A pilot study estimating liver fibrosis with ultrasound shear-wave elastography: does the cause of liver disease or location of measurement affect performance?

Objective: The purpose of this study was to evaluate the diagnostic accuracy of real-time shear-wave elastography for assessment of liver fibrosis in an unselected patient population, comparing shear-wave elastography measurements obtained at and remote from the site of random liver biopsy.

Subjects And Methods: In a prospective study of 50 patients (21 with and 29 without hepatitis C) referred for clinically indicated random liver biopsy for diffuse liver disease, shear-wave elastography measurements were taken from four locations before biopsy: one at the left lobe, two at the right lobe, and one at the biopsy location. The mean, minimum, maximum, and SD of shear-wave elastography were compared with pathologic grading.

Ipilimumab treatment associated pituitary hypophysitis: clinical presentation and imaging diagnosis.

Ipilimumab is an immunomodulating drug for use in treatment of unresectable or metastatic melanoma with autoimmune lymphocytic hypophysitis as a reported complication. We describe three recent cases of ipilimumab associated autoimmune hypophysitis (IAH) at our institution, and provide a selected literature review showing its variable clinical presentation, imaging appearance and treatment in order to expedite early and appropriate IAH management. Patients had variable clinical presentation of hypophysitis, including headache, fatigue, visual changes, endocrinopathy, and/or hyponatremia.

Weekly E-mail reminders influence emergency physician behavior: a case study using the Joint Commission and Centers for Medicare and Medicaid Services Pneumonia Guidelines.

Objectives: Improving physician compliance with evidence-based guidelines is challenging. The authors wanted to determine if weekly e-mail reminders to emergency department (ED) staff increase compliance with Joint Commission and the Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia quality measures.

Methods: One nurse administrator reviewed records on a weekly basis for all adult patients admitted to the hospital from the ED with a working diagnosis of pneumonia.