After diagnosis during a partial mastectomy, this patient’s estimated blood loss was 58 mL, causing anemia and requiring a red blood cell transfusion along with ventriculoperitoneal drain placement. With a substantive bleeding history before the diagnosis, what would you do next with this patient? Work her up for von Willebrand disease? Do a complete blood count test to look at platelet count, a peripheral smear to look at the morphology of the platelets, and a coagulation profile? Offer genetic testing for fibrinogen disorders? What would your next steps be? Read the full case presentation and expert opinion to see how your peers responded.

Publication: Blood Key Points: The authors identified the following four prognostic indicators that could help control CNS relapse in children with ALL. 1) Prephase dexamethasone treatment, 2) delayed intrathecal therapy, 3) use of total intravenous anesthesia during intrathecal therapy, and 4) flow cytometry examination of diagnostic CSF Design: 7,640 consecutive patients treated on Chinese Children’s Cancer Group ALL-2015 protocol

Publication: JAMA Oncology Objective: With NSCLC having relatively poor outcomes and the significant data supporting the use of metformin as an antineoplastic agent, the researchers wanted to compare overall or progression-free survival in chemoradiation alone vs. chemoradiation + metformin stage III NSCLC patients. Design: Randomized clinical trial, open-label, phase 2 study; 167 eligible patients

Expecting perfection when it comes to charting? Are you overly self-critical, telling yourself you’ll never get the charts done or you’re just not good at it? Do you go too big, watching your “identity-forming” charting spiral out of control? Keep calm and listen to this KevinMD.com podcast from Dr. Gail Gazelle, an internal medicine physician and the author of the book Everyday Resilience, who shares helpful advice for doctors struggling with these three mistakes.

Findings: Primary outcomes included AMI, HF, stroke, and CVEs; 51 secondary and safety outcomes included angioedema, cough, syncope, and electrolyte abnormalities. ACE inhibitors were associated with a significantly increased risk of four secondary and safety outcomes compared with ARBs.Design: Multinational cohort study; Patients: ~2.3M ACE, ~674K ARB 

The additional approval expands immunization coverage to the most at-risk group for acquiring shingles – the immunocompromised. It also shortens the time to the second dose in the 2-dose Shingrix schedule.  Decision support based on the Zoster Efficacy Study in Patients Undergoing HSCT (ZOE-HSCT) phase III trial (JAMA).