RESUMO
Secondary polycythemia (SP) occurs as a result of increase erythropoietin levels most commonly as a result of tissue hypoxia. Symptoms such as erythromelalgia, pruritis, and bleeding, which are frequently seen in polycythemia vera (PV), do not commonly occur in SP. Phlebotomy is considered one of the mainstays of therapy for PV but is rarely used for treatment of SP due to concern about worsening tissue hypoxia. We present the case of a patient with severe SP due to chronic hypoxic lung disease who presented with erythromelalgia, pruritis, and bleeding and was treated successfully with therapeutic phlebotomy. This case illustrates the importance of considering the use of therapeutic phlebotomy in symptomatic patients with severe SP.
RESUMO
BACKGROUND: A previous study showed that residents felt a universal well-being visit to a Faculty Staff Assistance Program (FSAP) would increase self-initiated visits. It is unknown whether such program is associated with more self-initiated visits, improved professionalism, or positive well-being measures. OBJECTIVE: We measured internal medicine (IM) resident-initiated visits before and after the universal well-being FSAP intervention to assess for increased utilization of FSAP services and effect on professionalism and well-being measures. METHODS: Universally scheduled, resident-initiated, program-mandated FSAP visits for IM residents at West Virginia University were counted for years 2014-2019. Professionalism reports of all residents and IM residents were tallied. A Mann-Kendall trend test was used to estimate slope of trends. Burnout and compassion satisfaction (CS) scores were assessed from 2017-2020. RESULTS: Residents opted-out of 8 of 239 (3.3%) universally scheduled FSAP visits. Resident-initiated visits significantly increased from 0 in 2014-2015 to 23 in 2018-2019 (slope = 6.5; P = .027; 95% CI [1.0, 8.0]). Program-mandated visits significantly decreased from 12 in 2014-2015 to 3 in 2018-2019 (slope = -2.4; P = .027; 95% CI [-3.0, -1.0]). IM-attributed professionalism reports significantly decreased from 17 of 62 (31%) in 2014 to 1 of 62 (1.6%) in 2019 (slope = -5.7%; P = .024; 95% CI [-11.6%, -0.6%]). Burnout scores remained in the low range (≤ 22) and CS scores in the average-high range (38.7-42) from 2017-2020. CONCLUSIONS: A universal well-being FSAP program increased resident utilization of mental health resources and was associated with fewer professionalism breaches.
