Background Current estimates of sexual harassment across the academic hierarchy are subject to recall bias and have limited comparability between studies due to inconsistent time frames queried for each stage of training. No studies have surveyed medical students, residents/fellows, and faculty collectively and many studies exclude a wide range of sexual harassment behaviors. We assessed the incidence of sexual harassment across the different stages of academic medicine over the same time frame and within the same institutional culture. Methodology Medical students, residents/fellows, and faculty at the same academic medical campus completed a prospective online study of sexual harassment experiences in 2018. We used a tool that comprehensively assessed sexual harassment behaviors and asked about the perpetrators. Pearson’s chi-square and Fisher’s exact tests (for cell counts <5) were used to compare responses by academic status and gender. Participants were also asked to suggest ways to improve knowledge about university/hospital policies, support services, and reporting process on sexual harassment. Results One-third of 515 respondents (18% of invitations) reported experiencing sexual harassment in 2018. Overall, 52% of medical students, 31% of residents/fellows, and 25% of faculty respondents experienced sexual harassment. Of these, 46% of women and 19% of men reported sexual harassment experiences. The most common experiences across all levels of academic hierarchy were offensive and sexually suggestive comments or jokes and offensive and intrusive questions about one’s private life or physical appearance. The most common perpetrators were “student, intern, resident, or fellow,” followed by “patient or patient’s family member.” To improve knowledge about the policies and services regarding sexual harassment, participants suggested facilitating easy access to resources, increasing awareness, assuring confidentiality, protecting against retaliation, and continued education and reminders about the topic. Conclusions Sexual harassment may be more prevalent than the literature suggests and incidence tends to decrease with increasing academic hierarchy. Harassment can often be subtle and can pass under the radar.

Introduction: Direct oral anticoagulants (DOAC) are increasingly utilized for the prevention of thrombotic events. Unlike warfarin they do not require drug-level monitoring making dedicated DOAC monitoring uncommon. The purpose of this study is to describe the interventions made by a DOAC monitoring service over 3 years. Materials and Methods: This was a single-center prospective observational study of patients seen at an outpatient clinic between February 14, 2017 and February 13, 2020. Following referral patients met a pharmacist for a DOAC-specific visit. Patient demographics and clinical interventions were collected for all patients. Continuous quality improvement status was received from the local Institutional Review Board. Results: A total of 153 patients completing 336 visits were included. The median age was 75 years (interquartile range [IQR] 69-81) and 41.2% were male. Apixaban was the most common DOAC (82.4% of visits) and atrial fibrillation (AF) was the most common indication (69.7% of visits). A total of 299 interventions were made over 336 visits with an average of 0.9 interventions per visit; the first visit had an average of 1.1 interventions per visit made. Need for updated laboratory monitoring (101 visits, 30.1% of visits) was the most common intervention. There were 94 interventions related to nonadherence and 24 interventions for incorrect dosing due to renal function, drug-drug interaction, or indication. Conclusions: A DOAC monitoring service frequently made interventions. Routine DOAC monitoring should be considered for all patients. It remains unclear if routine DOAC monitoring reduces the rate of clinical outcomes.

Introduction. Patients with urothelial carcinoma of the bladder often present with metastases to regional lymph nodes, with lymphadenopathy on physical examination or radiographic imaging. Case Presentation. We present the case of a 73-year-old Caucasian man with presumed metastatic urothelial carcinoma of the bladder to regional pelvic and retroperitoneal lymph nodes. He underwent systemic chemotherapy for treatment of urothelial carcinoma and was discovered on restaging to have findings suggestive of disease progression but ultimately was found to have a concurrent secondary malignancy. Conclusion. Our case suggests that in patients with urothelial carcinoma, the concurrent presentation of regional lymphadenopathy may not be metastatic urothelial carcinoma and may warrant further investigation.

Cryptococcus infection is caused by one of the two species, Cryptococcus neoformans, or the less common Cryptococcus gattii. While Cryptococcus neoformans commonly infects the immunocompromised population, Cryptococcus gattii has been seen more frequently in immunocompetent patients. Many seemingly immunocompetent patients, however, may have unidentified underlying immunodeficiencies. Recently, antigranulocyte-macrophage colony-stimulating (GM-CSF) antibodies have been identified as a risk factor for cryptococcosis. We describe a case of disseminated Cryptococcus gattii infection in a seemingly immunocompetent young man, who is found to have anti-GM-CSF antibodies.