Pleuroparenchymal fibroelastosis as a late complication of childhood cancer therapy: A case series.

Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial pneumonia with distinct clinicopathologic features. It has been associated with exposure to hematopoietic stem cell transplantation (HSCT) and classical alkylating agents. Here, we highlight PPFE as a late complication of childhood cancer therapy by describing the cases of four survivors of childhood cancer with a diagnosis of treatment-related PPFE. All patients received high-dose alkylating agents. PPFE should be considered in the differential diagnosis of restrictive lung disease in patients with history of exposure to alkylating agents or HSCT. Development of PPFE-specific, noninvasive diagnostic tools and disease-modifying therapies will clinically benefit these patients.

The Bloody Board Game: A Game-Based Approach for Learning High-Value Care Principles in the Setting of Anemia Diagnosis.

Introduction: With growing health care costs, high-value care is an increasingly important subject for medical training. Many resident and medical student curricula have incorporated lectures-based material about this topic. However, practical-type experiences are needed to refine critical-thinking skills essential for high-value care. Methods: To provide such practical experiences, we developed an instructional game for resident-level education that incorporated cost-constraint-based approaches in the workup of anemia. To play the game, teams of learners were given patients with anemia of unknown cause. To pay for their diagnostic tests of choice, teams earned money by correctly answering internal medicine resident-level anemia questions. The first team to successfully work up and diagnose three patients won. Results: Resident learners had very positive reviews of our game. As a team, groups of residents across all levels were able to develop cost-effective strategies for diagnosis. Our game also served as a resource for anemia education. Residents on average felt the game enhanced their ability to apply medical knowledge and clinical reasoning (M = 4.7 out of 5, where 5 = strongly agree), as well as high-value care (4.6), and should remain in the program for the high-value care curriculum (4.9). Discussion: Game-based learning provides a fun, orthogonal approach to learning critical-thinking skills used during anemia diagnostic patient workups. Although we did not quantify change in diagnostic test ordering, according to resident-learners, our high-value care game improved their ability to integrate cost-effective strategies into their practice of medicine.