WorldWideScience

Sample records for general internal medicine

  1. [Everyday bioethics in general internal medicine].

    Science.gov (United States)

    Lamy, O; Aujesky, D; Vollenweider, P; Waeber, G; Foppa, C

    2006-11-08

    The knowledge of the national legislation and the key concepts of bioethics are necessary for medical practice. The four principles of bioethics are autonomy, beneficence, non-maleficence, and justice. General internal medicine is the speciality of comprehensive care for often elderly patients with multiple chronic illnesses. This care is related to many ethically difficult decisions. In our article, we discuss common ethical problems in general internal medicine, including ethical aspects of the patient-physician relationship and medical decision making, the ethical significance of time management, research in bioethics and medical education.

  2. Academic general internal medicine: a mission for the future.

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    Armstrong, Katrina; Keating, Nancy L; Landry, Michael; Crotty, Bradley H; Phillips, Russell S; Selker, Harry P

    2013-06-01

    After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.

  3. Prevalence of myofascial pain in general internal medicine practice.

    OpenAIRE

    Skootsky, S A; Jaeger, B; Oye, R K

    1989-01-01

    Myofascial pain is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. We examined a series of 172 patients presenting to a university primary care general internal medicine practice. Of 54 patients whose reason for a visit included pain, 16 (30%) satisfied criteria for a clinical diagnosis of myofascial pain. These patients were similar in age and sex to other patients with pain, and the frequency of pain as a ...

  4. Audit of the consultation process on general internal medicine services.

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    Conley, J; Jordan, M; Ghali, W A

    2009-02-01

    To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists. Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85). Calgary, Alberta, Canada. A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004. The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable. Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question. More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.

  5. [Relevant publications in ambulatory general internal medicine in 2007].

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    Amstutz, R; Humair, J P; Junod Perron, N; Malacarne, S; Nyffenegger, L; Rieder, J P; Steiner, A S; Motamed, S

    2008-01-30

    Screening procedures for genital Chlamydia infection, cancer risks linked to oral contraceptives, indications and efficacy of HPV vaccination, and diagnostic tools for celiac disease in adults; these are just a few of the general practice themes that were reviewed and analysed in 2007 by residents and chief residents at the Community medicine and primary care Service of the Geneva University Hospitals. These commented summaries, intended for all our colleagues, constitute Geneva's contribution to the literature data base initiated in 2005 by chief residents in Lausanne.

  6. Update in outpatient general internal medicine: practice-changing evidence published in 2014.

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    Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F

    2015-10-01

    The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine.

  7. Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.

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    Salerno, Stephen M; Arnett, Michael V; Domanski, Jeremy P

    2009-01-01

    Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied. We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data. We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey. There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention. Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.

  8. Differences in prescribing patterns for anxiety and depression between General Internal Medicine and Family Medicine.

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    Brieler, Jay A; Scherrer, Jeffrey F; Salas, Joanne

    2015-02-01

    Depression and anxiety are routinely managed by physicians in Family Medicine (FM) or General Internal Medicine (GIM). Because FM requires more behavioral health training than GIM, we sought to determine if prescribing patterns for patients with anxiety, depression, or both differed between FM vs. GIM providers. In a cross-sectional design, patient data and provider type were obtained from 2008 to 2013 electronic medical record patient data registry (n=27,225 (FM=10,994, GIM=16,231)) Prescription orders were modeled for specific benzodiazepines and antidepressants and by drug class. Covariates included gender, age, race, marital status and comorbidity index. Separate logistic regression models were computed, before and after adjusting for covariates, to estimate the odds of FM vs. GIM providers prescribing benzodiazepine or antidepressant medication to patients with anxiety, depression, and both disorders. After adjusting for covariates, patients with anxiety alone, depression alone, and both had significantly greater odds of receiving an antidepressant (OR=2.08;95%CI:1.46-2.96, OR=2.13;95%CI:1.48-3.06, and OR=2.26;95%CI:1.09-4.66, respectively) if treated by FM vs. GIM. Benzodiazepine prescription did not differ by physician type. It is not known if results will generalize to other regions of the United States. Patients with anxiety, depression, and both seen by FM providers, as compared to GIM providers, are more likely to receive antidepressant medications. Further investigation into the determinants of these differences is warranted. Under-treatment in GIM may result in less advantageous outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. An evaluation of career paths among 30 years of general internal medicine/primary care internal medicine residency graduates.

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    Chen, Dan; Reinert, Steven; Landau, Carol; McGarry, Kelly

    2014-10-01

    Interest in primary care careers has been dwindling among medical trainees over the past decade, with poor quality of life among the perceived disadvantages. We sought to evaluate factors influencing career satisfaction among graduates of Brown's General Internal Medicine (GIM)/Primary Care residency program and assess its contribution to the primary care work force. Using an anonymous online survey, we queried GIM alumni from 1981-2012 to obtain information about demographics, job characteristics and career satisfaction measures. Fifty-nine percent of Brown's GIM/Primary Care residency graduates practice primary care, a rate higher than most primary care track programs. Seventy-six percent of respondents were "satisfied" or "very satisfied" with their current jobs. Career satisfaction correlated with self-rating of physical and emotional health and did not correlate with age, gender, income, debt burden, or practice setting. Among the diverse factors associated with attaining career satisfaction, attention to personal health plays a central role.

  10. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2015.

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    Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F

    2016-08-01

    Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal.

  11. The Kaleidoscope of General Internist Careers: A Challenge for Internal Medicine Training.

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    Parenti, Connie M.

    1995-01-01

    As internal medicine residency programs struggle to produce enough general internists adequately prepared for practice, the graduate medical education system must have a clear picture of what competencies these practitioners will need. It must constantly monitor the changing practice environment and its varied generalist career choices.…

  12. Student performance of the general physical examination in internal medicine: an observational study

    NARCIS (Netherlands)

    Haring, C.M.; Cools, B.M.; Meer, J.W.M. van der; Postma, C.T.

    2014-01-01

    BACKGROUND: Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general phy

  13. Redesigning the practice model for general internal medicine. A proposal for coordinated care: a policy monograph of the Society of General Internal Medicine.

    Science.gov (United States)

    2007-03-01

    General Internal Medicine (GIM) faces a burgeoning crisis in the United States, while patients with chronic illness confront a disintegrating health care system. Reimbursement that rewards using procedures and devices rather than thoughtful examination and management, plus onerous administrative burdens, are prompting physicians to pursue specialties other than GIM. This monograph promotes 9 principles supporting the concept of Coordinated Care--a strategy to sustain quality and enhance the attractiveness and viability of care delivered by highly trained General Internists who specialize in the longitudinal care of adult patients with acute and chronic illness. This approach supplements and extends the concept of the Advanced Medical Home set forth by the American College of Physicians. Specific components of Coordinated Care include clinical support, information management, and access and scheduling. Success of the model will require changes in the payment system that fairly reimburse physicians who provide leadership to teams that deliver high quality, coordinated care.

  14. General Nuclear Medicine

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z General Nuclear Medicine Nuclear medicine imaging uses small amounts of ... limitations of General Nuclear Medicine? What is General Nuclear Medicine? Nuclear medicine is a branch of medical ...

  15. Proposed standards for medical education submissions to the Journal of General Internal Medicine.

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    Cook, David A; Bowen, Judith L; Gerrity, Martha S; Kalet, Adina L; Kogan, Jennifer R; Spickard, Anderson; Wayne, Diane B

    2008-07-01

    To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.

  16. Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics.

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    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive

  17. Retractions in general and internal medicine in a high-profile scientific indexing database

    Directory of Open Access Journals (Sweden)

    Renan Moritz Varnier Rodrigues de Almeida

    Full Text Available CONTEXT AND OBJECTIVE: Increased frequency of retractions has recently been observed, and retractions are important events that deserve scientific investigation. This study aimed to characterize cases of retraction within general and internal medicine in a high-profile database, with interest in the country of origin of the article and the impact factor (IF of the journal in which the retraction was made. DESIGN AND SETTING: This study consisted of reviewing retraction notes in the Thomson-Reuters Web of Knowledge (WoK indexing database, within general and internal medicine. METHODS: The retractions were classified as plagiarism/duplication, error, fraud and authorship problems and then aggregated into two categories: "plagiarism/duplication" and "others." The countries of origin of the articles were dichotomized according to the median of the indicator "citations per paper" (CPP, and the IF was dichotomized according to its median within general and internal medicine, also obtained from the WoK database. These variables were analyzed using contingency tables according to CPP (high versus low, IF (high versus low and period (1992-2002 versus 2003-2014. The relative risk (RR and 95% confidence interval (CI were estimated for plagiarism/duplication. RESULTS: A total of 86 retraction notes were identified, and retraction reasons were found for 80 of them. The probability that plagiarism/duplication was the reason for retraction was more than three times higher for the low CPP group (RR: 3.4; 95% CI: [1.9-6.2], and similar results were seen for the IF analysis. CONCLUSION: The study identified greater incidence of plagiarism/duplication among retractions from countries with lower scientific impact.

  18. Communication channels in general internal medicine: a description of baseline patterns for improved interprofessional collaboration.

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    Conn, Lesley Gotlib; Lingard, Lorelei; Reeves, Scott; Miller, Karen-Lee; Russell, Ann; Zwarenstein, Merrick

    2009-07-01

    General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous and asynchronous-and analyze the relationship between them. Our findings reveal an essential relationship between synchronous and asynchronous modes of communication that has implications for the effectiveness of interprofessional collaboration in this and similar health care settings, and is intended to inform efforts to overcome existing interprofessional communication barriers.

  19. Information Resources in Clinical Medicine: Family Practice, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine.

    Science.gov (United States)

    Schwank, Jean; Allen, Joyce

    Designed for beginning health science librarians, this continuing education course syllabus presents a guide to information resources for answering physicians' questions about patient care. Sources from standard core lists, such as the Alfred Brandon list, are highlighted and described, along with additional titles. General resources covered…

  20. An analysis of the quality of research reports in the Journal of General Internal Medicine.

    Science.gov (United States)

    Cooper, G S; Zangwill, L

    1989-01-01

    Forty-four "original articles" published in the Journal of General Internal Medicine were reviewed using a rating instrument with 13 items developed from previously published standards for the design, analysis, and presentation of medical research. Each item was rated on a four-point (poor-to-excellent) scale. Inter-rater agreement was good (86% agreement; kappa = 0.65). Seven items received excellent or good ratings in 80% or more of the articles, but six problem areas were identified: description of study scope (generalizability), informed consent procedures, reliability assessments, references for statistical procedures or computer programs, and the use of descriptive and comparative statistics. Guidelines for these and other criteria are offered to help researchers prepare clear and informative reports.

  1. Abstract presentations: what do SGIM presenters prefer? Society of General Internal Medicine.

    Science.gov (United States)

    Tulsky, A A; Kouides, R W

    1998-06-01

    We surveyed physicians presenting abstracts at the 1995 Society of General Internal Medicine annual meeting to determine whether the oral or poster format better achieved their presentation goals. Poster presentations better met respondents' objectives for feedback and criticism and for networking and developing collaborative projects, while oral presentations better met their objectives for national visibility and sharing knowledge within one's field. Sixty-nine percent of respondents preferred to present oral abstracts. The majority of these presenters preferred to present their research in an oral format although poster presentations still played an important role for them, particularly as a venue for feedback on their work. As meeting size increases, different presentation formats should be explored that best meet the needs of the academic community.

  2. A Methodological Strategy for the Family Health Course in General Internal Medicine Residency

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    Mabel Rocha Vázquez

    2011-04-01

    Full Text Available Background: the continuous improvement of the educational process is one of the permanent challenges of medical education in Cuba. When dealing particularly with family medicine it must be ensured that physicians are always getting a better clinical approach to the management of families, since this is one of the key areas that have been identified as problematic in professional practices. Objective: to design a methodological strategy for the improvement of educational activities in the Family Health Course of the General Internal Medicine Residency. Method: a development research, conducted at the University of Medical Sciences of Cienfuegos, from November 2005 to January 2007 is presented. Document analysis and validation by expert criteria were also implemented. Results: for each of the four themes that make up this course, the following aspects are stated: teaching organization, length, contents, activity objectives, methodological guidelines to implement these activities, assessment proposals for some of them and some literature. Conclusions: the design of educational activities, with emphasis on actual or simulated medical practice, could help improving the quality of the teaching process. In addition, following the logical structure of activities, teachers can develop similar proposals to address other health problems according to the different learning needs.

  3. Resident satisfaction with continuity clinic and career choice in general internal medicine.

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    Peccoralo, Lauren A; Tackett, Sean; Ward, Lawrence; Federman, Alex; Helenius, Ira; Christmas, Colleen; Thomas, David C

    2013-08-01

    The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. IM residents at three urban medical centers. Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0-34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50-6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic. Resident satisfaction

  4. Are Canadian General Internal Medicine training program graduates well prepared for their future careers?

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    Snell Linda

    2006-11-01

    Full Text Available Abstract Background At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. Methods Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. Results Gaps (difference between importance and preparation were demonstrated in many of the CanMEDS 2000/2005® competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office, health advocate (counseling for prevention, for example smoking cessation, and professional (end of life issues, ethics. Conclusion Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps

  5. Primary medication non-adherence after discharge from a general internal medicine service.

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    Brooks A Fallis

    Full Text Available BACKGROUND: Medication non-adherence frequently leads to suboptimal patient outcomes. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is particularly important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention. METHODS: We studied older adults consecutively discharged from a general internal medicine service at a large urban teaching hospital to determine the prevalence of primary non-adherence and identify characteristics associated with primary non-adherence. We reviewed electronic prescriptions, electronic discharge summaries and pharmacy dispensing data from April to August 2010 for drugs listed on the public formulary. Primary non-adherence was defined as failure to fill one or more new prescriptions after hospital discharge. In addition to descriptive analyses, we developed a logistical regression model to identify patient characteristics associated with primary non-adherence. RESULTS: There were 493 patients eligible for inclusion in our study, 232 of whom were prescribed new medications. In total, 66 (28% exhibited primary non-adherence at 7 days after discharge and 55 (24% at 30 days after discharge. Examples of medications to which patients were non-adherent included antibiotics, drugs for the management of coronary artery disease (e.g. beta-blockers, statins, heart failure (e.g. beta-blockers, angiotensin converting enzyme inhibitors, furosemide, stroke (e.g. statins, clopidogrel, diabetes (e.g. insulin, and chronic obstructive pulmonary disease (e.g. long-acting bronchodilators, prednisone. Discharge to a nursing home was associated with an increased risk of primary non-adherence (OR 2.25, 95% CI 1.01-4.95. CONCLUSIONS: Primary non-adherence after medications are newly prescribed during a hospitalization is common, and was more likely to occur in patients discharged to a nursing home.

  6. Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study

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    Gotlib Conn Lesley

    2012-11-01

    Full Text Available Abstract Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data: [1] availability for interprofessional communication, [2] relationship-building for effective communication, and [3] physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment

  7. Generalism in modern subspecializing medicine.

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    Levi, Marcel

    2017-04-01

    Medicine is currently developing at a breath holding pace. Diseases and medical conditions for which no remedy was available only a few years ago, can now be treated or even completely cured. However, this advancement of medicine comes with increasing complexity in many situations. This article discusses how we have to adapt our health care organization and our work as physicians to better cope with the new challenges of the enormous advancement of medicine, with a specific focus on internal medicine. If we want our patients to obtain maximal benefit of the progress in biomedical knowledge and the ensuing improved clinical outcomes in many areas we need to further focus and concentrate complex medical care in a team-based approach. In addition, we need to match increasing subspecialization with an attitude of generalism, both in our clinical work and in our teaching and training programs. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  8. High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis.

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    Wharam, J Frank; Paasche-Orlow, Michael K; Farber, Neil J; Sinsky, Christine; Rucker, Lisa; Rask, Kimberly J; Figaro, M Kathleen; Braddock, Clarence; Barry, Michael J; Sulmasy, Daniel P

    2009-07-01

    Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

  9. A national comparison of burnout and work-life balance among internal medicine hospitalists and outpatient general internists.

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    Roberts, Daniel L; Shanafelt, Tait D; Dyrbye, Liselotte N; West, Colin P

    2014-03-01

    General internists suffer higher rates of burnout and lower satisfaction with work-life balance than most specialties, but the impact of inpatient vs outpatient practice location is unclear. Physicians in the American Medical Association Physician Masterfile were previously surveyed about burnout, depression, suicidal ideation, quality of life, fatigue, work-life balance, career plans, and health behaviors. We extracted and compared data for these variables for the 130 internal medicine hospitalists and 448 outpatient general internists who participated. Analyses were adjusted for age, sex, hours worked, and practice setting. There were 52.3% of the hospitalists and 54.5% of the outpatient internists affected by burnout (P = 0.86). High scores on the emotional exhaustion subscale (43.8% vs 48.1%, P = 0.71) and on the depersonalization subscale (42.3% vs 32.7%, P = 0.17) were common but similar in frequency in the 2 groups. Hospitalists were more likely to score low on the personal accomplishment subscale (20.3% vs 9.6%, P = 0.04). There were no differences in symptoms of depression (40.3% for hospitalists vs 40.0% for outpatient internists, P = 0.73) or recent suicidality (9.2% vs 5.8%, P = 0.15). Rates of reported recent work-home conflict were similar (48.4% vs 41.3%, P = 0.64), but hospitalists were more likely to agree that their work schedule leaves enough time for their personal life and family (50.0% vs 42.0%, P = 0.007). Burnout was common among both hospitalists and outpatient general internists, although hospitalists were more satisfied with work-life balance. A better understanding of the causes of distress and identification of solutions for all internists is needed. © 2014 Society of Hospital Medicine.

  10. The role of the internal medicine specialist in the management of infective complications in general surgical wards

    Directory of Open Access Journals (Sweden)

    Patrizia Zoboli

    2013-05-01

    Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

  11. Physiotherapists' perceptions of and experiences with the discharge planning process in acute-care general internal medicine units in ontario.

    Science.gov (United States)

    Matmari, Lakshmi; Uyeno, Jennifer; Heck, Carol S

    2014-01-01

    To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning.

  12. A 9-year analysis of bibliographical trends for journals in the subject category of general and internal medicine.

    Science.gov (United States)

    Foo, Jong Yong Abdiel

    2009-05-01

    For academic research outcomes, an important bibliometric scoring termed as the journal impact factor (JIF) is used when assessment of the quality of research is required. No known study has been conducted to explore the bibliographical trends of 'Medicine, General & Internal' journals indexed by the annual Journal Citation Reports. Data from the Journal Citation Reports and Web of Science database were extracted to formulate a comprehensive analysis. In this study, the trends of 15 journals (5 top ranked and 10 low ranked; 5 English and 5 non-English based) were selected and analysed over a 9-year period (starting from year 1999 to 2007). Using the year 1999 as the base year, the results showed that the JIF rose significantly for the selected top ranked journals (up to 180.9%) while the low ranked ones slipped in their JIF value (down to -44.4%). The observed upward or downward trend was caused by a combination of other bibliographical measures like citations, number of citable, and total items published. It is postulated that changes in bibliographical trends can be classified as editorial and non-editorial influences. The impacts of these influences on the 15 selected journals over the 9-year period were also discussed retrospectively.

  13. Improving hospital care and collaborative communications for the 21st century: key recommendations for general internal medicine.

    Science.gov (United States)

    Wu, Robert C; Lo, Vivian; Rossos, Peter; Kuziemsky, Craig; O'Leary, Kevin J; Cafazzo, Joseph A; Reeves, Scott; Wong, Brian M; Morra, Dante

    2012-09-24

    Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals' contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. Discussions from our meeting demonstrated the complexities of technological implementations in GIM settings

  14. Update in Internal Medicine

    Science.gov (United States)

    López-Jiménez, Francisco; Brito, Máximo; Aude, Y. Wady; Scheinberg, Phillip; Kaplan, Mariana; Dixon, Denise A.; Schneiderman, Neil; Trejo, Jorge F.; López-Salazar, Luis Humberto; Ramírez-Barba, Ector Jaime; Kalil, Roberto; Ortiz, Carmen; Goyos, José; Buenaño, Alvaro; Kottiech, Samer; Lamas, Gervasio A.

    2009-01-01

    More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine. PMID:11068074

  15. Core competencies in internal medicine.

    Science.gov (United States)

    Porcel, José Manuel; Casademont, Jordi; Conthe, Pedro; Pinilla, Blanca; Pujol, Ramón; García-Alegría, Javier

    2012-06-01

    The working group on Competencies of Internal Medicine from the Spanish Society of Internal Medicine (SEMI) proposes a series of core competencies that we consider should be common to all European internal medicine specialists. The competencies include aspects related to patient care, clinical knowledge, technical skills, communication skills, professionalism, cost-awareness in medical care and academic activities. The proposal could be used as a working document for the Internal Medicine core curriculum in the context of the educational framework of medical specialties in Europe.

  16. How to fulfill residents' training needs and public service missions in outpatient general internal medicine? An observational pilot study.

    Science.gov (United States)

    Junod Perron, Noelle; Humair, Jean-Paul; Gaspoz, Jean-Michel

    2012-07-12

    QUESTION UNDER STUDY/PRINCIPLES: Ambulatory care is a mandatory component of post-graduate training in general internal medicine. Academic outpatient clinics face challenges in training residents in terms of exposure to sufficient patient case-mix, diversity of clinical activities and continuity of care while fulfilling their mission to provide care to vulnerable populations. We report the development and evaluation of a new postgraduate curriculum in ambulatory care in Geneva, Switzerland, designed to overcome such challenges. The content of learning activities was adapted to core competencies and learning objectives. In the new 2-year curriculum, residents had their working week divided into 2½ days of continuity clinic over two years, and 2½ days of 6 to 12 months rotations (e.g., walk-in clinics). Team work was consolidated through the creation of subunits including an attending physician, 1-2 senior residents during one year and 6- to 8 residents, who met in bi-monthly meetings with other health professionals. In both local and national surveys, residents and senior residents expressed an overall global satisfaction with the new curriculum. Nursing and administrative staff were less satisfied, because of reduced residents' time in each unit. Interprofessional meetings were highly appreciated for both patient care and team building. Management of residents' absences became more complex. The new curriculum met its goals in gaining residents' satisfaction and in reinforcing interprofessional collaboration although management of human resources became more complex. It also gave insights into challenges to be addressed when disseminating a new curriculum, such as strong leadership, educational expertise and management skills and tools.

  17. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.

    Science.gov (United States)

    Muller-Juge, Virginie; Cullati, Stéphane; Blondon, Katherine S; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V; Savoldelli, Georges L; Nendaz, Mathieu R

    2014-01-01

    Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should insist on better redefinition of respective roles and

  18. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.

    Directory of Open Access Journals (Sweden)

    Virginie Muller-Juge

    Full Text Available BACKGROUND: Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. OBJECTIVE: To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. METHODS: A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis. Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. RESULTS: Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. CONCLUSIONS: Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional

  19. Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.

    Science.gov (United States)

    Vanbrabant, P; Knockaert, D

    2009-01-01

    Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors. A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed. The study was performed over a one year period at a tertiary hospital ED. Data are reported as relative risk (RR) and 95% confidence interval (CI). There were a total of 51.210 ED visits during the study period. The total number of ED return visits within 72 hours was 1.124 (2,19%; 95% CI 2,07 to 2,32). The total number of ED patients managed by the GIM service was 9.511. The percentage of patients treated by the GIM service who returned to the ED within 72 hours was 1,48% (95% CI 1,25 to 1,74) when calculated for the whole group and 2,9 % (95% CI 2,46-3,41) for those discharged home from the ED (n = 4.860). The majority (82,98%) of ED return visits by patients discharged from the GIM service were unscheduled and related to their index presenting complaint. Abdominal pain was the commonest initial presenting symptom in the patients who returned to the ED after discharge. Patients with diarrhoea as the initial initial presenting symptom had the highest relative risk of an ED return visit (RR = 4.07). The percentage ED return visits by patients discharged from the ED by the GIM service is 1,48%. Patients presenting with diarrhoea as the initial presenting symptom have the highest relative risk of an early ED return visit. Our main practical conclusion is that patients with abdominal pain need to be re-examined carefully and instructed about potential evolution before discharge.

  20. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, Mohammad Akbar Hosain

    2014-12-04

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green\\'s function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green\\'s function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green\\'s function and renders the higher order internal multiple image for display on a display device.

  1. Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.

    Science.gov (United States)

    Snow, Vincenza; Beck, Dennis; Budnitz, Tina; Miller, Doriane C; Potter, Jane; Wears, Robert L; Weiss, Kevin B; Williams, Mark V

    2009-08-01

    The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.

  2. Strategic business planning for internal medicine.

    Science.gov (United States)

    Ervin, F R

    1996-07-01

    The internal medicine generalist is at market risk with expansion of managed care. The cottage industry of Academic Departments of internal medicine should apply more business tools to the internal medicine business problem. A strength, weakness, opportunity, threat (SWOT) analysis demonstrates high vulnerability to the internal medicine generalist initiative. Recommitment to the professional values of internal medicine and enhanced focus on the master clinician as the competitive core competency of internal medicine will be necessary to retain image and market share.

  3. Redesigning training for internal medicine.

    Science.gov (United States)

    Weinberger, Steven E; Smith, Lawrence G; Collier, Virginia U

    2006-06-20

    The American College of Physicians supports the need for reform throughout the continuum of training in internal medicine. Today's internists must have the necessary knowledge, skills, and attitudes to meet the challenges of an expanding body of medical knowledge and a rapidly evolving system of health care delivery. Suggested priorities for undergraduate medical education include redesigning curricular experiences to afford students earlier and more exposure to career opportunities in internal medicine, improving ambulatory education, exposing students to outstanding faculty role models in internal medicine, and incorporating educational experiences during the fourth year that optimize its value and relevance to the student's future career plans in internal medicine. Internal medicine residency training should remain a 3-year experience, with a component of core education common to all trainees and a component of customized training in the third year targeted toward the resident's career goals. Residency programs should be designed around educational rather than institutional service needs. The ambulatory component of training requires substantial reform in its structure, sites, content, and timing. Team-based models should be used both for patient care and for flexibility in design of residency training. Better faculty models must be developed that build on the concept of a "core faculty," improve the rewards for teaching faculty, and provide appropriate faculty development focusing on a necessary set of educator competencies.

  4. The future of general medicine.

    Science.gov (United States)

    Firth, John

    2014-08-01

    It is a truth universally acknowledged that there is a problem with general medicine. Physicians have become increasingly specialised over the past 30 years or so, and specialist care has produced increasingly better outcomes for some patients. The patients left behind are looked after by general medicine, where demand is increasing, operational priority within hospitals is low, there is little professional kudos and recruitment is suffering. Three recent reports - Hospitals on the Edge?, the Future Hospital Commission report, and the Shape of Training report - have described the problems, but not articulated compelling solutions. Here, I discuss what is good about general medicine, what is bad and make suggestions for improvement. These involve getting specialities to take responsibility for care of appropriate admissions automatically and without delay, giving general physicians control over the service that they provide, and using well-chosen financial drivers to support movement in the right direction.

  5. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, M. A. H.

    2014-08-05

    Internal multiples deteriorate the image when the imaging procedure assumes only single scattering, especially if the velocity model does not have sharp contrasts to reproduce such scattering in the Green’s function through forward modeling. If properly imaged, internal multiples (internally scattered energy) can enhance the seismic image. Conventionally, to image internal multiples, accurate, sharp contrasts in the velocity model are required to construct a Green’s function with all the scattered energy. As an alternative, we have developed a generalized internal multiple imaging procedure that images any order internal scattering using the background Green’s function (from the surface to each image point), constructed from a smooth velocity model, usually used for conventional imaging. For the first-order internal multiples, the approach consisted of three steps, in which we first back propagated the recorded surface seismic data using the background Green’s function, then crosscorrelated the back-propagated data with the recorded data, and finally crosscorrelated the result with the original background Green’s function. This procedure images the contribution of the recorded first-order internal multiples, and it is almost free of the single-scattering recorded energy. The cost includes one additional crosscorrelation over the conventional single-scattering imaging application. We generalized this method to image internal multiples of any order separately. The resulting images can be added to the conventional single-scattering image, obtained, e.g., from Kirchhoff or reverse-time migration, to enhance the image. Application to synthetic data with reflectors illuminated by multiple scattering (double scattering) demonstrated the effectiveness of the approach.

  6. ANXIETY AND DEPRESSION IN INTERNAL MEDICINE

    Directory of Open Access Journals (Sweden)

    A. V. Fedotova

    2008-01-01

    Full Text Available The problem of anxiety and depression in internal medicine is discussed. Diagnosis of these disorders in general practitioner every day practice is surveyed. Possibilities of anxiety and depression treatment are highlight. Modern psychopharmacotherapy is focused, especially antidepressants usage.

  7. Depression and Internal Medicine

    Directory of Open Access Journals (Sweden)

    Domenico Panuccio

    2013-05-01

    Full Text Available BACKGROUND Depression is 2-4 times more frequent in medically ill patients than in the general population, it significantly undermines the quality of life and makes prognosis worse in terms of morbidity and mortality. Nevertheless the majority of cases are not recognized or appropriately treated. A growing body of evidence suggests that mood disorders and many medical illnesses are linked in a bidirectional way by several biological mechanisms. Autonomic function changes, hyperactivity of the hypothalamic-pituitary-adrenal axis, increases in plasma cortisol, elevated levels of proinflammatory cytokines, increased platelet activation and hypercoagulability, all of them occur in patients with depression and all of them are causal factors in development and progression of atherothrombotic lesions or they are implicated in the pathogenesis of neoplasm and other illness such as chronic pain, chronic obstructive pulmonary disease, rheumatoid arthritis and so on. CONCLUSIONS Although antidepressant use has not been shown to reduce mortality rates in patients with medical illness, it alleviates depression, improves the quality of life and reduces morbidity. Clinicians should be aware of this association and should make an effort in detecting and treating not only biological illness but also mood disorders.

  8. Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Saitoh Akiyoshi

    2010-04-01

    Full Text Available Abstract Background A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital. Methods Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ. Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records. Results Among 312 patients, 27 (8.7% and 52 (16.7% were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8% were recognized by physicians as having a mental disorder, but only three (11.1% were diagnosed as having a mood disorder. Only two patients with major depressive disorder (7.4% had been prescribed antidepressants. Even among those (n = 15 whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7% were prescribed an antidepressant. Conclusions Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring

  9. Nailfold videocapillaroscopy in internal medicine

    Directory of Open Access Journals (Sweden)

    Paola Faggioli

    2015-09-01

    Full Text Available Capillaroscopy is an actual inexpensive imaging technique, used to examine, non-invasively and safely, the morphology of nailfold dermal papillary capillaries. Many studies agree in the statement that the capillaroscopy is one of the gold standard methods for non-invasive examination of the microcirculation and it plays an important role in screening in Raynaud’s phenomenon and in monitoring of systemic sclerosis and other rheumatologic diseases. There are also many reports on the possible use of nailfold capillaroscopy in the diagnosis and monitoring of many other diseases in internal medicine.

