Mild Traumatic Brain Injury and Concussion in Sports

Current Program

Mild Traumatic Brain Injury and Concussion in Sports

Program # 923

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Mild traumatic brain injury (TBI) and concussion are complex and growing areas of concern, as the incidence in youth and professional sports rises and new understanding of its impact emerges. Both the immediate and long-term effects of concussion can impair a person’s cognitive abilities (activities such as using language, reasoning, and remembering), as well as his or her neurological, psychological, and physical health. In this video, excerpted from the 2015 NYU Comprehensive Review of Physical Medicine and Rehabilitation (available at www.hegalaxy.com/boards), Dr. Brian Im discusses how to effectively diagnose, treat, and manage mild TBI and concussive injuries.

Office Management of Chronic Pain: A Best Practice Method

Program # 922

Alleviating pain is one of the core principles in medicine. Yet, all too often opioids are prescribed as first line therapy before proper assessment and appropriate non-opioid treatment pathways are implements. In this video, Dr. Tauben provides a practical review of office-based management of pain. This segment is an excerpt from the University of Washington’s 42nd Annual Advances in Family Practice and Primary Care, available at www.hegalaxy.com/boards

Office Management of Chronic Pain: A Best Practice Method

Pericardial Diseases

Program # 921

Pericardial disease is often seen in clinical practice and may present either as an isolated process or in association with other systemic disorders. According to Dr. Klein, recognizing pericardial pathology can be relatively straightforward, particularly if the clinical manifestation is typical or when an associated disease process gives a direct clue to the diagnosis. In these situations, the diagnostic pathway can be limited to a relatively small sequence of tests to basically confirm the initial clinical suspicion. However, pericardial disease can also result in nonspecific symptoms and equivocal physical findings. In such difficult clinical situations, an integrated multimodality imaging approach may provide incremental value. This program is an excerpt from the Cleveland Clinic 26th Annual Intensive Review of Internal Medicine available on-demand at www.hegalaxy.com/boards.

Pericardial Diseases

Novel Oral Anticoagulants to Enhance Stroke Prevention in Patients with Atrial Fibrillation

Program # 920

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia, with more than 5.1 million US adults currently living with the disorder. By the year 2050, the prevalence of AF is expected to increase to between 12 and 15 million. Patients with AF have an elevated risk of stroke and mortality, and strokes associated with AF are often more severe than non-AF-related strokes. Thus, appropriate anticoagulation is essential to reduce the risk of thromboembolism. There are now several new oral anticoagulants that can be used as alternatives to warfarin in selected patients. Dr. Buch reviews the clinical data behind these new agents and discusses the 2014 guidelines for AF. In addition, he demonstrates clinical tools for risk stratification (e.g., stroke risk, bleeding risk) and provides practical advice on tailoring anticoagulation strategies based on individual patient characteristics.

Novel Oral Anticoagulants to Enhance Stroke Prevention in Patients with Atrial Fibrillation

Empathy and Patient Care

Program # 919

How can practitioners be more empathetic toward their patients without “burning out?” Is too much empathy harmful to the clinician who endeavors to remain objective and emotionally unattached to his or her patients? Can the right balance of empathy be learned, and does our current system of medical education “de-empathize” future physicians and nurses? These are just a few of the challenging questions Dr. Mauksch addresses in this important but often-neglected topic. This video segment is an excerpt from the University of Washington School of Medicine “Advances in Family Practice and Primary Care” Comprehensive Review Course, available on-demand at http://www.hegalaxy.com/boards/courses/u-washington-family-medicine.

Empathy and Patient Care

Irritable Bowel Syndrome

Program # 918

According to the American College of Gastroenterology, irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders worldwide. IBS is a global problem, with anywhere from 5 to 15% of the general population experiencing symptoms that would satisfy a definition of IBS. Given its prevalence, the frequency of symptoms, and their associated debility for many patients, the socioeconomic impact of IBS is considerable. These indirect medical costs are frequently compounded by the direct medical costs related to additional medical tests and the use of various medical and nonmedical remedies that may have limited impact. In this video, Dr. Edy Soffer, MD, explores the current state of IBS management. This program is an excerpt from the Cleveland Clinic Intensive Review of Gastroenterology and Hepatology, available on-demand at www.hegalaxy.com/boards.

Irritable Bowel Syndrome

Antibiotics: Newer Agents, New Uses for Older Agents, and Strategies to Minimize Resistance

Program # 917

Antibiotics remain one of the most important clinical tools available in medicine today. Unfortunately, one of the greatest drivers of antimicrobial resistance is antimicrobial use. In this video presentation, excerpted from the Emory University School of Medicine 39th Annual Comprehensive Board Review in Internal Medicine (available at www.hegalaxy.com/boards), Dr. Varkey examines the role of newer antibiotic drugs while exploring the use of older agents for new purposes. Throughout the presentation he emphasizes the importance of “antibiotic stewardship” – a means of optimizing clinical outcomes while minimizing unintended consequences of antimicrobial use such as toxicity and the emergence of antibiotic resistance.

Antibiotics: Newer Agents, New Uses for Older Agents, and Strategies to Minimize Resistance

Occupational Medicine and Cumulative Trauma Disorders

Program # 916

Virtually every practicing physician encounters patients presenting with symptoms associated with the workplace. Sometimes the answer is an easy ergonomic fix, other times the underlying problems are more complex. In this video, Dr. Horn provides historical perspectives on the development of workplace safety protocols and provides practical case anecdotes of workplace-related health issues and managing cumulative trauma disorders. This program is excerpted from the NYU Post-Graduate Medical School Comprehensive Review of Physical Medicine and Rehabilitation, available at www.hegalaxy.com/boards

Occupational Medicine and Cumulative Trauma Disorders

A Practical Approach to Anemia in the Pediatric Patient

Program # 915

Anemia is a reduction in red blood cell mass or blood hemoglobin concentration and is commonly measured using hemoglobin and hematocrit. According to Dr. Gowans, there is considerable variation in hemoglobin and hematocrit values in pediatric patients. In this presentation, excerpted from the Cleveland Clinic Intensive Review of Pediatrics (available on-demand at www.hegalaxy.com), Dr. Gowans emphasizes the importance of age- and sex-adjusted norms when evaluating a pediatric patient for anemia, and reviews current classification criteria, diagnostic clues, laboratory evaluation, and clinical manifestations.

