Washington State has a high rate of Alzheimer's disease deaths that is expected to increase 40% in the next 10 years. Many practices in the state lack guidelines for screening, diagnosing, and treating Alzheimer's and other dementias. The presentation discusses the Virginia Mason Cognitive Care in Primary Care program which provides resources and tools for a multidisciplinary approach to improve diagnosis, care, support, and planning for patients with cognitive issues. It also reviews diagnostic criteria and treatment approaches for vascular cognitive impairment, a common cause of dementia.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
Patient Access Network Foundation - PV ReporterDavid Wallace
The Patient Access Network Foundation (PAN) offers help and hope to people with chronic or life-threatening illnesses for whom cost limits access to breakthrough medical treatments. Myeloproliferative Neoplasms (MPNs) are a covered illness.
ChenMed is a physician group focused on providing primary care to low-income Medicare patients over 55 with multiple chronic conditions. Their care model emphasizes strong patient relationships, care coordination, and on-site services to improve outcomes. Data shows patients have high rates of medication adherence, fewer hospital visits, and more visits with their primary care physician compared to typical patients. ChenMed aims to scale this model across multiple markets using global risk contracts that incentivize keeping patients healthy.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
Patient Access Network Foundation - PV ReporterDavid Wallace
The Patient Access Network Foundation (PAN) offers help and hope to people with chronic or life-threatening illnesses for whom cost limits access to breakthrough medical treatments. Myeloproliferative Neoplasms (MPNs) are a covered illness.
ChenMed is a physician group focused on providing primary care to low-income Medicare patients over 55 with multiple chronic conditions. Their care model emphasizes strong patient relationships, care coordination, and on-site services to improve outcomes. Data shows patients have high rates of medication adherence, fewer hospital visits, and more visits with their primary care physician compared to typical patients. ChenMed aims to scale this model across multiple markets using global risk contracts that incentivize keeping patients healthy.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
The document provides information about the 9th Annual Symposium on Mild Cognitive Impairment that will take place on April 29-30, 2011 in Miami Beach, Florida. It includes the agenda, list of distinguished faculty, registration information, and logistical details about the event. The symposium will focus on new criteria for prodromal and preclinical Alzheimer's disease, with sessions on risk factors, diagnosis and progression of mild cognitive impairment and preclinical Alzheimer's disease.
This document provides information about the 7th Annual Mild Cognitive Impairment Symposium that will take place on March 27-28, 2009 in Miami, Florida. The symposium will focus on early Alzheimer's disease and non-Alzheimer's prodromal dementias. It will feature keynote speakers and breakout sessions on topics such as vascular cognitive impairment, prevention and treatment of mild cognitive impairment and early Alzheimer's, and distinguishing between early Lewy body disease and Alzheimer's disease. The document provides details on registration, continuing education credits, the agenda, faculty members, and objectives of the symposium.
This document summarizes the agenda and objectives for the 2nd Annual Mild Cognitive Impairment Symposium being held on February 27-28, 2004 in Miami Beach, Florida. The symposium consists of an educational module on day one and a research module on day two. Both modules will focus on understanding and detecting mild cognitive impairment, with objectives around diagnosis, subtypes, biomarkers, imaging, and screening tools. The symposium is sponsored by Mount Sinai Medical Center and aims to promote early detection and treatment of dementia.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD) and the value of advance care planning (ACP) for end-of-life patients.
This document provides an agenda for the 10th Annual Symposium on Mild Cognitive Impairment and the 1st Early Alzheimer's Diagnostic Workshop being held January 14-15, 2012 in Miami Beach, Florida. The symposium and workshop will focus on advances in the clinical diagnosis and progression of Alzheimer's disease and related disorders, with an emphasis on the early stages of the disease. Over the two-day event, there will be keynote speeches and panel discussions on topics such as atypical presentations of Alzheimer's, the prion-like progression of the disease, and new concepts in pathogenesis. The goal is to help clinicians more accurately diagnose Alzheimer's and related conditions earlier.
This document provides information about the 8th Annual Symposium on Early Alzheimer's Disease that will take place on March 12-13, 2010 in Miami Beach, Florida. The symposium will focus on mild cognitive impairment and preclinical Alzheimer's disease, with sessions on interpreting psychometric test results, biomarkers for early detection, and results from longitudinal studies. National experts will present the latest research. The target audience is medical professionals working with dementia patients. Registration information is provided.
