Time Management and Task Prioritization Curriculum for Pediatric and Internal Medicine Subinternship Students.

Introduction: As a physician, it is important to develop time management and task prioritization skills early to promote future career success. In medical education, there is minimal structured time to teach these skills prior to residency. Stephen Covey's Time Management Matrix Technique (TMMT) is one strategy that can be used to develop these skills. This technique categorizes tasks into a four-quadrant table based on importance and urgency. Using this technique as a model, the authors developed a workshop for medical students on an inpatient pediatric or internal medicine subinternship. Methods: Prior to the workshop, students read an article and completed a survey and two self-directed exercises. The exercises asked students to create a list of tasks, develop an individualized TMMT model, and review specialty-specific patient cases. The workshop consisted of discussions on the presession work and group exercises on prioritizing tasks and responding to patient-related pages. Students evaluated the curriculum after the workshop with a survey. Results: Most participants (82%) strongly agreed or agreed that the workshop improved their ability to manage time effectively and prioritize tasks on a clinical rotation. There was a statistically significant increase in both median time management and task prioritization confidence scores after completion of the workshop (p < .05). Discussion: This workshop provides one strategy that can be implemented within undergraduate medical education to enhance time management skills prior to residency. Future studies should be aimed at evaluating these skills within the clinical setting.

Therapeutic Hypothermia Modulates the Relationships Between Indicators of Severity of Neonatal Hypoxic Ischemic Encephalopathy and Serum Biomarkers.

Objective: To determine the changes due to therapeutic hypothermia (TH) exposure in the strength of association between traditional clinical and biochemical indicators of severity of neonatal hypoxic-ischemic encephalopathy (HIE) and serum biomarkers. We hypothesized that culmination of TH changes the strength of the relationships between traditional indicators of severity of HIE and serum biomarkers. Methods: This was a single-center observational cohort study of 178 neonates with HIE treated with TH and followed with serum biomarkers: (i) brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) (neurotrophins); (ii) tau and glial fibrillary acidic protein (GFAP) (neural cell injury); and (iii) interleukin 6 (IL-6), IL-8, and IL-10 (cytokines), during their first week of life. Adjusted mixed-effect models tested associations with HIE indicators in relation to TH exposure. Results: At admission, lower Apgar scores and base excess (BE) and higher lactate and nucleated red blood cell (NRBC) count correlated with higher Sarnat scores. These indicators of worse HIE severity, including higher Sarnat score, correlated with lower VEGF and higher tau, GFAP, and IL-10 levels at different time points. Within the first 24 h of life, patients with a Sarnat score >2 had lower VEGF levels, whereas only those with score of 3 also had higher GFAP and IL-10 levels. Tau levels increased during TH in patients with Sarnat score of 3, whereas tau and GFAP increased after TH in those with scores of 2. After adjustments, lower VEGF levels during TH and higher tau, GFAP, and IL-10 levels during and after TH were associated with worse Sarnat scores. Tau and GFAP relationship with Sarnat score became stronger after TH. Conclusion: Therapeutic hypothermia exerts an independent modulatory effect in the relationships between traditional indicators of severity of HIE and serum biomarkers after adjustments. Thus, the timing of biomarker testing in relation to TH exposure must be carefully considered if biomarkers are proposed for patient stratification in novel clinical trials.

Fatal SARS-CoV-2 Inflammatory Syndrome and Myocarditis in an Adolescent: A Case Report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. METHODS: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. RESULTS: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. CONCLUSIONS: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.

Primary ureteral lymphoma presenting as bilateral obstructive uropathy.

Primary ureteral lymphomas are rare. We present a case of extranodal B-cell lymphoma of the ureter presenting as asymptomatic bilateral ureteral obstruction. A 34-year-old male was incidentally found to have obstructive uropathy. Imaging showed severe bilateral hydronephrosis and percutaneous nephroureteral stents were placed. Diagnostic work up did not uncover any apparent etiology to the obstruction. Histopathological analysis of the ureter excised during ureteral reimplantation revealed CD20+, CD5-, CD10- B-cell lymphoma with areas of aggressive disease. The patient received six cycles of R-CHOP chemotherapy and is currently disease free.

Plasma and Cerebrospinal Fluid Candidate Biomarkers of Neonatal Encephalopathy Severity and Neurodevelopmental Outcomes.