A Practical Approach to Anemia in the Pediatric Patient

Medical Radiation: Controversy and Dose Reduction Tips

Program # 914

Contemporary imaging technologies provide remarkable views and diagnostic/treatment guidance in numerous regions of the human body. But how safe are these technologies to the patient in terms of radiation exposure? In recent years, several reports on the evening news, some based on study results in respected peer-reviewed journals, have created significant alarm and concern. In this presentation, excerpted from the Penn Radiology Review: An Update in Thoracic, Cardiovascular, Breast, and Body Imaging (available on-demand at www.hegalaxy.com), Dr. Gotway reviews the basics of radiation exposure with the use of medical imaging and systematically examines studies that have measured safety. While acknowledging that radiation is a carcinogen, he balances the exposure risk with clinical benefit, and compares medical imaging radiation exposure with common environmental radiation. Recommendations for medical radiation dose reduction are also covered in this balanced presentation separating the fears from the facts.

Medical Radiation: Controversy and Dose Reduction Tips

Medical and Surgical Approaches for Obesity Management

Program # 913

Obesity has reached epidemic proportions in the United States, with approximately 67% of the U.S. population now classified as overweight or obese. Obesity is associated with an increased risk for type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, musculoskeletal disorders, cancers, and mortality. Moreover, complications of uncontrolled diabetes include macro- and micro-vascular complications such as myocardial infarction, stroke, blindness, neuropathy, and renal failure. In this presentation, excerpted from the Cleveland Clinic 16th Annual Endocrinology and Metabolism Board Review (available on-demand at www.hegalaxy.com), Dr. Kashyap reviews lifestyle, pharmacologic, and bariatric surgery options for obese patients, with a focus on achieving significant weight loss and potential remission of diabetes.

Medical and Surgical Approaches for Obesity Management

Heart Failure in Clinical Perspective

Program # 912

The burden of heart failure (HF) continues to grow, making HF one of the single most expensive and deadly health care problems in the United States today. Medical therapies and non-pharmacologic measures for HF can reduce patients' need for re-hospitalization, lower costs of care, and improve survival. Unfortunately, these strategies are underutilized in conventional practice settings. Dr. Fonarow addresses multidisciplinary pathways to implement evidence-based HF therapies that optimize the care of patients with HF, including measures to prevent HF from developing in patients at risk.

Heart Failure in Clinical Perspective

Promoting Heart-Healthy Eating to Optimize Cardiovascular Nutrition

Program # 911

For weight control and reducing the risk of heart disease, stroke, and diabetes, a focus on healthy foods and overall dietary patterns -- rather than individual nutrients -- is most consistent with modern nutritional evidence. In this video segment, excerpted from the weeklong Brigham and Women’s “Cardiovascular Medicine Update for the Practitioner” Board Review Course (available at www.hegalaxy.com), Dr. Mozaffarian reviews contemporary principles of healthy eating and explores several evidence-based approaches to maximize behavior changes such as shared setting of focused, proximal goals; regularly scheduled follow-up; self-monitoring, and in-person, telephone, or electronic feedback. According to Dr. Mozaffarian, community and policy approaches are also effective, and healthcare providers or organizations should advocate such measures to improve the health of their patients, their communities, their families, and themselves.

Promoting Heart-Healthy Eating to Optimize Cardiovascular Nutrition

Hypertension: Clinical Perspectives on a Persistent Problem

Program # 910

While major strides have been made in cardiology, hypertension continues to challenge both clinicians and patients alike. Using illustrative case studies, Dr. Watson examines key clinical barriers that can result in suboptimal management, and offers evidence-based best practices and updated guidelines to overcome them.

Hypertension: Clinical Perspectives on a Persistent Problem

Individualizing Treatment and Stroke Prophylaxis for Atrial Fibrillation

Program # 909

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia. More than 5.1 million US adults are estimated to have the disorder and the prevalence of AF is expected to increase to between 12 and 15 million by the year 2050. In this video, Dr. Buch covers the three major goals for the management of patients with AF: stroke prevention, rate control, and maintenance of sinus rhythm. He presents an individualized approach to applying current guidelines and best practices while presenting key study results that support them.

Individualizing Treatment and Stroke Prophylaxis for Atrial Fibrillation

Contemporary Issues in the Management of COPD and Asthma

Program # 908

The 2013 Global Initiative for Chronic Obstructive Disease (GOLD) Guidelines defines chronic obstructive pulmonary disease (COPD) as "a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients." Similarly, the Global Initiative for Asthma characterizes asthma as airflow obstruction but typified by variable and recurring symptoms, bronchial hyperresponsiveness and underlying inflammation of the airways. The nuances between these two conditions can be challenging. In this video, Dr. Make differentiates COPD from asthma and provides current approaches to comprehensive COPD management.

Contemporary Issues in the Management of COPD and Asthma

Guiding Cardiovascular Patients and Their Families at the End of Life

Program # 907

In this video segment from the 36.5 hour Brigham and Women's "Cardiovascular Medicine Update for the Practitioner 2013" Board Review Course (available at www.hegalaxy.com/boards), Dr. Stevenson emphasizes that palliative therapies to control symptoms, address quality of life, and enhance communication are relevant throughout the course of cardiovascular disease, not just in advanced disease.

Guiding Cardiovascular Patients and Their Families at the End of Life

Osteoporosis: A Clinical Review

Program # 906

Osteoporosis is a major health threat in the United States. More than 10 million individuals currently have osteoporosis with an additional 34 million suffering from low bone mass. Between 40 and 50 percent of women over age 50, and approximately 25% of men over 50, will suffer an osteoporosis-related fracture within their lifetime. In this video segment from the 36.25 hour NYU Comprehensive Review of Physical Medicine and Rehabilitation (available at hegalaxy.com/boards), Dr. Peck reviews an evidence-based approach for working up and treating osteoporosis.