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
This document provides information about an upcoming symposium on Mild Cognitive Impairment (MCI). It will take place February 24-25, 2006 at the Eden Roc Resort & Spa in Miami Beach, Florida. The symposium is sponsored by several Alzheimer's research centers and will feature over 40 expert speakers. The goal is to provide the latest information on diagnosing and treating MCI, as well as discussing related topics like cognitive reserve, genetics, and vascular/medical factors. The symposium offers 15 hours of continuing education credits for physicians and psychologists.
The goal of this webinar was to educate professionals on hospice eligibility and care planning options for patients with dementia who are nearing the end of life, and their families.
This document provides information about the Mild Cognitive Impairment (MCI) Symposium that will take place from March 7-8, 2008 in Miami Beach, Florida. The symposium will focus on disease modifying treatments for Alzheimer's disease. It will feature expert speakers discussing biomarkers for measuring progression and treatment effects in Alzheimer's, pathogenic mechanisms of cognitive impairment, non-pharmacological treatments, and potential disease-modifying pharmaceutical agents. The target audience is medical professionals in fields related to neurology and geriatrics. The symposium will provide updates on the latest research and allow for discussion on improving diagnosis and treatment of early-stage Alzheimer's.
This document announces a symposium on Mild Cognitive Impairment (MCI) that will provide 15 hours of continuing education credits for physicians and psychologists, featuring experts who will present on the causes, detection, and treatment of early dementia; it discloses any relationships between faculty and industry sponsors, and provides contact information for the symposium.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
This document provides information about the Mild Cognitive Impairment (MCI) Symposium that will take place from April 13-14, 2007 in Miami Beach, Florida. The symposium, directed by Dr. Ranjan Duara, will focus on developing earlier diagnosis of Alzheimer's disease and feature experts in fields related to dementia. Over two days, speakers will present on topics such as the pathology of aging and prodromal Alzheimer's, diagnosis of early Alzheimer's in clinical and research settings, and algorithms for integrating elements to achieve earlier diagnosis. The goal is to promote better understanding of diagnosing Alzheimer's disease earlier in its progression.
This document discusses three approaches to tackling diabetes in specific populations: seniors in the Bronx, NY, veterans, and American Indians/Alaska Natives. For seniors, it highlights the importance of diabetes education programs to help patients better manage their condition and medications. It describes a program at Montefiore Medical Center that provides group education sessions. For veterans, it discusses a research study providing group appointments for diabetes monitoring and education. Finally, it notes the high rates of poverty, substance abuse and diabetes among American Indians/Alaska Natives and the need for innovative care approaches for this population.
This document discusses issues with care for the elderly and terminally ill in hospice facilities. It notes that doctors often have high patient loads in these facilities, which can lead to overmedication of patients due to lack of communication between doctors. The document also discusses how Americans often want a quick medical fix, which can negatively impact elderly patients if they mix over-the-counter drugs with prescription medications or overdose on medications. Overall, the document examines some of the challenges around quality of care for vulnerable patient populations in end-of-life care facilities.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
This document summarizes information from an Irish Hip Fracture Database (IHFD) audit report. It notes that over 50% of major traumas in Ireland result from falls under 2 meters. The elderly population is increasing significantly, putting more at risk for falls and fractures. The IHFD aims to optimize care for hip fracture patients through audits of hospitals. The 2015 audit found improvements were needed in meeting blue book standards for surgery time, assessments, and post-fracture care. Overall, the audit identified opportunities to strengthen fall prevention programs and bone health services to reduce fractures and improve outcomes for elderly patients.
Pump It Up: Inova Heart and Vascular Institute's bold new vision to save more...Jane Langille
In this cover story for INOVA Magazine, I profiled a patient with congestive heart failure who lived for many months with two ventricular assist devices (VADs) before he finally received a heart transplant. Expertise matters! INOVA is one of the few centers in the U.S. that can implant two VADs in one procedure and also performs the highest number of heart transplants in the mid-Atlantic region. Strong leadership at the Inova Heart and Vascular Insitute is setting a bold new course for the future to meet growing demand for heart failure patients, including new monitoring technologies, state-of-the-art interventional procedures and a new strategic plan that includes building a cardiac dream team of specialists.
