QJM : monthly journal of the Association of Physicians
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Identifying which patients presenting with undifferentiated chest pain are at risk of major cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest pain. ⋯ In unselected patients presenting with suspected cardiac pain, the GRACE risk score is superior to the TIMI risk score in predicting major cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.
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Randomized Controlled Trial
Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study.
Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studies suggest that bromelain, a pineapple extract, may be a safer alternative/adjunctive treatment for knee OA than current conventional treatment. ⋯ This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study.
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Predictive scores such as APACHE II and SAPS II have been used to assess patients in intensive care units, but only the modified early warning (MEW) score has been used to assess acutely ill general medical patients. ⋯ The Simple Clinical Score quickly and accurately identifies patients at both a low and high risk of death from the first to the 30th day after admission, enabling prompt triage and placement within a health-care facility.