Osteoporosis: A Clinical Review

Cognitive Impairment in Multiple Sclerosis: New Research on Diagnosis and Management

Program # 905

Cognitive changes can be expected in more than half of multiple sclerosis (MS) patients and include deficits in processing speed, working memory, episodic memory, spatial processing, verbal fluency and executive function. These impairments can be highly disruptive to personal independence, social interaction, and quality of life. Join Dr. Kottil Rammohan and a distinguished panel of experts for an expert review on the assessment of MS-related cognitive impairment, the role of neuroimaging in diagnosis and monitoring, and the potential impact of disease modifying therapies on improving cognition. This activity is based on the proceedings from a live interactive workshop held with MS clinical team members.

Cognitive Impairment in Multiple Sclerosis: New Research on Diagnosis and Management

Diagnosing Rheumatoid Arthritis: Epidemiology, Clinical Features, and Prognosis

Program # 904

Rheumatoid arthritis (RA) is a systemic, inflammatory polyarthritis that leads to joint destruction, deformity, and loss of function. The pathology of RA involves the synovial membranes and periarticular structures of multiple joints, resulting in pain, swelling, stiffness, uncontrolled inflammation, pannus formation, and functional limitation. In this video segment from the 27.5 hour NYU Advanced Rheumatology Board Review Course (available at www.hegalaxy.com/boards/), Dr. Lee reviews the epidemiology, patterns/modes/sites of onset, classification criteria, differential diagnosis, and prognosis of RA. The role of early diagnosis and treatment to slow the progression of disease is stressed.

Diagnosing Rheumatoid Arthritis: Epidemiology, Clinical Features, and Prognosis

Why Are We Still Talking About Hypertension?

Program # 903

Hypertension is strongly associated with an increased risk of morbidity and mortality. One in three US adults have the condition, which is defined as a blood pressure greater than 140 mm Hg systolic and/or greater than 90 mm Hg diastolic. In 2013, an estimated 20% of adults affected by hypertension in the US are not aware of it, 30% are not being treated for it, and greater than 50% do not have it under control. In this video, Dr. Hershon presents evidence-based, practical methods to improve high blood pressure detection and control.

A Team Approach to Diagnosing and Managing Fibromyalgia

Program # 902

Dr. Clauw presents the latest evidence-based best practices for the diagnosis and management of fibromyalgia, focusing on the challenges involved in proper assessment of this complex multifactorial disorder and the evolving pharmacologic and nonpharmacologic therapeutic treatment options. He provides practical advice on achieving patient outcomes for this often misunderstood condition.

A Team Approach to Diagnosing and Managing Fibromyalgia

Better REsults And THerapeutic Efficacy: The BREATHE Initiative for Asthma and COPD

Program # 901

A 41-year-old woman with a 35-year history of asthma, allergic rhinitis, recurrent sinusitis, and bronchitis visits her new primary care physician for the first time. See how this challenging case unfolds from the initial presentation through key decision points during testing, imaging, lab work, diagnosis, treatment and environmental control. In an unusual twist, our patient visits a pulmonologist 16 years later with related complaints marked by several significant differentiating factors. How has her living circumstances changed? What is her new environment like? How are the presenting signs and symptoms different than those from her primary care visit 16 years earlier? Using illustrative patient video vignettes, two experts in pulmonology and immunology explore the diagnosis and management of asthma and COPD. Practice guidelines and study results are presented to support the evidence-based management recommendations.

Better REsults And THerapeutic Efficacy: The BREATHE Initiative for Asthma and COPD

Complicated Skin and Skin Structure Infections: Prevention and Management Options in an Era of Multidrug-Resistant Organisms

Program # 900

Community- and healthcare-associated methicillin-resistant S aureus (MRSA) infections have become a growing public health issue over the past two decades. In this video, Dr. Fowler examines strategies to prevent Staphylococcus aureus infection and transmission, including whole body, systemic, environmental (surface and surroundings) decolonization, as well as pet decolonization in some instances. Interventions for uncomplicated skin and skin structure infections should ideally aim at reducing antibiotic use whenever safe and appropriate. For complicated skin and skin structure infections, there are now several appropriate broad-spectrum antibiotic treatment options available. Dr. Fowler reviews the pros and cons of these agents and provides practical clinical perspectives and advice for successful patient management.

Complicated Skin and Skin Structure Infections: Prevention and Management Options in an Era of Multidrug-Resistant Organisms

New Strategies for Meeting the Challenge of HIV/AIDS in the African American Community: An Expert-to-Expert Clinical Exchange

Program # 899

African Americans are disproportionately affected by HIV/AIDS and have worse outcomes than other ethnic groups. In this video roundtable of experts, Dr. Calderon discusses the burden of HIV/AIDS in the African American community. Dr. Leider presents the current therapy recommendations, highlighting changes made in the most recent guidelines for the use of antiretroviral agents in adults and adolescents. Next, Dr. Mack focuses on the management of comorbidities and antiretroviral toxicities in people living with HIV/AIDS. Dr. Foster concludes with practical advice and strategies for increasing treatment adherence — the key to successful outcomes.

New Strategies for Meeting the Challenge of HIV/AIDS in the African American Community: An Expert-to-Expert Clinical Exchange

Inpatient Management of Diabetes: Admission to Discharge

Program # 898

Achieving optimal outcomes for hospitalized patients with diabetes requires implementation of current, evidence-based guidelines and protocols for glycemic control. Uncontrolled hyperglycemia in the inpatient setting is a common occurrence and is associated with an increase in morbidity and mortality. In this video, Dr. Inzucchi presents the rationale for implementing updated glycemic control strategies, including the latest recommendations from the American Diabetes Association and American Association of Clinical Endocrinologists. A focused approach based on different patient characteristics and clinical settings within the hospital is discussed. Effective discharge planning to ensure continuity of care between inpatient and outpatient management is also emphasized.

New Strategies for Meeting the Challenge of HIV/AIDS in the African American Community: An Expert-to-Expert Clinical Exchange

Program # 899

African Americans are disproportionately affected by HIV/AIDS and have worse outcomes than other ethnic groups. In this video roundtable of experts, Dr. Calderon discusses the burden of HIV/AIDS in the African American community. Dr. Leider presents the current therapy recommendations, highlighting changes made in the most recent guidelines for the use of antiretroviral agents in adults and adolescents. Next, Dr. Mack focuses on the management of comorbidities and antiretroviral toxicities in people living with HIV/AIDS. Dr. Foster concludes with practical advice and strategies for increasing treatment adherence - the key to successful outcomes.

