, their likes and dislikes. I also had the opportunity to partner with them as people first — and patients second. 

Early on, I discovered that each patient's recovery journey is unique, and that by leveraging people's individuality and discovering their motivations and goals, I could create customized care plans that resulted in optimal recoveries and clinical outcomes.

As a leader, I still apply those tools and that way of thinking daily. I work to build rapport and relationships, knowing that everyone I encounter views the world around them differently.

No single person has all the answers and it's important to surround yourself with people who can provide fresh perspectives from their own unique angles. Leveraging the different viewpoints of your staff — and embracing their individuality — often results in discovering the most innovative solutions to the toughest challenges.

Lesson 8: Embrace change.

Mel Lagarde. Chief Strategy and Growth Officer at LCMC Health (New Orleans): Healthcare is a calling that draws leaders who not only have to embrace change but also view it as an opportunity rather than a threat. We see change daily within healthcare and that is never more present than the last few years. Healthcare leaders must be open-minded, adaptable and proactive in navigating and responding to changes in the business environment. 

My ability to embrace change has had several effects on my personal leadership style. Change often brings opportunities for innovation and creativity — especially in the healthcare industry. Leaders who embrace change encourage their teams to think outside the box, challenge the status quo and generate new ideas. They foster an environment that encourages experimentation and risk-taking, which can lead to breakthrough innovations and competitive advantage.

We have seen a lot of young talent and executives joining the organization. It has been inspiring to see the enthusiasm, passion and new perspective that they bring to this work. By embracing this change, it has allowed us to evolve and move the system forward.

Lesson 9: Empowerment breeds confidence.

David Levine, MD. Chief Medical Officer at Fisher-Titus Health (Norwalk, Ohio): As a young leader with a new job as medical director of a large emergency department, I knew I was facing the challenge of "saving" a contract that had been given six months to Excellerate or be terminated. The pressure I felt was enormous. But I was confident and embraced the challenge.

Shortly after the transition, I began to understand the dynamics of the team and appreciated the differences between the providers. Two providers really struck me as opposites. One was a very good clinician but was arrogant and clearly believed he was the best doctor on the team. However, he had very poor documentation and even worse patient experience scores. The other provider (Tim), was family practice-trained but felt insecure about his role on the team since he was not emergency medicine-trained. He had very solid clinical skills, a magnetic personality that the nurses and patients loved him.

After several weeks in the role, I approached Tim for his advice and asked him to help lead our throughput project. He had the respect of the nurses and understood what was needed. He was able to offer some very actionable solutions and engage the team in a way that they welcomed the changes. Tim's confidence was part of the catalyst that caused this change.

Lesson 10: Winning is an attitude.

Manuel Linares. President and CEO at Touro Infirmary (New Orleans): Our goal is to be the best hospital in New Orleans. Having and showing a winning attitude builds confidence and motivation in others and helps us reach that goal. By displaying unwavering self-belief and enthusiasm, you inspire others to push their limits and aim for higher levels of achievement. Leaders who promote the "winning is an attitude" philosophy often foster a positive and optimistic work environment —  a priority especially in healthcare as we experience high rates of burnout and turnover. 

This culture creates a space where challenges are seen as opportunities, and individuals are empowered to take risks and think creatively to achieve success. For any healthcare entity to be sustainable, we must look for innovative solutions to Excellerate operations and patient care models that challenge the norms. By encouraging out-of-the-box thinking, we can implement new processes and procedures to strengthen our organization.

Lesson 11: Humor cuts through tension

David Marshall, DNP. Chief Nursing Executive at Cedars-Sinai Medical Center (Los Angeles): Humor is often overlooked as a leadership trait, but it can be a powerful tool. As a new leader at Cedars-Sinai in 2019, I had big shoes to fill following Linda Burnes Bolton, DrPH, RN. I used humor to break the ice and make others feel comfortable around me. I used dad jokes, made self-deprecating comments and showed a willingness to laugh at myself.

I think humor has helped me build relationships as a leader. I take time to get to know my direct reports, and I use humor to build relationships with them. I joke around with them, tease them and show a genuine interest in their lives outside of work. This helps to create a sense of camaraderie and trust.

Throughout my nursing career, I have used humor to diffuse tension. I can remember a variety of tense situations throughout my career. I have never lost my sense of humor, even in the most tense situations. I have used humor to lighten the mood and to help co-workers, patients and family members relax.

Lesson 12: Courage is the willingness to attempt.

