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Altered mental status (AMS) and coma are terms used to describe disorders of arousal and content of consciousness. AMS may account for up to 4% to 10% of chief complaints in the emergency department setting and is a common accompanying symptom for other presentations. AMS is not a diagnosis, but rather a term for symptoms of acute or chronic disordered mentation, including confusion, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, agitation, altered behavior, inattention, hallucinations, delusions, and psychosis. Some of the most common disorders associated with AMS are underlying medical conditions, substance use, and mental disorders. This document focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Endometriosis is a common condition impacting individuals assigned female at birth. Though incompletely understood, the disorder is caused by endometrial-like tissue located outside of the endometrial cavity, associated with inflammation and fibrosis. Clinical presentation is variable, ranging from asymptomatic to severe pelvic pain and infertility. Treatment is determined by the patient's individualized goals and can include medical therapies to temporize symptoms or definitive surgical excision. Imaging is used to help diagnose endometriosis and for treatment planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

The Weismann-Netter syndrome is a rare genetic disorder of the skeleton, which is characterized by bowing of the legs, delayed ability to walk, and short stature. Most cases of this skeletal disease are diagnosed in persons older than 16 years of age, but symptoms often develop in childhood. A case is described of a four-year-old boy with bowing of the legs detected at two years of age. The child had an uncomplicated birth and normal development with the exception of learning to walk at a later-than-normal age of 14 months. His parents were older but of normal stature and his 10 siblings were also normal in stature. The patient's height, weight, and head size were all below normal, and X-ray findings of the legs - particularly the lower segments - and pelvis were consistent with Weismann-Netter syndrome. He had normal levels of calcium, phosphorus, protein, and 25-OH-cholecalciferol, a vitamin essential for development of bones and teeth; no evidence of syphilis; and elevated levels of the enzyme alkaline phosphatase, which functions in the mineralization of bone. Although the rate of growth may be normal in patients with the Weismann-Netter syndrome, the effect of weight bearing particularly during rapid growth in puberty may increase bowing of the legs and contribute to short stature. The persistence of elevated levels of the enzyme alkaline phosphatase, abnormal pelvic X-ray findings, worsening of bowed legs during puberty, and more pronounced short stature in adulthood are consistent with the enduring nature of this skeletal disorder throughout life. Although the child's parents and 10 siblings were of normal stature, the advanced age of the child's father at conception may have led to a genetic mutation responsible for the development of the Weismann-Netter syndrome in this case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nephropathic cystinosis is an error of metabolism that prevents the normal biochemical breakdown of the amino acid cystine. In patients who suffer from this condition, there is a gradual accumulation of cystine in virtually all tissues of the body. The accumulation in the kidney produces generalized renal failure, usually by about the 10th year of life. Recently it has been found that treatment with cysteamine (a related compound) can be used to deplete the cellular concentration of cystine and prevent or slow the progress of the disease. Before this treatment was available, approximately 70 patients in the United States underwent a kidney transplant for the condition. Because the kidney contains cells from the donor, who has normal cystine metabolism, the transplanted kidneys are free of the damage caused by the accumulation of cystine. A group of 43 patients with cystinosis were included in this study of age-related swallowing dysfunction. Twenty-four of this group had received a new kidney by transplantation. The ability of the patients to swallow was assessed by several techniques that allowed the swallowing process to be observed. Approximately half of the patients were found to eat slowly, a condition which may related to an underlying pathology. Seven of the nine patients in the 21- to 31-year-old age group were found to have detectable difficulties with all three phases of swallowing (oral, pharyngeal and esophageal), apparently because of reduced muscular abilities. The degree of swallowing difficulties appears to be related to length of time that the patient has had the disease, indicating that swallowing dysfunction is a late consequence of the disease. Various strategies can be used to aid patients with swallowing problems, including changing the consistency of food and learning new strategies, such as placing the food to be swallowed far back in the mouth. Long-term cysteamine therapy may also be useful for patients with cystinosis who have swallowing difficulties. (Consumer Summary produced by Reliance Medical Information, Inc.)

The E/M coding revisions aren't perfect, but they represent a huge step forward in reducing physicians' documentation burden, audit risk, and complexity of code selection. [ABSTRACT FROM AUTHOR]

Computer interviewing to obtain sensitive information is not a new concept. However, concerns about the acceptance of computers in disadvantaged populations with potentially low literacy led us to combine audio- and touch-screen technologies with an audio computerized self-report interview to obtain information about alcohol use. This study evaluated acceptance and ease of use by a disadvantaged population of pregnant women in the District of Columbia. Patients attending an initial visit at prenatal clinics answered questions anonymously about their consumption of alcoholic beverages and other personal information. The questionnaire was programmed on a laptop computer. The computer administered the recorded questions via earphones, as well as displayed them on the screen, and patients answered by touching the computer screen. Results were immediately available. A total of 507 women were interviewed, who were primarily African American, non-Hispanic, and never married. Nearly 24% did not complete a high school education, 43% were unemployed, and 30% received public assistance. Most of the women (59%) used computers occasionally (a few days a month) or never. Nearly all patients (96%) reported that the computer was not difficult to use, and approximately 90% liked answering the questions by computer. The study demonstrates that using computers to screen for alcohol use in disadvantaged pregnant populations is feasible and acceptable to the patients.