Leptomeningeal Metastasis: A Rare Complication of Non-small Cell Lung Cancer.

Leptomeningeal metastasis (LMM) is a rare complication of non-small cell lung cancer (NSCLC) that can present with a range of neurological symptoms depending on the site(s) of metastatic involvement. We present a case of a 54-year-old woman who was initially diagnosed with suspected inflammatory neuritis secondary to a known systemic lupus erythematosus (SLE) diagnosis after presenting with multiple months of progressive neuro-ophthalmologic symptoms; however, she was eventually diagnosed with LMM secondary to a previously undiagnosed NSCLC. This case both underscores the challenges of diagnosing LMM due to its nonspecific presentation, as well as highlights the importance of including LMM in the differential diagnosis for patients presenting with vague neurological symptoms in the context of another inflammatory disease process.

Levetiracetam-induced pancytopenia.

Pancytopenia is a rare side effect of levetiracetam (LEV) that is associated with severe morbidity that requires hospitalization. Here, we report a patient with a right temporoparietal tumor who underwent a temporal craniotomy with resection of the mass and was started on LEV for seizure prophylaxis per the neurosurgery local protocol. The patient developed LEV-induced pancytopenia, which was successfully managed by discontinuation of this medication.

Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study.

Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills.

A cost-effective interdisciplinary approach to microbiologic send-out test use.

Context: Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine.

Objective: To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing.

The ever-widening training-practice gap.

The quality of health care in this country depends, in part, on the quality of physician training. Educators in graduate medical education (GME) increasingly are concerned that residency training is not keeping pace with the changing demands of medical practice. This widening training-practice gap creates challenges for physicians entering practice, burdens physician employers with educational responsibilities, and has the potential to negatively affect the quality of health care.