James Matney. President and CEO of Colquitt Regional Medical Center (Moultrie, Ga.): Over my life, I've been willing to try new things, new technology or new service lines. We embarked on establishing a new family medicine residency. This is the first new residency in 20 years for the region. What's unique about this is we are a 99-bed hospital located in a rural area of Southwest Georgia. We also started a psychiatry residency. 

Both of these were an attempt to meet the needs of the people in our community. When I told people we were going to start a family medicine residency, many folks laughed. I had the courage to go ahead and start this. One of my favorite quotes is from George Bernard Shaw:  "Some people see things as they are and say why? I dream things that never were and say, why not?"

Lesson 13: Nobody is bigger than the team.

Danielle McCamey, DNP. Founder and CEO of DNPs of Color and Assistant Dean of Clinical Practice and Relationships at Johns Hopkins School of Nursing (Baltimore): Being a leader will humble you in so many ways. Sometimes you think you have it all figured out. Sometimes you think you can do it all. And, then, WHAM! Something or someone brings you back down to reality. These are humbling moments.

I'm sure we all know the age-old phrase "there is no 'I' in team," which is undeniably true. Life, the daily grind of work and various obligations create demands on our time and energy but also cultivates the many layers of experience and expertise we develop over time. It seems like post-pandemic life has underscored the value and importance of meeting our mission in life is much more effective when we do it together. We are humans with a variety of lived experiences and lived expertise that creates so many depths and layers to us that are not always uncovered at our workplaces. 

When we truly embrace that nobody is bigger than the team, we can effectively work to make each other better. Ultimately, at the end of the day, that is all that really matters. 

Lesson 14 : Be self-aware and genuine. A truly authentic leader doesn't have the time or the inclination to be anyone but themselves.

Dennis Pullin. President and CEO of Virtua Health (Marlton, N.J.): Effective leadership requires being your authentic self. There will always be detractors and people who disagree with your approach, but if you show up with authenticity and conviction, you establish yourself as reliable, consistent and well-suited for the responsibility of leadership.

Lesson 15: Don't dwell on mistakes or let them define you.

Janie Schumaker, BSN, RN. CEO at the Board of Certification for Emergency Nursing: When I was a very new nurse, I made a mistake with medication. Thankfully, there was no harm to my patient. However, I was mortified and certain that I was the worst nurse ever. I went to my leader immediately with my mistake. That leader helped me understand how important it is to own up to a mistake, learn from it, not repeat it and move on. That was 30 years ago and I have never forgotten it. This was a defining moment for me in my career. 

While no one wants to make a mistake, it does happen. I am a firm believer that leaders must be supportive of their team members and create a culture where people feel safe to own mistakes and share learnings and not let the mistake define them. This is how we learn and how we help others learn. Making a mistake is probably one of the best teachers out there. 

Lesson 16: Stay teachable.

Emily Sedgwick, MD. President and Chief Executive Officer of University Medical Center (New Orleans): Getting to know the team members, hearing their perspectives and understanding how I can be of service to them is a daily habit for me. We've made daily rounds mandatory for our clinical and nonclinical leaders so they can learn from the team. The resounding feedback is that it's not only a highlight of their day but mitigates burnout. By staying "teachable," I am inspired by the work of our team members every day.

At the beginning of the current parliamentary sitting, the Dewan Rakyat approved bills to amend the Penal Code and the Mental Health Act to decriminalise attempted suicide – syukur, Alhamdulillah.

These amendments were as follows:

• To repeal Section 309 of the Penal Code, which classifies suicide attempts as a criminal offence.
• To boost Sections 305 and 306 in order to increase penalties on those who aid and abet suicide attempts.
• To establish the role of crisis intervention officers, including the power to apprehend under the Mental Health Act 2001.

Given the steady calls to decriminalise attempted suicide over the years, and the mental health crisis that the country witnessed in 2021 at the height of the Covid-19 pandemic, the historic move is music to the ears of so many.

I wish to convey my heartfelt thanks and congratulations to those who have advocated tirelessly on this matter.

This is a win for the country, but most of all for those who suffer in silence.

It is a progressive step in the wider scheme of destigmatising suicide (its ideation and attempts too), and indeed, mental health altogether.

Decriminalisation is one battle that we have won in the war to break the stigma on mental health here at home.

Supporting decriminalisation

My organisation, the Green Ribbon Group (GRG), champions a community approach to mental health, based on the simple premise that as individuals, we ourselves are an untapped resource.

