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Drug & Disease Updates
Clinical Editorial: Do Patients Understand What We Are Saying?
FDA MedWatch Alerts
Clinical Question of the Month
DocAlert Editor’s Pick
2012 EHR Resolution
App Highlight: Procedures Consult –
Internal Medicine General
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Our New Year’s resolution to you is to support you and your practice, simply and wholeheartedly. We strive for your practice workflow to remain seamless in an increasingly complex world. We believe that we can save you time and money by developing intelligent, innovative clinical resources, and by creating channels for you to share your expertise. We at Epocrates are looking forward to a full new year, and it all stems from our dedication to the good work that you do.

George Bernard Shaw said, “The single biggest problem in communication is the illusion that it has taken place.” This issue aptly brings Dr. Meneghetti’s accounts and advice on navigating the clinician-patient communication gap; FDA MedWatch Alerts; and tips on how to locate indications and uses for drugs. We’ve also arrived at the last year Medicare providers can earn the maximum incentives for proving meaningful use of an EHR as defined in the American Recovery and Reinvestment Act. Read on the see how Epocrates is in a position to help.

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Clinical Editorial

Clinical Editorial: Do Patients Understand What We Are Saying?
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

They say that patients forget half of what we say during a visit. Worse yet, half of what is retained may be incorrect. We’ve all heard stories about a parent instilling an antibiotic suspension into the ear canal of a child with otitis, rather than giving the drug orally. The pressure of time, patients’ stress about health, barriers of language, culture, and literacy all conspire to create a gap between what we say and what patients hear.

During my fellowship at the multi-cultural magnet that was Boston City Hospital, I used to carry around a cheat-sheet for a basic patient consult in 3 languages. No doubt I sounded like an idiot to native speakers of Spanish, French, and Haitian Creole. Sure, interpreters existed, but what were the chances they would appear on my schedule? My fingers were crossed that an English-speaking relative would magically show up to ensure bi-directional communications. I dreamed of finding patient ed materials in multiple languages: asthma education in Tagalog, medication instructions in Farsi, and dietary advice in Vietnamese.

What are the ways to close the clinician-patient communication gap?

Be succinct. Boil the message down to 2 to 3 key points per visit, speaking slowly and plainly. Avoid multi-component statements.

Use images. Drawings, models, and demonstrations speak louder than words. Illustrated patient literature and prescription warning labels¹ with graphics can be helpful. No method is perfect; in a study of patients with low literacy², some misinterpreted the following as:


Using anatomical images on a tablet computer can also be an engaging way to describe procedures or discuss internal organs.

Confirm understanding. Use the “teach-back” method³ to ensure comprehension, e.g., “We’ve covered a lot today. To be sure I’ve explained it all: What will you do if you feel short of breath?”

Give enduring materials. Handing out printed patient literature, ideally tailored to language, culture, and literacy levels, is a great way to end a visit. Choose an EHR with a robust printable patient ed selection, preferably with auto-suggest functionality linked to the patient’s conditions.
 
Drug and Disease
Evaluation of ataxia
Osteoporosis
Sports preparticipation physical
Cholelithiasis
Evaluation of neck pain
Social anxiety disorder
Folliculitis
Inguinal hernia
Bruxism
Paronychia

Drugs
drug updates
Amethia Lo
(levonorgestrel/ethinyl estradiol)
amlodipine/atorvastatin
(first-time generic for Caduet)
atorvastatin
(first-time generic for Lipitor)
Camrese Lo
(levonorgestrel/ethinyl estradiol)
Excedrin Back & Body
(acetaminophen/aspirin)
Excedrin Tension Headache
(acetaminophen/caffeine)
felbamate
(first-time generic for Felbatol)
Ferriprox
(deferiprone)
Goody’s Powder Back &
Body Pain

(acetaminophen/aspirin)
imipenem/cilastatin
(first-time generic for Primaxin IV)
Jakafi
(ruxolitinib)
lamivudine
(first-time generic for Epivir)
lamivudine/zidovudine
(first-time generic for Combivir)
levonorgestrel/ethinyl estradiol
(first-time generic for LoSeasonique)
Little Fevers Children’s Fever/Pain Reliever
(acetaminophen)
Little Fevers Infant Fever/Pain Reliever
(acetaminophen)
Midol Teen
(acetaminophen/pamabrom)
Pamprin Cramp
(acetaminophen/magnesium salicylate/pamabrom)
Phillips’ M-O
(magnesium hydroxide/mineral oil)
polymyxin B
(generic)

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It is said that people remember not so much what we say, but how we make them feel. As clinicians, we are charged with having great bedside manner and conveying vital information. If you have tips on improving clinician – patient communication, share them with us.

