RESUMO
Assessment tools, such as the mini-clinical evaluation exercise (mini-CEX), have been developed to evaluate the competence of medical trainees during routine duties. However, their effectiveness in busy environments, such as the emergency department (ED), is poorly understood. This study assesses the feasibility, reliability, and acceptability of implementing the mini-CEX in the ED. PubMed, Google Scholar, ScienceDirect, Scopus, and Web of Science databases were scoured for observational and randomized trials related to our topic. Moreover, a manual search was also conducted to identify additional studies. After the literature search, data were extracted from studies that were eligible for inclusion by two independent reviewers. When applicable, meta-analyses were performed using the Comprehensive Meta-Analysis software. In addition, the methodological quality of studies was evaluated using the Newcastle-Ottawa Scale. Of the 2,105 articles gathered through database and manual searches, only four met the criteria for inclusion in the review. A combined analysis of three studies revealed that trainee-patient interactions averaged 16.05 minutes (95% CI = 14.21-17.88), and feedback was given in about 10.78 minutes (95% CI = 10.19-11.38). The completion rates for mini-CEX were high: 95.7% (95% CI = 87.6-98.6) for medical trainees and 95.8% (95% CI = 89.7-98.3) for assessors. Satisfaction with mini-CEX was notable, with 63.5% (95% CI = 51.5-74.1) of medical trainees and 75.7% (95% CI = 63.9-84.6) of assessors expressing contentment. Qualitative data from one study demonstrated that 70.6% of faculty members could allocate suitable time for mini-CEX during their clinical shifts. The mini-CEX is a feasible and acceptable assessment tool within the ED. Furthermore, there is evidence to suggest that it might be reliable.
RESUMO
Venous thromboembolism (VTE) is a condition often seen in patients diagnosed with cancer and is recognized as a predictor of poor outcomes in these patients. The probability of VTE recurring is generally higher in people with cancer than in those without; hence, addressing this issue is essential when making healthcare decisions. Therefore, our systematic review was primarily designed to compare low-weight- molecular heparin (LMWH) to warfarin in reducing recurrent VTE among cancer patients. However, other outcomes were also evaluated, such as mortality and bleeding events observed more in cancer patients. The selection of relevant articles was carried out using a database search and a manual search, which involved reviewing reference lists of articles eligible for inclusion in the current review. The methodological quality of each included study was then assessed using Cochrane's risk of bias tool in the Review Manager software (RevMan 5.4.1). Additionally, pooled results were examined using the Review Manager software and presented as forest plots. Our search of electronic databases elicited a total of 2163 articles, of which only six were deemed eligible for inclusion and analysis. Data pooled from the six studies demonstrated the effectiveness of LMWH in minimizing the reoccurrence of VTE over warfarin [risk ratio (RR): 0.67; 95% CI: 0.47 - 0.95; p = 0.03]. However, LMWH had a similar effect statistically as warfarin on the major bleeding events (RR: 1.05; 95% CI: 0.62 - 1.77; p = 0.85), minor bleeding events (RR: 0.80; 95% CI: 0.54 - 1.20; p = 0.28), and all-cause mortality (RR: 1.00; 95% CI: 0.88 - 1.13; p = 0.99). While LMWH demonstrated its effectiveness in minimizing the incidence of VTE recurrence over warfarin in cancer patients, it had no statistical difference in terms of mortality or bleeding events when compared to warfarin. Based on our findings, we recommend that LMWH continues to be used as a first-line treatment regimen to mitigate recurrent VTE in cancer patients.
RESUMO
The CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥ 65 years) score and the pneumonia severity index (PSI) are widely used and recommended in predicting 30-day mortality and the need for intensive care support in community-acquired pneumonia. This study aims to compare the performance of these two severity scores in both mortality prediction and the need for intensive care support. A systematic review and meta-analysis was carried out, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines, and PubMed, Scopus, ScienceDirect, and Google Scholar were searched for articles published from 2012 to 2022. The reference lists of the included studies were also searched to retrieve possible additional studies. Twenty-five studies reporting prognostic information for CURB 65 and PSI were identified. ReviewManager (RevMan) 5.4.1 was used to produce risk ratios, and a random effects model was used to pool them. Both PSI and CURB-65 showed a high strength in identifying high-risk patients. However, CURB-65 was slightly better in early mortality prediction and had more sensitivity (96.7%) and specificity (89.3%) in predicting admission to intensive care support. Thus, CURB-65 seems to be the preferred tool in predicting mortality and the need for admission into intensive care support.
