19 year old with palpitations
A 19-year-old college student presented with recurrent episodes of palpitations, dizziness, and shortness of breath lasting several minutes. He denied chest pain or syncope. On examination, his heart rate and rhythm were normal. A 12-lead ECG revealed a shortened PR interval and a delta wave. No structural abnormalities were noted on echocardiography. What is the ECG abnormality?
Four in 10 Patients Receiving Chemo Develop Chronic Painful Neuropathy
The pooled prevalence of chronic painful neuropathy is 41.22 percent among individuals with chemotherapy-induced peripheral neuropathy (CIPN), according to a meta-analysis published online Jan. 28 in Regional Anesthesia & Pain Medicine.
Ryan S. D'Souza, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a systematic review and meta-analysis to examine the prevalence of chronic painful neuropathy among patients diagnosed with CIPN. Estimates from each study were transformed using double arcsine transformation and pooled in a meta-analysis. Data were included from 77 studies from 28 countries, encompassing 10,962 patients with CIPN.
The researchers found that the pooled prevalence of those reporting chronic painful neuropathy among those diagnosed with CIPN was estimated at 41.22 percent. Across studies, there was considerable heterogeneity (I2 = 95.27 percent). Patients treated with platinum-based agents and taxanes had the highest prevalence of chronic painful CIPN (40.44 and 38.35 percent, respectively); among primary cancers, the highest prevalence was reported by those with lung cancer (60.26 percent). Nonsignificant moderators of prevalence estimates included study design, human development index, and publication year.
"The wide variability in prevalence rates across different countries, continents, chemotherapy regimens, and primary cancer history underscores the need for tailored strategies to address this debilitating condition," the authors write.
One author disclosed ties to the biopharmaceutical industry.
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Admission Rates Vary Greatly by Emergency Department Physicians
Emergency department physicians show wide variability in their admission propensity, despite seeing patients with similar prior health status, according to a study published online Dec. 23 in JAMA Internal Medicine.
Stephen Coussens, Ph.D., and Dan P. Ly, M.D., Ph.D., from the David Geffen School of Medicine at UCLA in Los Angeles, examined whether variation in emergency department physicians' admission propensities was associated with patients' subsequent mortality rates for visits involving chest pain, shortness of breath, and abdominal pain. The analysis included nationwide Veterans Affairs electronic health record data (2011 through 2019) for 2,098 physicians treating 2.1 million patient visits across 105 emergency departments.
The researchers found that physicians' adjusted admission rates varied greatly within the same emergency department (chest pain: 90th percentile of physicians, 56.6 percent admitted versus 10th percentile, 32.6 percent admitted), although there were no associations between these adjusted admission rates and patients' prior health status as measured by their Elixhauser Comorbidity Index score before the emergency visit. Patients admitted by physicians with higher admission rates were more likely to be discharged within 24 hours (31.0 versus 24.8 percent). However, mortality rates for patients did not differ between physicians with higher admission rates and those with lower admission rates.
"Future research that explores how such variation arises and the extent to which it is amenable to safe intervention may prove beneficial to patients, clinicians, and health care systems," the authors write.
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Decision Pathway Developed for Diagnosing, Managing Myocarditis
In a 2024 guidance document issued by the American College of Cardiology and published online Dec. 10 in the Journal of the American College of Cardiology, recommendations are presented for the diagnosis and management of myocarditis.
Mark H. Drazner, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues present an expert consensus decision pathway for diagnosing and managing acute myocarditis in adult patients, reflecting recent advancements in clinical practice.
