Spontaneous regression of malignant pleural mesothelioma: A case report

AbstractMalignant pleural mesothelioma (MPM) is a rare pleural disease with a poor prognosis. Currently treatment options are limited and the outcome is generally quite poor.We report the case of a 76-year-old man diagnosed with locally advanced MPM who had partial spontaneous response for 2 years and remained asymptomatic for more than 3 years. The patient was taking specific herbal and vegetable diet during the course of response.In our review of literature, a number of prognostic factors predict for better survival and response. However our patients did not have any of these factors. There have been reports of immune-induced responses in the literature. Our patient did indeed use some herbal products that might interfere with the immune system and explain his tumour regression and long period of disease stability. Further analyses and studies are needed in this setting to explore and identify specific immune pathways and targets to develop more effective treatment for MPM

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle

BACKGROUND: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents’ perceptions of the impact of the bundle on three domains: the senior residents’ wellness, ability to deliver quality health care, and medical education experience. METHODS: This prospective study compared eligible residents’ experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. RESULTS: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. CONCLUSIONS: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants’ perceptions