Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Filtros adicionales











País/Región como asunto
Intervalo de año
1.
J Oncol Pract ; 15(5): e439-e446, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30964734

RESUMEN

PURPOSE: Prospective hematology-oncology fellowship applicants use program Web sites as a critical source of information. The purpose of this study was to evaluate the current content and comprehensiveness of hematology-oncology fellowship Web sites and to identify specific areas for improvement. METHODS: This study assessed the presence of 27 commonly evaluated program and application and curriculum and training informational items for Web sites of all accredited hematology-oncology fellowship programs in 2018. The comprehensiveness score was calculated as the number of items present on a fellowship Web site out of 27 and was compared by program region and size using analysis of variance and two-tailed t tests. RESULTS: Of the 143 fellowship Web sites evaluated, the mean comprehensiveness score was 39.3% (10.6 ± 3.8 out of 27). Programs contained a mean of 42.1% (5.9 ± 2.3 out of 14) of program and application and 36.2% (4.7 ± 2.1 out of 13) of curriculum and training items. The program and application items most common among Web sites were program coordinator contact and faculty listing (83.2% and 74.1% of Web sites, respectively), whereas social events and salary and benefits were less common (31.5% and 20.3% of Web sites, respectively). Prevalent curriculum and training items were research publications and activity and rotation scheduling (86.0% and 81.1% of Web sites, respectively), whereas board examination pass rates and fellow call duties were uncommon (4.2% and 15.4% of Web sites, respectively). Large programs were associated with greater overall Web site items compared with small programs (43.0% [11.6 ± 4.1 out of 27] v 35.9% [9.7 ± 3.3 out of 27]; P = .003). CONCLUSION: Hematology-oncology fellowship Web sites vary considerably in the level and nature of content they contain. Because applicants rely on online information for decision making, more comprehensive online content may promote a better fit between program and applicant. There is room for improvement in hematology-oncology fellowship Web sites, and programs may consider directing resources toward enhancing these Web sites.

2.
Med Teach ; 41(8): 960-962, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30857449

RESUMEN

Intolerance of ambiguity among medical students is associated with negative attitudes towards psychosocially complex patients. In this paper, the authors evaluated the feasibility of a 3.5-hour workshop aimed at fostering tolerance for ambiguity in medical students through semi-structured interactions with horses that functioned as experiential surrogates for ambiguity. Among 26 first-year medical students who participated in the feasibility assessment, an overwhelming majority rated the workshop as academically valuable and recommended that it be offered again in the future. After feasibility was established, an additional group of 7 first-year medical students and 5 fourth-year students completed Budner's Tolerance of Ambiguity scale before and after the workshop to provide preliminary data on its effectiveness. The post-workshop mean scores on the Budner scale were lower than pre-workshop mean scores, suggesting that students developed greater tolerance for ambiguity following the workshop. This difference was statistically significant among the first-year students, but not among the fourth-year students. Our findings demonstrate that the equine-facilitated workshop is feasible and can potentially help medical students develop greater tolerance for ambiguity.

5.
Acad Med ; 91(3): 322-7, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26630602

RESUMEN

In comics, "gutters" are the empty spaces between panels that readers must navigate to weave disjointed visual sequences into coherent narratives. A gutter, however, is more than a blank space--it represents a creative zone for making connections and for constructing meaning from disparate ideas, values, and experiences. Over the course of medical training, learners encounter various "gutters" created by the disconnected subject blocks and learning experiences within the curriculum, the ambiguity and uncertainty of medical practice, and the conflicts and tensions within clinical encounters. Navigating these gutters requires not only medical knowledge and skills but also creativity, defined as the ability to make connections between disparate fragments to create meaningful, new configurations. To cultivate medical students' creative capacity, the authors developed the Integrated Clinical Arts (ICA) program, a required component of the first-year curriculum at the Warren Alpert Medical School of Brown University. ICA workshops are designed to place students in a metaphorical gutter, wherein they can practice making connections between medicine and arts-based disciplines. By playing in the gutter, students have opportunities to broaden their perspectives, gain new insights into both medical practice and themselves, and explore different ways of making meaning. Student feedback on the ICA program highlights an important role for creativity and the arts in medicine: to transform gutters from potential learning barriers into opportunities for discovery, self-reflection, and personal growth.


Asunto(s)
Creatividad , Curriculum , Educación Médica , Medicina en las Artes , Competencia Clínica , Formación de Concepto , Humanos
8.
Cancer Chemother Pharmacol ; 68(4): 1075-80, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21761371