  10. Teaching Prevention in Internal Medicine Clerkships.

    Science.gov (United States)

    Kinsinger, Linda

    2000-01-01

    Reviews the rationale for including prevention in the clinical medicine clerkship. Summarizes current guidelines, presents examples of curricula in several medical schools, and proposes a future direction that stresses integrating teaching preventive medicine into internal medicine clerkships and across the entire four-year medical curriculum. (DB)

  11. [Precision medicine : a required approach for the general internist].

    Science.gov (United States)

    Waeber, Gérard; Cornuz, Jacques; Gaspoz, Jean-Michel; Guessous, Idris; Mooser, Vincent; Perrier, Arnaud; Simonet, Martine Louis

    2017-01-18

    The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals.

  12. [Long-term outcome of patients discharged with fever of unknown origin in the Department of General Internal Medicine of Peking Union Medical College Hospital].

    Science.gov (United States)

    Li, Yuanjie; Zhu, Weiguo; Wang, Yu; Sha, Yue; Huang, Xiaoming; Huang, Chengjin; Jiao, Yang; Chen, Jialin; Fang, Weigang; Zeng, Xuejun

    2015-10-01

    To investigate the clinical characteristics and outcome of patients with undiagnosed fever of unknown origin (FUO). To retrospectively review the clinic data of patients discharged with FUO from the Department of General Internal Medicine, Peking Union Medical College Hospital during 2004 to 2008. Medical records and phone call follow-up data were collected until 2014. Among 758 in-patients diagnosed with FUO, 70 patients still discharged with FUO were enrolled in this study, including 23 males and 47 females. There were 14 missing patients. Finally, definite diagnoses were made in 20 patients by clinical reassessments, empirical therapy or repeated biopsies, in whom 3 patients dying from underlying diseases. A total of 36 patients did not get final diagnoses, while fever was relieved in 23 patients, including 10 treated with corticosteroids or non-steroid anti-inflammatory drugs (NSAIDs) from 1 month to 12 months due to suspected connective tissue diseases. Another 3 patients still had episodic fever. Seven patients died shortly after discharge. There were 3 dying in the long-term follow-up. The overall FUO-related mortality was 18.6%. Mortality was correlated with the number of dysfunctional organs, especially cytopenia, coagulation dysfunction, bleeding events, respiratory damage and acute renal failure with OR 2.1, 9.9, 3.3 and 6.6 (P < 0.05) respectively. Close follow-up, intermittent clinical reassessments, repeated biopsies will contribute to the diagnosis of patients discharged with FUO. Empirical therapy with corticosteroids, NSAIDs or anti-tubercular drugs in selected patients may be safe and effective. Mortality rates increased with impaired organs, especially the hematological, respiratory and renal systems.

  13. Influence of patient and provider factors on the workload of on-call physicians: A general internal medicine cohort observational study.

    Science.gov (United States)

    Hsu, Nin-Chieh; Huang, Chun-Che; Jerng, Jih-Shuin; Hsu, Chia-Hao; Yang, Ming-Chin; Chang, Ray-E; Ko, Wen-Je; Yu, Chong-Jen

    2016-08-01

    Factors associated with the physician workload are scarcely reported. The study aims to investigate the associated factors of on-call physician workload based on a published conceptual framework.The study was conducted in a general internal medicine unit of National Taiwan University Hospital. On-call physician workloads were recorded on a shift basis from 1198 hospitalized patients between May 2010 and April 2011. The proxy of on-call workloads included night calls, bedside evaluation/management (E/M), and performing clinical procedures in a shift. Multivariable logistic and negative binomial regression models were used to determine the factors associated with the workloads of on-call physicians.During the study period, 378 (31.6%) of patients had night calls with related workloads. Multivariate analysis showed that the number of patients with unstable conditions in a shift (odds ratio [OR] 1.89 and 1.66, respectively) and the intensive care unit (ICU) training of the nurse leader (OR 2.87 and 3.08, respectively) resulted in higher likelihood of night calls to and bedside E/M visits by the on-call physician. However, ICU training of nurses (OR = 0.37, 95% confidence interval: 0.16-0.86) decreased the demand of performing clinical procedures by the on-call physician. Moreover, number of patients with unstable conditions (risk ratio [RR] 1.52 and 1.55, respectively) had significantly increased the number of night calls and bedside E/M by on-call physicians by around 50%. Nurses with N1 level (RR 2.16 and 2.71, respectively) were more likely to place night calls and facilitate bedside E/M by the on-call physician compared to nurses with N0 level. In addition, the nurse leaders with ICU training (RR 1.72 and 3.07, respectively) had significant increases in night calls and bedside E/M by the on-call physician compared to those without ICU training.On-call physician workload is associated with patient factors and the training of nurses. Number of unstable patients

  14. Outpatient Management of Hypertension By General Medicine and Traditional Track Residents.

    Science.gov (United States)

    Robie, Peter W.; Andrus, Peter L.

    1982-01-01

    A study to determine whether general internal medicine and traditional track medicine residents differed in their outpatient management of essential hypertension is discussed. General internal medicine residents seem to do better in the areas of assessment of drug side effects and patient education. (MLW)

  15. International Journal of Medicine and Biomedical Research ...

    African Journals Online (AJOL)

    IJMBR publishes editorial, original and review papers, case reports, reports and commentaries, letters ... International Journal of Medicine and Biomedical Research alone at that point in time and has not been ... the material should be original

  16. A Learning-Curve Approach to the Self-Assessment of Internal Medicine Training.

    Science.gov (United States)

    Day, Susan C.; And Others

    1984-01-01

    In response to the perceived need for primary care physicians, two major changes in internal medicine training have occurred: (1) a third year of general training was required for internal medicine board certification and (2) many hospitals developed primary care internal medicine residencies with an increased emphasis on ambulatory training.…

  17. Complexity in graduate medical education: a collaborative education agenda for internal medicine and geriatric medicine.

    Science.gov (United States)

    Chang, Anna; Fernandez, Helen; Cayea, Danelle; Chheda, Shobhina; Paniagua, Miguel; Eckstrom, Elizabeth; Day, Hollis

    2014-06-01

    Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.

  18. An evaluation of the elements of internal medicine physiopathology curriculum in general practice based on the perspectives of faculty members of Shiraz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    JAMSHID ESLAMI

    2015-04-01

    Full Text Available Introduction: An evaluation of the curriculum elements can be recognized as a necessity in curriculum dynamic and improvement. This study aimed at evaluating five main elements of a physiopathology curriculum in internal medicine (objectives, content, methods, evaluation, and management. Method: The present study is of a descriptive-analytical type, and the study population consisted of a total of 48 faculty members of internal medicine physiopathology department at Shiraz University of Medical Sciences. Participants were selected using Cochran’s sample size formula and through simple random sampling. The data were collected using a 58-item questionnaire devised by the researcher, using curriculum planning experts. Face and content validity of the scale were obtained through expert views and modifications provided by 10 professors and experts in medical curriculum evaluation. Also, research reliability was calculated using Alpha Cronbachto be 0.99. Reliability value and coefficient was acceptable. Moreover, One-sample t-test, Independent t-test and One-way ANOVA were used for data analysis. Results: Based on the faculty members’ views, of the five curriculum elements, objectives and content were in relatively good conditions (at an average level while other elements including method, evaluation and management were in poor conditions (lower than average. According to results of two-way ANOVA, there was a significant relationship between faculty members with various work experience in terms of curriculum evaluation. Conclusion: According to research findings, a comparative examination of the curriculum elements and their characteristics in physiopathology course can be conducted, resulting in identification of curriculum weaknesses and their pitfalls. Also, with regard to teaching, evaluation, management methods, weak and strong points of the course, efficiency, and effectiveness of the elements were identified.

  19. Predictors of final specialty choice by internal medicine residents.

    Science.gov (United States)

    Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E

    2006-10-01

    Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. To identify factors that predict the clinical practice of residents following their training. Prospective cohort study. Two hundred and four categorical residents from 2 university-based residency programs. Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P personal attributes during the selection process.

  20. Realisation of the guidelines for faculty-internal exams at the Department of General Medicine at the University of Munich: Pushing medical exams one step ahead with IMSm.

    Science.gov (United States)

    Boeder, Niklas; Holzer, Matthias; Schelling, Jörg

    2012-01-01

    Graded exams are prerequisites for the admission to the medical state examination. Accordingly the exams must be of good quality in order to allow benchmarking with the faculty and between different universities. Criteria for good quality need to be considered - namely objectivity, validity and reliability. The guidelines for the processing of exams published by the GMA are supposed to help maintaining those criteria. In 2008 the Department of General Medicine at the University of Munich fulfils only 14 of 18 items. A review process, appropriate training of the staff and the introduction of the IMSm software were the main changes that helped to improve the 'GMA-score' to 30 fulfilled items. We see the introduction of the IMSm system as our biggest challenge ahead. IMSm helps to streamline the necessary workflow and improves their quality (e.g. by the detection of cueing, item analysis). Overall, we evaluate the steps to improve the exam process as very positive. We plan to engage co-workers outside the department to assist in the various review processes in the future. Furthermore we think it might be of value to get into contact with other departments and faculties to benefit from each other's question pools.

  1. A Methodological Strategy for the Family Health Course in General Internal Medicine Residency Estrategia metodológica para el módulo salud familiar en la residencia Medicina General Integral

    Directory of Open Access Journals (Sweden)

    María Aurelia San Juan Bosch

    2011-04-01

    Full Text Available Background: The continuous improvement of the educational process is one of the permanent challenges of medical education in Cuba. When dealing particularly with family medicine it must be ensured that physicians are always getting a better clinical approach to the management of families, since this is one of the key areas that have been identified as problematic in professional practices. Objective: To design a methodological strategy for the improvement of educational activities in the Family Health Course of the General Internal Medicine Residency. Method: A development research, conducted at the University of Medical Sciences of Cienfuegos, from November 2005 to January 2007 is presented. Document analysis and validation by expert criteria were also implemented. Results: For each of the four themes that make up this course, the following aspects are stated: teaching organization, length, contents, activity objectives, methodological guidelines to implement these activities, assessment proposals for some of them and some literature. Conclusions: The design of educational activities, with emphasis on actual or simulated medical practice, could help improving the quality of the teaching process. In addition, following the logical structure of activities, teachers can develop similar proposals to address other health problems according to the different learning needs.Fundamento: El perfeccionamiento permanente del proceso docente educativo, es uno de los retos permanentes de la Educación Médica en Cuba. La medicina familiar, en particular, debe lograr que los médicos tengan cada vez mejor actitud clínica en el manejo de las familias, por constituir una de las áreas claves en las cuales se han determinado deficiencias en la actuación profesional. Objetivo: Diseñar una estrategia metodológica para el perfeccionamiento de

  2. [Constitutions and generalities in traditional Tibetan medicine].

    Science.gov (United States)

    Rovere, P M

    1986-04-28

    The present work is the result of a preliminary study promoted by C.I.S.ME.T. (the International Tibetan Medicine Study Centre) and aims to unify the diagnostic and therapeutic language of various medical cultures. In line with the spirit of the W.H.O. aimed at safeguarding the cultural heritage represented by popular and traditional medicine, encouraged by the Tibetan Medical Centre and under the auspices of His Holiness the Dalai Lama a terminological and conceptual integration of the basic elements of traditional Tibetan medicine is proposed. The Rlung, Bad Kan, Mkris Pa constitution is correlated with embryological anatomy. The 5 exhalations, 5 biles and 5 phlegbs are analysed from a tissue viewpoint with a search for parallels with embryological tissues.

  3. Importance of international networking in academic family medicine

    Directory of Open Access Journals (Sweden)

    Zalika Klemenc-Ketiš

    2014-05-01

    Full Text Available European family medicine/general practice (FM/GP has travelled the long and successful journey of profiling the discipline and has produced valuable position papers on education and research. Nowadays, academic medicine is one of the pillars in the future development of FM/GP in Europe. A common European curriculum on undergraduate and postgraduate family medicine is needed. Also, a sound international platform of teaching institutions and/or teachers of family medicine would foster the further development of family medicine as an academic discipline. This would stimulate students and teachers to engage in international exchange to gain new knowledge and experiences, present their work and ideas abroad and prepare the conditions for further exchange of students and teachers. Conclusion. Established departments of FM/GP, led by a teacher who is a family physician/general practitioner, at each Medical School in Europe should provide students with knowledge and skills related to the core attributes of FM/GP. International exchanges of teachers and students should foster the development of a common curriculum on FM in Europe and foster improvement in the quality of FM education.

  4. THE CHINA MEDICAL ABSTRACTS (Internal Medicine English Edition)

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    The purpose of the China Medical Abstracts (Internal Medicine) is to promote international exchange of works done by the Chinese medical profession in the field of internal medicine. The papers selected from journals represent the newest and most important advances and progress in various specialities in internal medicine.

  5. THE CHINA MEDICAL ABSTRACTS(Internal Medicine English Edition)

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The purpose of the China Medical Abstracts (Internal Medicine) is to promote international exchange of works done by the Chinese medical profession in the field of internal medicine. The papers selected from journals represent the newest and most important advances and progress in various specialities in internal medicine.

  6. THE CHINA MEDICAL ABSTRACTS(Internal Medicine English Edition)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The purpose of the China Medical Abstracts (Internal Medicine) is to promote international exchange of works done by the Chinese medical profession in the field of internal medicine. The papers selected from journals represent the newest and most important advances and progress in various specialities in internal medicine.

  7. THE CHINA MEDICAL ABSTRACTS(Internal Medicine English Edition)

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The purpose of the China Medical Abstracts (Internal Medicine) is to promote international exchange of works done by the Chinese medical profession in the field of internal medicine. The papers selected from journals represent the newest and most important advances and progress in various specialities in internal medicine.

  8. THE CHINA MEDICAL ABSTRACTS(Internal Medicine English Edition)

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    The purpose of the China Medical Abstracts (Internal Medicine) is to promote international exchange of works done by the Chinese medical profession in the field of internal medicine. The papers selected from journals represent the newest and most important advances and progress in various specialities in internal medicine.

  9. The internal medicine specialist and neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Pizzini

    2013-05-01

    Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.

  10. The management of pneumonia in internal medicine.

    Science.gov (United States)

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  11. The management of pneumonia in internal medicine.

    Science.gov (United States)

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP.

  12. Preparing physicians for careers in primary care internal medicine: 17 years of residency experience.

    OpenAIRE

    Perez, J. C.; Brickner, P. W.; Ramis, C. M.

    1997-01-01

    The objective of this survey was to demonstrate whether a primary care track internal medicine residency program emphasizing community-based health care of the urban sick poor trains physicians who will continue to practice in general internal medicine or similar fields. Thirty-five primary care residents (100% of graduates) who trained from 1976 through 1993 in the Adult Primary Care Track of the Internal Medicine Residency Program at St. Vincent's Hospital, New York were used as participants.

  13. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

    Science.gov (United States)

    Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

    2017-05-11

    Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

  14. Curricula and Organization of Primary Care Residencies in Internal Medicine.

    Science.gov (United States)

    Eisenberg, John M.

    1980-01-01

    The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…

  15. Catatonia as an internal medicine disease: infrequent or still underdiagnosed?

    Science.gov (United States)

    Proenca, Margarida; Marques, Filipa; Cardoso, Débora; Fonseca, Cândida

    2016-04-22

    Catatonia is a motor and behavioural syndrome with multiple psychiatric, general medical and neurological aetiologies that might be simultaneously present. B12 deficiency is a rare, treatable cause of catatonia, not always easy to rule out. The authors present a case of a woman with catatonia associated with severe cyanocobalamin deficiency, admitted to an internal medicine ward. The benign course was related to an adequate and early diagnosis.

  16. Current progress on internal medicine in China-2006 Part Ⅱ

    Institute of Scientific and Technical Information of China (English)

    YAO Dingkang; ZHU Liang; YU Renqian; MEI Changlin

    2007-01-01

    A lot of progress has been made on internal medicine in the past year.Here a great deal of data were collected about internal medicine in China by searching for some most important medicine magazines published in China in 2006.Because there are so many articles on internal medicine,some representative reports were selected and further reviewed.In the part II,a summary of advances made in four branches includes nephrology,hematology,endocrinology and metabolism,rheumatology.

  17. Computer assistance in the practice of internal medicine.

    Science.gov (United States)

    Niermeijer, P

    1995-05-01

    An overview is given of the possibilities of electronic support in the practice of internal medicine and of the preferred electronic environment in the hospital. For efficient exchange of information, mutual cooperation between all departments and medical specialists in the hospital is of great importance. The development of a sufficient hospital information system has to start with the composition of an information design, based on the concept of an open hospital database with connections to subsystems of the different departments and medical specialisms. Within this design basic, organizational, management and (medical) knowledge-providing programs can be applied. General, medical, scientific and organizational aspects of electronic support in internal medicine are discussed with some practical examples. A brief comment is made on the necessity of using code numbers for diagnoses.

  18. ¿Medicina general integral o medicina familiar? ¿Integral general medicine or family medicine?

    Directory of Open Access Journals (Sweden)

    Leonardo A. Cuesta Mejías

    2007-09-01

    Full Text Available En el presente trabajo, además de ofrecer la opinión basada en la experiencia personal del autor, se aplica encuesta confeccionada al efecto en la que se indaga fundamentalmente cuál es la preferencia de los profesionales vinculados a la práctica de la Medicina General Integral o de la Medicina Familiar a la hora de denominar la especialidad que desempeñan. Es decir, responder la pregunta que da título al trabajo es la intención u objetivo general del mismo.At present paper, beside to offer author's personal experience-based opinion, it is applied survey to know which is the preference of professionals related to practice of Integral General Medicine o Family Medicine, at moment of to denominates its real specialty. That is, to answer the question that is the title of this paper, is its general aim.

  19. Heart Rate Variability Analysis in General Medicine

    Directory of Open Access Journals (Sweden)

    Yi Gang

    2003-01-01

    Full Text Available Autonomic nervous system plays an integral role in homeostasis. Autonomic modulation can frequently be altered in patients with cardiac disorders as well as in patients with other critical illnesses or injuries. Assessment of heart rate variability is based on analysis of consecutive normal R-R intervals and may provide quantitative information on the modulation of cardiac vagal and sympathetic nerve input. The hypothesis that depressed heart rate variability may occur over a broad range of illness and injury, and may inversely correlated with disease severity and outcome has been tested in various clinical settings over the last decade. This article reviews recent literature concerning the potential clinical implications and limitations of heart rate variability assessment in general medicine.

  20. Acute Internal Medicine Trainee Survey 2015.

    Science.gov (United States)

    Smallwood, Nicholas; Conway, Nerys

    2015-01-01

    To ascertain current Acute Internal Medicine (AIM) trainees' opinions on their training programme, practical procedures, specialist skills and AIM as a specialty. This can then be used to feedback to the national training committee to help shape training priorities. Online survey sent to all AIM Higher Specialty Trainees registered on the Society for Acute Medicine database, and advertised through e-mail communication and social media. The majority of trainees (55.5%) were quite happy or very happy with their training currently, although significant difficulties were highlighted with time off for specialist skill training and difficulty achieving certain procedural skills. The majority of trainees believe ultrasound should form a core component of AIM training (82.3%). A high proportion of trainees would recommend AIM as a specialty despite these difficulties. A number of issues were highlighted causing difficulties within AIM training, despite which the vast majority of trainees would recommend AIM as a career choice. The results were fed back to the training committee in March.

  1. Reflective writing in the internal medicine clerkship: a national survey of clerkship directors in internal medicine.

    Science.gov (United States)

    Chretien, Katherine C; Chheda, Shobhina G; Torre, Dario; Papp, Klara K

    2012-01-01

    Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students' grade. Respondents believed assignments contributed to students' learning in multiple domains, most often Professionalism (97%) and Communication (77%). Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.

  2. International Journal of Medicine and Biomedical Research ...

    African Journals Online (AJOL)

    IJMBR publishes novel findings valuable to researchers in Clinical and Basic ... Medicine, Alternative and Complementary Medicine, Nursing, Physiotherapy, and .... As part of the submission process, authors are required to check off their ...

  3. [Training in internal medicine and its specialties: universities' proposals].

    Science.gov (United States)

    Norero, C

    1996-04-01

    Medical School graduates can enter a medicine subspecialty training program upon completion of a 3 year Internal Medicine residency. The Ministry of Health has contributed to postgraduate training by defining the type of physician the country needs, and by financial support of specially (Internal Medicine) training. Before 1995, when applicants began being charged a fee, finding for subspecialty training was provided exclusively by the universities. Currently, 450 training post are available for 550 graduates from all medical schools. Of these, 59 are in Internal Medicine and 58 in its subspecialties. A quantitative analysis of 40 years of training programs in Internal Medicine by the traditional medical schools shows that only the Catholic University of Chile Medical School privileges subspecially training whereas all other schools favor general Internal Medicine training. A high number of Internal Medicine trainees never take final examination. Nevertheless, training through practice, not necessarily in a university setting, accounts for 67% of Autonomous National Corporation for Certification of Medical Specialties. CONACEM accredited subspecialists. About 63% of those who finish an Internal Medicine training program decide to go into subspecialization. It is felt that subspecialization involves technical as well as non-professional aspects, such as a philosophical stance towards the search for truth through research and creativity. An integral education in a subspecialty can only be given by the university. Non-university centers, however, can contribute to subspecialization by allowing trainees to gain access to newer technology or to larger numbers of patients. A critical question is how many subspecialists should exist in relation to the number of generalists and according to the country's health requirements. In my personal view, the proportion of subspecialists is excessive. The decision to subspecialize should not be exclusively a personal choice, but

  4. [HIV infection - a new disease of internal medicine].

    Science.gov (United States)

    Snopková, Svatava

    2017-01-01

    Modern antiretroviral treatment belongs to the greatest success of current medicine. HIV infection has gone from a death sentence to a manageable chronic disease which develops several decades. Thanks to treatment advances, people with HIV can and do live long and full lives. In the last two decades, the incidence AIDS defining illnesses have been dramatically reduced especially opportunistic infections and malignancies, whereas the role of non-infection comorbidities has risen than age-matched HIV uninfected adults. These comorbidities include cardiovascular diseases, venous and arterial thrombosis, metabolic disorders, chronic liver and renal diseases, nervous system disorders, osteoporosis and some cancers. This relatively large group of diseases is known as non-AIDS defining or indicating diseases and these diseases are associated in HIV uninfected general population with older age and ageing Most HIV positive individuals on antiretrovirals present an abnormal level of immune activation, inflammation and hypercoagulable condition. These hallmarks are typically seen in older HIV uninfected general population and are associated with aging and the immunosenescent phenotype. The explanation for this phenomenon is unclear. There are multiple factors, which may apply pathophysiologically, including the residual immune dysregulation syndrome and antiretrovirals alone. It is clear that changes in the nature of chronic HIV infection put it in internal medicine. Cardiology, internal medicine, geriatric and oncology syndromes are dominating manifestations in HIV positive patients on antiretrovirals. Care management for HIV infected individuals will need to draw on a wide range of medical disciplines in diagnosis and treatment. Clarification of these phenomena would be beneficial for the treatment of these non-infectious diseases in HIV positive and as well in HIV negative general population.Key words: antiretroviral therapy - HIV infection - immune dysregulation

  5. Six decades of the chair of Internal Medicine at the Medical Faculty in Skopje.

    Science.gov (United States)

    Chakalaroski, K

    2013-01-01

    The chair of internal medicine in Republic of Macedonia was created in 1947. The Department of Internal Medicine (CIM) is the most numerous at Skopje's medical faculty (currently 56 members). According to the archive material from the first session of the Scientific Teaching Council of the Faculty of Medicine (17.03.1947), Mr Mario Krmpotic (Professor of Internal Medicine) was proposed as the first Director of the Internal Clinic (1947). For reasons unknown, Mr Krmpotic never came to Skopje to accept the post. As a consequence of this fact, the real founder of the CIM was the Russian Professor Alexandar Ignjatovski (1875-1955). Mr Ignjatovski was elected as the first Director of the Clinic for Internal Medicine in 1948 for a period of 4 years (1948-1952). At the same time, he was the first Chief of the CIM in Skopje (Macedonia). Dr D. Arsov was elected as the first Assistant Professor of Medicine in 1947, and second (and last) Director of the Clinic for Internal Medicine (1952-1974). For the same period (22 years) he was Head of the CIM. Dr D. Arsov sequentially and successively became first associated and then ordinary professor of medicine in the years 1951 and 1958. The regular activities of the CIM are as follows: 1) Undergraduate education for students (Clinical Investigation, Internal Medicine, Clinical Pharmacy) in general medicine, dentistry, geriatrics, urgent and family medicine (ECKTS); Undergraduate educationfor nurses, speech therapists, physiotherapists, radiologists (high /three year/ nurses School, ECKTS); 2) Postgraduate education (candidates for specialisation in internal medicine, infectology, anaesthesiology, neurology and surgery; 3) Continual medical education (a traditional morning scientific meeting on Thursdays, 08 h; weekly meetings of all internal medicine subspecialists); Scientific meetings, symposiums, congresses of former internal medicine associations (cardiology, pulmoallergology, gastroenterology, nephrology, haematology

  6. International Federation for Emergency Medicine model curriculum for emergency medicine specialists

    Directory of Open Access Journals (Sweden)

    Cherri Hobgood

    2011-06-01

    Full Text Available To meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time-sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programs in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training program. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership with regard to the training of emergency medicine specialists.

  7. Personal health care of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Venkataraman Palabindala

    2012-01-01

    Full Text Available Medical residents, as part of their job to balance the demands of their work with caring for themselves so as to be mentally, emotionally, and physically sound to stay clinically competent. While regulatory and legislative attempts at limiting medical resident work hours have materialized but have yet to attain passage, there are fairly little data looking into how residents cope up with their demands and yet attend to their own personal health.Anonymous mailed survey.Three hundred and thirty-seven residents from all internal medicine residency programs within United States.We conducted a survey in the form of a questionnaire that was sent by e-mail to the program directors of various internal medicine residency programs within the United States, and responses were collected between May 19 and June 21, 2009. Response was well appreciated with total number of participants of 337 with even demographical distribution in gender, residency year, AMG/IMG, age group. Seventy-one percent of the residents felt that they would prefer getting admitted to their own hospital for any acute medical or surgical condition. Of the 216 residents who have had received health care in the past, almost half of them chose their own hospital because of the proximity, while 45% did not choose their own hospital despite proximity. Two out of three residents missed their doctors appointments or cancelled them due to demands of medical training. Only half of the residents have a primary care physician and almost 80% of them did not have their yearly health checkup. Close to 30% held back information regarding their social and sexual history from their provider because of privacy and confidentiality concerns. Eighty percent of residents never received information about barriers that physicians may face in obtaining care for their socially embarrassing conditions. Seventy percent felt that their performance then was suboptimal because of that health condition and also felt

  8. Virtual cases in internal medicine education

    Directory of Open Access Journals (Sweden)

    Ilja Tachecí

    2015-09-01

    Full Text Available Virtual patients represent a useful tool in teaching students clinical reasoning skills. Virtual Cases (www.e-kazuistiky.cz represent a newly developed interactive problem-based learning system, drawing information from virtual clinics, covering different fields of internal medicine, generating sets of unique virtual patients according to user-predefined program settings (spectrum of diagnoses, number of patients and criteria for passing the course. Basic clinical information including personal data, medical history, symptoms, laboratory values, etc. is generated for each virtual patient. The main task for the student is to determine the optimal diagnostic algorithm (choose adequate diagnostic steps in the correct order, and to determine the correct diagnosis in each virtual patient. Results of diagnostics tests and clinical findings are presented utilising a multimedia presentation (images, video-sequences, audio-recordings. Evaluation of students includes not only assessment of correctly determined diagnosis, but also the diagnostic pathway, which led the user to the specific diagnosis. Thus, the system enables assessment of appropriateness of each test as well as reasonable sequencing of tests and also financial costs of all examinations. The program is now routinely used in the undergraduate curriculum at the Medical Faculty in Hradec Králové. User hands-on experience was evaluated through anonymous questionnaires. The most appreciated attribute of the system is the game-like involvement and multimedia-supporting environment (for students as well as the possibility of a detailed analysis of each student’s performance and clear identification of their weakest areas (for tutors. The system is a useful tool for undergraduate medical education with positive feedback from both students and teachers. The main advantages are flexibility, potential for further growth and no restrictions regarding particular disease, clinical discipline

  9. [Patient centered practice in internal medicine].

    Science.gov (United States)

    Carneiro, Rui; Freire, Elga; Alves, Júlia; Rocha, Nelson

    2010-01-01

    We made a cross-sectional study aimed at 50 professionals (18 doctors, 32 nurses) of a tertiary hospital Internal Medicine (IM) ward, focusing the relevant knowledge in various areas of Patient-Centered Care in Chronic Disease: symptom control, pharmacology and palliative prognostic discussion. Almost 98% believe that most patients need strategies for symptomatic care, which died in hospital in considerable suffering (68%). Provision of palliative care in the community was rarely established with the primary health team. 90% were favourable on the creation of a hospital palliative care team. Around 57% find essential to prognosticate before thinking about mitigation strategies. While 75% of professionals had already discussed end-of-life directives with, at least, one patient, only one case could be formalized in writing. The rate of use of scales for assessing the intensity of pain was less than 50% and 38% did not indicate major opioids for the treatment of moderate intensity pain. These were considered contra-indicated for relief of dyspnoea in chronic obstructive pulmonary disease by 20% of professionals and 55% of those were unaware that its use and titration is governed by the same principles used in pain control. Around 44% of the respondents had already used the subcutaneous route for administration of drugs and 58% for hydration. Despite the team recognition of the potential for suffering of patients and the need for mitigation strategies, they remain linked to prognosis and not to symptomatic complexity. There are gaps in regard to control of pain, dyspnoea and in continuity of care.

