Lazarus effect in a patient initially empirically treated with osimertinib for EGFR L858R mutant non-small cell lung cancer with leptomeningeal disease: a case report.

Osimertinib has been shown to be effective for patients with non-small cell lung cancer (NSCLC) with activating EGFR mutations, and these patients are at risk for leptomeningeal disease. In this report, we present a patient of East Asian descent whose initial presentation included severe, progressive leptomeningeal carcinomatosis and a small lung mass, with limited tissue available for molecular testing. She responded to empiric, urgent initiation of osimertinib, repeat tissue sampling revealed an EGFR L858R mutation, and she has experienced durable disease improvement for 18 months on osimertinib monotherapy.

Do Medical Students Appreciate Lifestyle Medicine and Are They Confident in Their Skills?

Introduction: As the prevalence of chronic diseases increases worldwide, there is a need for educating future physicians in the use of lifestyle medicine to treat and prevent diseases. Any addition to the undergraduate medical curriculum requires a strategic educational approach with consideration for efficiency. This study aims to identify priorities for lifestyle medicine interventions in the undergraduate medical curriculum. Methods: Third-year medical students (N=115) were surveyed on their beliefs about lifestyle medicine and their confidence in lifestyle medicine skills. The survey consisted of seven items to which students responded with how closely they agreed via a 5-point Likert scale. Descriptive statistics were reported. Results: Most medical students entering their clinical years understand the value of lifestyle medicine in patient care (100%) and want to learn the skills and knowledge involved (98.2%). The value of lifestyle medicine counseling skills during the limited patient-doctor time was least universally acknowledged among third-year medical students (93.9%). Third-year medical students are most confident in being able to obtain a comprehensive lifestyle history (3.6±0.8) and least confident in setting clear, personalized, lifestyle change goals (3.1±0.9). Conclusion: Future interventions to increase confidence in lifestyle medicine skills should focus on educating students on setting lifestyle change goals, personalizing prescriptions, and motivational interviewing for use in clinical care.

Current practices in the instruction of lifestyle medicine in medical curricula.

OBJECTIVE: A review of current practices of educational interventions for lifestyle medicine was performed to inform the design of interventions with long-term goals of improving patient outcomes. METHODS: Systematic review of PubMed, MedEdPORTAL, and Cochrane using keywords "lifestyle medicine," "education," "medical students," and "medical school" was done by 3 independent reviewers. Location, learner, curricular hours, focus, outcomes, and impact are reported. RESULTS: Of 452 identified citations, 32 met criteria. Most studies (81%) were conducted in the U.S. and designed for medical students (72%). Studies focused primarily on nutrition (78%) and exercise (59%). Curricula were delivered on average across 13.7 h. Lectures were used in 53% of papers. The outcomes most commonly studied were satisfaction (66%,), knowledge perception (66%), and reported clinical practices (34%). Intervention impact at level 2b (31%) and level 3 (34%) were most common. CONCLUSION: Medical educators looking to integrate lifestyle education curriculum should consider current resources as a starting point, especially ones with higher outcome measurements. PRACTICE IMPLICATIONS: Novel interventions should target lifestyle medicine competencies with equitable distribution among learners using active learning approaches. The authors propose initial efforts focusing on instruction of clinical educators and practicing physicians, with advocacy for increased reimbursement.

Cultural Sensitivity and Learning About Healthcare Equity for the Underserved: Experiential Learning in a Student-Run Free Clinic.

With increased diversity in the USA comes a growing need to educate medical students on how best to manage diverse patient populations. Medical students on the board of a student-run free clinic (SRFC) were surveyed to determine how such a leadership experience might alter students' cultural sensitivity as it relates to healthcare equity. Forty-six students (42.2% response) reported their experiences helped them better understand patient's needs (4.37, 0.64; mean, SD), cultural barriers (4.44, 0.55), and racial/ethnic disparities (4.27, 0.70). Thus, service on the board of a SRFC improves cultural sensitivity.

Meta-Analysis Reveals the Prognostic Relevance of Nuclear and Membrane-Associated Bile Acid Receptors in Gastric Cancer.

