IntroductionExercise is Medicine™ (EIM) is an approach to clinic-based physical activity (PA) promotion. Study aims were to 1) assess the acceptability of current EIM protocols among healthcare providers (providers) and health and fitness professionals (fitness professionals); and 2) pilot test the resultant modified EIM protocols comparing patients referred to community PA programming with patients exposed to the EIM protocols alone.MethodsDuring 2012–2013 in Chattanooga, Tennessee, USA, 30/80 invited providers and 15/25 invited fitness professionals received training and provided feedback in the use of the EIM protocols. Following EIM use, feedback from providers and fitness professionals about acceptability of EIM protocols resulted in the adaptation of EIM protocols into the electronic health record. Subsequently, 50 providers and 8 fitness professionals participated in the intervention phase of the pilot study. Healthy and/or disease managed adults 18 years and older were enrolled with a sample of patients exposed to both the EIM protocols and community PA programming (EIM +) while another sample was exposed to the EIM protocols only (EIM). All patients were assessed for physical activity and Health-related Quality of Life. Measures were repeated ~ 3 months later for each patient.ResultsEighteen EIM + and 18 EIM participants were studied. The EIM + participants had a greater net increase in total PA (∆truex¯ = + 250 min/week) vs. EIM participants (∆truex¯ = − 38.6 min/week) (p = 0.0002).ConclusionsEIM + participation significantly increased PA levels among participants, suggesting this approach significantly impacts the PA of inactive adults more than just EIM only.

BackgroundProfessionalism is a core competency for residency required by the Accreditation Council of Graduate Medical Education. We sought a means to objectively assess professionalism among internal medicine and transitional year residents.InnovationWe established a point system to document unprofessional behaviors demonstrated by internal medicine and transitional year residents along with opportunities to redeem such negative points by deliberate positive professional acts. The intent of the policy is to assist residents in becoming aware of what constitutes unprofessional behavior and to provide opportunities for remediation by accruing positive points. A committee of core faculty and department leadership including the program director and clinic nurse manager determines professionalism points assigned.Negative points might be awarded for tardiness to mandatory or volunteered for events without a valid excuse, late evaluations or other paperwork required by the department, non-attendance at meetings prepaid by the department, and inappropriate use of personal days or leave. Examples of actions through which positive points can be gained to erase negative points include delivery of a mentored pre-conference talk, noon conference, medical student case/shelf review session, or a written reflection.ResultsBetween 2009 and 2012, 83 residents have trained in our program. Seventeen categorical internal medicine and two transitional year residents have been assigned points. A total of 55 negative points have been assigned and 19 points have been remediated. There appears to be a trend of fewer negative points and more positive points being assigned over each of the past three academic years.ConclusionCommitment to personal professional behavior is a lifelong process that residents must commit to during their training. A professionalism policy, which employs a point system, has been instituted in our programs and may be a novel tool to promote awareness and underscore the merits of the professionalism competency.

Vaccination behavior is an informative metric for assessing flu seasons and is especially important to understand for the 2020–2021 flu season, which coincided with the COVID-19 pandemic. This study aimed to estimate flu vaccine behavior and assess vaccine perceptions during the pandemic season. Using a cross-sectional descriptive study design, we conducted an online survey to assess vaccination behavior and perceptions of both COVID-19 and the flu. Patients were identified as recently seen by providers in an academic internal medicine practice (n = 827) and surveys were distributed as messages in the Epic electronic medical record system. We found that 88.3% of respondents (188/206) had received their flu vaccination for the season at the time of their survey response in December 2020–February 2021. Of those that had not yet received the flu vaccine, only 13.6% indicated they planned on getting one. 12.5% of respondents said they had changed their flu vaccine plans due to the COVID-19 pandemic. Looking at differences from past season’s behavior, more individuals switched to getting the flu vaccine than those that switched to not getting the vaccine this season. The most frequently cited reasons for not receiving the flu vaccination were concerns about side effects and not being in a priority group. Changes in flu vaccination behavior from previous seasons represent a net positive in the direction of vaccine acceptance. Barriers to vaccination were identified and results from this study provide more information on vaccine perceptions, beliefs, and behavior, which can benefit future vaccination programs.

Chemotherapy-associated cardiotoxicity can present as a spectrum from arrhythmia to acute congestive heart failure. Unlike anthracyclines, proteasome inhibitors – for example, bortezomib – are not notorious for causing cardiotoxicity in absence of pre-existing cardiac dysfunction or without concomitant use of other cardiotoxic agents. We describe a 66-year-old woman with end-stage renal disease who developed acute dyspnea hours after a third treatment with bortezomib for IgG kappa myeloma. The Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between bortezomib and acute left ventricular dysfunction. Patients receiving proteasome inhibitors should be closely monitored for evidence of cardiac dysfunction during treatment.

No abstract