  10. Epidemiological study on neurosis of internal medicine outpatient department in general hospital%大连市综合医院内科门诊神经症流行病学调查

    Institute of Scientific and Technical Information of China (English)

    孙月吉; 杜娟; 宛思莹; 刘启贵; 刘凤英; 曲芳; 陈锦波

    2008-01-01

    目的 了解综合科医院内科门诊神经症的发生率,探讨神经症发生特点.方法 采用了整群分层抽样方法,2006年7~8月,连续收集了3所大连市三级甲等综合科医院门诊病人600人.经神经症筛查量表筛查出阳性者,同时行DSM-Ⅳ确立诊断,符合诊断者309名作为研究对象.结果 内科门诊神经症病人的检出率约为57.43%(309例),非神经症约为42.56%(229例);其中焦虑210例,约占神经症总数的68%;广泛性焦虑115例,约37%;惊恐障碍67例,约占神经症总数的21.7%;抑郁伴发惊恐障碍28例,约占占神经症总数的9.6%.抑郁伴发广泛性焦,约占总数的14.2%.其他神经症患者83例,约占神经症总数的26.8%.重度抑郁障碍患者占总样本的3%;神经症患者不同诊断组之间的睡眠时间、累计就诊次数、累计医疗费用和累计就诊时间等均差异有显著性(P<0.01).自认病情态度和对内科医生诊断治疗的满意程度,各组之间差异有显著性(P=0.000).所调查的各组患者所经历的特殊检查(P=0.034)以及有无镇静止痛药物治疗均差异有显著性(P=0.000).结论 综合性医院内科门诊患者的精神障碍问题严重,其中以神经症为最常见.焦虑障碍在综合性医院内科门诊最常见.%Objective To investigate the prevalence status of neurosis among outpatients in internal medicine department of general hospital, and to find some characteristics of the neurosis. Methods 600 outpatients visiting the internal medicine department were investigated ,and they are from 3 general hospital in Dalian:seeond I-Iospital,Jinzhou hospital and second teaching hospital affiliated to Dalian medical university. 309 neurosis were selected with neurosis screening scale, and met the DSM-IV. Results Higher prevalence (57.43%) was found in neurosis of general hospital. The results showed that the prevalence rate of anxiety disorder is 68% within the neurosis, which included general anxiety (37.00%) and

  11. Medication discrepancies at discharge from an internal medicine service.

    Science.gov (United States)

    Herrero-Herrero, José-Ignacio; García-Aparicio, Judit

    2011-02-01

    Medication errors most commonly occur at the time of medication prescribing and particularly at the moment of the transitions of care. The objectives of this study were to identify and characterize the discrepancies between the physicians' discharge medication orders and the medication lists at admission obtained by an internal medicine specialist physician in a general internal medicine service. This descriptive, retrospective, study was carried out at a tertiary care university teaching hospital in Spain. It was based on the review of non selected, consecutive, hospital discharge reports. Discrepancies were identified, categorized and characterized through the analysis of the information (medication lists, laboratory tests results, diagnosis, and clinical evolution) contained in them. We analyzed 954 discharge reports. In the medication reconciliation process, we find discrepancies in 832 (87.2%) of them. Justified discrepancies were found in 828 (86.8%) reports and unjustified discrepancies in 52 (5.4%). Omission of a medication was the most frequent medication error detected in 86.4% of cases, followed by incomplete prescription (9.6%). The number of diagnosis, the length of hospital stay and the number of permanent medications at admission were the characteristics of cases associated with medication discrepancies in multivariate linear regression (Premarkable the low number of medication errors detected in our study. Appropriate routines to ensure an accurate medication history collection and a methodical elaboration of the medication list at discharge, when performed by trained internists, are important for an adequate medication reconciliation process. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Current progress on internal medicine in China-2006 Part Ⅰ

    Institute of Scientific and Technical Information of China (English)

    YAO Dingkang; ZHU Liang; ZHAO Xue; MEI Changlin

    2007-01-01

    The growing interest has been placed in the current state of China's internal medicine from all over the world.Many data of internal medicine in China were collected by searching through some of the most prominent medical magazines published in China in 2006.Because there are many researches on the field of internal medicine,just some representative reports focusing on this topic were selected in this paper.In part Ⅰ of this study,a summary of the advances made in cardiology,respiration diseases,and gastroenterology was presented.

  13. Exerting the Role of Journal of International Translational Medicine in Translational Medicine

    Institute of Scientific and Technical Information of China (English)

    YE Zhen-hua; DU Fu-rong; YANG Xue; WU Yin-ping; YI Zi; CHEN Chong

    2014-01-01

    As a new branch of medicine with unlimited prospect, Translational Medicine has been rapidly developed over the past decades and gained global attention. Translational Medicine can be vividly described as“bench to bedside (B2B)”model which focuses on the integration of multiple aspects, especially the basic medicine and clinical medicine, and has a great potential in treating many severe diseases and improving human health. Medical journals are carriers for medical information and play a great role in the development of medicines, and Journal of International Translational Medicine (JITM) is just a journal emerging at the right moment and specialized in translational medicine. With professionalized attitude and internationalized requirements, JITM is committed to promote the development of Translational Medicine.

  14. Index of International Publications in Aerospace Medicine

    Science.gov (United States)

    2010-10-01

    Aerospace Medicine technical reports are available in full-text from the Civil Aerospace Medical Institute’s publications Web site: www.faa.gov/library...Other Topics Related to Aerospace Medicine IBERIA Dirección Servicios al Cliente. Pasajeros con Movilidad Reducida. Consejos para el Viaje. Madrid...Enfermos. Madrid, Spain: Ministerio del Aire, Servicio Información Aeronáutica, 1956. National Air Transportation Association. NATA Bloodborne Pathogens

  15. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  16. Principles to consider in defining new directions in internal medicine training and certification.

    Science.gov (United States)

    Turner, Barbara J; Centor, Robert M; Rosenthal, Gary E

    2006-03-01

    SGIM endorses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care.

  17. General Issues in International and European Law

    Directory of Open Access Journals (Sweden)

    Gentian Zyberi

    2015-08-01

    Full Text Available As a former editor of the predecessor to this journal, namely Merkourios, it gives me great pleasure to write the editorial for the 81st issue of the Utrecht Journal of International and European Law (“UJIEL” on ‘General Issues in International and European Law’. After first providing a general overview of the materials contained in this issue, I will briefly highlight some of the main points made in, the five articles, the case note, two book reviews, and the interview.

  18. Advances in internal medicine. Volume 30

    Energy Technology Data Exchange (ETDEWEB)

    Stollerman, G.H.

    1984-01-01

    This book discusses the recent advances made in medicine. Topics discussed are--pathogenesis of T-cell Leukemia Virus; Immunosuppression; Acquired immune deficiency syndrome (AIDS)--organs affected and etiology; molecular biology of bacterial infections; pneumonia; patterns of aspergillosillosis infections; leukotrienes; cardiovascular action of beta-blockers; toxicity of drugs and biological effects of metals; and carcinogenesis of various carcinogens.

  19. [The practice of Internal Medicine in Andalusia follows the evidence-based medicine basic principles].

    Science.gov (United States)

    Zambrana García, J L; Velasco Malagón, M J; Díez García, F; Martín-Escalante, M D; Cruz-Caparrós, G

    2003-10-01

    To know the proportion of medical interventions carried out in the Services of Internal Medicine of the public hospitals of Andalusia based on randomized clinical trials. We have analyzed the primary treatments prescribed in a random sample of 326 patients admitted to these Internal Medicine services during 1998. One hundred and forty-three of the 326 treatments analyzed (43.9%) were based in clinical trials and 135 (41.4%) were interventions unanimously accepted by the medical community without being based in clinical trials. Most of the primary Andalusian treatments prescribed in the Internal Medicine services are evidence-based.

  20. The internal medicine clerkship and ambulatory learning experiences: results of the 2010 clerkship directors in internal medicine survey.

    Science.gov (United States)

    Shaheen, Amy; Papp, Klara K; Torre, Dario

    2013-01-01

    Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear. The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship. An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques. The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources. There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination

  1. The role of general nuclear medicine in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Greene, Lacey R, E-mail: lgreene@csu.edu.au [Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales (Australia); Wilkinson, Deborah [Faculty of Health, Wheeling Jesuit University, Wheeling, West Virginia (United States); Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales (Australia)

    2015-03-15

    The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.

  2. Study on international standard multilingual nomenclature of Chinese medicine.

    Science.gov (United States)

    Wang, Kui; Liu, Lu; Li, Wei; Shi, Da-zhuo; Zeng, Wen-ying; Zhu, Mian-sheng; Angles, Michel; Attali, Jean-Raymond; Choy, Pedro; Choy, Joao; Wu, Chi-haur; Zhai, Fu-han; Ramon, Maria Calduch; Chung, Ching

    2010-04-01

    The International Standard Chinese-English Basic Nomenclature of Chinese medicine (ISN) was released in 2007, a nomenclature list consisting of 6 500 Chinese medical terms. ISN was the culmination of several years of collaborative diligent work of over 200 specialists who represent Chinese medicine in 68 countries. The overall goal for devising standard English nomenclature for Chinese medicine is to develop a practical international standard nomenclature for Chinese medical basic terms, to make it compatible with contemporary research and educational standards in the globalized health care service. In this article, provided is an overview of principles and methods for the multilingual translations, the processes behind the particular content of the Chinese-English ISN and an introduction to the ongoing new projects, i.e. the multilingual versions of ISN (International Standards of Chinese-Spanish, Chinese-French and Chinese-Portuguese Basic Nomenclature of Chinese Medicine).

  3. Index of International Publications in Aerospace Medicine

    Science.gov (United States)

    2014-05-01

    Grazhdanskoi Aviatsii, 2004. Aviation and Environmental Physiology Acosta J. Historia Natural y Moral de las Indias. Seville, 1590. (English Translation...of the Upper Atmosphere. Albuquerque, NM, USA: The University of New Mexico Press, 1952. Whiteside TDC. The Problems of Vision in Flight at High...HW. Human Factors in Flight. Aldershot, England: Ashgate, 1993. Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: National

  4. [Smoking cessation: experience in general medicine].

    Science.gov (United States)

    Cnockaert, P

    2003-09-01

    The author reviews the main psychological resistances that may be the origin of discomfort and diminishing efficiency for the general practitioner when the meets tobacco addict patients in his practice. He examines the different stages of the tobacco addicts patients according to the Prochaska and Di Clemente model and discusses stage after stage the patient's motivations and the interventions of the general practitioner. He insists on the necessary adequacy between these aspects and proposes a possible content for follow-up consultations.

  5. Global health education in general preventive medicine residencies.

    Science.gov (United States)

    Bussell, Scottie A; Kihlberg, Courtney J; Foderingham, Nia M; Dunlap, Julie A; Aliyu, Muktar H

    2015-05-01

    Opportunities for global health training during residency are steadily increasing. For example, surveys show that more than half of residency programs now offer international electives. Residency programs are increasingly recognizing that global health training improves communication skills, fosters awareness of health disparities, and inspires careers in primary care and public health. Although research has focused on global health education in other specialties, there is a paucity of research on global health training in public health and general preventive medicine (GPM). We sought to describe the extent of global health training across GPM residencies, capture the perspectives of program directors regarding competencies residents need for careers in global health, and identify program directors' perceived barriers to providing global health training. The survey was sent electronically to 42 U.S. GPM residency program directors from September to October 2013. Twenty-three completed surveys were returned. Information from residencies that did not complete the study survey was collected through a predefined search protocol. Data analysis was performed from February through July 2014. Among program directors completing the survey, the most common types of reported global health education were courses (n=17), followed by international rotations (n=10). Ten program directors indicated that resident(s) were involved in global health training, research, or service initiatives. Commonly perceived barriers included funding (87%), scheduling (56.5%), and partnership and sustainability (34.8%). Through global health coursework, research, and practicum rotations, GPM residents could acquire skills, knowledge, and attitudes contributing to careers in global health.

  6. [100 essential drugs. An internal medicine approach].

    Science.gov (United States)

    Thomas, M; Arlet, P; Aumaitre, O; Cosserat, J; Grosbois, B; Guillevin, L; Kettaneh, A; Le Jeunne, C; Massot, C; Morlat, P

    2013-08-01

    Up to 4600 drugs in about 15,000 pharmaceutical forms are available in France which may be a source of misuse with increased occurrence of side effects and costs. While the World Health Organization is encouraging each developed country to work out its own list of essential drugs. The list provided in 2008 by the French Office for the safety of health products has had so far limited impact on practice, so it became obvious to a group of internists to work out a "wise list" of 100 essential medicines covering 95% of the disorders observed in France. In June 2011, 10 internists agreed to each provide a list of 100 essential medicines, according to individual experience. In December 2011, a meeting of the participants provided a list as initial consensus and mandated five among them to make proposals for those areas neglected by too many participants or in which needless dispersion of medicines was stated. After internet-facilitated exchanges, an additional list was validated in mild-January 2012. Fifty-four drugs were included in the list of initial consensus (including nine selected by all 10 participants), and 46 in the additional list. So the final "wise list" included 100 drugs. In June 2012, 56 of these drugs were available as generics. This list was compared to those lists set out by five countries in the European Union. Generating such a list is feasible. Undoubtedly still non-comprehensive, this list will benefit from the expertise of 14 general practitioners who are currently working out a similar list across France. The final list will be submitted for validation by the French associations of generalist teachers and Internists. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  7. REGENERATIVE MEDICINE AS APPLIED TO GENERAL SURGERY

    Science.gov (United States)

    Orlando, Giuseppe; Wood, Kathryn J; De Coppi, Paolo; Baptista, Pedro M; Binder, Kyle W; Bitar, Khalil N; Breuer, Christopher; Burnett, Luke; Christ, George; Farney, Alan; Figliuzzi, Marina; Holmes, James H; Koch, Kenneth; Macchiarini, Paolo; Sani, Sayed-Hadi Mirmalek; Opara, Emmanuel; Remuzzi, Andrea; Rogers, Jeffrey; Saul, Justin M; Seliktar, Dror; Shapira-Schweitzer, Keren; Smith, Tom; Solomon, Daniel; Van Dyke, Mark; Yoo, James J; Zhang, Yuanyuan; Atala, Anthony; Stratta, Robert J; Soker, Shay

    2012-01-01

    The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues or organs in order to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate. PMID:22330032

  8. Human genetics: international projects and personalized medicine.

    Science.gov (United States)

    Apellaniz-Ruiz, Maria; Gallego, Cristina; Ruiz-Pinto, Sara; Carracedo, Angel; Rodríguez-Antona, Cristina

    2016-03-01

    In this article, we present the progress driven by the recent technological advances and new revolutionary massive sequencing technologies in the field of human genetics. We discuss this knowledge in relation with drug response prediction, from the germline genetic variation compiled in the 1000 Genomes Project or in the Genotype-Tissue Expression project, to the phenome-genome archives, the international cancer projects, such as The Cancer Genome Atlas or the International Cancer Genome Consortium, and the epigenetic variation and its influence in gene expression, including the regulation of drug metabolism. This review is based on the lectures presented by the speakers of the Symposium "Human Genetics: International Projects & New Technologies" from the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held on the 20th and 21st of April 2015.

  9. Trend and impact of international collaboration in clinical medicine papers published in Malaysia.

    Science.gov (United States)

    Low, Wah Yun; Ng, Kwan Hoong; Kabir, M A; Koh, Ai Peng; Sinnasamy, Janaki

    2014-01-01

    Research collaboration is the way forward in order to improve quality and impact of its research findings. International research collaboration has resulted in international co-authorship in scientific communications and publications. This study highlights the collaborating research and authorship trend in clinical medicine in Malaysia from 2001 to 2010. Malaysian-based author affiliation in the Web of Science (Science Citation Index Expanded) and clinical medicine journals (n = 999) and articles (n = 3951) as of 30th Oct 2011 were downloaded. Types of document analyzed were articles and reviews, and impact factors (IF) in the 2010 Journal Citation Report Science Edition were taken to access the quality of the articles. The number of publications in clinical medicine increased from 4.5 % (n = 178) in 2001 to 23.9 % (n = 944) in 2010. The top three contributors in the subject categories are Pharmacology and Pharmacy (13.9 %), General and Internal Medicine (13.6 %) and Tropical Medicine (7.3 %). By journal tier system: Tier 1 (18.7 %, n = 738), Tier 2 (22.5 %, n = 888), Tier 3 (29.6 %, n = 1170), Tier 4 (27.2 %, n = 1074), and journals without IF (2.1 %, n = 81). University of Malaya was the most productive. Local collaborators accounted for 60.3 % and international collaborations 39.7 %. Articles with international collaborations appeared in journals with higher journal IFs than those without international collaboration. They were also cited more significantly than articles without international collaborations. Citations, impact factor and journal tiers were significantly associated with international collaboration in Malaysia's clinical medicine publications. Malaysia has achieved a significant number of ISI publications in clinical medicine participation in international collaboration.

  10. [International Relationship of Japanese General Thoracic Surgeons].

    Science.gov (United States)

    Okumura, Meinoshin

    2017-01-01

    Japanese thoracic surgeons have created personal relationship with European and North American surgeons. During the last 10 years, official relation between Japanese Association for Chest Surgery(JACS) and European Society of Thoracic Surgeons (ESTS) has been established besides personal interaction, and communication among the thoracic surgeons in Asia was prompted through Asia Thoracoscopic Surgery Education Program( ATEP). International relationship through academic associations is expected to contribute to encouraging general thoracic surgeons.

  11. The validity of peer review in a general medicine journal.

    Directory of Open Access Journals (Sweden)

    Jeffrey L Jackson

    Full Text Available UNLABELLED: All the opinions in this article are those of the authors and should not be construed to reflect, in any way, those of the Department of Veterans Affairs. BACKGROUND: Our study purpose was to assess the predictive validity of reviewer quality ratings and editorial decisions in a general medicine journal. METHODS: Submissions to the Journal of General Internal Medicine (JGIM between July 2004 and June 2005 were included. We abstracted JGIM peer review quality ratings, verified the publication status of all articles and calculated an impact factor for published articles (Rw by dividing the 3-year citation rate by the average for this group of papers; an Rw>1 indicates a greater than average impact. RESULTS: Of 507 submissions, 128 (25% were published in JGIM, 331 rejected (128 with review and 48 were either not resubmitted after revision was requested or were withdrawn by the author. Of 331 rejections, 243 were published elsewhere. Articles published in JGIM had a higher citation rate than those published elsewhere (Rw: 1.6 vs. 1.1, p = 0.002. Reviewer quality ratings of article quality had good internal consistency and reviewer recommendations markedly influenced publication decisions. There was no quality rating cutpoint that accurately distinguished high from low impact articles. There was a stepwise increase in Rw for articles rejected without review, rejected after review or accepted by JGIM (Rw 0.60 vs. 0.87 vs. 1.56, p<0.0005. However, there was low agreement between reviewers for quality ratings and publication recommendations. The editorial publication decision accurately discriminated high and low impact articles in 68% of submissions. We found evidence of better accuracy with a greater number of reviewers. CONCLUSIONS: The peer review process largely succeeds in selecting high impact articles and dispatching lower impact ones, but the process is far from perfect. While the inter-rater reliability between individual

  12. Performance of International Medical Students In psychosocial medicine.

    Science.gov (United States)

    Huhn, D; Lauter, J; Roesch Ely, D; Koch, E; Möltner, A; Herzog, W; Resch, F; Herpertz, S C; Nikendei, C

    2017-07-10

    Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. International medical students scored significantly poorer than their local peers (p International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship.

  13. Notes on "Clinical and Internal Medicine. Past, Present and Future”

    Directory of Open Access Journals (Sweden)

    Ricardo Hodelín Tablada

    2014-06-01

    Full Text Available "Clinical and Internal Medicine. Past, Present and Future" is a book written by Professor Alfredo Darío Espinosa Brito and published by Medical Sciences in 2011. It was awarded the prize of the Cuban Academy of Sciences. This article aims to encourage reading this book, a veritable compendium of the past, present and future of internal medicine. It outlines the issues addressed, from the structure designed for them to a fairly comprehensive assessment of the elements that define the scientific and literary value of this work.

  14. Intern underperformance is detected more frequently in emergency medicine rotations.

    Science.gov (United States)

    Aram, Narelle; Brazil, Victoria; Davin, Lorna; Greenslade, Jaimi

    2013-02-01

    To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Parkinson's disease between internal medicine and neurology.

    Science.gov (United States)

    Csoti, Ilona; Jost, Wolfgang H; Reichmann, Heinz

    2016-01-01

    General medical problems and complications have a major impact on the quality of life in all stages of Parkinson's disease. To introduce an effective treatment, a comprehensive analysis of the various clinical symptoms must be undertaken. One must distinguish between (1) diseases which arise independently of Parkinson's disease, and (2) diseases which are a direct or indirect consequence of Parkinson's disease. Medical comorbidity may induce additional limitations to physical strength and coping strategies, and may thus restrict the efficacy of the physical therapy which is essential for treating hypokinetic-rigid symptoms. In selecting the appropriate medication for the treatment of any additional medical symptoms, which may arise, its limitations, contraindications and interactions with dopaminergic substances have to be taken into consideration. General medical symptoms and organ manifestations may also arise as a direct consequence of the autonomic dysfunction associated with Parkinson's disease. As the disease progresses, additional non-parkinsonian symptoms can be of concern. Furthermore, the side effects of Parkinson medications may necessitate the involvement of other medical specialists. In this review, we will discuss the various general medical aspects of Parkinson's disease.

  16. Internal Medicine Residents Do Not Accurately Assess Their Medical Knowledge

    Science.gov (United States)

    Jones, Roger; Panda, Mukta; Desbiens, Norman

    2008-01-01

    Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well…

  17. Molecular Medicine - CHI's 17th International Tri-Conference: Mastering Medicinal Chemistry - CHI's Seventh Annual Conference.

    Science.gov (United States)

    Terrett, Nick

    2010-04-01

    CHI's 17th International Tri-Conference on Molecular Medicine, held in San Francisco, included topics covering new developments in the field of medicinal chemistry. This conference report highlights selected presentations on fragment-based drug discovery, quantum mechanical energy decomposition for the analysis of SARs, medicinal chemistry strategies and the role of imaging in drug discovery. Investigational drugs discussed include MLN-4924 (Millennium Pharmaceuticals Inc), GDC-0449 (Chugai Pharmaceutical Co Ltd/Curis Inc/F Hoffmann-La Roche Ltd/Genentech Inc/NCI), RDEA-119 (Ardea Biosciences Inc/Bayer HealthCare AG) and tafamidis (Fx-1006A; FoldRx Pharmaceuticals Inc).

  18. Teaching strategies used by internal medicine residents on the wards.

    Science.gov (United States)

    Smith, Dustin T; Kohlwes, R Jeffrey

    2011-01-01

    Residents serve as teachers to interns and students in most internal medicine residency programs. The purpose of our study is to explore what internal medicine residents perceive as effective teaching strategies in the inpatient setting and to formulate a guideline for preparing residents to lead their ward teams. Housestaff identified as excellent teaching residents were recruited from a large internal medicine residency program. Focus groups were formed and interviews were conducted using open-ended questions. Transcripts of the interviews were reviewed, analyzed, and compared for accuracy by two investigators. The transcripts were then coded to categorize data into similar subjects from which recurrent themes in resident teaching were identified. Twenty-two residents participated in four focus group interviews held in 2008. We identified five principal themes for effective teaching by residents: (T)aking advantage of teaching opportunities, (E)mpowering learners, (A)ssuming the role of leader, (C)reating a learning environment, and (H)abituating the practice of teaching. Strategies for effective teaching by residents exist. The TEACH mnemonic is a resident-identified method of instruction. Use of this tool could enable residency programs to create instructional curricula to prepare their residents and interns to take on the roles of team leaders and teachers.

  19. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter.

    Science.gov (United States)

    Block, Lauren; Hutzler, Lindsey; Habicht, Robert; Wu, Albert W; Desai, Sanjay V; Novello Silva, Kathryn; Niessen, Timothy; Oliver, Nora; Feldman, Leonard

    2013-11-01

    Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine.

  20. 6th International Conference on General Inequalities

    CERN Document Server

    1992-01-01

    The sixthInternational Conference on General Inequalities was held from Dec. 9 to Dec. 15, 1990, at the Mathematisches Forschungsinstitut Oberwolfach (Black Fa­ rest, Germany). The organizing committee was composed of W.N. Everitt (Birm­ ingham), L. Losonczi (Debrecen) and W. Walter (Karlsruhe). Dr. A. Kovacec ( Coimbra) served cheerfully and efficiently as secretary of the meeting. The con­ ference was attended by 44 participants from 20 countries. Yet again the importance of inequalities in both pure and applied mathematics was made evident from the wide range of interests of the individual participants, and from the wealth of new results announced. New inequalities were presented in the usual spread of the subject areas now expected for these meetings: Classical and functional analysis, existence and boundary value problems for both ordinary and partial differential equations, with special contributions to computer science, quantum holography and error analysis. More strongly than ever, the role played ...

  1. Documentation of quality improvement exposure by internal medicine residency applicants

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2016-02-01

    Full Text Available Background: Quality improvement (QI has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. Purpose: To document the reporting of QI training or experience in residency applications. Methods: Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs, personal statements (PSs, and letters of recommendation (LORs. CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI modules. Results: Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6% documented QI engagement. Conclusion: Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

  2. Documentation of quality improvement exposure by internal medicine residency applicants.

    Science.gov (United States)

    Kolade, Victor O; Sethi, Anuradha

    2016-01-01

    Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. To document the reporting of QI training or experience in residency applications. Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

  3. Molecular Medicine - CHI's 17th International Tri-Conference: Mastering Medicinal Chemistry - CHI's Seventh Annual Conference.

    Science.gov (United States)

    Semple, Graeme

    2010-04-01

    CHI's 17th International Tri-Conference on Molecular Medicine, held in San Francisco, included topics covering the drug discovery process, with an emphasis on lead optimization. This conference report highlights selected presentations on the development of several launched and investigational drugs, including Plerixafor, Trox-1 (CombinatoRX Inc), lorcaserin (Arena Pharmaceuticals Inc), vorapaxar (Merck & Co Inc) and ulimorelin (Tranzyme Pharma Inc).

  4. International Federation for Emergency Medicine point of care ultrasound curriculum.

    Science.gov (United States)

    Atkinson, Paul; Bowra, Justin; Lambert, Mike; Lamprecht, Hein; Noble, Vicki; Jarman, Bob

    2015-03-01

    To meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine. The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.

  5. Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept.

    Science.gov (United States)

    Lucini, Daniela; Cesana, Giovanna; Vigo, Chiara; Malacarne, Mara; Pagani, Massimo

    2015-11-01

    Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors amenable to change. Accordingly, addressing behavior might represent a strategic change in the health delivery system. Improving lifestyle requires a specific strategy embedding the active collaboration of individuals with a multilevel team-oriented medical practice. With the present study we sought to assess whether the implementation of cognitive-behavioral strategies, following the principles of lifestyle medicine in an outpatient clinic provides better results in weight reduction as compared to simpler strategies as presently executed in General Practitioners' offices. This is an observational study on 173 subjects (age 53.1 ± 11.5), comparing three different groups of preventive practice: a personalized lifestyle medicine, combining cognitive behavioral strategies with patient tailored prescription of exercise and nutrition (Group A); a semi-structured approach with generic counseling (Group B); and an unstructured advice (Group C). At the end of the intervention period (17-20 months), group A showed an average weight loss of 5.4 ± 5.1 kg, which was significantly (pinternal medicine clinics. This methodology appears more efficacious in inducing weight reduction after more than a year as compared to usual family medicine approaches. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  6. Definitions of Internal Medicine activities outside of the im department.

    Science.gov (United States)

    Montero Ruiz, E; Monte Secades, R

    2015-04-01

    The inpatient profile is changing towards patients with multiple diseases, the elderly and those with high comorbidity. The growing complexity of their care, the progressive medical superspecialization and the organizational problems that often hinder daily patient follow-up by the same physician have contributed to a progressive increase in the participation of medical departments, especially Internal Medicine, in the care of patients hospitalized in other medical and surgical specialties. The hospital activities that the departments of internal medicine perform outside of their own department do not have well-established definitions and criteria at the organizational level; their assessment and accountability are different in each hospital. In this document, we establish the definitions for shared care, advisory medicine, perioperative medicine and interconsultation, as well as their types in terms of priority, formality, care setting, timeliness, relationship with surgery and other circumstances. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now.

    Science.gov (United States)

    Sabath, Bruce F; Singh, Gurkeerat

    2016-01-01

    Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution - a community hospital - in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

  8. Author self-citation in the general medicine literature.

    Directory of Open Access Journals (Sweden)

    Abhaya V Kulkarni

    Full Text Available BACKGROUND: Author self-citation contributes to the overall citation count of an article and the impact factor of the journal in which it appears. Little is known, however, about the extent of self-citation in the general clinical medicine literature. The objective of this study was to determine the extent and temporal pattern of author self-citation and the article characteristics associated with author self-citation. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective cohort study of articles published in three high impact general medical journals (JAMA, Lancet, and New England Journal of Medicine between October 1, 1999 and March 31, 2000. We retrieved the number and percentage of author self-citations received by the article since publication, as of June 2008, from the Scopus citation database. Several article characteristics were extracted by two blinded, independent reviewers for each article in the cohort and analyzed in multivariable linear regression analyses. Since publication, author self-citations accounted for 6.5% (95% confidence interval 6.3-6.7% of all citations received by the 328 articles in our sample. Self-citation peaked in 2002, declining annually thereafter. Studies with more authors, in cardiovascular medicine or infectious disease, and with smaller sample size were associated with more author self-citations and higher percentage of author self-citation (all p≤0.01. CONCLUSIONS/SIGNIFICANCE: Approximately 1 in 15 citations of articles in high-profile general medicine journals are author self-citations. Self-citation peaks within about 2 years of publication and disproportionately affects impact factor. Studies most vulnerable to this effect are those with more authors, small sample size, and in cardiovascular medicine or infectious disease.

  9. First International Electronic Conference on Medicinal Chemistry (ECMC-1)

    Science.gov (United States)

    Mayence, Annie; Vanden Eynde, Jean Jacques

    2016-01-01

    The first International Electronic Conference on Medicinal Chemistry, organized and sponsored by MDPI AG, publisher, and the Journal Pharmaceuticals, took place in November 2015 on the SciForum website. More than 200 authors from 18 countries participated in the event and was attended by 25,000 visitors who had the opportunity to browse among 55 presentations, keynotes, and videos. A short description of some works presented during that scientific meeting is disclosed in this report.

  10. Recent trends in internal medicine education: a brief update.

    Science.gov (United States)

    Flannery, Michael T

    2014-03-01

    This perspective attempts to bring graduate medical offices, residency programs and medical students interested in categorical internal medicine (CIM) a brief update on the American Board of Internal Medicine (ABIM), Accreditation Council for Graduate Medical Education (ACGME) and the National Registry for Medical Programs (NRMP) changes for the past 3-5 years in the United States (US). The US model for certification and recertification may serve as a homogenous example for other countries. This model will be described so that there is an understanding of the importance of such changes in the American system and its effect on resident education. This is critical knowledge for both teachers and learners in internal medicine in preparation for a lifetime career and requirements for certification/credentialing for both programs and their residents/fellows. Data from the review indicate a small increase in the number of applicants but a concordant decrease in ABIM initial certification exams. Programs should well be aware of the new focus on outcomes via the Next Accreditation System (NAS) being put forth by the ACGME.

  11. Internal medicine interns have a poor knowledge of peripheral artery disease.

    Science.gov (United States)

    Schwarcz, Aron I; Quijano, Aimee; Olin, Jeffrey W; Ostfeld, Robert J

    2012-11-01

    Peripheral arterial disease (PAD) is common and carries an increased risk of morbidity and mortality. The level of knowledge among incoming medical trainees about PAD is unknown. During orientation to a single internal medicine residency program, incoming medical interns were given a 19-question multiple-choice questionnaire. The questions fell into 1 of 4 categories about PAD: (1) prevalence, (2) screening, (3) treatment, and (4) outcome. Sixty-two incoming interns were queried. The percentage of questions answered correctly overall was 41.7% (10.5%-73.7%). The percentage of questions answered correctly in the prevalence, screening, treatment, and outcome groups were 48.9% (0 to 100%), 33.8% (0 to 80%), 45.0% (0 to 87.5%), and 42.5% (0 to 100%), respectively. Internal medicine interns have poor knowledge about PAD including its prevalence, screening, treatment, and outcomes. Increased education during medical school is encouraged.

