Introduction Since the implementation of the Hospital Readmission Reduction Program, health systems have been working to reduce hospital readmission rates of patients with heart failure (HF). Of these efforts, the interventions with a multidisciplinary, multicomponent approach have lowered readmission rates as well as improved patient care, patient adherence, and patient outcomes. Objectives The primary objective of this study was to determine if the addition of a pharmacist to the Transitional Care Team (TCT) would decrease the number of high‐risk HF patients readmitted to the hospital before 30 days. Secondarily, this study assessed the change in self‐reported medication adherence. Methods This study was conducted at a community teaching hospital. A retrospective chart review was performed to identify HF patients who were at high risk for readmission admitted to the hospital from May 2012 to October 2013, as the historical control group. The intervention group included high‐risk patients with HF admitted from May 2014 to October 2015, who received the pharmacist‐led intervention during hospitalization and postdischarge. The pharmacist‐led intervention comprised five components: medication reconciliation, medication cost/formulary review, medication discharge counseling, providing and educating patients regarding self‐monitoring resources and postdischarge telephone follow‐up. The 8‐item Morisky Medication Adherence Scale was used to measure patients' self‐reported medication adherence at baseline, then 30 days after discharge. Results The pharmacist‐led intervention assisted in decreasing the readmission rate from 33.7% in the historical control group to 21.3% in the intervention group with a relative risk reduction of 0.696 (confidence interval: 0.488‐0.994). There was also a significant improvement in self‐reported patient medication adherence scores. Conclusion The addition of a pharmacist to the TCT that managed HF patients was associated with a decrease in the readmission rate for patients who were at high risk of readmission and improved self‐reported patient medication adherence.

The new American College of Cardiology/American Heart Association blood cholesterol guidelines of 2013 are the first major revision of cholesterol therapy guidance in over a decade. Commonly used low-density lipoprotein cholesterol (LDL-C) target goals have been abrogated in favor of intensity of statin therapy, more in line with data from randomized clinical trials. Four groups of adult patients have been identified from these studies who will most benefit from statins: patients with atherosclerotic cardiovascular disease (ASCVD); patients with primary elevations of LDL-C ≥ 190 mg/dL; diabetic patients between age 40 and 75 years without ASCVD whose LDL-C is between 70 and 189 mg/dL; and patients between age 40 and 75 years without ASCVD or diabetes with LDL-C between 70 and 189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or higher. This last primary prevention group has engendered the most controversy because the newly recommended risk calculator may overestimate risk or the 7.5% threshold may be too low, thereby subjecting too many patients to statins unnecessarily. This review summarizes the latest guidelines and pertinent evidence, and provides case examples to help clinicians familiarize themselves with the new recommendations.

SUMMARYA 58-year-old man presented to the emergency department with acute left-sided weakness and left visual field defect. His examination was significant for confusion, acetone odour, tachycardia and tachypnoea. Further blood tests revealed an anion gap of 31 mEq/L, serum osmolal gap of 34 mOsm/kg, and creatinine 3.6 mg/dL. Brain MRI revealed acute infarctions scattered throughout the brain along with generalised oedema. The patient deteriorated rapidly and soon thereafter it was reported that a bottle of antifreeze was found near him at home. Haemodialysis was initiated and the patient received fomepizole and bicarbonate. Three days later the patient did not show any neurological improvement and expired later that day. Ethylene glycol toxicity can rarely present with stroke which can be lifethreatening when not diagnosed and managed in a timely fashion. BACKGROUND

No abstract

The intermediate care unit (IMCU) is for patients who require a higher level of care than the acute medical/surgical floor but do not meet intensive care unit (ICU) criteria. Having a dedicated IMCU in the hospital has shown reduced mortality benefits, decreased health care costs, and utility optimization of the ICU. We aimed to see if there was any association between different variables which potentially could help dictate earlier ICU admission in select individuals.