Podcasts about diagnostic accuracy

https://bit.ly/4mDRbKKAula de Laringoscopia: O passo a passo para fazer do jeito certo.

Send us a textDiagnostic accuracy of an over-the-counter infant pulse oximeter for cardiorespiratory events.Travers CP, Nakhmani A, Armstead KM, Benz RL, Foshee KM, Carlo WA.Arch Dis Child Fetal Neonatal Ed. 2025 May 12:fetalneonatal-2025-328540. doi: 10.1136/archdischild-2025-328540. Online ahead of print.PMID: 40355254As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode, Dr. Ashwin Singh Parihar is joined by Dr. Jelijn Knip and Dr. Willemien Menke to discuss their study comparing FDG PET and FES PET for staging grade 1 or 2 ER-positive breast cancer, highlighting how FES PET may offer more accurate results for certain tumors. Tune in to learn how these imaging techniques can impact treatment decisions. The Diagnostic Accuracy of 18F-FDG PET and 18F-FES PET for Staging Grade 1–2 Estrogen Receptor–Positive Breast Cancer. Knip and Iqbal et al. Radiology 2025; 314(3):e241850.

Guest: Andrew J. Solomon, MD Accurately diagnosing multiple sclerosis (MS) involves understanding the diagnostic criteria, recognizing red flags to avoid misdiagnosis, and keeping up with new tools. Dr. Andrew Solomon, Professor and Interim Chair of the Department of Neurological Sciences and Chief of the Multiple Sclerosis Division at the University of Vermont, walks through the most difficult aspects of diagnosing patients with MS and potential breakthroughs reshaping how we approach these challenges. Dr. Solomon also spoke about this topic at the 2025 American Academy of Neurology Annual Meeting.

Guest: Andrew J. Solomon, MD Accurately diagnosing multiple sclerosis (MS) involves understanding the diagnostic criteria, recognizing red flags to avoid misdiagnosis, and keeping up with new tools. Dr. Andrew Solomon, Professor and Interim Chair of the Department of Neurological Sciences and Chief of the Multiple Sclerosis Division at the University of Vermont, walks through the most difficult aspects of diagnosing patients with MS and potential breakthroughs reshaping how we approach these challenges. Dr. Solomon also spoke about this topic at the 2025 American Academy of Neurology Annual Meeting.

Send us a textIn this episode of the Digital Pathology Podcast, I sit down with Matthew Nuñez, CEO of MUSE Microscopy, to discuss the groundbreaking advancements in direct-to-digital imaging in pathology. Traditional pathology workflows rely on glass slides, formalin fixation, and time-consuming processing steps. But what if we could skip the slide entirely and go straight to digital?

Dr. Linda Chu speaks with Dr. Daniele Andreini about the Advantage II Study, which evaluates the accuracy of dynamic stress myocardial CT perfusion in patients with coronary artery stents. They discuss how this technique compares to invasive testing, its advantages over static CT perfusion, and its impact on cardiac imaging. Diagnostic Accuracy of Dynamic Stress Myocardial CT PerfusionCompared with Invasive Physiology in Patients with Stents:The Advantage 2 Study. Andreini and Mushtaq et al. Radiology 2024; 313(3):e232225.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Diagnostic Accuracy of Apple Watch Electrocardiogram for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Advancements in artificial intelligence are transforming healthcare, and remote cardiac monitoring is at the forefront of this change. With cardiovascular disease impacting nearly 50% of the population at some point in their lives, early detection and efficient diagnosis are crucial. Enter AI-powered cardiac monitors that provide near real-time data, reduce diagnostic errors, and improve access to care. But how exactly does this technology work, and what does it mean for patients and healthcare providers?Welcome to I Don't Care. In this episode, Dr Kevin Stevenson sits down with Stuart Long, the CEO of InfoBionic.AI, to explore the transformative impact of AI on cardiac monitoring. From continuous monitoring that detects arrhythmias in real-time to algorithms developed in collaboration with Mayo Clinic, this conversation addresses a vital question: How can technology redefine the landscape of cardiac care?Key Points of Discussion:Continuous Monitoring Revolution: InfoBionic's device streams data to the cloud, using AI to process millions of heartbeats and prioritize critical information for physicians.Reducing False Positives: By leveraging advanced AI and signal processing, the company has reduced false positives for atrial fibrillation by over 85%, providing clinicians with cleaner, more actionable data.Improving Health Equity: With remote cardiac monitoring solutions that eliminate the need for in-person visits, InfoBionic ensures greater access to cardiac care, especially in rural areas.Stuart Long is a seasoned healthcare executive with over 30 years of experience leading and scaling companies in the medical device and healthcare IT sectors. As CEO of InfoBionic.AI, he has pioneered advancements in AI-powered cardiac monitoring, significantly improving diagnostic accuracy and patient outcomes. With expertise in enterprise software, medical imaging, and strategic operations, Long also brings a strong background in marketing strategy, honed at Cornell University's Johnson Graduate School of Management.

Are you frustrated with patient positioning during video fluoroscopy studies? Ever wonder why some facilities seem to breeze through MBS studies while others struggle to get basic views? This week's episode might just change how you think about your fluoroscopy equipment forever. We're thrilled to share our conversation with Julie Kobak, MA, CCC-SLP, CBIS, a […] The post 353 – Why Your MBS Chair Could Make or Break Your Diagnostic Accuracy with Julie Kobak MA, CCC-SLP, CBIS appeared first on Swallow Your Pride Podcast.

In resource-limited settings, an integrated AI tool allows novice users to improve gestational age estimates. Jeffrey Stringer, MD, University of North Carolina, joins JAMA+ AI Editor in Chief Roy H. Perlis, MD, MSc, to discuss "Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps." Related Content: The Low-Cost, Battery-Powered AI-Enabled Ultrasound Device That Could Improve Global Obstetric Care Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps

In the October 2024 replay features four episodes on approaches to clinical diagnosis of parkinsonism. The episode starts off with Dr. Colin Hoy discuss the concept of prodromal Parkinson disease and the ethical considerations surrounding its diagnosis. The episode leads into a conversation with Dr. Chris Gibbons discussing skin biopsies to detect phosphorylated α-synuclein. In the third episode Drs. Michiko K. Bruno and Lawrence Golbe about a practical diagnostic algorithm for atypical parkinsonian disorders Drs. Michiko K. Bruno and Lawrence Golbe discuss a practical diagnostic algorithm for atypical parkinsonian disorders. The episode concludes with Dr. Eduardo De Pablo-Fernández talking about the strengths of DAT imaging in diagnosing patients with Parkinsonian disorders. Previous Podcasts: The Ethical Landscape of Prodromal Parkinson Disease Skin Biopsy Detection of Phosphorylated α-Synuclein General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders Interpreting DAT Imaging Results in the Clinical Context Article Links: The Ethical Landscape of Prodromal Parkinson Disease  Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies A General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders  Neuropathologic Validation and Diagnostic Accuracy of Presynaptic Dopaminergic Imaging in the Diagnosis of Parkinsonism Disclosures can be found at Neurology.org.

Date: September 23, 2024 Reference: Essat et al. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis. Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. Case: You are working a busy shift in a rural emergency department (ED) […] The post SGEM#454: I Just Died in Your Arms Tonight – Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes first appeared on The Skeptics Guide to Emergency Medicine.

Gestational age estimation is foundational for obstetric care. In resource-limited settings, an integrated AI tool allows novice users to improve gestational age estimates. Author Jeffrey Stringer, MD, University of North Carolina, joins JAMA Deputy Editor Linda Brubaker, MD, MS, to discuss Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps. Related Content: Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps Enhancing Obstetric Ultrasonography With Artificial Intelligence in Resource-Limited Settings

Rebecca Le, MD discusses an article detailing how core needle biopsy may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces. ARTICLE TITLE - CT-Guided Core-Needle Biopsy of Pulmonary Lesions Associated With Cystic Airspaces: A Case-Control Study

Kaele M. Leonard, MD, and Robert J. Lentz, MD, join CHEST Podcast Moderator Dominique Pepper, MD, to discuss whether a conservative diagnostic yield definition may represent a useful outcome for future studies of diagnostic utility.

In this installment of "The Jaded Mechanic," Jeff Compton welcomes Zeb Beard, a revered figure in the automotive service industry. Zeb underscores the importance of accurate diagnostics, sharing that a two-hour diagnostic base not only bolsters customer trust but also underpins the financial health of the shop. Zeb also highlights his unique customer service philosophy, stressing the benefits of serving premium customers who rely on his expertise without second-guessing his decisions. Throughout the episode, both Jeff and Zeb delve into their regional differences in vehicle maintenance needs, with a particular focus on the challenges posed by rust and its influence on repair strategies.00:00 Vehicle maintenance and undercoating for older trucks.04:43 Challenges with Subaru and Ford wheel bearings.07:10 Road brine corrodes trucks and harms the environment.11:01 Refreshing to converse with a confident, like-minded peer.13:13 Struggling business owners seek simplicity and guidance.17:25 Guiding others through learning from past mistakes.21:35 Surprised by new lab scope test method.25:54 Intermittent issues and customer choices in repairs.26:50 Customer understanding through detailed explanation and demonstration.32:11 Customers can attract a new type of clientele.33:19 Prefers customers who seek personalized service.36:48 Building shop, need staff, reducing spending. Costly.40:24 Met in '98, married after a few months.44:07 Please like, comment, share, and download the podcast. Thanks to our sponsor Promotive! Find your dream job today: gopromotive.com/jeff 

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.                                                  >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.                                                                                  Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome back to "Ditch the Labcoat," where today we're diving deep with the compelling insights of Dr. James East. From intense medical shifts that demand lightning-fast responsiveness to the emotionally charged transitions from ICU pressures to family presence, Dr. East offers a rare window into the life-saving ballet performed daily by our healthcare heroes.Together, they shed light on the emotional fortitude required in this profession, the camaraderie needed to weather the storm, and the ever-evolving tools at their disposal.As the worlds of healthcare and technology collide, we explore the role of AI and technological interfaces, challenging the traditional white coat with terms like Chat GPT and electronic health records. Dr. East, a critical care maestro, and tech startup visionary, debates the true utility of inference-based decisions and AI-assisted diagnostics, while Dr. Bonta lends his seasoned skepticism to the conversation on tools like ECGs and their digital interpretations.From the lab to the living room, the discussion navigates the emotional labor physicians carry and the importance of processing traumatic cases. And as if navigating the corridors of care wasn't enough, our guests tackle the digital transformation of healthcare head-on, weighing in on the potential integration of AI in patient care and the necessity of maintaining the human touch amidst digital disruption.Strap in for a journey through the pulse-pounding, data-driven, and deeply human field of modern medicine. You don't need a lab coat where we're going—this is "Ditch the Labcoat," featuring Dr. James East.Dr. James East, GIM/ICU physician at Mackenzie Health and Trillium Health Partners. Chief Product Officer and Head of Content Development at FirstHx /  https://firsthx.com/about-us/Episode Timestamps :00:00 Doctor bridges clinical work with healthcare technology.10:16 Supportive partner helps balance demanding work schedule.13:33 Residency experience: few patients come home.18:43 Dealing with worst days, first responders' challenges.25:54 Advances in technology enhance clinical decision-making.27:13 Analyze electronic health records evolution from paper.36:55 AI engines lack meaningful benefits for clinicians.38:37 Need standardized, evidence-based, high-quality solutions for clinicians.48:06 AI can aid in efficient, thorough patient care.55:09 AI may struggle to replicate human empathy.59:16 Ethical concerns regarding AI in healthcare.01:05:11 Advocacy for seeking professional medical support online.01:09:04 AI aiding clinicians in diagnosing and treating.© 2024 ditchthelabcoat.com - All Rights Reserved 