Inpatient Management of Diabetes: Admission to Discharge

Program # 898

Achieving optimal outcomes for hospitalized patients with diabetes requires implementation of current, evidence-based guidelines and protocols for glycemic control. Uncontrolled hyperglycemia in the inpatient setting is a common occurrence and is associated with an increase in morbidity and mortality. In this video, Dr. Inzucchi presents the rationale for implementing updated glycemic control strategies, including the latest recommendations from the American Diabetes Association and American Association of Clinical Endocrinologists. A focused approach based on different patient characteristics and clinical settings within the hospital is discussed. Effective discharge planning to ensure continuity of care between inpatient and outpatient management is also emphasized.

Optimizing Patient Care for Acute Coronary Snydromes: An Evidence-Based Approach

Program # 897

Acute coronary syndromes (ACS), comprising unstable angina, non-ST-segment elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI) present many challenges to hospital teams, including those with and without cardiac catheterization laboratories. For STEMI, rapid and accurate diagnosis and keeping the encounter time to reperfusion as short as possible is critical. For UA/NSTEMI, efficient risk stratification is important to select the appropriate treatment pathway and help guide management decisions. In this video, Dr. Bhatt reviews key recommendations from the 2007 UA/NSTEMI ACC/AHA Practice Guidelines and 2009 ACC/AHA Focused Updates for STEMI and PCI. Topic areas include reducing time to treatment, risk stratification, selection/timing/dosing of antithrombotic therapies in the emergency department, perioperative therapies for PCI, and long-term, secondary prevention recommendations. The role of evidence-based critical pathways to improve quality of patient care and optimize patient outcomes is emphasized throughout the lecture.

Optimizing Outcomes in Schizophrenia

Program # 896

Despite multiple therapeutic advances, especially in psychopharmacology, treatment of schizophrenia has remained a major challenge. Not only do clinicians need to ensure that they are optimally and safely treating a patient's psychosis, they also must monitor and treat the patient for various comorbidities. The risks and benefits of any single medication need to be weighed individually with each patient, and that side-effect risk needs to be weight repeatedly during treatment. Side effects need to be continuously monitored and medication adjusted to maintain optimal medical and psychiatric health. As new development and compelling clinical trial data in the management of schizophrenia evolve constantly, clinicians must ensure that they stay abreast of the latest advances and new therapies. In this video, Dr. Christoph Corell reviews dosing strategies to achieve optimal antipsychotic efficacy while minimizing adverse events; antipsychotic switching strategies based on the agents' pharmacodynamic and pharmacokinetic properties; and the evidence for augmentation strategies of antipsychotic monotherapy in schizophrenia.

Inpatient Glycemic Management 2011: Rationale and Strategies

Program # 895

Uncontrolled hyperglycemia in the inpatient setting is a common occurrence and is clearly associated with an increase in adverse outcomes including morbidity, mortality, and increased costs. Hospital hyperglycemia in nonpregnant adults may be due to known type 1 or type 2 diabetes, previously unrecognized diabets, and/or stress associated with illness and hospitialization. Barriers contributing to suboptimal glycemic control in the inpatient setting are multifactorial and include deficits in knowledge regarding insulin requirements in health and in illness, prescribing, adjusting, and/or administering an insuling regimen tailored to acute care setting needs; fear of inducing hypoglycemia and lack of effective processes/protocols for implementing glycemic management stratagies hospital-wide. This video will support clinicians seeking to optimize hyperglycemia management protocols by applying current hyperglycemia management recommendations and stratagies to clinical practice. Dr. Michelle Magee reviews the prevalence and impact of hyperglycemia in the hospitalized patient; the evidence for implementing glycemic control; the latest clinical recommendations, stratagies, and protocols for impatient insulin management; and effective discharge planning which facilitates a smooth transition from hospital to the outpatient setting.

Managing UA/NSTEMI: A Rural Hospital Approach

Program # 894

Unstable angina and non-ST-segment elevation myocardial infarction, collectively known as UA/NSTEMI, is the most commonly-occuring form of acute coronary syndromes (ACS) and accounts for over one million hosptial discharges each year in the United States. Rural hospital teams have unique challenges in optimizing their resources to provide timely risk statification and treatment for patients present with UA/NSTEMI. In this video, a renowned cardiologis and distignuised emergency medicine specialist review key guideline recommendations along with practical advice for improving UA/NSTEMI patient care in the rural hospital setting. Quailty-improvement tools such as standing orders and discharge checklists are provided for download to help clinicians implement current guidelines in practice.

Uncomplicated and Complicated Hypertension: Diagnosis and Treatment

Program # 893

Uncomplicated hypertension is hypertension that occurs without associated clinical conditions, such as diabetes, heart failure, or coronary disease, which often complicate treatment of the hypertensive patient. When persistent hypertension develops into complicated hypertension, target organ damage to the aorta and small arteries, heart kidneys, retina, and central nervous system is evident. In this video, Dr. William Frishman presents four clinical cases scenarios, depicting patients with uncomplicated and complicated hypertension, which illustrate important teaching principles in the diagnosis and treatment of hypertension. Following presentation of each case, Dr. Fishman discusses the optimal treatment approach and the pertinent issues that need to be addressed for each patient.

The Programs Below Are Available on DVD

A Team Approach to Establishing Regional Systems of Care for STEMI

Program # 892

Essential elements in the care of patients with ST-segment elevation myocardial infarction (STEMI) are rapid, accurate diagnosis and keeping the encounter time to reperfusion as short as possible. The choice of method of reperfusion is based on an individual hospital's capability and the time to percutaneous coronary intervention (PCI), whether directly or via transfer, relative to fibrinolytic therapy. The American College of Cardiology/American Heart Association (ACC/AHA) 2009 joint STEMI/PCI focused update recommends that each community develop a STEMI system of care that follows standards at least as stringent as those developed for the AHA's Mission: Lifeline initiative. It should include ongoing multidisciplinary team meetings with emergency medical services (EMS), STEMI referral centers, and STEMI receiving centers; a process for prehospital identification and activation; destination protocols for STEMI receiving centers; and transfer protocols for STEMI referral centers. Ensuring that all patients receive optimum care requires having protocols in place, working together as a team, tracking time to treatment, and minimizing system-based errors.

