Gabriel T Bosslet

Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States

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Publications (11)23.12 Total impact

  • Laura Hinkle, W Graham Carlos, Gabriel Bosslet
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    ABSTRACT: Infectious Disease Cases IIISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Monday, October 28, 2013 at 04:15 PM - 05:15 PMINTRODUCTION: Fusarium is an angioinvasive mold recognized as an emerging cause of invasive fungal disease in immunocompromised patients resulting in significant mortality (1).CASE PRESENTATION: A 42 year-old male with relapsed acute lymphoblastic leukemia presented for salvage chemotherapy. He complained of five days of mild dyspnea, dry cough, and fatigue. He was afebrile and his exam was normal except for decreased breath sounds in the left lower lobe. Pertinent laboratory data included WBC of 1.0x109/L with 68% blasts. A chest CT showed nodular pulmonary opacities and a left pleural effusion; this was exudative with negative bacterial and fungal cultures. Chemotherapy and prophylactic ciprofloxacin and acyclovir were initiated. On day 3, the absolute neutrophil count was zero and fevers developed. Antimicrobial therapy was broadened to cefepime, vancomycin, and acyclovir. The fevers persisted and on day 8 micafungin was added. Repeat cultures were negative. On day 10 new nodular skin lesions with dark centers were biopsied, revealing epidermal necrosis and dermal fungal elements with angioinvasion. Serum galactomannan antigen index was 6.89. A presumptive diagnosis of disseminated aspergillosis was made and voriconazole replaced micafungin. On day 21 hypoxemic respiratory failure requiring mechanical ventilation developed and a chest CT showed bilateral pleural effusions and airspace disease. On day 23 blood cultures were reported positive for mold and liposomal amphotericin B was added. The patient's neutrophils never recovered and he died on day 27. The mold was subsequently confirmed to be Fusarium.DISCUSSION: Aspergillus and Fusarium species are causes of severe disseminated infections in immunocompromised patients and are often impossible to distinguish based on clinical presentation or histology. Fusarium is unique in its ability to frequently grow in standard blood culture media (1). Previously, a positive galactomannan antigen was considered sufficient to exclude Fusarium, but this case adds to a growing body of evidence refuting this (2). This distinction is important as several Fusarium species are resistant to voriconazole, and require treatment with amphotericin B (1).CONCLUSIONS: A positive galactomannan, even when combined with other findings suggesting aspergillosis, does not rule out Fusarium. Awareness of this is critical because of the high mortality associated with disseminated fusariosis and the potential resistance of Fusarium to standard aspergillosis therapy.Reference #1: Nucci M, Anaissie E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev 2007; 20:695-704Reference #2: Tortorano AM, Esposto MC, Prigitano A, et al. Cross-reactivity of Fusarium spp. in the Aspergillus Galactomannan enzyme-linked immunosorbent assay. J Clin Microbiol 2012; 50:1051-1053DISCLOSURE: The following authors have nothing to disclose: Laura Hinkle, W. Graham Carlos, Gabriel BossletNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):228A. · 5.85 Impact Factor
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    ABSTRACT: To evaluate medical students' behavior regarding online social networks (OSNs) in preparation for the residency matching process. The specific aims were to quantify the use of OSNs by students to determine whether and how these students were changing OSN profiles in preparation for the residency application process, and to determine attitudes toward residency directors using OSNs as a screening method to evaluate potential candidates. An e-mail survey was sent to 618 third- and fourth-year medical students at Indiana University School of Medicine over a three-week period in 2012. Statistical analysis was completed using nonparametric statistical tests. Of the 30.1% (183/608) who responded to the survey, 98.9% (181/183) of students reported using OSNs. More than half, or 60.1% (110/183), reported that they would (or did) alter their OSN profile before residency matching. Respondents' opinions regarding the appropriateness of OSN screening by residency directors were mixed; however, most respondents did not feel that their online OSN profiles should be used in the residency application process. The majority of respondents planned to (or did) alter their OSN profile in preparation for the residency match process. The majority believed that residency directors are screening OSN profiles during the matching process, although most did not believe their OSN profiles should be used in the residency application process. This study implies that the more medical students perceive that residency directors use social media in application screening processes, the more they will alter their online profiles to adapt to protect their professional persona.