  12. The association of students requiring remediation in the internal medicine clerkship with poor performance during internship.

    Science.gov (United States)

    Hemann, Brian A; Durning, Steven J; Kelly, William F; Dong, Ting; Pangaro, Louis N; Hemmer, Paul A

    2015-04-01

    To determine whether the Uniformed Services University (USU) system of workplace performance assessment for students in the internal medicine clerkship at the USU continues to be a sensitive predictor of subsequent poor performance during internship, when compared with assessments in other USU third year clerkships. Utilizing Program Director survey results from 2007 through 2011 and U.S. Medical Licensing Examination (USMLE) Step 3 examination results as the outcomes of interest, we compared performance during internship for students who had less than passing performance in the internal medicine clerkship and required remediation, against students whose performance in the internal medicine clerkship was successful. We further analyzed internship ratings for students who received less than passing grades during the same time period on other third year clerkships such as general surgery, pediatrics, obstetrics and gynecology, family medicine, and psychiatry to evaluate whether poor performance on other individual clerkships were associated with future poor performance at the internship level. Results for this recent cohort of graduates were compared with previously published findings. The overall survey response rate for this 5 year cohort was 81% (689/853). Students who received a less than passing grade in the internal medicine clerkship and required further remediation were 4.5 times more likely to be given poor ratings in the domain of medical expertise and 18.7 times more likely to demonstrate poor professionalism during internship. Further, students requiring internal medicine remediation were 8.5 times more likely to fail USMLE Step 3. No other individual clerkship showed any statistically significant associations with performance at the intern level. On the other hand, 40% of students who successfully remediated and did graduate were not identified during internship as having poor performance. Unsuccessful clinical performance which requires remediation in

  13. The Third International Genomic Medicine Conference (3rd IGMC, 2015: overall activities and outcome highlights

    Directory of Open Access Journals (Sweden)

    Muhammad Abu-Elmagd

    2016-10-01

    Full Text Available Abstract The Third International Genomic Medicine Conference (3rd IGMC was organised by the Centre of Excellence in Genomic Medicine Research (CEGMR at the King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia (KSA. This conference is a continuation of a series of meetings, which began with the first International Genomic Medicine Conference (1st IGMC, 2011 followed by the second International Genomic Medicine Conference (2nd IGMC, 2013. The 3rd IGMC meeting presented as a timely opportunity to bring scientists from across the world to gather, discuss, and exchange recent advances in the field of genomics and genetics in general as well as practical information on using these new technologies in different basic and clinical applications. The meeting undoubtedly inspired young male and female Saudi researchers, who attended the conference in large numbers, as evidenced by the oversubscribed oral and poster presentations. The conference also witnessed the launch of the first content for npj Genomic Medicine, a high quality new journal was established in partnership by CEGMR with Springer Nature and published as part of the Nature Partner Journal series. Here, we present a brief summary report of the 2-day meeting including highlights from the oral presentations, poster presentations, workshops, poster prize-winners and comments from the distinguished scientists.

  14. The Third International Genomic Medicine Conference (3rd IGMC, 2015): overall activities and outcome highlights.

    Science.gov (United States)

    Abu-Elmagd, Muhammad; Assidi, Mourad; Dallol, Ashraf; Buhmeida, Abdelbaset; Pushparaj, Peter Natesan; Kalamegam, Gauthaman; Al-Hamzi, Emad; Shay, Jerry W; Scherer, Stephen W; Agarwal, Ashok; Budowle, Bruce; Gari, Mamdooh; Chaudhary, Adeel; Abuzenadah, Adel; Al-Qahtani, Mohammed

    2016-10-17

    The Third International Genomic Medicine Conference (3(rd) IGMC) was organised by the Centre of Excellence in Genomic Medicine Research (CEGMR) at the King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia (KSA). This conference is a continuation of a series of meetings, which began with the first International Genomic Medicine Conference (1(st) IGMC, 2011) followed by the second International Genomic Medicine Conference (2(nd) IGMC, 2013). The 3(rd) IGMC meeting presented as a timely opportunity to bring scientists from across the world to gather, discuss, and exchange recent advances in the field of genomics and genetics in general as well as practical information on using these new technologies in different basic and clinical applications. The meeting undoubtedly inspired young male and female Saudi researchers, who attended the conference in large numbers, as evidenced by the oversubscribed oral and poster presentations. The conference also witnessed the launch of the first content for npj Genomic Medicine, a high quality new journal was established in partnership by CEGMR with Springer Nature and published as part of the Nature Partner Journal series. Here, we present a brief summary report of the 2-day meeting including highlights from the oral presentations, poster presentations, workshops, poster prize-winners and comments from the distinguished scientists.

  15. A Needs Assessment for a Longitudinal Emergency Medicine Intern Curriculum

    Science.gov (United States)

    Shappell, Eric; Ahn, James

    2017-01-01

    Introduction A key task of emergency medicine (EM) training programs is to develop a consistent knowledge of core content in recruits with heterogeneous training backgrounds. The traditional model for delivering core content is lecture-based weekly conference; however, a growing body of literature finds this format less effective and less appealing than alternatives. We sought to address this challenge by conducting a needs assessment for a longitudinal intern curriculum for millennial learners. Methods We surveyed all residents from the six EM programs in the greater Chicago area regarding the concept, format, and scope of a longitudinal intern curriculum. Results We received 153 responses from the 300 residents surveyed (51% response rate). The majority of respondents (80%; 82% of interns) agreed or strongly agreed that a dedicated intern curriculum would add value to residency education. The most positively rated teaching method was simulation sessions (91% positive responses), followed by dedicated weekly conference time (75% positive responses) and dedicated asynchronous resources (71% positive responses). Less than half of respondents (47%; 26% of interns) supported use of textbook readings in the curriculum. Conclusion There is strong learner interest in a longitudinal intern curriculum. This needs assessment can serve to inform the development of a universal intern curriculum targeting the millennial generation. PMID:28116005

  16. A Needs Assessment for a Longitudinal Emergency Medicine Intern Curriculum

    Directory of Open Access Journals (Sweden)

    Shappell, Eric

    2017-01-01

    Full Text Available A key task of emergency medicine (EM training programs is to develop a consistent knowledge of core content in recruits with heterogeneous training backgrounds. The traditional model for delivering core content is lecture-based weekly conference; however, a growing body of literature finds this format less effective and less appealing than alternatives. We sought to address this challenge by conducting a needs assessment for a longitudinal intern curriculum for millennial learners. We surveyed all residents from the six EM programs in the greater Chicago area regarding the concept, format, and scope of a longitudinal intern curriculum. We received 153 responses from the 300 residents surveyed (51% response rate. The majority of respondents (80%; 82% of interns agreed or strongly agreed that a dedicated intern curriculum would add value to residency education. The most positively rated teaching method was simulation sessions (91% positive responses, followed by dedicated weekly conference time (75% positive responses and dedicated asynchronous resources (71% positive responses. Less than half of respondents (47%; 26% of interns supported use of textbook readings in the curriculum. There is strong learner interest in a longitudinal intern curriculum. This needs assessment can serve to inform the development of a universal intern curriculum targeting the millennial generation. [West J Emerg Med. 2017;18(131-34.

  17. A Needs Assessment for a Longitudinal Emergency Medicine Intern Curriculum.

    Science.gov (United States)

    Shappell, Eric; Ahn, James

    2017-01-01

    A key task of emergency medicine (EM) training programs is to develop a consistent knowledge of core content in recruits with heterogeneous training backgrounds. The traditional model for delivering core content is lecture-based weekly conference; however, a growing body of literature finds this format less effective and less appealing than alternatives. We sought to address this challenge by conducting a needs assessment for a longitudinal intern curriculum for millennial learners. We surveyed all residents from the six EM programs in the greater Chicago area regarding the concept, format, and scope of a longitudinal intern curriculum. We received 153 responses from the 300 residents surveyed (51% response rate). The majority of respondents (80%; 82% of interns) agreed or strongly agreed that a dedicated intern curriculum would add value to residency education. The most positively rated teaching method was simulation sessions (91% positive responses), followed by dedicated weekly conference time (75% positive responses) and dedicated asynchronous resources (71% positive responses). Less than half of respondents (47%; 26% of interns) supported use of textbook readings in the curriculum. There is strong learner interest in a longitudinal intern curriculum. This needs assessment can serve to inform the development of a universal intern curriculum targeting the millennial generation.

  18. Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination Performance

    Science.gov (United States)

    Perez, Jose A., Jr.; Greer, Sharon

    2009-01-01

    The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical…

  19. Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

    Directory of Open Access Journals (Sweden)

    Kassam Narmin

    2011-06-01

    Full Text Available Abstract Background There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey. Methods A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4 fellowship match using focus group discussions involving third and fourth year internal medicine residents Results Based on content analysis of the discussion data, we identified five themes: 1 Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income 2 Exposure in rotations and to role models 3 Interest in subspecialty's patient population and common diseases 4 Prestige and respect of subspecialty 5 Fellowship training environment including fellowship program resources and length of training Conclusions There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.

  20. Determinants of internal medicine residents' choice in the Canadian R4 fellowship match: a qualitative study.

    Science.gov (United States)

    Daniels, Vijay J; Kassam, Narmin

    2011-06-29

    There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match) and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey. A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4) fellowship match using focus group discussions involving third and fourth year internal medicine residents Based on content analysis of the discussion data, we identified five themes:1) Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income 2) Exposure in rotations and to role models 3) Interest in subspecialty's patient population and common diseases 4) Prestige and respect of subspecialty 5) Fellowship training environment including fellowship program resources and length of training There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.

  1. Knowledge of addiction medicine among internal medicine residents and medical students.

    Science.gov (United States)

    Brown, Angel T; Kolade, Victor O; Staton, Lisa J; Patel, Neha K

    2013-03-01

    More than 22 million Americans are living with addiction, including nearly seven million who misuse prescription medications. However, most medical schools and residency programs provide little to no education addressing alcohol and drug addiction. Implementation of a new addiction medicine curriculum at a single internal medicine program provided an opportunity for knowledge assessment in a select population of health professionals. We hypothesized that knowledge of addiction medicine would not differ by training level or geographical location of medical school, but that knowledge would improve following a structured curriculum. Study participants included internal medicine and transitional year residents, as well as a group of medical students who were enrolled in a single internal medicine program at the time of the didactic series. A pre-test was administered prior to a four-week structured curriculum. The topics addressed included but were not limited to: 1) an overview of addiction, 2) opioids and chronic pain, 3) benzodiazepines and illicit stimulants, and 4) alcohol. A panel discussion was convened at the end of the fourth session. Following participation in the symposium, participants completed an online post-test. ANOVA was used to compare means. Paired t-tests were used to compare pre-test and post-test scores. 36 of 44 eligible medical students and residents completed the pre-test. Mean pre-test percentage scores were 64 percent for fourth year medical students and 62.5 percent for all residents. For residents, U.S. medical school trainees answered 65 percent of the pre-test questions correctly, versus 58.6 percent correct responses among their international medical graduate peers. No inter-group differences were statistically significant. Of the 36 participants, 20 completed both pre-tests and post-tests. The mean post-test score of 68.75 percent was higher than the mean pre-test score of 61.75 percent, p = 0.009. Knowledge of addiction medicine can be

  2. Internal medicine, art and science in the third millennium.

    Science.gov (United States)

    Muñoz C, Félix

    2013-02-01

    Internal medicine, art and science in the third millennium is a statement that Medicine is not only science. It acts on the sick individual to reestablish a natural state as a curative art. Medical art, commissioned by an individual or a society, is service. It requires vocation to obtain satisfaction. However due to the incidence of value changes, market globalization, technological and industrial development, the patient/physician relationship is becoming a user/provider relationship. Physician-related factors such as a higher health care demand, resource shortage and a progressive specialization have also influenced this change of paradigm. This is causing dissatisfaction, loss of self-esteem and a lower ethical commitment among professionals. We need to recover a professional repertoire of ideas in the context of a global ethics. Responsibility and co-responsibility are ethical principles addressed to technological civilizations and their collateral effects on people and environment that lead to a "responsible globalization". We also need a scientific futurology to define risks and avoid errors. In this era of progressive specialization, Internal Medicine, with its holistic vision of mankind, may play a fundamental role in the field of bioethics.

  3. Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

    Science.gov (United States)

    Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

    2015-01-01

    The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. General Practitioners Using Complementary and Alternative Medicine Differ From General Practitioners Using Conventional Medicine in Their View of the Risks of Electromagnetic Fields

    DEFF Research Database (Denmark)

    Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

    2015-01-01

    OBJECTIVE: General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks...

  5. [Pharmacovigilance center --internal medicine interactions: A useful diagnostic tool].

    Science.gov (United States)

    Rochoy, M; Gautier, S; Bordet, R; Caron, J; Launay, D; Hachulla, E; Hatron, P-Y; Lambert, M

    2015-08-01

    Patients hospitalized in internal medicine often have unexplained clinical symptoms for which a drug origin can be considered. The prevalence of patients hospitalized for iatrogenic is estimated between 4-22%. We wanted to evaluate the diagnostic value of the regional center of pharmacovigilance to identify or confirm an iatrogenic disease in the department of internal medicine of Lille and characterize factors associated with drug-related side effect. This is a single-center prospective diagnostic study. We included all subsequent requests from the department of internal medicine with the Nord-Pas-de-Calais regional pharmacovigilance center between 2010 and 2012. The opinion of the regional pharmacovigilance centre was held on the record of the adverse drug reaction in the national pharmacovigilance database and analyzed according to the conclusion of iatrogenic used by clinicians in internal medicine (reference diagnosis) with a follow-up to June 2013. The variables relating to the patient, medication and adverse events were analyzed by binary logistic regression. We analyzed 160 contacts: 118 concordant cases, 38 false-positives (drug-related side effect retained by the regional pharmacovigilance center only), 4 false negatives. Registration in the national pharmacovigilance database had a sensitivity of 96% (95% CI [0.92 to 0.99]), a specificity of 46% (95% CI [0.38 to 0.53]), a value positive predictive of 69% (95% CI [0.62 to 0.76]), a negative predictive value of 89% (95% CI [0.84 to 0.94]) and a negative likelihood ratio of 0.1. False-positive had chronological and semiological accountabilities questionable (adjusted RR=2.1, 95% CI [1.2 to 2.8]). In our study, the regional pharmacovigilance center confirms the clinician's suspicion of drug-related side effects and helps to exclude drug-induced with a high negative predictive value. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  6. Delirium in elderly patients hospitalized in internal medicine wards.

    Science.gov (United States)

    Fortini, Alberto; Morettini, Alessandro; Tavernese, Giuseppe; Facchini, Sofia; Tofani, Lorenzo; Pazzi, Maddalena

    2014-06-01

    A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

  7. 49 CFR 192.475 - Internal corrosion control: General.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Internal corrosion control: General. 192.475... Control § 192.475 Internal corrosion control: General. (a) Corrosive gas may not be transported by... taken to minimize internal corrosion. (b) Whenever any pipe is removed from a pipeline for any...

  8. Benchmarks of support in internal medicine residency training programs.

    Science.gov (United States)

    Wolfsthal, Susan D; Beasley, Brent W; Kopelman, Richard; Stickley, William; Gabryel, Timothy; Kahn, Marc J

    2002-01-01

    To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality. A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses. Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work

  9. Turkey and its international relations in the history of medicine.

    Science.gov (United States)

    Sari, N

    2001-12-01

    My discussions with ISHM members have disclosed considerable interest in the history of the relations that Turkey and its medicine have had with other countries. Dr Lellouch, the secretary of ISHM, originally suggested that I address the subject of Turkish-French relations by means of an essay in Vesalius. This led me to consider a wider ranging paper on Ottoman-European relations. For completeness, I have briefly covered the Turkish peoples' relations with the Eastern, as well as the Western World. The overall aim of this article is to act as a stimulus for further discussion on the international relations in health sciences between Turks and other peoples.

  10. Recruiting Quarterbacks: Strategies for Revitalizing Training in Primary Care Internal Medicine.

    Science.gov (United States)

    Goroll, Allan H

    2016-02-01

    Current U.S. primary care workforce shortages and trainees' declining interest in primary care residency training, especially regarding primary care internal medicine, have many parallels with circumstances in the early 1970s, when modern adult primary care first emerged. Rediscovery of the lessons learned and the solutions developed at that time and applying them to the current situation have the potential to help engage a new generation of young physicians in the primary care mission.The author compares the internal medicine residency primary care track at the University of New Mexico, described by Brislen and colleagues in this issue, with the nation's first three-year primary care internal medicine residency track introduced at Massachusetts General Hospital in 1973. Strategies for addressing the challenges of primary care practice and improving learner attitudes toward the field are discussed. The author suggests that primary care physicians should be likened to "quarterbacks" rather than "gatekeepers" or "providers" to underscore the intensity of training, level of responsibility, degree of professionalism, and amount of compensation required for this profession. The advent of multidisciplinary team practice, modern health information technology, and fundamental payment reform promises to dramatically alter the picture of primary care, restoring its standing as one of the best job descriptions in medicine.

  11. Medicines use among general public in Taif, KSA

    Directory of Open Access Journals (Sweden)

    Qasem M. A. Abdallah

    2014-01-01

    Full Text Available Objectives: Patient practice toward medication including the extent of self-medication has an important impact on therapeutic outcome. Therefore, this study aimed to assess general public practice toward the usage of medicines in Taif city. Materials and Methods: A cross-sectional research design using nonprobability convenience sampling technique was used in this study. Data were collected face-to-face from literate adults in public areas such as malls, shopping centers, and health centers. Data were analyzed using SPSS version 16 and significant values of difference were determined using the Chi-square and Fisher Exact tests. Results: Nine hundred questionnaires were successfully collected from literate adults in Taif city over 8 weeks. Eighty percent of respondents tend to stop taking their medications once they feel good. In addition, only 62% of respondents refer to pharmacists or doctors once they feel unwell. On the other hand, one-fifth of respondents store their medications as directed by the pharmacist or as written in the drug leaflet. Furthermore, as little as 12% of respondents consult a doctor or a pharmacist once they miss their medication dose. Conclusion: This study demonstrates that public in Taif city has, to a certain extent, improper practice toward medicine. Thus, it is of urge for healthcare and policymakers to develop healthcare programs aiming to enhance practice of public toward medicines.

  12. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

    Science.gov (United States)

    Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

    2017-02-03

    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  13. Italian intersociety consensus on DOAC use in internal medicine.

    Science.gov (United States)

    Prisco, Domenico; Ageno, Walter; Becattini, Cecilia; D'Angelo, Armando; Davì, Giovanni; De Cristofaro, Raimondo; Dentali, Francesco; Di Minno, Giovanni; Falanga, Anna; Gussoni, Gualberto; Masotti, Luca; Palareti, Gualtiero; Pignatelli, Pasquale; Santi, Roberto M; Santilli, Francesca; Silingardi, Mauro; Tufano, Antonella; Violi, Francesco

    2017-04-01

    The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug-drug interactions and peri-procedural protocols.

  14. Trialogue : managing hyperglycaemia in internal medicine: instructions for use.

    Science.gov (United States)

    Beltramello, Giampietro; Manicardi, Valeria; Trevisan, Roberto

    2013-06-01

    Hyperglycaemic patients admitted to hospital have worse clinical outcomes with higher operational costs than normoglycaemic patients. Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalisation; adequate 'continuity of care' must be assured after discharge. This requires a multidisciplinary clinical collaboration between the internist and the diabetes team, which plays a central role in the treatment course and should be involved soon after patient admission to the hospital. This document aims to establish guidelines and recommendations for good clinical practice in managing hyperglycaemic internal medicine patients, with or without previous diagnosis of diabetes. The Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) and Società Italiana di Diabetologia (SID) have decided to publish a document useful for internists in the management of hospitalised patients with hyperglycaemia. The Trialogue project, coordinated by a Board of Scientific Experts from the three scientific societies, was initiated for this purpose. A questionnaire consisting of 16 multiple choice questions on the management of hyperglycaemia in hospital was answered by 660 physicians from over 250 Internal Medicine units distributed throughout Italy. Analysis of responses has yielded an overview of routine clinical practice and provided a wealth of ideas to better identify critical points in the treatment of hospitalised patients with hyperglycaemia. These recommendations were developed with the aim of providing mutually agreed practical guidance (instructions for use) that can be readily applied by healthcare professionals in routine clinical practice.

  15. Moral distress and burnout in internal medicine residents

    Science.gov (United States)

    Sajjadi, Sharareh; Norena, Monica; Wong, Hubert; Dodek, Peter

    2017-01-01

    Background Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout. Methods The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013–2014 academic year at the University of British Columbia. Results Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/−3; 46% male) reported a median moral distress score (interquartile range) of 77 (50–96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (pburnout were associated with intention to leave the job. Conclusion Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job.

  16. Mindfulness, burnout, and effects on performance evaluations in internal medicine residents

    Directory of Open Access Journals (Sweden)

    Braun SE

    2017-08-01

    Full Text Available Sarah E Braun,1 Stephen M Auerbach,1 Bruce Rybarczyk,1 Bennett Lee,2 Stephanie Call2 1Department of Psychology, School of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA; 2Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA Purpose: Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents.Methods: Residents (n = 38 completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory.Results: Overall, 71.1% (n = 27 of the residents met criteria for burnout during the study. Lower scores on the “acting with awareness” facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5 = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the “system-based practices” and “professionalism” domains and negative effects on a milestone from the “patient care” domain.Conclusion: Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional

  17. Critical considerations on the traditional syllabus of the subject Internal Medicine

    Directory of Open Access Journals (Sweden)

    Ángel Julio Romero Cabrera

    2009-09-01

    Full Text Available Internal Medicine is a specialty of wide profile which has always supported the best qualities of clinics. The syllabus of this subject, which rules the Chair of Medical Clinics (traditional syllabus dates back to 1989 and, even when there could be some invariants regarding methods and objectives, many things have also changed in these years and it is important to perform modifications, particularly in its content. Thus, it is necessary to update the syllabus to adequate it to the requirements and events above mentioned, without transforming its core mission of educating a general comprehensive doctor with humanistic and social scope. The objective of this article was to critically analyze some aspects that can not be omitted if we want to foster a subject based in a comprehensive specialty as Internal Medicine.

  18. Thieme Textbook Internal Medicine - TIM; Thieme's Innere Medizin - TIM

    Energy Technology Data Exchange (ETDEWEB)

    Flasnoecker, M. [comp.

    1999-07-01

    The textbook and reference work covers the entire field of internal medicine arranged in 15 chapters, each covering a particular branch of internal medicine. This subject arrangement corresponds to the subject clusters of the regime of post-graduate education. Every branch, i. e. every chapter, has its own responsible editor. This selection of editors and authors,- all in all 180 experts in general and clinical practice -, guarantees a maximum of competence and compliance with the frontiers of research and clinical experience. (orig./CB) [German] Das Lehr- und Nachschlagewerk praesentiert die gesamte Innere Medizin in 15 Kapiteln, die jeweils ein Teilgebiet der IM darstellen. Die Gliederung in die 15 Kapitel entspricht den Schwerpunkten der Weiterbildungsordnung. Jedes Teilgebiet, d.h. jedes Kapitel, wird von einem eigenen Herausgeber betreut. Diese Zusammensetzung der Autoren, - insgesamt 180 Spezialisten aus Klinik und Praxis -, sichert ein Hoechstmass an Kompetenz und Aktualitaet. (orig./CB)

  19. Citation distribution profile in Brazilian journals of general medicine.

    Science.gov (United States)

    Lustosa, Luiggi Araujo; Chalco, Mario Edmundo Pastrana; Borba, Cecília de Melo; Higa, André Eizo; Almeida, Renan Moritz Varnier Rodrigues

    2012-01-01

    Impact factors are currently the bibliometric index most used for evaluating scientific journals. However, the way in which they are used, for instance concerning the study or journal types analyzed, can markedly interfere with estimate reliability. This study aimed to analyze the citation distribution pattern in three Brazilian journals of general medicine. This was a descriptive study based on numbers of citations of scientific studies published by three Brazilian journals of general medicine. The journals analyzed were São Paulo Medical Journal, Clinics and Revista da Associação Médica Brasileira. This survey used data available from the Institute for Scientific Information (ISI) platform, from which the total number of papers published in each journal in 2007-2008 and the number of citations of these papers in 2009 were obtained. From these data, the citation distribution was derived and journal impact factors (average number of citations) were estimated. These factors were then compared with those directly available from the ISI Journal of Citation Reports (JCR). Respectively, 134, 203 and 192 papers were published by these journals during the period analyzed. The observed citation distributions were highly skewed, such that many papers had few citations and a small percentage had many citations. It was not possible to identify any specific pattern for the most cited papers or to exactly reproduce the JCR impact factors. Use of measures like "impact factors", which characterize citations through averages, does not adequately represent the citation distribution in the journals analyzed.

  20. Examining the Reading Level of Internet Medical Information for Common Internal Medicine Diagnoses.

    Science.gov (United States)

    Hutchinson, Nora; Baird, Grayson L; Garg, Megha

    2016-06-01

    The National Institutes of Health (NIH) recommend that health materials be written at a grade 6-7 reading level, which has generally not been achieved in online reading materials. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses. Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were selected for analysis. In November and December 2014, these diagnoses were used as search terms in Google, and the top 5 Web sites across all diagnoses and a diagnosis-specific site were analyzed across 5 validated reading indices. On average, the lowest reading grade-level content was provided by the NIH (10.7), followed by WebMD (10.9), Mayo Clinic (11.3), and diagnosis-specific Web sites (11.5). Conversely, Wikipedia provided content that required the highest grade-level readability (14.6). The diagnoses with the lowest reading grade levels were chronic obstructive pulmonary disease (10.8), followed by diabetes (10.9), congestive heart failure (11.7), osteoporosis (11.7) and hypertension (11.7). Depression had the highest grade-level readability (13.8). Despite recommendations for patient health information to be written at a grade 6-7 reading level, our examination of online educational materials pertaining to 9 common internal medicine diagnoses revealed reading levels significantly above the NIH recommendation. This was seen across both diagnosis-specific and general Web sites. There is a need to improve the readability of online educational materials made available to patients. These improvements have the potential to greatly enhance patient awareness, engagement, and physician-patient communication. Published by Elsevier Inc.

  1. A General Introduction to International Bioenergy Trade

    NARCIS (Netherlands)

    Faaij, A.P.C.; Junginger, H.M.; Goh, C.S.

    2013-01-01

    The development of functional international markets for bioenergy has become an essential driver to develop bioenergy potentials, which are currently under-utilised in many regions of the world. Technical potential of bioenergy may be as large as 500 EJ/yr by 2050. However, large uncertainty exists

  2. Development and professional qualification of general practice and family medicine in Germany

    Directory of Open Access Journals (Sweden)

    Markus Herrmann

    2013-04-01

    Full Text Available Objective: This article aims to analyze the professional and faculty development of general practice and family medicine (GP/FM in Germany and discuss its facing challenges. Methods: It is a case study identifying characteristics and potential intervention tools, describing training and qualification requirements in family medicine in Germany. Results: The traditional caring role of GP in Germany has a long history, but GP has no gatekeeper function, which weakens its position in the system. In the past decades, GP has undergone several transformations; it is no longer a practice based on the traditional “Hausarzt” style. It has become a medical specialty of primary care with more modern foundations; it requires five years of practical training in internal medicine, paediatrics, surgery and general medicine, and it is governed by the Physician Chambers. In undergraduate education, courses in General Practice are mandatory. In recent years, the new curriculum requirements have led to an intense process of academic development with the creation of General Practice departments in 20 of the 36 public medical schools in the country. Conclusions: The process of professionalization and faculty development in GP/FM as well as the expansion of undergraduate training in the specialty aim to enhance the appeal of GP/FM to young doctors. This development strengthens academic research on GP/FM, which contributes to enhancing the institutional basis of GP/FM as a science, allowing bolder interaction and collaboration with other branches of medicine and real appreciation of this subject (GP/FM.

  3. In-Training Practice Patterns of Combined Emergency Medicine/Internal Medicine Residents, 2003-2007

    Directory of Open Access Journals (Sweden)

    Todd A Templeman

    2011-05-01

    Full Text Available Introduction: This study seeks to evaluate the practice patterns of current combined emergency medicine/internal medicine (EM/IM residents during their training and compare them to the typical practice patterns of EM/IM graduates. We further seek to characterize how these current residents perceive the EM/IM physician’s niche. Methods: This is a multi-institution, cross-sectional, survey-based cohort study. Between June 2008 and July 2008, all 112 residents of the 11 EM/IM programs listed by the Accreditation Council for Graduate Medical Education were contacted and asked to complete a survey concerning plans for certification, fellowship, and practice setting. Results: The adjusted response rate was 71%. All respondents anticipated certifying in both specialties, with 47% intending to pursue fellowships. Most residents (97% allotted time to both EM and IM, with a median time of 70% and 30%, respectively. Concerning academic medicine, 81% indicated intent to practice academic medicine, and 96% planned to allocate at least 10% of their future time to a university/academic setting. In evaluating satisfaction, 94% were (1 satisfied with their residency choice, (2 believed that a combined residency will advance their career, and (3 would repeat a combined residency if given the opportunity. Conclusion: Current EM/IM residents were very content with their training and the overwhelming majority of residents plan to devote time to the practice of academic medicine. Relative to the practice patterns previously observed in EM/IM graduates, the current residents are more inclined toward pursuing fellowships and practicing both specialties. [West J Emerg Med. 2011;12(4:530–536.

