The American journal of medicine
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Review Meta Analysis
The incidence of stroke after myocardial infarction: a meta-analysis.
While the risk of stroke after myocardial infarction (MI) is increased compared with the risk among those without MI, the magnitude of this risk remains unclear. Although numerous clinical trials have reported the incidence of stroke following MI, these are among selected populations. We reviewed cohort studies reporting the incidence of stroke after MI to better define the risk of ischemic stroke in an unselected population. ⋯ The public health implications of stroke among MI survivors, as well as the large number of MI survivors, underscore the need to be aware of this devastating complication. Further research is needed to determine the optimal stroke prevention strategies for MI survivors.
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Comparative Study
Does the content of primary care visits differ by the racial composition of physicians' practices?
The study compared the content of primary care visits between physicians with larger and smaller African American practices. ⋯ There are few differences in the content of office visits between physicians with larger and smaller African American practices.
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We sought to determine the risk of an allergic reaction to a cephalosporin exposure in those with prior penicillin reactions. ⋯ Patients with allergic-like events after penicillin had a markedly increased risk of events after either subsequent cephalosporins or sulfonamide antibiotics. Cross-reactivity is not an adequate explanation for this increased risk, and the risk of anaphylaxis is very low. Thus, our data indicate that cephalosporins can be considered for patients with penicillin allergy.
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In this article, we review the principal objectives and ideal elements of opioid contracts, as articulated by proponents of the practice. We examine the limited empirical evidence for the effectiveness of opioid contracts in achieving their intended objectives and identify areas of uncertainty and of ethical concern regarding their implementation. We argue that the challenge in deciding about implementing opioid contracts in clinical practice relates to the multiplicity of potential objectives they might serve, to a lack of empirical evidence regarding their effectiveness, and to ethical concerns over their implementation. Specialty and primary care clinicians contemplating the use of opioid contracts in treating patients with chronic nonmalignant pain need to be sensitive to these considerations, and further debate and research is necessary to establish the proper objectives, elements, effectiveness, and ethical justifications of opioid contracts in clinical practice.
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For the primary care physician, the occurrence of a red eye is a frequent and prominent finding of a disease process in patients. A careful history and simple examination with the observation of typical clinical signs are important for the management of this common disorder. ⋯ Simple diagnostic methods and an emergency management with some useful topical ophthalmic preparations are included. Although several conditions can be treated by the primary care physician the clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.