Diagnostics
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Blood Biomarker for the Diagnosis of Alzheimer’s Disease
In this population-based study of patients in Sweden with cognitive complaints, mild cognitive impairment, and dementia, the use of blood biomarkers, specifically, phosphorylated tau 217 and amyloid-beta 42/40 ratios, improved the diagnostic accuracy for pathological Alzheimer’s disease in primary care patients as well as patients seen by dementia specialists.
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Diagnostic Uncertainty in Community-Acquired Pneumonia
A national retrospective cohort study from the Veterans Administration found a high rate of diagnostic discordance for patients admitted and discharged for community-acquired pneumonia (CAP). Improvement in the diagnosis of CAP is needed.
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Know HCV Status to Take Effective New Medicines
The prevalence of hepatitis C virus infection is significantly higher in healthcare workers than in the general population. Healthcare workers could access effective medications with few side effects by testing for the virus and pursuing treatment. However, high costs and insurance barriers hinder these efforts.
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Cardiac MRI Predicts Outcomes in Aortic Regurgitation
Cardiac MRI could be used to make management decisions when treating patients living with chronic, asymptomatic aortic regurgitation with preserved left ventricular function, especially when trying to predict severity and possibility of adverse outcomes.
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Does One Negative Troponin Measurement Rule Out Acute Coronary Syndrome?
Using a common clinical chest pain algorithm plus a point-of-care troponin measurement for low-risk patients, researchers reported significantly lower healthcare costs. Also, this approach did not seem to result in more major adverse cardiovascular events.
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Facilities Require ‘Medical Clearance,’ But Evidence Suggests It Is Unnecessary
A patient may present with new delusions, but an otherwise normal physical exam. Why keep that person in a regular ED treatment space or hallway for hours while waiting for a CT scan? Instead, this patient can avoid exposure to radiation, be “cleared” for evaluation by an acute care psychiatrist or social worker, and receive access to treatment hours earlier.
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Where Are the P Waves?
The ECG in the figure was obtained from a previously healthy young woman with “palpitations.” How would one interpret this two-lead rhythm strip? Is there a conduction disorder?
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Repeat Visits Are Second Chances to Avoid Misdiagnosis
Conditions that start with subtle signs and evolve over time are traps for the practitioner who is too rushed to let the situation unfold.
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Tracking Undertriage Can Help Prevent Medical Errors
Investigators found several issues were important to track using quality improvement methods, including discrepancy in exam or history between the triage and assessment nurses, along with discrepancy between the chief complaint and the physical exam. Also, they found failure to synthesize historic or objective information.
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Lack of EP Evaluation of Chest Pain Can Lead to Disaster
If an emergency physician never evaluates such a patient, leaving the care solely to a physician assistant or a nurse practitioner, this could lay the foundation for litigation.