Impact of a longitudinal course on medical professionalism on the empathy of medical students.

OBJECTIVE: Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4-6 of medical training) that uses reflective learning approaches. METHODS: 241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires - the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) - and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants' empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). RESULTS: Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups. CONCLUSION: A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures. PRACTICE IMPLICATIONS: Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy.

Combined procedure of heart transplantation and ascending aorta replacement.

Concomitant heart transplantation and ascending aorta replacement is infrequent. In the few cases where this simultaneous procedure was performed, most patients were diagnosed with Marfan syndrome. We report the combined procedure of heart transplantation and ascending aorta replacement using the donor's ascending aorta, in a 70-year-old man who was not diagnosed with Marfan syndrome. This combined procedure can be performed successfully, providing a potentially life-saving heart transplant for patients with aortic disease of different etiologies.

Multidetector computed tomography findings of dense pulmonary emboli in oncologic patients.

Pulmonary embolism is a frequent condition for which multidetector computed tomography (MDCT) plays an important role in its detection. Occasionally, on MDCT studies, dense linear branching opacities may be found within the pulmonary vessels. They represent dense emboli within the pulmonary arteries (DEPA). These may occur in oncologic patients that undergo specific treatments or interventional procedures, such as cement embolus from vertebroplasty, catheter or coil migration after embolization procedures, radioactive seed embolus in patients treated with local brachytherapy for prostate, lung, or liver cancer, and also in chronic pulmonary embolism. Usually DEPA does not have any clinical significance but may be fatal when massive or when in patients with impaired cardiopulmonary function. Being familiar with their radiologic appearance and knowing about the good clinical outcome of these patients will avoid unnecessary imaging testing. In this article, we describe some examples of DEPA. Based on the MDCT imaging findings, these emboli have very few or no side effects on the underlying lung parenchyma. We would like to stress the need for using bone window values for identifying these emboli. We provide examples of dense linear nonvascular images (pulmonary calcification secondary to tuberculosis (TBC) or radiotherapy, calcified mucous plugs, lung sutures, etc) that may mimic DEPA.

Non-electrocardiogram-gated multidetector-row computed tomography findings of cardiac pathology in oncologic patients.

Multidetector-row computed tomography (MDCT) plays an essential role in oncologic imaging as the modality of mapping out the treatment strategy at staging, assessing response to the treatment, and following up patient outcome after the treatment. Even without electrocardiogram gating, MDCT provides accurate information about the heart. In the group of oncologic patients, different tumoral and non-tumoral-related heart disorders can be found, for example, metastatic cardiac involvement (approximately 10% of patients with lung or breast cancer will develop metastases to the heart), paraneoplastic cardiac disorders, non-tumor-related heart disorders, and chemotherapy- and radiotherapy-related cardiac side effects. MDCT plays a role in the detection of these entities. We show the non-electrocardiogram-gated MDCT findings of oncology-related cardiac disorders to encourage radiologists to recognize and report cardiac findings in oncologic patients. Appropriate knowledge of tumoral and non-tumoral-related MDCT features allows a complete evaluation of oncologic patients with ancillary cardiac findings. An adequate knowledge of the patient's medical history, previous treatments, and concomitant illnesses is essential to interpret heart findings in oncologic patients who undergo MDCT.

Percutaneous balloon pericardial window for patients with symptomatic pericardial effusion.

PURPOSE: To describe the technique and our experience in percutaneous creation of a pericardial window in patients with recurrent pericardial effusion. METHODS: Eleven consecutive patients (9 men, 2 women; mean age 61 years, range 37-79 years) with recurrent pericardial effusion were treated from December 1994 to October 2000. Malignant effusion was the cause of cardiac tamponade in nine patients. Puncture of the pericardial space was performed under ultrasound and fluoroscopic guidance. Once a guidewire was safely positioned in the pericardial cavity and the wall of the pericardium was identified, the pericardial keyhole was dilated with an 18 mm balloon catheter. A temporary (1-3 day) 8 Fr pigtail catheter was inserted in order to stabilize the tract and aspirate the fluid. RESULTS: The aim of creating a pericardial window was achieved in all 11 patients. There were three recurrences (27%) of pericardial effusion and three early deaths (27%) due to progression of the underlying disease, which occurred within 30 days following the procedure. Follow-up ranged from 6 days to 382 days, mean 147 days. CONCLUSIONS: Percutaneous creation of a pericardial window can be a safe therapeutic alternative for patients with symptomatic pericardial effusion, particularly if this has a malignant etiology.