{"id":35160,"date":"2015-09-09T10:00:18","date_gmt":"2015-09-09T09:00:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=35160"},"modified":"2015-09-09T10:01:05","modified_gmt":"2015-09-09T09:01:05","slug":"the-bmj-today-diagnostic-challenges-and-telemedicine","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/09\/09\/the-bmj-today-diagnostic-challenges-and-telemedicine\/","title":{"rendered":"The BMJ Today: Diagnostic challenges and telemedicine"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/pleural_effusion.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-35163 \" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/pleural_effusion-150x150.jpg\" alt=\"Pleural effusion. Coloured frontal X-ray of the lungs of a 60-year-old patient with a pleural effusion of the left lung (right). The lungs are the dark spaces either side of the chest. The left lung is smaller than the right lung due to a pleural effusion, an accumulation of fluid (lower right) in the chest cavity. The liquid compresses the lung, which leads to breathing difficulties. An effusion is treated by aspiring (draining) the fluid, which relieves the pressure.\" width=\"125\" height=\"125\" \/><\/a><\/p>\n<p><strong>\u2022\u00a0<\/strong>Pleural effusions present a common diagnostic problem: there are over 50 known causes. <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4520\">A clinical review describes how a primary care physician and a specialist can approach patients with pleural effusion<\/a> to reach\u00a0an etiologic diagnosis using clinical features, imaging, fluid analysis, and pleural biopsy. It also presents strategies to manage the breathlessness that afflicts patients with pleural effusion. The review includes the perspective of two patients and also identifies clinical and research questions that remain to be answered.<!--more--><\/p>\n<p><strong>\u2022\u00a0<\/strong>Pulmonary embolism is another condition that is often challenging to diagnose. Several clinical decision rules have been developed to help differentiate patients in the emergency room with symptoms suggestive of embolism who require further testing from\u00a0those who may be discharged home. <a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/gp_consultation.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-35164 \" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/gp_consultation-150x150.jpg\" alt=\"MODEL RELEASED. General practice (GP) doctor seeing an elderly female patient.\" width=\"125\" height=\"125\" \/><\/a>But can these decision rules be applied in a primary care setting?<\/p>\n<p>A <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4438\">systematic review found that five of the 10 identified prediction models could be validated in a primary care setting<\/a>, but they may have a relatively low sensitivity. The <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4594\">accompanying editorial argues that<\/a> a search for the optimal decision rule is still ongoing.<\/p>\n<p><strong>\u2022\u00a0<\/strong>A man with bilateral neck lumps secondary to subclavian artery aneurysms poses another diagnostic dilemma and <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4678\">is the focus of the latest endgames<\/a>.<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/telemedicine.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-35165 \" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/telemedicine-150x150.jpg\" alt=\"telemedicine\" width=\"125\" height=\"125\" \/><\/a><strong>\u2022\u00a0<\/strong>Telemedicine can help bring clinical expertise to underserved areas and to patients who may not be able to visit the doctor\u2019s office. It can be used in the setting of an established patient-physician relationship or it can be the basis for the establishment of such a relationship. An American College of Physicians (ACP) policy paper <a href=\"http:\/\/www.bmj.com\/content\/351\/bmj.h4799\">calls for changes to licensing and reimbursement rules in the US<\/a> to foster the development of these services.<\/p>\n<p><em><strong>Jos\u00e9 G Merino<\/strong> is the\u00a0US clinical research editor, <\/em>The BMJ<em>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u2022\u00a0Pleural effusions present a common diagnostic problem: there are over 50 known causes. A clinical review describes how a primary care physician and a specialist can approach patients with pleural [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/09\/09\/the-bmj-today-diagnostic-challenges-and-telemedicine\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5750],"tags":[],"class_list":["post-35160","post","type-post","status-publish","format-standard","hentry","category-the-bmj-today"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The BMJ Today: Diagnostic challenges and telemedicine - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/09\/09\/the-bmj-today-diagnostic-challenges-and-telemedicine\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The BMJ Today: Diagnostic challenges and telemedicine - The BMJ\" \/>\n<meta property=\"og:description\" content=\"\u2022\u00a0Pleural effusions present a common diagnostic problem: there are over 50 known causes. A clinical review describes how a primary care physician and a specialist can approach patients with pleural [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2015\/09\/09\/the-bmj-today-diagnostic-challenges-and-telemedicine\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2015-09-09T09:00:18+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-09-09T09:01:05+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/09\/pleural_effusion-150x150.jpg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"The BMJ Today: Diagnostic challenges and telemedicine\",\"datePublished\":\"2015-09-09T09:00:18+00:00\",\"dateModified\":\"2015-09-09T09:01:05+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/\"},\"wordCount\":289,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2015\\\/09\\\/pleural_effusion-150x150.jpg\",\"articleSection\":[\"The BMJ today\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/\",\"name\":\"The BMJ Today: Diagnostic challenges and telemedicine - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2015\\\/09\\\/pleural_effusion-150x150.jpg\",\"datePublished\":\"2015-09-09T09:00:18+00:00\",\"dateModified\":\"2015-09-09T09:01:05+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/09\\\/09\\\/the-bmj-today-diagnostic-challenges-and-telemedicine\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2015\\\/09\\\/pleural_effusion.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2015\\\/09\\\/pleural_effusion.jpg\",\"width\":540,\"height\":350,\"caption\":\"Pleural effusion. 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