Spinal Lymphoma Presenting as an Epidural and Retropleural Mass With Concomitant Pathologic Compression Fracture: A Case Report.

Lymphoma has traditionally earned the nickname "the great mimicker". Its presentation as a primary spinal tumor is rare, and therefore seldom included in the differential diagnosis. However, its mimicking nature and diverse presentation make it very difficult to exclude entirely. Here, we present an elderly patient with histology-confirmed spinal lymphoma presenting as both an epidural mass with transforaminal extension into the retropleural space as well as vertebral body compression fracture, together leading to severe spinal stenosis and compressive myelopathy. Additional non-malignant compression fractures found in our patient allow for an interesting discussion on disease presentation and imaging-based diagnosis. We discuss our approach to diagnosis, surgical treatment, and post-operative medical care.

Self-Efficacy and Short-Term Adherence to Continuous Positive Airway Pressure Treatment in Children.

Study Objectives: Infants, children, and adolescents are increasingly being prescribed continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea syndrome (OSAS), yet adherence is often poor. The purpose of this study was to examine the relationship between caregiver and patient-reported health cognitions about CPAP prior to starting CPAP and CPAP adherence at 1 month. We hypothesized that greater caregiver-reported self-efficacy would be positively associated with CPAP adherence in children. We also evaluated patient-reported self-efficacy and caregiver- and patient-reported risk perception and outcome expectations as they related to adherence, as well as how demographic factors influenced these relationships. Methods: A pediatric modification of the Self-Efficacy Measure for Sleep Apnea Questionnaire was administered to children and adolescents with OSAS-prescribed CPAP and their caregivers during the clinical CPAP-initiation visit. The primary outcome variable for adherence was the average total minutes of CPAP usage across all days from the date that CPAP was initiated to 31 days later. Results: Unadjusted ordinary least-square regression showed a significant association between caregiver-reported self-efficacy and adherence (p = .007), indicating that mean daily CPAP usage increased by 48.4 minutes when caregiver-reported self-efficacy increased by one point (95% confidence interval 13.4-83.4 minutes). No other caregiver- or patient-reported cognitive health variables were related to CPAP use. Conclusions: This study indicates that caregiver CPAP-specific self-efficacy is an important factor to consider when starting youth on CPAP therapy for OSAS. Employing strategies to improve caregiver self-efficacy, beginning at CPAP initiation, may promote CPAP adherence.

Consequences of Obstructive Sleep Apnea in Children.

Obstructive sleep apnea syndrome (OSAS) has various negative health and behavioral consequences in the pediatric population. As shown in adults, there are metabolic derangements such as obesity, insulin sensitivity, dyslipidemia, and metabolic syndrome, as well as cardiovascular derangements like hypertension, chronic inflammation, endothelial dysfunction, ventricular size/function abnormalities, and even elevated pulmonary arterial pressures, that can be seen in children with OSAS. The first two sections will discuss the metabolic and cardiovascular consequences on OSAS in children. The last section summarizes selected studies and reviews on the behavioral, neurocognitive and academic consequences of OSAS in children.

Evaluation of a clinical scoring scale to direct early appropriate therapy in heparin-induced thrombocytopenia.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a serious adverse effect associated with heparin therapy. Current laboratory confirmation for immune mediated HIT often results in false positives and unnecessary treatment, exposing individuals to possible complications. As a result, clinical evaluation has been recommended in conjunction with laboratory testing. We hypothesize that utilization of a clinical scoring scale, the 4T's, will result in the initial appropriate therapy for suspected HIT. METHODS: This is a retrospective chart review of 108 patients who underwent ELISA testing for HIT at a university hospital. The 4T's scale was applied, stratifying individuals into low, intermediate, and high-risk categories. Each risk score was compared to the ELISA results to determine if the 4T's can predict the diagnosis of HIT and result in appropriate management. ELISA optical density scores as well as incidence of adverse events were also compared among risk categories. STUDY RESULTS: Individuals with low risk correlate with a negative ELISA compared to intermediate and high-risk individuals (p = 0.01 and p<0.01) and also were significantly more likely to predict institution of appropriate therapy (p<0.01). Median optical density scores were 0.184 (0.046-2.116), 0.226 (0.067-1.887), and 0.476 (0.096-1.309) for low, intermediate, and high 4T scores. Major adverse events include thrombosis and bleeding. CONCLUSIONS: Individuals with low risk were more likely to receive initial, appropriate therapy and were also significantly more likely to have a negative ELISA test result. Individuals with low risk determined by the 4T score therefore may have therapy and serologic testing for HIT withheld.

Analysis of search in an online clinical laboratory manual.

Online laboratory manuals have developed into an important gateway to the laboratory. Clinicians increasingly expect up-to-date laboratory test information to be readily available online. During the past decade, sophisticated Internet search technology has developed, permitting rapid and accurate retrieval of a wide variety of content. We studied the role of search in an online laboratory manual. We surveyed the utilization of search technology in publicly available online manuals and examined how users interact with the search feature of a laboratory handbook. We show how a laboratory can improve its online handbook through insights gained by collecting information about each user's activity. We also discuss future applications for search-related technologies and the potential role of the online laboratory manual as the primary laboratory information portal.

Feasibility of an intelligent tutoring system for laboratory medicine.

Laboratory medicine is not adequately addressed in most medical school curricula. A review of the literature was performed to evaluate the feasibility of an intelligent tutoring system to enhance laboratory medicine training. This appraisal suggests that such a system must integrate basic science and clinical training. A system equipped with a clinical knowledgebase, in the form of an expert system, and a pathophysiology knowledgebase, in the form of multiple semantic networks, could provide such integration.

Using contextual design to identify potential innovations for problem based learning.

We report on the use of Contextual Design (CD) to develop models of the information management, resource integration, and collaborative processes of medical students in problem-based learning groups. CD is a modified ethnographic technique designed to provide a detailed understanding of the user's needs. Although the technique has been used in non-healthcare related fields, there is limited published data on the application of CD within healthcare settings. In this pilot study, we evaluated the feasibility of the CD methodology for this domain, developed an initial set of CD models, and formulated a series of design ideas based on the data. The study helps to clarify the effectiveness and feasibility of CD as well as the limitations for using this method in health-related domains.