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Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection
Tenecteplase for thrombolysis in a 4.5-to-24-hour window did not improve disability outcomes at 90 days in patients with ischemic stroke who had been chosen on the basis of imaging. Most patients had endovascular thrombectomy.
Journal Article
Point-of-Care Ultrasonography
Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing. Illustration by Jonathan Dimes
Journal Article
Clinical Medicine for Optometrists
Providing a solid foundation in clinical medicine for optometrists and optometry students, Clinical Medicine for Optometrists covers the systemic medical conditions that have serious impacts on ocular health and function, as well as the ocular exam findings that may be an early indication of significant systemic disease.
eBook
Deep learning in biomedical and health informatics : current applications and possibilities
\"This book provides a proficient guide on the relationship between AI and healthcare and how AI is changing all aspects of the health care industry. It also covers how deep learning will help in diagnosis and prediction of disease spread\"-- Provided by publisher.
Book
Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management
Objectives
To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms.
Methods
Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up.
Results
Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%,
p
=1.1x10
-6
) and management (88.5% to 95.8%,
p
=2.6x10
-6
) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement.
Conclusions
Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice.
Key Points
•
Systematic unenhanced CT improves significantly diagnosis accuracy compared to current practice.
•
Systematic unenhanced CT optimizes appropriate hospitalization by increasing the number of discharged patients.
•
Systematic unenhanced CT allows detection of about one-third of acute unsuspected abdominal conditions.
•
It should allow boosting emergency department management decision-making confidence in old patients.
Journal Article
Results of the Randomized Danish Lung Cancer Screening Trial with Focus on High-Risk Profiling
Abstract
Rationale
As of April 2015, participants in the Danish Lung Cancer Screening Trial had been followed for at least 5 years since their last screening.
Objectives
Mortality, causes of death, and lung cancer findings are reported to explore the effect of computed tomography (CT) screening.
Methods
A total of 4,104 participants aged 50–70 years at the time of inclusion and with a minimum 20 pack-years of smoking were randomized to have five annual low-dose CT scans (study group) or no screening (control group).
Measurements and Main Results
Follow-up information regarding date and cause of death, lung cancer diagnosis, cancer stage, and histology was obtained from national registries. No differences between the two groups in lung cancer mortality (hazard ratio, 1.03; 95% confidence interval, 0.66–1.6; P = 0.888) or all-cause mortality (hazard ratio, 1.02; 95% confidence interval, 0.82–1.27; P = 0.867) were observed. More cancers were found in the screening group than in the no-screening group (100 vs. 53, respectively; P < 0.001), particularly adenocarcinomas (58 vs. 18, respectively; P < 0.001). More early-stage cancers (stages I and II, 54 vs. 10, respectively; P < 0.001) and stage IIIa cancers (15 vs. 3, respectively; P = 0.009) were found in the screening group than in the control group. Stage IV cancers were nonsignificantly more frequent in the control group than in the screening group (32 vs. 23, respectively; P = 0.278). For the highest-stage cancers (T4N3M1, 21 vs. 8, respectively; P = 0.025), this difference was statistically significant, indicating an absolute stage shift. Older participants, those with chronic obstructive pulmonary disease, and those with more than 35 pack-years of smoking had a significantly increased risk of death due to lung cancer, with nonsignificantly fewer deaths in the screening group.
Conclusions
No statistically significant effects of CT screening on lung cancer mortality were found, but the results of post hoc high-risk subgroup analyses showed nonsignificant trends that seem to be in good agreement with the results of the National Lung Screening Trial.
Clinical trial registered with www.clinicaltrials.gov (NCT00496977).
Journal Article