GRG believes it is possible to empower individuals to learn to support themselves and one another, in order to lighten the load or lift the burden off mental health professionals, non-governmental organisations (NGOs), existing helplines and government agencies.

This is the sole purpose of my advocacy and that of my organisation.

When GRG was first set up in 2021, our advocacy on decriminalisation rested on the notion that the current system already offers a psychiatric assessment of those who attempt suicide without automatically penalising these individuals.

We said that current provisions in the Mental Health Act 2001 are adequate to direct those who attempt suicide to undergo a psychiatric evaluation before a decision is made on their “offence”.

Back then, we were mindful of the different layers involved in reviewing legislation, what more to amend or repeal altogether.

And we understood the sensitivities and concerns of other stakeholders around the table, from the Attorney General’s Chambers to key ministries, the police and religious authorities.

In the two years since, I am humbled to see that greater strides have been made to not only repeal Section 309 altogether, but to also ensure that our legislations pertaining to suicide attempts will be made even more robust.

For instance, the amendments to Sections 305 and 306 now mean that cyberbullies cannot get away with aiding or abetting children or those with severe psychological decompensation, to attempt suicide or to complete the act itself.

I applaud our Parliamentarians for allowing the prosecution of those who should be prosecuted.

The law should come down hard on those who seek to harm, coerce or intimidate vulnerable individuals.

Moreover, we know that prosecuting those who attempt suicide does not decrease suicides.

We also know that decriminalisation does not increase suicides either.

But preventative measures for suicide and its attempts must go beyond legal revisions, simply because stigma and prejudice remain mountains to climb.

Advocate and include

Because we are all stakeholders in mental health, we have a responsibility – within the context of decriminalisation – to increase our efforts towards building and strengthening a community approach to suicide prevention and awareness.

How do we do this?

My answer is advocacy and inclusion.

For advocacy, we must do more to fact-check and correct misperceptions and negative connotations about suicides altogether.

The assumption that talking about suicide encourages one to commit suicide is what I hear most often.

It must be eradicated completely and replaced by statements of fact to educate.

Suicides are preventable, ideations can be overcome, and attempts do not necessarily mean that individuals will eventually die by suicide.

These statements must ring loud and clear now that these amendments are made.

On World Suicide Prevention Day in 2020, I stated that connectedness is crucial to those vulnerable to suicide.

We have a duty to reach out to them and provide them with support and companionship.

The onus is on us to make them feel included in their communities, whether it is at home, at school, or in their workplaces.

Inclusion also refers to an all-hands-on-deck approach, by absorbing communities into the mental health talent pool.

We can learn to encourage help-seeking behaviour not only amongst those who are vulnerable to suicide, but also those who are experiencing mental health problems in general.

Setting an example by walking the talk is another means of helping to destigmatise mental health.

The more we talk about it, the more we impact those around us.

Talking about suicide

GRG, in collaboration with the Malaysian Mental Health Association (MMHA), initiated its own suicide prevention and awareness programme called “A Conversation on Suicide” in 2021 based on these principles.

It focused on early detection, prevention and intervention via interim help.

Responding to a suicide attempt or approaching someone we suspect may be thinking of attempting suicide must be done carefully and with the assumption that the person is likely to be mentally distressed.

During the rollout of the programme, we were able to capture some data on suicide prevention and awareness – another ongoing challenge for mental health policy in Malaysia and the region.

For instance, we learnt that there is interest to learn more across multiple communities in the country – Malay, Chinese and Indian – which indicates that similar initiatives should be conducted in multiple languages to cater for diverse communities.

We also learnt that men were generally more interested in learning about suicide than women, who preferred to know more about general mental health first aid.

Programmes like “A Conversation on Suicide” can further complement current efforts by the government.

While it offers the basics of suicide prevention and awareness – such as increasing literacy and ensuring that more and more people are able to offer interim help – amending the Mental Health Act 2001 to establish crisis intervention officers provides an additional layer of support for those who are equipped with the basics.

While an innovative and sound policy addition, the move must come with parameters that clearly distinguishes these officers from others, e.g. those who have attended the “A Conversation on Suicide” programme.

Such parameters should also include the training these officers will undergo, their certification and qualifications.

The public should also be made aware of who these officers are in order to ensure a more streamlined effort towards preventing suicides.

Be compassionate

Compassion is the solution and the only path forward towards building and strengthening a community approach to suicide prevention.

Those who experience suicidal ideation or attempt to commit suicide may feel helpless, but they are never hopeless with the support of their community.

A little compassion really does go a long way.

