Journal of general internal medicine
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To identify preventive care measures that are appropriate for and specific to patients with chronic liver disease and to provide recommendations and information that can be shared with patients. ⋯ Preventive care can play an important role in patients with chronic liver diseases. Based on the existing data, the preventive strategies of alcohol avoidance, hepatitis vaccination, avoidance of NSAIDs nonsteroidal anti-inflammatory drugs, iron supplementation when appropriate, and a low-fat diet are prudent in patients with chronic liver disease. Once cirrhosis develops, screening for hepatocellular cancer with alpha-fetoprotein testing and ultrasound, and screening for varices by endoscopy are justified.
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To assess physicians' response to implementation of an emergency department (ED) pneumonia practice guideline and determine if the guideline changed physicians' knowledge and attitudes about pneumonia care. ⋯ This locally developed, actively implemented guideline was well regarded by physicians. Guidelines can change practice and also alter underlying knowledge and attitudes about disease management. They may be most useful to those with less experience.
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To describe the etiologies of syncope in hospitalized patients and determine the factors that influence survival after discharge. ⋯ Among these elderly patients hospitalized with syncope, noncardiovascular causes were twice as common as cardiovascular causes. Because survival was not related to the cause of syncope, clinicians cannot be reassured that hospitalized elderly patients with noncardiovascular and unexplained syncope will have excellent outcomes.
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To evaluate the risks and benefits of third-generation oral contraceptives. ⋯ Although third-generation oral contraceptives most likely increase a user's risk of venous thromboembolism, their improved side-effect profile and their possible decreased association with myocardial infarction and stroke may make them a useful new class of oral contraceptives for most women except those at increased risk of venous thrombosis.
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To describe sources of health care used by homeless and housed poor adults. ⋯ Having no health insurance or need for care in the past 6 months increased the use of a non-ambulatory-care site as a place for usual care. Programs designed to decrease emergency department use may need to be directed at those not currently accessing any care.