  4. Internal medicine, complexity, evidence based medicine, almost ‘‘without evidences’’

    Directory of Open Access Journals (Sweden)

    Roberto Nardi

    2013-04-01

    Full Text Available Background: Internal medicine has been defined as the specialty of the adult medical complex patients. Complexity science suggests that illness (and health results from complex, dynamic, and unique interactions between different components of the overall system. In a patient, complexity involves the intricate entanglement of two or more systems (e.g.; body-diseases, family, socioeconomic status, therapies. Aim of the study: To evaluate the real applicability of Evidence Based Medicne (EBM in clinical Departments of Internal Medicine and its critical perspectives. Discussion: Habitually the internist takes decisions in these situations: a certainty (the ideal decision is adopted and the corresponding strategy follows, b risk (the more suitable alternative selected can be the determination of the probable value or mathematical hope and c uncertainty, in which decisions linked to triple agents: beliefs and personal values of the doctors (I for their patients (II in the society (III. In the medical decisions there are often different factors that go beyond the field of technical and scientific knowledge (family, social, economic problems, etc. and demanding an ethical analysis of the decision. Conclusions: The ‘‘evidence-based medicine’’, as other models of care, has — in itself — some limitations. ‘‘No evidence in medicine’’ matters that the postulates of the EBM are not always applicable to the real patients of Internal Medicine wards, mostly elderly, frail, complex, with comorbidities and polipharmacy, often with cognitive dysfunction and limitation of autonomy, with psycho-emotional, social and economic problems. The interacting effects of overall involved diseases/factors and their management require more complex and individualised care than simply the sum of separate guideline components. Further innovation is required to resolve the need to enhance integration of evidence with our patients’ values at the

  5. Generic - equivalent drugs use in internal and general medicine patients: distrust, confusion, lack of certainties or of knowledge? Part 2. Misconceptions, doubts and critical aspects when using generic drugs in the real world

    Directory of Open Access Journals (Sweden)

    Roberto Nardi

    2014-05-01

    Full Text Available A lot of issues have been raised to argue that equivalent drugs may not work as well or at least the same as what the drug industry likes to call innovator products. Many doubts and biases are also reported in connection with the use of generic drugs. Doctors are mostly concerned about their efficacy, their tolerability, the quality and amount of active ingredients, their formulation or excipients, their packaging, their pharmaceutical form and their palatability. We describe the differences between prescribability (equivalence when prescribing a drug to a patient for the first time and switchability (interchangeability of drugs for a patient already in treatment considering the notions of average bioequivalence, population bioequivalence and individual bioequivalence as well as the usefulness of the U.S. Orange Book in the assessment of bioequivalence. Other key issues deserve attention, such as: duplicate applications for medicinal products, different salt forms, formulations used in the development of each medicinal product and excipients, product quality. Clinicians in collaboration with pharmacists and research pharmacologists have to find solutions for unanswered questions and unsolved doubts, by developing targeted studies, communication tools and shared guidelines.

  6. Drug related hospital admissions in subspecialities of internal medicine.

    Science.gov (United States)

    Hallas, J

    1996-04-01

    It is well established in the literature that adverse drug reactions (ADRs) and drug non-compliance contribute substantially to the admissions at medical wards. Some important questions, however, remain unanswered. The purpose of this thesis was to characterise the drug-related hospital admissions (DRH) and to assess the magnitude of the problem seen in relation to the demographic parameters and drug use of the background population. In addition, an attempt was made to reduce the DRH incidence by an intervention program. The scope of the study program was adverse drug reactions, intended self-poisoning, non-compliance, underdosing and interactions. The material included 1999 admissions to six departments of internal medicine at Odense University Hospital. The patients were reviewed prospectively, while they were still in the wards, but use of standardised criteria fOR assessment of drug-ADR causality. With inclusion of a definite, probable and possible causal relationship, ADRs and toxic reactions were found as an important factor in 8.4% of all admissions. The incidense of ADR related admissions was 400 per 100,000 per year for the background population as a whole, but showing a strong increase with age. The drug-specific ADR incidences were generally small compared to the drug sales figures. Non-compliance contributed to 2.0% of admissions with diuretics and anti-asthmatics as the drugs most frequently involved. Two departments were re-investigated after an intervention program, primarily targetting general practitioners. The over-all incidence of DRHs was unaffected by the intervention, but the subset classified as avoidable DRHs showed a significant decline. The case material was subject to a blinded evaluation by an external peer group using the same criteria as the investigators. There was no indication that the observed decline in avoidable DRHs should be explained by a shift in the investigators' assessment of cases. It was concluded that the intervention

  7. Necessity of Internal Monitoring for Nuclear Medicine Staff in a Large Specialized Chinese Hospital.

    Science.gov (United States)

    Wang, Hong-Bo; Zhang, Qing-Zhao; Zhang, Zhen; Hou, Chang-Song; Li, Wen-Liang; Yang, Hui; Sun, Quan-Fu

    2016-04-12

    This work intends to quantify the risk of internal contaminations in the nuclear medicine staff of one hospital in Henan province, China. For this purpose, the criteria proposed by the International Atomic Energy Agency (IAEA) to determine whether it is necessary to conduct internal individual monitoring was applied to all of the 18 nuclear medicine staff members who handled radionuclides. The activity of different radionuclides used during a whole calendar year and the protection measures adopted were collected for each staff member, and the decision as to whether nuclear medicine staff in the hospital should be subjected to internal monitoring was made on the basis of the criteria proposed by IAEA. It is concluded that for all 18 members of the nuclear medicine staff in the hospital, internal monitoring is required. Internal exposure received by nuclear medicine staff should not be ignored, and it is necessary to implement internal monitoring for nuclear medicine staff routinely.

  8. INTERNAL AND EXTERNAL NETWORK ENTERPRISES GENERAL APPROACHES

    OpenAIRE

    2014-01-01

    The aim of this paper is to make distinction between multiple uses of the word "network" considered both inside and outside the enterprise. Starting from the reference literature on supply chain management, logistic, networks of enterprises, this article presents the main features of internal and external enterprise networks and investigates their impact on enterprises' organization manner. We also explore the relationship between networks and innovation deployment.

  9. Metabolic syndrome in Internal Medicine patients: the pilot NIMEC study (National Internal Medicine Equivalent/Complex C-V-@Risk

    Directory of Open Access Journals (Sweden)

    R. Nardi

    2013-05-01

    Full Text Available BACKGROUND Metabolic Syndrome (MetS, currently defined as slight differences in the criteria of diagnosis – depending on which authority is quoted [i.e.: NCEP-ATP III (National Cholesterol Education Program/Adult Treatment Panel III; WHO (World Health Organization; IDF (International Diabetes Federation; AACE (American Association of Clinical Endocrinologists], designates a cluster of metabolic risk factors that come together in a single individual, leading to cardiovascular disease. MetS is quite common, approximately 20-30% of the population in industrialized countries being affected. However, most of epidemiological data regarding MetS are derived from populations consisting mostly of middle-aged and younger subjects. AIM OF THE STUDY To assess the prevalence of the MetS in Internal Medicine wards and to determine its related comorbidities, including other clinical forms of atherosclerotic disease such as CHD risk equivalents. METHODS Our study was performed in patients admitted in Internal Medicine wards and selected as a randomization list in 12 Emilia Romagna-Marche FADOI centers. 1.316 patients were registered. According to explicit inclusion/exclusion criteria, we studied overall 902 participants (50.6% men, mean of age: 71-73 years. RESULTS According to NCEP-ATP III and IDF criteria the prevalence of MetS was 45.3% (IC 95%: 41.6-49.1 and 38.6% (IC 95%: 34.9-42.3, respectively. Patients with MetS presented a higher significant rate of ALT increase, syncope, atrial fibrillation, COPD, unstable angina, chronic kidney disease, cancer, valvular heart disease, peripheral arterial disease and carotid plaques. A strong association between IDF-MetS and congestive heart failure was observed, suggesting a role of central obesity as an independent risk factor in the elderly. DISCUSSION World-wide populations are becoming older. Aging and MetS are two conditions that represent an important part of health-care spending. Trunkal fatness increases in

  10. Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

    Science.gov (United States)

    Stein, Melissa R.; Arnsten, Julia H.; Parish, Sharon J.; Kunins, Hillary V.

    2011-01-01

    Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year…

  11. Features of patients with comorbid pathology treatment in internal medicine

    Directory of Open Access Journals (Sweden)

    L. F. Kuznetsova

    2015-10-01

    Full Text Available Aim. Nowadays more attention is paid to the comorbid pathologies in the internal medicine as they have important social and medical value. Different combinations of the arterial hypertension, chronic kidney disease, osteoartrosis and anemia influences are now studied. The article underlines the main features of the therapeutic tactics in these patients. Methods and results. The paper presents a case of a patient with mentioned pathology, sets out the main guidelines for the management of patients with such comorbid conditions. Conclusion. Treatment tactics should include: minimum interoperability path of excretion, metabolic neutrality, good tolerability and a positive impact on the affected organ, all of which may contribute not only to improve health and improve the quality of life of patients, but also its extension.

  12. Assessment of empathy in different years of internal medicine training.

    Science.gov (United States)

    Mangione, Salvatore; Kane, Gregory C; Caruso, John W; Gonnella, Joseph S; Nasca, Thomas J; Hojat, Mohammadreza

    2002-07-01

    The operational measurement of physician empathy, as well as the question of whether empathy could change at different levels of medical education, is of interest to medical educators. To address this issue, 98 internal medicine residents from all 3 years of training were studied. The Jefferson Scale of Physician Empathy was administered, and residents' empathy scores correlated with ratings on humanistic attributes made by postgraduate program directors. No statistically significant differences in scores were found among residents of different training levels. Empathy scores remained also stable during internship (test-retest reliability = 0.72). Correlation between empathy and ratings on humanism was 0.17. Thus, the findings suggest that empathy is a relatively stable trait that is not easily amenable to change in residency training programs. The issue of whether targeted educational activities for the purpose of cultivating empathy can improve empathy scores awaits empirical scrutiny.

  13. Real time curriculum map for internal medicine residency

    Directory of Open Access Journals (Sweden)

    Roberts J Mark

    2007-11-01

    Full Text Available Abstract Background To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD in a core internal medicine residency program. Methods We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching, comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis. Results There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years. Only 42 hours (15% involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year. Most AHD hours (78% focused on medical expert competencies. Resident satisfaction (90% response was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4, which improved after 1 year but returned to baseline after 2 years. Conclusion We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics.

  14. Citation distribution profile in Brazilian journals of general medicine

    Directory of Open Access Journals (Sweden)

    Luiggi Araujo Lustosa

    Full Text Available CONTEXT AND OBJECTIVE: Impact factors are currently the bibliometric index most used for evaluating scientific journals. However, the way in which they are used, for instance concerning the study or journal types analyzed, can markedly interfere with estimate reliability. This study aimed to analyze the citation distribution pattern in three Brazilian journals of general medicine. DESIGN AND SETTING: This was a descriptive study based on numbers of citations of scientific studies published by three Brazilian journals of general medicine. METHODS: The journals analyzed were São Paulo Medical Journal, Clinics and Revista da Associação Médica Brasileira. This survey used data available from the Institute for Scientific Information (ISI platform, from which the total number of papers published in each journal in 2007-2008 and the number of citations of these papers in 2009 were obtained. From these data, the citation distribution was derived and journal impact factors (average number of citations were estimated. These factors were then compared with those directly available from the ISI Journal of Citation Reports (JCR. RESULTS: Respectively, 134, 203 and 192 papers were published by these journals during the period analyzed. The observed citation distributions were highly skewed, such that many papers had few citations and a small percentage had many citations. It was not possible to identify any specific pattern for the most cited papers or to exactly reproduce the JCR impact factors. CONCLUSION: Use of measures like "impact factors", which characterize citations through averages, does not adequately represent the citation distribution in the journals analyzed.

  15. On internal medicine Chinese medicine nursing%谈内科中医护理

    Institute of Scientific and Technical Information of China (English)

    洪霞

    2013-01-01

    Chinese nursing based on TCM theory as a guide to the nursing program for the framework, the use of the whole concept of dialectical nursing disease and the use of traditional nursing techniques and methods, to impose care and service to patients and the crowd, the protection of human health of an applied science. Of China's medical and health services to obtain a more rapid development of China's policy of reform and opening up and integration into the World Trade Organization (WTO) since gradually from the traditional medicine of the past to the development of modern medicine, internal medicine completely toward modernization. As a branch of medicine Medical Nursing hospital for medical patients in the treatment process, play the role of indelible.%中医护理学是以中医理论为指导,以护理程序为框架,运用整体观念,对疾病进行辨证施护,并运用传统护理技术与方法,对患者和人群施以照顾和服务,保护人类健康的一门应用学科。自我国实施改革开放政策及融入世界贸易组织(WTO)以来,我国的医学卫生事业取得了较迅速地发展,逐渐由过去的传统医学向现代医学发展,内科就完全走向了现代化。而作为内科的一个分支的内科护理,在医院对内科患者的治疗过程中,发挥着不可磨灭之作用。

  16. [80 years' of internal medicine education at the medical school of the university in Belgrade (1922-2002)].

    Science.gov (United States)

    Micić, Jovan; Micić, Dragan

    2003-01-01

    ORGANISATION OF TEACHING INTERNAL MEDICINE: The Department for Internal Medicine and Internal Clinics were founded in spring 1922. Dr. Radenko Stankovic and Dr. Dimitrije Antic were appointed as part-time Professors, while Dr. Aleksandar Ignjatovski, a former Full-time Professor of the Warsaw University, was appointed as professor under contract. A year later, Dr. Aleksandar Radosavljevic was appointed as Part-time Professor. In the General State Hospital and Military Hospital, certain wards were turned into clinics. II and III Internal Clinics were situated in the barracks, while the Propedeutic and I Internal Clinics were located in the Military Hospital. Upon the construction of the buildings of the Internal Clinic and General State Hospital, the Propedeutic and I Internal Clinics were permanently placed in the new building, and II and III Internal Clinics in the General State Hospital. Teaching of Internal Medicine started 31 October 1922. Dr. R. Stanko vic delivered a lecture in Propedeutics for students of the fifth term. This date marks the beginning of teaching internal medicine at the newly established School of Medicine, University of Belgrade. Dr. A. Ignjatovski started lecturing Internal medicine 23 March 1923, whereas Dr. D. Antic and and Dr. A. Radosavljevic also delivered lectures in the areas of Internal Medicine within their professional scope. At the beginning, the clinics belonged to the General State Hospital. It was impossible to teach successfully in hospital, therefore upon the professors' request, the clinics were separated and thus became the institutions belonging to the School of Medicine-educational institutions, while hospitals were health institutions. The rule was 'one professor--one clinic'. After the Second World War, teaching Internal Medicine was begun in demolished buildings in very difficult financial circumstances. The Propedeutic Internal clinic was renamed IV Internal Clinic, which continued dealing predominantly with

  17. [Hospital based internal medicine: the year 2009 in review (I). The perspective of chief residents].

    Science.gov (United States)

    Tâche, Frédéric; Pantet, Olivier; Joly, Céleste; Pasquier, Mathieu; Maillard-Dewarrat, Géraldine; Méan, Marie; Cosma-Rochat, Monica; Deriaz, Sandra; Donzé, Jacques; Pasche, Antoine; Burnier, Coralie; Stadelmann, Raphaël

    2010-02-03

    Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.

  18. Topics of internal medicine for undergraduate dental education: a qualitative study.

    Science.gov (United States)

    Kunde, A; Harendza, S

    2015-08-01

    Due to the ageing population, internal medicine has become increasingly important for dental education. Although several studies have reported dentists' dissatisfaction with their internal medicine training, no guidelines exist for internal medicine learning objectives in dental education. The aim of this study was to identify topics of internal medicine considered to be relevant for dental education by dentists and internists. Eight dentists from private dental practices in Hamburg and eight experienced internal medicine consultants from Hamburg University Hospital were recruited for semi-structured interviews about internal medicine topics relevant for dentists. Internal diseases were clustered into representative subspecialties. Dentists and internists were also asked to rate medical diseases or emergencies compiled from the literature by their relevance to dental education. Coagulopathy and endocarditis were rated highest by dentists, whilst anaphylaxis was rated highest by internists. Dentists rated hepatitis, HIV, organ transplantation and head/neck neoplasm significantly higher than internists. The largest number of different internal diseases mentioned by dentists or internists could be clustered under cardiovascular diseases. The number of specific diseases dentists considered to be relevant for dental education was higher in the subspecialties cardiovascular diseases, haematology/oncology and infectiology. We identified the internal medicine topics most relevant for dental education by surveying practising dentists and internists. The relevance of these topics should be confirmed by larger quantitative studies to develop guidelines how to design specific learning objectives for internal medicine in the dental curriculum. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Factors associated with performance in an internal medicine clerkship

    Science.gov (United States)

    McNeal, Tresa; Lezama, Maybelline; Chandler, Martha; Forrester, Lisa; Metting, Austin; Mirkes, Curtis; Van Cleave, Holly; Win, Sonny; Myers, John D.

    2017-01-01

    The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. A model containing USMLE Step 1, clinical evaluation, and NBME was significantly associated with OSCE score, accounting for 30% of the variance. Additionally, a model containing age, MCAT score, undergraduate GPA, NBME subject exam score, and OSCE was significantly associated with clinical evaluation score, accounting for 22% of score variance. Age accounted for the most unique variance in clinical evaluation score. Gender and IM interest group were not significantly associated with any outcome variable. In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study. PMID:28127127

  20. Factors associated with performance in an internal medicine clerkship.

    Science.gov (United States)

    Colbert, Colleen; McNeal, Tresa; Lezama, Maybelline; Chandler, Martha; Forrester, Lisa; Metting, Austin; Mirkes, Curtis; Van Cleave, Holly; Win, Sonny; Myers, John D

    2017-01-01

    The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. A model containing USMLE Step 1, clinical evaluation, and NBME was significantly associated with OSCE score, accounting for 30% of the variance. Additionally, a model containing age, MCAT score, undergraduate GPA, NBME subject exam score, and OSCE was significantly associated with clinical evaluation score, accounting for 22% of score variance. Age accounted for the most unique variance in clinical evaluation score. Gender and IM interest group were not significantly associated with any outcome variable. In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study.

  1. Prevalence of delirium in hospitalized patients from an internal medicine service

    National Research Council Canada - National Science Library

    González Pezoa, Ana Carolina; Carrillo Venezian, Bernardita Claudia; Castillo Rojas, Sandra

    2015-01-01

    .... To determine the rate of prevalence of delirium in Internal Medicine Service patients and evaluate missed diagnosis of the syndrome made by attending physicians, medical residents or interns in charge...

  2. International trade and determinants of price differentials of insulin medicine.

    Science.gov (United States)

    Helble, Matthias; Aizawa, Toshiaki

    2017-02-01

    Empirical studies on pharmaceutical pricing across countries have found evidence that prices vary according to per capita income. These studies are typically based on survey data from a subset of countries and cover only one year. In this paper, we study the international trade and price of insulin by using detailed trade data for 186 importing countries from 1995 to 2013. With almost 12,000 observations, our study constitutes the largest comparative study on pharmaceutical pricing conducted so far. The large dataset allows us to uncover new determinants of price differentials. Our analysis shows that the international trade of insulin increased substantially over this time period, clearly outpacing the increasing prevalence of diabetes. Using the unit values of imports, we also study the determinants of price differentials between countries. Running various panel regressions, we find that the differences in prices across countries can be explained by the following factors: First, corroborating earlier studies, we find that per capita GDP is positively correlated with the unit price of insulin. Second, the price of insulin drugs originating from Organisation for Economic Co-operation and Development countries tends to be substantially higher than for those imported from developing countries. Third, more intense competition among suppliers leads to lower insulin prices. Fourth, higher out-of-pocket payments for health care are associated with higher prices. Finally, higher volumes and tariffs seem to result in lower unit prices. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Off-label prescriptions in Internal Medicine: difficulties involved

    Directory of Open Access Journals (Sweden)

    S. Gambetti

    2013-05-01

    Full Text Available INTRODUCTION Concern about off-label prescriptions, that is to say prescriptions of a drug for therapeutic indications and utilisations not approved in the medicine data sheet, is growing up more and more among hospital clinicians. AIM OF THE STUDY The aim of this work is to increase the consciousness that falling back upon off-label prescriptions has to be applied just in case of a validated therapeutic option missing, and provided that there are clinical evidences supporting the benefits reached by the patient through the assumption of that drug. Furthermore, it requires the patient involvement, in fact he has to be correctly informed and has to declare his acceptance to be treated with that kind of drug. The off-label prescription responsibility belongs to the prescribing clinician. The costs of these prescriptions can not be ascribed to the SSN (Servizio Sanitario Nazionale, unless the subjects treated are in-patients in the hospital or in a day-hospital service. METHODS a Understanding where the therapeutic indications arise and how to use medicines, on the basis of what is reported in the Summary of Product Characteristics (SPC following the correspondent declaration for marketing authorization. b Showing some examples of off-label utilisation. c Evaluating the current legislation that regulates and supports the possibility or impossibility to prescribe off-label. CONCLUSIONS It is always better to use offlabel drugs that are authorized: by Agenzia Italiana del Farmaco (AIFA, through the dynamic list of medicines included in the 648/96, by the Local Therapeutic Commission or by the Ethical Committee. The act of prescribing off-label drugs for out-patients has to be shared even with the patient’s general practitioner, who is responsible for the same patient territorially, knows his medical history very well and the potential chronic therapy assumed. This is important for a proper evaluation of possible interactions and incompatibilities

  4. Divergent Fates of the Medical Humanities in Psychiatry and Internal Medicine: Should Psychiatry Be Rehumanized?

    Science.gov (United States)

    Rutherford, Bret R.; Hellerstein, David J.

    2008-01-01

    Objective: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. Methods: The journals searched were the three highest-ranking…

  5. Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes.

    Science.gov (United States)

    Havyer, Rachel D A; Wingo, Majken T; Comfere, Nneka I; Nelson, Darlene R; Halvorsen, Andrew J; McDonald, Furman S; Reed, Darcy A

    2014-06-01

    Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. Review is limited to quantitative assessments of teamwork in internal

  6. A global resource to translational medicine: the International Park of Translational Medicine and BioMedicine (IPTBM).

    Science.gov (United States)

    Wu, Xiaodan; Marincola, Francesco M; Liebman, Michael N; Wang, Xiangdong

    2013-01-08

    Translational science consists of research and development that integrates multiple resources to expedite the successful treatment of disease. The International Park of Translational BioMedicine (IPTBM) is currently being developed within the interface between Zhejiang Province and Shanghai Municipality. IPTBM has been designed to pioneer comprehensive biomedical research that spans the continuum from the education of young scientists to providing the infrastructure necessary for clinical testing and direct observation to better understand human biology while promoting viable commercial results within a vibrant biotechnology community. IPTBM's goal is to attract global partners organized around five fundamental pillars: 1) Institutional Development, 2) Project Implementation, 3) Development and Production, 4) Investment and 5) Regulatory Clusters to address the needs of an international platform of scientists, institutes, universities, commercial enterprises, investors, politicians, and other stakeholders. The IPTBM differs from existing models including CTSA's (US, NIH) technology because of its comprehensive approach to merge education, research, innovation, and development to translate clinical and public health needs into target-oriented and cost-efficient projects.

  7. The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians

    Directory of Open Access Journals (Sweden)

    Lemaire Jane

    2006-05-01

    Full Text Available Abstract Background Two striking demographic shifts evident in today's workforce are also apparent in the medical profession. One is the entry of a new generation of physicians, Gen Xers, and the other is the influx of women. Both shifts are argued to have significant implications for recruitment and retention because of assumptions regarding the younger generation's and women's attitudes towards work and patient care. This paper explores two questions regarding the generations: (1 How do Baby Boomer and Generation X physicians perceive the generation shift in work attitudes and behaviours? and (2 Do Baby Boomer and Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Gen Xers include those born between 1965 and 1980; Baby Boomers are those born between 1945 and 1964. We also ask: Do female and male Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Methods We conducted exploratory interviews with 54 physicians and residents from the Department of Medicine (response rate 91% and asked about their perceptions regarding the generation and gender shifts in medicine. We limit the analyses to interview responses of 34 Baby Boomers and 18 Generation Xers. We also sent questionnaires to Department members (response rate 66%, and this analysis is limited to 87 Baby Boomers' and 65 Generation Xers' responses. Results The qualitative interview data suggest significant generation and gender shifts in physicians' attitudes. Baby Boomers generally view Gen Xer physicians as less committed to their medical careers. The quantitative questionnaire data suggest that there are few significant differences in the generations' and genders' reports of work-life balance, work hours and attitudes towards patient care. Conclusion A combined qualitative and quantitative approach to the generation shift and gender shift in

  8. The relationship between mental healthcare utilization and criminal behaviors among internal medicine outpatients.

    Science.gov (United States)

    Sansone, Randy A; Lam, Charlene; Wiederman, Michael W

    2011-06-01

    According to the scant empirical literature, largely in studies of offenders, there appears to be a general but diffuse relationship between various psychiatric disorders and criminal behavior. In this study, we examined mental healthcare utilization, a general measure of psychiatric dysfunction, in relationship to a history of criminal behavior in a sample of internal medicine outpatients. In a consecutive sample of 376 internal medicine outpatients being seen predominantly by resident providers, we examined the relationship between 27 illegal behaviors (charges, not convictions) as delineated by the Federal Bureau of Investigation's crime cataloguing schema and four items related to mental healthcare utilization (i.e., ever been seen by a psychiatrist, ever been hospitalized in a psychiatric hospital, ever been in counseling, ever been on medication for your "nerves"). Twenty-two percent of the sample reported a history of having been charged with at least one criminal behavior. With the exception of ever having been on "nerve" medication, the remaining mental-healthcare-utilization variables demonstrated statistically significant relationships with the number of illegal behaviors reported. However, overall correlations were relatively weak. Using both a sample and methodology that is unique to the current literature, we found relationships between past mental health treatment and history of criminal behavior.

  9. Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004

    Directory of Open Access Journals (Sweden)

    de Jong Judith D

    2006-10-01

    Full Text Available Abstract Background Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. Methods Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. Results Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. Conclusion In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are

  10. Characteristics of qualitative studies in influential journals of general medicine: a critical review.

    Science.gov (United States)

    Yamazaki, Hiroshi; Slingsby, Brian Taylor; Takahashi, Miyako; Hayashi, Yoko; Sugimori, Hiroki; Nakayama, Takeo

    2009-12-01

    Although qualitative studies have increased since the 1990s, some reports note that relatively few influential journals published them up until 2000. This study critically reviewed the characteristics of qualitative studies published in top tier medical journals since 2000. We assessed full texts of qualitative studies published between 2000 and 2004 in the Annals of Internal Medicine, BMJ, JAMA, Lancet, and New England Journal of Medicine. We found 80 qualitative studies, of which 73 (91%) were published in BMJ. Only 10 studies (13%) combined qualitative and quantitative methods. Sixty-two studies (78%) used only one method of data collection. Interviews dominated the choice of data collection. The median sample size was 36 (range: 9-383). Thirty-three studies (41%) did not specify the type of analysis used but rather described the analytic process in detail. The rest indicated the mode of data analysis, in which the most prevalent methods were the constant comparative method (23%) and the grounded theory approach (22%). Qualitative data analysis software was used by 33 studies (41%). Among influential journals of general medicine, only BMJ consistently published an average of 15 qualitative study reports between 2000 and 2004. These findings lend insight into what qualities and characteristics make a qualitative study worthy of consideration to be published in an influential journal, primarily BMJ.

  11. Management of chronic obstructive pulmonary disease exacerbations in Internal Medicine

    Directory of Open Access Journals (Sweden)

    Gelorma Belmonte

    2013-03-01

    Full Text Available Introduction: Chronic obstructive pulmonary disease (COPD is the second leading cause of hospitalization in Internal Medicine departments in Italy and the fourth leading cause of death all over the word. By 2020, COPD will be the third leading cause of death and the fifth leading cause of disability. It is — along with chronic congestive heart failure — one of the most common causes of unscheduled hospital readmissions, and as such it represents a significant economic burden for the health-care system. Exacerbations of COPD are important events in the natural history of this prevalent condition. Discussion: This review provides a comprehensive state-of-the-art look at prevention and management of COPD exacerbations. Treatment of these episodes has to be tailored to the severity of the clinical presentation. We now have a wide range of therapeutic available options, based on the results of clinical trials. Management of the acute event should include the necessary measures (mainly the administration of inhaled short-acting bronchodilators, inhaled or oral corticosteroids, and antibiotics, with or without oxygen and ventilator support. Conclusions: To improve the management of COPD exacerbations, the focus of care must be shifted from the episodic acute complications to their systematic prevention. The management of COPD, which is often associated with multiple co-morbidities, is complex and requires a tailored, multifaceted and multidisciplinary approach. Integrated care for COPD also requires that patients be informed about their condition, that they participate actively in their care, and that they have easy access to the necessary health-care services.

  12. Internal Medicine Residents' Perspectives on Receiving Feedback in Milestone Format.

    Science.gov (United States)

    Angus, Steven; Moriarty, John; Nardino, Robert J; Chmielewski, Amy; Rosenblum, Michael J

    2015-06-01

    In contrast to historical feedback, which was vague or provided residents' numerical scores without clear meaning, milestone-based feedback is focused on specific knowledge, skills, and behaviors that define developmental trajectory. It was anticipated that residents would welcome the more specific and actionable feedback provided by the milestone framework, but this has not been studied. We assessed internal medicine (IM) residents' perceptions of receiving feedback in the milestone framework, particularly assessing perception of the utility of milestone-based feedback compared to non-milestone-based feedback. We surveyed a total of 510 IM residents from 7 institutions. Survey questions assessed resident perception of milestone feedback in identifying strengths, weaknesses, and trajectory of professional development. Postgraduate years 2 and 3 (PGY-2 and PGY-3) residents were asked to compare milestones with prior methods of feedback. Of 510 residents, 356 (69.8%) responded. Slightly less than half of the residents found milestone-based feedback "extremely useful" or "very useful" in identifying strengths (44%), weaknesses (43%), specific areas for improvement (45%), and appropriate education progress (48%). Few residents found such feedback "not very useful" or "not at all useful" in these domains. A total of 51% of PGY-2 and PGY-3 residents agreed that receiving milestone-based feedback was more helpful than previous forms of feedback. IM residents are aware of the concepts of milestones, and half of the residents surveyed found milestone feedback more helpful than previous forms of feedback. More work needs to be done to understand how milestone-based feedback could be delivered more effectively to enhance resident development.

  13. 5th International Symposium on IT in Medicine and Education

    CERN Document Server

    Jin, Qun; Jiang, Xiaohong; Park, James; ITME 2013

    2014-01-01

    IT changes everyday’s life, especially in education and medicine. The goal of ITME 2013 is to further explore the theoretical and practical issues of IT in education and medicine. It also aims to foster new ideas and collaboration between researchers and practitioners.

  14. Student evaluation of an OSCE in General Medicine at Mamata Medical College, Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    Dharma Rao V, Pramod Kumar Reddy M, Rajaneesh Reddy M, HanumiahA, Shyam Sunder P, Narasingha Reddy T, Kishore Babu SPV

    2014-04-01

    Full Text Available The assessment of student’s clinical competence is of paramount importance, and there are several means of evaluating student performance in medical examinations. The OSCE is an approach to student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent and structured manner with close attention to the objectivity of the process. The faculty of general medicine in collaboration with other clinical departments, Mamata Medical College, Khammam first implemented the objective structured clinical examination (OSCE in the final MBBS Part-II examination during the internal assessment examination for the 2011-2012 academic years. The study was set out to explore student acceptance of the OSCE as part of an evaluation of final MBBS students. A self-administered questionnaire was completed by successive groups of students immediately after the OSCE. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organization, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. There was an overwhelming acceptance of OSCE in general medicine with respect to comprehensiveness (90% transparency (90% & authenticity of required tasks. Students felt that it was a useful form of examination. Student’s feedback was invaluable in influencing faculty teaching curriculum direction and appreciation of student opinion and overall the students were agreeable with newer form of OSCE. The majority of the students felt that OSCE is a fair assessment tool compared to traditional long and short cases and it covers a wide range of knowledge and clinical skills in general medicine.

