QJM : monthly journal of the Association of Physicians
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Review Meta Analysis
The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis.
Clinical assessment of patients with suspected pulmonary embolus (PE) is used to estimate the probability of PE and determine what (if any) diagnostic testing is required. ⋯ Individual clinical features only slightly raise or lower the probability of PE. In isolation, they have limited diagnostic value and none can be used to rule in or rule out PE without further testing.
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Review
A communication model for encouraging optimal care at the end of life for hospitalized patients.
Multiple studies have demonstrated that treatment at or near the end of life is rarely optimal. Unwanted death-prolonging treatments are frequently provided and open communication about death and dying is often lacking. ⋯ The five steps are founded upon the recognition that trials of life-sustaining treatments are also, by definition, trials of palliative care. A narrative review of currently available qualitative and quantitative research is used to support the recommendations.