Er wordt al jaren hard gewerkt aan een bloedtest voor het diagnosticeren van Alzheimer. Onderzoekers van een Zweedse Universiteit hebben één van de reeds ontwikkelde testen nu nader onderzocht. Hun conclusie: dit werkt evengoed als een ruggenprik of hersenscan. Omdat een ruggenprik invasief en onprettig is en een scan vaak enorm kostbaar, is de hoop dat een bloedtest een makkelijk en goedkoop alternatief is voor het stellen van de diagnose. Zeker als we ooit richting bevolkingsonderzoeken willen bewegen. Het uitvoerig bestuderen van ontwikkelde bloedtesten was nog moeilijk, omdat er vaak niet genoeg testen beschikbaar waren. Experts reageren hoopvol op een onderzoek waarin dat wel gelukt lijkt te zijn. Hierin werd gekeken naar een bestaande bloedtest die de aanwezigheid van het eiwit p-tau217 aantoont. Volgens de onderzoekers lukt het met de test evengoed als met een ruggenprik en zelfs beter dan met een scan om aan te tonen of er sprake van Alzheimer is. Het onderzoek zelf vind je hier: Diagnostic Accuracy of a Plasma Phosphorylated Tau 217 Immunoassay for Alzheimer Disease Pathology Er werd onder andere hier over geschreven: Blood test could revolutionise diagnosis of Alzheimer's, experts say en hier New blood test that screens for Alzheimer's may be a step closer to reality, study suggests. Hier vind je meer info over ALZpath, het bedrijf achter de test.  See omnystudio.com/listener for privacy information.

In this episode of The FARM Cast, we delve into the intricate world of Carpal Tunnel Syndrome (CTS) – a condition that affects millions worldwide. Join us as we unravel the complexities of CTS, exploring its causes, symptoms, and potential treatments. Dr. Beau sheds light on the anatomy of the wrist, explaining how the carpal tunnel, a narrow passageway in the wrist, can become a source of discomfort and pain. We discuss the common risk factors associated with CTS, including repetitive hand movements, poor ergonomics, and certain medical conditions. Listeners will gain valuable insights into recognizing the early warning signs of CTS, such as tingling, numbness, and weakness in the hand and fingers. Our guest shares practical tips on ergonomics and exercises that can help prevent and alleviate symptoms, making this episode a must-listen for anyone spending extended hours on keyboards or engaging in repetitive hand activities. -- Abdalbary SA, Abdel-Wahed M, Amr S, Mahmoud M, El-Shaarawy EAA, Salaheldin S, Fares A. The Myth of Median Nerve in Forearm and Its Role in Double Crush Syndrome: A Cadaveric Study. Front Surg. 2021 Sep 21;8:648779. doi: 10.3389/fsurg.2021.648779. PMID: 34621777; PMCID: PMC8490666. Karne SS, Bhalerao NS. Carpal Tunnel Syndrome in Hypothyroidism. J Clin Diagn Res. 2016 Feb;10(2):OC36-8. doi: 10.7860/JCDR/2016/16464.7316. Epub 2016 Feb 1. PMID: 27042500; PMCID: PMC4800566. Kong G, Brutus JP, Vo TT, Hagert E. The prevalence of double- and multiple crush syndromes in patients surgically treated for peripheral nerve compression in the upper limb. Hand Surg Rehabil. 2023 Dec;42(6):475-481. doi: 10.1016/j.hansur.2023.09.002. Epub 2023 Sep 14. PMID: 37714514. Louie D, Earp B, Blazar P. Long-term outcomes of carpal tunnel release: a critical review of the literature. Hand (N Y). 2012 Sep;7(3):242-6. doi: 10.1007/s11552-012-9429-x. PMID: 23997725; PMCID: PMC3418353. Mills ES, Mertz K, Fresquez Z, Ton A, Buser Z, Alluri RK, Hah RJ. The Incidence of Double Crush Syndrome in Surgically Treated Patients. Global Spine J. 2022 Nov 1:21925682221137530. doi: 10.1177/21925682221137530. Epub ahead of print. PMID: 36321208. Möllestam K, Rosales RS, Lyrén PE, Atroshi I. Measuring symptoms severity in carpal tunnel syndrome: score agreement and responsiveness of the Atroshi-Lyrén 6-item symptoms scale and the Boston symptom severity scale. Qual Life Res. 2022 May;31(5):1553-1560. doi: 10.1007/s11136-021-03039-1. Epub 2021 Nov 20. PMID: 34800220; PMCID: PMC9023404. Mondelli M, Farioli A, Mattioli S, Aretini A, Ginanneschi F, Greco G, Curti S. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures. PLoS One. 2016 Oct 21;11(10):e0164715. doi: 10.1371/journal.pone.0164715. PMID: 27768728; PMCID: PMC5074522. Pensy RA, Burke FD, Bradley MJ, Dubin NH, Wilgis EF. A 6-year outcome of patients who cancelled carpal tunnel surgery. J Hand Surg Eur Vol. 2011 Oct;36(8):642-7. doi: 10.1177/1753193411410155. Epub 2011 Jun 2. PMID: 21636619. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998 Jul-Sep;11(3):171-9. doi: 10.1016/s0894-1130(98)80035-5. PMID: 9730093. Sangram, B.S.; Mayne, A.I.W.; Jariwala, A.C. Can we accurately predict nerve conduction study outcome using a carpal tunnel syndrome questionnaire? Surgeon 2019, 17, 156–159. --- Send in a voice message: https://podcasters.spotify.com/pod/show/thefarmcast/message

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

Karen Pierce, Ph.D., explores using eye tracking to diagnose and treat autism. Her work identifies patterns in children's attention, aiming to streamline diagnosis, predict symptom severity, and tailor treatments. The focus is on early intervention by making social stimuli engaging for kids with varied attention patterns. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Science] [Show ID: 39170]

In this episode with Dr Chris Bleakley, we discuss his Research Review of a recent article looking at the Ottawa Ankle Rules. We discuss the components of the Ottawa Ankle Rules and how they can be used in your clinical practice to help guide your treatments. We also discuss the clinical accuracy of the Ottawa ankle rules and what the findings of this systematic review were. 

To close or not to close - that is the question!  Internal hernias following bariatric surgery can be a vexing source of delayed postoperative morbidity.  Join Drs. Matthew Martin, Kunoor Jain-Spangler, Adrian Dan, and Vincent Cheng for this EXCELLENT Journal Review in Bariatric Surgery.   Article #1: Stenberg 2023 - Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery Two mesenteric defects are created during Roux-en-Y gastric bypass (RNYGB) Petersen's Defect Jejuno-jejunostomy mesenteric defect  Consensus does not exist regarding the standard of care for mesenteric defect closure (e.g., closure of one or both defects, material used for closure).  Risks of leaving defects open: internal herniation with or without bowel ischemia  Risks of closing defects Kinking the bowel (especially near the jejunojejunostomy) leading to obstruction  Chronic abdominal pain This article discusses a randomized controlled trial of obese patients undergoing bariatric RNYGB Randomized into two groups: a closure group and a non-closure group  Followed patients for 10 years with 95-96% follow up rate Results analyzed using a Cox proportional hazards regression that included risk factors like BMI, total weight loss at 1 year after surgery, and the other  Highlighted outcomes  Within the first 30 postop days, there was a higher rate of SBO in the closure group (1.3%) compared to the non-closure group (0.2%). This was attributed to kinking of the jejunojejunostomy  After 30 postop days and up to 10 years, reoperation rates for SBO were higher in the non-closure group (14.9%) compared to the closure group (7.8%). This trend was consistent regarding each site of mesenteric defect.  No significant differences between the two groups regarding chronic opioid use as a metric of chronic abdominal pain. Article #2: Nawas 2022 - The Diagnostic Accuracy of Abdominal Computed Tomography in Diagnosing Internal Herniation Following Roux-en-Y Gastric Bypass Surgery Unless there is an indication to immediately operate on a RNYGB patient in whom internal herniation is suspected, computed tomography (CT) is the recommended diagnostic test This article is a meta-analysis of 20 studies published between 2007 and 2020 that analyzed the accuracy of CT or detecting internal hernias in adult patients who underwent RNYGB for morbid obesity. A collective total of 1,637 patients were included.   Accuracy was determined by comparing diagnostic CT with exploratory surgery or the combination of negative CT and a negative 90 days follow-up Internal herniation was defined as presence of herniated small bowel with or without obstruction or ischemia through a visible opening at the mesenteric defect Results Pooled sensitivity of CT was 82% and specificity was 85% Positive predictive value of CT was 83% and negative predictive value was 86% CT signs with the highest sensitivity (sensitivity of finding)  Venous congestion (79%) Swirl sign (78%)  Mesenteric edema (67%) 15% risk of an internal hernia even with a negative CT scan In conclusion, CT can provide useful information, but these are just additional data points to consider in the overall evaluation of a patient. Surgeons should still have a low threshold for diagnostic laparoscopy even with negative CT findings If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Go online to PeerView.com/NEF860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Alzheimer's disease (AD) is a devastating and highly prevalent condition, affecting 10% of people over 65 years of age, and increasing in prevalence as the population ages. Given the heavy economic and social burdens of AD, major emphasis has been placed on finding disease-modifying therapies (DMTs) that can address the underlying pathophysiology and prevent, delay, slow, or halt the inexorable decline of AD. Now, after almost two decades without a new AD treatment, recent advances in DMTs, including the accelerated approval from the FDA of two amyloid-targeting therapies (ATTs) and a third in late-stage development, have opened the door to the possibility of reductions in disease progression and improved patient outcomes. In order for these treatments to be successful, initiation in the prodromal or early symptomatic stages of AD is critical. Fortunately, significant advances have been made in the development and validation of molecular imaging techniques that may aid in an early diagnosis. It is therefore imperative that clinicians remain aware of the evolving role of molecular imaging tools (eg, amyloid PET, FDG PET, tau PET) and PET quantification techniques in the early diagnosis of AD, and are prepared to integrate these diagnostic tools into clinical practice. At a recent PeerView educational event, a panel of AD experts illustrated how to integrate validated and emerging neuroimaging biomarkers and quantitative measures into clinical practice to facilitate AD diagnosis. Through a case-based discussion, the faculty offered learners an in-depth look at the complex diagnostic challenges associated with early AD and mild cognitive impairment, and provided practical guidance on effectively and appropriately incorporating these strategies into patient care. You can now watch this on-demand version of the event! Upon completion of this activity, participants should be better able to: Employ molecular imaging tools to optimize the timely and accurate neuropathological diagnosis of AD; and Apply quantitative analysis to augment the visual interpretation of PET imaging in AD

