Day 1 :
Richmond University USA
Dr. Bloomfield attended medical school in Australia and cardiology training at the Hallstrom Institute of Cardiology in Sydney, the Heart Hospital in London, and Vanderbilt University in Nashville, Tennessee.
He was appointed Emeritus Professor of Medicine, New York Medical College. He directed the Department of Medicine, Richmond University Medical Center, Staten Island from 1995 – 2002 and presently directs The Department of Clinical Research at the same institution.
He has published over 100 scientific articles
Introduction. In office practice, particularly in winter months, removing layers of leg clothing, such as pantyhose, stockings and high boots in order to attach the ankle electrodes for EKGs, is time consuming, annoying, often embarrassing and occasionally exhausting for sick, elderly patients. Originally EKGs were recorded with the hands and feet immersed in saline-filled buckets which acted as electrodes, establishing these sites for modern electrode placement. This study was undertaken to determine whether abdominal and ankle electrode sites produced equally diagnostic EKGs.
Method. 108 office patients with a large variety of medical conditions had paired EKGs recorded firstly with standard ankle electrodes and then with electrodes placed on both sides of the lower abdomen. The pairs were statistically compared. 39 of these patients also had EKGs compared with standard ankle electrodes recorded in inspiration and expiration.
Results. The only difference between the ankle and abdominal EKGs was seen in the frontal plane axis. While this was significant, it was very small and did not alter the cardio logical interpretation in any way. The change was less than seen in the frontal plain between inspiratory expiratory EKGs, which occurs with standard electrocardiography and for which no adjustment in interpretation is ever made. There was no change in conduction time or rhythm. The lead placement also more closely fulfills Einthoven’s criteria.
Conclusion. In busy office practice, accurate diagnostic EKGs can be recorded using easily-accessible abdominal-sited electrodes, obviating the need to record from the ankles. This saves office time and patient effort, producing a more comfortable patient /doctor encounter.
California North state University USA
ISHWARLAL JIALAL graduated with the equivalent of an MD, PhD (MB.CH.B, MD) from the University of Natal Medical School, Natal, South Africa, and thereafter undertook fellowships at the Joslin Diabetes Center, Harvard Medical School, and in the Division of Endocrinology, Metabolism and Nutrition at the University of Washington in Seattle. He then joined the faculty of the University of Texas Southwestern Medical Center at Dallas in 1988 as Assistant Professor and became Professor of Internal Medicine and Pathology with tenure in 1997. He was Director of the Division of Clinical Biochemistry and Human Metabolism and was the first hold of the C. Vincent Prothro Chair in Human Nutrition Research. He then joined UC Davis Medical Center as the first holder of Robert E. Stowell Endowed Chair in Experimental Pathology, Director of the Laboratory for Atherosclerosis and Metabolic Research. On his retirement in 2016 he was Distinguished Professor of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, at the University of California, Davis, Medical Center and Staff Endocrinologist at the VA Medical Center, Sacramento.He is presently Professor of Physiology, Metabolism and Pathology at California Northstate university, College of Medicine and Staff Endocrinologist at the VA Medical Center, Mather, CA
Atherosclerotic Cardiovascular disease (ASCVD) is the leading cause of mortality in patients with diabetes. Whilst there are many potential mechanisms including dyslipidemia, hypertension, inflammation and increased oxidative stress, low density lipoprotein- cholesterol(LDL-cholesterol) ranked as the strongest predictor for future Cardiovascular events (CVE).
Furthermore numerous trials with statin drugs including HPS-(simvastatin) and CARDS, TNT , PROVE-IT(atorvastatin)have shown a reduction in CV events including ischemic stroke . A meta-analysis of 14 randomized trials showed that statin therapy in diabetics resulted in a 13 % reduction in vascular mortality. Numerous guidelines have been issued with respect to statin therapy. The most recent recommendation of the ADA (2016) is high intensity statin (> 50 % reduction in LDL-C ) for diabetics between ages 40-75 years with ASCVD or ASCVD risk factors(LDL-C>100mg/dl, hypertension, smoking, obesity ,albuminuria FH of premature ASCVD). In this age range if there is no ASCVD or risk factors moderate intensity statin is recommended(30-50% reduction in LDL-C). In patients > 75 years with ASCVD the only difference is moderate intensity/high intensity statin with ASCVD risk factors. Finally in patients <40 years with no risk factors statin therapy is not recommended whilst moderate/high intensity statin is recommended for patients with ASCVD risk factors and high intensity statin for patients with ASCVD. The ESC/EASD guidelines recommend targets ie LDL-C < 70mg/dl for diabetics with ASCVD or ASCVD risk factors ( or > 50 % reduction in LDL-C). In the remaining diabetics they recommend a LDL-C goal < 100mg/dl . Neither make a strong recommendation for combination therapy with fibrates and discourage combination with niacin .
