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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: Total body irradiation practice patterns: insights from a national survey

Date Published: 2026-10-09

Abstract:
Despite the expansion of hematopoietic stem cell transplantation (HSCT) services, contemporary Total Body Irradiation (TBI) practices remain insufficiently characterized in many healthcare settings. This study aimed to establish a national baseline for TBI practice to support benchmarking, standardization, and quality improvement. A cross-sectional online survey was distributed between May and June 2026 to seven Saudi centers that provided TBI services. The questionnaire collected data on service capacity, patient populations, dose fractionation, treatment techniques and delivery, planning methods, and quality assurance. A census sampling approach was used, inviting Radiation Oncologists, Medical Physicists, and Therapists. Data were analyzed using descriptive statistics in Python (v3.11). All seven centers responded. One center (C) submitted two responses covering conventional extended source-to-surface distance (SSD) and volumetric-modulated arc therapy (VMAT) practices. Commissioned between 1980 and 2020, the TBI programs manage an estimated 386 annual cases (range: 12–120). Fractionated TBI (10–12 Gy, six twice-daily fractions) predominated. The extended SSD opposed-beam technique remained in use at six centers, with the umbilicus as the most common prescription point. At two centers, extended-SSD TBI was used alongside Intensity-modulated radiation therapy (IMRT)-TBI (VMAT and Tomotherapy. IMRT-TBI-based centers reported volumetric target-coverage objectives of 90% and explicit organ-at-risk (OAR) dose planning constraints, particularly for the lungs and kidneys. Treatment planning for IMRT-TBI involved treatment planning systems (TPS), whereas extended-SSD techniques used varied planning approaches, including in-house spreadsheets, pre-calculated templates, and, in some cases, TPS-assisted planning. In vivo dosimetry was performed at all centers. The absorbed dose-rate at the prescription point ranged from <10 to 30 cGy/min for conventional techniques. Three centers planned their initial implementation of IMRT-TBI within three years. The ability to control OARs was the main driver, while linear accelerator availability and staff training were key barriers. Although conventional extended SSD TBI remains the most widely used technique, TBI practice is transitioning toward IMRT-based delivery. National practice guidelines based on existing international recommendations may help standardize care, address implementation barriers, and support the delivery of high-quality TBI services across treatment centers.

Introduction:
Total body irradiation (TBI), a specialized radiotherapy (RT) procedure, is a critical component of conditioning regimens for hematopoietic stem cell transplantation (HSCT) ( 1 ). Despite international guidelines advocating fractionated regimens and specifying dose and organ-at-risk (OAR) constraints to mitigate toxicity, substantial global variability persists in TBI delivery techniques, dose fractionation, shielding, and quality assurance (QA) protocols ( 2 , 3 ). Recent surveys have documented diverse…

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