¹ Pharmex Original Copyrighted Warning Labels were copied with authorization by Precision Dynamics Corporation.
² Low Literacy Impairs Comprehension of Prescription Drug Warning Labels. TC Davis, MS Wolf, PF Bass, et al. J Gen Intern Med. 2006 August; 21(8): 847–851.
³ NC Program on Health Literacy Toolkit. Prepared for the Agency for Healthcare Research and Quality, AHRQ Publication No. 10-0046-EF.

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FDA Medwatch Safety Alerts

Prescription drugs: Multaq (dronedarone): Increased risk of death or serious cardiovascular events. Zocor (simvastatin): New restrictions, contraindications, revised dose limitation from 10 to 20 mg when co-administered with amiodarone. Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants: Conflicting results make it premature to reach conclusions about a possible link between SSRI use in pregnancy and persistent pulmonary hypertension of the newborn. Stimulants: FDA did not find an association between certain ADHD medications and adverse cardiovascular events. Pradaxa (dabigatran etexilate mesylate): FDA is examining whether bleeding occurs more commonly than would be expected with anticoagulants. Gilenya (fingolimod): Safety review of a reported death after the first dose.

Medical devices: CooperVision AVAIRA Toric and Sphere Soft Contact Lenses: Expansion of worldwide recall due to unintended silicone oil residue on lenses. St. Jude Medical, Riata and Riata ST Silicone Endocardial Defibrillation Leads: Recall due to failures with lead insulation. ShoulderFlex Massager: Updated warning on risk of strangulation.


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Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

Q: Why don’t Epocrates drug monographs have an indications section?

A: Indications and uses for each prescription drug (and generic OTC drug) can be found under the Adult Dosing and Peds Dosing sections of Epocrates standard drug monographs. Each bolded header is an indication or use for the product, accompanied by appropriate dosing for that indication/use. An asterisk (*) before the indication denotes that it is "off-label" (i.e., not officially approved in the U.S. for that purpose). Since we express drug dosing in conjunction with each indication or use, it would be redundant to also include indications and uses in an entirely separate monograph section for these drugs. Epocrates handles brand name over-the-counter (OTC) products slightly differently, since these products commonly contain up to four or five different ingredients and each individual ingredient can have a different indication or use. To accommodate this, Epocrates brand OTC drug monographs do include a separate section entitled “Uses”, in which can be found the indications/uses of each individual ingredient.

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DocAlert Editor’s Pick

BMJ 2011;343:d6831
A 34 year old man with bilateral anterior uveitis and a rash
Anish N Bhuva, Harpreet K Lota

[Excerpts]
A 34 year old railway engineer of south Indian descent [was] being treated for bilateral anterior uveitis with topical steroids and mydriatics after a one month history of decreasing visual acuity, photophobia, and ocular pain. He also had a four month history of irritation over his tattoo sites that his general practitioner had suspected was dermatitis related to ultraviolet radiation. He was also having severe night sweats. His medical history included well controlled asthma and two hospital admissions for lower respiratory tract infections in the past five years. Full blood count, electrolytes, liver function tests, and bone profile tests were within normal ranges.



What abnormalities can be seen in the figures? What is the likely diagnosis? How would you manage a patient with this condition?

[Link to free full-text BMJ article for answers]

© 2011 BMJ Publishing Group Ltd

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2012 EHR Resolution

The industry is looking forward to accelerated EHR adoption in 2012 – are you ready? It’s the last year Medicare providers can earn the maximum incentives for proving meaningful use of an EHR as defined in the American Recovery and Reinvestment Act. Epocrates EHR is well positioned to support your achievement of meaningful use and put you on a clear path to earning the available incentives.

2012 will bring the launch of the Epocrates EHR native iPad app to complement the Epocrates EHR web and iPhone versions. Epocrates is leveraging our mobile expertise to deliver EHR capabilities that you can comfortably use in the exam room to enhance patient dialogue, rather than interfere like older EHRs. The iPad app, scheduled for release in the first half of 2012, will provide the simple, intuitive experience you have been searching for.


Epocrates EHR is offered for an affordable monthly subscription fee with limited upfront investment. We host the solution so practices don’t have to worry about maintaining servers or hiring technical resources to manage the implementation and ongoing upgrades. We handle it all in our secure data center, saving you both time and money.

If your 2012 New Year’s resolutions include implementation of an EHR in your practice, Epocrates can help get you there. Learn more
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App Highlight: Procedures Consult – Internal Medicine General

Prepare for the most common medical procedures encountered in a clinical setting with Procedures Consult: Internal Medicine - General. This application features a dynamic blend of video, illustrations, animations and text. Learn more

All content © Elsevier, Inc.

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Answer


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