TO: HTRS MembersPlease forward to others who may be interested.
Call for Applications: 2021 Pre-Symposium HTRS Trainee Workshop, “Building a Career in Hemostasis and Thrombosis”

Tuesday, March 9, 2021
The March 2021 HTRS Trainee Workshop will be a virtual eventThe APPLICATION DEADLINE has been EXTENDED to Friday, January 29, 2021 by 11:59 PM ETComplete and submit an Application located at:https://htrs.smapply.org/prog/2021_pre-htrs_virtual_htrs_trainee_workshopIf you have any issues accessing the online application, please contact HTRS at htrs@versiti.org.The Hemostasis and Thrombosis Research Society (HTRS) is now accepting applications from residents and fellows to attend the following educational activity:

Title:  “Building a Career in Hemostasis and Thrombosis”

Date:  Tuesday,  March 9, 2021

Time:  11:00 AM – 6:00 PM EST

Location:  The March 2021 HTRS Trainee Workshop will be a virtual event. Participants will receive login information closer to the date of the event.

Please see the Call for Applications for eligibility requirements, instructions for applying, and the event agenda.

We look forward to a successful workshop and to meeting our future leaders in benign hematology at this event!

Sincerely,The HTRS Trainee Workshop Planning Team:Arash Mahajerin, MD, MSCr – Chair
Lori Luchtman-Jones, MD
Michael White, MD, MSc

Friday School 1/22

This week at Friday School we took a deep dive in to various Major Neurocognitive Disorders(MNCD) with the assistance of Dr. Sladek and Dr. Chin. As differentiating MNCD relies heavily on history, we explored this topic via a “Choose Your Own Adventure” small group setting. Teams were given the opportunity to explore a fictional interaction with Mr. Schmitt to see how different HPIs resulted in a different diagnosis. Following our small group session we had a MNCD debrief with Dr. Sladek and Dr. Chin exploring common MNC disorders and how to differentiate between them. Furthermore we discussed how to work up MNCD and how to differentiate them from delirium!

In the second half of the session we transitioned our focus to Opiate Use Disorder and management strategies. We are grateful to Dr. Hill, Charat, Zayetes, Marienfeld and Vuong for lending us their perspective! OUD is an increasingly prevalent diagnosis in the US in which a large percentage of patients do not receive recommended treatment. According to some studies, only 25% of patients receive treatment within 3 months of their diagnosis. Some of the recommended therapies include methadone, naltrexone, and buprenorphine in combination with behavioral services. In the second hour we had the opportunity to learn from a patient about their experience with OUD as well as their insights into best practices that physicians can employ to help patients struggling with this diagnosis. We are deeply grateful to them for sharing their story!

Jacobs Afternoon Conference: Patient Safety!

Today during Jacobs Afternoon Conference, we continued our Hospital Medicine Pathway didactics with a case-based session on patient safety given by Dr. Komsoukaniants and Dr. Jenkins, two of our amazing hospital medicine attendings! We discussed several cases solicited from our residents and from our attendings. We focused on certain topics like overordering of imaging studies, the potential perils of ordering pharmacologic DVT prophylaxis in the hospital, delaying outpatient cancer and surgical care during an admission, handling delirium overnight, and potential adverse events from seemingly benign procedures such as feeding tube placement and urinary catheter placement. We ended the session with a few tips of advice for new hospital medicine attendings. Thanks to Dr. Komsoukaniants and Dr. Jenkins for leading the discussion!

They came in like a CAAAANNONBALL…

This morning’s VA MTC touched upon a case of cannonball lesions on chest xray! We got to review some key points about hemoptysis, how to triage patients presenting with this complaint, and then rounded it out with a review of which conditions lead to this distinct CXR finding!

  1. Cannonball metastases are typically described as discrete, well-circumscribed nodules seen on CXR or CT, usually of relatively uniform size
  2. These lesions are most commonly from one of 2 metastatic malignancies:
    • Renal Cell Carcinoma
    • Choriocarcinoma
  1. Something you can do when you see a CXR like this, is perform a testicular exam and consider lab tests associated with Choriocarcinoma (LDH, AFP, and beta-HCG)
  2. There are a few other malignancies that can cause this as well, but these are far less commonly associated:
    • Endometrial Cancer
    • Adrenal Cancer
    • Prostate Cancer
    • Synovial Sarcoma

JMC Afternoon Conference: Onc Emergencies!