The authors note that clinicians should be aware of the three classic presentations of myocarditis: chest pain, heart failure/shock, and/or symptoms related to arrhythmia. High-sensitivity cardiac troponin (hs-cTn) is a common diagnostic test for suspected myocarditis, but some patients with myocarditis do not have elevated hs-cTn. Pivotal tests for diagnosis of myocarditis include cardiac magnetic resonance imaging and endomyocardial biopsy. A novel four-stage classification of myocarditis is suggested: Stage A relates to having or being exposed to risk factors; stage B to asymptomatic patients with evidence of myocardial inflammation; stage C to symptomatic myocarditis; and stage D to advanced myocarditis. The trajectories of the four stages need to be defined, including their risk for progression to chronic heart failure. For patients with symptomatic myocarditis, risk stratification guides the decision to refer to an advanced heart failure center with a multidisciplinary team. For myocarditis patients, follow-up does not end after two to three weeks, even if symptoms resolve, but should include two cardiac imaging studies at an early interval after diagnosis and at six months.
"Once a patient is diagnosed, clinicians can then follow the next four steps in the care pathway, including triaging the patient, obtaining pivotal diagnostic tests, providing appropriate therapies, and then longitudinal follow-up," Drazner said in a statement.
Several authors disclosed ties to the pharmaceutical industry.
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CDC Will Test Travelers From Rwanda for Ebola-Like Marburg Virus
As health officials work furiously to stem the spread of Marburg virus in Rwanda, U.S. health officials announced Monday that all passengers flying from that country to the United States will soon be screened for the often deadly disease.
"Starting the week of October 14, CDC [U.S. Centers for Disease Control and Prevention] will begin public health entry screening of travelers entering the United States who have been in Rwanda in the past 21 days," the U.S. Department of Health and Human Services said in a statement. "This screening aims to reduce the risk of importation of Marburg cases into the United States and the spread within U.S. communities."
As of Monday, 56 cases of Marburg had been confirmed in Rwanda, with 36 people in isolation and treatment, and 12 deaths, according to that country's Ministry of Health. No cases of Marburg virus have been reported in the United States at this point.
Travelers coming from Rwanda will be routed to one of three airports: Chicago O’Hare, JFK in New York and Washington Dulles in Virginia, the CDC said in a statement Monday, NBC News reported.
According to the statement, passengers landing at one of those airports will need to meet with CDC staffers for temperature checks and assessments of any other symptoms, such as sore throat, vomiting or rashes that often appear on the torso.
People infected by the virus can start showing symptoms two to 21 days after their exposure, according to the CDC.
Marburg is a virus that causes hemorrhagic fevers and internal bleeding, much like Ebola. Like Ebola, it spreads through contact with bodily fluids, including blood and semen. There is no treatment or vaccine. The death rate can be as high as 88%, according to the World Health Organization.
While the risk to the American public remains low, the CDC first began alerting U.S. doctors about Marburg last year.
In addition to the airport screening measures, the CDC issued a level 3 travel health notice on Monday, warning people against unnecessary travel to Rwanda.
The advisory suggested that anyone who must travel to the outbreak area watch for symptoms for 21 days.
“If you develop fever, chills, headache, muscle aches, rash, chest pain, sore throat, nausea, vomiting, diarrhea, or unexplained bleeding or bruising,” the advisory said, “isolate immediately and seek medical care.”
More information
The CDC has more on the Marburg virus.
SOURCE: U.S. Department of Health and Human Services, news release, Oct. 7, 2024; U.S. Centers for Disease Control and Prevention, travel alert, Oct. 7, 2024; NBC News
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Source of Missouri Bird Flu Case Still Unknown, Could Be a 'One-Off': CDC
In a case that continues to confound scientists, U.S. health officials said Thursday that they still don't know how a Missouri patient caught the bird flu and that the case may just be a rare anomaly.
As bird flu continues to spread through dairy cow herds and poultry flocks, the Missouri case has raised the possibility of human-to-human transmission of bird flu. But officials stressed Thursday there is no evidence of other people being infected and the risk to the general public remains low.
“Right now, evidence points to this being a one-off case,” CDC Principal Deputy Director Dr. Nirav Shah told reporters during a media briefing, the Associated Press reported.
Citing patient confidentiality, health officials have shared few details about the Missouri case, which was first announced late last week.
The person had chest pain, nausea, vomiting, diarrhea and weakness and was hospitalized on Aug. 22 “for reasons related to their underlying medical conditions,” Shah said.
