You Can't Always Blame the Chemo: A Rare Case of Spontaneous Tumor Lysis Syndrome in a Patient with Invasive Ductal Cell Carcinoma of the Breast.

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by metabolic and electrolyte abnormalities, observed during the destruction of tumor cells. While it is commonly seen during cytotoxic treatment of hematologic malignancies, it is rarely seen or suspected in solid tumors. The incidence of spontaneous tumor lysis (before cancer treatment) in solid malignancies is even rarer. Herein, we present the case of a spontaneous tumor lysis syndrome (STLS) in a woman who presented with chest pain and was found to have metastatic ductal cell carcinoma of the breast. She presented with acute renal failure and demonstrated all laboratory derangements consistent with TLS, despite not being on chemotherapy. Fortunately, her clinical status improved with prompt treatment, but the long-term effects of TLS can be fatal if not recognized and managed immediately. This case highlights that early recognition and appropriate treatment can be lifesaving. Furthermore, it demonstrates the importance of maintaining a high clinical suspicion in all patients with malignancy, whether hematologic or solid, of the possibility of TLS, even in the absence of chemotherapy.

Rethink space: (Re)designing a workspace using human-centered design to support flexibility, collaboration, and engagement among clinical and translational research support services.

INTRODUCTION: Space matters. We read space like we read people's faces. Space is an instrument of collaboration and innovation. At the University of Michigan's Institute for Clinical and Health Research (MICHR), a team was created to creatively and economically enhance our operating space into a flexible workspace that supports privacy, innovation, creativity, and most important, a culture of collaboration. METHODS: The team used a human-centered design process to creatively engage the staff at large into analyzing our existing space, identifying latent needs, proposing solutions, generating feedback, and economically building the rethought process. RESULTS: The redesigned workspace embraces the differences among MICHR's teams while encouraging collaboration and teamwork and keeping costs at a minimum. It has resulted in a flexible space that includes co-located teams, spaces dedicated to different work goals, an open area for collaboration, quiet zones for focused work, and better wayfinding. CONCLUSIONS: Through our Rethink Space project, we hope to have demonstrated that, by initiating the project internally and by engaging the users of the space themselves in an empathetic, visual, and human-centered way, a space redesign can be undertaken economically while also leading to improved levels of employee and team satisfaction.