Background: Provider burnout remains a serious problem facing medical training programs and has been shown to affect more than half of internal medicine residents. In addition to broader efforts to revamp a health care system that contributes to this epidemic, exposure to the medical humanities offers potential to promote engagement, resilience, and restoration of meaning in residents’ daily lives. Objective: We aim to create a reproducible, evidence-based workshop utilizing artful thinking routines to prepare trainees to combat burnout with reflection, perspective-taking, and community-building. Methods: A single, 4-hour workshop for senior internal medicine residents, centered on visual artistic analysis, was offered in June 2017 at the Philadelphia Museum of Art. Pre- and post-workshop burnout metrics and survey evaluation data were analyzed using a mixed-methods approach. Results: Workshop participation was offered to 29 internal medicine residents, of whom 17 (59%) participated. All survey respondents (n=13) rated the workshop as excellent and would recommend it to colleagues. Moderate decreases in the observed frequencies of both high emotional exhaustion scores (64.7% before the workshop to 55.5% following the workshop) and high depersonalization scores (70.6% before the workshop to 55.5% following the workshop) were observed. Conclusions: While results are preliminary in nature, the workshop was received favorably and demonstrated modest decreases in emotional exhaustion and depersonalization. We are encouraged to explore and repeat this workshop with modifications to identify its optimal position in the broader landscape of emerging wellness curricula.

Rosai–Dorfman disease (RDD) is a rare, nonmalignant disorder of histiocyte proliferation typically involving the cervical lymph nodes. However, a subset of patients with RDD will display extranodal manifestations that are highly variable in presentation, more challenging to diagnose, and less likely to spontaneously regress compared to nodal disease. While case reports of extranodal involvement in nearly every organ system exist, documented instances of mediastinal and pulmonary artery involvement are particularly rare. This study describes the case of a middle-aged woman presenting with new onset right heart failure who was found to have extranodal RDD in the form of a large mediastinal mass with invasion and occlusion of the main pulmonary arteries.

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Introduction: Treatment of the elderly AML patient remains challenging. Standard induction chemotherapy may not be well tolerated and increased rates of higher risk disease have led to poor long-term outcomes. New strategies are needed in this population. Methods: A retrospective review of consecutive Acute Myelogenous Leukemia patients age >60 years treated with either 5-azacitidine 75mg/m2/d 7 days per month (5-aza) or 3 days idarubicin 12 mg/m2 with 7 days cytarabine 100 mg/m2 continuous infusion (3+7). Patients were offered both treatments, and supportive care alone, and chose their own therapy. Results: Between November 2004 and August 2006, 33 elderly patients with AML underwent therapy with either 5-aza (n=11, median age = 74 years) or 3+7 (n=22 median age = 67) (p=0.07) at Hackensack University Medical Center. Consolidation therapy in the 3+7 cohort consisted of high-dose cytarabine (n=12) and allogeneic transplantation (n=2). Rates of secondary leukemia were balanced between groups (27% 5-aza and 36% 3+7; p=0.9). SWOG cytogenetic risk categories were high-risk in 36% 5-aza and 45% 3+7, and intermediate risk in 64% 5-aza and 55% 3+7 (p=0.9). Marrow blast counts (median) at initiation of therapy were 42% in 5-aza and 65% in 3+7 (p=0.01). Median survival from diagnosis was similar between both therapies at 397 days for 5-aza and 276 days for 3+7 (Log-rank p=0.7). Patients with high-risk cytogenetics fared poorly in the entire cohort with a median survival of 154 days versus 435 days with intermediate risk cytogenetics (p=0.002). Patients with high-risk cytogenetics did not benefit from 5-aza therapy (median survival 35 days) compared to 3+7 (median survival 214 days) (p=0.09), but the trend was reversed among intermediate-risk cytogenetic patients (5-aza median survival 435 days; 3+7 median survival 276 days; p=0.13). Early mortality (<100 days) occurred in 36% 5-aza (2 infection, 1 disease, 1 cardiac) and 18% 3+7 (2 infection, 2 organ toxicity) (p=0.47). Using IWG MDS criteria for hematologic responses, red cell responses among 5-aza pts were CR:36%, PR:18% and among 3+7 pts were CR:68% (p=0.17 for CR rate and p=0.69 for ORR). Platelet responses among 5-aza were CR:36%, PR:18% and among 3+7 were CR:68% (p=0.17 for CR rate and p=0.69 for ORR rate). Median red cell transfusions from diagnosis were 7 units in 5-aza and 15 units in 3+7 (p=0.03). Median platelet transfusions were 4 units in 5-aza and 11 units in 3+7 (p=0.02). Bacteremia occurred in 2 of 11 (18%) 5-aza patients (3 episodes) and 17 of 22 (77%) 3+7 patients (30 episodes) (p=0.002). Patients receiving 5-aza induction spent a median of 11% of their at-risk days in the hospital compared to 33% median at-risk days for patients receiving 3+7 (p=0.12). Overall for the entire cohorts, 5-aza patients spent 213 days in hospital among 2651 at risk days (8%) versus 1229 days in hospital among 3759 at risk days (33%) (p=0.001). Conclusions: In this series of elderly (>60 year old) patients with AML, 5-azacitidine yielded similar survival outcomes compared to standard 3+7 induction and was associated with significantly less transfusional support, bacteremias, and hospital days. Although not a curative therapy, poor outcomes with standard chemotherapy in the elderly AML patient make consideration of the well tolerated outpatient 5-azacitidine therapy attractive.