ITEMS IN AFP WITH KEYWORD:
A collaboration between AFP and the Lown Institute promotes a vision of delivering heath care that is based on the evidence, balanced in its approach, and focused on the patient.
Kidney cancer is one of the 10 most common cancers in the United States. Risk factors include hypertension, tobacco use, obesity, and acquired cystic kidney disease in the setting of end-stage renal disease. More than 50% of patients with renal cell carcinoma are asymptomatic and are diagnosed incidentally during thoracoabdominal imaging. Prompt evaluation of warning signs can improve prognosis, and active surveillance is an option for certain patients.
We all need to test wisely and weigh the risks and benefits of diagnostic imaging. Imaging—and testing in general—has real downsides, such as stumbling onto things you wish you had not.
The risks of imaging, in addition to radiation exposure, include the identification of incidentalomas, which can lead to patient anxiety, further testing, and overtreatment. There is little research to guide what to do when they pop up on an imaging report (as the famous dodge “clinical correlation needed”).
There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE.
Find out when further workup of incidental findings is warranted for patients with pituitary, thyroid, pulmonary, hepatic, pancreatic, adrenal, renal, and ovarian incidentalomas.
Jul 1, 2014 Issue
Ethical Use of Diagnostic Technology: Balancing What's New and What's Necessary [Curbside Consultation]
This case boils down to being realistic about what new screening tools and techniques can and can't do, and understanding their actual value in diagnoses. I'd argue that it is not unethical to accommodate a patient's requests, as long as the physician's approach to the patient, the pathology, the te...
Oct 1, 2013 Issue
Ultrasound-Guided Steroid Injections for Shoulder Pain [Cochrane for Clinicians]
Ultrasound-guided glucocorticoid injection for shoulder pain provides no advantage over landmark-guided or intramuscular injection in terms of pain, function, range of motion, or safety when measured within a six-week follow-up period. However, the small sample size of this review means that a clinically significant benefit cannot be ruled out.
The use of CT imaging has risen dramatically in the past two decades, and there is substantial evidence that it is overused. One concern is that the harms and risks of CT have been underestimated and poorly understood, and are not often discussed with patients. These harms should be balanced with the potential diagnostic benefits.
Family physicians often must determine the most appropriate diagnostic tests to order for their patients. It is essential to know the types of contrast agents, their risks, contraindications, and common clinical scenarios in which contrast-enhanced computed tomography is appropriate. Many types of c...