Go online to PeerView.com/NEF860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Alzheimer's disease (AD) is a devastating and highly prevalent condition, affecting 10% of people over 65 years of age, and increasing in prevalence as the population ages. Given the heavy economic and social burdens of AD, major emphasis has been placed on finding disease-modifying therapies (DMTs) that can address the underlying pathophysiology and prevent, delay, slow, or halt the inexorable decline of AD. Now, after almost two decades without a new AD treatment, recent advances in DMTs, including the accelerated approval from the FDA of two amyloid-targeting therapies (ATTs) and a third in late-stage development, have opened the door to the possibility of reductions in disease progression and improved patient outcomes. In order for these treatments to be successful, initiation in the prodromal or early symptomatic stages of AD is critical. Fortunately, significant advances have been made in the development and validation of molecular imaging techniques that may aid in an early diagnosis. It is therefore imperative that clinicians remain aware of the evolving role of molecular imaging tools (eg, amyloid PET, FDG PET, tau PET) and PET quantification techniques in the early diagnosis of AD, and are prepared to integrate these diagnostic tools into clinical practice. At a recent PeerView educational event, a panel of AD experts illustrated how to integrate validated and emerging neuroimaging biomarkers and quantitative measures into clinical practice to facilitate AD diagnosis. Through a case-based discussion, the faculty offered learners an in-depth look at the complex diagnostic challenges associated with early AD and mild cognitive impairment, and provided practical guidance on effectively and appropriately incorporating these strategies into patient care. You can now watch this on-demand version of the event! Upon completion of this activity, participants should be better able to: Employ molecular imaging tools to optimize the timely and accurate neuropathological diagnosis of AD; and Apply quantitative analysis to augment the visual interpretation of PET imaging in AD

Go online to PeerView.com/NEF860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Alzheimer's disease (AD) is a devastating and highly prevalent condition, affecting 10% of people over 65 years of age, and increasing in prevalence as the population ages. Given the heavy economic and social burdens of AD, major emphasis has been placed on finding disease-modifying therapies (DMTs) that can address the underlying pathophysiology and prevent, delay, slow, or halt the inexorable decline of AD. Now, after almost two decades without a new AD treatment, recent advances in DMTs, including the accelerated approval from the FDA of two amyloid-targeting therapies (ATTs) and a third in late-stage development, have opened the door to the possibility of reductions in disease progression and improved patient outcomes. In order for these treatments to be successful, initiation in the prodromal or early symptomatic stages of AD is critical. Fortunately, significant advances have been made in the development and validation of molecular imaging techniques that may aid in an early diagnosis. It is therefore imperative that clinicians remain aware of the evolving role of molecular imaging tools (eg, amyloid PET, FDG PET, tau PET) and PET quantification techniques in the early diagnosis of AD, and are prepared to integrate these diagnostic tools into clinical practice. At a recent PeerView educational event, a panel of AD experts illustrated how to integrate validated and emerging neuroimaging biomarkers and quantitative measures into clinical practice to facilitate AD diagnosis. Through a case-based discussion, the faculty offered learners an in-depth look at the complex diagnostic challenges associated with early AD and mild cognitive impairment, and provided practical guidance on effectively and appropriately incorporating these strategies into patient care. You can now watch this on-demand version of the event! Upon completion of this activity, participants should be better able to: Employ molecular imaging tools to optimize the timely and accurate neuropathological diagnosis of AD; and Apply quantitative analysis to augment the visual interpretation of PET imaging in AD

Go online to PeerView.com/NEF860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Alzheimer's disease (AD) is a devastating and highly prevalent condition, affecting 10% of people over 65 years of age, and increasing in prevalence as the population ages. Given the heavy economic and social burdens of AD, major emphasis has been placed on finding disease-modifying therapies (DMTs) that can address the underlying pathophysiology and prevent, delay, slow, or halt the inexorable decline of AD. Now, after almost two decades without a new AD treatment, recent advances in DMTs, including the accelerated approval from the FDA of two amyloid-targeting therapies (ATTs) and a third in late-stage development, have opened the door to the possibility of reductions in disease progression and improved patient outcomes. In order for these treatments to be successful, initiation in the prodromal or early symptomatic stages of AD is critical. Fortunately, significant advances have been made in the development and validation of molecular imaging techniques that may aid in an early diagnosis. It is therefore imperative that clinicians remain aware of the evolving role of molecular imaging tools (eg, amyloid PET, FDG PET, tau PET) and PET quantification techniques in the early diagnosis of AD, and are prepared to integrate these diagnostic tools into clinical practice. At a recent PeerView educational event, a panel of AD experts illustrated how to integrate validated and emerging neuroimaging biomarkers and quantitative measures into clinical practice to facilitate AD diagnosis. Through a case-based discussion, the faculty offered learners an in-depth look at the complex diagnostic challenges associated with early AD and mild cognitive impairment, and provided practical guidance on effectively and appropriately incorporating these strategies into patient care. You can now watch this on-demand version of the event! Upon completion of this activity, participants should be better able to: Employ molecular imaging tools to optimize the timely and accurate neuropathological diagnosis of AD; and Apply quantitative analysis to augment the visual interpretation of PET imaging in AD

Today we have a special guest, Dr. Joel Topf, board-certified nephrologist and medical educator extraordinaire. Our listeners will likely recognize Dr. Topf from his prolific tweeting @Kidney_boy, as well as his numerous appearances on the Curbsiders podcast. He is a co-founder of the NephJC on Twitter, and host and founder of the NephJC podcast Freely Filtered. He is also host of the podcast Channel Your Enthusiasm, a deep dive monthly recap of the nephrology textbook Clinical Physiology of Acid Base and Electrolyte Disorders by Dr. Burton Rose (who, incidentally, is the creator of the original UpToDate). Dr. Topf wrote his own book on fluids, electrolytes and acid-base homeostasis.  He's the co-editor for the fourth edition of Nephrology Secrets and the first edition of The Handbook of Critical Care Nephrology. Dr. Topf joined us to talk about a new paper he co-authored on osmotic demyelination syndrome and hyponatremia. I'm also joined by Dr. Mita Hoppenfeld, hospitalist at the University of Utah, to talk about a new DOAC vs warfarin trial in On-X aortic valves, whether it's better to avoid hypertension or hypotension around time of surgery, and the diagnostic accuracy of CT abdomen scans without contrast. Check it out! Osmotic Demyelination and HyponatremiaApixaban vs Warfarin for On-X Aortic ValvePerioperative Blood Pressure Strategies Diagnostic Accuracy of CT Abdomen Without ContrastMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Paper for discussion: Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department JAMAsurg May 2023 Teaching topic: Statistical Tests part 1 - Chi-square Our tune is"Inspiring Optimistic Upbeat Energetic Guitar Rhythm" by Free Music | https://soundcloud.com/fm_freemusic Music promoted by https://www.free-stock-music.com Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/deed.en_US

(2:33) - Using Machine Learning to Detect Rare DiseasesThis episode was brought to you by Mouser, our favorite place to get electronics parts for any project, whether it be a hobby at home or a prototype for work. Click HERE to learn about how a) AI is being leveraged in healthcare and b) the tools available from vendors to empower development in this area.

What actually is Rovsing sign and is it useful?   Check out the papers mentioned. Prosenz J, Hirtler L.  Rovsing Signs Revisited - Effects of an Erroneous Translation on Medical Teaching and Research.  Journal of Surgical Education, 2014-9/01, Vol 71, Issue 5, pages 738-742 https://pubmed.ncbi.nlm.nih.gov/24776856/ Benabbas R, Hanna M, Sinert R.  Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Pont-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department:  A Systematic Review and Meta-analysis. Academic Emergency Medicine 2017; 24: 523– 551. https://onlinelibrary.wiley.com/doi/10.1111/acem.13181 Niels Thorkild Rovsing Obituary.  Br Med J.  1927 Feb 5; 1(3448):265 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2454133/?page=1     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor

Nathan Carlson is a physical therapist, coach, and business owner based out of Kansas City. He specializes in the management of bone stress injuries, managing the high school and collegiate runner, and implementing resistance training with endurance athletes. Nathan teaches nationally and internationally on these topics. Nathan has two digital resources - A Guidebook to Running After a Stress Fracture and A Guidebook to Navigating High School Running. In this episode, we have an in-depth conversation on bone stress injuries. Our conversation was packed with so much valuable information that we broke it down into two episodes. In part one, we discuss bone physiology, factors that contribute to bone stress injuries, clinical perils, and radiographic tools for diagnosis. Bone stress injuries are one of the most complex and frustrating injuries for runners. After our discussion with Nathan, we hope that you will have a better understanding of the training, nutrition, and metabolic factors that need to be considered with diagnosing and treating these injuries. What we talked about: 3:10- Introduction to Nathan 6:40- Weight lifting for high school athletes 8:25- Defining a bone stress injury 11:00- Differences between a stress reaction and stress fracture and what causes them 22:05- Obtaining a more in-depth background of an athlete to learn more about the injury 25:45- Diagnosis and prognosis of bone stress injuries 38:05- Testing and imaging for bone stress injuries Show notes: Nathan's website Nathan on Instagram References: Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. AJR Am J Roentgenol. 2004 Sep;183(3):635-8. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers. 2022 Apr 28;8(1):26. Kaeding CC, Miller T. The comprehensive description of stress fractures: a new classification system. J Bone Joint Surg Am. 2013 Jul 3;95(13):1214-20. Wright AA, Hegedus EJ, Lenchik L, Kuhn KJ, Santiago L, Smoliga JM. Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. Am J Sports Med. 2016 Jan;44(1):255-63. RED-S CAT - https://bjsm.bmj.com/content/bjsports/49/7/421.full.pdf

Go online to PeerView.com/FJH860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this animated educational activity, an expert in chronic inflammatory demyelinating polyneuropathy (CIDP) discusses the diagnosis, assessment, treatment, and monitoring of the disease. A patient also shares her experiences living with and treating her CIDP. Upon completion of this activity, participants should be better able to: Apply guideline-directed criteria to diagnose chronic inflammatory demyelinating polyneuropathy (CIDP), including correct interpretation of electrodiagnostic findings; Incorporate evidence surrounding efficacy, safety, and tolerability of recommended pharmacotherapies (eg, corticosteroids, IVIg, SCIg, and plasma exchange) and shared decision-making into CIDP treatment planning; and Employ validated assessment tools to monitor treatment response and guide clinical decision-making.

Go online to PeerView.com/FJH860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this animated educational activity, an expert in chronic inflammatory demyelinating polyneuropathy (CIDP) discusses the diagnosis, assessment, treatment, and monitoring of the disease. A patient also shares her experiences living with and treating her CIDP. Upon completion of this activity, participants should be better able to: Apply guideline-directed criteria to diagnose chronic inflammatory demyelinating polyneuropathy (CIDP), including correct interpretation of electrodiagnostic findings; Incorporate evidence surrounding efficacy, safety, and tolerability of recommended pharmacotherapies (eg, corticosteroids, IVIg, SCIg, and plasma exchange) and shared decision-making into CIDP treatment planning; and Employ validated assessment tools to monitor treatment response and guide clinical decision-making.

