• 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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  • Quality Measures

    By Ryan Squire

    Matt Sivret and Sally Brooks, MD addressed why outcomes matter greatly to Kindred Healthcare, measuring our organizational success through patient success, how to address outcomes across the continuum and why outcomes matter to our customers. Matt started by identifying the top seven reasons why outcomes matter:

     

    Matt SivretMatt Sivret

     

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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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  • Charlotte Smith, MDCharlotte Smith, MD

    Many positive changes in technology and innovation of science have been injected into the experience of health care over the last decade. Dr. Smith cautioned that the good has also brought challenges like less time, less communication, less trust, and more opportunities for things to go wrong.

    In addition, family issues have become a barrier to taking care of the rehabilitation patient. Dr. Smith has experienced that the family has less capacity to be caretakers because of the changes in family structure. Dual income couples, more singles, geographic distance between family members has increased, and definition of family has changed: these factors make it harder for family members to be effective caretakers and create stress.

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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.

    http://www.youtube.com/watch?v=YiSklZTDHyY

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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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  • Lawrence Cahalin, PhD, PTLawrence Cahalin, PhD, PT

    Activities of physical therapy and rehabilitation are critical in improving outcomes for the patient with heart disease.  The areas to be focused on include aerobic exercise training, resistance/strength training, and inspiration muscle training. These may have important impacts on measures such as hospitalization, quality of life (QOL), and even survival. One of the first steps is understanding your risk for heart attack. Cahalin urged the audience to visit the American Heart Association's website for heart attack risk factor assessment and asked that we have our patients do the same and take the assessment.

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

    Daniel Forman, MD, is Medical Director of the Cardiac Rehabilitation and Exercise Testing Laboratory at Brigham and Women's Hospital. Dr. Forman suggests that while most of focus of heart care is placed on diseases of the heart, there is an enormous opportunity to modify biology and lifestyle years before cardiopulmonary disease ever shows up. Lifestyle factors such as eating habits, exercise habits, tobacco use and sleep add up over time and lead to disease. Add biological factors like age, family history, and genetic predispositions and there are many factors that lead to disease.

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  • Clinical Impact Symposium Kicks Off

    By Ryan Squire

    The Third Annual Kindred Healthcare Clinical Impact Symposium kicks off tomorrow morning. This year's Symposium will focus on cardio-pulmonary rehabilitation across the continuum. Follow along here as we blog about the conference and bring you the highlights from the talks and presentations.

    Clinical Impact Symposium Kicks Off

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