    Academic medicine: journal of the Association of American Medical Colleges 09/2013; · 2.34 Impact Factor
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    ABSTRACT: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.
    The Permanente journal 01/2013; 17(2):73-79.
  • The Permanente journal 01/2013; 17(4):94.
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    ABSTRACT: SESSION TYPE: ILD Cases IPRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PMINTRODUCTION: Daptomycin is frequently used in patients with methicillin resistant staph aureus (MRSA) infections. The development of eosinophilic pneumonia secondary to daptomycin is a rare, but important side effect of this medication.CASE PRESENTATION: A 76 year-old caucasian male with recently diagnosed second digit MRSA osteomyelitis presented with one week of progressive exertional dyspnea, fevers and non-productive cough. He was discharged home on intravenous daptomycin three weeks prior to this presentation. He denied any associated chest pain, wheezing, dysphagia, rash or arthralgias. Patient had a past medical history of type II diabetes mellitus, coronary artery disease, and chronic kidney disease. At the time of this admission the patient had hypoxemia requiring 6 L/min oxygen and bilateral fine inspiratory crackles in the mid to upper lung fields. Laboratory evaluation was pertinent for leukocytosis of 17,000 with 5% eosinophils. A chest CT demonstrated patchy infiltrates in mid to upper lung zones with predilection to periphery ( Figure 1) in comparison to scan done one month prior. Bronchoalveolar lavage revealed a cell count showing 56% eosinophils (Figure 2). A presumptive diagnosis of daptomycin induced eosinophilic pneumonia was made. Daptomycin was discontinued with clinical improvement in 6 days. Follow-up at one month revealed complete resolution of symptoms and radiographic abnormalities.DISCUSSION: Eosinophilic pneumonia has been rarely associated with common drugs including antibiotics, NSAIDS, and beta blockers and exposure to radiation, cigarette smoke, cocaine, and heroin(1). Patients commonly present with fever, cough, malaise, weight loss and dyspnea with onset within 1-3 weeks of exposure. Physical examination is remarkable for hypoxia and bilateral crackles prominent in mid to upper lung zones. Some patients are found to have peripheral eosinophilia. Chest xray and CT imaging routinely show alveolar peripheral mid to upper lung zone infiltrates with relative central sparing. Further diagnostic evaluation includes bronchoscopy with bronchoalveolar lavage which in most cases shows a cell count with >25% eosinophils. The treatment of EP involves cessation of offending agent. There have been cases of daptomycin induced EP with relapse after discontinuation or weaning of glucocorticoid therapy requiring chronic prednisone (2).CONCLUSIONS: Early recognition of daptomycin induced eosinophilic pneumonia may prevent progression to respiratory failure and requirement of corticosteroid therapy.1) Solomon J, Schwarz M. Drug-, toxin-, and radiation therapy induced eosinophilic pneumonia. Semin Respir Crit Care Med. 2006;27(2):192-7.2) Yasir lal and Aristides P. Assimacopoulos. Two Cases of Daptomycin-Induced Eosinophilic Pneuomnia and Chronic Pneumonitis. Clin Infect Dis. (2010) 50 (5): 737-740.DISCLOSURE: The following authors have nothing to disclose: Bilal Safadi, Chadi Hage, William Carlos, Gabriel BossletNo Product/Research Disclosure InformationIndiana University School of Medicine, Indianapolis, IN.
    Chest 10/2012; 142(4_MeetingAbstracts):485A. · 5.85 Impact Factor
  • Gabriel T Bosslet
    Academic Emergency Medicine 11/2011; 18(11):1221-2. · 1.76 Impact Factor
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    ABSTRACT: The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient-doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described. To quantify the use of OSNs, patient interactions within OSNs, and attitudes toward OSNs among medical students (MS), resident physicians (RP), and practicing physicians (PP) in the United States. A random, stratified mail survey was sent to 1004 MS, 1004 RP, and 1004 PP between February and May 2010. Percentage of respondents reporting OSN use, the nature and frequency of use; percentage of respondents reporting friend requests by patients or patients' family members, frequency of these requests, and whether or not they were accepted; attitudes toward physician use of OSNs and online patient interactions. The overall response rate was 16.0% (19.8% MS, 14.3% RP, 14.1% PP). 