The patient was tested for flu, and was positive for influenza A. Follow-up testing found the virus belonged to a category of viruses typically seen in birds.
While the patient had a very low concentration of viral genetic material and officials could not confirm exactly which virus it was, partial genetic sequences were similar to those found in U.S. dairy cows, CDC officials added.
“Ultimately, a full sequence may not be technically feasible,” Shah noted.
The patient had no known contact with dairy cows or other animals associated with the ongoing bird flu outbreak. The person also told Missouri health officials that they didn’t drink unpasteurized milk or other unpasteurized dairy products, Shah added.
"This is the 14th human case of H5 [bird flu] reported in the United States during 2024 and the first case of H5 without a known occupational exposure to sick or infected animals," the CDC noted in a statement it released when the Missouri case first surfaced.
All the previous U.S. infections were among people who worked around cows and poultry, so this latest case raises concerns about disease transmission.
Bird flu has been detected in over 200 dairy herds in 14 states, but not in Missouri, according to the CDC. Bird flu has also been found in commercial and backyard flocks and in wild birds.
This was the first bird flu case detected through routine influenza surveillance, officials noted.
More information
The CDC has more on bird flu.
SOURCES: U.S. Centers for Disease Control and Prevention, news release, Sept. 6, 2024; Missouri Department of Health and Senior Services, statement, Sept. 6, 2024; Associated Press
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Black Patients Less Likely to Receive Diagnostic Testing in Emergency Department
Black patients are less likely than White patients with a nonspecific diagnosis of interest to receive related diagnostic testing in the emergency department, according to a study published online Aug. 27 in JAMA Network Open.
Michael I. Ellenbogen, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues used a previously validated diagnostic intensity index to assess differences in diagnostic testing rates by race and ethnicity in an acute care setting. The study included emergency department discharges, hospital observation stays, and hospital admissions using administrative claims among emergency departments and acute care hospitals in Kentucky, Maryland, North Carolina, and New Jersey from 2016 through 2018. To estimate rates of nondiagnostic testing, nonspecific principal discharge diagnoses (nausea and vomiting, abdominal pain, chest pain, and syncope) were paired with related diagnostic tests.
Most (80.6 percent) of the 3,683,055 encounters in the study were emergency department discharges. The researchers found that compared with White patients, Black patients discharged from the emergency department with a diagnosis of interest had an adjusted odds ratio of 0.74 for having related diagnostic testing. In none of the acute care settings were other racial or ethnic disparities of a similar magnitude observed.
"White patients discharged from the emergency department had higher rates of nondiagnostic testing, suggesting higher levels of testing overuse. Although Black patients were subjected to less test overuse, this may have come at a risk of undertesting and missed diagnoses," the authors write.
One author disclosed being an inventor on a provisional patent for smartphone-based stroke diagnosis in patients with dizziness, as well as receiving industry grants.
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FDA Approves Tecelra as First Gene Therapy for Synovial Sarcoma
The U.S. Food and Drug Administration has approved Tecelra (afamitresgene autoleucel), a gene therapy for the treatment of adults with unresectable or metastatic synovial sarcoma.
Specifically, the approval is for adults who have received prior chemotherapy, are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive, and have a tumor that expresses the MAGE-A4 antigen. The single-dose, intravenous T-cell immunotherapy is composed of a patient's own T-cells.
The approval was based on an open-label clinical trial of 44 patients with inoperable and metastatic synovial sarcoma. The overall response rate was 43.2 percent, and the median duration of response was six months. The most common adverse reactions seen with Tecelra included nausea, vomiting, fatigue, infections, fever, constipation, dyspnea, abdominal pain, noncardiac chest pain, decreased appetite, tachycardia, back pain, hypotension, diarrhea, and edema.