In conclusion , statin therapy is the cornerstone in our strategy to lower LDL-C to targets or by percentage to reduce ASCVD mortality .
Heinrich-Heine University, Germany
Time : 11:00
Inka Nisinbaum has completed her Diploma in Psychology at the age of 28 years from Heinrich-Heine University in Düsseldorf/Germany. She holds a mag.rer.nat. from the University of Vienna/Austria, and a MS from the University of Austin/Texas/USA. She is a published author, public speaker, cystic fibrosis patient, double lungs and liver transplant recipient since 2002, and the only woman worldwide who gave birth to a child after receiving a double lungs and liver transplant.
The doctor-patient relationship has transitioned throughout the ages. Was the doctor-patient relationship paternalistic and vertical prior to the last two decades, the doctor ordered and the patient obeyed silently, has it changed over the last 20 years into a more patient-centered and horizontal approach where “the physician tries to enter the patient's world, to see the illness through the patient's eyes”.
The evidence, which documents a wide range of strategic benefits of a patient-centered approach, is numerous, but number one reason cited by physicians for not implementing it into their work is the lack of communication skills and know how. Doctors aren’t trained in entering the patient's world, and to see the illness through the patient's eyes. On the contrary, many patients irrespective of their Health Literary skills, feel unable to access, understand and utilize health information.
The benefits of a horizontal approach remain. Improved quality of health, improved compliancy, improved active management of diseases by patient, and reduce of costs.
If patients are to be actively encouraged and engaged in understanding, achieving and maintaining good health, physicians must be trained in communication skills to ensure that health information is clear and easy to access for patients.
Questions that will be addressed: How can we utilize effective interpersonal communication? How to identify stress key words? Three approaches of tone; aggressive, nonassertive and assertive. How to implement the three basic models proposed by Szasz and Hollender (1956) into the doctor-patient relationship to find the right communication model for different situations.
University of Miyazaki, Miyazaki, Japan
Keynote: The translational research of adrenomedullin: Adrenomedullin as a Potential Therapeutic Agent for Ulcerative Colitis
Time : 2:30
Dr. Kazuo Kitamura graduated from Miyazaki Medical College with M.D. in 1980 and received his Ph.D. in biochemistry from Miyazaki Medical College in 1984. He worked as a post doctorate at the University of Texas Southwestern Medical Center from 1985 until 1988. From 1988 to 1995, he was Assistant Professor of Miyazaki Medical College, which is where he discovered adrenomedullin in human pheochromocytoma tissue. Since 2006, he has been a professor in the Department of Internal Medicine in the University of Miyazaki. His areas of research interest are translational reserches in cardiovascular disorders as well as inflammatory bowel diseases.
Adrenomedullin (AM) is a potent vasodilatory peptide ubiquitously produced in organs throughout the human body. AM shows multi-functional properties including diuresis, angiogenesis, inhibition of aldosterone secretion and anti-inflammatory activity. AM production and secretion can be induced by pro-inflammatory cytokines such as tumor necrosis factor-a and interleukin-1 and by lipopolysaccharide. Conversely, AM causes the downregulation of inflammatory cytokines in cultured cells. Furthermore, AM downregulates inflammatory processes in a variety of different colitis models, including acetic acid-induced colitis and dextran sulfate sodium induced colitis. AM works by exerting anti-inflammatory and antibacterial effects and by stimulating mucosal regeneration and supporting maintenance of the colonic epithelial barrier.
