My most recent rotation in the Senior’s Outpatient Clinic allowed an amazing opportunity to work with patients in the community presenting with complicated chronic disease states and medication regimens. The patients were at various places in their journey of chronic disease management. These included longstanding early on set Parkinson’s disease to newly diagnosed mixed Lewy body dementia. In this rotation, the emphasis on patient centered care was key. This rotation fostered the development of my patient interviewing skills and how to best approach the primary concerns of the patient with the added complexity of cognitive impairment or dementia. As my knowledge of the etiologies and presentation of cognitive impairment (mild cognitive impairment to severe dementia) increased, I was able to more thoroughly assess the patient and their ability to self-administer medications and reports ADRs. The final comprehensive consults challenged me to organize the information into detailed, comprehensive SOAP notes. I still require practice interviewing and clearly identifying DTPs in more complicated situations and this is an area I would like to focus on in my up coming internal medicine rotation. In addition to the technically skills I gained, this rotation gave me exposure to the community resources available for patients to help improve their quality of life and to support for them and their families while making difficult healthcare decisions.

Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia (Cummings JL et al. 2015)

One Journal Club Forward! As my first journal club facilitation, I was admittedly nervous. However once my role shifted from presenter to facilitator of the discussion, I surprised myself in my ability to exchange ideas with experts in Alzheimer’s dementia and related agitation. It was a valuable opportunity for me to explore their opinions regarding the difference between statistical and clinical significance. It was interesting to hear the varying perspectives of the geriatricians with regards to the possible applicability of the treatment to their practice based on risk vs. benefit. On one hand, there was the consideration of geriatric out patients with a high risk of serious side effects of the medication. Given the PD and PK changes that occur with aging and the high morbidity and mortality related to falls, the potential benefit of DMQ might be questionable. Conversely, in a highly agitated institutionalized patient, the potential benefit of an additional option for treatment sounded appealing. This discussion was a good example of the importance of assessing patient specific factors prior to considering a treatment.

This exercise contributed to my residency learning goal 5) I will demonstrate the ability to critically appraise literature in a systematic fashion and determine the applicability of the study to a specific patient.

dextromethorphan-quinidine journal club