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Lifestyle Intervention for Veterans With Chronic Diseases
Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the question that most interests you.
0:34 What does it mean for a veteran to undergo a lifestyle intervention?
2:14 What impact does LIVe have on those with other diseases such as hypertension and obesity?
3:25 Can a change in diet and exercise alone eliminate the need for patients to take prescription medications?
In 2010, Peter Kokkinos, PhD, established the Lifestyle Intervention for Veterans (LIVe) Program for diabetic and prediabetic patients at the Washington, DC VAMC. Since then, research has indicated this "hollistic, patient-centered approach," as Dr. Kokkinos describes it, can be expanded to patients with chronic diseases other than diabetes, such as hypertension and obesity.
The LIVe Program aims to transform the individual from a helpless patient to an empowered participant. "We do not just tell the patients what to do," Dr. Kokkinos said. "We ask for their input as to how to make the program work best for them."
Although Dr. Kokkinos couldn't say diet and exercise alone would eliminate the need for patients to take prescription medications, he did discuss the substantial improvements in premature mortality in patients stratified across 4 exercise capacity categories.
Click below to hear the full discussion.
Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the question that most interests you.
0:34 What does it mean for a veteran to undergo a lifestyle intervention?
2:14 What impact does LIVe have on those with other diseases such as hypertension and obesity?
3:25 Can a change in diet and exercise alone eliminate the need for patients to take prescription medications?
In 2010, Peter Kokkinos, PhD, established the Lifestyle Intervention for Veterans (LIVe) Program for diabetic and prediabetic patients at the Washington, DC VAMC. Since then, research has indicated this "hollistic, patient-centered approach," as Dr. Kokkinos describes it, can be expanded to patients with chronic diseases other than diabetes, such as hypertension and obesity.
The LIVe Program aims to transform the individual from a helpless patient to an empowered participant. "We do not just tell the patients what to do," Dr. Kokkinos said. "We ask for their input as to how to make the program work best for them."
Although Dr. Kokkinos couldn't say diet and exercise alone would eliminate the need for patients to take prescription medications, he did discuss the substantial improvements in premature mortality in patients stratified across 4 exercise capacity categories.
Click below to hear the full discussion.
Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the question that most interests you.
0:34 What does it mean for a veteran to undergo a lifestyle intervention?
2:14 What impact does LIVe have on those with other diseases such as hypertension and obesity?
3:25 Can a change in diet and exercise alone eliminate the need for patients to take prescription medications?
In 2010, Peter Kokkinos, PhD, established the Lifestyle Intervention for Veterans (LIVe) Program for diabetic and prediabetic patients at the Washington, DC VAMC. Since then, research has indicated this "hollistic, patient-centered approach," as Dr. Kokkinos describes it, can be expanded to patients with chronic diseases other than diabetes, such as hypertension and obesity.
The LIVe Program aims to transform the individual from a helpless patient to an empowered participant. "We do not just tell the patients what to do," Dr. Kokkinos said. "We ask for their input as to how to make the program work best for them."
Although Dr. Kokkinos couldn't say diet and exercise alone would eliminate the need for patients to take prescription medications, he did discuss the substantial improvements in premature mortality in patients stratified across 4 exercise capacity categories.
Click below to hear the full discussion.
Battling Multidrug Resistant UTIs With Methenamine Hippurate
Recently, Federal Practitioner talked with Rebecca McAllister, MS, FNP-BC, about her role in treating complicated urinary tract infections (UTIs) in elderly patients at the Community Living Center of the Bay Pines VA Healthcare System in Florida. The original July 2014 Case in Point, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” discussed 4 case studies, which suggested the safety and efficacy of treatment with methenamine hippurate.
Federal Practitioner: Much of the focus in your article was on the use of methenamine in Norway and Sweden and a lack thereof in the U.S. How are multidrug resistant UTIs generally treated in the U.S., and how could this be handled differently?
Rebecca McAllister, MS, FNP-BC: Because of the increased rates of bacterial resistance, treating recurrent UTIs prophylactically with low-dose antibiotics is no longer the standard of care. Currently, multidrug resistant UTIs are treated with broad-spectrum antibiotics, that organisms are susceptible to. The promise of methenamine relies on the bacteria not developing resistance to it; in turn, long-term use in patients does not contribute to developing resistance.
FP: Is methenamine hippurate readily available within the VA, and what are the guidelines surrounding its use?
RM: Methenamine is on the VA formulary available in 1-gm doses. Standard guidelines per Micromedex are for prophylaxis of recurrent UTIs, as mentioned in the article, and contraindicates use in patients with impaired renal function, although specific parameters are not identified, because testing was never done with geriatric patients.