Never underestimate the power of compassion and empathy.

Tengku Puteri Iman Afzan Al-Sultan Abdullah is the co-founder and president of the Green Ribbon Group. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. The Star does not provide any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

MILAN, Italy — Two independent efforts to use artificial intelligence (AI) to predict the development of early rheumatoid arthritis (RA) from patients with signs and symptoms not meeting full disease criteria showed good, near expert-level accuracy, according to findings from two studies presented at the European Alliance of Associations for Rheumatology (EULAR) 2023 Annual Meeting.

In one study, researchers from Leiden University Medical Center in the Netherlands developed an AI-based method to automatically analyze MR scans of extremities in order to predict early rheumatoid arthritis (RA). The second study involved a Japanese research team that used machine learning to create a model capable of predicting progression from undifferentiated arthritis (UA) to RA. Both approaches would facilitate early diagnosis of RA, enabling timely treatment and improved clinical outcomes.

Dr Lennart Jans

Lennart Jans, MD, PhD, who was not involved in either study but works with AI-assisted imaging analysis on a daily basis as head of clinics in musculoskeletal radiology at Ghent University Hospital and a professor of radiology at Ghent University in Belgium, said that integrating AI into health care poses several challenging aspects that need to be addressed. "There are three main challenges associated with the development and implementation of AI-based tools in clinical practice," he said. "Firstly, obtaining heterogeneous datasets from different image hardware vendors, diverse racial and ethnic backgrounds, and various ages and genders is crucial for training and testing the AI algorithms. Secondly, AI algorithms need to achieve a predetermined performance level depending on the specific use case. Finally, a regulatory pathway must be followed to obtain the necessary FDA [Food and Drug Administration] or MDR [medical devices regulation] certification before applying an AI use case in clinical practice."

RA Prediction

Yanli Li, the first author of the study and a member of the division of image processing at Leiden University Medical Center, explained the potential benefits of early RA prediction. "If we could determine whether a patient presenting with clinically suspected arthralgia (CSA) or early onset arthritis (EAC) is likely to develop RA in the near future, physicians could initiate treatment earlier, reducing the risk of disease progression."

Yanli Li

Currently, rheumatologists estimate the likelihood of developing RA by visually scoring MR scans using the RAMRIS scoring system. "We decided to explore the use of AI," Li explained, "because it could save time, reduce costs and labor, eliminate the need for scoring training, and allow for hypothesis-free discoveries."

The research team collected MR scans of the hands and feet from Leiden University Medical Center's radiology department. The dataset consisted of images from 177 healthy individuals, 692 subjects with CSA (including 113 who developed RA), and 969 with EAC (including 447 who developed RA). The images underwent automated preprocessing to remove artifacts and standardize the input for the computer. Subsequently, a deep learning model was trained to predict RA development within a 2-year timeframe.

The training process involved several steps. Initially, the researchers pre-trained the model to learn anatomy by masking parts of the images and tasking the computer with reconstructing them. Subsequently, the AI was trained to differentiate between the groups (EAC vs. healthy and CSA vs. healthy), then between RA and other disorders. Finally, the AI model was trained to predict RA.

The accuracy of the model was evaluated using the area under the receiver operator characteristic curve (AUROC). The model that was trained using MR scans of the hands (including the wrist and metacarpophalangeal joints) achieved a mean AUROC of 0.84 for distinguishing EAC from healthy subjects and 0.83 for distinguishing CSA from healthy subjects. The model trained using MR scans of both the hands and feet achieved a mean AUROC of 0.71 for distinguishing RA from non-RA cases in EAC. The accuracy of the model in predicting RA using MR scans of the hands was 0.73, which closely matches the reported accuracy of visual scoring by human experts (0.74). Importantly, the generation and analysis of heatmaps suggested that the deep learning model predicts RA based on known inflammatory signals.

"Automatic RA prediction using AI interpretation of MR scans is feasible," Li said. "Incorporating additional clinical data will likely further enhance the AI prediction, and the heatmaps may contribute to the discovery of new MRI biomarkers for RA development."

"AI models and engines have achieved near-expertise levels for various use cases, including the early detection of RA on MRI scans of the hands," said Jans, the Ghent University radiologist. "We are observing the same progress in AI detection of rheumatic diseases in other imaging modalities, such as radiography, CT, and ultrasound. However, it is important to note that the reported performances often apply to selected cohorts with standardized imaging protocols. The next challenge [for Li and colleagues, and others] will be to train and test these algorithms using more heterogeneous datasets to make them applicable in real-world settings."

