Journal of general internal medicine
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To explore the experience of violent injury among young African-American men with gunshot or stab wounds to better understand violent injury. ⋯ This study reveals an important perception among these young male victims of violence that if they fail to respond violently to injury or the threat of injury, they will be at risk of further victimization. The social environment in which young male victims of violence live and the meaning of being a sucker must be considered in efforts to decrease recurrent interpersonal violence. Providers who care for young men who are victims of or at risk of violence should understand the implications of the social context on individual behaviors.
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To measure the accuracy, reliability, and discrimination of physicians' predictions of the outcome of in-hospital cardiopulmonary resuscitation (CPR), using a large series of detailed clinical vignettes of patients with known outcomes. ⋯ Physicians were no better at identifying patients who would survive resuscitation than would be expected by chance alone. Further work is needed to establish which variables are used by physicians in the decision-making process, and to design educational interventions that will make physicians more accurate prognosticators.
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Echocardiography is frequently used as a screening test for cardiac disease in patients with syncope despite the lack of published data describing its utility in this regard. The goal of the study was to examine the frequency with which echocardiography was used in the evaluation of patients admitted to one medical center because of syncope and to examine the diagnostic information, over and above that provided by the initial history, physical examination, and electrocardiography, contributed by the echocardiogram. ⋯ Echocardiography was frequently used in the evaluation of patients admitted to the hospital because of syncope of unclear cause. For patients without suspected cardiac disease after history, physical examination, and electrocardiography, the echocardiogram did not appear to provide additional useful information, suggesting that syncope alone may not be an indication for echocardiography. For patients with suspected heart disease, echocardiography served to confirm or refute the suspicious in equal proportions. These data provide an objective basis to prospectively define the optimal role of echocardiography in the evaluation of patients with syncope.
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Internists frequently evaluate preoperative cardiopulmonary risk and co-manage cardiac and pulmonary complications, but the comparative incidence and clinical importance of these complications are not clearly delineated. This study evaluated incidence and length of stay for both cardiac and pulmonary complications after elective laparotomy. ⋯ For noncardiac surgery, previous research has focused on cardiac risk. In this study, pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment.
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To determine whether physicians' risk attitudes correlate with their triage decisions for emergency department patients with acute chest pain. ⋯ The physicians' risk attitudes as measured by a brief risk-taking scale correlated significantly with their rates of admission for emergency department patients with acute chest pain. These data do not suggest that the risk-seeking physicians achieved lower admission rates by releasing more patients who needed to be in the hospital, but an adequate evaluation of the appropriateness of triage decisions of risk-seeking and risk-avoiding physicians will require further study.