Chestnut Hill Hospital

Introduction: Cardiovascular disease (CVD) is the leading cause of death for women in the United States, yet prevention gaps persist due to provider shortages, underrecognition of sex-specific risk factors, and declining public and professional awareness of the burden of CVD in women. Scalable models that address workforce constraints and enable timely, preventive care for women—such as virtual shared medical appointments—remain poorly defined. Objective: To evaluate the impact of a virtual shared medical appointment (SMA) model on CV risk factor optimization in women with elevated cardiometabolic risk and/or established CVD. Methods: Systole Health, a group virtual care organization, enrolled 13 cohorts of 3–5 women into a six-week CV prevention program across 16 U.S. states (April 2024–May 2025). Eligible participants had documented or self-reported overweight/obesity, hypertension (HTN), dyslipidemia (DLD), (pre)diabetes, and/or established CVD. Exclusion criteria included active pregnancy and unstable CVD. The intervention included weekly physician-led SMAs, lifestyle health coaching, and peer support. Medication management was offered to a subset of patients based on clinical need. Outcomes were assessed at baseline and program completion, including self-reported body mass index (BMI), blood pressure (BP) (average of one week of home readings), and LDL cholesterol (LDL-C). Paired two-sample t-tests assessed mean changes. Results: Forty-five women enrolled, contributing 247 patient visits. Mean age was 52 ± 12 years; 87% were White. At baseline, mean systolic BP was 124 ± 15 mmHg, diastolic BP 78 ± 11 mmHg, LDL-C 117 ± 38 mg/dL, and BMI 33.4 ± 7.5 kg/m^2. Most (53%) had ≥3 unoptimized CV risk factors (BP ≥130/80, LDL-C above guideline-recommended thresholds, BMI ≥27, and/or A1c ≥5.7%). Among participants with complete data, mean change in LDL-C was –35.4% (p=0.001), systolic BP –7.0% (p<0.001), diastolic BP -3% (p=0.27), and BMI –4.7% (p<0.001) (Figure 1). Among those receiving medication management (N=20), 36 titrations were performed (mean 1.8 ± 1.5 per patient), with a median intensification time of 8 days (IQR 12.8). Conclusion: A virtual SMA model for women’s CV health is feasible, scalable, and improves key CV risk factors, offering a promising strategy to close care gaps and reduce population-level CVD risk for women with elevated cardiometabolic risk and/or established CVD.

We often think that either we are being patient or we have completely lost it. Whether we are at the kitchen table, in the office, or stuck in traffic, it's hard to appreciate that there is often a sweet spot directly in between, a fleeting moment in which we can choose a direction, as long as we are present to notice the signs. This essay shares my personal experience with rediscovering patience and living in the moment as a mother to a young boy with severe attention-deficit/hyperactivity disorder and sensory challenges. It mixes my clinical experience as a therapist with my parenting world and all the "stuff" in between. I hope it offers some tips to readers and clinicians on how to pause and take it all in-in order to capture and live in the moment. It helps us find humor in the frustration and love in all the distractions that are thrown our way. Maybe this is exactly the place where we can find the middle ground of patience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Placentophagy (maternal consumption of the placenta) has become increasingly prevalent in the past decade among women seeking to promote health and healing during the postpartum period. The purpose of this study was to assess patient and provider familiarity with and attitudes toward placentophagy, as well as patients' willingness to try placentophagy. Two cross-sectional surveys with questions regarding placentophagy practice were distributed to healthcare providers and patients. The provider survey was distributed via email listservers to international perinatal professional organizations and to obstetrics and gynecology, nurse midwifery, family medicine, and psychiatry departments at three urban hospitals. Patient surveys were administered in person at an urban hospital in Chicago, Illinois. Approximately two thirds (66%; n = 100) of patients and most (89%; n = 161) of providers were familiar with placentophagy. Patients with a history of a self-reported mental health disorder were more likely to be willing to consider placentophagy and to believe that healthcare providers should discuss it with their patients. Most providers and patients have heard of placentophagy but are unsure of its benefits and/or risks. Further research examining the potential therapeutic efficacy and/or risks of placentophagy is needed.

This excerpted article originally appeared in Stearns NS, Getchell ME, Gold RK. Continuing Medical Education in Community Hospitals: A Manual for Program Development. Boston: Postgraduate Medical Institute, 1971, 88-96; and was published by the Massachusetts Medical Society, as a supplement to The New England Journal of Medicine, Vol. 284; No. 20; May 20, 1971.

Although second-trimester nasal bone (NB) hypoplasia has been associated with fetal aneuploidy, its role as a single marker is still uncertain. Our objective was to evaluate the efficiency of NB hypoplasia as an independent marker for fetal aneuploidy. This was a prospective cohort study of women undergoing an anatomic survey between 16 and 22 weeks' gestation. The fetal NB and other markers of fetal aneuploidy, including nuchal fold, femur and humeral lengths, choroid plexus cysts, major fetal anomalies, echogenic bowel, pyelectasis, and hypoplastic fifth digits, were evaluated. Nasal bone hypoplasia was defined either as an absent NB or by a ratio of the biparietal diameter to NB. Fetuses or infants with fetal aneuploidy were compared with those without for the presence of NB hypoplasia either as a single marker or in the presence of other markers for aneuploidy. Of 2885 women evaluated, NB measurements were obtained in 2465 (85%). There were 35 (1.4%) cases with fetal aneuploidy. The sensitivity and specificity of a single NB in detecting Down syndrome varied from 23% to 64% and 57% to 99%, respectively, depending on the definition of NB hypoplasia used. There was an improvement in the efficiency of using the NB when combined with other markers, with sensitivity and specificity increasing from 59% to 82% and 74% to 87%, respectively. Nasal bone hypoplasia is a marker for fetal aneuploidy. The combination of the NB with other makers was associated with an improvement in detection of fetal aneuploidy.

Abstract The therapeutic contracting program represents a comprehensive cognitive-behavioral treatment system for persons with serious mental illness. This article introduces therapeutic contracting principles and procedures through a case study format. Specific methods are described for engaging clients in the development, evaluation, and continuous reformulation of competency-based treatment plans. Organizational structures which serve to coordinate staff members' efforts around person-centered recovery goals and interventions are discussed. Finally, the therapeutic contracting model is presented as a meaningful framework for structuring long-term therapy across inpatient, partial hospital, and outpatient treatment settings.

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through experimental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making.