Diagnostics
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Measure Stroke Risk with Asymptomatic Severe Carotid Artery Stenosis
A community-based, retrospective, observational study of patients with asymptomatic severe carotid artery stenoses showed the crude stroke risk over five years was about 5%. Patients whose stenoses progress to high grade or start at that severity were at the highest risk for stroke.
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COVID-19 and Headache
Headache is a common feature of acute COVID-19 infection, as well as a long-standing feature of “long COVID” after recovery from the acute infection. Treatment is symptomatic, based on the characteristics of the headache syndrome.
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Be Careful About Informed Consent if Pelvic Exams Happen While Patients Are Under Anesthesia
Incorporate explicit discussions with patients about pelvic exams conducted while patients are under anesthesia. These discussions should occur during consent processes for gynecologic procedures. Specifically, patients would be told about the potential for medical student involvement in these exams.
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COVID-19: Duration of Shedding of Transmissible Virus
Patients with COVID-19 were found, by culture, to shed replication-competent virus after an initial PCR test for median durations of four to five days.
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Provocative Testing with Intracoronary Acetylcholine as Part of Cardiac Catheterization Evaluation
In this systematic review and meta-analysis of invasive coronary provocation testing, intracoronary acetylcholine was found to be a safe procedure, with low rates of major complications.
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COVID-19 Rebound
Symptomatic and virologic recrudescence after treatment of patients with COVID-19 with Paxlovid occurs in a tiny percentage of patients and generally is mild and self-limited.
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The Value of Stress Testing in Patients with Known Coronary Artery Disease
A comparison of adenosine stress single-photon emission CT, PET, and MRI in stable patients with known coronary artery disease (CAD) showed PET to be more sensitive for detecting invasive fractional flow reserve-identified ischemic lesions. However, the sensitivity was disappointing. Patients with known CAD and new symptoms should be referred directly to invasive coronary angiography.
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The Joint Commission Puts Providers on Notice Regarding Diagnostic Overshadowing
When patients present with existing diagnoses or disabilities, clinicians might attribute any symptoms to the existing condition. This is called diagnostic overshadowing, a type of cognitive bias that can cause unnecessary suffering, unsafe care, and adverse events related to missed or delayed diagnoses. Unfortunately, the problem occurs more often among groups already experiencing healthcare disparities.
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New Details Emerge About Acute Flaccid Myelitis, Cases Could Surge This Year
Researchers uncovered evidence indicating enterovirus D68 directly infects neurons in the spinal cord, prompting an immune response that leads to the limb weakness that is characteristic of acute flaccid myelitis. Investigators shed important light on the disease process that takes place in children who develop this polio-like illness. This is progress that can help lead to better treatments.
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Legal Risks if Psychiatric History Clouds Medical Decision-Making
Patients with these life-threatening medical conditions may report mood swings, personality changes, irritability or aggression, depressed mood, anxiety, or trouble concentrating. If appropriate history, physical exam, and diagnostic testing are not completed, medical emergencies can be missed. This is particularly common if physical exam findings are subtle.