Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report.

Background: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects.

Case Presentation: We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion.

CathAI: fully automated coronary angiography interpretation and stenosis estimation.

Coronary angiography is the primary procedure for diagnosis and management decisions in coronary artery disease (CAD), but ad-hoc visual assessment of angiograms has high variability. Here we report a fully automated approach to interpret angiographic coronary artery stenosis from standard coronary angiograms. Using 13,843 angiographic studies from 11,972 adult patients at University of California, San Francisco (UCSF), between April 1, 2008 and December 31, 2019, we train neural networks to accomplish four sequential necessary tasks for automatic coronary artery stenosis localization and estimation.

Intracoronary Imaging and Physiology to Guide PCI: Are We Ready for a Class I Guideline Recommendation?

Purpose Of Review: Over the last decade, there has been a plethora of evidence to support the utilization of intravascular coronary imaging and physiological assessment to guide percutaneous coronary interventions (PCI). While there is a class I recommendation for the use of coronary physiology to guide PCI, the use of intravascular coronary imaging remains a class IIa recommendation. Herein, we aimed to review the recent scientific evidence from major trials highlighting the consideration for a future class I guideline recommendation for the use of intracoronary imaging.

Acute coronary syndrome in patients with hemophilia: a delicate balancing act.

Therapeutic advances have resulted in increased life expectancy in patients with hemophilia. Consequently, the prevalence of coronary artery disease in this population is increasing. Little is known about the optimal management of acute coronary syndrome in these patients.

Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: The Asia-Pacific Left Main ST-Elevation Registry (ASTER).

Introduction: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Long-term outcomes of angiographically confirmed coronary stent thrombosis: results from a multicentre California registry.

Aims: Limited data exist on long-term outcomes of patients with stent thrombosis (ST). Our aim was to describe the long-term outcomes after angiographically confirmed ST.

Methods And Results: In this multicentre registry, consecutive cases of definite ST were identified between 2005 and 2013.

"Not so fast!" the complexity of attempting to decrease door-to-floor time for emergency department admissions.

Background: Successful quality improvement is fundamental to high-performing health care systems, but becomes increasingly difficult as systems become more complex. Previous attempts at the University of California, San Francisco (UCSF) Medical Center to reduce door-to-floor (D2F) time -the time required to move an ill patient through the emergency department (ED) to an appropriate inpatient bed-had not resulted in meaningful improvement. An analysis of why attempts at decreasing D2F times in the ED had failed, with attention to contextual factors, yields recommendations on how to decrease D2F time.

Identifying entrustable professional activities in internal medicine training.

Background: Entrustable professional activities (EPAs) can form the foundation of competency-based assessment in medical training, focused on performance of discipline-specific core clinical activities.

Objective: To identify EPAs for the Internal Medicine (IM) Educational Milestones to operationalize competency-based assessment of residents using EPAs.

Methods: We used a modified Delphi approach to conduct a 2-step cross-sectional survey of IM educators at a 3-hospital IM residency program; residents also completed a survey.

Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study.

Background: Graduate medical education programs assess trainees' performance to determine readiness for unsupervised practice. Entrustable professional activities (EPAs) are a novel approach for assessing performance of core professional tasks.

Aim: To describe a pilot and feasibility evaluation of two EPAs for competency-based assessment in internal medicine (IM) residency.

The value in the evidence: teaching residents to "choose wisely".

The Accreditation Council for Graduate Medical Education mandates that training physicians "incorporate considerations of cost awareness" into practice. However, medical education has traditionally avoided addressing costs, and most residency programs currently lack curricula to fulfill this requirement. With the recent widespread emphasis on unsustainable costs, inefficiencies, and waste in healthcare, the need to appropriately train physicians in this domain is increasingly apparent.

Who's underworked and who's overworked now? An update on radiologist shortage and surplus.

Objective: The purpose of this study was to present an updated report on the radiologist surplus and shortage situation using a recently developed improved measure-namely, the extent to which radiologists desire less or more work if their income were to change by the same percentage as their workload.

Materials And Methods: Non-individually identifiable data from the American College of Radiology's (ACR's) 2007 Survey of Diagnostic Radiologists were used. Responses were weighted to be representative of all posttraining professionally active radiologists in the United States.