The clinical case study of a patient with advanced COPD who has multiple comorbid
conditions and develops sepsis provides the backdrop for two potential clinical pathways—
sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis
in both conditions.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
The document provides information about the 9th Annual Symposium on Mild Cognitive Impairment that will take place on April 29-30, 2011 in Miami Beach, Florida. It includes the agenda, list of distinguished faculty, registration information, and logistical details about the event. The symposium will focus on new criteria for prodromal and preclinical Alzheimer's disease, with sessions on risk factors, diagnosis and progression of mild cognitive impairment and preclinical Alzheimer's disease.
This document provides information about the 7th Annual Mild Cognitive Impairment Symposium that will take place on March 27-28, 2009 in Miami, Florida. The symposium will focus on early Alzheimer's disease and non-Alzheimer's prodromal dementias. It will feature keynote speakers and breakout sessions on topics such as vascular cognitive impairment, prevention and treatment of mild cognitive impairment and early Alzheimer's, and distinguishing between early Lewy body disease and Alzheimer's disease. The document provides details on registration, continuing education credits, the agenda, faculty members, and objectives of the symposium.
This document summarizes the agenda and objectives for the 2nd Annual Mild Cognitive Impairment Symposium being held on February 27-28, 2004 in Miami Beach, Florida. The symposium consists of an educational module on day one and a research module on day two. Both modules will focus on understanding and detecting mild cognitive impairment, with objectives around diagnosis, subtypes, biomarkers, imaging, and screening tools. The symposium is sponsored by Mount Sinai Medical Center and aims to promote early detection and treatment of dementia.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD) and the value of advance care planning (ACP) for end-of-life patients.
This document provides an agenda for the 10th Annual Symposium on Mild Cognitive Impairment and the 1st Early Alzheimer's Diagnostic Workshop being held January 14-15, 2012 in Miami Beach, Florida. The symposium and workshop will focus on advances in the clinical diagnosis and progression of Alzheimer's disease and related disorders, with an emphasis on the early stages of the disease. Over the two-day event, there will be keynote speeches and panel discussions on topics such as atypical presentations of Alzheimer's, the prion-like progression of the disease, and new concepts in pathogenesis. The goal is to help clinicians more accurately diagnose Alzheimer's and related conditions earlier.
This document provides information about the 8th Annual Symposium on Early Alzheimer's Disease that will take place on March 12-13, 2010 in Miami Beach, Florida. The symposium will focus on mild cognitive impairment and preclinical Alzheimer's disease, with sessions on interpreting psychometric test results, biomarkers for early detection, and results from longitudinal studies. National experts will present the latest research. The target audience is medical professionals working with dementia patients. Registration information is provided.
This webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
This document provides information about an upcoming symposium on Mild Cognitive Impairment (MCI). It will take place February 24-25, 2006 at the Eden Roc Resort & Spa in Miami Beach, Florida. The symposium is sponsored by several Alzheimer's research centers and will feature over 40 expert speakers. The goal is to provide the latest information on diagnosing and treating MCI, as well as discussing related topics like cognitive reserve, genetics, and vascular/medical factors. The symposium offers 15 hours of continuing education credits for physicians and psychologists.
The goal of this webinar was to educate professionals on hospice eligibility and care planning options for patients with dementia who are nearing the end of life, and their families.
This document provides information about the Mild Cognitive Impairment (MCI) Symposium that will take place from March 7-8, 2008 in Miami Beach, Florida. The symposium will focus on disease modifying treatments for Alzheimer's disease. It will feature expert speakers discussing biomarkers for measuring progression and treatment effects in Alzheimer's, pathogenic mechanisms of cognitive impairment, non-pharmacological treatments, and potential disease-modifying pharmaceutical agents. The target audience is medical professionals in fields related to neurology and geriatrics. The symposium will provide updates on the latest research and allow for discussion on improving diagnosis and treatment of early-stage Alzheimer's.
