American journal of hospital medicine, volume 4, issue 1 (2020 January-March)
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Item Single-cell RNA-sequencing reveals Transcriptional Changes and Clonal Architecture associated with Post-Transplant Relapse in Acute Myeloid Leukemia(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-01) Xu, Ziheng; Miller, Christopher A.; Srivatsan, Sridhar N.; Fronick, Catrina C.; Fulton, Robert S.; Ley, Timothy J.; Petti, Allegra A."Acute myeloid leukemia (AML) is a malignancy characterized by overproduction of myeloid precursors at the expense of more differentiated, functional hematopoietic cells, resulting in anemia, thrombocytopenia, and neutropenia. Despite initial sensitivity to chemotherapy, a majority of patients with AML ultimately relapse. Among the challenges associated with relapse, post-allogeneic stem cell transplant relapse is particularly intractable because of our relative lack of understanding - and thus lack of effective treatment options - of the underlying mechanisms."--IntroductionItem Improving Confidence in ACLS among UMKC Internal Medicine Residents(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-01) Segebrecht, Ray; Samanta, Anweshan; Derbas, Laith; Scharber, Alison; Elkaryoni, Ahmed; Singh, Annapoorna; Myadam, Rahul; Choudhury, Adnan; Wooldridge, David; Gohar, Ashraf; Banderas, Julie"The American Board of Internal Medicine requires all residents to have their certification in basic life support (BLS) and advanced cardiovascular life support (ACLS) renewed every two years. However, there is concern that residents do not retain the confidence and the medical knowledge gained during this course throughout the two years that follow. The goal of our quality improvement project was to add a training workshop to improve resident confidence in performing ACLS."Item A re-challenging case(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-01) Schiffer, Walter; Zhang, Kathleen; Kyrouac, Douglas; Leniham, Daniel"Immune Checkpoint Inhibitors (ICI) are associated with multiple cardiotoxic effects. Balancing adverse effects with anti-tumor response poses a challenge to treating advanced cancers. The safety of re-starting ICI therapy after an adverse event is unknown. We present the case of a 58-year-old man with stage IV melanoma ICI-related myocarditis and complete heart block (CHB)."--IntroductionItem "The Show" must go on : improving the no show rate in an internal medicine resident clinic through continuous quality improvement using lean methodology(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-01) Prishchepove, Anna; Levanos, Thomas; Kornblum, Helen; Buchanan, Paula; Farrag, Safa"'No shows' or missed appointments impede optimal medical care and organizational functioning, particularly in primary care setting 1. They lead to expenses associated with loss of the continuity of care, inadequate control of chronic diseases, and increased rates of emergency visits and hospitalizations 2. Our aim was to implement a multidisciplinary continuous quality improvement methodology utilizing Lean to identify the gaps resulting in no shows and to apply specific interventions to lower their rate in our clinic."--Introduction.Item Do Areas with More Primary Care Physicians have Lower Cardiovascular and Cancer Mortality?(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-01) Palle, Sindhuja; Singh, Annapoorna; Angraal, Suveen"There are an estimated 647 000 deaths in the United states from cardiovascular disease (CVD) each year and 606 000 from cancer in 2019 [2,3] . Primary, secondary and tertiary prevention are all independent factors in reducing overall mortality among various diseases such as cancer and CVD. Primary care physicians (PCP) are generally the first point of contact between the patient and health care system and are in an optimal position to practice prevention through managing risk factors, detection, and appropriate use of specialists. According to the Association of American Medical colleges (AAMC), the United States would currently need an additional 95,000 doctors, including PCPs, if health care use patterns equalized across race, insurance coverage and geographic location which are also known individual risk factors for CVD and cancer mortality [4]. Hence, we hypothesize that varying degree of access to primary care physicians at county level in the United States can have an effect on the patterns of CVD and cancer mortality."--Introduction