Welcome to the Delta Care Rx Blog

The contents of this blog contain topics relevant to end of life care written by our own hospice clinical pharmacists. Continue to check this site regularly for the newest post or subscribe to the RSS feed below.

Dr. Holly Lassila has been a hospice clinical pharmacist for the past 9 years. She is an Associate Professor of Clinical, Social and Administrative Sciences at the Mylan School of Pharmacy at Duquesne University in Pittsburgh, PA and received her Pharmacy and Doctor of Public Health degrees from the University of Pittsburgh in Pittsburgh, PA. In addition to her hospice work, Dr. Lassila works as a clinical pharmacist with the underserved population in Pittsburgh, PA. She received her MSEd in Community Mental Health Counseling from Duquesne University in 2013 and specializes in trauma recovery. She joined Delta Care RX in 2013.

Holly Lassila, DrPH, MSEd, MPH, RPh

Acute Myocardial Infarction in Women

2016 12 28 10 12 46The American Heart Association recently released a scientific statement concerning Acute Myocardial Infarction in Women.1 Cardiovascular disease is still the leading cause of death in women in the United States and globally and of the 2.7 million women with a history of an (myocardial infarction) MI, more than 53,000 have died of an MI, and an estimated 262,000 were hospitalized for AMI and unstable angina. The differences in the clinical presentation between men and women have consequences for timely identification of symptoms, appropriate triage, diagnostic testing and treatment. Compared with men women are more likely to have pain in the upper back, arm, neck, and jaw as well as unusual fatigue, flu-like symptoms, dyspnea, indigestion, nausea/vomiting, palpitations, weakness, and a sense of dread and anxiety feeling.

Mehta LS, et al reported the top ten things to know about acute myocardial infarction in women:

1. Although there has been a reduction in cardiovascular mortality death in women in the US, there has not been a substantial decline in acute MI event rates or MI deaths in young women. 

2. Compared with older women, younger women are trending with worse risk factor profiles and higher mortality.

3. Plaque characteristics differ for women, and recent data have suggested a greater role of microvascular disease in the pathophysiology of coronary events among women even though epicardial coronary artery atherosclerotic disease remains the basic cause of acute MI in both men and women.

4. Date from autopsy studies have shown that women have an increased prevalence of plaque erosion compared to men, and that MI without obstruction coronary artery disease (CAD) is more common at younger ages and among women.

5. Any young woman who presents with an acute coronary syndrome without typical atherosclerotic risk factors should be suspected of having spontaneous coronary artery dissection (SCAD). This is a very rare condition and occurs more frequently in women. The clinical presentation of SCAD can be unstable angina, MI, ventricular arrhythmias, and sudden cardiac death.

6. Recent evidence suggests that depression in women is a powerful predictor of early-onset MI, showing a strong association with MI and cardiac death in young and middle-aged women than in men of similar ages. In the general population, depression is 2 times more prevalent in women than in men.

7. Women with risk factors such as high blood pressure and diabetes have an increased risk of heart attack compared to men.

8. As mentioned above, women are more likely to present with pain in the upper back, arm, neck, and jaw, as well as unusual fatigue, dyspnea, indigestion, nausea/ vomiting, palpitations, weakness, and a sense of dread, compared with men who present with central chest pain.

9. Research suggests that women are delayed in seeking treatment for acute MI compared to men. Reasons for the delay include living alone, interpreting symptoms as non urgent and temporary, consulting with a physician or family member and fear and embarrassment.

10. Women, compared to men, tend to be undertreated and are less likely to participate in cardiac rehabilitation after a heart attack.


 Submitted by: Holly Lassila, DrPH, MSEd, MPH, RPh; Hospice Clinical Pharmacist at Delta Care Rx


 References:
1. Mehta LS, et al; on behalf of the American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. Acute myocardial infarction in women: a scientific statement from the American Heart Association [published online ahead of print January 25, 2016]. Circulation. doi: 10.1161/CIR.0000000000000351.

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Holly Lassila, DrPH, MSEd, MPH, RPh

Domains of Wellness

What is Wellness? Merriam Webster defines wellness as “the quality or state of being healthy”. The definition of “wellness” in Mosby’s Medical Dictionary is “the dynamic state of health in which an individual progresses towards a higher level of functioning, achieving an optimum balance between internal and external environments”. In general, wellness means overall well-being and from a holistic perspective, wellness incorporates the dimensions of mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person’s life. Each of these dimensions acts and interacts in ways that contribute to our quality of life.

