176 Caregiving demands of partners of HF patients related to medical treatment and lifestyle changes

Pouchitis is the most common complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Up to 81% of IPAA patients experience pouchitis, with 40% of patients presenting within the first year of surgery. Common risk factors include genetic mutations, extensive colitis, rheumatologic disorders, and primary sclerosing cholangitis. Currently, there are no medications with approved indications for pouchitis. As such, the conventional treatment of pouchitis is entirely off-label. This paper is intended to be a practical and up-to-date review of available therapies used for the management of pouchitis. The mainstay of treatment for acute pouchitis remains antibiotics, but newer therapeutics have also shown promise in the treatment of chronic pouchitis. Common lifestyle considerations that may play a role in pouchitis are also reviewed. Plain language summary Medical treatment of pouchitis: a guide for the clinician The ileal pouch-anal anastomosis (“pouch”) is the most common way patients who require surgery to remove their colon are able to avoid a permanent ileostomy (“ostomy”). This pouch, created from the small intestines, serves as a reservoir to hold stool. The most common complication after pouch surgery is pouchitis. Pouchitis symptoms include more frequent bowel movements, urgency to defecate, blood in the stool, incontinence, and abdominal pain. This paper is intended to be a practical review of available therapies including medications and lifestyle changes that can be considered for the management of acute pouchitis, chronic pouchitis, and cuffitis.

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The Role of Cardiac Rehabilitation in Achieving Optimal Treatment

European Cardiology Review ◽

10.15420/ecr.2011.7.1.62 ◽

2011 ◽

Vol 7 (1) ◽

pp. 62

Author(s):

Miguel Mendes ◽

Keyword(s):

Secondary Prevention ◽

Cardiac Rehabilitation ◽

Medical Treatment ◽

Lifestyle Changes ◽

Coronary Syndrome ◽

Secondary Prevention Programme ◽

Lifestyle Measures ◽

The Cost

The clinical practice of European cardiologists is directed by the European Society of Cardiology’s guidelines for several clinical entities, in which ‘optimal medical treatment’ (a specific drug regime and lifestyle measures) for each syndrome is defined. The described pharmacotherapy is composed of several drugs, since the clinical research behind the recommendations is conducted using an ‘on top of’ strategy. For example, an asymptomatic patient after an acute coronary syndrome with normal ventricular function and without residual ischaemia has an indication to take at least four types of tablets per day, which is difficult to understand and to follow long term. The cost of the drugs is sometimes beyond the patient’s means, which also contributes to lower compliance. A clinician’s practice is usually very busy, which means it is almost impossible to perform patient education and promote adherence to drug therapy and lifestyle changes. Cardiac rehabilitation, as proved by the Global Secondary Prevention Strategies to Limit Event Recurrence after Myocardial Infarction (GOSPEL) study, may be considered the best available secondary prevention programme, as it educates patients and promotes adherence to the optimal medical treatment to a greater degree than usual care.

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Secondary Prevention of Ischemic Stroke

10.1093/med/9780197512166.003.0051 ◽

2021 ◽

pp. 417-421

Author(s):

Lindsy N. Williams

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Secondary Prevention ◽

Medical Treatment ◽

Lifestyle Changes ◽

Diagnostic Evaluation ◽

Antithrombotic Medication ◽

Pharmacologic Agents ◽

Selection Of

After an ischemic stroke is diagnosed, a diagnostic evaluation ensues to determine the mechanism of the stroke and contributing risk factors. The appropriate antithrombotic is selected in accordance with the mechanism of the stroke, and the contributing risk factors are treated with pharmacologic agents and lifestyle changes. This chapter discusses the selection of antithrombotic medication, medical treatment, and lifestyle changes for contributing risk factors.

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Abstract WMP47: Poor Risk Factor Control and Lower Levels of Physical Activity Predict Incident Major Cardiovascular Events in Patients With Symptomatic Vertebrobasilar Disease: A Post-Hoc Analysis of the SAMMPRIS Trial

Stroke ◽

10.1161/str.51.suppl_1.wmp47 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Leah Croll ◽

Andrew Chang ◽

Erica Scher ◽

Koto Ishida ◽

Jose Torres ◽

...

Keyword(s):

Physical Activity ◽

Risk Factor ◽

Medical Treatment ◽

Cardiovascular Events ◽

Primary Outcome ◽

Recurrent Stroke ◽

Lifestyle Changes ◽

Major Cardiovascular Events ◽

Basilar Arteries

Background: Symptomatic vertebrobasilar (VB) atherosclerotic disease is associated with a high risk of recurrent stroke despite optimal medical therapy. Objective: In this study, we aim to examine the prognosis and associations between risk factors and recurrent major cardiovascular events (MACE) in patients with symptomatic VB stenosis randomized in the medical arm of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study. Methods: Data from subjects in the medical arm of the SAMMPRIS trial with an infarct in the territory of vertebral or basilar arteries (n= 73) were analyzed. The primary outcome was MACE: defined as stroke, myocardial infarction, or other cardiovascular death during follow up. Mean risk factor values were compared between subjects who met the primary outcome at 2 years versus those who did not, using T-tests and χ2 tests. Results: Among 73 patients with VB stenosis randomized to medical treatment, 18 patients (24.6%) had recurrent MACE over a mean follow up of 2.8 years. This was significantly less than the rate of MACE in those with VB enrolled in the WASID trial (9.7 per 100-patient years vs. 20.9 per 100-patient years, p<0.01). Predictors of MACE at 2 years were increased triglyceride level (adjusted OR per 50 units increase in triglyceride 1.94, 95% CI 1.15-3.28) and increased HbA1c level (adjusted OR per 1 unit increase in HbA1c 2.07, 95% CI 0.97-4.45), and lower physical activity status measured by PACE (out of target defined by PACE ≤ 4: moderate activity < 5 days per week or intense activity < 3 days per week) (2.5 ± 1.0 vs. 3.3 ± 1.8, p = 0.028) (Table). Conclusions: In patients with symptomatic VB disease, improvement of medical treatment over time led to a reduction in cardiovascular event rates but this risk remains elevated as nearly 1 in 5 patients had MACE within 2 years. Further risk factor optimization and lifestyle changes are needed to reduce the rates of MACE in this patient population.

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Parents' Perception of Diagnostic Reports and Conferences

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1402.114 ◽

1983 ◽

Vol 14 (2) ◽

pp. 114-120 ◽

Cited By ~ 2

Author(s):

Betty U. Watson ◽

Ronald W. Thompson

Keyword(s):

Medical Treatment ◽

Diagnostic Information ◽

Learning Language ◽

Speech Learning ◽

Hearing Problems

The purpose of this study was to evaluate parents' reactions and understanding of diagnostic information from written reports and conferences in a clinic which provides multidisciplinary evaluations for children with speech, learning, language, and hearing problems. Previous studies and anecdotal reports suggested that many parents do not receive appropriate diagnostic information about their children. In the present study questionnaires were mailed to parents who had received reports of evaluations and most of whom had attended hour-long conferences covering the findings. Questionnaires were also sent to professionals who had received reports. Fifty-seven percent of the parents, and 63% of the professionals returned the questionnaires. Ninety percent of the parents indicated that they had understood the results as they were presented in the conference. Ninety-three percent of the professionals and 89% of the parents stated they understood the conclusions of the written reports .Further, 83% of the parents and 80% of the professionals reported that the findings had made a change in the child's educational or medical treatment. The percentage of parents who reported understanding the findings was greater than expected. The specific informing techniques used in this study are discussed.

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