This document announces a symposium on Mild Cognitive Impairment (MCI) that will provide 15 hours of continuing education credits for physicians and psychologists, featuring experts who will present on the causes, detection, and treatment of early dementia; it discloses any relationships between faculty and industry sponsors, and provides contact information for the symposium.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
This document provides information about the Mild Cognitive Impairment (MCI) Symposium that will take place from April 13-14, 2007 in Miami Beach, Florida. The symposium, directed by Dr. Ranjan Duara, will focus on developing earlier diagnosis of Alzheimer's disease and feature experts in fields related to dementia. Over two days, speakers will present on topics such as the pathology of aging and prodromal Alzheimer's, diagnosis of early Alzheimer's in clinical and research settings, and algorithms for integrating elements to achieve earlier diagnosis. The goal is to promote better understanding of diagnosing Alzheimer's disease earlier in its progression.
This document discusses three approaches to tackling diabetes in specific populations: seniors in the Bronx, NY, veterans, and American Indians/Alaska Natives. For seniors, it highlights the importance of diabetes education programs to help patients better manage their condition and medications. It describes a program at Montefiore Medical Center that provides group education sessions. For veterans, it discusses a research study providing group appointments for diabetes monitoring and education. Finally, it notes the high rates of poverty, substance abuse and diabetes among American Indians/Alaska Natives and the need for innovative care approaches for this population.
This document discusses issues with care for the elderly and terminally ill in hospice facilities. It notes that doctors often have high patient loads in these facilities, which can lead to overmedication of patients due to lack of communication between doctors. The document also discusses how Americans often want a quick medical fix, which can negatively impact elderly patients if they mix over-the-counter drugs with prescription medications or overdose on medications. Overall, the document examines some of the challenges around quality of care for vulnerable patient populations in end-of-life care facilities.
Advance Directives & Advance Care Planning | VITAS HealthcareVITAS Healthcare
Learn how healthcare professionals can ensure that their patients’ voices are heard by embracing advance care planning (ACP), defined as honest conversations about how patients want to be cared for at the end of life if they are unable to communicate or make decisions. This webinar explores advance directives, the legal documents that spell out patients’ wishes for family members, caregivers and healthcare teams.
This document summarizes information from an Irish Hip Fracture Database (IHFD) audit report. It notes that over 50% of major traumas in Ireland result from falls under 2 meters. The elderly population is increasing significantly, putting more at risk for falls and fractures. The IHFD aims to optimize care for hip fracture patients through audits of hospitals. The 2015 audit found improvements were needed in meeting blue book standards for surgery time, assessments, and post-fracture care. Overall, the audit identified opportunities to strengthen fall prevention programs and bone health services to reduce fractures and improve outcomes for elderly patients.
Pump It Up: Inova Heart and Vascular Institute's bold new vision to save more...Jane Langille
In this cover story for INOVA Magazine, I profiled a patient with congestive heart failure who lived for many months with two ventricular assist devices (VADs) before he finally received a heart transplant. Expertise matters! INOVA is one of the few centers in the U.S. that can implant two VADs in one procedure and also performs the highest number of heart transplants in the mid-Atlantic region. Strong leadership at the Inova Heart and Vascular Insitute is setting a bold new course for the future to meet growing demand for heart failure patients, including new monitoring technologies, state-of-the-art interventional procedures and a new strategic plan that includes building a cardiac dream team of specialists.
The clinical case study of a patient with advanced COPD who has multiple comorbid
conditions and develops sepsis provides the backdrop for two potential clinical pathways—
sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis
in both conditions.
(1) Non-communicable diseases like kidney disease, obesity, and diabetes have emerged as a major global health crisis, yet prevention efforts are lacking; (2) The document proposes a comprehensive prevention strategy using continuous learning system approaches starting with kidney disease surveillance; (3) The strategy involves robust surveillance systems, predictive analytics, tailored messaging, and multi-sector partnerships to raise awareness and motivate behavior change at individual and community levels.
This document discusses population health management and how it can help address health needs. It begins by defining population health management as improving systems and policies that affect healthcare quality, access, and outcomes to ultimately improve the health of an entire population. It then provides examples of individual-focused patient care policies and population-focused policies. Population-focused policies aim to improve access to services, overcome non-medical barriers to maximize health outcomes, coordinate care, provide meaningful integration, and monitor and address health disparities. The document concludes by describing a case study of a stroke risk screening program developed in North Carolina to identify modifiable stroke risks in high-risk communities.