"Adults with metastatic synovial sarcoma, a life-threatening form of cancer, often face limited treatment options in addition to the risk of cancer spread or recurrence," Nicole Verdun, M.D., director of the Office of Therapeutic Products in the FDA Center for Biologics Evaluation and Research, said in a statement. "Today's approval represents a significant milestone in the development of an innovative, safe, and effective therapy for patients with this rare but potentially fatal disease."
The approval of Tecelra was granted to Adaptimmune.
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American College of Obstetricians and Gynecologists, May 17-19
The annual meeting of the American College of Obstetricians and Gynecologists was held from May 17 to 19 in San Francisco and was attended by more than 4,000 clinicians, academicians, allied health professionals, and others interested in obstetrics and gynecology. The conference highlighted recent advances in the prevention, detection, and treatment of conditions impacting women, with presentations focusing on the advancement of health care services for women worldwide.
In one study, Madelaine E. McElrath, of New York Medical College and Westchester Medical Center in Valhalla, and colleagues identified a discrepancy in tone and content between how patients and how medical professionals discuss Pap smears on TikTok.
The authors collected and analyzed 100 videos tagged with #PapSmear on TikTok using a data-scraping program. They found that medical professionals created most of the positive videos (68.0 percent), while the majority of the creators of the negative videos were not medical professionals (91.4 percent). Most of the negative videos (60.0 percent) recounted personal patient experiences, and common themes found in the patient videos were fear, embarrassment, and pain. In addition, videos on TikTok presenting educational material regarding #PapSmear scored highly on understandability but low on health information quality.
"Providers should consider that patients may approach health care discussions and decisions with preconceived negative influence from TikTok," McElrath said. "Health care providers may consider becoming more active on TikTok to contribute educational content and show relatability to patients."
In another study, Chris Soudah, of the University of Texas Medical Branch at Galveston, and colleagues found that patients who contract COVID-19 between three and 12 months prior to pregnancy have an increased relative risk for preeclampsia, fetal growth restriction, and antepartum hemorrhage compared with women who are not infected with COVID-19.
The authors aimed to investigate the risk for adverse pregnancy outcomes associated with COVID-19 infection acquired at least three months prior to pregnancy. The adverse pregnancy outcomes evaluated included fetal growth restriction, preeclampsia, antepartum hemorrhage, death, gestational diabetes, and preterm labor.
The authors created two cohorts using deidentified patient data from TriNetX. One cohort included patients of child-bearing age (15 to 45 years) with a history of COVID-19 infection three to 12 months prior to pregnancy. The second cohort included patients of child-bearing age without a history of COVID-19 infection three to 12 months prior to pregnancy. The cohorts were propensity score-matched for age, sex, race, and ethnicity.
Compared with women who were not infected with COVID-19, the researchers found that patients who had contracted COVID-19 between three and 12 months prior to pregnancy had an increased relative risk for preeclampsia, fetal growth restriction, and antepartum hemorrhage.
"Further investigation is warranted to validate these findings in prospective studies with needed consideration for other comorbidities to guide more focused and evidence-based peripartum care for this population," Soudah said. "In addition, these results encourage clinicians and providers to exercise further surveillance for women seeking pregnancy after recovery from COVID-19 infection."
One author disclosed a financial relationship with Medtronic.
Diana S. Wolfe, M.D., and Kevin Flatley, M.D., of the Montefiore Health System in New York City, and colleagues found that large-scale standardized screening for cardiovascular disease (CVD) is feasible and gets higher-risk patients in touch with experts to set them up for the safest pregnancy possible.
The authors evaluated the effectiveness of a CVD screening assessment tool proposed by the California Maternal Quality Care Collaborative. Specifically, the CVD risk assessment tool was embedded in the electronic medical record for prenatal care providers, prompting them to perform at least one CVD risk assessment during pregnancy and/or the postpartum period.
According to the researchers, universal CVD risk screening in pregnant and postpartum patients in the United States is critical, and implementing universal screening among pregnant and postpartum patients provides an incredible opportunity to identify newly diagnosed cardiac disease as well as decrease maternal morbidity and mortality in the United States.