We assessed the safety and preliminary efficacy of exogenous AM administered to patients with refractory ulcerative colitis in an open-labeled exploratory trial. AM (1.5 pmol/kg/min) was administered intravenously for 8 hours daily for 12-14 days. Disease activity index (DAI) score and endoscopic findings were evaluated before and after administration of AM. We enrolled seven patients with active ulcerative colitis, refractory to usual combination medical therapy. In all patients, DAI score after AM therapy was improved compared with that at baseline. The average DAI score of all patients improved from 9.3±1.5 points at baseline to 4.7±2.2 points at 2 weeks, and to 1.2±1.1 points at 12 weeks. Endoscopic findings also showed remarkable amelioration with mucosal healing and scarring. During infusion of AM, hemodynamics kept almost stable, and no adverse effect has shown clinically.
In conclusion, AM is a promising agent for patients with refractory ulcerative colitis.
Organization – Bobby Whisnand Fitness
Time : 11:30
Bobby Whisnand rewrites the book on wellness by delivering an eye-opening keynote presentation on the state of wellness in the United States. Bobby turns heads as he clearly shows the medical industry, health associations, companies, and individuals what’s missing in their ways of wellness. With topics like “Mobility Is The Real Gold”, “Eating Is A Business Decision”, “Wait Management”, and “Living Your Life In Dog Years”, Bobby opens the eyes and hearts of his audience by showing his turn key solutions for a much healthier and accountable exercise industry, a clearer path to a nation of healthier eating, and a more practical and effective way to manage stress in both the workplace and home. Bobby helps his audiences see wellness in an entirely new light, and paves the way to a much healthier and longer living nation.
- Cooper Clinic Certified Personal Trainer
- ISSA Certified Personal Trainer
- ISSA Certified Elite Trainer
- ISSA Certified Specialist in Exercise Therapy
- ISSA Certified Specialist in Sports Nutrition
- Two years of Physical Therapy Internship
- Doctor and Surgeon Endorsed
- Three years as a Behavioral Therapist
- Fitness Expert for the Dallas Division of the American Heart Association
- Community Team Committee Chair, American Heart Association
- 26 years in fitness
- Corporate Wellness Program Design
- Keynote Speaker - Over 500 presentations on heart health, exercise, stress management, nutrition, corporate wellness, and motivation. He has spoken on behalf of the Dallas American Heart Association at over 60 events.
Built In America; Making Wellness Fit For Life
- Internal Medicine and Hospital Medicine
Indiana University Health Medical Center, Indianapolis,USA
Neetu Mahendraker is currently a lead hospitalist at Indiana University Medical Center and is currently involved in several quality trials at the hospital. She completed M.B.B.S from Gandhi Medical College, Hyderabad, India in 2002. She finished her residency in Internal Medicine from University Of Illinois at Urbana Champaign, Illinois in 2009. She has been working as a hospitalist at Indiana University Medical Center since 2009. She has presented several posters at local chapters, national conferences and is actively involved in publishing.
Hospitalists frequently provide pain management for medical patients, post trauma and post-surgical patients. It is well recognized that there is lack of knowledge in standardizing opioid administration in the inpatient setting.
Opioid tolerance leveling (OTL) is a novel strategy where patients are leveled based on their daily morphine equivalent dosage (MED) intake prior to hospitalization. This is the first pilot known to the best of our knowledge addressing standardization of opioid usage in non-surgical patients
Patients on chronic daily opioids were leveled on admission from naïve to tolerant based on their daily MED intake over 45 days prior to hospitalization. OTL 1 patients had intermittent MED intake, OTL 2 patients had 15-90 mg daily MED intake and OTL 3 patients had greater than 90 mg of daily MED intake. The patients were placed under a respective order set based on the OTL category. Each pre-populated order set had increasing dosages and frequency of intravenous and oral opioid choices calculated to be safely administered to that category of patients. Retrospective data analysis was completed on 48 patients.
Safety of the OTL order set was demonstrated by the lack of naloxone administration in the sample. This pilot showed higher incidence of opioid tolerance as hypothesized in all OTL3 patients but also strikingly in OTL2 patients with psychiatric issues supporting early addiction consultation in these patients. By incorporating this standardized novel order set into their clinical practice hospitalists can now use opioids safely and effectively to manage pain in the hospitalized non-surgical patients.