The Role of Virtual Autopsy in Uncertain Clinical Scenarios

Abstract Background Differentiated thyroid carcinoma (DTC) has an excellent prognosis and the role of high-sensitive thyroglobulin measured during levothyroxine (ON-T4 hs-Tg) testing to discriminate patients with structural from not-evidence of disease (SED and NED, respectively) has been investigated. We conducted a systematic review and meta-analysis evaluating the performance of ON-T4 hs-Tg in two clinical scenarios considering its negative predictive value (NPV) as primary outcome: (1) diagnostic performance of Tg when undetectable value and NED status are simultaneously demonstrated; (2) prognostic performance of undetectable Tg in predicting NED in the subsequent follow-up. Methods This systematic review and meta-analysis were registered on PROSPERO (CRD42019125092). PubMed, Scopus, CENTRAL and Web of Science were searched until February 12, 2019. Original articles reporting data on SED/NED in patients with detectable/undetectable ON-T4 hs-Tg were selected. Summary operating points were estimated using a random-effects model. Results Out of 1413 retrieved papers, 10 studies evaluating 1796 patients were included. Participants were outpatients diagnosed with DTC, treated with near-total (NTx) or total thyroidectomy (TTx) with or without radioactive iodine (RAI). The NPV of ON-T4 hs-Tg for diagnostic and prognostic performance was 99.4% (95% CI 98.9–99.9; I2 = 13%) and 99.4% (95% CI 98.8–100; I2 = 0%), respectively. Conclusions Our findings show that ON-T4 hs-Tg is an excellent diagnostic tool and prognostic factor to rule-out SED. A high level of evidence is provided to decrease the intensity and frequency of follow-up in those DTC patients having undetectable high-sensitive Tg.

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Lifelong Aspirin for All in the Secondary Prevention of Chronic Coronary Syndrome

Circulation ◽

10.1161/circulationaha.120.045695 ◽

2020 ◽

Vol 142 (16) ◽

pp. 1579-1590

Author(s):

Alan P. Jacobsen ◽

Inbar Raber ◽

Cian P. McCarthy ◽

Roger S. Blumenthal ◽

Deepak L. Bhatt ◽

...

Keyword(s):

Myocardial Infarction ◽

Secondary Prevention ◽

Coronary Intervention ◽

Net Benefit ◽

Coronary Syndrome ◽

Clinical Scenarios ◽

Percutaneous Coronary ◽

Historical Role ◽

Prevention Trials

Four decades have passed since the first trial suggesting the efficacy of aspirin in the secondary prevention of myocardial infarction. Further trials, collectively summarized by the Antithrombotic Trialists’ Collaboration, solidified the historical role of aspirin in secondary prevention. Although the benefit of aspirin in the immediate phase after a myocardial infarction remains incontrovertible, a number of emerging lines of evidence, discussed in this narrative review, raise some uncertainty as to the primacy of aspirin for the lifelong management of all patients with chronic coronary syndrome (CCS). For example, data challenging the previously unquestioned role of aspirin in CCS have come from recent trials where aspirin was discontinued in specific clinical scenarios, including early discontinuation of the aspirin component of dual antiplatelet therapy after percutaneous coronary intervention and the withholding of aspirin among patients with both CCS and atrial fibrillation who require anticoagulation. Recent primary prevention trials have also failed to consistently demonstrate net benefit for aspirin in patients treated to optimal contemporary cardiovascular risk factor targets, indicating that the efficacy of aspirin for secondary prevention of CCS may similarly have changed with the addition of more modern secondary prevention therapies. The totality of recent evidence supports further study of the universal need for lifelong aspirin in secondary prevention for all adults with CCS, particularly in stable older patients who are at highest risk for aspirin-induced bleeding.

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Utility of point-of-care ultrasound in the pediatric intensive care unit

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v23i3.1142 ◽

2019 ◽

Author(s):