Acute Pediatric Asthma: Therapeutic Evidence and Controversies

Program # 891

Asthma is one of the most common diseases of childhood, with a prevalence rate of 5.4%in the pediatric population, accounting for 17% of pediatric encounters in US emergency departments. Although there is no known cure for asthma, advances in scientific understanding of the disease's underlying mechanisms have produced treatment tools and management strategies that can improve the health of children with asthma. However, the variability in patient responses to asthma therapies makes a single treatment strategy particularly challenging. In this video, Dr. Jill Baren presents an evidence-based discussion about some of the controversies in the management of pediatric asthma, including the use of metered-dose inhalers versus nebulizers, levalbuterol versus albuterol, the role of ipratropium, and the use of inhaled corticosteroids in acute asthma. In addition, she reviews novel or uncommon therapeutic interventions, such as the use of bi-level positive airway pressure (BiPAP) and heliox therapy.

Improving Medication Adherence Among HIV-Infected Drug Users

Program # 890

The management of the HIV-infected drug user poses a considerable challenge for clinicians. These patients often have medical, psychiatric, and social comorbidities that adversely influence each other and the overall clinical outcomes. Furthermore, individuals with HIV and chemical dependency have a high incidence of nonadherence to their drug regimens, which greatly diminishes the benefits of treatment. In this video, Dr. Altice reviews the multiple factors that contribute to medication nonadherence in this population, discusses interventions for optimizing adherence and improving clinical outcomes, and offers strategies for integrating HIV and addiction therapy. He also discusses novel approaches that use directly administered antiretroviral therapy (DAART) to facilitate medication adherence.

Death Just Isn't What It Used to Be

Program # 889

Controversy in diagnosing death has a long history, but the essential difficulties have not changed for hundreds of years. A major source of confusion in understanding death is the mixing of the definition of death-a decision about when life has ended-with criteria and tests used to assess when death has occurred. What is it that shifts human beings from alive to dead-lack of sentience? Lack of personhood? Cessation of all spontaneous biological activity? Departure of the soul? In this video, Dr. James Kirkpatrick revisits the concept of death. He traces the historical difficulties in diagnosing death, reviews the current controversies and criteria-cardiopulmonary versus neurological-for determining death, discusses the legal and ethical issues surrounding organ harvesting, and explores the inherent problems with making the diagnosis of death a matter of personal choice.

Electronic Health Records: Impact on Safety

Program # 888

The electronic health record (EHR) has evolved to a point where widespread utilization is now a possibility. The implications for improving patient safety are significant. In this video discussion, Dr. David Krusch explores several keycapabilities with regard to EHRs including clinical decision support, computerized physician order entry, and follow-up reminders. By providing accessibility and a global view of all matters pertaining to the "whole patient" - electronic health records can lead to reduced medical error, enhanced communications, and potentially improved patient outcomes.

The Role of the Hospitalist in Contemporary Patient Care

Program # 887

Hospital inpatients are sicker today than they were in past decades and treatment regimens are more technologically complex than ever before. These realities, combined with pressures on hospitals to control costs, increase efficiency, improve patient outcomes, and reduce medical errors are changing the nature of inpatient care. One strategy that is increasingly being used to adapt to these changes is the establishment of hospital medicine programs, which feature physicians who are called "hospitalists." In this video Dr. Alpesh Amin reviews the evolution of the field of hospital medicine, provides demographic information on hospitalists, and explores their practice models, education, and training. He also examines the value hospitalists bring to health care, discusses policy recommendations that could further define the value of hospitalists in improving the delivery of healthcare, and concludes with a discussion on integrating hospitalists into the hospital team.

Palliative Care and Hospice

Program # 886

"A medicine that embodies an acceptance of death would represent a great change in the common conception, and might set the stage for viewing the care of dying people not as an afterthought when all else has failed, but as one of the ends of medicine. The goal of a peaceful death should be as much a part of the purpose of medicine, as the promotion of good health." This quote from the medical ethicist, Daniel Callahan, serves as the foundation for this review of contemporary palliative care and hospice issues by Dr. Bruce Ellsweig. In this program, Dr. Ellsweig compares palliative and end-of-life care with the curative model of medicine. Recommendations for identifying patients who may be candidates for palliative care and/or hospice include eligibility criteria for the Medicare Hospice Benefit. A multidisciplinary approach to management with early and sustained communications between the patient, caregivers, family, and friends is critical to optimize end-of-life care and is stressed throughout the program.

2009 Pandemic H1N1 Influenza Preparedness

Program # 885

The Centers for Disease Control and Prevention has predicted that up to 30% of Americans could become infected with the novel H1N1 virus this year and next if a successful vaccine campaign and other mitigation efforts are not implemented quickly enough. Many US hospitals-and especially emergency departments-are already in a state of crisis, facing challenges that cannot be fixed without long-term, fundamental, and systemic changes. But ready or not, a flu pandemic is here, with a second and potentially more severe wave possible this fall and winter. By applying basic preparedness principles, along with some out-of-the-box strategic planning, hospitals can gain a footing against the coming pandemic. In this video, Dr. Stuart Weiss reviews the H1N1 disease characteristics; the current status and potential future threat of the influenza pandemic; employee protection strategies, including administrative, environmental, and engineering controls, and personal protective equipment; vaccine recommendations; and antiviral prophylaxis and therapy.

Gender Differences in Acute Coronary Syndromes Care and Outcomes

Program # 884

Gender plays an important role in a patient's risk of developing disease, as well as in the complications that are most likely to occur. Data also show that gender may affect what treatment options are most appropriate. While men with acute coronary syndromes (ACS) appear to benefit from early treatment using invasive options, women often do not. Current American College of Cardiology/American Heart Association guidelines for unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) recommend a conservative strategy for women with low-risk features. They also stress the use of risk stratification as an integral prerequisite to decision making, not only in the intensive initial assessment of patients but also during continuous clinical assessment. In this video program, Dr. Christopher Cannon addresses the treatment of women with ACS, specifically with regard to early risk stratification and assessment, the role of cardiac biomarkers, and the efficacy and safety of GP IIb/IIIa inhibitor therapy.

