Disseminated Legionella micdadei infection in a liver transplant patient presenting as pulmonary nodules and a laryngeal lesion.

We report a liver transplant patient with disseminated Legionella micdadei infection with pulmonary, laryngeal, and suspected muscle involvement. This organism, which stains weakly acid-fast, primarily affects immunocompromised patients. The diagnosis is difficult to make; in this case, the organism was identified via molecular diagnostics on laryngeal and pulmonary biopsy tissue.

Embodied health: the effects of a mind-body course for medical students.

OBJECTIVE: An effective career in medicine requires empathy and compassion, yet the demands of a medical education increase stress and decrease students' ability to connect with patients. However, research suggests mind-body practices improve psychological well-being. This study aimed to evaluate the psychological effects on medical students of an 11-week elective course, Embodied Health or EH, which combines yoga and meditation with neuroscience didactics. METHODS: The effects on 27 first- and second-year medical students were evaluated via surveys in four areas: empathy, perceived stress, self-regulation, and self-compassion. Scales used were 1. Jefferson Scale of Physician Empathy, which measures empathy among health students and professionals and medical students on a scale of 1 (least empathetic) to 7 (most empathetic); 2. Cohen's Perceived Stress Scale, a measure of the perceived uncontrollability of respondents' lives, from 0 (least stressed) to 4 (most stressed); 3. Self-Regulation Questionnaire, which measures the development and maintenance of planned behavior to achieve goals, from 1 (least self-regulated) to 5 (most self-regulated); and 4. Self-Compassion Scale, which measures self-criticism, from 1 (least self-compassionate) to 5 (most self-compassionate). Students also reflected on EH's impact on their well-being in a post-course essay. RESULTS: Self-regulation and self-compassion rose 0.13 (SD 0.20, p=0.003) and 0.28 (SD 0.61, p=0.04), respectively. Favorable changes were also seen in empathy and perceived stress, which went up by 0.11 (SD 0.50, p=0.30) and down by 0.05 (SD 0.62, p=0.70), respectively; these changes did not reach statistical significance. Students' essays were found to discuss the following recurrent themes: 1) Reconnection between mind and body; 2) Community in a competitive environment; 3) Increased mindfulness; 4) Confidence in use of mind-body skills with patients; and 5) Stress management. These themes overlapped with the measures EH affected quantitatively. CONCLUSION: A mind-body course for medical students increased self-regulation and self-compassion. Qualitative themes discussed in students' post-course essays reflected these effects.

Have you had a tetanus booster in the last 10 years? Sensitivity and specificity of the question.

OBJECTIVE: To evaluate the accuracy of patients' recall of their last Tetanus/Diphtheria (Td) booster in the setting of employee health clinics known for high immunization rates and good documentation of vaccine status. METHODS: Five hundred and seventy-two patients of an employee health clinic answered a written questionnaire about whether they have had a Td booster in the last 10 years. Answers were compared with patients' charts as the gold standard. RESULTS: The sensitivity of the question is 92.4% (95% CI 89.0-95.0) and specificity is 26.5% (95% CI 12.9-44.4). Positive predictive value is 92.6% (95% CI 89.3-95.2) and negative predictive value is 25.7% (95% CI 12.5-43.3). Age and gender do not affect the accuracy of recall. CONCLUSION: A positive answer to this question is highly reliable whereas a negative answer is unreliable. PRACTICE IMPLICATIONS: In the setting of employee health clinics, when patients affirm the receipt of a Td booster within the previous 10 years, it is quite likely that they are up to date and do not require re-administration of the vaccine. Any other answer to this question (No, I do not know) is unreliable and a booster should be recommended if not contraindicated.