The document summarizes key points about effective practices in programs treating patients with myelofibrosis. It provides:
1) Fast facts about myelofibrosis including symptoms, prevalence, and treatment challenges. 2) Highlights from ACCC's survey on gaps and needs in myelofibrosis care. 3) Examples of three community cancer centers' myelofibrosis programs including comprehensive services, multidisciplinary teams, clinical trials, and partnership with primary care physicians to coordinate long-term patient care.
The goal of this webinar is to educate physicians and healthcare professionals about hospice eligibility and benefits for patients with advanced cardiac disease (ACD) who have a prognosis of ≤6 months. Through evidence-based data and a review of case studies, attendees understand the benefits of advance care planning, complex modalities for high-acuity cardiac patients, how to manage symptoms, address pain and provide comfort and dignity near the end of life.
Six nurses from the Visiting Nurse Association (VNA) recently received certification in chemotherapy from the Oncology Nursing Society after completing a two-day training program. The VNA also welcomed two new patient care managers and one nurse received wound care certification. Additionally, the current medical director of VNA Hospice is relocating and several changes are being made to physician coverage of hospice patients and facilities. The newsletter also provides information on the VNA's cardiac care program and answers frequently asked questions about artificial nutrition and hydration at the end of life.
International Health Policy and Practice: Comparing the U.S. and Canada on Ef...The Commonwealth Fund
The document compares the healthcare systems of the US and Canada based on data from the Commonwealth Fund's International Health Policy Survey. It finds that Canada outranks the US in several areas of healthcare system effectiveness, including quality of care, effective care, safe care, and coordinated care. Specifically, Canadians are more likely than Americans to report high quality experiences such as having their healthcare providers discuss treatment plans and contact them between visits. The US outperforms Canada in measures of timely access but lags in efficiency, equity, and healthy lives. Overall, the survey ranks Canada's healthcare system as 10th best globally and the US system as 11th.
The document summarizes evaluation forms from Eastern Virginia Medical School's program to expand care for uninsured patients in the western Tidewater area of Virginia over three reporting periods. It describes the program goals of providing medical care and establishing primary care physicians for patients. Key outputs included over 450 patient visits, 132 unique patients served with 192 appointments in the first period, and over 500 visits and 268 patients in the second. Benefits included establishing regular sources of healthcare and comparable treatment to national standards. Medical students, residents, and attending physicians contributed over 1000 service hours across periods to the Western Tidewater Free Clinic through this program.
Predictive Analytics Help Achieve the Triple Aimjetweedy
The document discusses how predictive analytics can help achieve the Triple Aim of improving patient experience of care, improving population health, and reducing per capita costs. It describes different types of predictive models that can identify high-risk patients for proactive intervention, such as models predicting disease progression, hospitalization, death, and healthcare expenditures. Examples of successful predictive models and interventions for conditions like heart failure, COPD, diabetes, and CKD are provided. The document concludes that predictive modeling can aid in reducing spending, increasing patient satisfaction, and improving overall population health as part of the Triple Aim.
This document summarizes a case presentation of a patient with recurrent diabetic foot infections and osteomyelitis leading to multiple amputations over several years. Despite aggressive treatments including multiple debridements and long-term IV antibiotics, the patient continued to experience complications from non-adherence to wound care and medications. A discussion of the case highlighted potential errors like lack of standardized treatment protocols, fragmented care coordination, and challenges providing consistent care for a patient in a rural area with psychiatric issues. Lessons focused on the need for multidisciplinary teams and addressing both medical and social factors to best manage these complex cases.
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
Prevention of stroke in patients with tiaSachin Shende
This document provides guidelines from the American Heart Association/American Stroke Association for the prevention of future stroke in patients who have experienced an ischemic stroke or transient ischemic attack (TIA). Some key points:
- Over 690,000 adults in the US experience an ischemic stroke each year, and an additional 240,000 will experience a TIA. The risk of future stroke after an initial event is approximately 3-4% annually.
- The aim of the guidelines is to provide evidence-based recommendations to clinicians for controlling risk factors and preventing recurrent brain ischemia in these high-risk patients.
- Important revisions from the previous guidelines include new sections on sleep apnea and aortic arch atherosclerosis, expanded sections
This document discusses special considerations for managing chronic myeloid leukemia (CML) during pregnancy and in the pediatric population. For pregnancy:
- Tyrosine kinase inhibitors (TKIs) used to treat CML are teratogenic and known to cause fetal toxicities. TKI therapy during pregnancy has been associated with higher rates of miscarriage and fetal abnormalities.
- If a patient wants to conceive, discontinuing TKI therapy may be considered if a deep molecular response has been maintained for at least 2 years. Close monitoring would be needed if CML recurs during pregnancy.
- For pediatric CML management, no evidence-based recommendations exist since CML is relatively rare in children. Specialized care at a cancer center is
When reducing cancer risk in our population, let’s not exacerbate disparitiesGraham Colditz
The document discusses reducing cancer disparities through precision prevention approaches. It highlights that while precision medicine focuses on treating existing disease, precision prevention aims to tailor behavioral interventions to individual characteristics to reduce cancer risk. However, efforts to refine prevention strategies could inadvertently worsen disparities if factors like health literacy levels and access to care are not considered. Priorities for avoiding disparities include collaborating with diverse partners to improve communication and applying implementation research approaches to ensure evidence-based programs reach all groups.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD). Through evidence-based data and case studies, attendees will understand the advantages of advance care planning, complex modalities for high-acuity patients, and management of symptoms and pain to provide comfort and dignity near the end of life.
MedicalResearch.com: Medical Research Exclusive Interviews August 8 2015Marie Benz MD FAAD
This study examined the association between insulin resistance, brain glucose metabolism, and memory performance in 150 middle-aged participants at risk for Alzheimer's disease. The main findings were that higher insulin resistance was associated with lower glucose metabolism in brain regions important for memory, and this predicted worse memory performance. The results suggest that insulin resistance has negative effects on the brain decades before Alzheimer's typically occurs. Clinicians and patients should aim to prevent or reduce insulin resistance through moderate exercise, which is the most important intervention.
Similar to Resident 2018 - cog care in primary care (20)
Critical care involves managing organ system failures while considering the overall clinical picture of the patient. Less invasive interventions are preferred when possible to avoid iatrogenic harm. Prognostication is difficult, and outcomes depend on the individual patient's values and preferences. Family meetings require skilled communication to make difficult end-of-life decisions. The goal is providing humane care that aligns with patient priorities through a team-based approach.
This document summarizes a bioethics case discussion involving a 68-year-old female patient with metastatic lung cancer. The patient was admitted for pneumonia and influenza and experienced a complex clinical course involving recurrent infections, malnutrition, and declining functional status. Discussions with family focused on unclear goals of care and difficulty accepting a transition to comfort measures. An ethics consult recommended a one-week trial of aggressive care with clear outcomes to help guide decision making. After the trial failed and a deathbed visit from her son, the family agreed to transition to comfort care, where the patient later passed away. The document reviews key challenges, outcomes, and bioethics considerations around medically appropriate treatment and incorporating patient perspectives when decisional capacity is lacking
The document summarizes several infectious disease cases presented at a noon conference. The first case discusses a male presenting with cough and fever who was diagnosed with blastomycosis after cytology found Blastomyces dermatitidis. The second case involves a pregnant woman from Nigeria with malaria diagnosed on peripheral smear after visiting a rural village. The third case is about a man returning from Saint Martin with joint pains and fever, possibly due to arboviral infections like chikungunya or dengue. The last two cases discuss a man with L4-L5 osteomyelitis and sacroiliitis diagnosed with brucellosis, and a woman with cervical lymphadenopathy possibly having toxoplasmosis
Meghan Caballero presented a noon conference on factitious disorder. The objectives were to review definitions, epidemiology, pathogenesis, clinical features, diagnosis, and treatment options for factitious disorder. Factitious disorder involves patients deceiving doctors by misrepresenting or inducing medical symptoms without an obvious reward. It affects about 1% of clinical settings and usually presents in adults in their 30s or 40s following hospitalization. Diagnosis requires falsified symptoms and deception according to DSM-5 criteria. Treatment focuses on psychotherapy but many patients refuse or do not follow up with psychiatric care.
This document discusses obstructive sleep apnea (OSA) in women. It notes several anatomical factors that can contribute to OSA in women, such as a smaller airway size, elongated airway, and micrognathia. It compares the costs, convenience, accuracy, and comfort of different diagnostic tests for OSA, including home sleep tests, in-lab polysomnography (PSG), and PSG with positive airway pressure titration (PAP). The document also images several CPAP mask options and oral appliance therapies that can be used to treat OSA. It concludes by providing contact information for a sleep physician.