Is It Delirium or Dementia? How to Differentiate and Manage the Two Common Age-related Conditions

Program # 883

Two common cognitive disorders that frequently pose a challenge in the acute care setting are delirium and dementia. Distinguishing between these two age-related conditions can often be difficult. Moreover, these disorders often occur together in older hospitalized patients. The inability to diagnose delirium or dementia appropriately can increase morbidity and mortality in this patient population. It is therefore important to understand these conditions in detail, as well as to have a firm grasp on diagnosis, causes, and treatment options. In this video, Dr. Jay Lombard reviews the pathophysiology, etiology, and clinical characteristics of each of these conditions, and provides the latest evidence-based treatment approaches to effectively manage patients presenting with delirium and/or dementia.

Venous Thromboembolism: Prophylaxis in Medical and Surgical Patients

Program # 882

Venous thromboembolism (VTE) is the leading preventable cause of hospital death in the US. Although the risk of VTE is thought to be most commonly associated with surgical patients, 50 to 70 percent of symptomatic thromboembolic events and 70 to 80 percent of fatal pulmonary embolism (PE) occur in nonsurgical patients. In September 2008, the Acting Surgeon General issued a "Call to Action" to reduce the number of VTE cases in the country, urging a coordinated, multifaceted plan and emphasizing the need for evidence-based practices. In addition, Joint Commission/National Quality Forum VTE voluntary consensus standards for 2009 will be available for data collection and reporting for discharges beginning autumn 2009. In this video, Dr. Steven Cohn provides the latest guidelines and study results pertaining to VTE prophylaxis and offers advice for meeting current and forthcoming quality measures.

The Febrile Child

Program # 881

The vaccines for Haemophilus influenza type B and Streptococcal pneumoniae have saved countless lives and prevented many disabilities. But even with the success of these vaccines, and partly because of their success, the diagnosis and management of the febrile child is still a challenge. Healthcare providers need to be aware of how the differences between age groups affect their vulnerability and guide the diagnostic and therapeutic options. Today, while there are fewer cases of pneumonia and meningitis, occult urinary tract infections are on the rise. This is a timely program with practical information on a very serious problem.

Posttraumatic Stress Disorder: Overview and Psychosocial Treatments

Program # 880

Post-traumatic stress disorder, or PTSD, is an anxiety disorder that develops in some individuals after seeing or living through an event that caused or threatened serious harm or death. Symptoms include flashbacks, bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling "on edge," or avoiding thoughts and situations that remind them of the trauma. PTSD affects many civilians as well as veterans and military personnel. Approximately 8 percent of the American population will be affected by PTSD at some point in their lives. In this program, Dr. Freidman provides an overview of the diagnostic criteria for PTSD and explores its epidemiology, risk factors, and neurobiological findings. Evidence-based treatment options are also discussed.

Update on Bioterrorism

Program # 879

According to the experts, a bioterrorism attack is virtually inevitable, possibly in the next five years. In this program, Eric Toner, MD, an emergency medicine expert and a Senior Associate with the Center for Biosecurity, provides insight into the how bioterrorism agents are used and what can be done post-attack. He will examine the relative risks of different agents - anthrax, smallpox, botulism, the hemorrhagic fevers, and others - and discuss a course of therapy for people exposed. Given the growing global threat of terrorism, this timely and authoritative program will enable you to be better prepared to respond in the event of a bioterrorism attack.

Managing Diabetes in the Hospital

Program # 878

Hyperglycemia is an increasingly common and often complex condition to manage in the inpatient setting. Numerous clinical studies have shown a link between uncontrolled diabetes and poor clinical outcomes in a number of inpatient settings. In this program, Thomas Donner, MD, an endocrinologist and the Director of the Joslin Diabetes Center at the University Of Maryland School Of Medicine, provides a detailed look at the challenges of managing glucose levels in hospitalized patients. He describes the rationale for tight glycemic control, provides the how and why to implement intensive insulin therapy, and offers expert guidance on transitioning inpatients back to their homes.

Primary Prevention of Cardiovascular Disease

Program # 877

Clinical risk assessment tools such as the Framingham risk score are used to identify patients at low, intermediate, or high risk of developing cardiovascular disease. New approaches to risk stratification go beyond the standard risk factor assessment (eg, age, sex, blood pressure, smoking, lipids) to include measurement of high-sensitivity C-reactive protein to detect subclinical atherosclerosis, evaluation for metabolic syndrome, and imaging for preclinical vascular disease. Noninvasive detection of atherosclerosis provides a direct and individualized patient-specific approach to assessing the presence of low-, intermediate-, or high-risk subsets. Although atherosclerosis develops over decades, it is typically asymptomatic in many individuals until it is quite advanced. The goal is to identify the at-risk patient and intervene before the patient develops an event. Emerging modalities for detecting preclinical vascular disease, such as computed tomographic evaluation of coronary artery calcium and carotid ultrasonography, help to further define a group of patients who warrant more aggressive intervention with either medication or, potentially, revascularization interventions. Management of global cardiovascular risk requires extensive and comprehensive risk evaluation using traditional and newer assessment tools and aggressive treatment of multiple risk factors.

What Language Are You Speaking?
Improving Communication as a Safety, Quality, and Efficiency Imperative

Program # 876

Communication directly impacts patient care quality and safety. Research has shown that the better the members of the healthcare team communicate, the more effective and safe the patient's care. Notably, breakdown in communication was the leading cause of sentinel events reported to the Joint Commission between 1995 and 2006. As a result, many of the current patient safety solutions proposed by the Joint Commission/Joint Commission International/World Health Organization are based on improving communication. Among the areas targeted for improvement in communication are when interacting with patients, during patient handovers, and prior to surgical procedures (to avoid performance of wrong-procedure or wrong-site surgery). In this program, Prof. Mario Moussa, a healthcare management consultant and leading authority on strategic persuasion, discusses barriers to effective communication in the healthcare setting and explains how to overcome them.