93.5% of MS, 79.4% of RP, and 41.6% of PP reported usage of OSNs. PP were more likely to report having visited the profile of a patient or patient's family member (MS 2.3%, RP 3.9%, PP 15.5%), and were more likely to have received friend requests from patients or their family members (MS 1.2%, RP 7.8%, PP 34.5%). A majority did not think it ethically acceptable to interact with patients within OSNs for either social (68.3%) or patient-care (68.0%) reasons. Almost half of respondents (48.7%) were pessimistic about the potential for OSNs to improve patient-doctor communication, and a majority (79%) expressed concerns about maintaining patient confidentiality. Personal OSN use among physicians and physicians-in-training mirrors that of the general population. Patient-doctor interactions take place within OSNs, and are more typically initiated by patients than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic.
    Journal of General Internal Medicine 06/2011; 26(10):1168-74. · 3.28 Impact Factor
  • Gabriel T Bosslet
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    ABSTRACT: The advent of prenatal genetic diagnosis has sparked debates among ethicists and philosophers regarding parental responsibility towards potential offspring. Some have attempted to place moral obligations on parents to not bring about children with certain diseases in order to prevent harm to such children. There has been no rigorous evaluation of cystic fibrosis in this context. This paper will demonstrate cystic fibrosis to have unique properties that make it difficult to categorize among other diseases with the goal of promulgating a reproductive rule. Once this is established, it will be demonstrated that procreative rules that appeal to future health are inadequate in the era of advancing genetic knowledge. Utilising a specification of Joel Feinberg's 'open future' concept outlined by Matteo Mameli, it will offer an analysis of parental obligation that does not constrain parents of potential children with cystic fibrosis with a moral obligation not to bring them about.
    Journal of medical ethics 02/2011; 37(5):280-4. · 1.42 Impact Factor
  • Gabriel T. Bosslet, Praveen N. Mathur
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    ABSTRACT: Physicians charged with the task of caring for the critically ill will inevitably encounter patients who require drainage of the pleural cavity, e.g., those with pneumonia, central lines, and mechanical ventilation. Practitioners caring for these individuals should be comfortable with placement and management of chest tubes
    07/2010: pages 287-305;
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    ABSTRACT: Propofol is a fast-acting intravenous sedative that has advantages as a procedural sedative over traditional regimens. It has been shown to have a similar safety profile to traditional sedating medications in the setting of gastroenterologic endoscopy. Nurse-administered propofol sedation is given by a specially-trained nurse, without anesthesiologist involvement. We have used nurse-administered propofol sedation in our bronchoscopy suite for several years. In this report, we summarize our experience with nurse-administered propofol sedation, and demonstrate it to be feasible and safe for bronchoscopic procedures. Procedure reports and nursing notes for 588 bronchoscopic procedures performed between July 2006 and June 2008 were retrospectively reviewed. Patient demographics, procedure type and indication, procedure time, medication doses, and adverse events were noted and analyzed. Nurse-administered propofol sedation was used in 498/588 (85%) procedures. Patients utilizing nurse-administered propofol sedation had an average age of 53 years (range 18-86) with an average weight of 80 kg. 56% of the patients were male, and 57% of the procedures were performed on outpatients. Average procedure duration was 25 min (range 3-123). The average propofol dose was 3.13 mg/kg (range 0.12-20 mg/kg). Adverse events attributable to sedation were noted in 33 (6.6%) procedures. Of the 14 (2.8%) major adverse events (death, need for intubation, ICU stay, or hospitalization), only 6 (1.2%) were potentially attributable to the sedation regimen. There were 2 deaths, neither of which was related to sedation. Nurse-administered propofol sedation is a feasible and safe sedation method for bronchoscopic procedures.
    Respiration 12/2009; 79(4):315-21. · 2.62 Impact Factor
  • Gabriel Bosslet, Chadi Hage

Publication Stats

35 Citations
23.12 Total Impact Points

Institutions

  • 2009–2013
    • Indiana University-Purdue University Indianapolis
      • • Department of Communication Studies
      • • Division of General Internal Medicine and Geriatrics
      • • Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine
      Indianapolis, IN, United States