FP: Of the 4 patients discussed in the article, 3 were aged > 89 years and the fourth was aged exactly 89 years. Was this a coincidence, or does the success of methenamine in this oldest-old cohort highlight UTI recurrence rate late in life, the failed efficacy of other drugs over time, or both?
RM: The success of methenamine highlights both UTI recurrence rate late in life and the failed efficacy of other drugs over time. The primary patient group in these case studies was composed of homebound veterans.
FP: At the beginning of the discussion portion of your article, following 4 case studies, you mention, “Patients with similar profiles to those discussed in this report were treated with less dramatic results.” How do you, as a family nurse practitioner, consider treatment a success, and how might this differ from expectations set by a medical facility?
RM: As is always the challenge with preventive interventions, it is difficult to measure what does not happen. Successful treatment for recurrent UTIs is lack of recurrence, also asymptomatic colonization vs a symptomatic UTI, which can be measured by a urinalysis is a success. In the oldest of the old, delayed hospitalization for urosepsis, reduced risk of falls, and increased mortality are also successes. Cost savings to the health care system by administering an inexpensive preventive medication vs very expensive IV antibiotic therapy, another success. The observed changes in bacterial resistance in patients treated with methenamine offers great hope in the battle against bacteria.
Ms. McAllister coauthored the July 2014 article, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” with Janice Allwood, MS, ARNP, CUNP.
Ms. McAllister is a Community Living Center family nurse practitioner and Ms. Allwood is an advanced registered nurse practitioner in Urology Surgery, both at the Bay Pines VA Healthcare System in Florida.
Recently, Federal Practitioner talked with Rebecca McAllister, MS, FNP-BC, about her role in treating complicated urinary tract infections (UTIs) in elderly patients at the Community Living Center of the Bay Pines VA Healthcare System in Florida. The original July 2014 Case in Point, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” discussed 4 case studies, which suggested the safety and efficacy of treatment with methenamine hippurate.
Federal Practitioner: Much of the focus in your article was on the use of methenamine in Norway and Sweden and a lack thereof in the U.S. How are multidrug resistant UTIs generally treated in the U.S., and how could this be handled differently?
Rebecca McAllister, MS, FNP-BC: Because of the increased rates of bacterial resistance, treating recurrent UTIs prophylactically with low-dose antibiotics is no longer the standard of care. Currently, multidrug resistant UTIs are treated with broad-spectrum antibiotics, that organisms are susceptible to. The promise of methenamine relies on the bacteria not developing resistance to it; in turn, long-term use in patients does not contribute to developing resistance.
FP: Is methenamine hippurate readily available within the VA, and what are the guidelines surrounding its use?
RM: Methenamine is on the VA formulary available in 1-gm doses. Standard guidelines per Micromedex are for prophylaxis of recurrent UTIs, as mentioned in the article, and contraindicates use in patients with impaired renal function, although specific parameters are not identified, because testing was never done with geriatric patients.
FP: Of the 4 patients discussed in the article, 3 were aged > 89 years and the fourth was aged exactly 89 years. Was this a coincidence, or does the success of methenamine in this oldest-old cohort highlight UTI recurrence rate late in life, the failed efficacy of other drugs over time, or both?
RM: The success of methenamine highlights both UTI recurrence rate late in life and the failed efficacy of other drugs over time. The primary patient group in these case studies was composed of homebound veterans.
FP: At the beginning of the discussion portion of your article, following 4 case studies, you mention, “Patients with similar profiles to those discussed in this report were treated with less dramatic results.” How do you, as a family nurse practitioner, consider treatment a success, and how might this differ from expectations set by a medical facility?
RM: As is always the challenge with preventive interventions, it is difficult to measure what does not happen. Successful treatment for recurrent UTIs is lack of recurrence, also asymptomatic colonization vs a symptomatic UTI, which can be measured by a urinalysis is a success. In the oldest of the old, delayed hospitalization for urosepsis, reduced risk of falls, and increased mortality are also successes. Cost savings to the health care system by administering an inexpensive preventive medication vs very expensive IV antibiotic therapy, another success. The observed changes in bacterial resistance in patients treated with methenamine offers great hope in the battle against bacteria.
Ms. McAllister coauthored the July 2014 article, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” with Janice Allwood, MS, ARNP, CUNP.
Ms. McAllister is a Community Living Center family nurse practitioner and Ms. Allwood is an advanced registered nurse practitioner in Urology Surgery, both at the Bay Pines VA Healthcare System in Florida.
Recently, Federal Practitioner talked with Rebecca McAllister, MS, FNP-BC, about her role in treating complicated urinary tract infections (UTIs) in elderly patients at the Community Living Center of the Bay Pines VA Healthcare System in Florida. The original July 2014 Case in Point, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” discussed 4 case studies, which suggested the safety and efficacy of treatment with methenamine hippurate.