What Language Are You Speaking? Improving Communication as a Safety, Quality, and Efficiency Imperative

Report From the XVII International AIDS Conference in Mexico City - August 3-8, 2008

Program # 875

Approximately 1.2 million people in the United States are living with HIV/AIDS today. Using new technology, the Centers for Disease Control and Prevention estimates the yearly incidence of HIV disease since 1990 to be approximately 56,000 cases per year, representing an almost 40% increase compared with earlier estimates. Advances in HIV/AIDS treatment have substantially reduced AIDS-related morbidity and mortality and extended the lives of many. New treatments, however, are not a cure and do not benefit or reach all people with HIV. The epidemic continues to have a disproportionate impact on certain populations, particularly racial and ethnic minorities. The XVII International AIDS Conference, which was held in Mexico City from August 3-8, 2008, provides a forum in which key scientific and practice-based research, best practice, lessons learned, and gaps in knowledge are addressed. In this video, Drs. Bruce Polsky and Jin S. Suh discuss state-of-the-art data, as presented at the conference, on the epidemiology of HIV, the revised International AIDS Society-USA treatment guidelines, the use of antiretroviral agents in the treatment-naïve and -experienced patients, new antiretroviral agents, and antiretroviral-associated complications.

Antimicrobial Resistance: 12 Simple Steps Toward Prevention

Program # 874

Antimicrobial resistance and the evolution of killer "superbugs" is a major concern in health care today. But physicians and health care workers need not accept this as an inevitable part of our health care landscape. Prevention of antimicrobial resistance is well within the grasp of every health care worker, and effective measures are not necessarily elaborate, expensive, or time consuming. In this video, Dr. Jerome Levine outlines 12 simple steps identified by the Centers for Disease Control that health care workers can personally implement to prevent harmful bacteria from infecting patients.

Diet as a Means to Prevent and Control Elevated Blood Pressure

Program # 873

Dietary modifications and other lifestyle changes are vital in preventing or controlling blood pressure (BP) in people of all ages: in children, to blunt the steep age-related rise in BP; in middle-aged adults, to prevent hypertension; and in older adults, to improve BP control even if on medication. Lifestyle changes also provide substantial but unrecognized opportunites to reduce racial disparities in BP. In this video, Dr. Lawrence Appel, a leading authority on nutrition and health, discusses studies in which sodium restriction and other dietary modifications were shown to reduce BP. He also describes the results of studies demonstrating the effect of sodium restriction in reducing the risk of cardiovascular disease events. In addition, he reviews the merits of DASH and other current diets, and provides specific recommendations regarding the types of dietary changes that patients need to make to prevent hypertension or reduce BP.

Best Practices in Blood Management

Program # 872

Potential adverse effects of blood transfusions range from immunomodulatory reactions to infections with blood-borne pathogens. In addition to these health risks, issues of blood shortages, blood storage, and high costs make alternatives to transfusion even more attractive. In this timely and authoritative video, Dr. Shander explores strategies to markedly reduce the need for transfusion, such as optimizing the perioperative hemoglobin level through the use of pharmacologic agents, preoperative autologous blood donation, acute normovolemic hemodilution, and meticulous hemostasis and operative techniques. In addition, he discusses steps hospital taems can take toward developing cost-effective blood management programs for their own institutions.

Preventing Falls in Older Hospitalized Adults: Six Steps to Lower Liability and Reduce Nonreimbursed Costs

Program # 871

Patient falls continue to remain the largest single category of reported incidents in hospitals, making fall prevention a vital National Patient Safety Goal from The Joint Commission. As many as 10% of older adults fall during an acute care impatient stay. While the acute care environment itself contributes to falls in older persons, manifestations of acute illness, polypharmacy, and medication side effects are also risk factors in the acute care setting. The injuries as a result of falls in older people are a significant source of disability and will no longer be compensated for treating certain preventable conditions acquired during patients stays, including injuries from falls. In this video, Dr. Steve C. Castle outlines the necessary steps and recommendations for improving fall prevention in the acute care setting and for exceeding compliance requirements.

Applying New ACC/AHA Guidelines for STEMI in 2008

Program # 870

When a patient presents to the emergency department with ST-elevation myocardial infarction, or STEMI, the goal is to get the patient into the cath lab within 90 minutes, or if no lab is available, to initiate fibrinolysis within 30 minutes. This goal of rapid reperfusion however, is only achieved in a minority of hospitals. Evidence-based guidelines have been developed by the ACC/AHA to address this time-to-reperfusion challenge and man others related to optimizing treatment for patients with STEMI. In this program, Dr. Pollack uses a case study to illustrate how the new guidelines for STEMI apply to clinical decision-making along the patient care continuum-from initial intake through patient discharge and long-term prevention of secondary events.

Measuring and Improving the Quality and Safety of Medical Care: Beyond Joint Commission

Program # 869

In this timely and informative program, Dr. David Nash tracks the recent transformation of medicine - through the eyes of an outcomes researcher - and speculates on how the future of healthcare will evolve. He presents the cost of healthcare from a purchaser's perspective and describes the market complexities surrounding pay-for-performance plans. Dr. Nash lays out a vision for a healthcare delivery system where self-evaluation and improvement are integrated into every step of patient care.

Improving Acute Pain Management in Children: Essential Tools, Techniques, and Treatments

Program # 868

Acute pain, occurring as a result of injury, illness, and necessary medical procedures, is one of the most frequent adverse stimuli experienced by children. The common "wisdom" that children neither respond to, nor remember, painful experiences to the same degree that adults do is simply untrue. Evidence suggests that physicians, nurses, and parents underestimate the amount of pain experienced by children, and that they overestimate the risks inherent in the drugs used in the treatment of pain. Unrelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity and/or mortality. While the past 25 years has witnessed notable advances in the understanding of pain during development and improvements in the management of acute pain in the pediatric population, this knowledge has not been widely or effectively translated into routine clinical practice. In addition to the numerous myths, insufficient knowledge among caregivers and inadequate application of nowledge contribute to the lack of effective management. The pediatric acute pain experience involves the interaction of physiologic, psychological, behavioral, developmental, and situational factors. Pain is an inherently subjective, multifactorial experience and should be assessed and treated as such. Physicians are responsible for eliminating or assuaging pain and suffering in children when possible. Moreover, The Joint Commission (formerly known as JCAHO) has made pain assessment and management a focal point of its review process. Physicians and other healthcare professionals need current, state-of-the-art education to assist them in developing the skills required to evaluate and manage pain in children. In this video, Dr. Neil Schechter, a pioneer in pediatric pain relief, reviews important considerations in the pain management in children, strategies for assessing pain, specific pain assessment tools, and nonpharmacologic and pharmacologic management options specific to children.

