A catastrophic series of events

Introduction: Catastrophic Anti-phospholipid Syndrome (CAPS) is a rare life-threatening condition that occurs i

Bias in the eyes of resident physicians

Conclusion: The majority of resident physicians did recognize bias in their colleagues\u27 approach to patient care. Given the evidence that implicit bias can be recognized and improved upon, this study reinforces the need for implicit bias training/discussion to be included in residency programs

Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction

OBJECTIVE: To explore the reasons for underutilization of beta blocker treatment after acute myocardial infarction. DESIGN: A retrospective chart review. SETTING: Two large community hospitals in Milwaukee, Wisconsin. PATIENTS/PARTICIPANTS: All subjects (n = 694) discharged alive from July 1, 1990, to June 30, 1991, who had a diagnosis of acute myocardial infarction were eligible. Of these, 250 had missing data, resulting in a final sample of 444. RESULTS: Twenty-nine percent of the 444 patients were prescribed beta blocker therapy on discharge. Characteristics of the patients and their treatment associated with receipt of beta blocker therapy were identified with a logistic regression model. The adjusted odds ratios were 0.52 for female gender, 0.34 for no health insurance, 0.21 for chronic obstructive pulmonary disease, 0.46 for congestive heart failure, 0.28 for atrioventricular block, 1.86 for hypertension, 1.93 for chest pain during acute myocardial infarction, and 4.65 for prehospital beta blocker use. Prescription of beta blocker therapy was also influenced by receipt of other treatment modalities. The adjusted odds ratios were 0.23 for receipt of beta blocker therapy associated with myocardial revascularization, 0.18 for prescription on discharge of calcium channel blockers, and 0.22 for receipt of angiotensin-converting enzyme inhibitors. CONCLUSION: A minority of patients discharged after acute myocardial infarction receive beta blocker therapy, and women are only half as likely as men to receive it, after controlling for other factors. Though there are no data relating to whether calcium channel blockers or angiotensin-converting enzyme inhibitors lessen the protective effect of beta blocker therapy post-acute myocardial infarction, it would appear that these agents are frequently being used in lieu of beta blocker therapy for post-acute myocardial infarction patients

Running and rapping our way to wellness: internal medicine residency approach to preventing burnout

Background: Physician burnout has led to increased cardiovascular disease, shorter life expectancy, problematic alcohol use, depression, and suicide. A recent meta-analysis on burnout and patient experience highlighted the strong association between physician wellness and the quality of patient care. Unfortunately, burnout in internal medicine ranks among the highest of all specialties, with rates up to 76%. Purpose: To facilitate resident mental and physical well-being through initiatives focused on supportive colleague relationships and exercise. Methods: We implemented two related interventions. 1) RAPS (Resident Advisor for Peer Success) is a structured peer advisor program for incoming interns to jump-start a “connection” with their continuity clinic team shortly after match day. This early and sustained contact provides interns with an immediate resource for questions/support and ongoing connections with senior residents and a faculty advisor. 2) Fit4Life intervention continued to build/ support colleague relationships through personal fitness. Wellness challenges between trainee years were held to promote physical health per American Heart Association (AHA) exercise guidelines. Three measures — a Fit4Life survey, semi-structured interviews with interns, and Mayo Well-Being Index (MWBI) — were used to evaluate process and outcomes. Results: Fit4Life pre-, during, and postchallenge data showed that less than 20% of internal medicine residents met AHA guidelines: 150 minutes/week of aerobic physical activity. Challenge period results showed a modest but not significant increase in exercise. Average completion rate was 83% of internal medicine residents. Exercise, per AHA recommendations, was paired \u3e50% of time with another activity (eg, watch/listen to television, movies, music, podcasts; connecting with family/friends). RAP intern interviews (13 of 13 [100%]) revealed that 85% were supportive of RAPS and 100% met weekly with RAPS team member(s) at continuity clinic. MWBI scores throughout intervention were well below instruments established at risk level for burnout (5.0), with below burnout scores ranging from 3.1 preintervention (February 2018) to 2.3 postintervention (December 2018). Conclusion: The results of our well-being interventions focused on supportive colleague relationships through RAPS and exercise reveal high participation rates and support but no significant impact on physical or mental health as measured by Fit4Life and MWBI

Running and rapping our way to wellness: internal medicine residency approach to preventing burnout

Background: Physician burnout has led to increased cardiovascular disease, shorter life expectancy, problematic alcohol use, depression, and suicide. A recent meta-analysis on burnout and patient experience highlighted the strong association between physician wellness and the quality of patient care. Unfortunately, burnout in internal medicine ranks among the highest of all specialties, with rates up to 76%. Purpose: To facilitate resident mental and physical well-being through initiatives focused on supportive colleague relationships and exercise. Methods: We implemented two related interventions. 1) RAPS (Resident Advisor for Peer Success) is a structured peer advisor program for incoming interns to jump-start a “connection” with their continuity clinic team shortly after match day. This early and sustained contact provides interns with an immediate resource for questions/support and ongoing connections with senior residents and a faculty advisor. 2) Fit4Life intervention continued to build/ support colleague relationships through personal fitness. Wellness challenges between trainee years were held to promote physical health per American Heart Association (AHA) exercise guidelines. Three measures — a Fit4Life survey, semi-structured interviews with interns, and Mayo Well-Being Index (MWBI) — were used to evaluate process and outcomes. Results: Fit4Life pre-, during, and postchallenge data showed that less than 20% of internal medicine residents met AHA guidelines: 150 minutes/week of aerobic physical activity. Challenge period results showed a modest but not significant increase in exercise. Average completion rate was 83% of internal medicine residents. Exercise, per AHA recommendations, was paired \u3e50% of time with another activity (eg, watch/listen to television, movies, music, podcasts; connecting with family/friends). RAP intern interviews (13 of 13 [100%]) revealed that 85% were supportive of RAPS and 100% met weekly with RAPS team member(s) at continuity clinic. MWBI scores throughout intervention were well below instruments established at risk level for burnout (5.0), with below burnout scores ranging from 3.1 preintervention (February 2018) to 2.3 postintervention (December 2018). Conclusion: The results of our well-being interventions focused on supportive colleague relationships through RAPS and exercise reveal high participation rates and support but no significant impact on physical or mental health as measured by Fit4Life and MWBI

Age-related differences in the utilization of therapies post acute myocardial infarction

OBJECTIVE: To describe the effect of age on the care of patients hospitalized with acute myocardial infarction (MI). DESIGN: Retrospective chart review of all cases with a primary or secondary discharge diagnosis of acute MI. SETTING: Two large community hospitals in Milwaukee, Wisconsin, from July 1, 1990 to June 30, 1991. PATIENTS: There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 203 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older. MEASUREMENTS: Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and procedures, as well as length of stay and in-hospital mortality. RESULTS: Older patients were more likely to be female (18%, 20%, 38%, and 56% for the four age groups, respectively, P \u3c .001 chi-square for linear trend), more likely to present with congestive heart failure (31%, 39%, 51%, and 72%, P \u3c .001), and had a higher in-hospital mortality rate (5%, 7%, 10%, and 18%, P \u3c .001). Older patients had a longer length of stay in the hospital. The use of cardiac catheterization in these post-MI patients was high and did not decrease until after age 75 (85%, 88%, 88%, and 47%, P \u3c .001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%, P \u3c .001), whereas the percentage of patients receiving myocardial revascularization did not significantly differ with age (15%, 22%, 25%, and 19%, P = .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%, P \u3c .001). CONCLUSION: A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older adults