Reagan Lyman ◽

Yoshikazu Yamaguchi ◽

Alok Moharir ◽

Joseph D. Tobias

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Point Of Care ◽

Pediatric Intensive Care ◽

Therapeutic Interventions ◽

Point Of Care Ultrasound ◽

Critical Care Units ◽

Clinical Scenarios

For critically ill patients, point-of-care ultrasound (POCUS) has been rapidly adopted for use in emergency departments and critical care units for diagnostic purposes and to guide decision making. We present two unique clinical scenarios in the Pediatric Intensive Care Unit (PICU), one in which ultrasound was used as a diagnostic tool to identify pulmonary edema, and the other in which ultrasound was used to facilitate placement of a naso-duodenal tube for enteral feeding. The potential role of POCUS in the PICU is presented and its utility in these two unique clinical scenarios discussed. Although, many cases will still require further radiological tests, The success of POCUS lies in immediate diagnosis allowing at the spot therapeutic interventions without wasting precious time.Citation: Lyman R, Yamaguchi Y, Moharir A, Tobias JD. Utility of point-of-care ultrasound in the pediatric intensive care unit. Anaesth pain & intensive care 2019;23(3):314-317

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How to use: creatine kinase

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2019-317184 ◽

2019 ◽

Vol 105 (3) ◽

pp. 157-163 ◽

Cited By ~ 1

Author(s):

Tanmoy Chakrabarty ◽

Sandya Tirupathi ◽

Andrew Thompson

Keyword(s):

Decision Making ◽

Creatine Kinase ◽

Diagnostic Tests ◽

Myocardial Injury ◽

Decision Making Process ◽

Muscular Weakness ◽

Diagnosis And Management ◽

Essential Tool ◽

Clinical Scenarios

Creatine kinase (CK) remains an essential tool for assessment of muscular weakness and pain in children despite the advent of advanced diagnostic tests in this field. It is also useful in diagnosing and monitoring various other conditions. This article will explore the physiology of CK and clinical situations where the estimation of CK can help the clinicians’ decision-making process with the diagnosis and management of these conditions. Some clinical scenarios are used to highlight how the tests can be used in different clinical situations. The role of CK as a biomarker of myocardial injury has been purposefully omitted in this article.

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The role of non-medical factors in physicians’ decision-making process in a pediatric telemedicine service

Health Informatics Journal ◽

10.1177/1460458219870660 ◽

2019 ◽

Vol 26 (2) ◽

pp. 1152-1176 ◽

Cited By ~ 1

Author(s):

Motti Haimi ◽

Shuli Brammli-Greenberg ◽

Yehezkel Waisman ◽

Nili Stein ◽

Orna Baron-Epel

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Medical Decision ◽

Decision Making Process ◽

Medical Decisions ◽

Telemedicine Service ◽

Medical Factors ◽

Complex Process ◽

Clinical Scenarios

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.

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The role of pediatric surgery in writing clinical scenarios for the undergraduate first three year-students in problem-based learning

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2013.033 ◽

2013 ◽

pp. 33-36

Author(s):

Burak Tander ◽

Unal Bicakci ◽

Mithat Gunaydin ◽

Riza Rizalar ◽

Ender Ariturk ◽

...

Keyword(s):

Pediatric Surgery ◽

Problem Based Learning ◽

Clinical Scenarios

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The Role of Clinical Scenarios in the Management of Acute Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.07.060 ◽

2010 ◽

Vol 16 (9) ◽

pp. S143

Author(s):

Akihiro Shirakabe ◽

Noritake Hata ◽

Shinya Yokoyama ◽

Takurou Shinada ◽

Nobuaki Kobayashi ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Clinical Scenarios

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Will Virtual Autopsy Technology Replace the Role of Forensic Pathologist in the Future?

American Journal of Forensic Medicine & Pathology ◽

10.1097/paf.0b013e31822c8ef2 ◽

2011 ◽

Vol 32 (4) ◽

pp. e17-e18 ◽

Cited By ~ 1

Author(s):

Antonio Oliva ◽

Matteo Polacco ◽

Pasquale D’Alessio ◽

Laura Filograna ◽

Tommaso Tartaglione ◽

...

Keyword(s):

Forensic Pathologist ◽

Virtual Autopsy ◽

The Future

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A Review of Novel Cardiac Biomarkers in Acute or Chronic Cardiovascular Diseases: The Role of Soluble ST2 (sST2), Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Myeloperoxidase (MPO), and Procalcitonin (PCT)

Disease Markers ◽

10.1155/2021/6258865 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Junpei Li ◽

Tianyu Cao ◽

Yaping Wei ◽

Nan Zhang ◽

Ziyi Zhou ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Diseases ◽

Phospholipase A2 ◽

Cardiac Biomarkers ◽

Soluble St2 ◽

Diagnosis And Prognosis ◽

Clinical Scenarios ◽

Chronic Cardiovascular Diseases ◽

Work Up

While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.

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