Annals of internal medicine
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To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients. ⋯ Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.
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Meta Analysis Comparative Study
Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty.
To compare the efficacy, safety, and cost-effectiveness of low-molecular-weight heparin with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. ⋯ Low-molecular-weight heparin is more effective and is at least as safe as standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Based on the current French price ratio of low-molecular-weight heparin to standard heparin, the use of low-molecular-weight heparin in North America would result in overall savings in cost; however, the relative cost-effectiveness is critically dependent on the price ratio between the two drugs. Further research is needed to compare the cost-effectiveness of low-molecular-weight heparin with other prophylactic regimens and postoperative deep vein thrombosis management strategies.
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To investigate an outbreak of gram-negative bacteremia in an outpatient hemodialysis unit and to identify the source of contaminating bacteria and the route by which bacteria gained access to the bloodstream. ⋯ Because dialyzers with removable headers and O-rings are widely used in patients receiving long-term hemodialysis, disinfection procedures should include measures to ensure adequate disinfection of O-rings.
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Internal medicine may be in its twilight because it has failed to address the shortage of primary care physicians by training more general internists. Data from several sources indicate that progressively fewer persons are entering general internal medicine as opposed to its subspecialties. ⋯ Other actions that must be taken include stopping the proliferation of subspecialty certificates, designating and accrediting primary care tracks, and cutting subspecialty positions. Internal medicine's fate is in its own hands, and the discipline must reorient itself to conform to societal needs.