Arch Intern Med
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Significant uncertainty surrounds the treatment of patients who must discontinue warfarin sodium therapy before an invasive procedure. In part, the uncertainty results from the lack of published information about the risk of thromboembolism associated with short-term warfarin therapy interruption. We aimed to assess the frequency of thromboembolism and bleeding within a large cohort of patients whose warfarin therapy was temporarily withheld for an outpatient invasive procedure. ⋯ For many patients receiving long-term anticoagulation who need to undergo a minor outpatient intervention, a brief (< or =5 days) periprocedural interruption of warfarin therapy is associated with a low risk of thromboembolism. The risk of clinically significant bleeding, even among outpatients undergoing minor procedures, should be weighed against the thromboembolic risk of an individual patient before the administration of bridging anticoagulant therapy.
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Collecting data on medical errors is essential for improving patient safety, but factors affecting error reporting by physicians are poorly understood. ⋯ Most faculty and resident physicians are inclined to report harm-causing hypothetical errors, but only a minority have actually reported an error.
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Experimental and human studies demonstrate that long-term exposure to elevated aldosterone levels results in cardiac and vascular damage. ⋯ Primary aldosteronism is associated with a cardiovascular complication rate out of proportion to blood pressure levels that benefits substantially from surgical and medical treatment in the long term.