Background: Recent observational studies suggest that the risk for stroke may be high in the first 90 days after transient ischemic attack (TIA). This finding may, however, not be consistent across existing studies assessing stroke risk after TIA. The objectives of our study were to conduct a systematic review and meta-analysis of observational studies estimating the risk of stroke at 2, 30, and 90 days after TIA and to explore clinical and methodological factors that may explain variability in findings across studies.Methods: Articles were obtained by searching the Cochrane Database of Systematic Reviews (1996 to present), MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), and BIOSIS previews (1980 to present). Searches were supplemented by scanning bibliographies of included articles, review articles, and conference proceedings and by contacting an expert in the field. Abstracts were retained if they reported original data and addressed early risk of stroke in patients with TIA. We identified 51 candidate studies reporting early risk of stroke after TIA. Two reviewers independently extracted information from 11 selected studies. Indicators of study quality were collected and in-cluded consecutive enrollment, losses to follow-up, explicit criteria used to define TIA and stroke, and method of ascertainment. Pooled early risk of stroke was estimated using fixed and random effects models, and metaregression was used to assess the association between clinical and methodological factors and the reported early risk of stroke.Results: Based on a random effects model, the pooled early risk of stroke was 3.5%, 8.0%, and 9.2% at 2, 30, and 90 days after TIA, respectively. Studies reported higher risks when the methodology involved active ascertainment of stroke outcome compared with passive ascertainment. Early risk of stroke was 9.9%, 13.4%, and 17.3% at 2, 30, and 90 days, respectively, when only studies with active outcome ascertainment were considered. Conclusions:Transient ischemic attack is associated with high early risk of stroke. The methodological design of studies accounts for some of the variability seen in previous reports of early stroke risk after TIA.

Approximately 15% of ischemic strokes are preceded by transient ischaemic attack (TIA) 1 . Risk of stroke after TIA is higher than was previously thought, with more recent reports estimating risk of stroke within 90 days of TIA ranging between approximately 6-10%. [2][3][4] We recently performed a systematic review and meta-analysis of studies reporting early risk of stroke after TIA and demonstrated a pooled risk of 9.2% at 90 days. 5There is growing consensus regarding the need for early stratification and management of patients presenting with a TIA. There have been no randomized clinical trials addressing the efficacy of rapid evaluation and treatment of TIA. Recent observational studies suggest that rapid evaluation and treatment of these patients in a 'TIA clinic' usually within 24 hours of their event may reduce recurrent stroke by up to 80%. 6,7 ABSTRACT: Background: Current 'standard of care' for patients presenting with a 'high-risk' TIA varies, with use of several outpatient and inpatient approaches. We describe the clinical outcomes and costs for high risk TIA patients who received care in a 'rapid evaluation unit', and compare these to a historical 'high-risk' cohort. Methods: The study cohort was comprised of patients with TIA admitted to a 'rapid evaluation unit' during the period March 2002 to April 2003. The comparison cohort was established by screening Calgary Health Region ER discharge records to identify all patients presenting with a diagnosis of TIA during the year 2000. A 'highrisk standard care cohort' was then identified based on the clinical admission criteria used to select patients for the rapid evaluation unit. Outcomes (stroke within 90 days, death) and costs were identified using chart review and provincial administrative data. Results: The early risk of stroke in the high risk standard care group (392 patients) was 9.7%, compared to 4.7% in the rapid evaluation cohort (189 patients) (p=0.05). Median 1-year costs post TIA were CAN$8360 for patients in the rapid evaluation cohort, compared with CAN$4820 for patients in the high risk standard care group (p<0.001). Conclusions: The risk of early stroke was lower for patients in the rapid evaluation cohort compared to the high risk standard care cohort, suggesting that the use of rapid evaluation programs in patients with TIA at high risk of stroke may be beneficial, but incur greater costs over the course of the first year. L'issue (accident vasculaire cérébral dans les 90 jours, décès) et les coûts ont été déterminés par une revue des dossiers et des données administratives provinciales. Résultats : Le risque précoce d'accident vasculaire cérébral dans le groupe à haut risque qui a reçu des soins standards (392 patients) était de 9,7% comparé à 4,7% dans la cohorte qui a bénéficié de l'évaluation rapide (189 patients) (p = 0,05). Un an après l'ICT, les coûts étaient de 8 360 $CA pour les patients de la cohorte d'évaluation rapide et de 4 821 $CA pour les patients du groupe de soins standards de patients à haut risque (p < 0,001). ...

Patients who are CMV seromismatched are at higher risk of acute renal allograft rejection. This finding suggests that CMV infection or disease is a risk factor for acute rejection.

Our finding support in-group bias during resident selection, possibly due to the interdependent relationship between residents and students. Considering the career implications of residency matching, we feel that further studies are needed to identify and mitigate sources of bias in the residency application process.