Clinical Review Demonstration Sample

DEMONSTRATION SAMPLE — NOT CLIENT WORK

This is a simulated review excerpt created to demonstrate the structure, depth and risk classification used by Malheiros Medical & Bioengineering Research. It does not contain client material and is not patient-specific medical advice.

Demonstration context

Fictional asset: a continuing-medical-education module for clinicians on stroke-risk reduction in atrial fibrillation. The purpose of this demonstration is to show how a clinical reviewer converts unsupported or unsafe wording into traceable, production-ready corrections.

Review method

• Classify each issue as Critical, Major, Minor or Query
• Identify the exact wording and the production risk
• Trace the claim to an authoritative source
• Propose bounded replacement language
• Record resolution status for the production team

Issue 01 — CRITICAL

Original simulated statement

“Aspirin is an acceptable alternative to oral anticoagulation for stroke prevention in atrial fibrillation.”

Why this is critical

The statement could change clinical action and conflicts with current guideline-based recommendations for patients who are candidates for anticoagulation and have no separate indication for antiplatelet therapy.

Evidence check

The 2023 ACC/AHA/ACCP/HRS atrial-fibrillation guideline summary states that aspirin alone, or aspirin with clopidogrel, is not recommended as an alternative to anticoagulation for stroke-risk reduction in eligible patients without another antiplatelet indication.

Proposed production-ready wording

“For patients with atrial fibrillation who are candidates for anticoagulation and have no separate indication for antiplatelet therapy, aspirin alone or with clopidogrel should not be used as an alternative to anticoagulation for stroke-risk reduction. Treatment selection requires assessment of thromboembolic risk, bleeding risk, contraindications, comorbidities and patient preferences.”

Resolution status

Replace before release. Clinical owner to confirm alignment with the jurisdiction and intended learner group.

Issue 02 — MAJOR

Original simulated statement

“Warfarin is the preferred first-line anticoagulant for most patients with atrial fibrillation.”

Why this is major

The claim reverses the guideline preference and omits important exceptions. It can mislead the learner even if it does not immediately prescribe an individual regimen.

Evidence check

The 2023 ACC/AHA/ACCP/HRS guideline summary prefers direct oral anticoagulants over warfarin for eligible patients, except in specified groups such as patients with mitral stenosis or mechanical heart valves.

Proposed production-ready wording

“Direct oral anticoagulants are generally preferred over warfarin in eligible patients with atrial fibrillation, while warfarin remains appropriate in specified groups, including patients with mechanical heart valves or relevant mitral stenosis. Selection must follow the applicable guideline and individual clinical context.”

Resolution status

Replace and add a linked source note.

Issue 03 — MAJOR

Original simulated statement

“A high bleeding-risk score is sufficient reason to withhold anticoagulation.”

Why this is major

This overstates what a bleeding-risk score can decide. Used in isolation, the claim can turn a risk-identification tool into an exclusion rule.

Proposed production-ready wording

“Bleeding-risk scores should not be used in isolation to determine eligibility for oral anticoagulation. They can help identify modifiable bleeding risks and inform clinical review and shared decision-making.”

Resolution status

Replace before release; add local protocol or jurisdiction-specific caveats when applicable.

What the client receives

• Tracked corrections in the source asset
• Risk-ranked issue log
• Claim-source matrix
• Proposed replacement wording
• Open queries and decisions requiring client ownership
• Executive summary and one consolidated revision

Demonstration sources

American College of Cardiology. 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation — key perspectives: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2023/11/27/19/46/2023-acc-guideline-for-af-gl-af

European Society of Cardiology. 2024 ESC Guidelines for the management of atrial fibrillation: https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/atrial-fibrillation/

Sources were verified for this demonstration on 31 August 2026. The final client deliverable would use the agreed jurisdiction, audience and reference standard.

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sidario@malheirosresearch.com