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To determine the impact of radiation therapy (XRT) in addition to trastuzumab (TZB) adjuvant chemotherapy for HER2+ breast cancer on left ventricular systolic function, we assessed demographics, oncologic treatment history including XRT exposure, and serial measurements of left ventricular ejection fraction (LVEF) in 135 consecutively identified women receiving TZB for treatment of adjuvant breast cancer. Longitudinal mixed effects models were fit to identify baseline to treatment changes in LVEF among those receiving TZB with or without concomitant anthracycline or XRT. Women averaged 53 ± 3 years in age, 77% were white, 62% patients had 1 or more cardiovascular risk factors at baseline, and mean duration of TZB was 11 ± 5 months. Seventy-seven women were treated with XRT and received between 4000 and 5500 cGy of radiation. The LVEF declined by an average of 3.4% after 1 year for those in the study. Relative to baseline upon completion of adjuvant TZB, LVEF remained reduced for those receiving anthracycline with or without XRT (p=0.002 for both), or XRT alone (p=0.002), but not in those without these therapies. Amongst patients treated only with XRT and TZB, LVEF declined 3.1% on average in those with left-sided disease and 6.9% on average in those with right-sided disease (p= 0.06, p= 0.008 respectively). Among women receiving TZB for adjuvant treatment of HER-2 positive breast cancer, the administration of XRT, anthracycline, or the combination of the 2 is associated with a persistent post-treatment as opposed to a temporary treatment related decline in LVEF.

We describe a case of platypnea-orthodeoxia syndrome in an 88-year-old man who presented with progressive dyspnea. Right-to-left shunting through a patent foramen ovale (PFO) was seen in the setting of normal right-sided heart pressures. He was successfully treated with percutaneous transcatheter PFO closure. (Level of Difficulty: Beginner.), Graphical abstract, This study describes a case of platypnea-orthodeoxia syndrome in an 88-year-old man who presented with progressive dyspnea. Right-to-left shunting…

Right-to-left shunting across a PFO typically occurs with elevated right atrial pressures. Significant shunting can cause debilitating symptoms of hypoxia, leading to platypnea-orthodeoxia syndrome (POS). Here we describe a case of POS with PFO in the setting of normal right heart pressures. An 88

Background: Families with newborns in the neonatal intensive care unit (NICU) often feel detached from the newborn’s care. While studies encourage family centered rounds (FCR) for parent participation, many infants have extended hospitalization with parents unable to attend rounds. Studies have demonstrated improved family satisfaction and readiness for discharge with a daily electric medical record (EMR) derived report with laymen terminology distributed to families unable to participate in daily rounds. However, this(THERE) is limited data on EMR tools for documenting communication with families, and how such tools may improve parent satisfaction. Specific Aim: Within 9 months, daily parent rounding reports through the EMR will be …