Yet little is known regarding determinants of nonforensic autopsy rates. In this issue of JAMA Internal Medicine, Gupta et al 4 provide contemporary, nationwide data on the association of race with the use of clinical autopsy. Using a national Centers for Disease Control and Prevention death database, the investigators found an overall 7.9% autopsy rate among more than 20 million total decedents between 2008 and 2017, which is less than half the autopsy rate in the 1970s. Moreover, rates continued to decrease during the decade of study for all causes of death except those associated with diabetes. The overall autopsy rate was significantly higher in black (12.7%) than white (7.3%) decedents and higher in black individuals for all causes of death.Given the current state of health care policy and financial incentives, autopsy is likely to become an even scarcer resource; therefore, it is critical that we understand and monitor the determinants of autopsy. Gupta et al 4 hypothesize that the higher rate of autopsies in black decedents may reflect health care disparities, a mistrust in the health care system, and less-extensive premortem diagnostics in minority populations. However, it is easy to envision a near future where autopsy availability, restricted to academic hospitals or affluent populations, reflects health care privilege. Overall, further study, education, and advocacy are needed to preserve access to the invaluable clinical autopsy.
Spontaneous splenic infarction can occur in patients with sickle trait who live at low altitudes. It is unclear whether this complication is rare, or whether it is relatively common but under-recognized.
Summary
Background
Evidence‐based medicine (EBM) is a key aspect of medical training that can be challenging for trainees to learn. Tumour boards (TBs) are multidisciplinary meetings that are often opportunities for trainees to deliver patient case presentations, which is another integral part of medical education; however, TBs are time intensive, typically lack academic structure and may fail to emphasise EBM.
Objective
To design a systematic approach to improve both trainee satisfaction and the level of evidence cited at typical academic TBs.
Methods
From 2017 to 2018, Plan–Do–Study–Act (PDSA) methodology was used to develop a systematic approach for medical oncology trainees towards TBs. Statistical testing was used to assess which characteristics of a patient case made it more difficult to apply EBM.
Anonymous surveys were distributed to trainees before and after the intervention to assess the educational utility.
Results
We developed a shared voluntary case database, so that references with higher levels of evidence could be rapidly recalled and applied to similar cases. We then developed EBM‐focused review sessions to highlight database trends. Both the database and the review sessions had high participation rates (>90% cases had voluntary data entry), and each were reported to have educational value by trainees.
Conclusions
A two‐step implementation of an easy‐to‐use case database followed by review sessions focused on high‐yield sources of evidence improved trainee satisfaction for TBs, but did not significantly improve the strength of the evidence cited.
to similar rates as matched related and matched unrelated recipients. Infection and relapse remain the most common causes of mortality amongst all 3 groups, suggesting that further investigation is warranted to reduce the incidences of both outcomes.
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