Clinical Documents

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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: Prevention and management of enteral nutrition-related diarrhea in stroke patients: barriers and enablers from best evidence to best practice

Date Published: 2026-05-19

Abstract:
This study aimed to identify the gap between the clinical practice and best evidence for preventing and managing enteral nutrition-related diarrhea in stroke patients, to recognize barriers and enablers in translating this evidence into best practice, and to develop specific and effective action strategies to advance evidence-based practice. A convergent mixed-methods study was conducted, integrating cross-sectional surveys with descriptive qualitative research. Twenty-nine audit criteria were developed based on the current best evidence for the prevention and management of enteral nutrition-related diarrhea in stroke patients. A self-designed audit sheet, which was based on the developed audit criteria, was administered to conduct a baseline audit to identify gaps between best evidence and current clinical practice. A self-designed questionnaire based on the current best evidence was used to collect data on healthcare professionals’ knowledge regarding the prevention and management of enteral nutrition-related diarrhea in stroke patients. In-depth interviews were used to produce in-depth views of stakeholders about implementing the best evidence for preventing and managing enteral nutrition-related diarrhea in stroke patients. The qualitative data was analyzed using directed content analysis, guided by the Ottawa Model of Research Use (OMRU). A total of 86 stroke patients, 34 nurses, and 4 doctors were recorded for their adherence to best evidence. The audit results showed that compliance rates for 19 out of 29 audit criteria were below 60.00%, and the incidence of enteral nutrition-related diarrhea among stroke patients was 43.02%. Thirty-eight healthcare professionals from the neurology department completed the questionnaire. The average knowledge score of the prevention and management of enteral nutrition-related diarrhea among these professionals was 53.68 (SD 15.74) points, with a pass rate of 42.11%. A total of 8 healthcare providers and 8 stroke patients were interviewed. We generated 11 themes and 23 sub-themes based on the data, which were categorized under three aspects of OMRU. At the evidence-based innovation level, the evidence meeting clinical needs served as a facilitator, while the lack of specific implementation standards for some evidence acted as a barrier. At the level of potential adopters, healthcare professionals’ positive attitudes toward evidence implementation and their exceptional work capabilities served as enablers for the best practice in preventing and managing diarrhea related to enteral nutrition in stroke patients. However, a lack of initiative among medical staff and the increased workload from evidence implementation were barriers. At the practice environment level, comprehensive supporting facilities, positive interpersonal relationships, patients’ positive rehabilitation mindset, and their absolute trust in medical professionals were important enablers. Important barriers included non-establishment of a multidisciplinary team, insufficient organizational support (e.g., lack of diarrhea prevention and management systems, lack of a quality assessment system for enteral nutrition), patients’ lack of relevant knowledge, low self-efficacy, and patients’ diminished abdominal sensitivity. Eleven strategies were developed to amplify enablers and overcome barriers to the implementation of evidence-based practice in preventing and managing enteral nutrition-related diarrhea in stroke patients. This study systematically investigated the barriers and enablers contributing to the gaps between the best evidence and clinical practice regarding the prevention and management of enteral nutrition-related diarrhea in stroke patients. Action strategies to promote the implementation of best evidence should focus on addressing barriers related to evidence-based innovation, potential adopters, and the practice environment.

Introduction:
Stroke is defined as a brain dysfunction caused by acute focal damage resulting from altered cerebral blood supply ( 1 ). Malnutrition is a common complication of stroke, closely associated with poor prognosis, slow functional recovery, and prolonged hospital stays ( 2 , 3 ). Previous studies have demonstrated that adequate nutritional support is a key factor in improving patient recovery outcomes, reducing the risk of complications, mitigating neurological deficits, and lowering healthcare expenditures ( 3 , 4 ).…

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