  15. Neurology for internal medicine residents: working towards a national Canadian curriculum consensus.

    Science.gov (United States)

    Lazarou, Jason; Hopyan, Julia; Panisko, Danny; Tai, Peter

    2011-01-01

    Partly due to the absence of a standardized neurology curriculum, internal medicine residents often perceive neurology lowest in terms of the level of knowledge and clinical confidence. To compare the learning needs of internal medicine residents with the perceived learning needs of neurology and internal medicine program directors and to integrate these needs by developing a focused nationwide neurology curriculum for internal medicine residents rotating through neurology. Medical residents and neurology and internal medicine program directors from programs across the Canada were asked to complete an online survey and to rank an exhaustive list of neurology topics. A modified Delphi approach was used to obtain consensus on the top 20 topics to include in the curriculum. Over 80% of residents felt their competency in neurology was average or below after completing their neurology rotation. There was very high correlation between the topics ranked by residents and staff. We were able to achieve consensus on 20 topics to be included in a neurology curriculum for internal medicine residents. Through a modified Delphi approach we were able to produce a neurology curriculum for internal medicine residents rotating through neurology based on the input of program directors across the country.

  16. [The Computer Book of the Internal Medicine resident: validity and reliability of a questionnaire for self-assessment of competences in internal medicine residents].

    Science.gov (United States)

    Oristrell, J; Casanovas, A; Jordana, R; Comet, R; Gil, M; Oliva, J C

    2012-12-01

    There are no simple and validated instruments for evaluating the training of specialists. To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident. Copyright © 2012 Elsevier Espa

  17. Evaluating the Effectiveness of the General Surgery Intern Boot Camp.

    Science.gov (United States)

    Schoolfield, Clint S; Samra, Navdeep; Kim, Roger H; Shi, Runhua; Zhang, Wayne W; Tan, Tze-Woei

    2016-03-01

    The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants' confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.

  18. Politics and Graduate Medical Education in Internal Medicine: A Dynamic Landscape.

    Science.gov (United States)

    Wardrop, Richard M; Berkowitz, Lee R

    2017-02-01

    The promotion of change and growth within medical education is oftentimes the result of a complex mix of societal, cultural and economic forces. Graduate medical education in internal medicine is not immune to these forces. Several entities and organizations can be identified as having a major influence on internal medicine training and graduate medical education as a whole. We have reviewed how this is effectively accomplished through these entities and organizations. The result is a constantly changing and dynamic landscape for internal medicine training. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  19. Interactions between modern and Chinese medicinal drugs: a general review.

    Science.gov (United States)

    Cheng, K F; Leung, K S; Leung, P C

    2003-01-01

    While the use of health food and over-the-counter drugs for health promotion and adjuvant therapy is becoming increasingly popular, the concern about adverse effects is mounting. The possible adverse effects that may arise from drug interactions between these herbal preparations and standard modem therapy are equally worrying. Herbal toxicity and adverse effects are well documented in classical Chinese medicinal volumes. Interactions between herbal preparations and standard modem therapy are known. Extensive work needs to be done before useful guidelines can be established. However, based on available reports and clinical observations, some commonly used herbs and Chinese medicines have already demonstrated the need for special attention when used together with modern therapy. This paper analyzes the important material already available, and would serve as a preliminary checklist for patients who are taking herbal preparations, while at the same time receiving treatment from modern medicine.

  20. Internal exposure in nuclear medicine: application of IAEA criteria to determine the need for internal monitoring

    Directory of Open Access Journals (Sweden)

    Bernardo Maranhão Dantas

    2008-12-01

    Full Text Available The manipulation of unsealed sources in nuclear medicine poses significant risks of internal exposure to the staff. According to the International Atomic Energy Agency, the radiological protection program should include an evaluation of such risks and an individual monitoring plan, assuring acceptable radiological safety conditions in the workplace. The IAEA Safety Guide RS-G-1.2 recommends that occupational monitoring should be implemented whenever it is likely that committed effective doses from annual intakes of radionuclides would exceed 1 mSv. It also suggests a mathematical criterion to determine the need to implement internal monitoring. This paper presents a simulation of the IAEA criteria applied to commonly used radionuclides in nuclear medicine, taking into consideration usual manipulated activities and handling conditions. It is concluded that the manipulation of 131I for therapy presents the higher risk of internal exposure to the workers, requiring the implementation of an internal monitoring program by the Nuclear Medicine Centers.A manipulação de fontes abertas em Serviços de Medicina Nuclear envolve riscos de exposição externa e contaminação interna. O plano de proteção radiológica das Instalações licenciadas pela CNEN deve incluir a avaliação de tais riscos e propor um programa de monitoração individual de forma a controlar as exposições e garantir a manutenção das condições de segurança radiológica. As recomendações da AIEA apresentadas no Safety Guide RS-G-1.2 sugerem que seja implementado um programa de monitoração interna do trabalhador sempre que houver possibilidade da contaminação interna conduzir a valores de dose efetiva comprometida anual igual ou superior a 1 mSv. Este trabalho apresenta a simulação da aplicação de tais critérios para os radionuclídeos mais utilizados na área de Medicina Nuclear, levando-se em consideração as condições usuais de manipulação das fontes e as

  1. Maintaining a Twitter Feed to Advance an Internal Medicine Residency Program’s Educational Mission

    Science.gov (United States)

    Narang, Akhil; Arora, Vineet M

    2015-01-01

    Background Residency programs face many challenges in educating learners. The millennial generation’s learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective The authors sought to understand how social media enhances a residency program’s educational mission. Methods While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results At the year’s end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents’ tweets informative, and most residents (42/61, 69%) agreed that Twitter enhanced their overall education in residency. Conclusions Data from this single-site intervention corroborate that Twitter can strengthen a residency program’s educational mission. The program’s robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media’s role in improving residents’ educational experiences. PMID:27731845

  2. Innovative strategies for transforming internal medicine residency training in resource-limited settings: the Mozambique experience.

    Science.gov (United States)

    Mocumbi, Ana Olga; Carrilho, Carla; Aronoff-Spencer, Eliah; Funzamo, Carlos; Patel, Sam; Preziosi, Michael; Lederer, Philip; Tilghman, Winston; Benson, Constance A; Badaró, Roberto; Nguenha, A; Schooley, Robert T; Noormahomed, Emília V

    2014-08-01

    With approximately 4 physicians per 100,000 inhabitants, Mozambique faces one of the most severe health care provider shortages in Sub-Saharan Africa. The lack of sufficient well-trained medical school faculty is one of Mozambique's major barrier to producing new physicians annually. A partnership between the Universidade Eduardo Mondlane and the University of California, San Diego, has addressed this challenge with support from the Medical Education Partnership Initiative. After an initial needs assessment involving questionnaires and focus groups of residents, and working with key members from the Ministry of Health, the Medical Council, and Maputo Central Hospital, a set of interventions was designed. The hospital's internal medicine residency program was chosen as the focus for the plan. Interventions included curriculum design, new teaching methodologies, investment in an informatics infrastructure for access to digital references, building capacity to support clinical research, and providing financial incentives to retain junior faculty. The number of candidates entering the internal medicine residency program has increased, and detailed monitoring and evaluation is measuring the impact of these changes on the quality of training. These changes are expected to improve the long-term quality of postgraduate training in general through dissemination to other departments. They also have the potential to facilitate equitable distribution of specialists nationwide by expanding postgraduate training to other hospitals and universities.

  3. Interdisciplinary, interinstitutional and international collaboration of family medicine researchers in Taiwan.

    Science.gov (United States)

    Lin, Yi-Hsuan; Tseng, Yen-Han; Chang, Hsiao-Ting; Lin, Ming-Hwai; Tseng, Yen-Chiang; Chen, Tzeng-Ji; Hwang, Shinn-Jang

    2015-01-01

    The family medicine researches flourished worldwide in the past decade. However, the collaborative patterns of family medicine publications had not been reported. Our study analyzed the collaborative activity of family medicine researchers in Taiwan. We focused on the types of collaboration among disciplines, institutions and countries. We searched "family medicine" AND "Taiwan" in address field from Web of Science and documented the disciplines, institutions and countries of all authors. We analyzed the collaborative patterns of family medicine researchers in Taiwan from 2010 to 2014. The journal's impact factor of each article in the same publication year was also retrieved. Among 1,217 articles from 2010 to 2014, interdisciplinary collaboration existed in 1,185 (97.3%) articles, interinstitutional in 1,012 (83.2%) and international in 142 (11.7%). Public health was the most common collaborative discipline. All international researches were also interdisciplinary and interinstitutional. The United States (75 articles), the United Kingdom (21) and the People's Republic of China (20) were the top three countries with which family medicine researchers in Taiwan had collaborated. We found a high degree of interdisciplinary and interinstitutional collaboration of family medicine researches in Taiwan. However, the collaboration of family medicine researchers in Taiwan with family medicine colleagues of other domestic or foreign institutions was insufficient. The future direction of family medicine studies could focus on the promotion of communication among family medicine researchers.

  4. Overcoming Barriers to Generalism in Medicine: The Residents' Perspective.

    Science.gov (United States)

    Steiner, Elizabeth; Stoken, Jacqueline M.

    1995-01-01

    This paper presents medical residents' opinions regarding barriers to producing more generalist physicians, such as lack of appropriate training in ambulatory generalist practice and the increased prestige given to specialists. Recommendations are offered to medical schools, residency programs, the community, and the culture of medicine to…

  5. General sale of non-prescription medicinal products

    DEFF Research Database (Denmark)

    Lind, Johanna Lena Maria; Schafheutle, Ellen; Hägg, Annika Nordén

    2016-01-01

    between Sweden and the UK. METHOD: The main method was analysis of legislative text and policy documents, conducted in 2012. RESULTS: Both countries had specified medicines available to the public in non-pharmacy outlets, but with restrictions on different factors, e.g. placement and package size...

  6. Level of Educational Objectives Achievement in Health and Community Medicine Internship Course; Interns Viewpoint

    OpenAIRE

    2016-01-01

    Aims: Nowadays, the community oriented medicine education model has been mainly noticed. The aim of this study was to survey the interns about achievement to the educational goals confirmed by Health Ministry in health internship and community medicine courses.    Instrument & Methods: In the descriptive cross-sectional study, 56 health internship and community medicine students of one of the military universities of medical sciences in Tehran were studied in 2014 and 2015....

  7. Introduction of total quality management (TQM) into an internal medicine residency.

    Science.gov (United States)

    Ellrodt, A G

    1993-11-01

    In spite of significant enthusiasm for the principles and methods of total quality management (TQM) in health care organizations, there have been only a few creative programs applying TQM to medical education. In addition, teaching programs are under significant pressure to teach and practice cost-effective medicine and to produce more sophisticated general internists. In July 1992, the governance and operation of the internal medicine training program at Cedars-Sinai Medical Center was restructured to integrate a TQM program with a health services research section and a resource management department. This restructured program transfers significant programmatic responsibility and power to houseofficers. Within the playing field defined through a housestaff values statement and requirements of the Accreditation Council for Graduate Medical Education and the American Board of Internal Medicine, the housestaff have brought about substantial change. The first housestaff survey after the new program was operational for six months revealed that 68% of the 77 respondents felt the housestaff had greater programmatic influence, 68% felt that the rate of program change was "better," and 63% felt the overall training program had improved, while 3% felt it had worsened after the restructuring. Fifty-six percent of the housestaff felt the new program should be continued unchanged, and 29% felt it should be continued with changes. Housestaff teams have approached educational issues, quality-of-care problems, and resource management challenges through formal scientific problem-solving techniques. This article discusses the lessons learned in the first six months and the program improvements that will be attempted in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. European School of Internal Medicine: a window of opportunity for RCP activities in Europe.

    Science.gov (United States)

    Davidson, Chris; Higgens, Clare

    2009-04-01

    The Royal College of Physicians (RCP) is to host the European School of Internal Medicine for two years from 2009-10. This affords a unique opportunity for specialist registrars to exchange ideas about professional development and training and to make contacts with young internists from across Europe. Such links should prove useful for future RCP initiatives in European medicine.

  9. A Qualitative Study of Work-Life Choices in Academic Internal Medicine

    Science.gov (United States)

    Isaac, Carol; Byars-Winston, Angela; McSorley, Rebecca; Schultz, Alexandra; Kaatz, Anna; Carnes, Mary L.

    2014-01-01

    The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career…

  10. A Qualitative Study of Work-Life Choices in Academic Internal Medicine

    Science.gov (United States)

    Isaac, Carol; Byars-Winston, Angela; McSorley, Rebecca; Schultz, Alexandra; Kaatz, Anna; Carnes, Mary L.

    2014-01-01

    The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career…

  11. Implementing evidence-based medicine in general practice: a focus group based study

    Directory of Open Access Journals (Sweden)

    Aertgeerts Bert

    2005-09-01

    Full Text Available Abstract Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice, commercial and consumer organisations on the meso-level (institutions, organisations and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community. Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.

  12. International Federation for Emergency Medicine Model curriculum for medical student education in emergency medicine

    Directory of Open Access Journals (Sweden)

    Cherri Hobgood

    2011-09-01

    The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is designed, not to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.

  13. Did Osler suffer from "paranoia antitherapeuticum baltimorensis"? A comparative content analysis of The Principles and Practice of Medicine and Harrison's Principles of Internal Medicine, 11th edition.

    Science.gov (United States)

    Hogan, D B

    1999-10-05

    One of the most important legacies of Sir William Osler was his textbook The Principles and Practice of Medicine. A common criticism of the book when it was first published was its deficiency in the area of therapeutics. In this article, the 1st edition of The Principles and Practice of Medicine is compared with the 11th edition of Harrison's Principles of Internal Medicine. The analysis focuses on the treatment recommendations for 4 conditions that were covered in both books (diabetes mellitus, ischemic heart disease, pneumonia and typhoid fever). Osler's textbook dealt with typhoid fever and pneumonia at greater length, whereas Harrison's placed more emphasis on diabetes mellitus and ischemic heart disease. Notwithstanding Osler's reputation as a therapeutic nihilist, the 2 books devoted equivalent space to treatment (in terms of proportion of total sentences for the conditions). For all conditions except ischemic heart disease, Osler concentrated on general measures and symptomatic care. Throughout Osler's textbook numerous negative comments are made about the medicinal treatment of various conditions. A more accurate statement about Osler's therapeutic approach was that he was a "medicinal nihilist." His demand for proof of efficacy before use of a medication remains relevant.

  14. Generalized internal multiple imaging (GIMI) using Feynman-like diagrams

    KAUST Repository

    Zuberi, M. A. H.

    2014-05-19

    Single scattering events recorded in surface seismic data do not fully illuminate the subsurface structure, especially if it is complicated. In such cases, multiple internal scatterings (internal multiples) can help improve the illumination. We devise a generalized internal multiple imaging (GIMI) procedure that maps internal multiple energy to their true location with a relatively mild addition to the computational cost. GIMI theory relies heavily on seismic interferometry, which often involves cumbersome algebra, especially when one is dealing with high-order terms in the perturbation series. To make the derivations, and inference of the results easier, we introduce Feynman-like diagrams to represent different terms of the perturbation series (solution to the Lippman–Schwinger equation). The rules we define for the diagrams allow operations like convolution and cross-correlation in the series to be compressed in diagram form. The application of the theory to a double scattering example demonstrates the power of the method.

  15. Initial evaluation of thyroid nodules by primary care physicians and internal medicine residents

    OpenAIRE

    Quianzon, Celeste C. L.; Pamela R. Schroeder

    2015-01-01

    Objective: The article studied the knowledge and practice patterns of primary care providers and internal medicine residents in their initial evaluation of thyroid nodules and determined whether their practice is in accordance with published guidelines by the American Thyroid Association and American Association of Clinical Endocrinologists.Method: A survey was distributed to primary care physicians (PCPs) and internal medicine residents at a community hospital in Baltimore and a chart review...

  16. CIS7/419: Information Content of Conventional Patient Files in Internal Medicine

    OpenAIRE

    Bobrowski, C; Kreymann, G.

    1999-01-01

    Introduction Migration from conventional patient files to an electronic patient records requires to estimate the amount of information generated per case. This is particularly necessary when planning a distributed environment, i.e. an Intranet. As part of our intranet design, the information content of patient files in internal medicine was measured. Methods A random sample of patient files was drawn form the archive of the Medizinische Kernklinik Department of Internal Medicine The sample co...

  17. Interdisciplinary, interinstitutional and international collaboration of family medicine researchers in Taiwan

    Directory of Open Access Journals (Sweden)

    Yi-Hsuan Lin

    2015-10-01

    Full Text Available The family medicine researches flourished worldwide in the past decade. However, the collaborative patterns of family medicine publications had not been reported. Our study analyzed the collaborative activity of family medicine researchers in Taiwan. We focused on the types of collaboration among disciplines, institutions and countries. We searched “family medicine” AND “Taiwan” in address field from Web of Science and documented the disciplines, institutions and countries of all authors. We analyzed the collaborative patterns of family medicine researchers in Taiwan from 2010 to 2014. The journal’s impact factor of each article in the same publication year was also retrieved. Among 1,217 articles from 2010 to 2014, interdisciplinary collaboration existed in 1,185 (97.3% articles, interinstitutional in 1,012 (83.2% and international in 142 (11.7%. Public health was the most common collaborative discipline. All international researches were also interdisciplinary and interinstitutional. The United States (75 articles, the United Kingdom (21 and the People’s Republic of China (20 were the top three countries with which family medicine researchers in Taiwan had collaborated. We found a high degree of interdisciplinary and interinstitutional collaboration of family medicine researches in Taiwan. However, the collaboration of family medicine researchers in Taiwan with family medicine colleagues of other domestic or foreign institutions was insufficient. The future direction of family medicine studies could focus on the promotion of communication among family medicine researchers.

  18. A clinical investigation and analysis on multiple somatic symptoms of Chinese of foreign nationality in general and internal medicine clinic of foreign invested hospitals%外资医院全科及内科门诊外籍华人多躯体症状调查分析

    Institute of Scientific and Technical Information of China (English)

    徐蔚; 刘兢晟; 毛家亮

    2016-01-01

    目的:分析外资医院全科及内科门诊外籍华人多躯体症状患者的躯体症状、躯体疾病、心理状态及医疗资源的使用等特点,探讨相关的因素。方法方便取样法选取2013年1-8月在上海东方国际医疗中心、2013年9月至2015年3月在上海百汇医疗中心全科及内科门诊收治的160例患者,进行躯体化症状量表(SSS)及抑郁症状严重程度九项量表(PHQ-9)和广泛性焦虑七项量表(GAD-7)自评。根据SSS得分,将SSS得分≥37分者设为多躯体症状组(SOM阳性组),将SSS得分6个月的患者比例在SOM阳性组中显著高于SOM阴性组(P<0.05)。结论多躯体症状患者并没有更多明确诊断的躯体疾病,此类患者的抑郁焦虑程度更高、工作生活受影响的程度更大,抑郁焦虑分高及无商业医疗保险是多躯体症状的影响因素。%Objective To analyze multiple somatic symptoms, physical illness, psychological characteristics and facilities usage by Chinese patients with foreign nationalities,at GP and Internal Medicine Clinics at the foreign funded hospitals,on the purpose of symp-toms improvement with effective cost. Methods Totally 160 patients were recruited from GP and internal medicine clinics in Shanghai East International Medical Center from January to August in 2013,and Parkway health Shanghai from September 2013 to March 2015, who were screened with self-rating Somatic Symptoms Scale ( SSS ) , in addition to self-rating Depression scale of the Patient Health Questionnaire(PHQ-9)and Generalized Anxiety Disorder(GAD-7). Based on the cut off value of 36/37,160 patients were divided into somatic symptom group( SOM+) and the control group( SOM-) . All the subjects received 30 minutes of structural interview on cur-rent history,past medical history and physical examination. Results Female,jobless,less than 6 months of residing in China,born o-verseas,self-paid were more significant in SOM positive group(SOM+)than in SOM

  19. [Inventory of training of internal medicine in France: Results of a national survey].

    Science.gov (United States)

    Samson, M; Terrier, B; Mangin, O; Mouthon, L

    2017-05-01

    To make an inventory of training of Internal Medicine in France. This study was conducted between May and September 2015 with coordinators (interviews of 45minutes) of local Internal Medicine training and fellows (online questionnaire). All coordinators (n=28) responded to the interviews. Local training of Internal Medicine exists in 86% of regions (3.1±3.1hours/month) and an interregional training in all interregions (34.7±13.9hours/year). When excluding Île-de-France, no correlation between the number of teachers and the amount of lessons was noted (P=0.61). Of the 550 fellows in Internal Medicine in 2014-2015, 223 (41%) responded to the online questionnaire. Mean level was 5.5±2.7 semesters. The rate of satisfaction (1=very dissatisfied and 5=very satisfied) was 3.0±1.0 and 3.8±0.8 for regional and interregional teaching, respectively (PInternal Medicine. This survey states for the first time an inventory of training of Internal Medicine dedicated to fellows in France. This report highlights that fellows wish to have a national program, be further evaluated and have access to more interactive approach of teaching. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  20. Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis

    Directory of Open Access Journals (Sweden)

    Krautter M

    2014-09-01

    Full Text Available Markus Krautter,1 Sven Andreesen,2 Nadja Köhl-Hackert,2 Katja Hoffmann,3 Wolfgang Herzog,2 Christoph Nikendei2 1Department of Nephrology, University of Heidelberg, 2Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, 3Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany Background: Peer-assisted learning (PAL has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective.Purpose: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors.Methods: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80. The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants. The discussions were analyzed using content analysis.Results: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available.Conclusion: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor–student working alliance

  1. International survey of self-reported medicine use among adolescents

    DEFF Research Database (Denmark)

    Hansen, Ebba H; Holstein, Bjørn E; Due, Pernille

    2003-01-01

    OBJECTIVE: To examine gender, age, and country variations in adolescents' self-reported medicine use. DESIGN: Cross-sectional school surveys of representative samples of 11- to 15-year-old girls and boys were used. The 1997/1998 Health Behaviour in School-aged Children study was referenced. A sta...

  2. Nonadherence to antihypertensive medications and associated factors in general medicine clinics

    Directory of Open Access Journals (Sweden)

    Al Ghobain M

    2016-08-01

    Full Text Available Mohammed Al Ghobain,1,2 H Alhashemi,1,2 A Aljama,3 S Bin Salih,1,2 Z Assiri,4 A Alsomali,4 Gamal Mohamed5 1Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2King Abdullah International Medical Research Centre, 3Department of Medicine, King Abdulaziz Medical City, 4College of Nursing, 5College of Public Health, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia Objectives: Nonadherence to antihypertensive medications has not been assessed in the Saudi population. The aim of this study was to address and evaluate the magnitude of nonadherence among hypertensive patients and the risk factors associated with it. Methods: A cross-sectional survey was conducted on hypertensive patients who attended the general internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a questionnaire that was modified after reviewing the literature. Hypertensive patients were labeled as nonadherent if they missed their medications for a total of 7 days during the previous month. Results: A total of 302 patients participated in the study, of whom 63% were females with a mean age of 64 years, and 64% were illiterate. The prevalence of nonadherence to medications among hypertensive patients was found to be 12.3%. Poor disease knowledge was reported in 80% of patients, while 66% of the patients had poor monitoring of their disease. Younger age (≤65 years, poor monitoring, and uncontrolled blood pressure (BP ≥140/90 mmHg were the predictor factors associated with nonadherence (odds ratio [OR] =2.04, P=0.025; OR=2.39, P=0.004; and OR=2.86, P=0.003, respectively. Conclusion: Nonadherence to antihypertensive medications is lower than that previously reported in the literature. Younger age, uncontrolled BP, and poor monitoring are the main risk factors associated with nonadherence. Keywords: nonadherence, hypertension, Saudi Arabia, uncontrolled blood

  3. An investigation into the use of complementary and alternative medicine in an urban general practice.

    LENUS (Irish Health Repository)

    Mc Kenna, F

    2010-11-05

    Several International studies have shown the substantial growth in the use of complementary and alternative medicine (CAM). However, no study in the Republic of Ireland to date has looked at its use among the population. A cross-sectional survey of 328 patients attending an urban general practice was conducted. A high number of respondents reported having visited a CAM practitioner within the past 12 months (89 patients; 27%). A significant positive association was found between CAM use and female gender (p = 0.006), middle-aged (p = 0.013), private health insurance (p = 0.016) and full time employment (p = 0.031). Massage was the most common modality used (35 patients; 39.8%), the most common reason for use was \\'to treat an illness for which conventional medicine was already sought\\' (31 patients; 42%), a high rate of non-disclosure to GPs was found (34 patients; 41%) and personal recommendation was the most important source of information (42 patients; 53.2%). This study demonstrates the current popularity of an alternative healthcare system.

  4. Interprofessional collaboration on an internal medicine ward: role perceptions and expectations among nurses and residents.

    Directory of Open Access Journals (Sweden)

    Virginie Muller-Juge

    Full Text Available BACKGROUND: Effective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles. OBJECTIVE: Describe and compare residents' and nurses' perceptions and expectations of their own and each other's professional roles in the context of an Internal Medicine ward. METHODS: A convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents' and nurses' professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios. RESULTS: Three main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses' autonomy in patient management, nurses' participation in the decision-making process, professional interdependence, and residents' implication in teamwork. Results from the clinical scenarios showed that nurses' intended actions differed from residents' expectations mainly regarding autonomy in patient management. Correlation between residents' expectations and nurses' intended actions was 0.56 (p=0.08, while correlation between nurses' expectations and residents' intended actions was 0.80 (p<0.001. CONCLUSIONS: There are discordant perceptions and unmet expectations among nurses and residents about each other's roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other's roles and clarify the boundaries

  5. [Highlights of hospital-based internal medicine in 2010: chief residents' perspective].

    Science.gov (United States)

    Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël

    2011-02-02

    Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

  6. Introduction of the World Health Organization project of the International Classification of Traditional Medicine.

    Science.gov (United States)

    Gao, Peng-fei; Watanabe, Kenji

    2011-11-01

    The World Health Organization plans to incorporate "traditional medicine" into the next revision of its International Classification of Diseases-Version 11 (ICD-11). If traditional medicine is included in ICD-11, it is definitely an epoch-making issue. The expected result is the International Classification of Traditional Medicine, China, Japan and Korea Version (ICTM-CJK). The intention of the ICTM project is not only beneficial for traditional medical components, but also might be beneficial for Western biomedicine. For this shared purpose, China, Japan and Korea must understand the meaning of this project and collaborate to develop it.

  7. International cooperation in support of homeopathy and complementary medicine in developing countries: the Tuscan experience.

    Science.gov (United States)

    Rossi, Elio; Di Stefano, Mariella; Baccetti, Sonia; Firenzuoli, Fabio; Verdone, Marco; Facchini, Mario; Stambolovich, Vuk; Viña, Martha Perez; Caldés, Maria José

    2010-10-01

    Health is a fundamental human right which contributes to reducing poverty, and encourages social development, human safety, and economic growth. International initiatives have fallen far short of their goals. This paper describes collaboration between the region of Tuscany and Cuba, Western Sahara, Senegal and Serbia. These have introduced various forms of Complementary and Alternative Medicine, including homeopathy and Traditional Chinese Medicine into primary healthcare particularly obstetrics, and into veterinary medicine. Complementary and traditional medicine can represent a useful and sustainable resource in various fields of health care. Inclusion in the public health system must go hand in hand with scientific evaluation.

  8. Intention to Encourage Complementary and Alternative Medicine among General Practitioners and Medical Students

    Science.gov (United States)

    Godin, Gaston; Beaulieu, Dominique; Touchette, Jean-Sebastien; Lambert, Leo-Daniel; Dodin, Sylvie

    2007-01-01

    The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that…

  9. [Pulmonary medicine 2012: news for the general practitioner].

    Science.gov (United States)

    Gex, G; Petitpierre, N; Charbonnier, F; Rochat, T

    2013-01-16

    This review reports on papers published in 2012 that will most likely impact on daily medical practice in four different areas of pulmonary medicine. How should treatment of asthma with inhaled corticosteroids be adjusted on the long run? Should idiopathic pulmonary fibrosis receive treatment with immunosuppressive drugs? Is a long-term treatment with azithromycine for bronchiectasis supported by evidence, apart from patients with cystic fibrosis? And finally, can treatment of obstructive sleep apnea with continuous positive pressure (CPAP) prevent the occurrence of new, systemic hypertension?

  10. An educational intervention to improve internal medicine interns' awareness of hazards of hospitalization in acutely ill older adults.

    Science.gov (United States)

    Wilkerson, Loren M; Iwata, Isao; Wilkerson, Matthew D; Heflin, Mitchell T

    2014-04-01

    Hospitalized older adults are susceptible to complications termed "hazards of hospitalization" (HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This study investigated the effect of an educational intervention to increase internal medicine interns' knowledge and self-efficacy of HOH and to improve their care of hospitalized older adults as measured by their documentation of HOH. Targeted learners were internal medicine interns on their geriatrics rotation at a large academic hospital in 2011 to 2012. The intervention covered 10 specific HOH: delirium, pressure ulcers, urinary incontinence and retention, functional decline, falls, suboptimal prescribing, dehydration and malnutrition, infection, depression, and inappropriate interventions. Knowledge and self-efficacy were measured before and after training. HOH documentation rates of interns who did and did not complete the training were compared over a preset 8-week period. Forty-two of 43 eligible interns completed the curriculum. After training, knowledge was significantly greater (approximately 1 more correct question out of 3, P interns had significantly more-frequent documentation of patients' activities of daily living, gait, and plan for functional decline prevention than interns who were not trained (P interns who were not trained (P < .01). Implementation of an educational intervention was successful in improving educational and behavior change outcomes regarding HOH. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  11. Die Umsetzung der Leitlinien für Fakultäts-interne Leistungsnachweise am Lehrbereich Allgemeimedizin der Ludwig-Maximilians-Universität (LMU München [Realisation of the guidelines for faculty-internal exams at the Department of General Medicine at the University of Munich

    Directory of Open Access Journals (Sweden)

    Boeder, Niklas

    2012-05-01

    Full Text Available [english] Graded exams are prerequisites for the admission to the medical state examination. Accordingly the exams must be of good quality in order to allow benchmarking with the faculty and between different universities. Criteria for good quality need to be considered - namely objectivity, validity and reliability. The guidelines for the processing of exams published by the GMA are supposed to help maintaining those criteria. In 2008 the Department of General Medicine at the University of Munich fulfils only 14 of 18 items. A review process, appropriate training of the staff and the introduction of the IMSm software were the main changes that helped to improve the ‘GMA-score’ to 30 fulfilled items. We see the introduction of the IMSm system as our biggest challenge ahead. IMSm helps to streamline the necessary workflow and improves their quality (e.g. by the detection of cueing, item analysis. Overall, we evaluate the steps to improve the exam process as very positive. We plan to engage co-workers outside the department to assist in the various review processes in the future. Furthermore we think it might be of value to get into contact with other departments and faculties to benefit from each other’s question pools.[german] Benotete Prüfungen sind Voraussetzung für die Zulassung zum zweiten Abschnitt der Ärztlichen Prüfung (Staatsexamen in der Medizin. Daraus lässt sich die Notwendigkeit ableiten, qualitativ hochwertige Prüfungen zu konzipieren, die einen Leistungsvergleich unter Absolventen einer Fakultät und darüber hinaus auch interfakultär erlauben. Hierbei sind Kernqualitätsmerkmale Objektivität, Validität und Reliabilität zu beachten. Die im Leitlinienkatalog der GMA genannten Kriterien sollen die Qualität der Prüfungen sicherstellen. Das Prüfungskonzept des Lehrbereichs Allgemeinmedizin an der LMU erreichte bei Betrachtung der MC-Klausur 2008 nur 14 von 48 möglichen Kriterien. Ein fest eingeplanter Review

  12. [The Strategic Plan for the development of Internal Medicine in Andalusia].

