European journal of internal medicine
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Eur. J. Intern. Med. · Apr 2022
ReviewSepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?
Sepsis can lead to cardiac arrhythmias, of which the most common is atrial fibrillation (AF). Sepsis is associated with up to a six-fold higher risk of developing AF, where it occurs most commonly in the first 3 days of hospital admission. In many patients, AF detected during sepsis is the first documented episode of AF, either as an unmasking of sub-clinical AF or as a newly developed arrhythmia. ⋯ This is pertinent when considering that more patients are surviving episodes of sepsis and are left with post-sepsis sequalae such as AF. This review provides a summary on the literature available surrounding sepsis-driven AF, focusing on AF recurrence and ischaemic stroke risk. Using this, pragmatic advice to clinicians on how to better detect and reduce an individual's stroke risk after developing AF during sepsis is discussed.
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Eur. J. Intern. Med. · Apr 2022
Meta AnalysisHigh-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis.
High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease. ⋯ hs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.
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Herein we recount the legacy of Sir David Roxbee Cox (15 July 1924 - 18 January 2022) from the perspective of practicing clinicians. His-pioneering work in developing the logistic and Cox proportional hazard regression models revolutionized the analysis and interpretation of categorical and time-to-event survival outcomes in modern medicine. This legacy is an inspiration for all those who follow on Sir David Cox's path.
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Eur. J. Intern. Med. · Apr 2022
Generalist vs specialist acute medical admissions - What is the impact of moving towards acute medical subspecialty admissions on efficacy of care provision?
The discussion surrounding generalist versus specialist acute medical admissions continues to stimulate debate and patients with certain conditions benefit from specialist care. ⋯ Widespread adoption of specialist care may not be beneficial for all medical inpatients and physicians should continue to undergo dual specialist and GIM training.