Go online to PeerView.com/FJH860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this animated educational activity, an expert in chronic inflammatory demyelinating polyneuropathy (CIDP) discusses the diagnosis, assessment, treatment, and monitoring of the disease. A patient also shares her experiences living with and treating her CIDP. Upon completion of this activity, participants should be better able to: Apply guideline-directed criteria to diagnose chronic inflammatory demyelinating polyneuropathy (CIDP), including correct interpretation of electrodiagnostic findings; Incorporate evidence surrounding efficacy, safety, and tolerability of recommended pharmacotherapies (eg, corticosteroids, IVIg, SCIg, and plasma exchange) and shared decision-making into CIDP treatment planning; and Employ validated assessment tools to monitor treatment response and guide clinical decision-making.

Go online to PeerView.com/FJH860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this animated educational activity, an expert in chronic inflammatory demyelinating polyneuropathy (CIDP) discusses the diagnosis, assessment, treatment, and monitoring of the disease. A patient also shares her experiences living with and treating her CIDP. Upon completion of this activity, participants should be better able to: Apply guideline-directed criteria to diagnose chronic inflammatory demyelinating polyneuropathy (CIDP), including correct interpretation of electrodiagnostic findings; Incorporate evidence surrounding efficacy, safety, and tolerability of recommended pharmacotherapies (eg, corticosteroids, IVIg, SCIg, and plasma exchange) and shared decision-making into CIDP treatment planning; and Employ validated assessment tools to monitor treatment response and guide clinical decision-making.

Drs. Thomas Hemmerling and Ahmed Alkhatip discuss the article “The Diagnostic Accuracy of Noninvasive Methods to Measure the Intracranial Pressure: A Systematic Review and Meta-Analysis” published in the March 2021 issue of Anesthesia & Analgesia.

Today we talk to one of our mentors, Valerie Carter, about her experience as a neuro PT who had the unique opportunity to study the effects of exercise on people with Parkinson's by helping her mom live very well for 30 years with PD. Valerie became really interested in utilizing the most sensitive outcome measures which led her down the road of studying backwards walking. Valerie shares why you should use the 3 Meter Backward Walking Test (3MBWT), exactly how to implement it, what the cutoff scores for falls are for the elderly and for people with PD, and more! Article in 2020 w/ Becky Farley: Diagnostic Accuracy of the 3-Meter Backward Walk Test in Persons with Parkinson Disease https://www.researchgate.net/publication/343173711_Diagnostic_Accuracy_of_the_3-Meter_Backward_Walk_Test_in_Persons_With_Parkinson_Disease  

Theme: Cardiology.Participants: Dr Karan Rao (cardiologist), Dr Nick Moore (ED consultant), Dr Hao Tran (cardiology advanced trainee), David Emmerig (ED trainee), Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Shreyas Iyer, and Samoda WilegodaDiscussion:Boyle, R., & Body, R. (2021). The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis. Annals Of Emergency Medicine, 77(4), 433-441. https://doi.org/10.1016/j.annemergmed.2020.10.020.Presenter: David Emmerig. Credits:This episode was produced by HETI's Emergency Medicine Training Network 5.Music/Sound Effects Ascension by Keys of Moon | https://soundcloud.com/keysofmoon, Music promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.  Descriptions by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Maximalism by Punch Deck | https://soundcloud.com/punch-deck, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Something 'bout July by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

When should you suspect clozapine-induced myocarditis? Myocarditis has nonspecific manifestations. In this episode, Dr. Phelps explains the clinical presentation and the steps to take if you suspect myocarditis. Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 32 Clozapine-Induced Myocarditis: Electronic Health Register Analysis of Incidence, Timing, Clinical Markers, and Diagnostic Accuracy  

The Medical Director of Neuropathology at Northwestern University, Dr. Craig Horbinski, joins Steve Bertrand on Chicago's Afternoon News to talk about a new genetic test for brain tumors and how it improves diagnostic accuracy and treatment plans.

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

The Need for Speed: Improving Diagnostic Accuracy and Effective Management of aTTP in Emergency and Intensive Care

Commentary by Dr. Tozu Suzuki

Listen to the future voices of addiction research. Ten students/ECRs discuss their excellent work which will also be presented live, along with other excellent research, on August 13, 2021 during the NIAAA/NIDA student/ECR poster session. The poster session is sponsered by NIDA/NIAAA, and all researchers were provided travel awards by either NIAAA or NIDA. Primary presenters, poster titles, and timestamps for posters below. To learn more about the poser session or to sign up to attend this free live event, please click here. 1. Julie Wojtaszek (2:09-7:10) - Changes and moderating influences on addictive and mental health symptoms associated with COVID-19 2. Tessa Frohe (7:10-17:50) - Qualitative Findings from a Smartphone Intervention Application for Individuals on Medication for Opioid Use Disorder: How User-Centered Design Offers Promise for Harm Reduction 3. Nathan Kearns (17:50-28:17) - Effect of Trauma-Related Stress After Alcohol Consumption on Perceived Likelihood of Negative Consequences and Willingness to Drive 4. Satveer Kler (28:17-33:37) - Are Social Support and Racialized Heterosexism Predictors of Alcohol Dependence among QTBIPOC? 5. Courtney Doxbeck (33:37-41:49) - Exploring Social Norms, Pandemic Partying, and E-cigarette Use in United States College Students 6. Benjamin Shepherd (41:49-52:01) - Suicidal Ideation, Substance Use Disorders, and Co-occurrences among Sexual Minority People of Color 7. Kirsten Smith (52:01-1:02:11) - Psychosocial and substance use correlates of lifetime Kratom use in a large online sample 8. Andrea Vásquez Ferreiro (1:02:11-1:09:55) - Relations among Key Correlates in a Mobile Attentional Bias Retraining Study for Opioid Use Disorder 9. Irene Pericot-Valvedre (1:09:55-1:18:09) - Diagnostic Accuracy of the BDI-II and its Relationship to Direct-Acting Antiviral Adherence: Implications for Hepatitis C treatment Among People Who Inject Drugs on Medications for Opioid Use Disorder 10. Alexandra Palmisano (1:18:09-1:28:21) - Examining the Association between PTSD Symptom Heterogeneity and Alcohol Use Disorder in Veterans

00:00-01:59- Introduction by Dr. Chu 02:00-08:34- Dr. Linda Chu interviews Dr. Licia Luna. Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and Meta-Analysis of 68 Observational Studies. Luna et al. Radiology 2021; 300:338–349. 08:35-18:00 Dr. Manisha Bahl interviews Mr. Kiran Vaidhya Venkadesh and Dr. Colin Jacobs. Deep Learning for Malignancy Risk Estimation of Pulmonary Nodules Detected at Low-Dose Screening CT. Venkadesh et al. Radiology 2021; 300:438–447. 18:01-25:16- Dr. Refky Nicola interviews Dr. Vincent Mellnick. Clinical Appendicitis Scores May Lower CT Utilization and Diagnostic Accuracy. Song and Lee et al. Radiology 2021; 300:350–358.  25:17-25:42- Conclusion

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.21.25640  Characteristic CT findings of COVID-19 pneumonia have been extensively described, including the substantial overlap with findings of other infectious etiologies such as influenza. However, CT findings also have substantial overlap with those of non-infectious organizing pneumonia. Matthew Peterson, MD discusses a new AJR study sample with equal proportions of these infectious and non-infectious diagnoses, in which radiologists' diagnostic accuracy was low.

Yakın dönemde olgu olarak Cevabı Görselinde serisinde paylaştığımız, pulmoner embolide (PE) erken sistolik çentik (ESN) bulgusunun acil servis hastalarında tanısal duyarlılığı ile ilgili çok merkezli çalışmasını da yayımladık.​1​ Bu yazımızda, bu bulgunun acil servis hastalarında ne kadar güvenilir olduğu ile ilgili sonuçları paylaşacağız. İyi okumalar. Giriş Afonso ve ark., 2019 yılında, masif ve submasif PE hastalarında ESN bulgusunun %92 duyarlılık ve %99 özgüllük ile çok yüksek tanısal doğruluğa sahip olduğunu bildirdi.​2​ Bu sonuçlar, akademik dünyada büyük bir yankı yaptı. Fakat çalışmanın retrospektif olması ayrıca bilinen pulmoner hipertansiyon, orta-ileri kapak patolojisi ve PE tanısı olan hastaların dışlanmış olması çalışmadaki büyük sınırlamalardı. Dahası, çalışma sadece masif ve submasif hastalarda yüksek tanısal doğruluk bildiriyordu. Bu nedenle bu bulgunun acil servis hastalarında belirgin bir dışlama kriteri olmadan tüm hastaları kapsayacak şekilde ele alınması önem arz etmekteydi. Yöntem Dizayn: Prospektif kohort Hasta Alımı: Örneklem Merkezler: Dört akademik acil servis Kabul Kriterleri: Acil servise başvuran ve PE öntanısıyla toraks CTA çekilen 18 yaş ve üzeri hastalar. Dışlama Kriterleri: Gebeler, görüntüleme öncesi trombolit tedavi alan ve yetersiz görüntüye sahip hastalar. Görüntüleme: Odaklanmış kardiyak US (FOCUS), 4 acil tıp uzmanı ve 4 acil tıp asistanı tarafından kaydedildi. Görüntüler içerisinde sadece sağ ventrikül çıkış yolu (RVOT) görüntüleri cihaza kaydedildi. Triküspit kaçak akımı, sağ/sol ventrikül oranı ve vena cava inferior ölçümleri formlara not edildi. Cihaza kaydedilen RVOT görüntüleri çalışmada yer alan kardiyolog tarafından ESN varlığı açısından yorumlandı. Ayrıca bu görüntüler, hasta alımına katılmayan ve FOCUS konusunda deneyimli başka bir acil tıp uzmanına kişiler arası uyum açısından yorumlatıldı. Çalışma akış şeması ise tüm araştırmacılara önceden bildirildi ve yorumları alındı. RVOT görüntülemesi ve ESN bulgusu ile sonografik değerlendirme yöntemine önceki yazımızdan ulaşabilirsiniz. Bulgular Altı aylık sürede toplam 183 hasta çalışmaya dahil edildi. Bu hastaların 96'sında PE ve 36'sında ESN bulgusu mevcuttu. Ayrıntılı demografik veriler Tablo 1'de sunulmaktadır. PE hastaların içerisinde sadece 33 hastada ESN bulgusu mevcuttu. Geriye kalan ve ESN bulgusu olan 3 hastada PE saptanmadı. PE yönelik ayrıntılı veriler Tablo 2'se sunulmaktadır. ESN'nin tüm acil servis hastalarındaki tanısal duyarlılığı %34, özgüllüğü %97 ve doğruluğu %64 saptandı. Bu oran, yüksek ve orta-yüksek risk PE grubunda (eski tanımlama ile masif ve submasif) %69 duyarlılık, %90 özgüllük ve %86 doğruluk olarak bulundu. Fakat orta-düşük ve düşük risk PE grubunda, tanısal değerliliğe sahip değildi. FOCUS deneyimli acil tıp uzmanı ve kardiyolog arasındaki uyum yüksek olarak saptandı (Kappa 0,87). Sonuç ESN bulgusu tüm PE hastalarında yüksek-orta özgüllük ve düşük duyarlılık değerlerine sahiptir. Yüksek ve orta-yüksek risk PE hastalarında ise orta özgül ve düşük duyarlıdır. Bununla beraber, ESN bulgusunun PE'de tek başına kullanımını destekleyen halen yeterli veri yoktur, bu nedenle bir süre daha diğer kardiyak US bulguları ile birlikte değerlendirilmesi uygun olacaktır. Ayrıca, bu görüntüleme temel US seviyesinin üstünde bir deneyim gerektirdiği için şüpheli olgularda ileri görüntüleme ve konsultasyon istemi gerekmektedir. Kaynaklar 1. Aslaner MA, Karbek Akarca F, Aksu ŞH, et al. Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism. J Ultrasound Med. Published online May 14, 2021. doi:10.1002/jum.15744 2. Afonso L, Sood A, Akintoye E, et al. A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus. Journal of the American Society of Echocardiography. Published online July 2019:799-806. doi:10.1016/j.echo.2019.03.004

