As the prevalence of obesity increases, the prevalence of associated comorbid diseases, obesity‐related mortality rates and healthcare costs rise concordantly. Two main factors that hinder efforts to treat obesity include a lack of recognition by patients and documentation by physicians. This study evaluates the relationship between patient perception of obese weight and physician documentation of obesity. This quality improvement observational study surveyed patients of an academic internal medicine clinic on their perception of obesity. Responses were compared to longitudinal physician documentation of obesity and body mass index (BMI). A total of 59.9% of patients with obesity perceived their weight as obese. While 33.7% of patients with a BMI of 30 to 34.9 kg/m2 perceived themselves as having obesity, 71.4% of patients with a BMI of 45 to 49.9 kg/m2 perceived themselves as having obesity. A total of 42.4% of patients with obesity had physician documentation of obesity in the last year. While 25% of patients with a BMI of 30 to 34.9 kg/m2 had physician documentation of obesity, 85.7% of patients with a BMI of 45 to 49.9 kg/m2 had physician documentation of obesity. For patients with a BMI ≥50 kg/m2, 52.9% perceived their weight to be obese and 76.5% had physician documentation of obesity in the last year. Both patient perception and physician documentation of obesity were significantly less than the prevalence of obesity. Patient perception of obesity and provider documentation of obesity increased as BMI increased until a BMI ≥50 kg/m2. Both patients and providers must improve recognition of this disease.

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we found improvements in verbal memory 6 months and 12 months post-placement and in visual memory between 12 and 24 months. Objectives: The purpose of the current follow-up study was to assess the impact of an increased sample (n = 17) and additional follow-up testing. Methods: We again compared cognition pre-and post-LVAD placement across time points (A: 3-6 months; B: 6-12 months; C: 2 years) for individuals using paired samples t-tests. Individuals were administered the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. Patients' cognition was stable or improved up to 24 months post-placement. Results: In addition to the verbal and visual memory impairment previously observed, we now saw. Statistically significant improvement in cognition was observed on measures assessing processing speed (Pre to A) and verbal recognition memory (Pre to B). Trends toward significance were observed in visual memory (Pre to A), delayed list memory (Pre to B), and delayed story memory (A to C). Conclusions: Findings add to limited extant research showing stable or modest improvements in cognition and provide further understanding of the effects of LVAD placement on neurocognition.

The prevalence of anomalous circumflex coronary arteries is rare. Identifying the presence of an anomalous coronary is quite easy when there is no severe stenosis. However, in the presence of severe stenosis, there is limited anterograde flow, which makes it challenging to visualize the course of the stenotic artery, and it can be assumed to be a chronic total occlusion (CTO). This case demonstrates how the anomalous circumflex artery with severe stenosis masqueraded as a CTO and the patient was treated medically for several years, despite continued symptoms. The retrograde filling of an anomalous circumflex has a specific angiographic pattern which should be recognized. This case is an excellent illustration of the said angiographic pattern.