Baseline Knowledge Attitudes Satisfaction and Aspirations With Advance Care Planning: A Cross-Sectional Study.

BACKGROUND: Studies have consistently demonstrated low rates of adoption of Advance Care Planning in the community. METHODS: We studied Medicare enrollees age 65 and over and non-Medicare patients using a cross-sectional survey undertaken in February and March 2019 using questionnaires completed by out-patients attending a teaching hospital clinic in East Tennessee USA. We evaluated patient knowledge, attitudes, satisfaction and aspirations towards Advance Care Planning. RESULTS: 141 properly completed questionnaires were used. All Medicare enrollees were aware of Advanced Care Planning compared to 43% in the non-Medicare group. 70% of the Medicare enrollees and 94% of non-Medicare group were not ready to complete a written Advanced Care Plan. Of the respondents, 46% had appointed spouses, 24% adult children, 11% siblings, 10% parents, 3.6% friends and 1.2% aunts as their surrogate medical decision makers. 41% agreed that they were satisfied with their current advance care planning arrangements. This research identified that individual's knowledge, attitudes and aspirations influenced the adoption of Advance Care. CONCLUSIONS: Patients have adopted the Advance Care Plan concept but have modified it to reduce their concerns by using family and loved ones to convey their wishes instead of filling the required legal documents. Clinicians could improve this informal system and increase the observability of the treatment choices including the use of video and web-based tools.

Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Small Cell Lung Cancer: A Case Report.

Tumor lysis syndrome is an oncologic emergency that usually occurs after chemotherapy in patients with hematologic malignancies. Tumor lysis syndrome is rare in cases of solid tumors, especially when it occurs spontaneously. Herein, we present a case of spontaneous tumor lysis syndrome in a 55-year-old woman who presented with dyspnea and was found to have extensive metastatic small cell lung cancer. She developed acute oliguric renal failure and multiple electrolyte abnormalities requiring hemodialysis. The findings of this case suggest that clinicians should maintain a high index of suspicion for patients with malignancies who demonstrate the classic symptom of laboratory abnormalities even in the absence of chemotherapy.

Valacyclovir-associated neurotoxicity in peritoneal dialysis patients.

Valacyclovir is an oral antiviral agent being used more frequently than acyclovir because of the ease of administration and efficacy. Serious neuropsychiatric side effects have been demonstrated with the use of valacyclovir in renal failure patients. We report a case of valacyclovir neurotoxicity to emphasis the importance of dose adjustment in patients with chronic kidney disease and on dialysis.

A case study: using social tagging to engage students in learning Medical Subject Headings.

In exploring new ways of teaching students how to use Medical Subject Headings (MeSH), librarians at Boston University's Alumni Medical Library (AML) integrated social tagging into their instruction. These activities were incorporated into the two-credit graduate course, "GMS MS 640: Introduction to Biomedical Information," required for all students in the graduate medical science program. Hands-on assignments and in-class exercises enabled librarians to present MeSH and the concept of a controlled vocabulary in a familiar and relevant context for the course's Generation Y student population and provided students the opportunity to actively participate in creating their education. At the conclusion of these activities, students were surveyed regarding the clarity of the presentation of the MeSH vocabulary. Analysis of survey responses indicated that 46% found the concept of MeSH to be the clearest concept presented in the in-class intervention.

The rotating hospitalist: a solution for an academic internal medicine practice.

BACKGROUND: Concerns have been raised about the role that hospitalists may have in changing the educational process for medical students and residents, especially with regard to the primary care specialties. METHODS: We implemented rotating hospital and office duties within our five-physician group. RESULTS: Resident and student satisfaction increased, and additional faculty members could be added without expanding office space. Financial benefits then also ensued. CONCLUSION: Rotating hospital with office duties among a small group of internists has resulted in most of the advantages with few of the drawbacks related to the hospitalist approach.