The American journal of medicine
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Hematuria is a common clinical finding and represents the most frequent presenting sign of bladder cancer. The American Urological Association recommends cystoscopy and abdomino-pelvic imaging for patients aged more than 35 years. Nonetheless, less than half of patients presenting with hematuria undergo proper evaluation. We sought to identify clinical and nonclinical factors associated with evaluation of persons with newly diagnosed hematuria. ⋯ Patients with hematuria rarely underwent complete evaluation. Although established risk factors for malignancy were associated with increasing use of diagnostic testing, factors unassociated with risk, such as practice site, also accounted for significant variation. Inconsistency across practice sites is undesirable and may be amenable to quality improvement interventions.
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The purpose of this study was to assess physician adherence to 2001 American Urological Association (AUA) guidelines for evaluating patients with asymptomatic hematuria and its impact on the diagnosis of urologic cancer. ⋯ Although most physicians did not adhere to 2001 AUA guidelines when evaluating patients with asymptomatic hematuria, no urologic cancers were diagnosed in patients without guideline-adherent evaluation, barring the possibility of occult cancers. Evaluation by a urologist was the only predictor of a guideline-adherent evaluation. Future studies are needed to determine the optimal evaluation of patients with asymptomatic hematuria.
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Stroke is a major cause of morbidity and mortality. We describe trends in the incidence, outcomes, and risk factors for stroke in the US Medicare population from 1988 to 2008. ⋯ Incident strokes in the Medicare population aged ≥65 years decreased by approximately 40% over the last 2 decades, a decline greater than expected on the basis of the population's stroke risk factors. Case fatality from stroke also declined. Although causality cannot be proven, declining stroke rates paralleled increased use of statins and antihypertensive medications.
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Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination. ⋯ Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.