In this episode of the MGMA Week in Review podcast, we feature articles on competitive benefits packages, modifications to the Provider Relief Fund, and improving diagnostic accuracy. Sources in this episode: https://www.mgma.com/data/data-stories/a-competitive-and-comprehensive-benefits-package-c https://www.mgma.com/advocacy/advocacy-statements-letters/advocacy-letters/may-13,-2021-mgma-urges-modifications-to-the-provi https://www.mgma.com/resources/health-information-technology/using-data-to-improve-patient-satisfaction-and-dia Additional resources: To keep up with the latest healthcare legislation, visit mgma.com/advocacy. If you want to become part of the discussion, join the MGMA STAT panel by texting “stat” to 33550. Keep up with the latest industry news by subscribing to the MGMA Insights Newsletter at mgma.com/insightsnewsletter. If you have a story you want to share with us, email us at podcasts@mgma.com. Have a great weekend!

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-227   Overview: Join us as we discuss a recent review article on the evidence behind monofilament testing for peripheral neuropathy in people with diabetes.   Episode resource links:  J Diabetes Res. 2017; 2017: 8787261. Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis Diabetes Care 2017 Jan;40(1):136-154   Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-227   Overview: Join us as we discuss a recent review article on the evidence behind monofilament testing for peripheral neuropathy in people with diabetes.   Episode resource links: J Diabetes Res. 2017; 2017: 8787261. Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis Diabetes Care 2017 Jan;40(1):136-154   Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

In episode 461, James and Mike invite Tina Korownyk to talk about the important question of whether or not virtual visits are as good as face-to-face when it comes to diagnosing undifferentiated presentations.

This week we delve into the world of fetal cardiology to review a recent work on accuracy of fetal echo in the diagnosis of congenital heart disease. We speak with Dr. Namrita Mozumdar of Pediatric Cardiology Of Long Island about her work. What factors are associated with diagnostic discrepancies? DOI: 10.1016/j.echo.2020.06.017 Also joining us is Professor Kenan Stern of Mount Sinai Children's Heart Center to share with us information about the upcoming Mount Sinai Hot Topics In Fetal Cardiology Conference on May 1. Information can be found at: https://mssm.cloud-cme.com/course/courseoverview?P=3000&EID=4460

In episode 461, James and Mike invite Tina Korownyk to talk about the important question of whether or not virtual visits are as good as face-to-face when it comes to diagnosing undifferentiated presentations. Show notes  Tools for Practice

References1.Wagner M, Tubre DJ, Asensio JA. Evolution and Current Trends in the Management of Acute Appendicitis. Surg Clin North Am. 2018;98(5):1005-23.2.Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-87.3.Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000;215(2):337-48.4.Radiology ACo. ACR Appropriateness Criteria®Suspected Appendicitis–Child. 2018.5.CC G. Overview and Diagnosis of Acute Appendicitis in Children. Semin Ped Surg. 2016.6.Swenson DW, Ayyala RS, Sams C, Lee EY. Practical Imaging Strategies for Acute Appendicitis in Children. AJR Am J Roentgenol. 2018;211(4):901-9.7.Penticuff R, Jeffrey RB, Olcott EW. Hyperechoic Periappendiceal Fat: Evaluation of Criteria for Improving Specificity in the Sonographic Diagnosis of Appendicitis in Pediatric Patients. J Ultrasound Med. 2020.8.Ilyas M, Ahmad Z, Parry AH. Target sign: appendicitis. Abdom Radiol (NY). 2019;44(1):379-80.9.Xu Y, Jeffrey RB, Chang ST, DiMaio MA, Olcott EW. Sonographic Differentiation of Complicated From Uncomplicated Appendicitis: Implications for Antibiotics-First Therapy. J Ultrasound Med. 2017;36(2):269-77.10.Telesmanich ME, Orth RC, Zhang W, Lopez ME, Carpenter JL, Mahmood N, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol. 2016;46(11):1539-45.11.Repplinger MD, Pickhardt PJ, Robbins JB, Kitchin DR, Ziemlewicz TJ, Hetzel SJ, et al. Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis. Radiology. 2018;288(2):467-75.12.Mushtaq R, Desoky SM, Morello F, Gilbertson-Dahdal D, Gopalakrishnan G, Leetch A, et al. First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. Radiology. 2019;291(1):170-7.13.Wi SA, Kim DJ, Cho ES, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol (NY). 2018;43(12):3456-61.14.Kinner S, Pickhardt PJ, Riedesel EL, Gill KG, Robbins JB, Kitchin DR, et al. Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults. AJR Am J Roentgenol. 2017;209(4):911-9.15.Horrow MM, White DS, Horrow JC. Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 2003;227(1):46-51.16.Foley WD. CT Features for Complicated versus Uncomplicated Appendicitis: What Is the Evidence? Radiology. 2018;287(1):116-8.17.HY K. Analysis of cT Features for Differentiating complicated and Uncomplicated appendicitis. Radiology. 2017.18.Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology. 2018;287(1):104-15.19.Riedesel EL, Weber BC, Shore MW, Cartmill RS, Ostlie DJ, Leys CM, et al. Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis. Pediatr Radiol. 2019;49(13):1726-34.20.Kim HY, Park JH, Lee SS, Jeon JJ, Yoon CJ, Lee KH. Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study. Abdom Radiol (NY). 2020.21.Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-41.

References1.Wagner M, Tubre DJ, Asensio JA. Evolution and Current Trends in the Management of Acute Appendicitis. Surg Clin North Am. 2018;98(5):1005-23.2.Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278-87.3.Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000;215(2):337-48.4.Radiology ACo. ACR Appropriateness Criteria®Suspected Appendicitis–Child. 2018.5.CC G. Overview and Diagnosis of Acute Appendicitis in Children. Semin Ped Surg. 2016.6.Swenson DW, Ayyala RS, Sams C, Lee EY. Practical Imaging Strategies for Acute Appendicitis in Children. AJR Am J Roentgenol. 2018;211(4):901-9.7.Penticuff R, Jeffrey RB, Olcott EW. Hyperechoic Periappendiceal Fat: Evaluation of Criteria for Improving Specificity in the Sonographic Diagnosis of Appendicitis in Pediatric Patients. J Ultrasound Med. 2020.8.Ilyas M, Ahmad Z, Parry AH. Target sign: appendicitis. Abdom Radiol (NY). 2019;44(1):379-80.9.Xu Y, Jeffrey RB, Chang ST, DiMaio MA, Olcott EW. Sonographic Differentiation of Complicated From Uncomplicated Appendicitis: Implications for Antibiotics-First Therapy. J Ultrasound Med. 2017;36(2):269-77.10.Telesmanich ME, Orth RC, Zhang W, Lopez ME, Carpenter JL, Mahmood N, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol. 2016;46(11):1539-45.11.Repplinger MD, Pickhardt PJ, Robbins JB, Kitchin DR, Ziemlewicz TJ, Hetzel SJ, et al. Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis. Radiology. 2018;288(2):467-75.12.Mushtaq R, Desoky SM, Morello F, Gilbertson-Dahdal D, Gopalakrishnan G, Leetch A, et al. First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. Radiology. 2019;291(1):170-7.13.Wi SA, Kim DJ, Cho ES, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol (NY). 2018;43(12):3456-61.14.Kinner S, Pickhardt PJ, Riedesel EL, Gill KG, Robbins JB, Kitchin DR, et al. Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults. AJR Am J Roentgenol. 2017;209(4):911-9.15.Horrow MM, White DS, Horrow JC. Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 2003;227(1):46-51.16.Foley WD. CT Features for Complicated versus Uncomplicated Appendicitis: What Is the Evidence? Radiology. 2018;287(1):116-8.17.HY K. Analysis of cT Features for Differentiating complicated and Uncomplicated appendicitis. Radiology. 2017.18.Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology. 2018;287(1):104-15.19.Riedesel EL, Weber BC, Shore MW, Cartmill RS, Ostlie DJ, Leys CM, et al. Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis. Pediatr Radiol. 2019;49(13):1726-34.20.Kim HY, Park JH, Lee SS, Jeon JJ, Yoon CJ, Lee KH. Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study. Abdom Radiol (NY). 2020.21.Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-41.

Uzun süredir yazdığım ama sürekli güncellenerek bitmeyen tanısal doğruluk çalışmalarına dair birkaç yazıdan oluşan bir seri kaleme alacağım. Bu ilk yazıda tanısal doğruluk çalışmalarının temellerinden bahsedeceğiz. Bu seride matematiksel hesaplamalar kısmına girmeyeceğim. Hesaplamalar kısmını son bir yazıya bırakacağım. Umarım faydalanırsınız. Tanı testi nedir? Tanısal testlerin temel ortak özelliği, bildirdiği sonucun yapısıdır: Belirli bir hastalık durumu …

