Blood clots: What cancer patients need to know
Furman Football Player's Death Was Unrelated To Practice, University Says
GREENVILLE — The sudden death of a Furman University football player in early February after he collapsed during a team workout was unrelated to football, the university told The Post and Courier.
Bryce Stanfield, a 21-year-old junior defensive lineman, died Feb. 9 after he collapsed during a morning workout at Paladin Stadium two days prior.
An autopsy concluded Stanfield's cause of death was a pulmonary embolism, unrelated to football, Furman spokesman Clinton Colmenares said.
Sign up for updates! Get the latest Greenville news from The Post and Courier in your inbox.A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung, according to the Mayo Clinic.
Stanfield, a health sciences major from Acworth, Ga., had no signs of sickness or injury besides a back muscle strain ahead of the workout Feb. 7, Furman head coach Clay Hendrix said during a news conference following Stanfield's death.
Furman University football player Bryce Stanfield died two days after school officials said he collapsed suddenly during an early morning practice Feb. 7.
Furman University Athletics/Provided"Bryce was an outstanding young man and an equally fine student, football player and friend," Hendrix said. "He was so much a part of who we are as a program and school."
After Stanfield collapsed, he was rushed to Greenville Memorial Hospital in critical condition and put on life support, school officials said.
Prior to his death, the school conducted a small, private ceremony to confer his bachelor of science degree, magna cum laude.
Stanfield was a significant player on the Paladins' defense, seeing action in all 13 games last fall and totaling 13 tackles, with four tackles for loss and 2.5 sacks.
AI In Pulmonary Embolism: 'Transformative' For Patient Care
MIAMI BEACH, FL—Pulmonary embolism (PE), an often-deadly condition that's best served by a multidisciplinary approach to care, is the perfect target for artificial intelligence (AI), according to experts at last week's ISET meeting. Clinicians at some centers have already begun to apply this rapidly developing technology to streamline the management of PE patients, and say they're learning as they go.
"AI is everywhere," Sanjay Misra, MD (Mayo Clinic, Rochester, MN), told attendees of the packed ISET Town Hall session. "It's ubiquitous, and I think it's really important for us in healthcare to start looking at it and understanding how we're going to use it." That day has come in many large health systems, where AI is harnessed for stroke triage, image analysis, and more, he said.
Pulmonary embolism, in particular, stands out as an area of clinical need, Misra said. "PE is a huge problem." There are 900,000 cases of PE each year in the United States, leading to 300,000 deaths annually, with a stark rural/urban divide in mortality risk.
Increasingly, academic medical centers approach the challenges of PE through pulmonary embolism response teams (PERTs). This strategy isn't universal, however, and the centers that lack PERTs could especially stand to benefit from AI tools, said Robert Lookstein, MD (Icahn School of Medicine at Mount Sinai, New York, NY), not only for diagnostics but also for connecting and informing caregivers across disciplines.
Lookstein, in an ISET session devoted to venous clot management, had the opportunity to discuss his own firsthand experiences with AI in PE. He described himself as an "absolute zealot" about the technology's potential. "Literally, this is where we are going to go for treating PE, and this is in my opinion the future of advanced diagnosis and triage of all cardiovascular emergencies," said Lookstein.
For him and his colleagues at Mount Sinai, using AI for PE "has been such a transformative experience," one that he wants to share with other centers, Lookstein told TCTMD. "Everyone on our clinical team, on our PERT, can't imagine going back to what it was like before we had this. Everybody agrees that we are triaging patients much more rapidly. We're identifying who needs escalation in care. We're identifying disposition. We have proven that we've reduced length of stay. Now, we need to prove that we're improving outcomes."
What It Does
Admittedly, AI has been around in healthcare for some time, Lookstein said, but it's only within the past several years that platforms like Aidoc aiOS, RapidAI, and Viz.Ai debuted in PE care. Their smartphone apps, as a first step, could rapidly identify PE based on an initial CT, then "ping the physician and notify them" when the PE is diagnosed. More complicated has been fine-tuning these algorithms to winnow down the alerts to those that are most actionable, drawing a distinction between patients who require intervention and those who can be medically managed based on factors like RV/LV ratio, biomarker elevations, and ECG changes.
Then, the app must connect all the clinicians involved, Lookstein said, such that "regardless of whether somebody is in the emergency room, on the floor, in the operating room, cath lab, etc, that everybody is communicating about this urgent diagnosis at the exact same time, sharing their opinions and their concerns about where the patient should be triaged to." And finally, this information needs rapid integration with the patient's electronic health record (EHR), he said.
It's taken time, and a lot of work, to reach the stage where all of these AI-based functions are available for clinical use, he added.
Everybody is communicating about this urgent diagnosis at the exact same time, sharing their opinions and their concerns about where the patient should be triaged to. Robert Lookstein
Misra also called out the complexity of care for acute PE. Patients pass through many steps—with many different components—from the initial suspicion of disease to diagnosis on CT, creation of the radiology report, and pursuit of other testing that's relevant to PE treatment, he noted.
