Overcoming patient reluctance to statin intolerance.

Statin therapy is a cornerstone in the management of dyslipidemia, both in primary and secondary prevention of cardiovascular events. Despite strong guidelines supporting statin use, concerns regarding side effects, particularly musculoskeletal symptoms, contribute to statin intolerance and patient reluctance. While statin intolerance is reported in 5% to 30% of patients, its true prevalence may be overestimated due to the influence of the nocebo effect. Factors associated with higher incidence of statin intolerance include older age, female sex, comorbidities such as diabetes and chronic kidney disease, and concurrent use of medications such as antiarrhythmic agents or calcium channel blockers. Clinical characterization of statin intolerance requires thorough evaluation and exclusion of alternative causes of musculoskeletal symptoms. Strategies to address statin intolerance include reassessing cardiovascular risk, engaging in shared decision-making, statin rechallenge after appropriate washout periods, dosage titration for tolerability, and consideration of alternative therapies when low-density lipoprotein goals cannot be achieved with statins. This review provides an overview of the spectrum of statin intolerance, its clinical assessment, and a systematic approach to caring for a patient with statin intolerance.

Obesity Management Education Needs Among General Internists: A Survey.

OBJECTIVE: The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice. PATIENTS AND METHODS: An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues. RESULTS: In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30's (30%) or 50's (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics. CONCLUSION: Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.

A Process of Acceptance of Patient Photographs in Electronic Medical Records to Confirm Patient Identification.

Appropriate patient identification is a critical component of safe health care delivery. With increasing reliance on electronic medical records (EMRs), errors of test ordering and documentation have become commonplace. Incorporating patients' photograph in the EMR has considerably decreased error frequency and improved health care delivery by making it easier for physicians to identify a patient. We conducted a survey of all 35 physicians working in the Executive Health Program to determine the importance of having patient photographs in the EMR. Of the 35 physicians who received the survey, 26 (74.3%) responded, 24 (92.3%) of whom agreed that it was important to improve patient identification, care, and safety. Based on these data, we implemented a quality improvement project to increase the percentage of new patients having a photograph included in the EMR. Our goal was to increase photograph inclusion by more than 20% from baseline within 6 months without any unintended consequences (ie, not slowing down any of the workflow during the intake process). The intervention took place between June 1, 2015, and February 8, 2016. Using Define-Measure-Analyze-Improve-Control models, the baseline rate of photographs in the EMR was 49.5% (302 of 607). We initiated 3 Plan-Do-Study-Act cycles targeting awareness and data sharing campaigns. After the Plan-Do-Study-Act cycles, the weekly rate of patient photographs incorporated into the EMR was at 71.4%, which was significantly improved compared with baseline (F test, P<.001). No unintended consequences were identified. Increased inclusion of patient photographs in the EMR aided in patient identification and improved staff satisfaction with minimal interruption to workflow.

Developing a Comprehensive Perioperative Education Curriculum for Internal Medicine Residency Training.

Background: Patients undergoing surgery are becoming increasingly complex and internists are becoming more involved in their perioperative care. Therefore, new requirements from the ACGME/ABIM necessitate education in this area. We aim to discuss how our institution adapted a perioperative curriculum to fill this need. Methods: Perioperative education is primarily given to the residents during their one month rotation through the General Internal Medicine Consult Service rotation. This is an inpatient rotation that provides perioperative expertise to surgical teams, medicine consultation to medical subspecialty teams, and outpatient preoperative evaluations. Results: Our implementation complies with ACGME/ABIM requirements and ensures that the educational and clinical needs of our institution are met. Conclusions: Developing a new curriculum can be daunting. We hope that this explanation of our approach will aid others who are working to develop an effective perioperative curriculum at their institutions.

Antiepileptic drugs toxicity: A case of toxic epidermal necrolysis in patient with phenytoin prophylaxis post-cranial radiation for brain metastases.

BACKGROUND: Treatment of epilepsy with antiepileptic drugs (AED) is effective and remains the principal mode of management. A group of adverse effects and drug toxicity can develop immediately or later in the course of treatment. AEDs also have the potential of precipitating idiosyncratic adverse effects including serious cutaneous, hematological and hepatic events. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse reactions are related to or caused by a variety of medications including AEDs, they carry a high mortality and morbidity rate, accurate diagnosis and rapid treatment may improve the prognosis. OBJECTIVE: To characterize the clinical features and methods of differentiating Stevens-Johnson syndrome from toxic epidermal necrolysis using a case study and to identify other factors that may contribute to this critical illness. CONCLUSION: Clinical knowledge of potential sever adverse reaction of AEDs is essential and may overcome treatment failure with major impact on health-related quality of life in people with epilepsy.