    Science.gov (United States)

    Bernabeu-Wittel, M; García Morillo, S; Ollero, M; Hernández-Quero, J; González de la Puente, M A; Montero Pérez-Barquero, M; Díez, F; García-Alegría, J; Pujol, E; Sanromán, C; Cuello, J A

    2008-06-01

    The Strategic Plan for the Development of Internal Medicine in Andalusia arose from the need that the internal medicine doctors had to redefine the purpose and values of their specialty to cope with the numerous changes occurring in the health care area. The project was developed in three phases. First, the tendency of the health care system and current position of the specialty were analyzed. After, the internal and external opinions on the present-future of Internal Medicine were checked out. Finally, five strategic lines with their action plans were established. Specific objectives were defined within each line: results to be achieved, methodology according to action plan. After several years of collegial work in this initiative, very positive results have been achieved. We conclude that the Strategic Plan has been useful to better define the position of our specialty and to state which tools such as those mentioned are effective to cope with the new challenges that may occur in other groups.

  13. Animal-assisted interventions in internal and rehabilitation medicine: a review of the recent literature.

    Science.gov (United States)

    Muñoz Lasa, S; Ferriero, G; Brigatti, E; Valero, R; Franchignoni, F

    2011-06-01

    While conventional wisdom has always affirmed the value of animals in promoting human well-being, only recently has their therapeutic role in medicine become the focus of dedicated research. Therapeutic modalities that use animals as a tool for improving the physical, emotional, cognitive and/or social functioning of humans are called animal-assisted interventions (AAI), and are classified into: animal-assisted activities (AAA); animal-assisted therapy (AAT); and service animal programs (SAP). The aim of this review is to analyze the papers published between 2001 and 2010 in the most influential medical journals dealing with AAI, and discuss their findings in the light of what may be of interest for internal medicine and rehabilitation. A total of 35 articles met the strict inclusion criteria for this review: 18 papers dealing with AAA, 8 with AAT, and 9 with SAP. The therapeutic outcomes associated with AAA are: enhancement of socialization; reduction of stress, anxiety and loneliness; improvement in mood and general well-being; and development of leisure/recreation skills. Regarding AAT, horses are often used as a complementary strategy to facilitate the normalization of muscle tone and improve motor skills in children with cerebral palsy and persons with lower limb spasticity. Finally, most SAP utilize dogs, that assist people with various disabilities in performing everyday activities, thus reducing their dependence on other persons. Further studies are needed to better define the fields and programs for the therapeutic use of animals and to increase their utilization in medicine, as a promising, complementary and natural means to improve both functional autonomy and quality of life.

  14. Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

    Science.gov (United States)

    Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

    2017-08-01

    Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen

  15. International Society of Physical and Rehabilitation Medicine (ISPRM):strengthening Physical and Rehabilitation Medicine (PRM) worldwide

    Institute of Scientific and Technical Information of China (English)

    Gerold Stucki; Jan D.Reinhardt; Marta Imamura; Jianan Li; Joel A.De Lisa

    2011-01-01

    @@ Physiral and Rehabilitation Medicine (PRM) is the Medicine of Functioning in light of health conditions, under consideration of the person and in interaction with the environment[1-2].PRM focuses on the application of rehabilitation, the third health strategy which complements the preventive and curative health strategies.Thanks to the increasing survival of people after injury and formerly conditions as well as aging populations and an associated increase in chronic conditions, PRM as the leader of the rehabilitation will, over the next decades, assume an ever more important role in the health care systems worldwide.

  16. Medical Students' Perception of OSCE at the Department of Internal Medicine, College of Medicine, King Khalid University, Abha, KSA.

    Science.gov (United States)

    Elfaki, Omer Abdelgadir; Al-Humayed, Suliman

    2016-02-01

    The aim of this study was to explore the students' acceptance of Objective Structured Clinical Examination (OSCE) as a method of assessment of clinical competence in internal medicine. This cross sectional study was conducted from June to August 2013, at King Khalid University, Abha, KSA, through a self-administered questionnaire which was completed by fourth year medical students, immediately after the OSCE. Student feedback confirmed their acceptance of OSCE. This was encouraging to the department to consider implementing OSCE for graduating students.

  17. Editorial: European Journal of Case Reports in Internal Medicine

    Directory of Open Access Journals (Sweden)

    John Kellett

    2014-02-01

    Full Text Available Modern medicine began in the last half of the nineteenth century when doctors started practising the scientific method at the bedside. However, in his presidential address to the Association of American Physicians in 1979 James Wyngaarden postulated that the clinical scientist was an endangered species. Several reasons for this have been suggested, including “the seductive incomes that now derive from procedure-based specialty medicine”. Others have suggested that it is simply because the things left to be discovered at bedside have become exhausted, and that all the big medical advances will now be made by high-powered institutions.

  18. Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive.

    Science.gov (United States)

    Aksoy, Duygu Yazgan; Durusu Tanriover, Mine; Unal, Sule; Dizdar, Omer; Kalyoncu, Umut; Karakaya, Jale; Unal, Serhat; Kale, Gulsev

    2014-01-01

    The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

  19. Empiricism in Hellenistic MedicineGeneralizations without Aetiologies

    Directory of Open Access Journals (Sweden)

    Maja Grgic Hudoletnjak

    2006-06-01

    Full Text Available The Empiricists argued that medical knowledge is a matter of experience, and that no theory is required either for its formation or application. The central part of their position was rejecting the possibility of the discovery of causal connections by the use of reason. The theorems that make up medical knowledge are empirical generalizations that do not include the specification of the cause. However, the Greek authors outside Empiricism, both medical and philosophical, made a strong case for the claim that a generalization must be explanatory to be scientific or artistic. In this paper I discuss how non-explanatory generalizations, being statements of frequency of joint occurrences which are statistically accurate, can be taken by the Empiricists as scientific.

  20. 6th International Conference on the History of General Relativity

    CERN Document Server

    Eisenstaedt, Jean; The Universe of General Relativity; GR 6

    2005-01-01

    This volume from the Einstein Studies Series is based largely on papers presented at the Sixth International Conference on the History of General Relativity, held in Amsterdam on June 26-29, 2002. These contributions from notable experts offer both new and historical insights on gravitation, general relativity, cosmology, unified field theory, and the history of science. Topics discussed include the prehistory of special relativity, early attempts at a relativistic theory of gravitation, the beginnings of general relativity, the problem of motion in the context of relativity, conservation laws, the axiomatization of relativity, classical and contemporary cosmology, gravitation and electromagnetism, quantum gravity, and relativity as seen through the eyes of the public and renowned relativists. Contributors: K. Brading; G. Gale; H.F.M. Goenner; J. Goldberg; S. Katzir; D. Kennefick; H. Kragh; C. Lehner; U. Majer; J. Mattingly; E.T. Newman; J.D. Norton; J. Renn; R. Rynasiewicz; J.M. Sánchez-Ron; T. Sauer; C. Sm...

  1. [Conversion disorder in an internal medicine department: A series of 37 cases].

    Science.gov (United States)

    Régny, P; Cathébras, P

    2016-04-01

    To describe the clinical characteristics of a series of patients presenting conversion disorder in a general internal medicine ward and outpatient clinic, the arguments retained by the physicians in favour of the diagnosis, the somatic and psychiatric co-morbidities, the management and the outcome of the disorder. We report the study of 37 patients diagnosed with conversion disorder in an internal medicine department of a French university hospital over a period of 14 years. We retrospectively reviewed the charts of the patients and contacted their primary care physicians to obtain follow-up data. No structured instrument was used for the diagnosis of conversion disorder or for the assessment of psychiatric comorbidities. As expected, patients were mostly young females, although a great variety of age, gender, and socio-cultural background was observed. Motor symptoms predominated (62%). A relevant psychogenic factor was explicitly mentioned in only 43% of the cases. In many cases, organic disease was also present, and an organic cause for the symptom initially considered as conversion was suspected in 3 cases. Depressive and anxious disorders were present respectively in 38% and 35% of cases. A pain complaint was associated in half of the cases. Among patients for whom follow-up data is available, conversion symptoms persisted or recurred in 70% of cases and were associated with a poor quality of life. This case series confirms that the DSM-IV-TR criterion of "psychogenicity" (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  2. Proceso organizacional del departamento de Medicina General Integra Organizational process of the Department of Comprehensive General Medicine

    Directory of Open Access Journals (Sweden)

    Alcides Abad Ochoa Alonso

    2005-04-01

    Full Text Available Se realizó un estudio descriptivo para analizar el desarrollo organizativo del Departamento de Medicina General Integral de la Facultad de Ciencias Médicas "Mariana Grajales Coello", de Holguín, desde su constitución a inicios del curso académico 1988-1989 hasta la culminación del curso académico 2000-2001. Se definieron las variables y factores clave de éxito que integraron las 2 matrices construidas como instrumento de evaluación. Los resultados obtenidos en ambas matrices muestran que el proceso organizacional en el departamento se fortaleció al alcanzar para los factores de carácter externo un resultado total ponderado de 2,5 en el curso académico 2000-2001, superior al 2,1 del curso 1988-1989, y de 3,5 y 1,45, respectivamente para los factores de carácter interno, lo que indica un fortalecimiento general del proceso. Particularmente se transforman de manera favorable aquellos factores susceptibles de intervenciones administrativas. Se identificaron además, las áreas en que deben intensificarse o modificarse las estrategias en curso.A descriptive study was conducted to analyze the organizational development of the Department of Comprehensive General Medicine of "Mariana Grajales Coello" Medical Faculty, in Holguín since it was founded at the beginning of the academic course 1988-2001. The variables and key factors for success that integrated the 2 matrixes created as evaluation tools were defined. The results obtained in both matrixes showed that the organizational process in the department was strenghthened on obtaining a total weighted result for the factors of external character of 2.5 in the academic course 2000-2001, which was higher than the achieved in the course 1988-1989 (2-1, whereas 3.5 and 1.45 were attained, respectively, for the factors of internal character, which proved that there was a general strenghthening of the process. Those factors susceptible to managerial interventions were particularly transformed in

  3. General formulation of vibronic spectroscopy in internal coordinates.

    Science.gov (United States)

    Baiardi, Alberto; Bloino, Julien; Barone, Vincenzo

    2016-02-28

    Our general platform integrating time-independent and time-dependent evaluations of vibronic effects at the harmonic level for different kinds of absorption and emission one-photon, conventional and chiral spectroscopies has been extended to support various sets of internal coordinates. Thanks to the implementation of analytical first and second derivatives of different internal coordinates with respect to cartesian ones, both vertical and adiabatic models are available, with the inclusion of mode mixing and, possibly, Herzberg-Teller contributions. Furthermore, all supported non-redundant sets of coordinates are built from a fully automatized algorithm using only a primitive redundant set derived from a bond order-based molecular topology. Together with conventional stretching, bending, and torsion coordinates, the availability of additional coordinates (including linear and out-of-plane bendings) allows a proper treatment of specific systems, including, for instance, inter-molecular hydrogen bridges. A number of case studies are analysed, showing that cartesian and internal coordinates are nearly equivalent for semi-rigid systems not experiencing significant geometry distortions between initial and final electronic states. At variance, delocalized (possibly weighted) internal coordinates become much more effective than their cartesian counterparts for flexible systems and/or in the presence of significant geometry distortions accompanying electronic transitions.

  4. Quality management: patients reflections on health care at outpatient clinic of internal medicine department.

    Science.gov (United States)

    Ljubičić, Neven; Boban, Marko; Gaćina, Petar; Adzija, Jasminka; Benceković, Zeljka; Rajković, Ana

    2009-06-01

    Middle and older age group relative share in the community permanently grows. Those are commonly burdened with several chronic health conditions or elevated incidence of acute ones and in more frequent need for consulting health services. In the era of modern technical medicine, it is important to increase quality of services particularly patients orientated. Department of Internal Medicine developed questionnaire to assess reflections on medical care from the receiver of medical services point of view. Sample was formed from individuals that visited outpatient triage Unit (OTU) and voluntary enrolled, during period April 1-August 31, 2008 for any medical reason. Study population structure had similarly equally of both genders, socio-economical background, and was in age range 18-87. Questionnaire was developed by team of experienced personnel covering satisfaction on received medical care. There were 279 returned formulary in a sample of 6700 patients (4.18%). Patients visited OTU chiefly on behalf medical condition secondary to address of residency, followed by personal choice, on advice given by general practitioner, by emergency transportation services, or just due to earlier experiences. Regarding provided medical care extent, 4/5 of patients were examined in lesser than 2 hours, while total workup lasted mostly for 2-4, followed by over four. Over half of patients were moderate toward highly satisfied with provided medical information, personnel communication style and general reflection on all services while being in the Department premises. Astonishing proportion of patients (93%) was satisfied with positive personnel communication. Integration of patients' self-perceived reports about medical services in organizing process is inevitable for augmenting content and at the same time valuable for developing overall quality of treatment. Communication excellence is of premier importance and unavoidable for giving additional positive effect to remain health

  5. The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms.

    Science.gov (United States)

    Hazekamp, Arno; Ware, Mark A; Muller-Vahl, Kirsten R; Abrams, Donald; Grotenhermen, Franjo

    2013-01-01

    Cannabinoids, including tetrahydrocannabinol and cannabidiol, are the most important active constituents of the cannabis plant. Over recent years, cannabinoid-based medicines (CBMs) have become increasingly available to patients in many countries, both as pharmaceutical products and as herbal cannabis (marijuana). While there seems to be a demand for multiple cannabinoid-based therapeutic products, specifically for symptomatic amelioration in chronic diseases, therapeutic effects of different CBMs have only been directly compared in a few clinical studies. The survey presented here was performed by the International Association for Cannabinoid Medicines (IACM), and is meant to contribute to the understanding of cannabinoid-based medicine by asking patients who used cannabis or cannabinoids detailed questions about their experiences with different methods of intake. The survey was completed by 953 participants from 31 countries, making this the largest international survey on a wide variety of users of cannabinoid-based medicine performed so far. In general, herbal non-pharmaceutical CBMs received higher appreciation scores by participants than pharmaceutical products containing cannabinoids. However, the number of patients who reported experience with pharmaceutical products was low, limiting conclusions on preferences. Nevertheless, the reported data may be useful for further development of safe and effective medications based on cannabis and single cannabinoids.

  6. Prevalence of medicinal drugs in suspected impaired drivers and a comparison with the use in the general Dutch population

    NARCIS (Netherlands)

    Bezemer, Karlijn D B; Smink, Beitske E; van Maanen, Rianne; Verschraagen, Miranda; de Gier, Johan J

    2014-01-01

    The aim of this study was to investigate the prevalence of psychotropic medicines in drivers suspected of driving under the influence of medicinal and illicit drugs in The Netherlands and to compare the prevalence of selected impairing medicines with the use of these medicines in the general Dutch p

  7. The Internal Medicine of the 21st century: Organizational and operational standards.

    Science.gov (United States)

    Casariego-Vales, E; Zapatero-Gaviria, A; Elola-Somoza, F J

    2017-07-19

    The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Evaluation of an internal research funding program in a school of veterinary medicine.

    Science.gov (United States)

    Baker, David G; Kearney, Michael T

    2012-01-01

    The present article describes a paradigm for evaluating the internal research funding program of a college or school of veterinary medicine, using as an example a similar exercise recently conducted at the Louisiana State University School of Veterinary Medicine (LSU SVM). The purpose of the exercise was to quantify and evaluate the effectiveness of the LSU SVM internal research funding mechanism known as the Competitive Organized Research Program (CORP). The evaluation resulted in several important observations that will allow us to further improve the effectiveness of our internal research funding program investment. Among the most important of these was the greater return on investment for CORP projects funded with smaller awards (approximately $10,000 US) compared to projects funded with larger awards (approximately $52,000 US). Other colleges and schools of veterinary medicine may find such an exercise similarly informative and beneficial.

  9. General Survey of Traditional Chinese Medicine and Western Medicine Researches on Tumor Metastasis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Metastasis and recurrence of tumors is the chief cause of death for such patients. Therefore,researches on the mechanism of its metastasis, prevention and treatment are the focal points in the field of traditional Chinese medicine (TCM) and Western medicine (WM) at present. WM practitioners' study on tumor metastasis involved its occurrence and development including every detail and process, and now it even has developed into the molecular biological field. In treatment surgical operation and radio- chemotherapy is used as the main means, but the efficacy is not too optimistic. In recent years, TCM, as part of the comprehensive therapy, has been gradually gaining attention of oncologists. Aimed at solving the difficult problems in metastasis of tumor, many TCM practitioners on the basis of syndrome differentiation have raised theories about the cause of tumor metastasis. On the basis of these theories, some TCM recipes against tumor metastasis have been developed to serve as an effective supplement to surgical operation, radio- and chemotherapy. The present article summarizes research results in recent years about the cause of formation of tumor and its metastasis by TCM and WM, so as to offer some theoretical clues to the study of tumors metastasis.

  10. Postgraduate internal medicine residents' roles at patient discharge - do their perceived roles and perceptions by other health care providers correlate?

    Science.gov (United States)

    Card, Sharon Elizabeth; Ward, Heather A; Chipperfield, Dylan; Sheppard, M Suzanne

    2014-01-01

    Knowing one's own role is a key collaboration competency for postgraduate trainees in the Canadian competency framework (CanMEDS®). To explore methods to teach collaborative competency to internal medicine postgraduate trainees, baseline role knowledge of the trainees was explored. The perceptions of roles (self and others) at patient discharge from an acute care internal medicine teaching unit amongst 69 participants, 34 physicians (25 internal medicine postgraduate trainees and 9 faculty physicians) and 35 health care professionals from different professions were assessed using an adapted previously validated survey (Jenkins et al., 2001). Internal medicine postgraduate trainees agreed on 8/13 (62%) discharge roles, but for 5/13 (38%), there was a substantial disagreement. Other professions had similar lack of clarity about the postgraduate internal medicine residents' roles at discharge. The lack of interprofessional and intraprofessional clarity about roles needs to be explored to develop methods to enhance collaborative competence in internal medicine postgraduate trainees.

  11. Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards-a retrospective study.

    Science.gov (United States)

    Eliakim-Raz, Noa; Babaoff, Roi; Yahav, Dafna; Yanai, Shirly; Shaked, Hila; Bishara, Jihad

    2016-11-01

    The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients. A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed. A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p48h. IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. A Delphi study among internal medicine clinicians to determine which therapeutic information is essential to record in a medical record.

    Science.gov (United States)

    van Unen, Robert J; Tichelaar, Jelle; Nanayakkara, Prabath W B; van Agtmael, Michiel A; Richir, Milan C; de Vries, Theo P G M

    2015-12-01

    Several studies have demonstrated that using a template for recording general and diagnostic information in the medical record (MR) improves the completeness of MR documentation, communication between doctors, and performance of doctors. However, little is known about how therapeutic information should be structured in the MR. The aim of this study was to investigate which specific therapeutic information registrars and consultants in internal medicine consider essential to record in the MR. Therefore, we carried out a 2-round Internet Delphi study. Fifty-nine items were assessed on a 5-point scale; an item was considered important if ≥ 80% of the respondents awarded it a score of 4 or 5. In total, 26 registrars and 30 consultants in internal medicine completed both rounds of the study. Overall, they considered it essential to include information about 11 items in the MR. Subgroup analyses revealed that the registrars considered 8 additional items essential, whereas the consultants considered 1 additional item essential to record. Study findings can be used as a starting point to develop a structured section of the MR for therapeutic information for both paper and electronic MRs. This section should contain at least 11 items considered essential by registrars and clinical consultants in internal medicine.

  13. Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum.

    Science.gov (United States)

    Basu, Gaurab; Pels, Richard J; Stark, Rachel L; Jain, Priyank; Bor, David H; McCormick, Danny

    2017-04-01

    Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education. In academic year (AY) 2012, the Cambridge Health Alliance internal medicine residency program transformed an elective into a required social medicine and research-based health advocacy curriculum. The course has three major innovations: it has a yearlong longitudinal curriculum, it is required for all residents, and all residents complete a group research-based health advocacy project within the curricular year. The authors describe the structure, content, and goals of this curriculum. Over the last four years (AYs 2012-2015), residents (17/32; 53%) have rated the overall quality of the course highly (mean = 5.2, where 6 = outstanding; standard deviation = 0.64). In each year since the new course has been implemented, all scholarly work from the course has been presented at conferences by 31 resident presenters and/or coauthors. The course seems to enhance the residency program's capacity to recruit high-caliber residents and faculty members. The authors are collecting qualitative and quantitative data on the impact of the course. They will use their findings to advocate for a national health advocacy competency framework. Recommendations about how to initiate or further develop social medicine and health advocacy curricula are offered.

  14. Intellectual Property Rights and Access to Medicines: International Trade Issues

    Science.gov (United States)

    2009-05-28

    Kelley Lee, “Managing the Pursuit of Health and Wealth: The Key Challenges,” The Lancet , vol. 373 (January 24, 2009), pp. 328-329. 11 National Science...Richard D. Smith, Carlos Correa, and Cecilia Oh, “Trade, TRIPS, and Pharmaceuticals,” The Lancet , vol. 373 (February 21, 2009). 35 Kevin Outterson...and Cecilia Oh, “Trade, TRIPS, and Pharmaceuticals,” The Lancet , vol. 373 (February 21, 2009). Oxfam International, US Bullying on Drug Patents: One

  15. Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents.

    Science.gov (United States)

    Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy

    2017-08-01

    Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings

  16. Chronicity of Voice-Related Health Care Utilization in the General Medicine Community.

    Science.gov (United States)

    Cohen, Seth M; Lee, Hui-Jie; Roy, Nelson; Misono, Stephanie

    2017-04-01

    Objectives To examine voice-related health care utilization of patients in the general medical community without otolaryngology evaluation and explore factors associated with prolonged voice-related health care. Study Design Retrospective cohort analysis. Setting Large, national administrative US claims database. Subjects and Methods Patients with voice disorders per International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes from January 1, 2010, to December 31, 2012, seen by a general medical physician, and who did not see an otolaryngologist in the subsequent year were included. Voice-related health care utilization, patient demographics, comorbid conditions, and index laryngeal diagnosis were collected. Logistic regression with variable selection was performed to evaluate the association between predictors and ≥30 days of voice-related health care use. Results In total, 46,205 unique voice-disordered patients met inclusion criteria. Of these patients, 8.5%, 10.0%, and 12.5% had voice-related health care use of ≥90, ≥60, and ≥30 days, respectively. Of the ≥30-day subset, 80.3% and 68.5%, respectively, had ≥60 and ≥90 days of voice-related health care utilization. The ≥30-day subset had more general medicine and nonotolaryngology specialty physician visits, more prescriptions and procedures, and 4 times the voice-related health care costs compared with those in the <30-day subset. Age, sex, employment status, initial voice disorder diagnosis, and comorbid conditions were related to ≥30 days of voice-related health care utilization. Conclusions Thirty days of nonotolaryngology-based care for a voice disorder may represent a threshold beyond which patients are more likely to experience prolonged voice-related health care utilization. Specific factors were associated with extended voice-related health care.

  17. Determining the Frequency of Defensive Medicine Among General Practitioners in Southeast Iran

    Directory of Open Access Journals (Sweden)

    Mahmood Moosazadeh

    2014-04-01

    Full Text Available Background Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results The majority of participants were male (58.2%. The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001. Conclusion The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo.

  18. [Deafness in adults. Study of practices in general medicine].

    Science.gov (United States)

    Leveque, P; Kossowski, M; Pons, Y

    2012-01-01

    Deafness is a sensory disability responsible for communication disorder, sometimes impairing social life. In children, the hearing is an important concern for all stakeholders in early childhood (systematic neonatal screening, etc.). On the other hand, in the adult, it is rarely tested, and patients do consult when their audiometric status is already badly impaired. But their care is all the better if the deafness diagnosis is made early, as for the audio-prosthetic rehabilitation for example. Today, the general practitioner is the first link of the diagnostic and therapeutic management chain. The objective of this study was to evaluate the diagnostic practices of practitioners in front of deafness in adults. This prospective study included 74 practitioners based in "Ile de France" interviewed using a multiple choice questionnaire (MCQ) on otoscopic and audiometric diagnostics and a Script Concordance test (SC) on clinical adult deafness situations validated by a 5 experts panel. The obtained average score was 66.35% of correct answers to the MCQ and 47.76% to the SC. In our study, the surveyed practitioners showed a good level of otoscopic and audiometric diagnosis in the MCQ. However, their answers were not concordant with those of the expert panel in the SC. They have been particularly poorly performing on issues related to functional signs and their use in a given clinical situation, often driving to establish an otoscopic misdiagnosis while their diagnostic recognition of a pathological eardrum in the MCQ was rather good. These results reflect a lack of confidence in their otoscopic diagnosis related to the lack of knowledge of the causes of deafness in adults and their symptoms.

  19. Leadership and cooperation at the general medicine department of LMU Munich: Good grades despite difficult conditions.

    Science.gov (United States)

    Schelling, Jörg; Braun, Susanne

    2011-01-01

    The relevance of general medicine at German universities will increase over the next few years. Consequently, the discussion of teaching content and even more the improvement of the structures within the still small and dependent departments of general medicine are of major importance. The example of our department at LMU Munich shows which challenges for leadership and cooperation result from lack of financial and personnel structure. The project "cooperation culture" that the department has conducted in collaboration with the LMU Center for Leadership and People Management is presented as a means to promote leadership and cooperation. This project can serve as an inspiration for the coordinators of smaller departments of general medicine at other German universities that are also striving to improve their structure and their position within the university.

  20. [The department budget, in the context of the hospital global budget. Initial results in general medicine].

    Science.gov (United States)

    Besançon, F

    1984-02-23

    In a general hospital (Hôtel-Dieu, in the center of Paris), run with a global budget, budgets determined for each unit were introduced as an experiment in 1980. Physicians were in charge of certain expenses, mainly: linen, drugs, transportation of patients to and from other hospitals within Paris, and blood fractions. The whole does not exceed 4% of the turnover (FF 20 millions in 1980) of a 67 bed internal medicine unit. Other accounts deal with the stays, admissions, prescriptions of technical acts, laboratory analyses, and X-rays. In 1980, expenses were 11% more than budgeted, but the increase in stays and particularly in admissions was significantly greater. The resulting savings were 8.8% and 18.7% for stays and admissions respectively. Psychic reactions were variable. The subsequent budgets followed the fluctuations of recorded expenses, which were fairly important in both directions. The unit budget may be an advance or a regression, in a restrictive and past-perpetuating context. The coherence between the unit budget and the global hospital budget is questionable. Physicians were willing to take part in accounting and saving. They have good reason for not enlarging their financial responsibilities. Conversely, they may give more attention to diseases of public opinion.

  1. Basic Geriatrics Knowledge Among Internal Medicine Trainees in a Teaching Hospital in Saudi Arabia.

    Science.gov (United States)

    Al-Aama, Tareef

    2016-06-01

    To assess the basic knowledge of medical trainees, in the absence of a structured geriatrics curriculum, around a variety of geriatric medicine components that are considered essential for the care of the rapidly increasing elderly population. Eighty-three trainees at different levels of training in internal medicine were asked about a variety of common geriatric conditions. Those included: delirium, falls, geriatric syndromes, pain, cognitive impairment, and medications. The trainees' knowledge about common geriatric condition was overall poor. The most pronounced deficits included: the lack of familiarity in diagnosing geriatric syndromes (63 %) or managing them (67 %), the underestimation of the prevalence of delirium (49 %), and the tendency to undertreat pain (64 %). Poor familiarity with polypharmacy and its impact, as well as inappropriate prescription practices in the elderly were also observed. In the absence of a structured geriatric medicine curriculum, internal medicine trainees' knowledge about important geriatric conditions is poor, even if their internal medicine knowledge is overall adequate. This would translate into suboptimal care for this vulnerable and rapidly expanding segment of the population.

  2. A nomogram to predict the probability of passing the American Board of Internal Medicine examination

    Directory of Open Access Journals (Sweden)

    Andrei Brateanu

    2012-10-01

    Full Text Available Background : Although the American Board of Internal Medicine (ABIM certification is valued as a reflection of physicians’ experience, education, and expertise, limited methods exist to predict performance in the examination. Purpose : The objective of this study was to develop and validate a predictive tool based on variables common to all residency programs, regarding the probability of an internal medicine graduate passing the ABIM certification examination. Methods : The development cohort was obtained from the files of the Cleveland Clinic internal medicine residents who began training between 2004 and 2008. A multivariable logistic regression model was built to predict the ABIM passing rate. The model was represented as a nomogram, which was internally validated with bootstrap resamples. The external validation was done retrospectively on a cohort of residents who graduated from two other independent internal medicine residency programs between 2007 and 2011. Results : Of the 194 Cleveland Clinic graduates used for the nomogram development, 175 (90.2% successfully passed the ABIM certification examination. The final nomogram included four predictors: In-Training Examination (ITE scores in postgraduate year (PGY 1, 2, and 3, and the number of months of overnight calls in the last 6 months of residency. The nomogram achieved a concordance index (CI of 0.98 after correcting for over-fitting bias and allowed for the determination of an estimated probability of passing the ABIM exam. Of the 126 graduates from two other residency programs used for external validation, 116 (92.1% passed the ABIM examination. The nomogram CI in the external validation cohort was 0.94, suggesting outstanding discrimination. Conclusions : A simple user-friendly predictive tool, based on readily available data, was developed to predict the probability of passing the ABIM exam for internal medicine residents. This may guide program directors’ decision

  3. Japanese representation in leading general medicine and basic science journals: a comparison of two decades.

    Science.gov (United States)

    Fukui, Tsuguya; Takahashi, Osamu; Rahman, Mahbubur

    2013-01-01

    During 1991-2000, Japan contribution to the top general medicine journals was very small although the contribution to the top basic science journals was sizeable. However, it has not been examined whether the contribution to the top general medicine and basic science journals has changed during the last decade (2001-2010). The objective of this study was to compare Japan representation in high-impact general medicine and basic science journals between the years 1991-2000 and 2001-2010. We used PubMed database to examine the frequency of articles originated from Japan and published in 7 high-impact general medicine and 6 high-impact basic science journals. Several Boolean operators were used to connect name of the journal, year of publication and corresponding authors' affiliation in Japan. Compared to the 1991-2000 decade, Japan contribution to the top general medicine journals did not increase over the 2001-2010 period (0.66% vs. 0.74%, P = 0.255). However, compared to the same period, its contribution to the top basic science journals increased during 2001-2010 (2.51% vs. 3.60%, P journals showed an upward trend over the 1991-2000 period (P journals remained flat both during 1991-2000 (P = 0.273) and 2001-2010 (P = 0.073). Overall, Japan contribution to the top general medicine journals has remained small and unchanged over the last two decades. However, top basic science journals had higher Japan representation during 2001-2010 compared to 1991-2000.

