Journal of general internal medicine
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The Internet has become a leading source of health information accessed by patients and the general public. It is crucial that this information is reliable and accurate. ⋯ This comprehensive systematic review demonstrated suboptimal quality of online health information. Therefore, the Internet at the present time does not provide reliable health information for laypersons. The quality of online health information requires significant improvement which should be a mandate for policymakers and private and public organizations.
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Development of electronic health record (EHR) prediction models to improve palliative care delivery is on the rise, yet the clinical impact of such models has not been evaluated. ⋯ Targeting hospital-based palliative care using an EHR mortality prediction model is a clinically promising approach to improve the quality of care among seriously ill medical patients. More evidence is needed to determine the generalizability of this approach and its impact on patient- and caregiver-reported outcomes.
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Fluid resuscitation is a widely used intervention that is mandated in the management of sepsis. While its use can be life-saving, its overuse is associated with harm. Despite this, the best means of assessing a need for fluid resuscitation in an acute medical setting is unclear. ⋯ While fluid resuscitation is considered a key part of the management of sepsis, evidence to support fluid assessment in awake adults is lacking. This review has highlighted a number of research recommendations that should be addressed as a matter of urgency if patient harm is to be avoided.
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Clinical decision-making relies heavily on making a correct diagnosis. Clinicians have a responsibility to understand the full spectrum of the diagnostic information conveyed by a physical exam finding, laboratory test result, or imaging. ⋯ This approach can lead to waste of important diagnostic information and substandard clinical decision-making. The aim of this paper is to demonstrate the role of ROC curves in developing a more comprehensive understanding of diagnostic information portrayed by continuous tests to augment clinical decision-making.
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Studies of interventions to reduce low-value care are increasingly common. However, little is known about how the effects of such interventions are measured. ⋯ Most published studies focused on reductions in utilization rather than on clinically meaningful measures (e.g., improvements in appropriateness, patient-reported outcomes) or unintended consequences. Investigators should systematically incorporate more clinically meaningful measures into their study designs, and sponsors should develop standardized guidance for the evaluation of interventions to reduce low-value care.