Uzun süredir yazdığım ama sürekli güncellenerek bitmeyen tanısal doğruluk çalışmalarına dair birkaç yazıdan oluşan bir seri kaleme alacağım. Bu ilk yazıda tanısal doğruluk çalışmalarının temellerinden bahsedeceğiz. Bu seride matematiksel hesaplamalar kısmına girmeyeceğim. Hesaplamalar kısmını son bir yazıya bırakacağım. Umarım faydalanırsınız. Tanı testi nedir? Tanısal testlerin temel ortak özelliği, bildirdiği sonucun yapısıdır: Belirli bir hastalık durumu lehine veya aleyhine iki seçenekli bir karar ya da öneri sunar. Ayırt edilecek bu iki hastalık durumu, klasik "hastalıklı" ile "hastalıksız" ayrımı olabileceği gibi, bir hastalığın çok müphem bir özelliği, bir fizik muayene bulgusu ya da bir mutasyonun varlığı veya yokluğu olabilir. Hastalık varHastalık yokağır hastalıkhafif hastalıkEvre 2Evre 1Lenf notu tutulumu varLN tutulumu yokReseptör pozitifReseptör negatifTümör >= 5 cmTümör < 5 cmMutasyon varMutasyon yok Rebound varRebound yokTablo 1. Klasik iki seçenekli (dikotom) tanısal testin ayırt ettiği hastalık durumları Tanısal test, tek bir belirti veya tek bir soru gibi çok basit prosedürlerden (Ağrınız karnın sol tarafında mı yoksa sağ tarafında mı?) birçok testin ardarda uygulanması ile tek bir sonuç elde edilen karmaşık algoritmalara kadar değişebilir. Test tipiÖrnekBelirtikarın ağrısıSoruKarın ağrınız sağ tarafta mı?Eşik değeri olan klinik ölçümAteş > 38,3 CEşik değeri olan lab parametresiTroponin T > 0,01 ng/mlGörsel olarak yorumlanan görüntü Direk grafiğe pnömoni varlığıSayısal olarak ölçülen görüntüROI ile ölçülen kanama Eşik değeri olan semptom skalasıPHQ-9: Hasta Sağlığı Anketinin depresyon alt ölçeği. Şiddetli depresyon için eşik değer: 20Algoritma ile gen ekspresyonu ölçümüOncotype DX: Meme kanseri hastalarında adjuvan kemoterapiye yanıtın tahminiTablo 2. Tanısal test örnekleri Genellikle, tanısal testler iki bileşenden oluşur: Bilgiyi elde etmek için bir tür teknik ölçüm prosedürü ve bir görüntünün yorumlanması gibi öznel unsurları içerebilen ikili bir sonuç bildirmek için bir tür karar veya karar verme kuralı. Doğruluk, Duyarlılık, Özgüllük Tanısal test hakkında sorabileceğimiz ilk temel soru şudur: Bu test, iki hastalık durumunu birbirinden ne kadar iyi ayırabiliyor? Buna testin doğruluğu (accuracy) adını veriyoruz. Elbette bu cevabı verebilmemiz için her hastanın gerçek hastalık durumunu belirlememize izin veren başka bir testimiz daha olması gerekiyor. Bu teste uzun yıllar boyunca altın standart adı verilmiş. Dolayısıyla, herhangi bir doğruluk çalışmasının temel fikri, hem ilgilenilen testi hem de altın standardı bir gruba uygulamak ve ilgilenilen testin altın standarda göre doğruluğunu hesaplamaktan geçiyor. Yani her bir hastalık durumunda (Tablo 1, mesela reseptör pozitif ve negatif) ilgilenilen testin altın standarda göre doğru sonuç verme yüzdelerini hesaplıyoruz. Bu iki sayıyı sizler duyarlılık (sensitivity) ve özgüllük (specificity) olarak biliyorsunuz. Duyarlılık, hasta olanlar arasında "hastalıklı" olarak sınıflandırılan deneklerin yüzdesi; Özgüllük, hastalığı olmayanlar arasında "hastalıksız" olarak sınıflandırılan deneklerin yüzdesidir. Dolayısıyla, her iki hastalık durumunda testin ne kadar doğru olduğunu gösterirler. Fayda çalışmaları Daha geniş bir perspektiften bakıldığında, doğruluk kavramı önemli bir yönden yoksundur: bu testin hastalar için faydası. Bir testin çok yüksek doğruluğa sahip olması, hastalar için bu testin çok faydalı olduğu manasına gelmeyebilir. Burada esas fayda, test sonucunun tedavi kararlarını, hasta yönetimini ve tedavi sonucunu değiştirmesi olacaktır. Buna örnek olarak yaşlı ve komorbiditesi yüksek hastalarda subsegmenter pulmoner emboli tanısı için BT anjiyografi testinin yapılmasını verebiliriz. Komorbiditelerden ya da düşme riskinden ötürü kumadin vb ilaçları alamayacak olan, ve zaten hareketsizlik nedeniyle DMAH profilaksisi endike bir hastada BT anjiyografi ile subsegmenter pulmoner emboli tanısı konulması hasta yönetimini...

Oncotarget Volume 11, Issue 27 published "Correction of the NSE concentration in hemolyzed serum samples improves its diagnostic accuracy in small-cell lung cancer" by Genet et al. which reported that this study aimed to develop a hemolysis correction equation and evaluate its role in small-cell lung cancer (SCLC) diagnostics. A hemolysis correction equation was obtained by analyzing the relationship between the measured Neuron-specific enolase (NSE) concentration and the degree of hemolysis. Correction of the measured NSE concentration in patients suspected of lung cancer caused an increase in AUC and a significantly lower cut-off value for SCLC detection when compared to uncorrected results. Therefore, a hemolysis correction equation should be used to correct falsely elevated NSE concentrations. Application of the equation illustrates the importance of hemolysis correction in SCLC diagnostics and questions the correctness of the currently used diagnostic cut-off value. Dr. Daan van de Kerkhof from The Catharina Hospital Eindhoven as well as The Máxima Medical Center said, "Neuron-specific enolase (NSE) is a dimeric metalloenzyme which functions as a cell specific isoenzyme of the glycolytic enzyme enolase." Furthermore, improved discrimination of the two main lung cancer subtypes, SCLC and non-small cell lung cancer was achieved when applying a diagnostic cut-off value of 25 ng/mL NSE or analyzing multiple protein tumor markers such as NSE and progastrin-releasing peptide at the same time. Considering the use of NSE in lung cancer diagnostics and the medical actions that may follow, accurate and reliable quantification of NSE is of main importance. However, previous studies evaluating the prognostic value of NSE in lung cancer diagnostics did not apply exclusion criteria or did not include the effect of hemolysis on the measured NSE concentration as such, while other factors that could influence serum tumor marker concentrations were addressed. Therefore, this study aimed to develop, validate and apply a hemolysis correction equation that nullifies the effect of hemolysis on NSE quantification in samples of adult patients. Using this equation, the effect of hemolysis correction on the NSE cut-off value in SCLC diagnostics was evaluated and the maximum acceptable degree of hemolysis for reliable correction was established. The Kerkhof Research Team concluded in their Oncotarget Research Paper, "this study demonstrates that a hemolysis correction equation improves diagnostic accuracy of serum NSE concentrations in patients suspected of lung cancer. A hemolysis correction equation is therefore suggested to be incorporated in NSE-based clinical decision making, bearing in mind that results of samples with an H-index above 30 μmol/L should not be reported to clinicians." DOI - https://doi.org/10.18632/oncotarget.27664 Full text - https://www.oncotarget.com/article/27664/text/ Correspondence to - Daan van de Kerkhof - daan.vd.kerkhof@catharinaziekenhuis.nl. Keywords - small-cell lung cancer, protein tumor markers, neuron-specific enolase, hemolysis correction equation About Oncotarget Oncotarget is a weekly, peer-reviewed, open access biomedical journal covering research on all aspects of oncology. To learn more about Oncotarget, please visit https://www.oncotarget.com or connect with: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Oncotarget is published by Impact Journals, LLC please visit http://www.ImpactJournals.com or connect with @ImpactJrnls Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957x105

Five articles from the July 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Return to Sports After High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation", "Influence of Glenoid Labral Bumper Height and Capsular Volume on Clinical Outcomes After Arthroscopic Bankart Repair as Assessed With Serial CT Arthrogram: Can Anterior-Inferior Volume Fraction Be a Prognostic Factor?", "Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury", "Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study", and "The Use of Recombinant Human Growth Hormone to Protect Against Muscle Weakness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pilot, Randomized Placebo-Controlled Trial".   Click here to read the articles.

Do you personally have a Diagnostic Accuracy cutoff in terms of diagnostic factors to determine if you would use the test? No, but if there are multiple tests available I look at the most accurate ones. I do not really like it when clinicians do every test available just because. Are we image happy? X-ray, […] The post Diagnostic Accuracy – 635 appeared first on The Sports Medicine Broadcast.

Today in Episode 133: 4 Ways to Improve Your Clinical Diagnostic Accuracy I give a few pointers that should help to shorten the learning "bell curve" with regards to evaluating patients. I talk about decreasing medical costs, decreasing the time a patient is in pain, the importance of mentoring and so much more! Enjoy!!Want to join the OEP community? Click HERE to jump onto our email list. SUBSCRIBE at the bottom of the page.WE HAVE A NEW WEBSITE!! Click HERE to check it outAre you looking for One on one Coaching? We have it!Ask me your ortho evaluation questions and I will answer them on the show: paul@orthoevalpal.comBe sure to check out our 360+ videos on our YouTube Channel called Ortho Eval Pal with Paul MarquisFollow our Podcast show on Apple Podcasts, Spotify and most all other podcasting platforms. Just search: Ortho Eval Pal Podcast and Enjoy!#OrthoEvaluations #DiagnoseBetter #PaulMarquisPT #OrthoEvalPal#OrthopedicsSupport the show (https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=6GY24EJMBHTMU&source=url)

It's said that 10-20% of all medical diagnoses are wrong. That's a bit scary, but it's not surprising. Medical diagnostics is inherently complex, the medical literature is always expanding, and doctors, like all humans, grapple with availability bias – they diagnose diseases they know instead of diseases they don't. Diagnostic accuracy is clearly a problem. Today's guest is Art Papier, MD. Art is the co-founder and CEO of VisualDx. According to Art, there are common diseases and rare diseases, and there are common presentations and rare presentations. The bulk of diagnostic errors are made on common diseases with rare presentations. The goal of VisualDx, a clinical decision support system, is to “augment the brain” of physicians and help them make better diagnoses at the point of care. On this episode, you'll learn: The importance of being crystal clear on why you exist as a company. What problem are you trying to solve? Why and how most diagnosis errors occur with common diseases. Why physicians need a guidance system (and why that's not Google). Why diagnosis is NOT “big data”. What's the ETTO principle – Efficiency Thoroughness Trade-Off and how clinical decision support systems can help. Why it's so critical for startups and entrepreneurs to have doctors on their team. Why Art favors pull technologies over push technologies when serving doctors. And the problems you have to overcome as a result of using them. Why machine learning (ML) is a great way to augment the brain, but will likely never be the full solution. How machine learning can be effectively applied to very good data (i.e. 20 years worth). Why labeling and terminology are so critical to any successful machine learning application. Why general artificial intelligence is a fool's game and how to stand out with niche and nuance. How VisualDx is sharing it's 20 years of imaging with consumers and combining it with machine learning to help them better understand common skin conditions with Aysa. How Apple CoreML allows Aysa to apply machine learning algorithms to consumer images without ever moving the picture off of the consumer's device.   For full show notes and links: https://thehcbiz.com/116-art-papier-visualdx-diagnostic-accuracy/

In this episode from the ACEP-EQUAL series, Drs. Godwin and Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin, Professor and Chair, Department of Emergency Medicine University of Florida Dr. Richard Shih, Professor of Integrated Medical Science and Program , Charles E Schmidt College of Medicine at Florida Atlantic University Host: Jason Woods, MD www.acep.org/equal References: Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642

Listen to Ami Iskandrian and Wanda Acampa discuss the recently published paper entitled ‘Head-to-head comparison of diagnostic accuracy of stress-only myocardial perfusion imaging with conventional and cadmium-zinc telluride single-photon emission computed tomography in women with suspected coronary artery disease’. The authors of this article have provided a PowerPoint file which summarises the contents of the paper and is free for re-use at meetings and presentations: https://link.springer.com/article/10.1007/s12350-019-01789-7#SupplementaryMaterial The article is available at: https://rdcu.be/bOycc Be sure to subscribe on your mobile device - search 'JNC/ASNC Podcast'.