Superior vena cava syndrome

Today during JMC afternoon conference we continued our Hospital Medicine Pathway didactics with a series of cases focused on oncologic emergencies. This session was mediated by Dr. Alex Truong and Dr. Jay Varughese, two of our fantastic hosptialists! We covered:

  1. Spinal cord compression due to spinal metastases: including the clinical presentation (weakness, saddle anesthesia), workup (MRI spinal imaging), and initial management steps (steroids, surgical consultation, and radiation treatment).
  2. Hypercalcemia of malignancy: including all the potential management options (cinacalcet, iHD, bisphosphonates, calcitonin, and their time courses for effect)
  3. SVC Syndrome: including how the chronicity and time course of presentation affect initial management (i.e. SVC stenting, chemotherapy, and radiation)
  4. Tumor lysis syndrome: including the management of TLS (Urate-lowering therapy, fluids, diuretics, and renal replacement therapy for anuria)

Video Vault from TCOYD!

Dr. Boeder and Dr. Edelman explaining the benefits of using CGM data!

Our endocrine faculty have released a new Video Vault through their nonprofit diabetes support organization, Taking Control Of Your Diabetes (TCOYD)! The Video vault has a ton of free video lectures geared towards patients and addressing every diabetes topic you can imagine. Check out their website below to see some of their informative talks!

Grand Rounds 1/20/21

Today Dr. Heather Patton gave an excellent grand rounds on the topic of Integration of Palliative Care into Medicine Subspecialty Clinics: The Case for Cirrhosis. Dr. Patton is an Associate Clinical Professor of Medicine at UCSD in the division of Hepatology and she is the Director of Population Management and Hepatology at the VA San Diego Healthcare System. 

Dr. Patton started with defining and reviewing barriers to palliative care.  Palliative care can be introduced early in the course of an illness and can be give with active therapy. Palliative care is give to help alleviate suffering among patients facing life limiting illness. There has been a shift in the traditional algorithm towards trying to introduce palliative care earlier in the course of disease. 

Dr. Patton also discussed the differences between primary care palliative care and speciality palliative care as described in the figure above. All physicians however should have the skills to assess palliative care concerns with their patients. Dr. Patton reviewed NCCN Distress thermometer and other functional assessments that can help us better evaluate palliative care needs in our patients. 

Dr. Patton also discussed care giver burden and the important role that plays. She showed us some tools we can use to help measure and predict caregiver strain. Families of patients with cirrhosis also face significant burdens including loss of savings, loss of employment, sense of entrapment, deferred education.

She also highlighted the importance that communication plays in delivering palliative care to our patients. Prognosis is also important and should be evaluated in our patients and communicated. Associated with this she discussed the SPIKES model as a tool to help us deliver bad news to patients. 

Dr. Patton reviewed health related quality of life and its impairment in patients with cirrhosis. It seems to be most impaired in those with HCV, PBC and NAFLD. It is associated with worse prognosis and increased hospitalization risk. She also reviewed where patients died among patients with cirrhosis. A large portion are still dying in the hospital and not at home or his a hospice setting. White patients are more likely to die in a hospice setting. 

Dr. Patton discussed how to better improve advanced care planning in outpatients with cirrhosis including having a standardized note template and educational session and better identification of patients in need of AD.  She also reviewed patient facing resources such as a website called prepare for your care. 

InTOXOcate me now – Britney (probably)

Today Dr. Sheila Bhavsar (PGY3 and rising UCSD Geriatrics Fellow!!) shared a case she saw while working on our Owen’s consult service. This patient presented with fevers and new-onset focal weakness, and was found to have new ring-enhancing lesions on his CT scan. We also discovered that this patient had a new diagnosis of HIV, with a CD4 count of only 5!! We talked about our differential for CNS lesions, contrast enhancement, and brought in ID expert Dr. Darcy Wooten to help us focus on these things in the setting of the severely immunocompromised patient!! This patient ended up having Toxoplasma encephalitis!! Check out some of our key takeaways!!

  1. When it comes to CNS lesions, contrast enhancement means a space-occupying lesion causing mass effect and edema.
  2. Because steroids reduce swelling/edema, they can actually take away contrast-enhancement and give you a false-negative for this component of your imaging study!
  1. Toxoplasmosis makes it’s way to humans through cat feces (gross). People can get it from direct ingestion (didn’t wash your hands after cleaning the litterbox?), or from eating foods contaminated with cat feces (fresh fruits, vegetables, or even undercooked meats).
  2. Testing for this can be a little unsatisfying, usually without a slam dunk. Getting Toxo IgG, looking at the imaging findings, and considering your differential typically leads to empiric treatment for presumed Toxoplasma for 2 weeks (then reassessment) rather than jumping to brain biopsy straightaway.