Abstract 179: International Survey of Clinical Case Vignettes in Acute Ischemic Stroke

Background and Purpose: To quantify consistency across stroke centers worldwide in the typical imaging and treatment decisions made when presented with independent clinical case vignettes including various imaging findings across specific time from onset intervals. Methods: Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging circulated an online survey of clinical case vignettes through its website, through the websites of national professional societies from multiple countries as well as through email distribution lists from STIR and participating societies. Vignettes varied in terms of patient’s age, time from onset, neurological symptoms and NIHSS. The survey displayed the imaging findings offered by the imaging strategy selected, and the responders selected the appropriate therapy considering time from onset, clinical presentation and imaging findings. Results: We received responses from 30 countries including 260 centers. The specific onset interval presented: 0-3 hours, 6 hours, 10 hours or wake-up, influenced the type of imaging work-up selected rather than the clinical scenario. CT was used more often than MRI across all time intervals. For cases with M1 occlusion and large penumbra, vascular imaging was most common (36%) in 0-3 hours and perfusion imaging more frequently used in 6 hours (62%) and wake-up stroke (65%). For large penumbra cases with M1 or ICA occlusion, combination, IV tPA thrombolysis followed by endovascular\IA, treatment (81%) was most common in 0-3 hours. Endovascular treatment was selected the most at 6 hours (43%) for M1 occlusion and large penumbra cases but still selected in 27% of patients up to 10 hours for ICA occlusion and large penumbra cases. For M1 occlusion and large penumbra cases imaged with MRI only, treatment of wake-up stroke increased to 89% from 58% cases imaged with CT alone. Sites that obtained more imaging tended to be more aggressive in terms of revascularization treatment, particularly endovascular therapy. Conclusions: Adding vascular and\or perfusion imaging increased the likelihood of thrombolysis across all time intervals. Usage of MRI perfusion imaging was associated with an increased likelihood of enrollment into a randomized trial up to 83%.

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Physician’s changes in management of return visits to the Emergency Department

Emergency Care Journal ◽

10.4081/ecj.2016.5594 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Adrianna Long ◽

Robert Cambridge ◽

Melissa Rosa

Keyword(s):

Emergency Department ◽

Online Survey ◽

Statistical Significance ◽

The United States ◽

Chief Complaint ◽

Repeat Visit ◽

Chief Complaints ◽

Case Vignettes ◽

Return Visits ◽

Work Up

Return visits to the Emergency Department (ED) are estimated between 2-3.1%, which impacts ED care costs and wait times. Adverse events for unscheduled return visits (URVs) have been reported to be as high as 30%. The objective of this study was to characterize the attitudes and management of Emergency Medicine (EM) physicians regarding patients presenting with the same chief complaint to the ED for an URV. An online survey questionnaire was developed and sent to 160 accredited EM Graduate Medical Education programs in the United States. The questionnaire consisted of case vignettes wherein providers were asked to submit what orders they would place for each scenario. The mean numbers of tests and treatments were compared from initial visit to repeat visit with same chief complaint. Physicians also provided feedback regarding their management of URVs. There were estimated 6988 eligible participants with 397 responses (response rate 5.7%). There was a statistical significance (P<0.001) in provider management of URVs with pediatric fever, but there was no statistical significance for management of the other chief complaints. There were 77% of physicians that felt an increased work up is warranted for URVs. The results of this study indicate that majority of EM residents and staff working in training programs feel that they should approach the management of URV patients with a more extensive workup despite no clinical change. These findings suggest that further analysis should be performed regarding provider management of URVs and the associated healthcare costs.

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Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

memo - Magazine of European Medical Oncology ◽

10.1007/s12254-021-00701-9 ◽

2021 ◽

Author(s):

Josia Fauser ◽

Stefan Köck ◽

Eberhard Gunsilius ◽

Andreas Chott ◽

Andreas Peer ◽

...

Keyword(s):

Immune Response ◽

Case Report ◽

Macrophage Activation ◽

Post Mortem ◽

Life Threatening ◽

Appropriate Therapy ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

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Assessing clinicians' management of first episode schizophrenia using clinical case vignettes

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2009.00152.x ◽

2010 ◽

Vol 4 (1) ◽

pp. 31-38 ◽

Cited By ~ 4

Author(s):

Jeff C. Huffman ◽

Oliver Freudenreich ◽

Sarah Romeo ◽

Lee Baer ◽

Kelly Sutton-Skinner ◽

...

Keyword(s):

Clinical Case ◽

First Episode ◽

Case Vignettes ◽

First Episode Schizophrenia

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Outcomes Assessment in Psychiatric Postgraduate Medical Education: An Exploratory Study Using Clinical Case Vignettes

Academic Psychiatry ◽

10.1176/appi.ap.34.6.445 ◽

2010 ◽

Vol 34 (6) ◽

pp. 445-448 ◽

Cited By ~ 2

Author(s):

J. C. Huffman ◽

T. Petersen ◽

L. Baer ◽

S. Romeo ◽

K. Sutton-Skinner ◽

...

