JAMA : the journal of the American Medical Association
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To determine the incidence and effect of unrecognized cardiac injury in critically ill patients. ⋯ The incidence of myocardial injury defined by elevated levels of cardiac troponin I was unexpectedly high and associated with increased morbidity and mortality. Clinically, it was often unrecognized.
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To test the hypothesis that insulin resistance precedes impaired insulin secretion in individuals genetically predisposed to non-insulin-dependent diabetes mellitus (NIDDM). ⋯ In this study population, heterogeneous defects in insulin secretion were demonstrated, while defects in insulin sensitivity were not evident. We therefore conclude that since the earliest defects identified in a group genetically at high risk to develop NIDDM are those related to insulin secretion, defects in insulin secretion rather than insulin sensitivity are likely the major genetic factor predisposing to development of NIDDM.
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To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. ⋯ Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients' families information that may prove useful in patient care decisions and resource allocation.
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To quantify the actual cost of inpatient medical care for firearm-related injuries at a university trauma center. ⋯ Treatment of firearm-related injuries produces net income for this university trauma center by virtue of the cost shifting built into its pricing structure. If data from this institution are extrapolated to the nation, then the actual cost of providing medical care for firearm-related injuries in the United States in 1995 is projected to be $4.0 billion. The majority of this cost will be paid indirectly by private health insurance.