OBJECTIVES: To identify candidate biomarkers in both plasma and cerebrospinal fluid (CSF) that are associated with neonatal encephalopathy severity measured by encephalopathy grade, seizures, brain injury by magnetic resonance imaging (MRI), and neurodevelopmental outcomes at 15-30 months. STUDY DESIGN: A retrospective cohort study of plasma (N = 155, day of life 0-1) and CSF (n = 30, day of life 0-7) from neonates with neonatal encephalopathy and healthy neonates born at term (N = 30, ≥36 weeks of gestation) was conducted. We measured central nervous system necrosis (glial fibrillary acidic protein [GFAP], neurogranin [NRGN], tau), inflammatory (interleukin [IL]-6, IL-8, IL-10), and trophic (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor) proteins. Clinical outcomes were Sarnat scores of encephalopathy, seizures, MRI scores, and Bayley Scales of Infant and Toddler Development III at 15-30 months. RESULTS: Plasma NRGN, tau, IL-6, IL-8, and IL-10 were greater, whereas BDNF and vascular endothelial growth factor were lower in patients with neonatal encephalopathy vs controls. In plasma, tau, GFAP, and NRGN were directly and BDNF inversely associated with encephalopathy grade. IL-6 was inversely related to seizures. Tau was directly related to MRI abnormalities. Tau was inversely associated with Bayley Scales of Infant and Toddler Development III cognitive and motor outcomes. In CSF, NRGN was inversely associated with cognitive, motor, and language measures. GFAP, IL-6, and IL-10 were inversely related to cognitive and motor outcomes. IL-8 was inversely related to motor outcomes. CSF candidate biomarkers showed no significant relationships with encephalopathy grade, seizures, or MRI abnormalities. CONCLUSIONS: Plasma candidate biomarkers predicted encephalopathy severity, seizures, MRI abnormalities, and neurodevelopmental outcomes at 15-30 months.

Incidental periprostatic schwannoma discovered during evaluation for prostatic adenocarcinoma.

Schwannomas of the prostate are exceedingly rare. We present a noteworthy case of a sporadic prostatic schwannoma diagnosed in conjunction with prostatic adenocarcinoma. A 60-year-old male presented with mild lower urinary tract symptoms and a prostate specific antigen (PSA) level of 4.84 ng/mL. A transrectal ultrasound guided prostate biopsy revealed multifocal Grade Group 2 prostate cancer. MRI demonstrated a PI-RADS 4 lesion and a periprostatic cystic lesion. Prostatectomy was performed. Final pathology demonstrated prostatic adenocarcinoma, with a separate periprostatic schwannoma. We present the first case in the literature of a sporadic periprostatic schwannoma discovered during evaluation for prostatic adenocarcinoma.

Cloaking as a Community: Re-imagining the White Coat Ceremony With a Medical School Learning Community.

The Johns Hopkins School of Medicine's Learning Community-White Coat Ceremony (LC-WCC) is held each spring as a learning community (LC) event. Learning communities (LCs) connect people to learn and work across boundaries to achieve a shared goal. The LC-WCC invites first-year students to collaborate with school leaders, define the class professional values, and innovate with community members. Class-elected student leaders recruit peers to join committees to plan and lead several aspects of the ceremony, including a class-nominated speaker, a personal statements presentation, a patient inclusion presentation, a class-authored statement of values, and artistic performances. Student cloaking is performed by LC advisors in their LC small groups. A 2015 post-LC-WCC survey asking students to compare experiences of a traditional Stethoscope Ceremony (SC) with the LC-WCC found that the latter significantly increased students' sense of accomplishment (38% vs 68%, P < .001), sense of connection to the school (59% vs 82%, P < .001), to classmates (71% vs 93%, P < .001), and to the event (42% vs 76%, P < .001). Cloaking as a community is an effective way for a medical school LC to instill a greater sense of community and student leadership in this milestone celebration of humanistic values in medicine.

Addressing childhood obesity using a multidisciplinary approach with social workers.

Childhood obesity can be effectively addressed with behavioral interventions in programs such as CATCH and Planet Health using a multidisciplinary approach. Social workers and school nurses are in close contact with children and youths at risk of obesity and their families within the school setting and are prepared to lead a multidisciplinary team in program planning, implementation, and evaluation related to reducing childhood obesity.