INDIANAPOLIS - Sometimes medical decisions are left to family members or emergency personnel who don't know a patient's medical treatment wishes.

According to Dr. Susan Hickman of the Indiana University School of Nursing, a medical ethics researcher, that's why the legislature created the POST Act, with POST standing for Physician Orders for Scope of Treatment. And, she said, it's about more than just resuscitation.

"Do you want to return to the hospital and under what circumstances? Do you want a feeding tube? Do you want antibiotics if you get a life-threatening infection? So, the POST really expands beyond the code status order, in order to cover a much wider range of decisions," the doctor said.

Hickman said the POST order is the property of the patient. Emergency personnel suggest keeping it near prescriptions or on the refrigerator to be taken to the hospital or other medical setting if necessary. The POST order is something that can be updated, or verbally revoked, if circumstances merit.

The doctor said that, without a POST order or other medical directive, emergency personnel do everything possible - and that's not always what the patient wants. She said the POST order was created with certain individuals in mind, such as "people with advanced chronic progressive disease and frailty. People with terminal conditions. So, this gives them an opportunity to consider these issues and decisions in advance of a crisis, to bring their family member into the conversation," she said.

Hickman noted that other medical documents aren't recognized by all agencies, but the POST order will be because it is signed by a physician.

"Emergency medical services, nursing facilities staff" will recognize it, she said. "So, you have a tool that actually allows us to act upon and honor those preferences because it is a physician order."

The doctor cautioned that it may take a while before POST orders are widely used in Indiana, as the POST Act just took effect on July 1.




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April is National Stress Awareness Month. Stress is the body's way of processing work, personal, and family pressures, or other triggers.

A new study in the Journal of the American Medical Association has found a link between stress and chronic pain, which is defined as pain that persists for three months or more and lasts beyond the normal healing time of an injury or illness.

Former chiropractor Dr. Sean Pastuch is CEO of Active Life, a personal coaching company focusing on chronic pain-management options.

He suggested that biological, psychological and social interventions could be effective forms of treatment.

"The connection between all of those three things -- the physical, the mental, and the emotional -- is that when we think about pain, no one's defining what the word means," said Pastuch. "So, if we evaluate what the word 'pain' means, then we come to find that in order for there to be pain, there needs to be a negative emotional component to it."

He said that if you feel something, you have to decide if you like the way it feels or not. And what is viewed as pleasurable to some may feel painful to others.

The study also says depression and anxiety caused by chronic pain may contribute to a poor quality of life and reduce life expectancy.

A 2022 Indiana Chronic Care Policy Alliance report shows almost 8% of adults have chronic pain, with arthritis as the leading disorder.

Patsuch said patients face obstacles in finding a physician who can identify their pain, which means fewer or no opportunities to receive treatment.

"The reason why doctors struggle to help people with chronic pain, and why the confidence level among doctors is low," said Pastuch, "is because of all the medical schools, fewer than 15 actually have dedicated curriculum to supporting a patient with chronic pain."

Of the medical schools that offer a pain-management curriculum, he said the majority focus on students in the anesthetics department.

Patsuch suggested that when a patient is with their doctor, to use words other than "it just hurts." They need to be able to describe what hurts and ask, "How do I want to resolve it?"




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By Dawn Attride for Sentient.
Broadcast version by Chrystal Blair for Michigan News Connection reporting for the Sentient-Public News Service Collaboration

What's on the menu for a healthy microbiome? High-fiber foods, like broccoli and lentils are key - according to two new studies with two vastly different approaches published in Cell and Nature. As the debate about the role ultra-processed plant-based meat substitutes should play in a healthy diet rages on, these new studies focus on a more balanced, plant-forward approach, finding that a diet high in plants (fruits, vegetables and legumes) is good for a healthy gut. In addition to reducing climate emissions then, adapting a plant-forward diet can help to create a balanced gut microbiome, which in turn can reduce inflammation and risk of developing chronic diseases.

Each of our microbiomes is a nexus of bacteria, specific to factors like our environment, stress and age. Microbiomes can be vastly different among people - and even twins - that they're often likened to a microbial fingerprint of sorts. But we know that diet plays a large role in forming healthy gut bacteria. An Italian team of researchers set out to identify if there are signature microbiomes for vegans, vegetarians and omnivores (people who eat both plants and meat) out of a group of nearly 22,000 people living in the United States, the United Kingdom and Italy. And, as it turns out, there is a pattern of key bacteria associated with each dietary cohort.

How Much Does Diet Affect Your Microbiome?

"As more and more people adopt vegan and vegetarian diets, we wanted to find out how different their microbiomes are and which microorganisms are responsible for these differences," Gloria Fackelmann, postdoctoral researcher at the Department of Cellular, Computational and Integrative Biology, University of Trento, said in a press release. According to the paper, published in Nature, vegan and vegetarian diet signatures were associated with a healthy cardiometabolic system and production of beneficial fatty acids.

"Our data showed that omnivores on average ingest significantly fewer healthy plant-based foods than vegetarians or vegans," the researchers wrote, adding that "optimizing the quality of omnivore diets by increasing dietary plant diversity could lead to better gut health." Omnivores had strong signals of bacteria like A. putredinis, associated with meat consumption, which the paper links to inflammatory bowel disease and an increased risk of colon cancer. However, an important caveat - Fackelmann notes that they didn't measure health markers of these specific participants, they instead looked to the scientific literature of what is known about these bacteria (They did, however, study stool samples - more on this in a bit).

