Tuesday, August 7, 2012

Improving Cardiovascular Risk

Medivision presents an excerpt from our 60 minute pharmacy education video Improving Cardiovascular Risk, featuring Sian Carr-Lopez PharmD. on the topic of Hypertension and Cardiovascular Risk. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com, and also includes Robert B. Supernaw, PharmD. and Mary J. Ferrill, PharmD. discussing the roles of hyperlipidemia, cholesterol medications and hypertension.

Hypertension is quantitatively the most important risk factor for premature cardiovascular disease; it is more common than other risk factors such as cigarette smoking, dyslipidemia, and diabetes. Hypertension accounts for an estimated 54 percent of all strokes and 47 percent of all ischemic heart disease events globally. Hypertension increases the risk for a variety of cardiovascular diseases, including stroke, coronary artery disease, heart failure, and peripheral vascular disease. Coronary disease in men and stroke in women are the principal first cardiovascular events noted after hypertension onset, and in view of the evidence that the mortality rates are rising in younger people in the United States and the increasing impact of cardiovascular diseases in developing countries, greater attention must be given to prevention of these diseases. The increase in cardiovascular risk has primarily been described in terms of elevated systolic pressure in those over age 60 and elevation in diastolic pressure in younger individuals. Pulse pressure, which is the difference between the systolic and diastolic blood pressures and is determined primarily by large artery stiffness, is also a strong predictor of risk.

High concentrations of total and LDL cholesterol and low levels of high-density lipoprotein (HDL) cholesterol predict cardiovascular risk in both men and women. High triglyceride levels have been associated with greater risk in women only. The risk of cardiovascular disease increases by an average of 2% for each corresponding 1% rise in total cholesterol.

Clinical studies have shown that statins significantly reduce the risk of heart attack and death in patients with proven coronary artery disease (CAD), and can also reduce cardiac events in patients with high cholesterol levels who are at increased risk for heart disease. While best known as drugs that lower cholesterol, statins have several other beneficial effects that may also improve cardiac risk, and that may turn out to be even more important than their cholesterol-reducing properties.

Thursday, August 2, 2012

Building Healthy Communities

Featuring Mary Totten; President, Totten and Associates, Ted Landsmark; President, Boston Architectural Center, and Philip Newbold, President and CEO of Memorial Health System.
This video is designed to assist community developers in gaining a better understanding of the assets and resources in your community. Learn how to create partnerships that makes the most effective use of your community's resources, understand the changing role of the board from community relations to community health, develop a community-focused mission and learn what boards can do to ensure effective involvement in community health and how to identify unmet needs in the community. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com

Many important initiatives to engage communities in addressing their health care crises are currently underway throughout the United States. National organizations are convening community dialogues and organizing consumer advocacy projects. Foundations and academic centers are identifying effective community strategies, analyzing the secrets of their success, and disseminating them as effective models and
approaches. State governments, many of which are dealing with significant budgetary shortfalls, are monitoring the creative initiatives of certain pioneering communities. In some regions, federal, state, and community stakeholders are working together to improve access and coverage.

Effective collaborations involve a process through which citizens, providers, advocates, government officials, and other stakeholders explore obstacles, differences and alternative strategies for improving access to health care.

Ingenuity and determination are behind efforts in communities that are successfully overcoming barriers to health care access. The models vary widely, but all involve diverse community partners who have come together and reached consensus on strategies. Virtually all the effective projects involve regular monitoring and cost/benefit analysis, projecting or demonstrating dramatic savings to local and regional economies.
Some have tackled the issue of coverage by creating local, nonprofit managed care plans for low-income
workers, other uninsured residents, or people living with chronic diseases. Among the most promising programs for future sustainability are those where financing involves cost sharing—in which employers, employees, government and community funders all contribute.

Other communities have addressed different elements of access. Volunteers and staff members may find
under served patients a “medical home.” Or they may facilitate patients’ enrollment in public programs,
ensure transportation to health care appointments, provide translation and interpretation services, or case-manage those with chronic and costly illnesses. Effective community collaborations usually enlist health care providers, social service agencies, pharmacies, and even insurance agents to donate or deeply discount their services to support the newly created systems.

The emphasis of community-based healthcare has been changing; among other aims, asset based working promotes well-being by building social capital, promoting face-to-face community networks, encouraging civic participation and citizen power. High levels of social capital are correlated with positive health outcomes, well-being and resilience.
Local government and health services face cuts in funding. Demographic and social changes such as an aging population and increasing unemployment mean that more people are going to be in need of help and support; new ways of working will be needed if inequalities in healthcare are not to get worse.