INTRODUCTION: Bile acids (BAs) arising from duodenogastric reflux are known to facilitate gastric cancer (GC) development. Although BAs traditionally contribute to carcinogenesis through direct cellular cytotoxicity, increasing evidence implicates nuclear and membrane BA receptors (BARs) as additional factors influencing cancer risk. Indeed, some BARs are already linked with GC, but conflicting evidence and lack of information regarding other endogenous BARs warrant further investigation. In this study, we meta-analyzed multiple data sets to identify clinically relevant relationships between BAR expression and prognosis, clinicopathology, and activity in GC. METHODS: We collected transcriptomic data from the Gene Expression Omnibus and The Cancer Genome Atlas to analyze associations between BAR expression and GC prognosis, subtype, and clinicopathology. We also used Ingenuity Pathway Analysis to assess and predict functions, upstream regulators, and downstream mediators of membrane and nuclear BARs in GC. RESULTS: BARs showed differential distribution in GC; membrane BARs (G protein-coupled BAR 1, sphingosine-1-phosphate receptor 2, and cholinergic receptor muscarinic 2) were enriched in diffuse-, genome-stable, and mesenchymal-type tumors, whereas nuclear BARs (pregnane-X-receptor, constitutive androstane receptor, and farnesoid-X-receptor) were enriched in chromosome instability and metabolic subtypes. High expression of all membrane but not nuclear BARs was associated with poor prognosis and unfavorable GC clinicopathologic features. Similarly, expression patterns of membrane but not nuclear BARs varied geographically, aligning with Helicobacter pylori infection and GC mortality rates. Finally, GC-related oncogenes, namely transforming growth factor ß1, were associated with membrane BARs, whereas many metabolic-associated genes were associated with nuclear BARs. DISCUSSION: Through transcriptomic meta-analysis, we identified distinct expression profiles between nuclear and membrane BARs that demonstrate prognostic relevance and warrant further investigation.

A patient-centredness improvement study for efficacy of behaviour change for healthy lifestyle and weight loss in a student-run free clinic.

BACKGROUND: Primary care is the ideal place to implement behaviour change interventions for weight management. However, most primary care physicians are not managing patient weight as a standard of care due to lack of knowledge, skills and reimbursement. Generating more physicians who are familiar and comfortable with providing weight management is essential in leveraging a global change. In our university free clinic, medical students provide healthy lifestyle counselling using shared decision making to each patient at every clinic visit. OBJECTIVE: Improve the efficacy of behaviour change interventions via increased patient responsiveness and adherence. METHODS: The needs assessment demonstrated a subpar patient response rate to check-ins regarding behavioural change goals. In the first and second interventions, check-in message structure and contact schedule were varied to maximize patient responsiveness and goal achievement. RESULTS: In the needs assessment, 58% of patients responded to follow-ups and 58% of patients accomplished their goal. The first intervention cycle resulted in an improvement of responsiveness to 70% and accomplishment of goals to 59%. The second intervention cycle resulted in an improvement of responsiveness to 78% and accomplishment of goals to 74%. CONCLUSIONS: Messages that were frequent, unique, succinct and delivered within 4 weeks after the clinic visit resulted in the highest response rate and goal attainment. Other primary care clinics can use these interventions to increase patient completion of implemented behaviour changes for a healthier lifestyle.

An Evidence-Based Guide for Medical Students: How to Optimize the Use of Expanded-Retrieval Platforms.

Recommendations have been made for improving medical education based on the available evidence regarding learning. Traditional learning methods in medical education (e.g. reading from textbooks) do not ensure long-term retention. However, expanded-retrieval studying methods have been shown to improve studying efficiency. Using evidence-based practices to optimize an expanded-retrieval platform has the potential to greatly benefit knowledge acquisition and retention for medical students. This literature review was conducted to identify the best practices of expanded-retrieval platforms. Themes within learning that promote knowledge gain and retention include presentation of related categorical information, schema formation, dual-coding, concrete examples, elaboration, changes in text appearance, and interleaving. Presentation of related categorical material together may mitigate retrieval-induced forgetting (RIF). Spaced retrieval helps to reinforce schema formation by solidifying the framework the individual students form when learning the material. Dual-coding improves learning by creating more neural pathways. Multiple concrete examples can be compared by students to see their respective differences, highlighting the true underlying principle. Variation in text appearance is most useful during the initial, short-term inter-study intervals. Interleaving is a theme where different topics are combined in the same study session and is unpopular with students but shown to be successful. Students' subjective competency ratings of new material are largely inaccurate. More in-depth processing and learning methods that give off a sense of lower competency are actually associated with improved long-term retention. Expanded-retrieval platforms should utilize these evidence-based components of learning to increase knowledge gain and retention within all fields of medical education.