Internal medicine journal
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Internal medicine journal · Feb 2022
ReviewMachine Learning in the Prediction of Medical Inpatient Length of Stay.
Length of stay (LOS) estimates are important for patients, doctors and hospital administrators. However, making accurate estimates of LOS can be difficult for medical patients. This review was conducted with the aim of identifying and assessing previous studies on the application of machine learning to the prediction of total hospital inpatient LOS for medical patients. ⋯ The variable performance reported by the studies identified in this review supports the need for further research of the utility of machine learning in the prediction of total inpatient LOS in medical patients. Future studies should follow and report a more standardised methodology to better assess performance and to allow replication and validation. In particular, prospective validation studies and studies assessing the clinical impact of such machine learning models would be beneficial.
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Internal medicine journal · Feb 2022
Meta AnalysisDirect oral anticoagulants for cancer associated venous thromboembolisms: a systematic review and network meta-analysis.
Several recent randomised controlled trials (RCT) have investigated the use of direct oral anticoagulants (DOAC) in the treatment of malignancy-associated venous thromboembolism (VTE). ⋯ DOAC are effective in treating malignancy associated VTE; however, caution is required in patients with high risk of bleeding. Apixaban had lower risk of bleeding compared to other DOAC in this population.
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Internal medicine journal · Feb 2022
ReviewThe association between socioeconomic status and joint replacement of the hip and knee: A population-based cohort study of older adults in Tasmania.
A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown. ⋯ The present study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES.
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Internal medicine journal · Feb 2022
ReviewOral health and cardiometabolic disease: understanding the relationship.
Examination of the oral cavity can identify clinical signs indicative of underlying systemic disease. Key features to examine include the general appearance and number of the teeth, signs of inflammation of the mucosa or gingival tissues including bleeding of the gums and redness, swelling or hyperplasia. Additionally, the tongue should be assessed for any ulceration or discolouration and the presence of excessive build-up (coating). ⋯ Key features of periodontitis and xerostomia will be provided along with a brief discussion of current concepts in early prevention and management of these oral health conditions. The biological mechanisms linking cardiometabolic disease and periodontitis will be outlined and the evidence supporting the association between cardiometabolic disease and oral health conditions will be presented together with an identification of areas where further research is indicated. Last, guidance for general practitioners to assess and support early diagnosis and management of oral health conditions by raising awareness of the relationship between oral health and cardiometabolic disease, providing simple oral health advice and referring to a dental practitioner will be presented.
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Internal medicine journal · Feb 2022
ReviewLeft ventricular contractile reserve as a determinant of adverse clinical outcomes: a systematic review.
An abnormal left ventricular contractile reserve is often seen in patients undergoing stress echocardiogram and may indicate the presence of obstructive coronary artery disease. The techniques and indexes used to identify abnormal left ventricular contractile response and its prognostic value in the absence of known causes has not been well studied. ⋯ Dobutamine stress echocardiogram was the most commonly performed modality (19 studies) followed by exercise stress echocardiogram (4 studies), dipyridamole stress echocardiogram (2 studies), invasive hemodynamic measurement (1 study) and dobutamine stress magnetic resonance imaging (1 study). All but one study demonstrated a significant association between the absence of left ventricular contractile reserve and increased rate of cardiovascular events, cardiac death and all-cause mortality.