European journal of internal medicine
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Eur. J. Intern. Med. · Apr 2022
ReviewA systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows.
Although early warning scores were intended to simply identify patients in need of life-saving interventions, prediction has become their commonest metric. This review examined variation in the ability of the National Early Warning Scores (NEWS) in adult patients to predict absolute mortality at different times and cut-offs values. ⋯ NEWS reliably identifies patients most and least likely to die within 24-hours, which is what it was designed to do. However, many patients identified to have a low risk of imminent death die within 30-days. NEWS mortality predictions beyond 24-hours are unreliable.
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Eur. J. Intern. Med. · Apr 2022
Critical appraisal of international adult bronchiectasis guidelines using the AGREE II tool.
Guidelines aim to standardize and optimize diagnosis and management. We evaluated the quality of evidence supporting recommendations from different international adult guidelines on bronchiectasis, and classified with the GRADE system. ⋯ Updated guidelines reported after 2017 improved quality, although well-designed randomized clinical trials remain an unmet need. AGREE II quality assessment identified four guidelines qualified as recommended for use. Improvements are required in stakeholder involvement and applicability.
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Eur. J. Intern. Med. · Apr 2022
Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis.
To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia. ⋯ We propose the novel diagnostic category of "Truly Unexplained Fall", resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.