RESUMEN

PURPOSE: Gemcitabine induces a 20% response as single-agent therapy in patients with relapsed or refractory NHL. We report phase I findings of gemcitabine in combination with standard CHOP chemotherapy with G-CSF support for intermediate grade NHL. The protocol was modified during enrollment to include rituximab in CD 20+ lymphomas. METHODS: Patients received CHOP plus gemcitabine at 500 mg/m(2) (Cohort 1) or 750 mg/m(2) (Cohort 2) on days 1 and 4 of each 21-day cycle. Accrual was suspended once each cohort was filled. Dose escalation occurred after all patients in the cohort were determined to not have a dose-limiting toxicity. RESULTS: Between April 2002 and May 2004, 10 patients were enrolled and completed the study treatment (6 in Cohort 1, 4 in Cohort 2). In Cohort 1, grade 3 toxicities included neutropenia, anemia, neuropathy, and constipation. Grade 4 toxicities were febrile neutropenia and thrombocytopenia. In Cohort 2, grade 3 toxicities included neutropenia, thrombocytopenia, mucositis, anemia, and intestinal obstruction. Grade 4 toxicities included febrile neutropenia, neutropenia, and thrombocytopenia. One patient developed MDS 36 months after chemotherapy. Three of four patients in Cohort 2 developed dose-limiting toxicities (mucositis and thrombocytopenia) requiring dose reduction in gemcitabine after cycle 1. Overall, the survival rate at 2.5 years was 71%. CONCLUSIONS: This Phase I trial concludes that gemcitabine 500 mg/m(2) on days 1 and 4 of each 21-day cycle is the maximum tolerated dose when combined with standard CHOP chemotherapy with G-CSF support for intermediate grade NHL.


Asunto(s)
Antígenos CD20/inmunología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Estudios de Seguimiento , Humanos , Dosis Máxima Tolerada , Persona de Mediana Edad , Prednisona/administración & dosificación , Prednisona/efectos adversos , Prednisona/uso terapéutico , Rituximab , Tasa de Supervivencia , Resultado del Tratamiento , Vincristina/administración & dosificación , Vincristina/efectos adversos , Vincristina/uso terapéutico
9.
Virulence ; 2(1): 4-11, 2011 Jan-Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21224728

RESUMEN

Splenosis describes ectopic splenic tissue found in patients after rupture of the spleen. These implants are commonly located on the omentum but can be scattered throughout the body in varying number and size. Although splenosis was first documented over a century ago, the precise mechanism for its development remains unknown. The degree of immunoprotection offered by this tissue remains unclear. Much of the human data is in the form of case reports documenting failure of splenotic tissue to protect against septicemia. Even accessory spleens may not offer complete protection once the primary spleen is removed. This review of the literature demonstrates that no amount of splenosis should be considered protective against overwhelming post-splenectomy infection.


Asunto(s)
Sepsis/fisiopatología , Esplenosis/fisiopatología , Animales , Humanos , Sepsis/inmunología , Sepsis/microbiología , Sepsis/cirugía , Bazo/anatomía & histología , Bazo/inmunología , Bazo/fisiopatología , Bazo/cirugía , Esplenosis/inmunología , Esplenosis/cirugía
10.
Blood Coagul Fibrinolysis ; 21(5): 431-5, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20595823

RESUMEN

Patients with chronic liver disease are susceptible to bleeding and thrombotic complications of their disease, but the incidence of thrombosis and what predisposes them to thrombotic disease is largely unknown. One hundred and eight patients with chronic liver disease admitted with a first episode of venous thromboembolism, matched with patients of similar age, sex, and cause of liver disease without thrombosis were compared in a retrospective, case-control study over a 4-year period at two academic hospitals in Rhode Island. Incidence was determined from all admissions of patients with chronic liver disease during the specified time. Minimum and maximum values of complete blood counts, liver and kidney function tests, and coagulation tests during admission were compared between cases and controls. Incidence of new venous thrombosis in patients admitted with chronic liver disease was 0.73%. Patients with thromboses were more likely to have a lower albumin (2.77 vs. 3.49; P < 0.01) and hematocrit (37.7 vs. 40.2; P < 0.01) and higher platelet counts (143 vs. 109; P = 0.03), bilirubin (1.71 vs. 1.11; P < 0.01) and activated partial thromboplastin time (87 vs. 60.3; P < 0.01) as compared with controls. Although the incidence of thrombosis in patients with chronic liver disease is lower than the general medical population, hypoalbuminemia, anemia, and hyperbilirubinemia may confer increased risk of thrombosis whereas thrombocytopenia may be protective. Elevation of traditional markers of coagulation such as the prothrombin time and partial thromboplastin time does not safeguard against thrombotic events.


Asunto(s)
Hepatopatías/complicaciones , Trombosis de la Vena/complicaciones , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rhode Island , Factores de Riesgo
12.
J Grad Med Educ ; 2(2): 201-5, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21975620

RESUMEN

BACKGROUND: Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions. INTERVENTION: We created a survey to judge patient satisfaction and to determine who patients believe is their "main physician" on the teaching service. METHODS: Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages. RESULTS: Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician. CONCLUSION: Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.

