Systemic-to-pulmonary venous shunt in a patient with non-Hodgkin lymphoma: A case report and review of the literature

We describe a case of a systemic-to-pulmonary venous shunt secondary to superior vena cava obstruction in a patient with newly diagnosed non-Hodgkin lymphoma. This rare condition manifested with symptoms of dyspnea and hypoxemia that were out of proportion to the pleural effusion diagnosed on chest imaging. Standard treatment of such rare collateral plexuses is observation. However, it is important for clinicians to be cognizant that in rare cases such plexuses can lead to right-to-left shunt complications such as embolism

The Effect of Adoption of an Electronic Health Record on Duplicate Testing

Background. The electronic health record (EHR) has been promoted as a tool to improve quality of patient care, reduce costs, and improve efficiency. There is little data to confirm that the use of EHR has reduced duplicate testing. We sought to evaluate the rate of performance of repeat transthoracic echocardiograms before and after the adoption of EHR. Methods. We retrospectively examined the rates of repeat echocardiograms performed before and after the implementation of an EHR system. Results. The baseline rate of repeat testing before EHR was 4.6% at six months and 7.6% at twelve months. In the first year following implementation of EHR, 6.6% of patients underwent a repeat study within 6 months, and 12.9% within twelve months. In the most recent year of EHR usage, 5.7% of patients underwent repeat echocardiography at six months and 11.9% within twelve months. All rates of duplicate testing were significantly higher than their respective pre-EHR rates (p<0.01 for all). Conclusion. Our study failed to demonstrate a reduction in the rate of duplicate echocardiography testing after the implementation of an EHR system. We feel that this data, combined with other recent analyses, should promote a more rigorous assessment of the initial claims of the benefits associated with EHR implementation