A "Transitional Phase" of Applying AI Techniques

"In a medical setting, as computer scientists, we face unique challenges," pointed out Berend C. Stoel, MSc, PhD, the senior author of the Leiden study. "Our team consists of approximately 30 to 35 researchers, primarily electrical engineers or computer scientists, situated within the Radiology Department of Leiden University Medical Center. Our focus is on image processing, seeking AI-based solutions for image analysis, particularly utilizing deep learning techniques."

Their objective is to validate this method more broadly, and to achieve that, they require collaboration with other hospitals. Up until now, they have primarily worked with a specific type of MR images, specifically extremity MR scans. These scans are only conducted in a few centers equipped with extremity MR scanners, which can accommodate only hands or feet.

Dr Berend Stoel

"We are currently in a transitional phase, aiming to apply our methods to standard MR scans, which are more widely available," Stoel informed Medscape Medical News. "We are engaged in various projects. One project, nearing completion, involves the scoring of early RA, where we train the computer to imitate the actions of rheumatologists or radiologists. We started with a relatively straightforward approach, but AI offers a multitude of possibilities. In the project presented at EULAR, we manipulated the images in a different manner, attempting to predict future events. We also have a parallel project where we employ AI to detect inflammatory changes over time by analyzing sequences of images (MR scans). Furthermore, we have developed AI models to distinguish between treatment and placebo groups. Once the neural network has been trained for this task, we can inquire about the location and timing of changes, thereby gaining insights into the therapy's response.

"When considering the history of AI, it has experienced both ups and downs. We are currently in a promising phase, but if certain projects fail, expectations might diminish. My hope is that we will indeed revolutionize and enhance disease diagnosis, monitoring, and prediction. Additionally, AI may provide us with additional information that we, as humans, may not be able to extract from these images. However, it is difficult to predict where we will stand in 5-10 years," he concluded.

Predicting Disease Progression

The second study, which explored the application of AI in predicting the progression of undifferentiated arthritis (UA) to RA, was presented by Takayuki Fujii, MD, PhD, assistant professor in the department of advanced medicine for rheumatic diseases at Kyoto University's Graduate School of Medicine in Japan. "Predicting the progression of RA from UA remains an unmet medical need," he reminded the audience.

Dr Takayuki Fujii

Fujii's team used data from the KURAMA cohort, a large observational RA cohort from a single center, to develop a machine learning model. The study included a total of 322 patients initially diagnosed with UA. The deep neural network (DNN) model was trained using 24 clinical features that are easily obtainable in routine clinical practice, such as age, sex, C-reactive protein (CRP) levels, and disease activity score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The DNN model achieved a prediction accuracy of 85.1% in the training cohort. When the model was applied to validation data from an external dataset consisting of 88 patients from the ANSWER cohort, a large multicenter observational RA cohort, the prediction accuracy was 80%.

"We have developed a machine learning model that can predict the progression of RA from UA using clinical parameters," Fujii concluded. "This model has the potential to assist rheumatologists in providing appropriate care and timely intervention for patients with UA."

"Dr. Fujii presented a fascinating study," Jans said. "They achieved an accuracy of 80% when applying a DNN model to predict progression from UA to RA. This level of accuracy is relatively high and certainly promising. However, it is important to consider that a pre-test probability of 30% [for progressing from UA to RA]  is also relatively high, which partially explains the high accuracy. Nonetheless, this study represents a significant step forward in the clinical management of patients with UA, as it helps identify those who may benefit the most from regular clinical follow-up."

Li and Stoel report no relevant financial relationships with industry. Fujii has received speaking fees from Asahi Kasei, AbbVie, Chugai, and Tanabe Mitsubishi Pharma. Jans has received speaking fees from AbbVie, UCB, Lilly, and Novartis; he is cofounder of RheumaFinder.

The Leiden study was funded by the Dutch Research Council and the China Scholarship Council. The study by Fujii and colleagues had no outside funding.

European Alliance of Associations for Rheumatology (EULAR) 2023 Annual Meeting: Abstract OP0002, presented May 31, 2023; Abstract OP0190, presented June 1, 2023.

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As per Future Market Insights’ latest industry analysis, the valuation for the global Single-Use Gastroscopes Market revenue is expected to reach US$ 188.9 Million in 2023 and is projected to exhibit a CAGR growth of close to 15.6% over the forecast period, with an estimated valuation of US$ 807.8 Million in 2033.