Physical Wellness: A healthy body maintained by good nutrition, regular exercise and avoiding harmful habits.

Intellectual Wellness: A state in which our mind is open to new ideas and experiences and is engaged in the interaction with the world around us. This dimension includes the desire to learn new concepts, improve skills and seek challenges in pursuit of lifelong learning.

Emotional Wellness: The ability to understand our own feelings and cope with the challenges which life brings. Emotional wellness implies the ability to express emotions appropriately, adjust to change and cope with stress in a healthy way.

Social Wellness: The ability to relate and connect with others. Social wellness is our ability to establish and maintain positive relationships with family, friends and co-workers. Spiritual Wellness: This dimension is the ability to establish peace and harmony in our lives. It implies that life is meaningful and has a purpose and the ethics, values and morals that guide us given meaning and direction to life.

Occupational Wellness: The ability to get personal fulfillment from our professions or chosen career fields while maintaining balance in our lives. Occupational wellness means having commitment to our occupations that is satisfying and rewarding.

Environmental Wellness: The ability to recognize our own responsibility for the quality of the air, the water and the land that surrounds us.

In our own self-assessment and self-evaluation of the above dimensions we often discover certain dimensions that are balanced and others that we can improve on. Wellness is an active, lifelong process of becoming aware of choices and making decisions towards a more balanced and fulfilling life.

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Holly Lassila, DrPH, MSEd, MPH, RPh

Health Literacy: Do Patients Really Understand What We Are Communicating?

The definitions of literacy range from the Merriam Webster definition of the “ability to read and write” to the National Literacy Act of 1991 definition of “an individual’s ability to read, write and speak English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.” Functional health literacy can be distinguished from literacy as the “ability to read and comprehend prescription bottles, appointment slips, and the other essential health-related materials required to successfully function as a patient.”3

Poor health literacy affects people of all ages, races, incomes and education levels and affects 36% of U.S. adults.4 According to Doak et al, the average American reads at an 8th or 9th grade level; however, most health care materials are written on a 10th grade level.5 Poor health literacy is of great concern within a public health context as demonstrated by the inclusion of “increasing health literacy skills” as one of the objectives in the Healthy People 2020 goals.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients. Low health literacy may result in poor self-care management, increased disability and morbidity, and adverse health outcomes such as ED visits and hospitalizations.4

Health care professionals working in hospice are often educating not only the patient but the caregivers and other support systems for the patient. Being aware of available tools can aid in supporting patients and families. Health communication materials which may be helpful include:

1. SIMPLY PUT: A guide for creating easy-to-understand materials. This is a publication developed by the Centers for Disease Control and Prevention which highlights many best practices regarding assessing and creating written information for the public on almost any scientific subject. [http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf]

2. ASK ME 3: This is an educational program designed by the National Patient Safety Foundation to improve communication between patients and health care providers and encourage patients and caregivers to become active members of their health care team. [https://npsf.siteym.com/?page=askme3]

3. SCRIPT YOUR FUTURE: This is a campaign designed to help patients become adherent with taking their prescribed medication regimens. Some of the tools included allow the health care provider and patient to personalize health literacy interventions regarding medication adherence and education. [http://www.scriptyourfuture.org/]

Communicating with patients is a large component of clinical practice. Being well versed in cultural competence, understanding socioeconomic factors, a patients/caregivers education level, and patient’s priorities or motivations can be powerful tools in the promotion of health literacy and clear communication.


REFERENCES:

1. Merriam Webster: An Encyclopedia Britannica Company. Available at: http://www.merriam-webster.com/dictionary/literate. Accessed December 15, 2014.

2. National Literacy Act of 1991. Available at: https://www.govtrack.us/congress/bills/102/hr751. Accessed December 15, 2014.

3. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health Literacy: Report of the Council on Scientific Affairs. JAMA. 1999; 281(6):552-557.

4. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Accessed December 15, 2014.. 5. Doak CC, Doak LG, Root JH. The literacy problem in teaching patients with low literacy skills. 2nd ed. Philadelphia, PA: JB Lippincott Co; 1996.

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