"The bottom line is that all clinicians, obstetrician-gynecologists, and other practitioners (i.e., emergency department, family medicine providers, etc.) who encounter pregnant and postpartum persons should perform CVD risk screening and be aware of the signs and symptoms of CVD in pregnancy and postpartum period," Wolfe said. "CVD is the leading cause of maternal mortality in our country, a rising statistic especially among vulnerable populations, particularly communities that have been socially and economically marginalized. To turn the needle, all stakeholders need to join hands and implement universal CVD risk screening among pregnant and postpartum persons."
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Biomarkers + Patient-Reported Outcomes Up Prediction of Interstitial Cystitis
TUESDAY, May 7, 2024 (HealthDay News) -- The integration of biomarkers and patient-reported outcomes (PROs) improves prediction of interstitial cystitis (IC)/bladder pain syndrome, according to a study published online April 24 in Urology.
Laura E. Lamb, Ph.D., from the Oakland University William Beaumont School of Medicine in Rochester, Michigan, and colleagues generated a machine learning predictive classification model (the Interstitial Cystitis Personalized Inflammation Symptom score), which uses PRO and cytokine levels, and then compared it to a challenger model. The machine learning model was based on 1,264 urine samples (536 IC and 728 age-matched controls) with corresponding PRO pain and symptom scores and 296 urine samples (78 IC and 218 controls) from three academic centers.
The researchers found that the top-performing model using biomarker measurements and PROs was a support vector classifier and had an area under the curve (AUC) of 0.87; the model offered better IC prediction than PROs alone (AUC, 0.83). Biomarkers alone did not exhibit strong predictive performance (AUC, 0.58).
"Our study demonstrates its effectiveness in accurately distinguishing individuals with nonulcerative or ulcerative IC from both normal asymptomatic controls and other bladder-centric confusable disorders, surpassing the capabilities of traditional PROs alone," the authors write.
One author disclosed ties to Stata Oncology; several authors have intellectual property associated with methods for diagnosing IC.
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FDA Approves Eohilia for Eosinophilic Esophagitis
FRIDAY, Feb. 16, 2024 (HealthDay News) -- The U.S. Food and Drug Administration has approved Eohilia (budesonide oral suspension) as the first and only oral treatment for eosinophilic esophagitis (EoE).
The oral corticosteroid therapy is approved for individuals aged 11 years and older and will be available in 2-mg/10-mL single-dose stick packs by the end of February. The approval calls for twice-daily use for 12 weeks of treatment.
The approval is based on two multicenter, randomized, double-blind, parallel-group, placebo-controlled 12-week studies in patients (ages 11 to 56 and 11 to 42 years, respectively). The two studies revealed that significantly more patients receiving Eohilia achieved histologic remission versus those receiving placebo (study 1: 53.1 versus 1 percent; study 2: 38 versus 2.4 percent). From baseline, the absolute change in the Dysphagia Symptom Questionnaire combined score was −10.2 with Eohilia versus −6.5 with placebo in study 1 and −14.5 and −5.9, respectively, in study 2. Compared with those taking placebo, more patients receiving Eohilia experienced no dysphagia or only experienced dysphagia that "got better or cleared up on its own" during the last two weeks of each study.
"For people living with eosinophilic esophagitis, sitting down for a meal can include painful and difficult swallowing, chest pain, and a choking sensation," Brandon Monk, senior vice president and head of the U.S. Gastroenterology Business Unit at Takeda, said in a statement. "With Eohilia, patients and their physicians now have the first and only FDA-approved oral treatment option for EoE that was shown during two 12-week clinical studies to reduce esophageal inflammation and improve the ability to swallow."
The approval of Eohilia was granted to Takeda.
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CDC Restarts National Anti-Smoking Campaign, With Focus on Menthols
TUESDAY, Feb. 6, 2024 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has resumed a national campaign that uses the stories of former smokers to warn Americans about the many health dangers of tobacco.
Known as the "Tips From Former Smokers" campaign, seven new people are featured in ads sharing their stories about how cigarette smoking damaged their health.