13.
Am J Surg Pathol ; 31(9): 1439-45, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17721201

RESUMEN

Human herpesvirus-8 (HHV-8) is associated with several distinct lymphoproliferative disorders: primary effusion lymphoma, multicentric Castleman disease (MCD), MCD-associated plasmablastic lymphoma and HHV-8+, Epstein-Barr virus (EBV)+ germinotropic lymphoproliferative disorder. We report the case of a human immunodeficiency virus (HIV)+ male with fever, generalized lymphadenopathy, and splenomegaly. Two peripheral lymph nodes were excised and showed features of MCD and a prominent proliferation of HHV-8+, EBV+, CD20, CD138, MUM1+, lambda dim+, Ig heavy chain plasmablasts and immunoblasts replacing some follicles. Subsequently, a splenectomy and biopsy of retroperitoneal lymph nodes were performed; the retroperitoneal and splenic hilar lymph nodes showed changes similar to those in the peripheral lymph nodes while the markedly enlarged spleen showed replacement of occasional white pulp by the HHV-8+, EBV+ large cells. The histologic features and coinfection by EBV and HHV-8 suggested a diagnosis of HHV-8+ germinotropic lymphoproliferative disorder. However, the occurrence in an HIV+ individual, the background of MCD, the widespread anatomic distribution and the aggressive clinical course tended to exclude germinotropic lymphoproliferative disorder, and to favor multifocal plasmablastic microlymphoma. The patient died shortly after surgery; postmortem examination showed progression to overt lymphoma. The marrow showed extensive hemophagocytosis, consistent with development of a hemophagocytic syndrome. This unique case has clinical features compatible with a MCD-associated plasmablastic lymphoproliferative disorder, with pathologic features intermediate between HHV-8+ plasmablastic microlymphoma, and HHV-8+ germinotropic lymphoproliferative disorder, although in contrast to both of these, in our case, light chain expression was dim and heavy chain was not detected.


Asunto(s)
Enfermedad de Castleman/diagnóstico , Seropositividad para VIH/complicaciones , Herpesvirus Humano 4/aislamiento & purificación , Herpesvirus Humano 8/aislamiento & purificación , Linfoma/virología , Trastornos Linfoproliferativos/diagnóstico , Antígenos CD20/análisis , Células de la Médula Ósea/patología , Células de la Médula Ósea/virología , Enfermedad de Castleman/inmunología , Enfermedad de Castleman/patología , Enfermedad de Castleman/virología , Proliferación Celular , Diagnóstico Diferencial , Progresión de la Enfermedad , Resultado Fatal , Humanos , Factores Reguladores del Interferón/análisis , Antígeno Ki-67/análisis , Ganglios Linfáticos/patología , Ganglios Linfáticos/virología , Linfohistiocitosis Hemofagocítica/patología , Linfohistiocitosis Hemofagocítica/virología , Linfoma/inmunología , Linfoma/patología , Trastornos Linfoproliferativos/inmunología , Trastornos Linfoproliferativos/patología , Trastornos Linfoproliferativos/virología , Masculino , Persona de Mediana Edad , Receptores de Complemento 3d/análisis , Esplenomegalia/patología , Esplenomegalia/virología , Sindecano-1/análisis
14.
Medicine (Baltimore) ; 86(4): 225-32, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17632264

RESUMEN

Type B lactic acidosis is a rare complication of hematologic malignancies. The exact mechanism of this process is not well understood. Because caregivers may not be aware of the association of type B lactic acidosis with hematologic malignancies, it may go unrecognized as a cause of acidosis in these patients. We report the cases of 7 patients with type B lactic acidosis who were cared for by members of the Brown Medical School Hematology/Oncology Division. Of the 7 patients reported, 5 had lymphomas and 2 had chronic lymphocytic leukemia. One of the lymphomas was a T-cell lymphoma. Of the patients we were able to evaluate, there did not seem to be a unique cluster of differentiation marker in association with type B lactic acidosis. We also review 14 additional cases, most reported since 2001. From our review of the literature, we suggest that a deficiency of thiamine or riboflavin may play a more pivotal role than previously recognized in the development of type B lactic acidosis associated with malignancy. Further investigation should be undertaken to learn if thiamine or riboflavin replacement might be useful in treating this disorder.


Asunto(s)
Acidosis Láctica/etiología , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Mieloide Aguda/complicaciones , Linfoma no Hodgkin/complicaciones , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
15.
AIDS Read ; 17(12): 596-8, 601, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18178978

RESUMEN

The case of a 45-year-old man with HIV disease with bulky lymphadenopathy, fevers, and weight loss is presented. Immune reconstitution inflammatory syndrome was initially believed to be the cause, but the patient was found to suffer from Kaposi sarcoma, multicentric Castleman disease, hemophagocytic syndrome, and a newly described lymphoproliferative disorder. The diagnostic reasoning related to the causes of the fulminant illness is discussed as well as the roles of Epstein-Barr virus, human herpesvirus 8, and hepatitis C virus in the patient's clinical presentation and the therapeutic choices.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por Herpesviridae/complicaciones , Herpesvirus Humano 8 , Linfohistiocitosis Hemofagocítica/complicaciones , Trastornos Linfoproliferativos/complicaciones , Sarcoma de Kaposi/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Enfermedad de Castleman/complicaciones , Enfermedad de Castleman/diagnóstico , Enfermedad de Castleman/patología , Diagnóstico Diferencial , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , VIH-1 , Infecciones por Herpesviridae/diagnóstico , Infecciones por Herpesviridae/patología , Humanos , Ganglios Linfáticos/citología , Ganglios Linfáticos/virología , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/patología , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/patología , Masculino , Persona de Mediana Edad , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/patología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA