• Healthcare in 2012 and beyond has given all of us great challenges and opportunities to meet the needs of our population. Knowing that the fastest growing industry sector in the United States is healthcare at 2.3% per year (Bureau of Labor Statistics), we must continue to enhance our processes and outcomes. This growth can be further broken down into segments with home healthcare services forecasting a 3.9% yearly growth followed close behind by offices outside the traditional hospital setting at 3.0%, nursing and residential care at 1.9% and hospitals at a 1.1% yearly rate. Statistics from 2011 have shown us that 69% of the job growth in 2011 was in the ambulatory service area. According to Bloomberg News in February 2012, healthcare will add more than 5.6 million employees to be the biggest job gainer by 2020.

    Captured 2-23-12 from: http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf

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  • The 2011 Clinical Impact Symposium Cardio-Pulmonary Rehabilitation Across the Continuum, held December 6-8 in Louisville, Ky., offered some great information on providing patients the highest level of care.

    Cardio-Pulmonary Clinical Impact Symposium “The clinical guidelines for long-term care and rehabilitation have evolved gradually and changed considerably over the last several years,” he says. “Skilled nursing facilities have sometimes lagged behind. Dr. Pandya provided some easy-to-follow instructions and tools that will help those facilities to better manage their patients with diabetes.”

    Sean Muldoon, M.D., Chief Medical Officer and Senior Vice President, Hospital Division, Kindred Healthcare, says that the “hazards of immobility that lead to polymyoneuropathy” theme was a common one during several of the sessions. “This validates the Kindred model of integrated restorative services, which will lead staff to update these findings with renewed determination into hospital care models,” he says.


    Daniel Forman, MD, FACC, FAHADaniel Forman, MD, FACC, FAHA


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  • Your Most Important 30 Minutes Today

    By Ryan Squire

    We found this video on YouTube and thought that it did a great job summing up one of the most important themes of the 2011 Clinical Impact Symposium on Cardio-Pulmonary Rehabilitation across the Continuum. We would like you to share what you do in the most important 30 minutes you take for yourself today; you never know, you may inspire another reader with a unique way you stay active. Just add your thoughts in the comments.

    23 1/2 hours, What is the single best thing we can do for our health?


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  • Cardiodiabesity

    By Ryan Squire

    CardiodiabesityVisceral adipose tissue or VAT fat was the target of Sharon Himmelstein's opening remarks, and for good reason: VAT fat releases chemicals that enter the liver and lead to diabetes and cardiovascular disease. Himmelstein explained that the amount of VAT is an indicator for diabetes.

    The leading reasons for the spike in VAT in the world population is the change in eating habits over the last few decades. Convenience, advertising, erratic eating, and over eating have lead to VAT levels to shoot up.

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  • Ehtel Frese, PT, DPT, MHS, CCSEhtel Frese, PT, DPT, MHS, CCS

    Congestive heart failure is a very common reason for hospitalization, with over 1 million congestive heart failure (CHF) admissions per year; readmission rates are 30% at 30-60 days. Identifying methods to reduce the frequency of hospitalization and the associated costs are critically important.

    Early exercise training may be useful in reducing morbidity and mortality in CHF. Aerobic and strength training are both key as muscle strength is a key predictor of long term survival, better than peak VO2.

    The 6 min walk test is commonly used to measure functional capacity.  A result under 300 meters is associated with increased mortality.  The test is sensitive to changes in cardiac function, and a difference of 99 feet is considered the minimal improvement of clinical  importance according to Ethel Frese.

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  • There have been substantial improvements to Ventricular Assist Devices (VAD) since there original introduction as bulky external devices that required a suitcase-sized support device to be moved with the patient. VADs were originally thought of almost exclusively as a bridge to cardiac transplantation. Chris Wells shared that they may now be a bridge to recovery or even destination therapy, that is a long-term management strategy.

    Most are left ventricular assist devices (LVAD), although right ventricular units also exist.  All are independent of the cardiac rhythm evident on the EKG. Consequently, one can do therapy when the patient appears by EKG to be in ventricular tachycardia, ventricular fibrillation, or asystole. VADs require a variable range of anticoagulation. All are susceptible to infection, bleeding, thrombosis/stroke and mechanical failure.

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  • Cindy Cassel, PhD, RD, LDCindy Cassel, PhD, RD, LD

    The prevalence and pathopshiology of congestive heart failure is 25% of patients with heart disease. Evidence based dietetics practices approved by the American Dietetics Association (ADA) have been developed to guide the medical nutrition therapy for patients with heart failure.

    Cindy Cassel educated the audience on how the ADA uses workgroups to develop disease specific guidelines, which recommend what should be done in terms of nutrition and then how it should be delivered. In addition, the ADA has developed a guideline rating system that helps guide the dietician and patient on the strength of the guideline based on evidence base.

    The ADA recommends that the treatment of heart failure symptoms should be based on a comprehensive nutrition assessment to maximize adequate intake and control for the symptoms of disease. In general the nutrition assessment of a heart failure patient should focus on protein needs (should be higher to save muscle) and energy needs.

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  • Diabetes: Risk for Cardio-Pulmonary Disease

    By Ryan Squire
    Naushira Pandya, MD, CMDNaushira Pandya, MD, CMD

    Dr. Pandya outlined identified the objectives of her talk to review the goals of glycemic control: One size does not fit all, review the current guidelines from several national organizations for cardiovascular risk, and review best practices for diabetes management.

    Diabetes is a head to toe disease: Retinal disease, stroke, nephropathy, neuropathy, large and small vessel disease of the extremities and  this emphasizes the range of diabetes impact.

    There are many potential barriers to improved management of diabetes: Institutional challenges, staff/practitioner resistance, and complexity of medication regimens and all may negatively impact diabetic control. Yet, there are several basic principles that apply to diabetes management, and must involve an inter professional clinical team:

    Maintaining functional status is the over arching goal of all interventions applicable to diabetes management.

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  • Cocheco Cardiopulmonary Recovery Program Kindred Transitional Care and Rehabilitation Dover, NH.

    Presented at the 2011 Kindred Healthcare Clinical Impact Symposium by Linda Dubois, RN, AND.


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  • Weakness: Polyneuromyopathy - the Role of Mobility

    By Ryan Squire
    Peter Morris, MDPeter Morris, MD

    The issue of chronic critical illness or Post Intensive Care Unit Syndrome (PICS) is of great importance in the management of patients in the ICU.   There are many additional synonyms for the problem, and the number of names for syndrome demonstrates lack of critical understanding of the syndrome.

    Why is this an important concern? Acute respiratory failure results in 1.1 million ICU admissions needing mechanical ventilation annually.   There are 400,000 ICU deaths/yr with resp failure; hospital mortality: 37%.  The cost of this care is substantial and rising; total health care costs total 17.6% of GDP in the US.

    The key questions to be answered about early rehab care in the ICU are:

    Morris points out fiscal considerations of ICU rehabilitation are a potential barrier and historically, the fear of early movement of ICU patients may also fuel reluctance to intervene.

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