Clinical Medicine
September 26, 2023
Normalizing Predictive Values for Appropriate Interpretation of Diagnostic Test Results
As clinicians, we often evaluate diagnostic test results like imaging studies to guide patient care. An important consideration is how disease prevalence in the tested population impacts the meaning of positive and negative predictive values. For example, a recent study using cardiac CT angiography (CTA) to diagnose coronary artery disease reported an excellent 99% negative…
September 21, 2023
Higher cardiac MIBG washout rates predict sudden cardiac death in CHF
A study from 2009 found that CHF patients who experienced sudden cardiac death had significantly higher cardiac MIBG washout rates than those who survived. The crossover point between the groups was 33.5%. Simply reporting group means and standard deviations does not adequately characterize the data. Providing reference values like the crossover point and odds ratios…
September 9, 2023
Finding Strength Through Gratitude
In this article, I reflect on how cultivating gratitude has helped me and can help other healthcare providers overcome burnout and continue serving patients with compassion. I share a story deeply meaningful to me of a dying patient who continues to teach us important lessons about finding peace and maintaining strength of spirit when facing…
September 5, 2023
Incidental Detection of Giant Cell Arteritis in PET/CT Scans for Renal Carcinoma
A case study involving a 71-year-old male undergoing 18F-FDG PET/CT scans for renal carcinoma staging revealed incidental findings of giant cell arteritis. The patient was administered 370 MBq of 18F-FDG, and the scan spanned from the base of the skull to the mid-thighs. Increased tracer uptake was observed throughout the aorta, corroborating the patient’s known…
September 3, 2023
The Role of Electrocardiography in Predicting Cardioversion Outcomes for Atrial Fibrillation
Cardioversion is a common treatment for atrial fibrillation, a cardiac arrhythmia affecting millions. However, the success of this procedure is not guaranteed and often depends on various factors such as patient age and existing heart conditions. Recent research has delved into the electrocardiographic markers that could serve as predictors for successful cardioversion. The study, although…
August 30, 2023
Critically Evaluating Industry-Sponsored Clinical Trials
When reviewing clinical research, we should carefully examine the methodology and potential biases, especially in industry-funded studies. A new editorial highlights concerns about a drug-maker-backed trial on a medication for diabetes. Despite claims of cardiovascular benefits, the analysis failed to correct for HbA1c. Selective reporting and marketing contractor involvement also raise red flags. While sponsorship…
August 28, 2023
The Link Between Bioethics and Moral Injury in Healthcare
This perspective article proposes an important connection between bioethics and moral injury in healthcare. The authors argue that when clinicians witness violations of core bioethical principles like autonomy and justice, it can cause moral injury – emotional distress from compromised morality. They provide examples of how this happens routinely in medical settings. They suggest viewing…
August 19, 2023
Molecular Imaging Advances in Thyroid Cancer
Thyroid cancer is relatively uncommon compared to other malignancies but its incidence is increasing. This article reviews the clinical aspects of evaluating a thyroid nodule and the role of various imaging modalities. Ultrasound and fine needle aspiration biopsy are the mainstays for initial evaluation. Radioiodine scintigraphy helps characterize nodules that are indeterminate on cytology. PET/CT…
Statistical Limitations in Comparing 123I-MIBG and 18F-FDG PET in Neuroblastoma Staging
123I-MIBG and 18F-FDG PET were compared for neuroblastoma staging. Small sample sizes limit statistical power. More data is needed before eliminating either modality. Heston TF. 123I-MIBG Versus 18F-FDG: Which Is Better, or Which Can Be Eliminated? Journal of Nuclear Medicine February 2010, 51 (2) 330; DOI: https://doi.org/10.2967/jnumed.109.069401
August 18, 2023
An Excess of Information
A partial solution to information overload would be to display laboratory data in z-scores, speeding up the evaluation of multiple lab tests. A simple review would determine whether a test was normal or abnormal and the severity of the abnormality. Heston TF. An Excess of Information. Southern Medical Journal. 1991; 84 (8): 1063.
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