That doesn't mean that excluding animal products automatically equals a healthy microbiome. Here's where that balanced diet comes back in. A varied diet of fiber-rich foods like plants is key. "Avoiding meat or dairy products does not necessarily have a positive effect if it does not come with a variety of quality plant-based products," Nicola Segata, research lead on the paper, said in a press release.

For the microbiome, a critical ingredient is fiber. "Your microbiota is tuned towards digesting fiber predominantly, so eating a largely plant based diet gets more of those nutrients to them," Eric Martens, a professor of microbiology and immunology at University of Michigan Medical School, who was not involved in the studies, tells Sentient.

There was less bacterial diversity in vegetarians and vegans than in omnivores, but another important detail is that diversity doesn't always equal an optimal microbiome. On the one hand, a diverse microbiome means more bacteria, so more opportunity for defense against infections and ability to break down various food types. But that's assuming those bacteria are beneficial and not all bacteria are. A person could have a diverse array of harmful microbes, which would negate the whole concept. So while diversity is important, of more importance is what bacteria are present, rather than how many. "When people hear diversity, we hear about it in the context of biodiversity and always more diversity is better. But for the gut...higher diversity wouldn't exactly equate to having a more favorable microbiome composition," Fackelmann tells Sentient.

In the Nature study, the participants' stool samples were analyzed using shotgun metagenomic sequencing, which yields highly specific information about the species of gut bacteria present. Interestingly, they found that vegans had more soil-derived microbes and omnivores more dairy, highlighting that gut bacterial members may come directly from the food we eat.

Looking To a Non-Industrialized Diet for Answers

In a different vein, a team of microbiologists based in Ireland tested the effects of a non-industrialized diet on the microbiome - in other words, mostly plants and low in processed foods. "Industrialization has drastically impacted our gut microbiome, likely increasing the risk of chronic diseases," Jens Walter, a professor of Ecology, Food, and the Microbiome at University College Cork, tells Sentient. Walter and his colleagues developed a diet - called the NiMe diet (Non-industrialized Microbiome Restore) - high in plants and fiber and low in meat and processed foods, based on the eating habits of rural Papua New Guineans.

In a strictly human controlled trial, 30 participants followed this diet and consumed L. reuteri, a beneficial bacterium found in the gut of rural Papua New Guineans but rarely found in industrialized microbiomes. Unlike the Nature study, Walter and his colleagues directly measured the health risk factors of participants and found that after just three weeks, the diet had decreased low-density lipoprotein (LDL) cholesterol by 17 percent, reduced blood sugar by six percent and reduced levels of a protein associated with heart disease. Martens put more emphasis on the findings of this paper, as the authors both staged a dietary intervention and measured the health effects, rather than finding correlations with the scientific literature.

The magnitude of the findings was surprising, Walter tells Sentient. "I didn't think a three-week study would be enough to improve blood glucose or cholesterol," he says. Another surprise was that participants lost weight even though the calories were the same as their usual diet. The researchers are sharing their "NiMe diet" with the public via online free recipes on Instagram.

In practice, shifting to a non-industrialized diet may be difficult. We are increasingly consuming more ultra-processed foods and less whole foods than we were just two decades ago. Misleading food marketing claims and the rise of various dubious "wellness" trends also make grocery shopping for a healthy diet that much harder. Keep it simple, Martens says. He recommends supplementing your diet with plant-based fiber from whole sources as opposed to picking up the quick-fix fiber snack bar.

The Bottom Line

No matter the specific details of your diet, the microbiome is crucial in all stages of life to maintain health. Research shows food and lifestyle changes can bolster protection against chronic diseases, although this tends to be challenging for most Americans just based on what we actually eat. Small incremental changes towards eating more plants may feel like a less daunting prescription. These studies, among others, act as a signal that dietary tweaks and increased intake of high fiber food like plants can reap significant microbiome and health benefits.


Dawn Attride wrote this article for Sentient.


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About 1.3 million Missourians are currently enrolled in Medicaid and nonprofits around the state have warned proposed federal cuts would be devastating.

In Missouri, children are the largest group served by Medicaid, with 61% enrolled. States could face more than $800 billion in Medicaid cuts and more than $200 billion in the Supplemental Nutrition Assistance Program, known as SNAP or food stamps.

McClain Bryant Macklin, vice president of policy and impact for the Kansas City nonprofit Health Forward Foundation, emphasized how important Medicaid is to the organization.

"From a policy perspective as well as where we tend to lend our funding support is squarely in that direction, and Medicaid access has been our primary policy issue, really since our inception," Bryant Macklin explained. "It's just our number one priority."

Supporters of the cuts argued Medicaid is inefficient because of waste and fraud, and restructuring or reducing funding could improve sustainability.

Bryant Macklin noted the Health Forward Foundation played a key role in advocating for Medicaid expansion in Missouri, contributing to policy changes which extended coverage to thousands of low-income residents. She stressed as a Medicaid expansion state, Missouri will need to find funding from other critical sources, which could result in further challenges.

"State legislators are going to be forced to -- and administrators forced to -- find those dollars elsewhere," Bryant Macklin pointed out. "That elsewhere will be from other key social services that folks are relying upon and that the state has grown accustomed to receiving that federal support."

Those in favor of the cuts said they would give states greater control over Medicaid through block grants, which are fixed amounts of federal funding states can use with more flexibility, to tailor programs to local needs and priorities.