Host: Jennifer Caudle, DO Guest: Erin Schenk MD, PhD The lingering fear of CT-based screenings delivering false positives has caused many challenges, but that doesn’t mean achieving accurate diagnostic staging with our non-small cell lung cancer patients is impossible. To prove it, Dr. Erin Schenk walks through the steps she takes to determine a patient’s stage of cancer and how it impacts her treatment approach. Closing the Gaps in NSCLC is sponsored by Lilly. Content for this non-certified educational series is produced and controlled by ReachMD. This series is intended for health care professionals only.

Host: Jennifer Caudle, DO Guest: Erin Schenk MD, PhD The lingering fear of CT-based screenings delivering false positives has caused many challenges, but that doesn’t mean achieving accurate diagnostic staging with our non-small cell lung cancer patients is impossible. To prove it, Dr. Erin Schenk walks through the steps she takes to determine a patient’s stage of cancer and how it impacts her treatment approach. Closing the Gaps in NSCLC is sponsored by Lilly. Content for this non-certified educational series is produced and controlled by ReachMD. This series is intended for health care professionals only.

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles from the August 2018 issue of Radiology. ARTICLES DISCUSSED Summary of Current Applications and Future Impact of Machine Learning in Radiology. Radiology 2018; 288(2):318-329. Summary of Automated Volumetric Analysis of Mammographic Density in a Screening Setting: Worse Outcomes for Women with Dense Breasts. Radiology 2018; 288(2):343-352. Summary of Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis. Radiology 2018; 2018; 288(2):467-475.

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles and five review articles from the April 2018 issue of Radiology. ARTICLES DISCUSSED Summary of Observed Deposition of Gadolinium in Bone Using a New Noninvasive in Vivo Biomedical Device: Results of a Small Pilot Feasibility Study. Radiology 2018;287(1):96-103 Summary of Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology 2018;287(1):104-115. Summary of Glioma Grade Discrimination with MR Diffusion Kurtosis Imaging: A Meta-Analysis of Diagnostic Accuracy. Radiology 2018;287(1):119-127. Summary of The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study. Radiology 2018;287(1):156-166. Summary of Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. Radiology 2018;287(1):185-193.

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles and five review articles from the April 2018 issue of Radiology.ARTICLES DISCUSSED Summary of Prostate Cancer: Improving the Flow of Research. Radiology 2018;287(1):5-10. Summary of Cerebral Microbleeds: Imaging and Clinical Significance. Radiology 2018;287(1):11-28. Summary of Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program. Radiology 2018;287(1):37-46. Summary of Fractional Flow Reserve Estimated at Coronary CT Angiography in Intermediate Lesions: Comparison of Diagnostic Accuracy of Different Methods to Determine Coronary Flow Distribution. Radiology 2018;287(1):76-84.

Explores effective medical decision making - specifically identifying ways  to overcome the tendency to make decisions before sufficient information has been gathered.Read the accompanying article to this new podcast: http://onlinelibrary.wiley.com/doi/10.1111/medu.13382/full

Q&A from David's talk at the Veterinary Evidence Today conference, Edinburgh November 2nd, 2016. Read more here.

Therapy and prognosis are entailed by the diagnosis: the holistic success of the EBVM approach therefore firmly and critically rests on diagnostic accuracy. Unfortunately, medical professionals do not appear to be very accurate with diagnoses. In human medicine, there is 30-50% discordance reported between doctors’ ante- (presumptive) and post-mortem (definitive) diagnoses, with no significant change in the last 100 years (Goldberg et al 2002). Veterinary surgeons do not perform much better, although it is a chronically under-researched area. This talk looks at how vets and vet nurses can maximise their impact on clinical performance. Read more here.  DM - Diagnostic Accuracy: The Wellspring of EBVM Success, and How We Can Improve It   Veterinary Evidence TodayEdinburgh, 1-3 November 2016

Matthew McInnes

Daniel Korevaar

On this week's Medtech Insight podcast: cybersecurity and US FDA warning letter headaches for St. Jude; a conversation with AdvaMed CEO Scott Whitaker; a profile of device-maker InVivo Therapeutics, which is looking to leverage 2tst Century Cures provisions; a verdict was reached in a Kimberly-Clark fraud suit; comments roll in on the Diagnostic Accuracy and Innovation Act in the US; and more.

Have a dog presenting to you with abdominal pain and vomiting? In today's VETgirl online veterinary continuing education podcast, we discuss the diagnostic accuracy of canine pancreatitis tests. Specific tests that are often used to test for canine pancreatitis are the Spec cPL and the SNAP cPL test; however, these tests must be interpreted carefully.

Have a dog presenting to you with abdominal pain and vomiting? In today's VETgirl online veterinary continuing education podcast, we discuss the diagnostic accuracy of canine pancreatitis tests. Specific tests that are often used to test for canine pancreatitis are the Spec cPL and the SNAP cPL test; however, these tests must be interpreted carefully.

In this episode, Russ Gothard and I talk about diagnostic imaging for suspected stress fractures according to a published study called “Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review with Evidence-Based Recommendations for Clinical Practice.” In this podcast you will learn: How accurate different diagnostic modalities are for stress fractures, The sensitivities and specificities for each When it is appropriate to use each imaging modality. Join ignitephysio today for free and get access reviewed resources, an active discussion forum and great blog content.  Download the stress fracture diagnostic imaging algorithm resource here. 

