Internal medicine journal
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Internal medicine journal · May 2023
Case ReportsCost-effectiveness of Screening for Paroxysmal Atrial Fibrillation in Patients undergoing Echocardiography.
Screening for atrial fibrillation is recommended for patients > 65 years on current guidelines. Targeted screening may be more efficient, however the appropriate location for screening programs has not been well defined. Our aim was to compare the cost-effectiveness of unselected electrocardiographic (ECG) screening for atrial fibrillation (AF), and selective screening based on an abnormal echocardiogram. ⋯ In patients with a previous echocardiogram, AF screening of those with baseline clinical and imaging risk parameters is more cost-effective than age-based screening.
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Internal medicine journal · May 2023
Review Meta AnalysisOne-Minute Preceptor and SNAPPS for clinical reasoning: a systematic review and meta-analysis.
Clinical reasoning teaching strategies could be important models to teach healthcare trainees. This study aims to assess the effectiveness of clinical reasoning teaching strategies (one-minute preceptor (OMP) and SNAPPS) for developing clinical reasoning skills, attitudes and satisfaction of medical/healthcare students and post-graduate trainees as compared to controls. A systematic review and meta-analysis of randomised controlled studies, with no restriction on language or publication date, were carried out by searching the PubMed, SCOPUS, ERIC, Web of Science, Embase and Cochrane Library databases. ⋯ The strategies for teaching clinical reasoning improved the performance of healthcare students and professionals on this skill, promoting deeper discussion of clinical cases and a higher number of differential diagnoses. Further good-quality trials are needed to corroborate these findings. PROSPERO Registration: CRD42020175992.
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Internal medicine journal · May 2023
ReviewThe Importance of Frailty Assessment in Multiple Myeloma: A Position Statement From The Myeloma Scientific Advisory Group (MSAG) To Myeloma Australia.
Multiple myeloma (MM) is a disease of older people, yet factors relating to comorbidity and frailty may threaten treatment tolerability for many of this heterogenous group. There has been increasing interest in defining specific and clinically relevant frailty assessment tools within the MM population, with the goal of using these frailty scores, not just as a prognostic instrument, but also as a predictive tool to allow for a frailty-adapted treatment approach. ⋯ While the IMWG-FI remains the most widely accepted tool, the simplified frailty scale is the most user-friendly in busy day-to-day clinics based on its ease of use. This paper summarises the recommendations from the Myeloma Scientific Advisory Group (MSAG) of Myeloma Australia, on the use of frailty assessment tools in clinical practice and proposes a frailty-stratified treatment algorithm to aid clinicians in tailoring therapy for this highly heterogeneous patient population.
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Internal medicine journal · May 2023
Non-beneficial resuscitation during in-hospital cardiac arrests in a metropolitan teaching hospital.
There is increasing recognition that a proportion of hospitalised patients receive non-beneficial resuscitation, with the potential to cause harm. ⋯ Over one in seven resuscitation attempts were non-beneficial. MET reviews and specialist ward rounds provide opportunities to improve the documentation and visibility of NFR status.