It’s important to assess your community’s strengths and assets as well as your needs, as is the ability to focus your efforts on policies and programs that build on your community’s existing assets and resources. Identifying these elements early will help you later as you choose effective policies & programs and begin to act on what’s important to implement policies and programs.

Social community assets involve the extent to which community residents interact with each other for the good of the community. This collective interaction may take the form of participating in community meetings, voting in local and national elections, and helping out with community problems like teen violence or wide-spread drug abuse. It also may involve community mobilization to advocate for projects that may further strengthen the community, such as increased funding for new community centers or after school programs.

Additional Information:
Improving Health Care Access: Finding Solutions in a Time of Crisis

Monday, July 23, 2012

Cancer Update: Diagnosis & Treatment of Urologic Cancers

Medivision presents an excerpt from our 120 minute medical education video Cancer Update: Diagnosis and Treatment of Urologic Cancers, featuring Richard Williams Md. discussing Chemotherapy and Immunotherapy of Superficial Bladder Cancer. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com, and also includes Seth Lerner, MD., Ron Bukowski, MD., Chris Logothetis, MD. and Michael Sorodsky, MD. discussing testes cancer, bladder cancer, BCG, alternatives to BCG therapy, and metastatic bladder cancer; also covers renal cell cancer - single agent therapies including IL-2 high dose and alpha interferon, combination therapy of IL-2 low dose and alpha interferon, and surgery to treat renal cells.

Superficial bladder carcinoma includes a diverse group of lesions, ranging from Ta grade I to T1 grade III tumors and high-grade flat CIS. Although it is crucial to distinguish the small group of lesions that carry a serious risk of progression to life-threatening muscle invasive and metastatic disease, the vast majority of superficial tumors have low rates of progression. Rather, they have a significant tendency to recur at multiple sites throughout the urothelium. 

Bacillus Calmette-Guerin (BCG) is a live bacterium related to cow tuberculosis. It is a common treatment for non-muscle invasive bladder cancer, particularly for cancers that have a risk of worsening over time. BCG is believed to work by triggering the body's immune system to destroy any cancer cells that remain in the bladder after TURBT (transurethral resection of bladder tumor). BCG is in a liquid solution that is put into the bladder with a catheter. The person then holds the solution in the bladder for two hours before they urinate. The treatment is usually given once per week for six weeks, starting approximately two to three weeks after the last TURBT. Further booster (maintenance) treatments can extend the benefit of BCG.
Intravesical BCG, in combination with TURBT, is the most effective treatment for non-muscle invasive bladder cancer. BCG therapy has been shown to delay (although not necessarily prevent) tumor growth to a more advanced stage, decrease the need for surgical removal of the bladder at a later time, and improve overall survival

Monday, July 16, 2012

Management of Anorexia and Bulimia

Medivision presents an excerpt from our 60 minute medical education video Management of Anorexia and Bulimia, featuring Mary E. Muscari, PhD, CRNP, CS and Marrian Farrell, PhD, RNC, CS. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and describes the clinical manifestations and potential complications associated with anorexia and bulimia nervosa; the nursing techniques used to prevent and manage the physiologic consequences, and assists the physician in developing an understanding of the psychosocial needs of clients with eating disorders while examining various psychosocial interventions based on appropriate theoretical perspectives for clients with eating disorders.

Competent and comprehensive care of eating disorders must involve understanding the medical aspects of these illnesses, not just for physicians but for any clinician treating them. A therapist must know what to look for, what certain symptoms might mean and when to send a patient for medical evaluation. A dietitian will likely be a team member who performs the nutrition evaluation and must have adequate knowledge of all medical/nutritional aspects of eating disorders. A psychiatrist may prescribe medication for an underlying mood or thought disorder and must coordinate this with the rest of the treatment.

Eating disorder medical complications vary with each individual; some patients who self-induce vomiting have low electrolytes and a bleeding esophagus while others can vomit for years without ever developing these symptoms. It is necessary to have a well-trained and experienced physician as part of the treatment team of an eating disordered patient. Not only do these physicians have to treat symptoms that they find, but they have to anticipate what is to come and discuss what is not revealed by medical lab data. Unfortunately, physicians with special training and/or experience in diagnosing and treating eating disorders are not very common, and patients who seek psychotherapy for an eating disorder often have their own family doctors which they prefer over a therapist referral.

Most eating disorder complaints like headaches, stomachaches, insomnia, fatigue, weakness, dizzy spells, and even fainting do not show up on lab results. Parents, therapists and doctors too often make the mistake of expecting to scare patients into improving their behaviors by having them get a physical exam in order to discover whatever damage has been done. Patients are rarely motivated by medical consequences and often have the attitude that being thin is more important than being healthy, or nothing bad is really going to happen to them, or they don't care if it does. Furthermore, patients can appear to be healthy and receive normal lab results even though they have been starving or vomiting for months or years.

