Strother, Robert K.

Introduction Correct inhaler technique is of utmost importance in the optimal delivery of therapeutics utilized for respiratory illnesses. Previous research suggests that the ability of both patients and providers to correctly use these inhalers is sub-optimal and is associated with poorer patient outcomes. Further education about inhaler types and technique as part of residency education could serve to correct these trends. Methods Family medicine residents were taught correct inhaler technique with an inhaler training device (In-Check TM DIAL G16) using a didactic lecture with hands-on teaching exercise utilizing pharmacy interprofessional teaching. We assessed pre- and post-intervention comfort and knowledge of correct inhaler technique. Results Twenty of twenty-seven eligible family medicine residents attended an interdisciplinary workshop with clinical pharmacists with the purpose of improving inhaler technique comfort level and knowledge. A pre- and post-knowledge test and comfort questionnaire were provided to those participating. Comfort levels with prescribing different inhaler types increased after the intervention and knowledge of different inhalers improved. Conclusion Use of an inhaler training device coupled with an interdisciplinary lecture format improved provider knowledge of correct inhaler technique and comfort with prescribing inhalers.

A 72-year-old gentleman who presented to the outpatient clinic for a preventive health appointment with symptoms of depression and fatigue was found to have persistent hypercalcemia on routine laboratory monitoring. Initial laboratory testing was consistent with primary hyperparathyroidism with elevation in parathyroid hormone and low vitamin D levels. Further imaging demonstrated an ectopic mediastinal parathyroid adenoma. The ectopic lesion was treated surgically and lead to normalization of calcium levels and objective improvement in depressive symptoms. Primary hyperparathyroidism, which can be secondary to an adenoma, multigland hyperplasia, or neoplasm, can lead to the development of bone pain, fractures, and nephrolithiasis among other symptoms. The evaluation of hypercalcemia and the identification of primary hyperparathyroidism are important for the primary care physician to recognize so as to reduce disease morbidity as well as identify patients in need of further specialty care.