Medical Ethics: Informed Consent to Medical Treatment

Program # 867

Informed consent to medical treatment is a unique process of communication between a physician and a patient. Although the physician assumes the role of educator, decision making is shared, and both physician and patient engage in ascertaining and monitoring each other's goals, expectations, and understanding of treatment. The process does not end when the patient undergoes treatment, but extends throughout the treatment relationship. In this program, Dr. Paul Appelbaum, a leading authority on informed consent, explains the elements of informed consent and information disclosure every physician should know, and presents established models of informed consent that can be readily incorporated into clinical practice.

Domestic Violence: Still A ''New'' Agenda in Healthcare

Program # 866

Domestic violence is a common, often tragic, public health problem in the United States that affects men as well as women, children as well as the elderly. As often the first professionals to encounter victims of domestic violence, physicians have a dual role-an individual as well as a public or advocacy role. Physicians are now expected to inquire routinely about domestic violence, document the findings, validate and support patients, and communicate concerns. Although fear keeps patients affected by domestic violence from leaving abusive relationships and from disclosing the abuse, these patients want to be identified and helped by their healthcare providers. In this video, Dr. Elaine Alpert explains how physicians can quickly and confidentially screen patients for domestic violence, prepare adequate legal documentation, provide appropriate medical and supportive care, and coordinate outside resources, all within the constraints of a busy medical practice

Influenza Update

Program # 865

Seasonal influenza causes substantial morbidity and mortality in the United States. At least 60 million people develop influenza virus infection each year. Of those infected, approximately 36,000 die and 200,000 to 400,000 are hospitalized annually. Although immunization is the most effective method for preventing influenza virus infection and its potentially severe complications, vaccine supplies are often limited and vaccination coverage is suboptimal. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recently released 2007 recommendations for the control and prevention of influenza. In this important and timely video program, Dr. Jerome Levine reviews the updated ACIP recommendations for vaccine selection, dosing and timing, and identification of candidates for immunization. He also discusses the vital infection control practices that should be applied regularly to prevent the transmission of influenza virus infection in the hospital.

Applying the ACC/AHA 2007 Guidelines for UA/NSTEMI in Clinical Practice

Program # 864

The American College of Cardiology and American Heart Association (ACC/AHA) recently released updated guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI). The new guidelines provide physicians with up-to-date, detailed information on initial diagnostic tests and treatment options that can provide the best possible outcomes for patients with these acute coronary syndromes (ACS). The 2007 update also includes a number of important changes regarding long-term management after discharge for ACS to prevent secondary events. Dr. Cannon reviews the new guidelines, highlighting the major changes from the previous 2002 guidelines based on evidence from recent clinical trials, and discusses how the new guidelines can be applied to critical pathways and implementation tools currently used in clinical practice for the acute and long-term management of patients with UA/NSTEMI.

In-Hospital Stroke: An Evidence-Based Approach to Recognition and Management

Program # 863

In-hospital strokes affect an estimated 35,000 to 75,000 people a year, occuring in 7% to 15% of patients already in the hospital for other causes. Strokes that occur in the hospital are often more severe and result in worse outcomes than strokes that occur outside the hospital. Although rapid recognition and assessment of in-hospital stroke are critical to improvedo utcomes, a substantial number of patients experience long delays between symptom recognition and neurologic evaluation. This program highlights the significant morbidity and mortality associated with in-hospital stroke, and details steps for rapid identification, assessment, and treatment, including a review of the new 2007 American Heart Association/American Stroke Association guidelines for the early management of adults with ischemic stroke.

HCV and HIV Coinfection

Program # 862

More than 170 million people worldwide have chronic hepatitis C virus (HCV) infection and approximately 40 million individuals are infected with the human immunodeficiency virus (HIV). Coinfection with HIV and HCV is common and affects 15% to 30% of HIV-infected individuals in the United States. Immunosuppression can increase the risk of progressive liver disease in HIV patients coinfected with HCV. In addition, coinfected patients are 3 times more likely to develop cirrhosis and 4.6 times more likely to die of liver disease than are individuals infected with HIV alone. In this program, Dr. Polsky discusses evidence-based strategies for optimizing the management of patients coinfected with HCV and HIV.

Elder Abuse: Detection, Management, and Prevention

Program # 854

Elder abuse is one of the fastest-growing forms of domestic violence in the United States. Each year, an estimated 1 to 2 million elderly Americans are victims of physical, emotional, financial, or other abuse. Americans over the age of 80 years are 2 to 3 times more likely to suffer abuse than are younger adults; yet most cases of elder abuse go undetected. In this video program, Dr. Barbara Paris, an international expert on elder abuse and a long-time advocate for the rights of elders, explains how to recognize elderly patients who are at risk for or who are victims of mistreatment, and presents steps that can be taken to protect and monitor elderly patients who are victims of abuse or neglect.

Avian Influenza

Program # 853

Global concern about the potential for pandemic avian influenza is rooted in the pathogenicity of avian influenza virus strains in humans and the lack of immunity to these highly mutable viruses in the general population. Avian influenza A (H5N1) re-emerged in 2003 with greater virulence and a wider host range than that seen following its 1997 debut. Although transmission of avian influenza A (H5N1) from animals to humans remains inefficient at this time, mutation or genetic reassortment with human influenza virus strains could trigger an influenza pandemic facilitated by the mobility of modern society and the lack of an effective vaccine. Dr. Alan Sanders provides timely, practical advice on how to improve clinical awareness and implement strategies for diagnosing, treating, and preventing avian influenza.

Medical Ethics and End of Life Decisions

Program # 851

Medical ethics encompasses a broad range of difficult clinical issues and decisions. Some of these issues, such as embryonic research, in vitro fertilization, cloning, and gene mapping, deal with the beginning of life. Others, such as those involving informed consent, organ donation, and human experimentation, can occur at any time during life. End-of-life decisions, including withdrawing and withholding treatment, euthanasia, and advance directives, comprise a significant and especially challenging part of medical ethics. In this program, Dr. William Matory interviews Dr. Edmund Pellegrino, a world-renowned spokesman on ethics and the medical profession. Dr. Pellegrino addresses end-of-life and other difficult decisions faced by physicians and other healthcare professionals in caring for patients, and provides clinically and morally sound advice, based on his belief in the moral nature of medicine and the ethical obligations of physicians.