Federal Practitioner: Much of the focus in your article was on the use of methenamine in Norway and Sweden and a lack thereof in the U.S. How are multidrug resistant UTIs generally treated in the U.S., and how could this be handled differently?
Rebecca McAllister, MS, FNP-BC: Because of the increased rates of bacterial resistance, treating recurrent UTIs prophylactically with low-dose antibiotics is no longer the standard of care. Currently, multidrug resistant UTIs are treated with broad-spectrum antibiotics, that organisms are susceptible to. The promise of methenamine relies on the bacteria not developing resistance to it; in turn, long-term use in patients does not contribute to developing resistance.
FP: Is methenamine hippurate readily available within the VA, and what are the guidelines surrounding its use?
RM: Methenamine is on the VA formulary available in 1-gm doses. Standard guidelines per Micromedex are for prophylaxis of recurrent UTIs, as mentioned in the article, and contraindicates use in patients with impaired renal function, although specific parameters are not identified, because testing was never done with geriatric patients.
FP: Of the 4 patients discussed in the article, 3 were aged > 89 years and the fourth was aged exactly 89 years. Was this a coincidence, or does the success of methenamine in this oldest-old cohort highlight UTI recurrence rate late in life, the failed efficacy of other drugs over time, or both?
RM: The success of methenamine highlights both UTI recurrence rate late in life and the failed efficacy of other drugs over time. The primary patient group in these case studies was composed of homebound veterans.
FP: At the beginning of the discussion portion of your article, following 4 case studies, you mention, “Patients with similar profiles to those discussed in this report were treated with less dramatic results.” How do you, as a family nurse practitioner, consider treatment a success, and how might this differ from expectations set by a medical facility?
RM: As is always the challenge with preventive interventions, it is difficult to measure what does not happen. Successful treatment for recurrent UTIs is lack of recurrence, also asymptomatic colonization vs a symptomatic UTI, which can be measured by a urinalysis is a success. In the oldest of the old, delayed hospitalization for urosepsis, reduced risk of falls, and increased mortality are also successes. Cost savings to the health care system by administering an inexpensive preventive medication vs very expensive IV antibiotic therapy, another success. The observed changes in bacterial resistance in patients treated with methenamine offers great hope in the battle against bacteria.
Ms. McAllister coauthored the July 2014 article, “Recurrent Multidrug Resistant Urinary Tract Infections in Geriatric Patients,” with Janice Allwood, MS, ARNP, CUNP.
Ms. McAllister is a Community Living Center family nurse practitioner and Ms. Allwood is an advanced registered nurse practitioner in Urology Surgery, both at the Bay Pines VA Healthcare System in Florida.
Dr. Geppert on the Legal and Clinical Implications of Medical Marijuana
Recently, Federal Practitioner talked with Cynthia M.A. Geppert, MD, MA, MPH, MSBE, about ethics issues facing the Veterans Health Administration (VHA), including federal guidance on treating patients who disclose their use of marijuana and the rapidly changing environment of pain management and resulting substance use disorders. To find out more about these discrepancies and dilemmas facing the VHA, read the March 2014 cover story, Legal and Clinical Evolution of Veterans Health Administration Policy on Medical Marijuana.
Dr. Geppert is a professor of psychiatry and the director of ethics education at the University of New Mexico School of Medicine and chief of consultation psychiatry and ethics at the New Mexico Veterans Administration Health Care System, all in Albuquerque, New Mexico.
Recently, Federal Practitioner talked with Cynthia M.A. Geppert, MD, MA, MPH, MSBE, about ethics issues facing the Veterans Health Administration (VHA), including federal guidance on treating patients who disclose their use of marijuana and the rapidly changing environment of pain management and resulting substance use disorders. To find out more about these discrepancies and dilemmas facing the VHA, read the March 2014 cover story, Legal and Clinical Evolution of Veterans Health Administration Policy on Medical Marijuana.
Dr. Geppert is a professor of psychiatry and the director of ethics education at the University of New Mexico School of Medicine and chief of consultation psychiatry and ethics at the New Mexico Veterans Administration Health Care System, all in Albuquerque, New Mexico.
Recently, Federal Practitioner talked with Cynthia M.A. Geppert, MD, MA, MPH, MSBE, about ethics issues facing the Veterans Health Administration (VHA), including federal guidance on treating patients who disclose their use of marijuana and the rapidly changing environment of pain management and resulting substance use disorders. To find out more about these discrepancies and dilemmas facing the VHA, read the March 2014 cover story, Legal and Clinical Evolution of Veterans Health Administration Policy on Medical Marijuana.
Dr. Geppert is a professor of psychiatry and the director of ethics education at the University of New Mexico School of Medicine and chief of consultation psychiatry and ethics at the New Mexico Veterans Administration Health Care System, all in Albuquerque, New Mexico.