A 38-year-old woman presents with abnormally heavy menstrual bleeding. Her periods are now 10 days long compared to her normal 5 days. She has lower abdominal cramping and mild dizziness. Exam is normal. Initial testing shows a hemoglobin of 10.5 (down from 12 six months ago). Pelvic ultrasound reveals a left-sided submucosal fibroid. The patient is prescribed a course of progesterone which does not fully resolve her bleeding. She is referred for hysteroscopic or laparoscopic myomectomy to treat her symptomatic submucosal fibroid.
The document discusses guidelines for tuberculosis (TB) testing and treatment. It provides criteria for positive TB test results based on induration size and risk factors. It notes that interferon gamma release assays (IGRAs) are at least as sensitive as the tuberculin skin test (TST) for detecting TB infection. Both tests detect exposure to TB but cannot differentiate between active disease and latent infection. IGRAs are preferred in those with BCG vaccination or nontuberculous mycobacterium infection history. Treatment options for latent TB infection include various combinations of isoniazid and rifampin administered for 3-9 months, depending on medications and patient risk factors such as HIV status.
A 42-year-old healthcare worker presents for follow-up of a recent tuberculin skin test (TST) which showed 12mm of induration. He has no symptoms of active tuberculosis such as cough, fever, or night sweats. The next most appropriate step in management is to start isoniazid treatment for latent tuberculosis.
This document provides guidance on performing and interpreting CT head scans. It outlines the basic search pattern for a CT head, including examining for hemorrhage, signs of infarct, brain parenchyma, and other structures. It also lists some blind spots on CT head scans. The document then describes several case examples of acute stroke, subdural hemorrhages of different ages, epidural hematomas including a special venous type, subarachnoid hemorrhage, fat embolism after injury, and interpreting gunshot wound head CTs.
This document summarizes information about subacute granulomatous (De Quervain) thyroiditis and compares it to Adult Stills disease. Subacute thyroiditis is often caused by a viral infection and presents with neck or jaw pain, a tender thyroid, and elevated inflammatory markers. It follows a path of varying thyroid hormone levels and typically resolves with follicular regeneration. Adult Stills disease has an unclear trigger but presents with quotidian fevers, arthritis, and an evanescent rash, requiring immunosuppression for treatment. Key differences between the conditions are highlighted regarding epidemiology, clinical presentation, diagnostics, and therapeutics.
This document summarizes a noon conference on cerebellar infarcts. It discusses the cerebellum's anatomy and circuitry, the clinical presentation of cerebellar infarcts including limb ataxia and gait imbalance. Physical exam techniques like HINTS are covered. Diagnostic tests like MRI are discussed as the gold standard. Treatment options like tPA are mentioned. An illness script compares cerebellar infarct to vestibular neuritis, outlining their differences in pathophysiology, epidemiology, clinical presentation, diagnostics and therapeutics.
This document provides information on common primary headaches including migraine, tension-type headache, and cluster headache. It discusses prevalence, diagnostic criteria, pathophysiology, comorbidities, and treatment approaches for each headache type. For migraine specifically, it notes higher prevalence in women ages 25-55 and common comorbidities like depression and anxiety. Treatment involves both acute and preventive options.
This document discusses Wernecke's encephalopathy, a neurological condition caused by thiamine (vitamin B1) deficiency. It begins by outlining the objectives and importance of thiamine. The classic triad of signs includes encephalopathy, oculomotor dysfunction, and gait ataxia, though this full triad is only seen in about 33% of cases. Diagnosis is clinical but may include MRI showing lesions in the thalamus, mamillary bodies, and periaqueductal region. Treatment involves high-dose intravenous or intramuscular thiamine supplementation. Wernecke's encephalopathy is commonly associated with chronic alcoholism but can occur in other conditions involving malnutrition
1) The objectives of the noon conference were to review warm autoimmune hemolytic anemia (AIHA), including diagnostic criteria, clinical presentation, and treatment.
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Expansion of Rapid-Access Transient Ischemic Attack (TIA) Clinic Referrals From Emergency
Department to Primary Care: Improving Outcomes and Reducing Costs
• Sarah Hermanson, DNP, ARNP1; Nirali Vora, MD2; Nancy Isenberg, MD, MPH, FAAN1
Neurology, 1Virginia Mason Seattle, WA and 2Stanford University Medical Center, CA
METHODS
CONCLUSIONS
OBJECTIVE
Key elements in the development and implementation of the Rapid-
Access TIA Clinic include:
• Standardized patient triage protocol tools (Figures 1 and 2)
• Direct scheduling from the ED and PC to the Neurology Clinic with
commitment to complete appointments within 72 hours
• Multi-disciplinary collaboration between stakeholders, including ED,
PC, Neurology and Radiology.
• Strong emphasis on risk factor reduction, secondary stroke
prevention, and medication adherence.
The Rapid-Access TIA Clinic at Virginia Mason relocates care for
low-risk patients from the hospital setting to the outpatient setting
and improve outcomes at lower costs. We aim to expand the clinic to
include timely, high value referrals directly from Primary Care (PC)
in addition to referrals from the Emergency Department (ED). The
expanded clinic continues to breaks down specialty silos by working
across departments to reduce unnecessary, costly ED visits, and
improve value and care for patients.
RESULTS
• 3 (3.7%) patients lost to follow-up in clinic, but did complete
telephone follow-up at 2 days
• No patients had recurrent admission for stroke at 90 days
• An estimated cost savings of at least $304,000 in approximately
over 2 years was achieved.1
Figure 3. Emergency Department triage
tool
Figure 4. Final diagnosis by neurologist
of patients seen in Rapid-Access TIA
Clinic
Patients achieve improved outcomes at lower costs at our
specialized outpatient Rapid-Access TIA Clinic by establishing safe
triage protocols to identify appropriate patients and collaborating
across departments to create safe patient pathways.
This value-added, efficient strategy is feasible for direct referral from
PC allowing appropriate, low-risk patients to bypass the ED directly.
Key points to establish a successful Rapid-Access TIA Clinic with
referral from either ED or PC include:
• Stakeholder identification from each department (ED, PC,
Neurology, Radiology) at every step of planning and
implementation
• Collaborative process with commitment from key stakeholders.
• Importance of continual education and communication
• Allocated time to design and implement plan.
BACKGROUND
TIA is a warning sign for stroke, a leading cause of disability and
health-related societal cost. The evaluation of TIA is urgent and
necessitates rapid diagnostics and early initiation of treatment for
secondary stroke prevention. In the United States, many patients
with suspected TIA are routinely admitted to the hospital and ED
despite substantial evidence that for low-risk TIAs, patients can
achieve improved outcomes at lower costs through utilization of
specialized rapid-access TIA clinics.1,2,3
REFERENCES
1. Kalanithi L, Tai WA, Conley J, et al. Better Health, Less Spending. Stroke.
2014;45(10):3105-3111.
2. Sacco RL, Rundek T. The Value of Urgent Specialized Care for TIA and
Minor Stroke. New England Journal of Medicine. 2016;374(16):1577-1579.
3. Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after
transient ischemic attack or minor stroke. New England Journal of
Medicine. 2016;374(16);1533-1542.
RESULTS (Continued)
Figure 2. Primary Care triage tool
Referral Origin 2016 2017 2018 Total n (%)
Emergency Department 28 23 3 54 (69%)
Primary Care N/A 15 7 22 (28%)
Other: Neurosurgery,
Ophthalmology
N/A 1 1 2 (3%)
Table 2. Time to scheduling clinic and MRI by referral origin
Table 1. Number of referrals to Rapid-Access TIA Clinic by
origin
Patient presents to clinic with resolved transient
neurological symptoms > 24 hours ago
Neurologist confirms patient is appropriate for
Rapid-Access TIA Clinic, orders neuroimaging, and
ensures clinic appointment within 24-72 hours
PCP or PC RN pages on-call outpatient neurologist
• From 3/2016-3/2018, 78 patients were triaged to the Rapid-
Access TIA clinic, of which 22 (28%) were referred directly from
PC.
Referral Origin
Days to Clinic,
median (IQR)
Days to MRI,
median (IQR)
Emergency Department 1 (0.5, 2.5) 1 (0.5, 2.5)
Primary Care 2 (1.5, 3) 2 (1, 3)
Other: Neurosurgery, Ophthalmology 1 (0, 2) 2 (N/A, N/A)
• 100% of patients who followed up were scheduled within 72
hours