Managing binge eating disorder patients most likely involves the same medical considerations to be taken into account when treating obese individuals, such as heart or gallbladder disease, diabetes, high blood pressure, and so on. Most symptoms of binge eating will be a result of the accompanying weight gain associated with this disorder. Occasionally people have binged to the point of becoming breathless when their distended stomachs press up on their diaphragms. In very rare cases a medical emergency may occur if the stomach wall becomes so stretched that it is damaged or even tears. 

While many people with an eating disorder will recover fully, relapse is common and may occur months or even years after treatment. An estimated 5 to 10 percent of anorexics will die from the disorder; their deaths most commonly result from starvation, suicide or electrolyte imbalance. More favorable outcomes for anorexics have been associated with a younger age of onset of the disorder, less denial, less immaturity, and improved self-esteem.
The outcome for bulimia nervosa is not as well documented, and mortality rates are not yet known. It is a chronic, cyclic disorder. Of those bulimics who are treated for the disorder, fewer than one-third will be fully recovered three years after treatment, more than one-third will show some improvement in their symptoms at a three-year follow-up, and about one-third will resume chronic symptoms within three years.

Friday, June 15, 2012

Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction

Medivision presents an excerpt from our 60 minute medical education video Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction, featuring Denise Drummond Hayes MSN, RN, CCRN from Allegheny University Hospitals.
The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and discusses the physicians need to differentiate between heart failure secondary to left-ventricular systolic dysfunction and heart failure secondary to left-ventricular diastolic dysfunction, describe the initial pharmacologic management for patients with heart failure in the setting of reduced left-ventricular systolic function, as well as the current AHCPR recommendations for patient and family education and counseling in reference to left - ventricular systolic dysfunction.

Older people living with heart abnormalities that could lead to heart failure may have never had those abnormalities diagnosed, meaning they miss out on treatments that could help. But deciding whether someone would benefit from taking these drugs in the last stages of life is also important.

The heart naturally gets weaker as people age, but scientists don't often study heart failure in the elderly. A new study looked at 375 people ages 87 to 89 in northeast England, and found that about one-third of them had a reduced ability to pump blood due to a left ventricular systolic dysfunction. Another 20 percent had a diastolic dysfunction; heart muscles that could not relax enough to allow the heart's chambers to fill with blood, which keeps the heart from pumping enough blood to the rest of the body.
These abnormalities increase as people age and develop cardiovascular diseases, such as high blood pressure and coronary artery disease. They can also lead to heart failure.

For 26 percent of the people in the study, the problems had never been diagnosed by a physician.

About 5.8 million Americans have heart failure according the National Heart Lung and Blood Institute, and as greater numbers of people age and survive heart attacks in Western countries it's possible that that number will grow.

Doctors say although the symptoms of these heart abnormalities seem common for older people, it's important that they not be dismissed as simply signs of "old age."
There are few treatment options for patients whose hearts don't relax enough to fill with blood, but patients whose hearts don't pump hard enough can take classes of drugs called beta blockers and ACE inhibitors, both of which increase the heart's ability to pump blood effectively. Those drugs come with side effects such as weakness, drowsiness or dizziness that may make it not feasible to give them to an older person.


Wednesday, May 23, 2012

Recent Advances in the Management of IBS

Medivision presents an excerpt from our 60 minute medical education video Recent Advances in the Management of IBS (Irritable Bowel Syndrome), featuring Brenda Toner, PhD. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and describes the application of symptom-based criteria for diagnosis of IBS, the role of dysmotility and visceral hypersensitivity in IBS, patient care and the role of pharamacotherapeutic agents.

Irritable bowel syndrome (IBS), a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving over 40% of patients to experience symptoms up to 5 years before diagnosis.

The myoelectric activity of the colon is composed of background slow waves with superimposed spike potentials. Colonic dysmotility in irritable bowel syndrome manifests as variations in slow-wave frequency and a blunted, late-peaking, postprandial response of spike potentials. Patients who are prone to diarrhea demonstrate this disparity to a greater degree than patients who are prone to constipation.
Small bowel dysmotility manifests in delayed meal transit in patients prone to constipation and in accelerated meal transit in patients prone to diarrhea. In addition, patients exhibit shorter intervals between migratory motor complexes (the predominant interdigestive small bowel motor patterns).
Current theories integrate these widespread motility aberrations and hypothesize a generalized smooth muscle hyperresponsiveness. They describe increased urinary symptoms, including frequency, urgency, nocturia, and hyperresponsiveness to methacholine challenge.

