Spontaneous Pneumothorax in an Elderly Patient With Coronavirus Disease (COVID-19) Pneumonia.

Background: The relationship between the 2019 novel coronavirus (COVID-19) and pneumothorax is not yet established. As of June 2020, few cases of nonintubated patients developing pneumothorax had been documented. Case Report: We present the case of an elderly patient with COVID-19 pneumonia that resulted in a prolonged hospital course because of pneumothorax complication. The patient did not develop severe symptoms and did not require intubation. Conclusion: This case report should aid clinicians assessing patients with COVID-19 pneumonia.

Medical student preferences for the internal medicine residency interview day: A cross-sectional study.

BACKGROUND: Applicant recruitment is an essential part of a residency program's activities with valuable resources dedicated to ensuring its success. Most programs design interview days based on a mix of tradition, budget availability and perception of applicant preferences. There is a paucity of available data on preferences of applicants for interview days. OBJECTIVE: We sought to investigate Internal Medicine applicant preferences for a residency recruitment day in aggregate and stratified by medical school background: United States vs. International Medical School Graduate. METHODS: A survey was developed and used in a cross-sectional study of Internal Medicine categorical and preliminary medicine candidates. Applicants ranked different facets of the interview day using a Likert scale. Variables included interview type, start time, length of interview day, number of interviews, length of each interview, background of interviewers, types of questions, interaction time with residents, month of interview, and components of interview day. RESULTS: 265 applicants received the surveys and 215 completed them correctly (81%). Overall, applicants tended to favor an 8-9 am start time (81.9%) and an optimal duration of four hours (82.8%). The interview was the most preferred component of the day (80.0%) with one-on-one (98.1%) and 15-30 min (95.3%) interviews preferred. Several statistically significant differences were found between the United States and International students as well as Categorical and Preliminary applicants. CONCLUSION: Our findings offer insights into various factors of the interview day that may appeal to Internal Medicine candidates. This information will be useful to graduate medical education departments engaged in recruitment.

Bullying in the American Graduate Medical Education System: A National Cross-Sectional Survey.

OBJECTIVES: To deliver an estimate of bullying among residents and fellows in the United States graduate medical education system and to explore its prevalence within unique subgroups. DESIGN/SETTING/PARTICIPANTS: A national cross-sectional survey from a sample of residents and fellows who completed an online bullying survey conducted in June 2015. The survey was distributed using a chain sampling method that relied on electronic referrals from 4,055 training programs, with 1,791 residents and fellows completing the survey in its entirety. Survey respondents completed basic demographic and programmatic information plus four general bullying and 20 specific bullying behavior questions. Between-group differences were compared for demographic and programmatic stratifications. MAIN OUTCOMES/MEASURES: Self-reported subjected to workplace bullying from peers, attendings, nurses, ancillary staff, or patients in the past 12 months. RESULTS: Almost half of the respondents (48%) reported being subjected to bullying although both those subjected and not subjected reported experiencing ≥ 1 bullying behaviors (95% and 39% respectively). Attendings (29%) and nurses (27%) were the most frequently identified source of bullying, followed by patients, peers, consultants and staff. Attempts to belittle and undermine work and unjustified criticism and monitoring of work were the most frequently reported bullying behaviors (44% each), followed by destructive innuendo and sarcasm (37%) and attempts to humiliate (32%). Specific bullying behaviors were more frequently reported by female, non-white, shorter than < 5'8 and BMI ≥ 25 individuals. CONCLUSIONS/RELEVANCE: Many trainees report experiencing bullying in the United States graduate medical education programs. Including specific questions on bullying in the Accreditation Council for Graduate Medical Education annual resident/fellow survey, implementation of anti-bullying policies, and a multidisciplinary approach engaging all stakeholders may be of great value to eliminate these pervasive behaviors in the field of healthcare.

Two Cases of Acute Renal Infarction in the Setting of Atrial Fibrillation.

BACKGROUND: Acute renal infarction (ARI) is an uncommon and often overlooked diagnosis in patients presenting with acute kidney injury and abdominal pain. CASE REPORTS: We present 2 cases of ARI in the setting of atrial fibrillation along with a review of medical literature pertaining to ARI. CONCLUSION: This article should aid clinicians in the diagnosis of ARI.

Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism.

BACKGROUND: Tissue plasminogen activator (tPA) is used emergently to dissolve thrombi in the treatment of fulminant pulmonary embolism. Currently, there is a relative contraindication to tPA in the setting of traumatic or prolonged cardiopulmonary resuscitation > 10 minutes because of the risk of massive hemorrhage. METHODS: Our single-center, retrospective study investigated patients experiencing cardiac arrest (CA) secondary to pulmonary embolus. We compared the effectiveness of advanced cardiac life support with the administration of tPA vs. the standard of care consisting of advanced cardiac life support without thrombolysis. The primary endpoint was survival to discharge. Secondary endpoints were return of spontaneous circulation (ROSC), major bleeding, and minor bleeding. RESULTS: We analyzed 42 patients, of whom 19 received tPA during CA. Patients who received tPA were not associated with a statistically significant increase in survival to discharge (10.5% vs. 8.7%, P = 1.00) or ROSC (47.4% vs. 47.8%, P = 0.98) compared to the control group. We observed no statistically significant difference between the groups in major bleeding events (5.3% in the tPA group vs. 4.3% in the control group, P = 1.00) and minor bleeding events (10.5% in the tPA group vs. 0.0% in the control group, P = 0.11). CONCLUSION: This study did not find a statistically significant difference in survival to discharge or in ROSC in patients treated with tPA during CA compared to patients treated with standard therapy. However, because no significant difference was found in major or minor bleeding, we suggest that the potential therapeutic benefits of this medication should not be limited by the potential for massive hemorrhage. Larger prospective studies are warranted to define the efficacy and safety profile of thrombolytic use in this population.

Vascular closure devices in acute coronary syndromes: from arbitrary to a necessity?

Vascular closure devices (VCDs) were initially developed to improve access site hemostasis and allow for earlier ambulation in patients undergoing diagnostic catheterization and percutaneous coronary intervention (PCI). Though initially thought to be beneficial, large meta-analysis has shown conflicting data regarding whether VCDs alter access site bleeding in a variety of clinical settings. One area of particular interest for the adoption of VCDs has been in the setting of acute coronary syndromes (ACS) in which multiple antiplatelet strategies are often employed leading to a high risk of bleeding. Bleeding in ACS has been shown to be a powerful independent predictor of 30-day mortality. Recently, investigators have reported that VCDs reduce access site bleeding in the setting of ACS. In our review, we use several selected representative clinical trials to provide a historical account for the use of VCDs. We also provide for a review of data as it relates to access site bleeding in ACS along with analysis showing that VCDs may potentially provide for reductions in bleeding and vascular complications in patients with ACS undergoing PCI.