SRJ Episode 3, Volume 1(5) by Rothenberg and Borg-Stein

It's a busy shift.  Today no one seems to have a chief complaint. Someone sends a troponin on a child.  Good, bad, or ugly, how are you going to interpret the result? And while we’re at it – what labs do I need to be careful with in children – sometimes the normal ranges of common labs can have our heads spinning! Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids?   A fundamental tenet of emergency medicine:     We balance our obligation to detect a dangerous condition with our suspicion of the disease in given patient. Someone with a cough and fever may simply have a viral illness, or he may have pneumonia.  Our obligation is to evaluate for the pneumonia.  It’s ok if we “miss” the diagnosis of a cold. It could be bad if we don’t recognize the pneumonia.   How do we decide?  Another fundamental concept:     The threshold. Depending on the disease and the particular patient, we have a threshold for testing, and the threshold for treating.  Every presentation – and every patient for that matter – has a complicated interplay between what we are expected to diagnose, how much we suspect that particular serious diagnosis, and where testing and treating come into play.     What's wrong with "throwing on some labs"? Easy to do right?  They are but a click away… Often a good history and physical exam will help you to calibrate your investigational thresholds.  This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care.  If your patient is ill, then by all means; otherwise, consider digging a bit deeper into the history, get collateral information, and make good use of your general observation skills. First, a brief word about basic labs.     The punchline is, use a pediatric reference. If you don’t have a trusted online reference available during your shift, make sure you have something like a Harriett Lane Handbook accessible to you. Don’t rely on your hospital’s lab slip or electronic medical record to save you, unless you are sure that they use age-specific pediatric reference ranges to flag abnormal values. Believe it or not, in this 21st century of ours, some shops still use adult reference ranges when reporting laboratory values on children.   Notable differences in basic chemistries Potassium: tends to run a bit higher in infants, because for the first year of life, your kidneys are inefficient in excreting potassium. BUN and creatinine: lower in children due to less muscle mass, and therefore less turnover (and usually lack of other chronic disease) Glucose: tends to run lower, as children are hypermetabolic and need regular feeding (!) Alkaline phosphatase: is always high in normal, growing children, due to bone turn over (also fond in liver, placenta, kidneys) Ammonia: high in infancy, due to immature liver, trends down to normal levels by toddlerhood ESR and CRP: low in healthy children, as chronic inflamation from comorbidities is not present; both increase steadily with age Thyroid function tests: all are markedly high in childhood, not as a sign of disease, but a marker of their increased metabolic activity     Big Labs     Troponin Reliably elevated in myocarditis, and may help to distinguish this from pericarditis (in addition to echocardiography) Other causes of elevated troponin in children include: strenuous activity, status epilepticus, toxins, sepsis, myocardial infarction (in children with congenital anomalies).  Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease.   Don't go looking, if you won't do anything with the test.   Brain natriuretic peptide (BNP) In adults, we typically think of a BNP < 100 pg/mL as not consistent with symptoms caused by volume overload. Luckily, we have data in children with congenital heart disease as well.  Although each company's assay reports slightly different cut-offs, in general healthy pediatric values match healthy adult values. One exception is in the first week of life, when it is high even in healthy newborns, due to the recent transition from fetal to newborn circulation. Use of BNP in children has been studied in both clinic and ED settings. Cohen et al. in Pediatrics used BNP to differentiate acute heart failure from respiratory disease in infants admitted for respiratory distress. They compared infants with known CHF, lung disease, and matched them with controls. Later, Maher et al. used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. The bottom line is: BNP reliably distinguishes cardiac from respiratory causes of shortness of breath in children with a known diagnosis of heart failure.   D-dimer To cut to the chase: d-dimer for use as a rule-out for pulmonary embolism has not been studied in children. The only data we have in using d-dimer in children is to prognosticate in established cases. It is only helpful to track therapy for children who have chronic clots. This is where our adult approach can get us into trouble. Basically, think of the d-dimer in children like it doesn’t even exist. It’s not helpful in our setting for our indications.   An adult may have an idiopathic PE – in fact, up to a third of adults with PE have no known risk factor, which makes decision tools and risk stratification important in this population. Children with PE almost always have a reason for it. There is at least one identifiable risk factor in up to 98% of children with pulmonary embolism. The majority have at least two risk factors. If you’re suspecting deep venous thrombosis, perform ultrasonography, and skip the d-dimer. If you’re worried about PE, go directly to imaging. In stable patients, you may elect to use MR angiography or VQ scan, but most of us will go right to CT angiography. Radiation is always a concern, but if you need to know, get the test. This is yet another reminder that your threshold is going to be different in children when you think about PE – they should have a reason for it. After you have excluded other causes of their symptoms, if they have risk factors, and you are still concerned, then do the test you feel you need to keep this child safe. You are the test. Risk factors only inform you, and you’ll have to just pull the trigger on testing in the symptomatic child with risk factors.   Lactate A sick child with sepsis syndrome? The short answer – yes. In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. The acute recognition and treatment of sepsis is first and foremost, clinical. And it’s all about perfusion and providing oxygen to the tissues. Lactate and other laboratory testing is not a substitute for clinical assessment – it should be used as an extension of your assessment.  There are two main reasons for an elevated lactate: the stress state and the shock state. The stress state is due to hypermetabolism and an increase in glycolysis, as an example, in early sepsis. The shock state is due to tissue hypoxia, seen in septic shock. The confusion and frustration with lactate is that we often test the wrong people for it. We could use it to track treatment, and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Serial clinical assessments are even more useful to gauge your success with treatment. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. It may inform your decision for level of care, intensive care versus some other lower level. Have you every been in this situation: "Why, oh why, did we send a lactate?" There are times when a lactate is ordered – maybe by protocol or maybe accidentally – or maybe in retrospect, the patient didn’t need it. Here is a quick mnemonic to remember the reasons for an elevated lactate: LACTATES L – liver – any liver disease affects how lactate is metabolized by the Cori cycle A – albuterol (or for our international friends, salbutamol), beta-agonists like albuterol, increase lactate production via cyclic amp C – “can’t breathe” – respiratory distress and increased work of breathing shifts the ratio of aerobic and anerobic repiration T – toxins – all kinds of wonder drugs and recreational drugs do it – look up your patient’s list if you’re suspicious A – alcohol, not an infrequent offender T – thiamine deficiency – think of this in your cachectic or malnourished patients E – epinephrine – a by-product of the cori cycle, how lactate is metabolized. Difficult to interpret lactates when a patient is on an epinephrine drip. S – seizure or shock – most commonly septic, but can be any type: cardiogenic, bstructive, hypovolemic, distributive. Bottom line: high serum lactate levels have been associated with morbidity and mortality in children with sepsis and trauma, the two best-studied populations.   A summary of how labs can help you – or hurt you – in pediatric emergency medicine: Have a good reference for normal values and always be skeptical of how your lab reports them. Troponin testing is great for the child with suspected cardiogenic shock, myocarditis, or in unwell children with congenital heart disease. BNP in children can be used just like you do in adults – to get a sense of whether the presenting symptoms are consistent with heart failure. D-dimer is mostly a waste of time in the PED. Lactate can be useful in the right patient – use it to risk-stratify the major trauma patient or the patient with sepsis that may be suffering from occult shock. And lastly, make sure that you are mindful of your threshold for testing, and our threshold for treatment. If will vary by disease and by the patient at hand.   References Troponin Gupta SK, Naheed Z. Chest Pain in Two Athletic Male Adolescents Mimicking Myocardial Infarction. Pediatr Emer Care. 2014;30: 493-495. Kelley WE, Januzzi JL, Christenson RH. Increases of Cardiac Troponin in Conditions other than Acute Coronary Syndrome and Heart Failure. Clinical Chemistry. 2009; (55) 12:2098–2112. Kobayashi D, Aggarwal S, Kheiwa A, Shah N. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome. Pediatr Cardiol. 2012; 33:1040–1045. Koerbin G, Potter JM, Abhayaratna WP et al. The distribution of cardiac troponin I in a population of healthy children: Lessons for adults. Clinica Chimica Acta. 2016; 417: 54–56. Liesemer K, Casper TC, Korgenski K, Menon SC. Use and Misuse of Serum Troponin Assays in Pediatric Practice. Am J Cardiol. 2012;110:284 –289. Newby KL et al. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations. J Am Coll Cardiol. 2012; 60(23): 2427-2463. Schwartz MC, Wellen S, Rome JJ et al. Chest pain with elevated troponin assay in adolescents. Cardiology in the Young; 2013. 23: 353–360. BNP Auerbach SR, Richmond ME, Lamour JM. BNP Levels Predict Outcome in Pediatric Heart Failure Patients Post Hoc Analysis of the Pediatric Carvedilol Trial. Circ Heart Fail. 2010;3:606-611. Cohen S, Springer C, Avital A et al. Amino-Terminal Pro-Brain-Type Natriuretic Peptide: Heart or Lung Disease in Pediatric Respiratory Distress? Pediatrics. 2005;115:1347–1350. Fried I, Bar-Oz B, Algur N et al. Comparison of N-terminal Pro-B-Type Natriuretic Peptide Levels in Critically Ill Children With Sepsis Versus Acute Left Ventricular Dysfunction. Pediatrics. 2006; 118(4): 1165-1168. Koch A, Singer H. Normal values of B type natriuretic peptide in infants, children, and adolescents. Heart. 2003;89:875–878. Maher KO, Reed H, Cuadrado A et al. , B-Type Natriuretic Peptide in the Emergency Diagnosis of Critical Heart Disease in Children. Pediatrics. 2008;121:e1484–e1488. Mir TS, Marohn S, Laeer S, Eistelt M. Plasma Concentrations of N-Terminal Pro-Brain Natriuretic Peptide in Control Children From the Neonatal to Adolescent Period and in Children With Congestive Heart Failure. Pediatrics. 2002;110(6)1:6. Mir TS, Laux R, Hellwege HH et al. Plasma Concentrations of Aminoterminal Pro Atrial Natriuretic Peptide and Aminoterminal Pro Brain Natriuretic Peptide in Healthy Neonates: Marked and Rapid Increase After Birth. Pediatrics. 2003;112:896–899. D-Dimer Goldenberg NA, Knapp-Clevenger RA, Manco-Johnson MJ. Elevated Plasma Factor VIII and d-Dimer Levels as Predictors of Poor Outcomes of Thrombosis in Children for the Mountain States Regional Thrombophilia Group. Pediatrics. 2003;112:896–899. Manco-Johnson MJ. How I treat venous thrombosis in children. Blood. 2006; 107(1)21-31. Naqvi M, Miller P, Feldman L, Shore BJ. Pediatric orthopaedic lower extremity trauma and venous thromboembolism. J Child Orthop. 015;9:381–384. Parasuraman S, Goldhaber SZ. Venous Thromboembolism in Children. Circulation. 2006;113:e12-e16. Strouse JJ, Tamma P, Kickler TS et al. D-Dimer for the Diagnosis of Venous Thromboembolism in Children. N Engl J Med. 2004;351:1081-8. Lactate Andersen LW, Mackenhauer J, Roberts JC et al. Etiology and therapeutic approach to elevated lactate. Mayo Clin Proc. 2013; 88(10): 1127–1140. Bai et al. Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatrics. 2014; 14:83. Scott HF, Donoghue AJ, Gaieski DF et al. The Utility of Early Lactate Testing in Undifferentiated Pediatric Systemic Inflammatory Response Syndrome. Acad Emerg Med. 2012; 19:1276–1280. Shah A, Guyette F, Suffoletto B et al. Diagnostic Accuracy of a Single Point-of-Care Prehospital Serum Lactate for Predicting Outcomes in Pediatric Trauma Patients. Pediatr Emer Care. 2013; 29:715-719. Topjian AA, Clark AE, Casper TC et al. for the Pediatric Emergency Care Applied Research Network. Early Lactate Elevations Following Resuscitation From Pediatric Cardiac Arrest Are Associated With Increased Mortality. Pediatr Crit Care Med. 2013; 14(8): e380–e387. This post and podcast are dedicated to Daniel Cabrera, MD for his vision and his leadership in thinking 'outside the box'. Troponin     |     BNP     |     D-Dimer     |     Lactate Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies

Dr. Fergus Shanahan discusses his manuscript, "Diagnostic Accuracy of Computed Tomography Using Lower Doses of Radiation for Patients With Crohn's Disease."

Background: Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. Methods: We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n = 78, leimyoma: n = 66, endometriosis: n = 52, functional ovarian cysts: n = 79, other: n = 10), 16 low malignant potential (LMP) ovarian tumors and 125 OC (stage 1: 22, II: 15, III: 78, IV: 10). CA 125 was analyzed using the ARCHITECT system, HE4 using the ARCHITECT(a) system and EIA(e) technology additionally. Results: The lowest concentrations of CA125 and HE4 were observed in healthy individuals, followed by patients with benign adnexal masses and patients with LMP tumors and OC. The area under the curve (AUC) for the differential diagnosis of adnexal masses of CA 125 alone was not significantly different to HE4 alone in premenopausal (CA 125: 86.7, HE4(a): 82.6, HE4(e): 81.6% p > 0.05) but significantly different in postmenopausal {[}CA125: 93.4 vs. HE4(a): 88.3 p = 0.023 and vs. HE4(e): 87.8% p=0.012] patients. For stage I OC, HE4 as a single marker was superior to CA 125, which was the best single marker in stage H-IV. The combination of CA 125 and HE4 using risk of malignancy algorithm (ROMA) gained the highest sensitivity at 95% specificity for the differential diagnosis of adnexal masses {[}CA 125: 70.9, HE4(a): 67.4, HE4(e): 66.0, ROMA(a): 76.6 and ROMA(e): 74.5%], especially in stage I OC {[}CA 125: 27.3, HE4(a): 40.9, HE4(e): 40.9, ROMA(a): 45.5 and ROMA(e): 45.5%]. Conclusions: CA 125 is still the best single marker in the diagnosis of OC. HE4 alone and even more the combined analysis of CA 125 and HE4 using ROMA improve the diagnostic accuracy of adnexal masses, especially in early OC.

Objective: The aim of the current prospective study was to analyse the validity of MRI based diagnosis of brainstem gliomas which was verified by stereotactic biopsy and follow-up evaluation as well as to assess prognostic factors and risk profile. Methods: Between 1998 and 2007, all consecutive adult patients with radiologically suspected brainstem glioma were included. The MRI based diagnosis of the lesions was made independently by an experienced neuroradiologist. Histopathological evaluation was performed in all patients from paraffin embedded specimens obtained by multimodal image guided stereotactic serial biopsy technique. Histopathological results were compared with prior radiological assessment. Length of survival was estimated with the Kaplan–Meier method and prognostic factors were calculated using the Cox model. Results: 46 adult patients were included. Histological evaluation revealed pilocytic astrocytoma (n=2), WHO grade II glioma (n=14), malignant glioma (n=12), metastasis (n=7), lymphoma (n=5), cavernoma (n=1), inflammatory disease (n=2) or no tumour/ gliosis (n=3). Perioperative morbidity was 2.5% (n=1). There was no permanent morbidity and no mortality. All patients with ‘‘no tumour’’ or ‘‘inflammatory disease’’ survived. Patients with low grade glioma and malignant glioma showed a 1 year survival rate of 75% and 25%, respectively; the 1 year survival rate for patients with lymphoma or metastasis was 30%. In the subgroup with a verified brainstem glioma, negative predictors for length of survival were higher tumour grade (p=0.002) and Karnofsky performance score (70 (p=0.004). Conclusion: Intra-axial brainstem lesions with a radiological pattern of glioma represent a very heterogeneous tumour group with completely different outcomes. Radiological features alone are not reliable for diagnostic classification. Stereotactic biopsy is a safe method to obtain a valid tissue diagnosis, which is indispensible for treatment decision.

In 63% of 265 patients with erectile dysfunction a relevant arterial inflow disturbance was found by Doppler ultrasound examination. Correlation between Doppler and arteriography in 58 patients showed an accuracy of 95% in detecting penile arteries and an accuracy of 91% in discovering a pathological arterial pattern (arterial anomaly or arteriosclerotic obstruction). In 15 patients the arterial inflow was measured additionally by Doppler ultrasound technique after intracavernosal injection of vasoactive drugs (IIVD) (7.5 mg papaverine and 0.25 mg phentolamine). This technique proved to be more reliable than in the flaccid state and markedly facilitated localization and assessment of pathological changes of the cavernosal arteries.