Sunday, November 24, 2019

Rotation 5: Inpatient Bone Marrow Transplant

Posted by Makenzie at Sunday, November 24, 2019

A typical day for me during inpatient bone marrow transplant (BMT) started at 7am, where I would work up patients prior to 9am rounds.  Most BMT patients are in the hospital for at least seven days (usually more) post-transplant which allowed me monitor long-term changes in therapy.  Despite BMT being a specialized unit, the patient caseload was diverse.  It included patients receiving who were receiving conditioning therapy prior to transplant and post-transplant patients awaiting engratment.  It also usually included at least two patients who were readmitted.  Readmission reasons usually included neutropenic fever or workup for graft vs host disease.

After working up patients I would meet with my preceptor to go to interdisciplinary rounds.  There were three attendings for the inpatient BMT unit who would rotate inpatient rounding weekly.  There would be 8-14 patients on our service and rounds typically lasted 1.5-2.5 hours, usually longer at the beginning of the week and then shortened throughout the week as the attending became more familiar with each case.  The rounding team included mid-level practitioners, a nutritionist, a BMT pharmacist, a case manager, and sometimes a social worker.

After rounds, there may be a number of patient-related activities to follow up on.  If a patient was being discharged, we would make a medication schedule and they would receive a visit from the BMT pharmacist prior to leaving.  The autologous transplant patients would typically only be discharged on twice daily acyclovir (in addition to any medications they had prior to admission) while the allogeneic transplant patient would need careful counseling regarding their immunosuppressants.  Other post-round patient care activities included immunosuppressant dosing, renal insufficiency dosing, or any other research regarding medications.  During my time at BMT they were two patients who had acute GVHD that was refractory to steroids which required a significant amount of follow-up research.  Afternoons were generally dominated by topic discussions or working on projects such a patient case presentation or journal club. 

Overall, BMT had a steep learning curve due to the specialized nature of the unit and the amount of emerging therapies.  However, it helped me become an independent learner and keep current on recent literature.  BMT patients, due to their immunocompromised state, were also on prophylaxis antibacterial, antifungal, and antiviral medications.  At least half of the patients would spike a neutropenic fever during admission and would require broad-spectrum antimicrobials.  Since I have an interest in infectious diseases, being on the BMT service helped me keep current with antimicrobials and examine more closely some less common infections.

Thursday, November 21, 2019

Rotation 4 and 5: Inpatient Oncology and Gen Med in Pediatrics

Posted by Polly at Thursday, November 21, 2019

My rotation 4 was my inpatient oncology rotation specifically in solid tumors. The patients I saw were admitted due to oncologic emergencies and other cancer related problems. A few patients were there to receive chemotherapy that resulted in them staying for several days at the hospital to be closely monitored. Rotation 4 was my hardest rotation by far. I was coming off of two nontraditional rotations and it was hard to get back into the groove of things. I forgot a lot of my clinical knowledge because I haven't had the chance to use it. Overall, it experience.

Rotation 5 was in general medicine, specifically in pediatrics at Mott. This was by far my favorite rotation. It had me seriously consider going into a pediatric residency and abandoning my fellowship route I had been pursuing since my P2 year. I was coming off of an adult inpatient rotation and I can't say I enjoyed it due to a number of reasons. I entered my rotation 5 having very low expectations. To my surprise, I actually liked working up my kiddos. In school, we focus a majority of our time on the adult population. The pediatric population was new and I liked learning about all the new disease states that were not talked about in school. From upper respiratory infections to meningitis to eating disorders, there was a good variety of things I could work up in my patients. There were many interesting cases and one particular one that comes to mind was seeing Kawasaki disease in person. I remember receiving a one sentence summary of what it was in class and that was it. It was an interesting case and was a great topic discussion! I also owed my enjoyment of this rotation to my preceptor. She was a great teacher and I could always depend on her to answer my questions, no matter how silly. It goes to show what a difference it makes having a good preceptor, versus having one that you cannot connect with.

Rotation 3: Another nontraditional – Paragon Biosciences

Posted by Polly at Thursday, November 21, 2019

I really enjoyed this rotation. Not just because it was in Chicago but because it is a pharmaceutical industry rotation. Most of the projects I completed are confidential, and I signed a non-disclosure agreement so I cannot say in detail what I did most of the time. Some of my projects include designing a poster for a congress, a rare disease priority review voucher, writing up press releases, and comparing clinical trials.A large portion of this rotation was completing research, writing, and attending meetings with my preceptor

Like the FDA, my day to day schedule was not structured. I found myself becoming more adapted to an unstructured schedule because I had the freedom to plan out the day for myself. I was able to see a drug approved for narcolepsy during the end of my rotation (Look it up, it’s called Pitolisant). Although I did not work on this drug from the beginning to the end, I saw the happiness and satisfaction of the employees to see their drug finally be approved by the FDA. Having a rotation at the FDA gave me an insider look at what the FDA considers for pharmaceutical industry. During my block 3, I was able to see the other side of the coin.

Here are some tips about Chicago for those of you who got chosen:
  1.   If you are driving from Michigan to Chicago, go on the road that avoids the toll road. Saves you $20 and a headache. The trip is just longer by 30 minutes and I didn’t have much of a problem navigating the roads.
  2. Know which side of Chicago to avoid. The south side and the west side should be avoided. There are some pocket neighborhoods in these areas that are fine so it is not all bad. I don’t think I ever went further than Chinatown so I can’t say for experience how these areas are. Chicago is a great city but all big cities come with some risks. Just be smart! I had no problems getting around the city.
  3. My rotation was downtown, and I lived in a up and coming neighborhood called East Village on the border of Ukrainian Village just 15-20 minutes away from downtown. Beautiful neighborhood and VERY hipster. It was right on the blue line for the metro so I had no problem getting to my site. Parking is awful and very expensive downtown. My suggestion is to just get the 30-day metro pass. It was around $105 and I took the blue line the majority of the time. I had no problems! Parking for more than 8 hours could easily add up to 15-30 dollars a day. Public transportation saves money and it was nice pretending to be a local 😊
  4. BRING REUSABLE BAGS. The amount they charge per bag is borderline ridiculous.

Sunday, November 17, 2019

Rotation 5: Drug Information

Posted by Sarah Choi at Sunday, November 17, 2019

My drug information rotation was very different from my last three rotations as it was mainly project based. Rather than directly impacting patients with recommendations or interventions I made on rounds, I was able to impact the hospital as a whole while working on different projects.

One of the major projects I worked on was creating a SGLT2 inhibitor class monograph, in order to assess whether one agent should be added to formulary. This involved reviewing package inserts, databases, and primary literature for each SGLT2 inhibitor and then synthesizing the information into one document. The committee members will then review the monograph prior to meeting and make a decision about adding SGLT2 inhibitors to formulary—an addition that impacts the entire hospital and not just one patient.

Other projects I worked on included analysis of ethanol (beer) use in hospitalized patients over the last year, determining the efficacy of a “magic” mouthwash, running experiments with a suspected faulty device, and reporting a device related adverse event to the FDA MedWatch System and the hospital’s internal reporting system. I was also able to attend the P&T committee’s and other subcommittees’ meetings and witness the process of revising and approving policies firsthand. I presented a topic discussion on literature evaluation and also a journal club on dapagliflozin’s efficacy and safety in heart failure patients.

The best part of this drug information rotation was being exposed to so many different aspects of the hospital and working on unique projects. It’s very different having project based work and making recommendations on things that will impact the entire health system. I’m really grateful for the opportunity to explore drug information and I’m looking forward to being exposed to more new things in my future rotations.