For all members of the team to be informed, there must be ways of "pulling this data out of silos . . . And coordinating a story about the patient and what's best for the patient," said Misra. "And this can be hard."
According to Lookstein and Misra, both Mount Sinai and the Mayo Clinic are using the Aidoc aiOS system, whose features for PE include a smartphone app that provides PERT alerts, mobile image viewing, RV/LV ratio-based risk stratification, EHR integration, and a platform for chats across departments. Additional dashboards offer center-specific details on things like turnaround time and percent positives. "If you're a large healthcare system, this kind of data may be valuable for you to understand workflow, diagnoses, and communication," Misra said.
"It's amazing how automatically the data is aggregated," Lookstein concurred. The numbers that come out of that can be used to create reports on a weekly, monthly, or quarterly basis for sharing with PERT members, said Lookstein. At Mount Sinai, they've also provided the AI vendor with real-time feedback that's improved diagnostic accuracy: the negative predictive value has reached nearly 99%.
Money and Knowledge
The potential to save money, by targeting the right resources to the right patients, is another thing on everyone's minds.
Misra, looking forward, cited a recent American Heart Association scientific statement that calls for "value creation" as artificial intelligence is applied in cardiovascular imaging. "What we don't want to do is drive up the cost of medicine," he urged. Additional elements include the need to better standardize data collection from disparate sources and to reduce disparities in care, as well as the requirement for adequate IT infrastructure and the ability to safely deal with patient privacy.
The hype around artificial intelligence is high but justified, Misra noted. "I would encourage those of you that are interested: start engaging with AI because you are at the right time."
What we don't want to do is drive up the cost of medicine. Sanjay Misra
Gradually, studies are documenting what AI adds to PE care, said Lookstein. "There is research, but honestly in my opinion this field is moving so fast it's hard to generate data that's reflective of what's happening now."
AI isn't just under study itself: it's also bolstering the research infrastructure of the hospitals that use it. Lookstein said the PERT Consortium has been working with the various AI vendors to optimize their products and ensure they are consistent among each other. Beyond this, though, "the PERT Consortium has been committed, since its inception, to supporting, promoting, and advocating for prospective research in this space," he said. By tracking detailed information over time, AI "allows you to make sure that your research site is ideally suited to screen every single patient, not miss one, and allow them to be screened for participation in these pivotal, prospective trials."
Can Chest X-rays Show Pulmonary Embolisms?
A pulmonary embolism is a blood clot that blocks the lung's arteries. Blood clots do not show on chest X-rays. However, these X-rays may help doctors rule out other health conditions with similar symptoms.
Pulmonary embolisms can reduce oxygen in the blood, increase pressure on the heart, and spike blood pressure in the lungs. They are potentially life threatening.
However, people can recover from pulmonary embolisms after receiving prompt and correct treatment. A person can speak with a healthcare professional about possible pulmonary embolism symptoms. A doctor may recommend several imaging scans, including CT, angiography, and ultrasound.
This article explains when X-rays may be useful, how doctors diagnose pulmonary embolisms, and how to treat the condition.
X-rays do not show blood clots directly, including pulmonary embolisms. However, they may be able to show:
While X-rays cannot directly show an embolism, a 2023 case study highlighted that X-rays can show certain physical effects of some clots to direct further scans. These may include:
These signs are rare and do not always indicate a pulmonary embolism. However, they may help doctors recognize and treat the condition.
Healthcare professionals may find it difficult to diagnose pulmonary embolism. It is also a potentially life threatening health problem unless a person receives prompt treatment.
Symptoms of pulmonary embolism may include breathing difficulty or cardiac arrest (heartbeat stopping). These symptoms are not unique and may occur due to other conditions, including:
A chest X-ray may help a doctor rule out other conditions that cause breathlessness, such as tumors or pneumonia. They may also check the legs for a red, swollen, warm, or tender area — a possible sign of a deep vein clot. This type of clot can move up to the lungs and cause a pulmonary embolism.
Other scans and tests might include:
Treating most pulmonary embolisms generally involves taking medication to prevent the clot from growing and reducing the risk of new clots. People with a large clot may need surgery to remove it to avoid it from becoming life threatening.
Treatments might include:
A person with pulmonary embolism may not show symptoms at all. Up to two-thirds of people with pulmonary embolism do not show symptoms, according to a 2018 review.
However, symptoms that may occur include:
It is best to speak to a doctor upon noticing these symptoms. They may indicate a pulmonary embolism or other serious heart and lung problems.
A chest X-ray does not directly show pulmonary embolism. However, it may help a doctor rule out health problems that cause similar symptoms, such as pneumonia and some heart conditions. An X-ray may also show some physical lung changes that can indicate a blood clot.
Once a doctor has used an X-ray to guide diagnosis, they often order a CTPA, an ultrasound scan, and blood tests to locate clots. Treatment usually includes blood-thinning medications but may require surgery.
People should contact a doctor if they notice any symptoms of pulmonary embolism.
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