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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Research Article: Diagnostic performance of wearable acoustic–electrocardiographic indices for screening secundum atrial septal defect in children

Date Published: 2026-05-08

Abstract:
To evaluate the diagnostic performance of acoustic–electrocardiographic indices derived from a wearable phonocardiogram–electrocardiogram (ECG) sensor for screening secundum atrial septal defect (ASD) in children. In this cross-sectional study, 50 children (4–12 years) with secundum ASD and 50 age- and sex-matched healthy controls were enrolled. A wearable patch device recorded synchronized single-lead ECG and phonocardiogram, and S2 splitting time, S1–S2, S1–S2/RR (%), EMAT and EMAT/RR (%) were derived from artifact-free sinus beats at end-expiration. Group differences were assessed using independent-samples t -tests or ? 2 tests. Receiver operating characteristic analysis evaluated the ability of S2 splitting time and S1–S2/RR (%) to detect ASD, with optimal cut-offs defined by the Youden index. Multivariable logistic regression examined the independent association of these indices with ASD. Baseline demographic, anthropometric, and hemodynamic variables were well balanced between ASD and control groups. Compared with healthy controls, children with ASD had significantly prolonged S2 splitting time (39.65?±?8.37 vs. 28.20?±?8.91?ms; t =?6.623, P <?0.001) and an increased systolic fraction S1–S2/RR (%) (37.53?±?2.39% vs. 34.47?±?2.99%; t =?5.653, P <?0.001), whereas S1–S2 interval, EMAT, and EMAT/RR (%) did not differ significantly between groups. ROC analysis showed that S2 splitting time had good discriminative ability for detecting ASD, with an area under the curve (AUC) of 0.831 [95% confidence interval (CI): 0.752–0.910]. A cut-off value of ?31.75?ms yielded a sensitivity of 0.90 and a specificity of 0.66. S1–S2/RR (%) demonstrated acceptable discrimination, with an AUC of 0.776 (95% CI 0.686–0.866) and an optimal cut-off of ?35.25% (sensitivity 0.88, specificity 0.60). In multivariable logistic regression, both S2 splitting time [odds ratio (OR): 1.19 per 1-ms increase; 95% CI: 1.09–1.29; P <?0.001] and S1–S2/RR (%) (OR: 1.58 per 1% increase; 95% CI: 1.25–2.00; P <?0.001) remained independently associated with ASD. Wearable acoustic–electrocardiographic monitoring enables quantitative assessment of S2 splitting and systolic time fractions in children. Prolonged S2 splitting time and increased S1–S2/RR (%) are characteristic of secundum ASD and show good diagnostic performance, supporting these simple indices from a patch-type phonocardiogram–ECG sensor as a practical non-invasive tool for pediatric ASD screening.

Introduction:
Secundum atrial septal defect (ASD) is one of the most common congenital heart diseases in children. Many affected children remain asymptomatic or have only subtle, non-specific complaints during early childhood, and the diagnosis is often made incidentally or delayed until adolescence or adulthood ( 1 ). Persistent left-to-right shunting at the atrial level leads to chronic right ventricular volume overload, increased pulmonary blood flow, and, if unrecognized, may eventually result in atrial arrhythmias,…

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