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BackgroundStandard interviews are used by most residency programs in the United States for assessment of aptitude of the non-cognitive competencies, but variability of interviewer skill, interviewer bias, interviewer leniency or stringency, and context specificity limit reliability.AimTo investigate reliability and acceptability of five-station multiple mini-interview (MMI) model for resident selection into an internal medicine residency program in the United States.SettingOne independent academic medical center.ParticipantsTwo hundred and thirty-seven applicants and 17 faculty interviewers.Program descriptionFive, 10-min MMI stations with five different interviewers blinded to the candidate's records and one traditional 20-min interview with the program director. Candidates were rated on two items: interpersonal and communication skills, and overall performance.Program evaluationGeneralizability data showed that the reliability of our process was high (>0.9). The results of anonymous surveys demonstrated that both applicants and interviewers consider the MMI as a fair and more effective tool to evaluate non-cognitive traits, and prefer the MMI to standard interviews.DiscussionThe MMI process for residency interviews can generate reliable interview results using only five stations, and it is acceptable and preferred over standard interview modalities by the applicants and faculty members of one US residency program.

Adherence to antiretroviral therapy reduces morbidity and mortality; however rates of non-adherence are variable among women for unclear reasons. This study was a single-center qualitative analysis of interviews with 18 female HIV-positive non-adherent patients (defined by virologic failure) to explore psychosocial factors impacting adherence. Factors identified were categorized as promoting, inhibiting or having no effect on adherence. Three themes, characterized as social factors, illness factors and other societal pressures, were identified. Medical systems support, family support and compliance for children were most commonly identified as promoting adherence, while psychiatric comorbidities, lack of medical systems support and side effects were identified most often as inhibitors of adherence. While stigma was frequently identified, it was not seen as a barrier to adherence. Enhancing relationships between patients and their providers as well as their community support systems are critical avenues to pursue in improving compliance. Interventions to promote compliance are important avenues of future research.

ObjectiveThe multiple mini-interview (MMI) has been shown to have a positive correlation with early medical school performance, clerkship evaluations, and national licensing examinations. There is limited data on its predictive validity at the postgraduate level.MethodsSix hundred and nineteen internship candidates were interviewed using the MMI format by the internal medicine residency program of The Reading Health System, between September 2011 and February 2014. Fifty-two interns were recruited. Each intern participated in an objective structured clinical examination (OSCE) 3–4 months after the start of the program. The OSCE score of each intern was used as the independent variable to test the relationship with both the MMI interpersonal score and the MMI overall score.ResultsThere was a moderate positive correlation between the average MMI interpersonal score and the communication score on the OSCE, r=0.384, n=52, p=0.005, and a negligible relationship between the average MMI overall score and the communication score on the OSCE, r=0.175, n=52, p=0.214.ConclusionThe MMI is a useful tool for residency programs to assess interpersonal and communication skills prior to matriculation into residency training. This study provides evidence for its validity in assessing these competencies.

Screening patients at high risk of glucose-6-phosphate dehydrogenase (G6PD) deficiency (individuals of African and Mediterranean descent) is recommended prior to initiation of rasburicase. However, a high index of suspicion of G6PD deficiency is also crucial in a patient who develops methaemoglobinaemia or haemolytic anaemia following rasburicase therapy, irrespective of ethnic origin. We report a 56-year-old Hispanic male with mantle cell lymphoma with bulky lymphadenopathy who presented to the emergency department with dyspnoea and chest discomfort. Forty-eight hours prior to presentation, he had received chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with pegfilgrastim support and two 6 mg doses of intravenous rasburicase for the prevention of tumour lysis syndrome. Physical examination was unremarkable. Oxygen saturation (SpO 2 ) was 85% on 100% oxygen via a non-rebreather mask at 10 l/min. Arterial blood gases showed a partial oxygen pressure (PaO 2 ) of 216 mmHg. A full blood count showed haemoglobin concentration (Hb) 93 g/l and white blood cell count 77Á9 9 10 9 /l (0Á8% lymphocytes). Serum creatinine was 73Á37 lmol/l, uric acid 35Á69 lmol/l and methaemoglobin 8Á4%. Because of the presence of methaemoglobinaemia, intravenous methylene blue was administered. Eight hours later, the patient complained of diaphoresis and lightheadedness. SpO 2 had dropped to 80% and Hb to 66 g/l. Total and direct bilirubin were 41Á05 and 6Á84 lmol/l respectively, haptoglobin was less than 10 mg/l and lactate dehydrogenase was elevated at 864 u/l (normal range 94-202), consistent with acute haemolytic anaemia. A peripheral blood film showed irregularly contracted cells and retraction of haemoglobin from the red cell membrane (left). Heinz bodies were demonstrated on supravital staining with new methylene blue (right). The patient was managed with supportive treatment and four units of packed red blood cells were transfused. By 24 h, methaemoglobin levels had dropped to zero. The suspicion of G6PD deficiency was confirmed by enzyme assay with an enzyme level of 1Á5 u/g Hb (8Á8-13Á4). G6PD deficiency is associated with NADPH deficiency, and methylene blue is dependent on NADPH to reduce methaemoglobin to haemoglobin. This renders methylene blue ineffective in G6PD-deficient patients, and it may aggravate methaemoglobinaemia at high doses by oxidizing haemoglobin. Its use should be avoided.

T-AML following radioiodine therapy for thyroid cancer appears to have a shorter latency period than other types of t-AML, which is an important consideration for post-therapy surveillance. Reporting of cases and outcomes will help provide data for further research. Identifying biomarkers that help risk-stratify patients prior to therapy and specific genetic-guided therapies may help improve outcomes.

This pooled analysis suggests that varenicline is effective in achieving a 7-day point prevalence of SLT abstinence at 12 weeks but showed that this effect was not sustained at 26 weeks.

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