One tactic is new in this latest round of ads: They take direct aim at the harms of menthol cigarettes, which have become popular among minorities and in marginalized communities.
"Many of this year’s new ads include messaging about the harms of menthol cigarettes, which can contribute to tobacco-related health disparities," the agency noted in a news release. "Menthol in cigarettes can make it easier to start smoking and harder to quit."
Tammy W. is one of the former menthol cigarette smokers featured in the campaign. An avid runner, the 50-year-old ate healthy and avoided drugs and alcohol but had a "side hobby" of smoking menthol cigarettes -- like many members of her Little Travers Bay Bands of Odawa Indians tribe.
After having chest pains during a daily 10-mile run when she was 44, she went to see her doctor and was told she needed open-heart surgery immediately. During the operation, she flatlined three times and had a stroke. She has since recovered, but she can no longer run as far.
Tammy quit smoking soon after her surgery.
“Open-heart surgery and the possibility of dying motivated me,” she said in the CDC news release. “Life is a gift. I want to stay here as long as I can.”
More than 45 former smokers -- who were not identified with their last names -- share their stories as part of the campaign.
The first iteration of the campaign ran from 2012 to 2018 and prompted 16.4 million smokers to try to quit, 1 million of whom did, CDC surveys show.
While cigarette smoking has fallen to one of the lowest levels in U.S. history, the proportion of those who smoke menthols has been climbing, according to the CDC.
Young people, racial and ethnic minorities, LGBTQ+ people, women, people with low incomes and those with mental health conditions are more likely to smoke menthol cigarettes than other groups, the agency said.
Why might menthol cigarettes be so appealing?
Menthol masks the taste and smell of tobacco and cools the throat, making it easier to inhale. That enhances the effects of nicotine on the brain and can make cigarettes even more addictive, according to the CDC.
Cigarette smoking kills more than 480,000 Americans every year, and 16 million Americans are living with at least one serious smoking-related disease, CDC data shows.
Banning menthol cigarettes would save up to 654,000 lives within 40 years, including 255,000 members of the Black community, a 2022 study found.
The U.S. Food and Drug Administration is now weighing a federal ban on menthol cigarettes and flavored cigars.
In October, the FDA sent final rules on banning menthol cigarettes to the White House for review. But things have stalled since it was submitted to the White House’s Office of Management and Budget.
This delay has frustrated anti-tobacco groups, CNN reported.
“In an extremely disappointing end to 2023, the White House bowed to tobacco industry pressure and failed to move forward in 2023 with finalizing rules to eliminate menthol as a characterizing flavor in cigarettes and prohibit all characterizing flavors in cigars,” the American Lung Association wrote in its annual State of Tobacco Control report. “This lack of action prioritizes politics and tobacco industry profits over public health if the White House fails to finalize the rules.”
More information
Visit the U.S. Centers for Disease Control and Prevention for more on quitting smoking.
SOURCE: U.S. Centers for Disease Control and Prevention, news release, Feb. 5, 2024; CNN
Copyright © 2020 HealthDay. All rights reserved.
CT Appears to Be the Best First Strategy for Evaluating Stable Chest Pain
MONDAY, Feb. 5, 2024 (HealthDay News) -- A "computed tomography (CT)-first" strategy may be the best way to determine if stable chest pain patients need revascularization, according to a study presented at the American College of Cardiology Cardiovascular Summit 2024, which took place Feb. 1 to 3 in Washington, D.C.
William E. Downey, M.D., from Atrium Health Sanger Heart & Vascular Institute in Charlotte, North Carolina, and colleagues assessed whether a "CT-first" strategy versus functional testing or no testing is associated with higher rates of subsequent revascularization after invasive coronary angiography (ICA) in clinical practice. The analysis included 786 consecutive patients who had no prior diagnosis of coronary artery disease and were referred for elective ICA to evaluate chest pain.
