Amy Barger Stevens

Patients' attitudes regarding physical characteristics of family practice physicians.

Background This study examined patient perceptions and attitudes toward various aspects of the male and female physician’s professional appearance in the family practice setting. Methods Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionnaire. Questionnaires were offered to all patients on registering at their respective clinic during a 2-week period. Results Most patients had no preference regarding the age or sex of their medical care provider. A nametag, white coat, and visible stethoscope were the most desirable characteristics, whereas sandals, clogs, and tennis shoes were the least desirable items. Younger patients were generally more accepting of casual attire than were older patients. Office clinic location was the most important predictor of preferences in six of the significant characteristics. Conclusion Our findings support the results of both studies published two decades earlier and more recently. Patients prefer a traditionally dressed physician as opposed to one who is dressed more casually.

Epistaxis associated with dabigatran in an elderly patient with reduced creatinine clearance.

Since its approval in October 2010, dabigatran etexilate use has increased due to ease of monitoring and simplified dosing compared with warfarin.[1][1] The RE-LY trial led to FDA approval of dabigatran etexilate at a dosage of 150 mg twice daily.[2][2]–[4][3] Dabigatran etexilate 150 mg twice

Development and implementation of an interdisciplinary pulmonary care clinic within an existing clinic program.

Asthma and chronic obstructive pulmonary disease (COPD) continue to impose noteworthy public health burdens. In the United States, COPD is the third leading cause of death, claiming approximately 138,000 lives annually, while asthma exacerbations contribute to over 1.8 million emergency room visits

Intractable Epistaxis With Febuxostat

Objective To report a case of serious, intractable epistaxis warranting an emergency department (ED) visit and hospital admission for transfusion following initiation of febuxostat. Case Summary An 86-year-old female presented to the ED after onset of intractable epistaxis for the previous 24 hours. Medications included aspirin, clopidogrel, metoprolol tartrate, valsartan, rosuvastatin, levothyroxine, esomeprazole, and febuxostat. She was treated with prednisone in the ED for a gout flare 3 weeks prior to the current visit, then was started on febuxostat at her follow-up primary care visit. Ten days after starting febuxostat therapy, she had onset of epistaxis. Initial treatment did not provide hemostasis and hemoglobin, and hematocrit values decreased. She was admitted and transfused. Aspirin, clopidogrel, and febuxostat were held during hospitalization. Bleeding subsided following bedside cautery. On hospital day 3, she restarted aspirin and clopidogrel and was discharged with no recurrence of bleeding. Discussion Epistaxis is relatively common and can be caused by multiple etiologies. Patient did not have prior episodes of epistaxis and had been on all medications for more than a year, except for febuxostat. This patient was also taking aspirin and clopidogrel; however, she had been taking these agents concomitantly for at least 4 years with no prior report of bleeding. Epistaxis occurred 10 days after the first dose of febuxostat with no other reported changes. Conclusions Epistaxis due to febuxostat use cannot be ruled out. Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding.

Atypical preeclampsia – Gestational proteinuria

There are many rural areas where obstetric care is predominately performed by family medicine physicians. As such, it is important for family medicine physicians to stay up to date with the latest obstetric guidelines. Preeclampsia is a well-established disorder and the guidelines for screening and treatment are well known. However, atypical presentations of preeclampsia have been less studied. Notably, what constitutes atypical preeclampsia and when to be concerned for increased morbidity and mortality in the mother and neonate. This report describes a unique case in which a woman with proteinuria of pregnancy developed atypical preeclampsia with severe features. This report discusses the care that was given by a practicing family medicine physician and the reasoning behind it.