Keyword(s):

Medical Education ◽

Exploratory Study ◽

Clinical Case ◽

Outcomes Assessment ◽

Postgraduate Medical Education ◽

Case Vignettes

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Practice Current

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000656 ◽

2019 ◽

Vol 9 (3) ◽

pp. 263-270

Author(s):

Ajal Dave ◽

Aravind Ganesh ◽

Malik Muhammad Adil ◽

Jack W. Tsao

Keyword(s):

Expert Opinion ◽

Online Survey ◽

Preventative Treatment ◽

Ongoing Debate ◽

Link Type ◽

Common Complaint ◽

Expectation Management ◽

Work Up

A common complaint after concussion is the development of new or worsening headaches which can make it difficult or even impossible for patients to work or function in their day-to-day lives. Uncertainties associated with the complaints and a wide variety of approaches exist regarding the appropriate work-up and management of these patients. Areas of ongoing debate include the need for neuroimaging; optimal, acute, and preventative treatment; and proper counseling and expectation management. Given the wide variety of potential approaches and the lack of consensus, we sought expert opinion from around the globe on how to evaluate and manage patients with headache following concussion. Similar questions were posed to the rest of our readership in an online survey (links.lww.com/CPJ/A96), the results of which are also presented.

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Interpreting CT perfusion in stroke

Practical Neurology ◽

10.1136/practneurol-2018-001917 ◽

2018 ◽

Vol 19 (2) ◽

pp. 136-142 ◽

Cited By ~ 7

Author(s):

Stevan Christopher Wing ◽

Hugh S Markus

Keyword(s):

Acute Stroke ◽

Perfusion Imaging ◽

Treatment Time ◽

Ct Perfusion ◽

Time Windows ◽

Onset Time ◽

Brain Perfusion ◽

Reperfusion Therapy ◽

Imaging Protocol ◽

Stroke Imaging

CT perfusion images can be rapidly obtained on all modern CT scanners and easily incorporated into an acute stroke imaging protocol. Here we discuss the technique of CT perfusion imaging, how to interpret the data and how it can contribute to the diagnosis of acute stroke and selection of patients for treatment. Many patients with acute stroke are excluded from reperfusion therapy if the onset time is not known or if they present outside of traditional treatment time windows. There is a growing body of evidence supporting the use of perfusion imaging in these patients to identify patterns of brain perfusion that are favourable for recanalisation therapy.

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COMPLEX ORPHAN PATHOLOGY: COMORBIDITY OF MUCOVISCIDOSIS AND CONGENITAL DYSFUNCTION OF ADRENAL GLANDS CORTEX (REFERENCES REVIEW AND OWN RESEARCH)

Wiadomości Lekarskie ◽

10.36740/wlek202008137 ◽

2020 ◽

Vol 73 (8) ◽

pp. 1790-1795

Author(s):

Mariana A. Ryznychuk ◽

Vasyl P. Pishak ◽

Тatiana V. Khmara ◽

Nataliia V. Bachuk-Ponych ◽

Valentyna N. Pidgirna ◽

...

Keyword(s):

Cystic Fibrosis ◽

Clinical Case ◽

Adrenal Glands ◽

Late Diagnosis ◽

Substitution Therapy ◽

Adrenogenital Syndrome ◽

Mixed Form ◽

Pathological Conditions ◽

Appropriate Therapy ◽

Viral Form

The aim: The clinical case was studied: comorbidity of mucoviscidosis and congenital dysfunction of adrenal glands cortex. Materials and methods: The clinical case of combined orphan pathology – cystic fibrosis and congenital dysfunction of adrenal glands cortex (adrenogenital syndrome) has been described. Clinical case: A 2-month child has been diagnosed with mucoviscidosis, of a mixed form, which was genetically confirmed. The proband and the father were found to be heterozygotes for the F508del mutation of the CFTR gene (the father suffers from mucoviscidosis). Congenital dysfunction of the adrenal glands, a viral form, was diagnosed when he was three years old. The child is currently receiving: Creon 100 000 units per day with eating, Colomycin 1 vial per day, Pulmozyme 2.5 mg/2.5 ml daily in the morning for inhalations, Ursofalk 600 mg every day constantly, Hydrocortisone 50 mg/day. Conclusions: This clinical case can be attributed to rare, as most such pathological conditions are usually diagnosed in maternity homes along with the prescription of appropriate therapy. This is an example of late diagnosis of the viral form of congenital adrenal dysfunction against the background of cystic fibrosis, indicating the need for earlier detection and timely introduction of substitution therapy to improve favourable prognosis for a disease.

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Clinical case of myocardial infarction with unspecified familial hypercholesterolemia

Атеросклероз ◽

10.52727/2078-256x-2021-17-4-74-78 ◽

2022 ◽

Vol 17 (4) ◽

pp. 74-78

Author(s):

N. G. Lozhkina ◽

A. N. Spiridonov

Keyword(s):

Myocardial Infarction ◽

Familial Hypercholesterolemia ◽

Clinical Case ◽

Autosomal Dominant ◽

Clinical Symptoms ◽

Cholesterol Metabolism ◽

Single Gene ◽

Low Density Lipoproteins ◽

Dominant Disease ◽

Appropriate Therapy

Familial hypercholesterolemia is a hereditary autosomal dominant disease characterized by a violation of cholesterol metabolism. This nosology was first described in the late 1930s by the Norwegian clinician Karl Moeller, he proposed the idea that hypercholesterolemia and tendon xanthomas are associated with cardiovascular diseases through the inheritance of a single gene. In 1964, two clinical phenotypes of familial hypercholesterolemia were discovered: heterozygous and homozygous, associated with an unfavorable prognosis. To date, it is known that the long-running process of accumulation of low-density lipoproteins in the intima of blood vessels may not have clinical symptoms for many years due to the developed system of collaterals and the absence of hemodynamically significant stenosis. However, without timely diagnosis and appropriate therapy, this condition inevitably leads to the development of a cardiovascular event. The article presents a clinical case demonstrating the development of myocardial infarction in a patient with a late diagnosis of this disease.

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