The researchers found that the pre-ICA testing strategies included no testing in 44 percent, stress echo in 3 percent, stress myocardial perfusion imaging in 15 percent, stress magnetic resonance imaging in 2 percent, and coronary CT angiography in 36 percent. Subsequent revascularization occurred in 62 percent using the "CT-first" strategy versus 34 percent for other modalities.
"While care must be individualized, for patients with unknown or unestablished coronary artery disease, the transition to a 'CT-first' strategy should be a high priority for cardiovascular care providers," senior author Markus D. Scherer, M.D., also from the Sanger Heart & Vascular Institute, said in a statement. "The noninvasive approach has a lower risk and cost than a diagnostic heart catheterization and, for the CT approach -- but not stress testing -- provides information on the absence, presence, and extent of coronary atherosclerosis and whether or not there are high risk plaques as well as vessel blockages, which helps streamline patient management and risk reduction.”
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AI Produces History of Present Illness Summaries Comparable With Residents
THURSDAY, July 20, 2023 (HealthDay News) -- History of present illness (HPI) writeups are of similar quality whether written by a chatbot or senior internal medicine residents, according to a study published online July 17 in JAMA Internal Medicine.
Ashwin Nayak, M.D., from Stanford University in California, and colleagues evaluated the ability of a chatbot to generate an HPI compared with senior internal medicine residents. The analysis included HPIs generated by ChatGPT and those written by four residents based on three patient interview scripts portraying different types of chest pain.
The researchers found that the acceptance rate for chatbot-generated HPIs improved from 10.0 to 43.3 percent by the final round of prompt engineering. Based on the 15-point composite scale, grades of resident and chatbot-generated HPIs differed by less than 1 point (resident mean, 12.18, versus chatbot mean, 11.23). Resident HPIs scored higher on level of detail scale (resident mean, 4.13, versus chatbot mean, 3.57). HPIs were correctly characterized as written by residents or the chatbot by attending physicians 61 percent of the time.
"These findings underscore the potential of chatbots to aid clinicians with medical documentation," the authors write.
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AI can’t replicate this key part of practicing medicine
I’ve heard “WebMD said it could be cancer” countless times in my 15 years working as an emergency medicine physician. I get it: When someone is feeling unwell or hoping a worrying symptom will go away, it makes sense for them to turn to easily accessible resources. As people become increasingly familiar with artificial intelligence platforms like ChatGPT, it’s only a matter of time before patients turn to these tools in search of a diagnosis or second opinion.Change is already on the horizon. ChatGPT passed the United States Medical Licensing Exams, And recently the New England Journal of Medicine announced NEJM AI, a whole new journal devoted fully to artificial intelligence in clinical practice. These and many other developments have left many wondering (and sometimes worrying) what role AI will have in the future of health care. It’s already predicting how long patients will stay in the hospital, denying insurance claims, and supporting pandemic preparedness efforts.
While there are areas within medicine ripe for the assistance of AI, any assertion that it will replace health care providers or make our roles less important is pure hyperbole. Even with all its promise, it’s hard to imagine how AI will ever replicate that gut feeling honed by sitting at the bedside and placing our hands on thousands of patients. Recently, I had an encounter that revealed one of the limitations for AI at the patient’s bedside, now and perhaps even in the future. While working in the emergency room, I saw a woman with chest pain. Based on nearly every algorithm and clinical decision rule that providers like me use to determine next steps in care of cases like this, my patient was safe for discharge. But something didn’t feel right. It’s hard to say exactly what tipped me off that day. But my gut instinct compelled me to do more instead of just discharging her. When I repeated her blood tests and electrocardiogram a short while later, the results were unequivocal — my patient was having a heart attack.
We have algorithms to guide us, but we still need to select the right one and navigate the sequence correctly despite sometimes conflicting information. Even then, they aren’t flawless. It’s these intricacies of our jobs that likely cause many providers to cast a suspicious eye at the looming overlap of artificial intelligence and the practice of medicine...Read more
Will AI diminish physicians'' ability to trust there gut?
Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease
A comprehensive systematic review and meta-analysis was conducted to assess the diagnostic accuracy and prognostic value of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain. The study aimed to provide contemporary quantitative data on the topic and shed light on the low-risk period for adverse cardiovascular (CV) events after a negative stress CMR result. A total of 64 studies involving 74,470 patients were included in the analysis, with data obtained from PubMed, Embase, Cochrane Database of Systematic Reviews, PROSPERO, and ClinicalTrials.gov.
The findings revealed that stress CMR exhibited high diagnostic accuracy, with a sensitivity of 81% and specificity of 86% for detecting functionally obstructive coronary artery disease. The presence of stress-inducible ischemia and late gadolinium enhancement (LGE) were associated with higher all-cause mortality, CV mortality, and major adverse cardiovascular events (MACEs). Subgroup analysis indicated that stress CMR had even higher diagnostic accuracy when suspected coronary artery disease was present or when 3-T imaging was used. Importantly, patients with normal stress CMR results had a lower risk of MACEs for at least 3.5 years after the test...Read more
Could this be a feasible routine investigation for stable chest pain?
Should Doctors Wear Body Cameras?
How biases and political views can affect medical care.
Imagine a profession designed to serve the public and protect individuals from harm. But then it comes to light that its members are riddled with biases and political beliefs that prevent them from doing their job equitably and that these faulty thoughts lead them to harm defenseless people whom they are serving. But, rather than wearing blue uniforms and being armed with weapons, members of this profession wear white lab coats and carry stethoscopes.That’s right, even though we don’t see their wrongs captured on video and they haven’t been subject to protests throughout the nation, physicians are not immune to the negative repercussions of their beliefs.Physicians do not always practice objective, evidence-based medicine but are impacted by their beliefs.Physicians’ implicit racial biases have been shown to affect patient treatment and satisfaction.In one study, physicians’ political beliefs affected evaluations of drugs promoted by their party.
About 50 percent of physicians admit to being biased against certain groups. But demonstrating a self-serving bias, more than 90 percent claim that their biases don’t affect patient care. Is that true?There is growing evidence that involuntary and unintentional beliefs about social groups affect the quality of patient care and patient satisfaction. In one experiment, about 300 emergency room (ER) and internal medicine doctors from Atlanta and Boston read a description of a 50-year-old man who presented to the ER with chest pain and an electrocardiogram suggestive of a heart attack. The man’s face was visually altered to appear either Black or white. Those doctors who scored the highest on several tests of implicit bias against Blacks were much more likely to recommend the optimal treatment—thrombolytic drugs—for a white patient but not a Black patient. Their automatic and unintentional beliefs about the worth and cooperativeness of Black patients led to substandard and potentially life-damaging care...Read more
How can physicians stop their unconscious bias from affecting quality of patient care?
Twelve Symptoms Contribute to Postacute Sequelae of SARS-CoV-2
FRIDAY, June 2, 2023 (HealthDay News) -- A group of symptoms has been identified that can define postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), according to a study published online May 25 in the Journal of the American Medical Association.
Tanayott Thaweethai, Ph.D., from Massachusetts General Hospital in Boston, and colleagues used self-reported symptoms to develop a definition of PASC and describe PASC frequencies across cohorts in a prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 sites located in 33 states, Washington, D.C., and Puerto Rico. A total of 9,764 participants met the selection criteria (8,646 infected; 1,118 uninfected).
The researchers found that for 37 symptoms, the adjusted odds ratios were 1.5 or greater for infected versus uninfected participants. Postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements were included as symptoms contributing to the PASC score. Overall, 10 percent of the 2,231 participants first infected on or after Dec. 1, 2021, and enrolled within 30 days of infection were PASC-positive at six months.
"This study is an important step toward defining long COVID beyond any one individual symptom," a coauthor said in a statement. "This research definition -- which may evolve over time -- will serve as a foundation for scientific discovery and treatment design."
Several authors disclosed ties to the pharmaceutical industry.
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