European journal of internal medicine
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Eur. J. Intern. Med. · Jul 2020
Clinical practice guidelines adaptation for internists - An EFIM methodology.
The rising number of clinical guidelines poses a new challenge to the internists. The main problems are: 1) available documents suffer from heterogeneous methodological quality, and 2) most of clinical guidelines target an 'ideal' patient affected by a single condition, while in real practice internists must face with comorbid patients typically undergoing a polypharmacy. ⋯ The project started with the creation of a research protocol containing details about all the steps needed to write the Clinical Practice Guideline Summary. In particular, this methodological document specifies the rules: 1) to select topics and clinical questions; 2) to build up a panel of experts, carefully managing eventual conflict of interests; 3) to critically appraise clinical guidelines (using a validated tool as AGREE II), selecting the most valid and applicable to the common clinical practice (using ADAPTE; 4) to address and solve potential disagreements among the selected documents.
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Eur. J. Intern. Med. · Jul 2020
Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality.
An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality. ⋯ The co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.
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Eur. J. Intern. Med. · Jul 2020
Anticoagulation in thrombocytopenic patients with hematological malignancy: A multinational clinical vignette-based experiment.
Thrombocytopenia in cancer patients with an indication for anticoagulation poses a unique clinical challenge. There are guidelines for the setting of venous thromboembolism but not atrial fibrillation (AF). Evidence is lacking and current practice is unclear. ⋯ This study indicates what the widely accepted management strategies are. These strategies, and possibly others, should be assessed prospectively to ascertain effectiveness. The decision process is intricate and compatible with current venous thromboembolism guidelines.
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Eur. J. Intern. Med. · Jul 2020
Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients.
Sarcoidosis is a heterogeneous disease with high variability in natural history and clinical spectrum. The study aimed to reveal different clinical phenotypes of patients with similar characteristics and prognosis. ⋯ Cluster analysis identified 6 different clinical patterns with similar phenotypic variables and predicted chronicity in our large cohort of patients with sarcoidosis. Classification of sarcoidosis into phenotypes with prognostic value may help physicians to improve the efficacy of clinical decisions.