Lifestyle Medicine Inpatient Consultation Services at Loma Linda University Health: A Novel Approach in a Tertiary Care Center.

As a nation facing primary care provider shortages, an expanding chronic disease burden, and rising health care costs, lifestyle medicine interventions have become critical for patient care and management. The current fee-for-service health care system in the United States is designed for delivering acute care but has made it challenging to deliver and be reimbursed sufficiently for lifestyle interventions that can help prevent and treat chronic disease. Loma Linda University Health began to address these concerns through the creation of an inpatient consultation service for the neurology rehabilitation stroke team. Initiation of the consultation service took 2 years of planning, testing, and resource development. Currently, the consultation service operates one half-day per week in the rehabilitation hospital utilizing 1 attending physician and 2 residents. Visiting residents and medical students are also permitted to rotate with the new service. In coordination with billing experts, a standard number of 21.2 to 25.4 RVUs (relative value units) has been established for the half-day service. As the service continues to expand, future considerations include adding consultation availability to other departments and increasing the consultation workforce.

The Lifestyle Medicine Outpatient Clinic at Loma Linda University Health.

Medical management of chronic health concerns relies heavily on behavioral change, most specifically medication adherence. Yet approximately 50% of patients with chronic illnesses are not thought to take their medications as prescribed. Moreover, it is recognized that lifestyle and behavioral changes can reduce the need for medication. It is well documented that patient outcomes and their success in achieving behavioral change is improved with engagement and support from a medical care team. As the inpatient lifestyle medicine service was being conceptualized at Loma Linda University Health (LLUH), it became apparent that an outpatient service would be necessary for follow-up care of the patients and support the lifestyle medicine treatments initiated in the hospital. Additionally, an outpatient clinic would be available to the patient population at Loma Linda and potentially prevent hospitalizations, morbidity, and mortality with proactive lifestyle medicine treatment. The initial outpatient clinic opened in February 2017 and was soon expanded to meet patient demand. Currently, the LLUH Lifestyle Medicine Outpatient Clinic is available 5 days a week, utilizing 5 physicians.

Survey of the effective exercise habits of the formerly obese.

BACKGROUND AND OBJECTIVE: Patients must subscribe to behavioral and lifestyle modifications for continued success after weight loss surgery (WLS). Few data exist about the ideal type, duration, and intensity of exercise for WLS patients. After surgery, should we mandate that patients exercise like a young, lean individual does? To reconcile this, we compared the exercise habits of successful bariatric surgery patients with physically fit controls. METHODS: One hundred individuals were enrolled. The operative group (OG) included 50 laparoscopic Roux-Y gastric bypass patients (LRYGB) who achieved excess weight loss of at least 80% one year after the surgery. The control group (CG) included 50 individuals of normal BMI who exercised regularly and did not undergo LRYGB. The exercise habits were compared using Fisher's exact and Mantel-Haenszel chi square tests. RESULTS: The 2 groups had equivalent BMIs (24.7 vs. 23.4 kg/m(2)). The OG was older (39.5 years) than the CG (26.2 years). There was a statistically significant difference between the groups regarding cardiovascular exercise, 80% walking (OG) vs. 60% running (CG). OG patients exercised longer and with similar frequency as CG did. A high proportion of CG lifted weights (86%) vs. OG (44%). Sixty percent of CG performed recreational sports compared with 34% of OG. CONCLUSION: Regular exercise is of utmost importance in maximizing and maintaining weight loss after WLS. Although patients who undergo WLS are older than the typical exercise enthusiast, they can achieve excellent weight loss and sustain a normal BMI with regular exercise habits that are quite distinct from younger individuals whose bodies were never undermined by obesity.

Superior mesenteric artery aneurysm: an uncommon disease with potentially serious complications.

Superior mesenteric artery aneurysms (SMAAs) are visceral arterial aneurysms that can result from a variety of conditions. About half of SMAAs are mycotic and occur subsequent to infective endocarditis. The clinical presentation of SMAA is nonspecific, and some patients may be asymptomatic while others may report mild to severe abdominal pain. Herein, we present a case of a 53-year-old man who presented to the emergency department with abdominal pain 5 months after receiving medical treatment for infective endocarditis. CT scan demonstrated an aneurysm in the superior mesenteric artery and a splenic infarct. The patient underwent surgical excision with an uneventful recovery. Although rare, SMAAs are associated with a high risk of death secondary to rupture. They are difficult to detect through physical examination and the history is usually nonspecific. In this report we discuss the etiology of SMAA, diagnostic work-up and treatment options aiming for early diagnosis and management of this potentially fatal condition.