The American journal of medicine
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Review Meta Analysis
Application of U.S. guidelines in other countries: aspirin for the primary prevention of cardiovascular events in Japan.
Clinical guidelines developed in the United States are used frequently in other countries without assessment of their appropriateness in non-U.S. populations. We explored the relevance of recent U.S. guidelines for the use of aspirin for the primary prevention of cardiovascular events in the Japanese population. ⋯ The thresholds of antiplatelet therapy for Asian populations should be two to five times higher than those for the U.S. population because of higher risks of hemorrhagic complications. The assumptions and implications of U.S. guidelines should be evaluated before use in other countries.
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Clinical Trial Controlled Clinical Trial
Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments.
Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments. ⋯ A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.
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To determine how often disability in essential activities of daily living develops insidiously, and to evaluate whether the likelihood of insidious disability differs on the basis of physical frailty. ⋯ Disability in essential activities of daily living often occurs insidiously, particularly among older persons who are physically frail or who have had prior episodes of disability.
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To describe the prevalence of patients admitted to hospital with a diagnosis of community-acquired pneumonia who have normal chest radiographs; the extent to which patients actually had pneumonia on radiographs; and to compare presentation and outcomes in patients with a lower respiratory tract infection and those whose clinical diagnosis of pneumonia was confirmed by radiography. ⋯ One third of patients suspected of having pneumonia and admitted to hospital did not have pneumonia, but had serious lower respiratory tract infections with substantial rates of bacteremia and mortality. The absence of radiographic findings should not supercede clinical judgment and empiric treatments in these patients.
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Meta Analysis
Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomized controlled trials.
Magnesium supplementation may reduce the incidence of arrhythmias, which often occur after cardiac surgery; however, recent findings of the effectiveness of magnesium prophylaxis have yielded discrepant results. ⋯ Administration of prophylactic magnesium reduced the risk of supraventricular arrhythmias after cardiac surgery by 23% (atrial fibrillation by 29%) and of ventricular arrhythmias by 48%. Supplementation had no notable benefit with respect to length of hospitalization, incidence of myocardial infarction, or mortality.