Gastroscopes are medical instruments used to examine the inside of a person’s digestive tract, specifically the esophagus, stomach, and duodenum. They consist of a long, flexible tube with a camera and light source at the end, allowing doctors to see the inside of the digestive tract and potentially identify any issues or abnormalities. Gastroscopes are typically used during a procedure called an esophagogastroduodenoscopy (EGD) which involves inserting the scope through the mouth and down into the digestive tract.

Disposable gastroscopes eliminate the risk of cross-contamination and reduce the need for sterilization, making them more convenient and cost-effective for healthcare providers. Some manufacturers have also introduced single-use disposable gastroscopes that are lightweight, portable, and easy to use.

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• Gastroscopy device that is lightweight, portable, and easy to use is the ‘SlimView Gastrocam’. The SlimView Gastrocam is a cutting-edge gastroscopy system designed to provide efficient and comfortable examination of the gastrointestinal tract.

Manufacturers are investing heavily in research and development to create advanced gastroscopes that are more efficient, accurate, and patient-friendly.

• For instance, In May 2023, FDA has approved the new EVIS X1 endoscopy system from Olympus Corporation, along with two gastrointestinal endoscopes that are compatible with it: the GIF-1100 gastrointestinal videoscope, which is intended for use in the upper digestive tract, which includes the oesophagus, stomach, and duodenum.

The global Single-Use Gastroscopes market has been experiencing steady growth in recent years due to several factors, including the rising prevalence of gastrointestinal disorders, an aging population, and advancements in endoscopic technologies

Overall, these factors are contributing to the growth of the Single-Use Gastroscopes market, and are expected to continue to drive demand for effective and innovative applications options in the coming years.

Key Takeaways:

• GERD is the leading segment as application among patients and professionals, and held about 34.5% market share in 2022, gastroscopes allow doctors to directly visualize the inside of the esophagus and stomach, and to take biopsies or remove small tissue samples for further testing.
• By end user, the hospitals dominated the global Single-Use Gastroscopes market withholding the total market share of about 46.4% by the end of 2022, owing to the convenience and ease of accessibility to new technological advanced applications.
• By region, North America is leading in the global Single-Use Gastroscopes market with US contributing around 94.5% value share to the regional market in 2022.

“Increasing adoption of Single-Use Gastroscopes and growing awareness and diagnosis of the gastrointestinal diseases to create lucrative potential for the market to grow,” says an analyst at Future Market Insights (FMI).

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Market Competition:

Major players in the single-use gastroscope market use partnerships, acquisitions, mergers, and other corporate growth strategies to expand their businesses. The focus of major players is on tactics like increasing sales and applying new technologies for the development of novel products.

• In January 2022, Two of PENTAX Medical’s most recent inventions, the i20c video endoscope series and PENTAX Medical INSPIRA, have received CE certification. The new video processor, which was created with the needs of healthcare providers in mind, retains compatibility with current endoscope models from PENTAX Medical while also setting new benchmarks when used with the i20c video endoscope generation.
• In April 2023, Boston Scientific acquired Apollo Endo-surgery. Apollo is involved in designing, development, and marketing of next-generation, less invasive medical devices. This acquisition will enhance Boston’s gastrointestinal therapeutic endoscopy and endobariatrics portfolio.

Key Players:

• Ambu A/S
• Boston Scientific Corporation
• Fujifilm Holdings Corporation
• HOYA Corporation
• Olympus Corporation
• Pentax Medical
• KARL STORZ SE & Co. KG
• Medtronic
• Others

What Does the Report Cover?

Future Market Insights offers a unique perspective and actionable insights on the Single-Use Gastroscopes market in its latest study, presenting a historical demand assessment of 2017 to 2022 and projections for 2023 to 2033. The global Single-Use Gastroscopes market is segmented in detail to cover every aspect of the market and present a complete market intelligence approach to the reader.

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Key Segments Covered:

By Application:

• GERD
• Chronic Gastritis
• Gastric Ulcers
• Barrett’s Esophagus
• Others

By End User:

• Hospitals
• Ambulatory Surgical Centers
• Specialty Clinics
• Diagnostic Centers

About Future Market Insights, Inc.

Future Market Insights, Inc. (ESOMAR certified, Stevie Award – recipient market research organization and a member of Greater New York Chamber of Commerce) provides in-depth insights into governing factors elevating the demand in the market. It discloses opportunities that will favor the market growth in various segments on the basis of Source, Application, Sales Channel and End Use over the next 10-years.

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