Visceral hypersensitivity (the experience of pain in internal organs at an increased level than what is normally expected) may also play a role in irritable bowel syndrome (IBS). This pain sensitivity is usually studied using some variation of balloon distention in the rectum, and as an overall research trend people who suffer from IBS experience discomfort and pain in the rectal area at lower levels of pressure than individuals who do not suffer from IBS. But the issue is not a simple one; it appears likely that the visceral hypersensitivity seen in some IBS patients is a result of changes in nervous system functioning on both the level of the intestines and the brain. At the level of the gut, it seems as if nerve pathways in the gastrointestinal tract become sensitized to stimulation, resulting in over-reactivity and resulting in pain amplification. Brain imaging studies provide more clues; in individuals who do not have IBS, rectal distension triggers a response in parts of the brain that are associated with modulating pain. In IBS patients, this same rectal stimulation triggers a response in the parts of the brain associated with vigilance and anxiety -- parts of the brain that serve to amplify the sensation of pain.

Certain types of psychotherapy have been shown to be effective in reducing IBS symptoms. Although it is not known precisely why therapy is beneficial, it is thought to be related to the effect of the therapy on the close interconnections between the brain and the intestinal system.

Wednesday, April 11, 2012

Cardiology Perspectives: Effective Management of Cholesterol

Medivision.com is pleased to present an excerpt from our 2 hour educational video; Cardiology Perspectives: Effective Management of Cholesterol, featuring John Kane, MD; Alan Chait, MD; John LaRose, MD; Tom Bersot, MD; Stephen G. Young, MD; Gustav Schoenfeld, MD and Virgil Brown, MD. The full length video is available on DVD or VHS from health-e-mall.com and discusses the importance of controlling cholesterol in patients with heart disease and other high risk individuals.

High cholesterol is a well-known risk factor in heart disease, the number one killer of both women and men in the United States, with more than a million heart attacks and about a half million deaths annually.
High cholesterol doesn't cause overt symptoms, and many people are unaware of elevated cholesterol levels and how it may influence their cardiac risk. To complicate matters, high cholesterol is not the only predictor of cardiovascular events such as heart attack and stroke; somewhere between 30-50 percent of first heart attacks occur in people with normal cholesterol levels, but it is essential to test and monitor cholesterol levels, especially for anyone with a family history of heart disease. Lowering high cholesterol does seem to lessen the risk for developing heart disease, and reduces the chance of a heart attack or dying of heart problems if you already have them. However, some research has indicated that all-cause mortality (that is, dying from any disease, not just heart disease) actually increases when cholesterol is lowered in those over age 65.

Genetics and lifestyle both combine in individuals to create high levels of cholesterol in the blood. Those who are overweight tend to have increased cholesterol.
Diet is an important component of controlling cholesterol ratios and maintaining heart health. Recent evidence indicates that added sugar and overabundance of flour in the diet are probably greater contributors to heart disease than saturated fat; certain components of full-fat dairy foods may be cardio-protective.
However, a chemically altered type of fat known as trans fatty acids (TFAs) can worsen cholesterol ratios. TFAs are mostly found in animal fats and vegetable oils, and are also created in the hydrogenation process that makes fats more stable, giving them a longer shelf-life.
In addition to diet, LDL cholesterol levels appear to be heavily dependent on genetic factors. Anyone at increased risk of heart disease should have tests for LDL particle size in addition to the basic lipid profile. Best results show low numbers of LDL particles overall.
A different cholesterol problem is present when one shows a tendency towards low HDL cholesterol and high triglycerides. This pattern, sometimes called “Syndrome X,” is associated with insulin resistance. It is frequently influenced by diet and lifestyle, but is also genetically driven and appears to affect at least 30 percent of the population. It carries with it an increased risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatments are often quite effective in treating this pattern, but are a bit different from those for high total and LDL cholesterol levels.

High cholesterol is treated conventionally with lifestyle changes focusing on diet, physical activity and weight management. For patients seen in busy medical practices this approach is frequently difficult to fully implement and utilize. If lifestyle changes are not effective, drug therapy is often recommended. Statin drugs are commonly used to lower cholesterol and protect against heart disease and heart attacks by blocking an enzyme that is necessary for the synthesis of cholesterol in the liver. They can be very effective, and there is growing medical enthusiasm for them because they also seem to provide antioxidant and anti-inflammatory properties. These drugs can reduce plaque formation in coronary arteries by preventing the oxidation of LDL ("bad") cholesterol, and their anti-inflammatory properties may help prevent plaque from rupturing.
Despite their benefits, they do have adverse effects including liver toxicity: physicians need to monitor liver function carefully in patients with liver disease of any kind.