ObjectivesTo design a tool to assess and improve physician communication, provide physicians with personalised feedback in real time, and relate specific communication behaviours to patient experience measures. It was hypothesised that performance of fundamental communication behaviours would correlate with individual patient experience scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.DesignProspective observational study.SettingSingle-centre study at a mid-sized academic tertiary medical centre.ParticipantsThirteen hospitalists across 305 patient interactions were assessed in this study. Participants were recruited from three geographically cohorted adult general medicine-teaching teams on two inpatient units. Participants with cognitive impairment or who were unable to speak English were excluded from the study.Main outcome measuresFrequency of performance of 10 fundamental communication behaviours.ResultsThe communication behaviours of 13 hospitalists were assessed by 305 surveys: 146 observations, 106 patient reports and 52 excluded interactions. During rounds, 50% of physicians introduced themselves, 40% explained their role, 44% introduced other members of the team, 59% addressed patients by name, 58% addressed friends/family, 59% attempted to be at eye level, 41% asked permission before performing a physical examination, 40% asked if patients had questions and 20% asked if patients understood the plan of care. Several variables correlated with higher HCAHPS scores; however, addressing patients by name (r=0.60482, p=0.0492) and introducing other members of the team (r=0.87239, p=0.0234) were statistically significant.ConclusionThis study highlights the importance of effective physician–patient communication and presents a unique data collection tool to assess and improve physician communication in real time. This tool can provide physicians with personalised feedback and relate specific communication behaviours to patient experience measures to provide high-quality care and improve the patient experience.

Prolonged or excessive use of the central nervous system depressant difluoroethane, which is an easily acquired and inexpensive volatile substance that can be inhaled recreationally, is associated with toxicity, and abrupt cessation can induce withdrawal.

Takotsubo cardiomyopathy is a relatively uncommon condition triggered by severe physical and/or emotional stress. It is characterized by transient ventricular wall dysfunction in the absence of coronary artery disease (CAD). Herein, we report a case of a 59-year-old female who had three episodes of recurrent Takotsubo cardiomyopathy. On each occasion, she presented with symptoms of acute coronary syndrome accompanied by left ventricular wall motion abnormalities; however, repeat cardiac catheterization failed to show CAD. Each recurrence resulted in resolution of her symptoms and recovery of left ventricular function. While emotional triggers were identified, on two occasions, the patient presented with ventricular fibrillation for which an implantable cardioverter defibrillator (ICD) was ultimately placed. We encourage clinicians to no longer look at Takotsubo cardiomyopathy as a benign, reversible disease process, but rather as a pathological entity with real, life-threatening complications that may be managed with ICD placement.

Patient: Female, 60-year-old Final Diagnosis: Malnutrition Symptoms: Edema Medication:— Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare disease Background: Kwashiorkor disease is a subtype of severe acute protein malnutrition characterized by peripheral edema associated with hypoalbuminemia and ascites. It can result from both protein deficiency and protein loss. In resource-poor countries, the disease often is caused by inadequate dietary intake, but in resource-rich countries, it can be seen as a rare complication of severe malabsorption. Case Report: We present the case of a 60-year-old woman who presented with 1 week of progressive anasarca in the setting of decreased dietary intake and poor tolerance of total parenteral nutrition (TPN). She had a history of Roux-en-Y gastric bypass surgery which was complicated by a strangulated internal hernia that required an exploratory laparotomy and small bowel resection. She subsequently developed short gut syndrome with TPN dependence. Work-up revealed hypoalbuminemia with several micronutrient deficiencies consistent with secondary kwashiorkor disease. With a multidisciplinary approach that included Gastroenterology, Pharmacy, and Nutrition, she was treated with albumin, furosemide, nutritional supplementation, and ultimately rechallenged with TPN. At discharge, her swelling had improved, her weight had decreased, and her albumin improved to the normal range. Conclusions: This case is a unique presentation of secondary kwashiorkor disease. In our patient, the combination of gastric bypass surgery and short gut syndrome with poor TPN tolerance likely led to severe protein malabsorption. This underscores the importance of recognizing the signs and symptoms of kwashiorkor disease and understanding the associated complications so that treatment can be instituted promptly. Furthermore, the case demonstrates how an interdisciplinary approach to management can increase the chance of a successful outcome.