  4. The Geneva Conferences and the emergence of the International Network for Person-centered Medicine.

    Science.gov (United States)

    Mezzich, Juan E

    2011-04-01

    The yearly Geneva Conferences on Person-centered Medicine started in May 2008 as a collaborative effort of global medical and health organizations and committed clinicians and scholars to place the whole person at the centre of medicine and health care. They were informed by the traditions of great ancient civilizations and recent developments in clinical care and public health. The process of the Geneva Conferences led to the development of the International Network for Person-centered Medicine as a non-for-profit institution aimed at organizing future editions of the Geneva Conference and building person-centred medicine as a paradigmatic repriorizing of the medical and health fields in collaboration inter alia with the World Medical Association, the World Health Organization and the World Organization of Family Doctors.

  5. Training Future Leaders of Academic Medicine: Internal Programs at Three Academic Health Centers.

    Science.gov (United States)

    Morahan, Page S.; Kasperbauer, Dwight; McDade, Sharon A.; Aschenbrener, Carol A.; Triolo, Pamela K.; Monteleone, Patricia L.; Counte, Michael; Meyer, Michael J.

    1998-01-01

    Reviews need for internal leadership training programs at academic health centers and describes three programs. Elements common to the programs include small classes, participants from many areas of academic medicine and health care, building on prior experience and training, training conducted away from the institution, short sessions, faculty…

  6. The nature and causes of unintended events reported at 10 internal medicine departments.

    NARCIS (Netherlands)

    Lubberding, S.; Zwaan, L.; Timmermans, D.R.M.; Wagner, C.

    2011-01-01

    Objective: This study aimed to examine the nature and causes of unintended events (UEs) at internal medicine departments (IMD). Methods: An observational study was conducted at 10 IMDs in 8 Dutch hospitals. The study period per participating department was 5 to 14 weeks. During this period, staff we

  7. Adverse drug reactions in internal medicine units and associated risk factors

    OpenAIRE

    Sánchez Muñoz-Torrero, Juan Francisco; Barquilla, Paloma; Velasco, Raul; Fernández Capitan, Maria Del Carmen; Pacheco, Nazaret; Vicente, Lucia; Chicón, Jose Luis; Trejo, Sara; Zamorano, Jose; Lorenzo Hernandez, Alicia

    2010-01-01

    Abstract Objectives This study was designed to assess the prevalence of adverse drug reactions (ADRs) in the internal medicine wards of two teaching Hospitals, identify the most common ADRs, the principal medications involved, and determine the risk factors implicated in the occurrence of such ADRs. Methods All admissions over 10 weeks were followed prospectively using an intensive drug surveillance method...

  8. The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives.

    Science.gov (United States)

    Oristrell, J; Oliva, J C; Casanovas, A; Comet, R; Jordana, R; Navarro, M

    2014-01-01

    The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  9. Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

    Science.gov (United States)

    Auewarakul, Chirayu; Downing, Steven M.; Praditsuwan, Rungnirand; Jaturatamrong, Uapong

    2005-01-01

    Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical…

  10. International Conference on Advancements of Medicine and Health Care through Technology

    CERN Document Server

    Ciupa, Radu

    2014-01-01

    This volume presents the contributions of the third International Conference on Advancements of Medicine and Health Care through Technology (Meditech 2014), held in Cluj-Napoka, Romania. The papers of this Proceedings volume present new developments in - Health Care Technology, - Medical Devices, Measurement and Instrumentation, - Medical Imaging, Image and Signal Processing, - Modeling and Simulation, - Molecular Bioengineering, - Biomechanics.

  11. Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

    Science.gov (United States)

    Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

    2017-06-01

    While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

  12. Comparison of Initial House Staff Goals with Eventual Career Plans in Internal Medicine

    Science.gov (United States)

    Marienfeld, R. Dennis

    1977-01-01

    This study represents a preliminary effort toward the ultimate goal of identifying some of the major determinants of final career plans of residents in internal medicine. Initial career goal statements indicating future subspecialization are found to be important but the incidence of goal reversal is high. (LBH)

  13. 5th International Conference on Advancements of Medicine and Health Care through Technology

    CERN Document Server

    Roman, Nicolae

    2017-01-01

    This volume presents the contributions of the fifth International Conference on Advancements of Medicine and Health Care through Technology (Meditech 2016), held in in Cluj-Napoka, Romania. The papers of this Proceedings volume present new developments in - Health Care Technology, - Medical Devices, Measurement and Instrumentation, - Medical Imaging, Image and Signal Processing, - Modeling and Simulation, - Molecular Bioengineering, - Biomechanics.

  14. The U.S. National Library of Medicine and International MEDLARS Cooperation

    Science.gov (United States)

    Corning, Mary E.

    1972-01-01

    The National Library of Medicine has eight international MEDLARS quid-pro-quo arrangements with the United Kingdom, Sweden, France, West Germany, Japan, Australia, Canada and the World Health Organization. Policy aspects of these arrangements are discussed as well as the organizational and operational characteristics of the non-U.S. Medlars…

  15. Ultrasound for internal medicine physicians: the future of the physical examination.

    Science.gov (United States)

    Dulohery, Megan M; Stoven, Samantha; Kurklinsky, Andrew K; Kurklinksy, Andrew; Halvorsen, Andrew; McDonald, Furman S; Bhagra, Anjali

    2014-06-01

    With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians' baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. Training was performed at the Mayo Clinic in June 2010 and June 2011. The participants consisted of internal medicine residents. The workshop included didactics and hands-on US experiences with human and cadaver models in a simulation center. Pretests and posttests of residents' knowledge, attitudes, and skills with US were completed. We reassessed the 2010 group in the spring of 2012 with a long-term retention survey for knowledge and confidence in viewing images. A total of 136 interns completed the workshop. Thirty-nine residents completed the long-term retention survey. Posttest assessments showed a statistically significant improvement in the knowledge of US imaging, confidence in identifying structures, image identification, and image acquisition (P internal medicine training and practice. © 2014 by the American Institute of Ultrasound in Medicine.

  16. [Corticosteroid therapy and therapeutic education: experience of an internal medicine department

    NARCIS (Netherlands)

    Simon, A.; Ane, A.M.; Afroun, A.

    2013-01-01

    In 2003, we sought to determine what were the needs of patients prescribed with long-term glucocorticoid therapy in our internal medicine department. Following this inventory, we decided to homogenize the medical practices regarding glucocorticoid prescriptions in our institution. We also set up a t

  17. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

    Science.gov (United States)

    Daniels, Michael N; Maynard, Sharon; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel

    2017-01-01

    Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative

  18. A simulator-based curriculum to promote comparative and reflective analysis in an internal medicine clerkship.

    Science.gov (United States)

    McMahon, Graham T; Monaghan, Colleen; Falchuk, Kenneth; Gordon, James A; Alexander, Erik K

    2005-01-01

    To develop and evaluate a novel curricular framework using high-fidelity patient simulation in an internal medicine clerkship. Two 90-minute simulator-based modules of ischemic heart failure and hypoxemic respiratory failure were developed from adult and experiential learning principles. Three short simulated cases focused on each pathophysiologic concept were intermixed with two short teaching sessions and a period of comparative analysis. In 2002-03, the program was piloted among 90 third-year medical students at Harvard Medical School assigned to complete their core internal medicine clerk-ship. An entry and two follow-up questionnaires were used to assess the process. The instructors conducted quantitative and qualitative data analysis and directly observed students' performances. Instructors consistently noted students' ability to appropriately extract a history, perform a basic examination, and order appropriate tests. However, students demonstrated repeated errors in the application of knowledge to the clinical circumstance. A final comparative discussion was essential to new learning and students recognized this integrative analysis as the most critical component of the exercise. Every student reported the experience as useful. Ninety-four percent (n = 85) felt the simulator should become a routine part of the clerkship and 68% (n = 71) desired three or more sessions during their internal medicine clerkship. Simulator-based curricular modules are feasible in an internal medicine clerkship and can successfully complement existing curricula. By comparing similar cases in a compressed time frame, students may achieve enhanced efficiencies in reflective and meta-cognitive learning. As medical simulation is increasingly available, such a curriculum may represent valuable additions to the internal medicine educational environment.

  19. [Establishment of knowledge, attitudes and opinions of general population about rational use of medicines].

    Science.gov (United States)

    Puig Soler, Rita; Perramon Colet, Meritxell; Yahni, Corinne Zara; Garcia Puig, Anna M

    2015-01-01

    Identify the level of knowledge, opinions and attitudes of medicines in general population. Descriptive transversal study realised in a sample of≥18 years old public health users from primary health centres in the city of Barcelona. Sample has been chosen using a two phases sampling, stratified by district, gender and age. Questionnaire administered face-to-face. SPSSv15 used for the analysis. December 2011. 484 surveys has been done (IC 95%, α=5%). 53% were women and 21,3% had university studies. Medicine use: 81% had taken medicines in the last 3 months; average of 2,34. 80% of medicated people know what they take and its indication. 55,6% don't know active ingredient concept. Only 35% recognise the active ingredient showed in the box of the medicine (3 cases shown) and 44,5% not one. 22,7% know the meaning of security concepts contraindication, adverse effect and drug interaction. 20% ignore. This fact grows with age and reduces with high study levels. Global rational use of medicines indicator obtains 5,03 from 10: 3,42 opinion and 6,51 attitude. 70% of people think there is no rational use of medicines in general and 21,3% would promote raising awareness. Low level of knowledge and poor attitude and opinion in rational use of medicines have been shown in this study. It is necessary involve citizens and improve their basic knowledge to promote rational use of medicines. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  20. Did Osler suffer from "paranoia antitherapeuticum baltimorensis"?: A comparative content analysis of The Principles and Practice of Medicine and Harrison's Principles of Internal Medicine, 11th edition

    OpenAIRE

    1999-01-01

    One of the most important legacies of Sir William Osler was his textbook The Principles and Practice of Medicine. A common criticism of the book when it was first published was its deficiency in the area of therapeutics. In this article, the 1st edition of The Principles and Practice of Medicine is compared with the 11th edition of Harrison's Principles of Internal Medicine. The analysis focuses on the treatment recommendations for 4 conditions that were covered in both books (diabetes mellit...

  1. Level of training and experience in physicians performing interhospital transfers of adult patients in the internal medicine department

    DEFF Research Database (Denmark)

    Hallas, P; Folkestad, L; Brabrand, M

    2009-01-01

    AIM: To establish the level of training doctors who participate in interhospital transfers in Denmark. METHODS: A questionnaire was sent to every hospital department in Denmark with acute internal medicine admissions. RESULTS: Eighty-nine internal medicine departments were contacted and 84...

  2. The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study

    Science.gov (United States)

    Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

    2013-01-01

    Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

  3. General medicine advanced training: lessons from the John Hunter training programme.

    Science.gov (United States)

    Jackel, D; Attia, J; Pickles, R

    2014-03-01

    Recent years have seen a rapid growth in the number of advanced trainees pursuing general medicine as a specialty. This reflects an awareness of the need for broader training experiences to equip future consultant physicians with the skills to manage the healthcare challenges arising from the demographic trends of ageing and increasing comorbidity. The John Hunter Hospital training programme in general medicine has several characteristics that have led to the success in producing general physicians prepared for these challenges. These include support from a core group of committed general physicians, an appropriate and sustainable funding model, flexibility with a focus on genuine training and developing awareness of a systems approach, and strong links with rural practice.

  4. Chaplains on the Medical Team: A Qualitative Analysis of an Interprofessional Curriculum for Internal Medicine Residents and Chaplain Interns.

    Science.gov (United States)

    Hemming, Patrick; Teague, Paula J; Crowe, Thomas; Levine, Rachel

    2016-04-01

    Improved collaboration between physicians and chaplains has the potential to improve patient experiences. To better understand the benefits and challenges of learning together, the authors conducted several focus groups with participants in an interprofessional curriculum that partnered internal medicine residents with chaplain interns in the clinical setting. The authors derived four major qualitative themes from the transcripts: (1) physician learners became aware of effective communication skills for addressing spirituality. (2) Chaplain interns enhanced the delivery of team-based patient-centered care. (3) Chaplains were seen as a source of emotional support to the medical team. (4) The partnership has three keys to success: adequate introductions for team members, clear expectations for participants, and opportunities for feedback. The themes presented indicate several benefits of pairing physicians and chaplains in the setting of direct patient care and suggest that this is an effective approach to incorporating spirituality in medical training.

  5. Alternative medicine and general practitioners in The Netherlands: towards acceptance and integration.

    NARCIS (Netherlands)

    Visser, G.J.; Peters, L.

    1990-01-01

    A questionnaire on alternative medicine was sent to 600 general practitioners in the Netherlands. Most of the 360 (60%) GPs who replied expressed on interest in alternative practice; and 47% revealed that they used one or more alternative methods themselves, most often homoeopathy. However, the

  6. Alternative medicine and general practitioners in The Netherlands: towards acceptance and integration.

    NARCIS (Netherlands)

    Visser, G.J.; Peters, L.

    1990-01-01

    A questionnaire on alternative medicine was sent to 600 general practitioners in the Netherlands. Most of the 360 (60%) GPs who replied expressed on interest in alternative practice; and 47% revealed that they used one or more alternative methods themselves, most often homoeopathy. However, the numb

  7. A General Introduction of HIV/AIDS Treatment with Traditional Chinese Medicine in China

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    This paper gives a general introduction of HIV/AIDS treatment with Traditional Chinese Medicine (TCM) in China during the past 20 years. Although the role of TCM in treatment of HIV/AIDS is promising, there is still a long way to go.

  8. Piloting a Structured Practice Audit to Assess ACGME Milestones in Written Handoff Communication in Internal Medicine.

    Science.gov (United States)

    Martin, Shannon K; Farnan, Jeanne M; McConville, John F; Arora, Vineet M

    2015-06-01

    Written communication skills are integral to patient care handoffs. Residency programs require feasible assessment tools that provide timely formative and summative feedback, ideally linked to the Accreditation Council for Graduate Medical Education Milestones. We describe the use of 1 such tool-UPDATED-to assess written handoff communication skills in internal medicine interns. During 2012-2013, the authors piloted a structured practice audit at 1 academic institution to audit written sign-outs completed by 45 interns, using the UPDATED tool, which scores 7 aspects of sign-out communication linked to milestones. Intern sign-outs were audited by trained faculty members throughout the year. Results were incorporated into intern performance reviews and Clinical Competency Committees. A total of 136 sign-outs were audited (averaging 3.1 audits per intern). In the first trimester, 14 interns (31%) had satisfactory audit results. Five interns (11%) had critical deficiencies and received immediate feedback, and the remaining 26 (58%) were assigned future audits due to missing audits or unsatisfactory scores. In the second trimester, 21 interns (68%) had satisfactory results, 1 had critical deficiencies, and 9 (29%) required future audits. Nine of the 10 remaining interns in the final trimester had satisfactory audits. Faculty time was estimated at 10 to 15 minutes per sign-out audited. The UPDATED audit is a milestone-based tool that can be used to assess written sign-out communication skills in internal medicine residency programs. Future work is planned to adapt the tool for use by senior supervisory residents to appraise sign-outs in real time.

  9. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  10. Assesment of Drug Use in Internal Medicine Patients using World Health Organization Indicators

    Directory of Open Access Journals (Sweden)

    Dika P. Destiani

    2013-12-01

    Full Text Available Internal medicine is the branch of medicine that should provide comprehensive knowledge of disease with a holistic approach. Holistical approach done by developing symptoms and signs for diagnostic and it would be polypharmacy. This study aimed to evaluate drug use by the internal medicine using five prescribing indicators WHO guideline such as average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotics and injection prescribed, and drugs prescribed from essential drugs list or formulary. Outpatient prescription of internal medicine period Januari to Maret 2013 in one of health facilities in Bandung collected retrospectively. Average number of drugs per encounter was gained by dividing 567 drugs with 186 prescription. Percentage of using generic drugs was 23,63%, antibiotics and injection drugs were 17,20% and 4,84% per encounters, whereas percentage of drugs prescribed from essential drugs list was 36,86%. The result showed that the usage of generic drugs and essential drugs are low and should be improved. Furthermore, there are no misuses usage of antibiotics and injection, thereby can minimize antimicrobial resistances.

  11. Complementary and alternative medicine use by visitors to rural Japanese family medicine clinics: results from the international complementary and alternative medicine survey.

    Science.gov (United States)

    Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D

    2014-09-25

    There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use

  12. Out of the wilderness: flipping the classroom to advance scholarship in an internal medicine residency program.

    Science.gov (United States)

    Vincent, Dale S

    2014-11-01

    Residents in an internal medicine residency program "flipped the classroom" in a series of learner-centered activities which included the creation of a medical student interest group, a continuing medical education symposium, and a journal supplement focused on wilderness medicine topics in Hawai'i and Asia Pacific. The project encompassed both scholarly activities (discovery, integration, application, and teaching) as well as scholarship (writing for publication). The project advanced the professional formation of residents by developing competencies and producing outcomes that are key features of the ACGME Next Accreditation System.

  13. International Journal of Medicine and Public Health [IJMEDPH] is now published by EManuscript

    Directory of Open Access Journals (Sweden)

    Mueen Ahmed KK

    2016-07-01

    Full Text Available The year 2016 is an important milestone for International Journal of Medicine and Public Heath [IJMEDPH] (www.ijmedph.org as it is entering 5th year. It is known as one of the peer-reviewed medicine and Public Health journal and I am pleased to present you this issue being published by EManuscript (A Publishing division of Phcog.Net. The new issue content for volume 5 is available “http://www.ijmedph.org” and archives are also available in the same link. IJMEDPH is now built with the responsive website the site can be easily browsed on mobile devices, tablets, and desktop screens.

  14. Theoretical fundament modifications performed in the evaluation system at the Internal Medicine ward round performance.

    Directory of Open Access Journals (Sweden)

    Luis Alberto Corona Martínez

    2003-04-01

    Full Text Available The medical clinic department in the medicine school located in Cienfuegos city, Cuba performed modifications to the evaluation system in the subject Internal Medicine during the academic course 1999-2000. The main ideas are shown in this investigation constituting the theoretical backgrounds of the changes performed due to the identified deficiencies found and based on the actual pedagogical concepts and acceptation. It is emphasized on the need that the whole system of evaluation should be pertinent, productive, wide, profound, and conformed by the diversity of instruments, so that its instructive, educative, oriented, motivated, and feedback functions should be accomplished.

  15. Core Addiction Medicine Competencies for Doctors, An International Consultation on Training.

    LENUS (Irish Health Repository)

    Ayu, Astri Parawita

    2017-07-18

    Despite the high prevalence of substance use disorders, associated comorbidities and the evidence-base upon which to base clinical practice, most health systems have not invested in standardised training of healthcare providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, we undertook this study to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education.

  16. Understanding support for complementary and alternative medicine in general populations: use and perceived efficacy.

    Science.gov (United States)

    Stoneman, Paul; Sturgis, Patrick; Allum, Nick

    2013-09-01

    Proponents of complementary and alternative medicine argue that these treatments can be used with great effect in addition to, and sometimes instead of, conventional medicine, a position which has drawn sustained opposition from those who advocate an evidence-based approach to the evaluation of treatment efficacy. Using recent survey data from the United Kingdom, this article seeks to establish a clearer understanding of the nature of the public's relationship with complementary and alternative medicine within the general population by focusing on beliefs about the perceived effectiveness of homeopathy, in addition to its reported use. Using recent data from the United Kingdom, we initially demonstrate that reported use and perceived effectiveness are far from coterminous and argue that for a proper understanding of the motivations underpinning public support of complementary and alternative medicine, consideration of both reported use and perceived effectiveness is necessary. We go on to demonstrate that although the profile of homeopathy users differs from those who support this form of medicine, neither outcome is dependent upon peoples' levels of knowledge about science. Instead, the results suggest a far greater explanatory role for need and concerns about conventional medicine.

  17. General practitioners using complementary and alternative medicine differ from general practitioners using conventional medicine in their view of the risks of electromagnetic fields: a postal survey from Germany.

    Science.gov (United States)

    Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

    2015-01-01

    General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks. Moreover, we assessed whether the kind of alternative medicine has an influence on the results. A total of 2795 GPs drawn randomly from lists of German GPs were sent an either long or short self-administered postal questionnaire on EMF-related topics. Adjusted logistic regression models were fitted to assess the association of an education in alternative medicine with various aspects of perceiving EMF risks. Concern about EMF, misconceptions about EMF, and distrust toward scientific organizations are more prevalent in CAM-GPs. CAM-GPs more often falsely believed that mobile phone use can lead to head warming of more than 1°C (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.5-3.3), more often distrusted the Federal Office for Radiation Protection (OR = 2.2, 95% CI = 1.4-3.6), were more often concerned about mobile phone base stations (OR = 2.4, 95% CI = 1.6-3.6), more often attributed own health complaints to EMF (OR = 3.2, 95% CI = 1.8-5.6), and more often reported at least 1 EMF consultation (OR = 2.5, 95% CI = 1.6-3.9). GPs using homeopathy perceived EMF as more risky than GPs using acupuncture or naturopathic treatment. Concern about common EMF sources is highly prevalent among German GPs. CAM-GPs perceive stronger associations between EMF and health problems than COM-GPs. There is a need for evidence-based information about EMF risks for GPs and particularly for CAM-GPs. This is the precondition that GPs can inform patients about EMF and health in line with current scientific knowledge. © The Author(s) 2014.

  18. Addressing the Primary Care Shortage on a Shoestring: A Successful Track in an Internal Medicine Residency.

    Science.gov (United States)

    Brislen, Heather; Dunn, Angela; Parada, Alisha; Rendon, Patrick

    2016-02-01

    Nationally, shortages of primary care providers are of major concern. Internal medicine programs, once the major supplier of primary care physicians, are no longer producing large numbers of primary care providers to help meet the needs of the growing patient population. In 2009, residents at the University of New Mexico created a resident-driven Primary Care Track (PCT) within the internal medicine residency, and after six years this track is thriving. The PCT allows residents to designate blocks of time specifically devoted to primary care training. Residents opt in to the track at the end of intern year and arrange their own schedules over large blocks of time in the last two years of training to allow for an individualized curriculum that prepares them for independent practice in primary care. Approximately 85% (11/13) of residents who have graduated from the track have gone on to practice in primary care after graduation, and the internal medicine residency program as a whole has also seen an increase in the fraction of residents pursuing primary care since the inception of this track. The PCT is currently at maximum capacity and may be forced to turn away applicants. To expand while still maintaining the core principles of the track, the PCT will strive to find additional ways to use New Mexico's existing resources and to develop a more robust mentoring structure and didactic programs. Formalized financial, faculty, and administrative support of the program also will be needed.

  19. Social network analysis. Review of general concepts and use in preventive veterinary medicine.

    Science.gov (United States)

    Martínez-López, B; Perez, A M; Sánchez-Vizcaíno, J M

    2009-05-01

    Social network analysis (SNA) and graph theory have been used widely in sociology, psychology, anthropology, biology and medicine. Social network analysis and graph theory provide a conceptual framework to study contact patterns and to identify units of analysis that are frequently or intensely connected within the network. Social network analysis has been used in human epidemiology as a tool to explore the potential transmission of infectious agents such as HIV, tuberculosis, hepatitis B and syphilis. In preventive veterinary medicine, SNA is an approach that offers benefits for exploring the nature and extent of the contacts between animals or farms, which ultimately leads to a better understanding of the potential risk for disease spread in a susceptible population. Social network analysis, however, has been applied only recently in preventive veterinary medicine, therefore the characteristics of the technique and the potential benefits of its use remain unknown for an important section of the international veterinary medicine community. The objectives of this paper were to review the concepts and theoretical aspects underlying the use of SNA and graph theory, with particular emphasis on their application to the study of infectious diseases of animals. The paper includes a review of recent applications of SNA in preventive veterinary medicine and a discussion of the potential uses and limitations of this methodology for the study of animal diseases.

  20. Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

    Directory of Open Access Journals (Sweden)

    Juan E Corral

    Full Text Available BACKGROUND: Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. METHODS: A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals. RESULTS: In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. CONCLUSION: Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

  1. Bibliometric analysis of medicine - related publications on refugees, asylum-seekers, and internally displaced people: 2000 - 2015.

    Science.gov (United States)

    Sweileh, Waleed M

    2017-03-20

    Wars and violent domestic conflicts have forced millions of people to move outside their homes. Meeting the basic health needs of those people requires an understanding of research activity and research output on this topic. The objective of this study was to shed light on the quantity and impact of medicine - related publications on refugees, asylum seekers and internally displaced people (IDP). Scopus database was used to retrieve required data. Specifically, the number of publications, top productive countries and institutions, highly cited articles, citation analysis, international collaboration, and journals involved in publishing articles on refugees, asylum seekers and IDP were reviewed and analyzed. The time span for the study was set from year 2000 to 2015. Two thousands five hundred and thirty publications were retrieved. The h-index of retrieved articles was 64. A steep rise in number of publications was noticed after 2011. Top productive countries were the United States of America, Australia and the United Kingdom. The American public health institute (Centers for Disease Control and Prevention) and the United Nations refugee agency were among the top active organizations on this topic. Active journals in publishing on health of refugees, asylum seekers and IDP were those on mental health, psychology, public health and general medicine. Publications on Somali, Afghani, Iraqi, and Syrian refugees received a significant share of medicine-related publications. Analysis of publications based on region showed that publications on refugees from Middle East is rising sharply and is approaching those on African refugees. Bibliometric analysis reveals that research publications on refugees have been increasing in a dramatic way and articles are being published in journals with high impact factor and international reputation, not only in general medicine and public health, but also mental health and psychology journals. Analysis of publications related to

  2. International VLBI Service for Geodesy and Astrometry: General Meeting Proceedings

    Science.gov (United States)

    Vandenberg, Nancy R. (Editor); Baver, Karen D. (Editor)

    2002-01-01

    This volume contains the proceedings of the second General Meeting of the International VLBI Service for Geodesy and Astrometry (IVS), held in Tsukuba, Japan, February 4-7, 2002. The contents of this volume also appear on the IVS Web site at http://ivscc.gsfc.nasa.gov/publications/gm2002. The key-note of the second GM was prospectives for the future, in keeping with the re-organization of the IAG around the motivation of geodesy as 'an old science with a dynamic future' and noting that providing reference frames for Earth system science that are consistent over decades on the highest accuracy level will provide a challenging role for IVS. The goal of the meeting was to provide an interesting and informative program for a wide cross section of IVS members, including station operators, program managers, and analysts. This volume contains 72 papers and five abstracts of papers presented at the GM. The volume also includes reports about three splinter meetings held in conjunction with the GM: a mini-TOW (Technical Operations Workshop), the third IVS Analysis Workshop and a meeting of the analysis working group on geophysical modeling.

  3. 4th International Workshop on Adaptive Optics for Industry and Medicine

    CERN Document Server

    Wittrock, Ulrich

    2005-01-01

    This book treats the development and application of adaptive optics for industry and medicine. The contributions describe recently developed components for adaptive-optics systems such as deformable mirrors, wavefront sensors, and mirror drivers as well as complete adaptive optical systems and their applications in industry and medicine. Applications range from laser-beam forming and adaptive aberration correction for high-power lasers to retinal imaging in ophthalmology. The contributions are based on presentations made at the 4th International Workshop on Adaptive Optics in Industry and Medicine which took place in Münster, Germany, in October 2003. This highly successful series of workshops on adaptive optics started in 1997 and continues with the 5th workshop in Beijing in 2005.

  4. Prof. CHEN Ke-ji Winning the Prize of "Ren Ji Cup" for International Contribution to Chinese Medicine by WFCMS

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ In order to promote the exchange and cooperation of Chinese medicine among the states and regions globally and fasten the step of Chinese medicine to the world, the World Federation of Chinese Medicine Societies (WFCMS) has set up an award for those who have greatly contributed to medical treatment, education, scientific research of Chinese medicine, and the establishment of the statutory registration of Chinese medicine. The First International Contribution to Chinese Medicine Award Ceremony was held on April 10 at the Great Hall of the People in China. Prof. CHEN Ke-ji (China), Lin Tzi Chang (Australia) and David Molony (U.S.A) were awarded "Ren Ji Cup", the Prize for International Contribution to Chinese Medicine.

  5. Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training.

    Science.gov (United States)

    Lorin, Scott; Heffner, John; Carson, Shannon

    2005-02-01

    To evaluate the attitudes and perceptions of internal medicine residents regarding pulmonary and critical care medicine (PCCM) training. Prospective study. Three university hospitals. An eight-page survey was distributed and collected between March 1, 2002, and June 30, 2002. All internal medicine or internal medicine/pediatric residents training at the three institutions were eligible for the study. One hundred seventy-eight residents in internal medicine from an eligible pool of 297 residents returned the survey (61% response rate). PCCM accounted for only 3.4% of the career choices. Forty-one percent of the residents seriously considered a pulmonary and/or critical care fellowship during their residency. Of these residents, 23.5% found the combination of programs the more attractive option, while 2.8% found pulmonary alone and 14.5% found critical care alone more attractive. Key factors associated with a higher resident interest in PCCM subspecialty training included more weeks in the ICU (p = 0.008), more role models in PCCM (3.02 +/- 0.78 vs 3.45 +/- 0.78, p = 0.0004), and resident observations of a greater sense of satisfaction among PCCM faculty (3.07 +/- 0.82 vs 3.33 +/- 0.82, p = 0.04) and fellows (3.05 +/- 0.69 vs 3.31 +/- 0.86, p = 0.03) [mean +/- SD]. The five most commonly cited attributes of PCCM fellowship that would attract residents to the field included intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%). The five most commonly cited attributes of PCCM that would dissuade residents from the field included overly demanding responsibilities with lack of leisure time (54%), stress among faculty and fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%). Internal

  6. A commitment to high-value care education from the internal medicine community.

    Science.gov (United States)

    Smith, Cynthia D; Levinson, Wendy S

    2015-05-05

    The Alliance for Academic Internal Medicine, American Board of Internal Medicine (ABIM), ABIM Foundation, and American College of Physicians are collaborating to enhance the education of physicians in high-value care (HVC) and make its practice an essential competency in undergraduate and postgraduate education by 2017. This article serves as the organizations' formal commitment to providing a foundation of HVC education on which others may build. The 5 key targets for HVC education are experiential learning and curriculum, environment and culture, clinical support, regulatory requirements, and sustainability. The goal is to train future health care professionals for whom HVC is part of normal practice, thus providing patients with improved clinical outcomes at a lower cost.

  7. A new model for accreditation of residency programs in internal medicine.

    Science.gov (United States)

    Goroll, Allan H; Sirio, Carl; Duffy, F Daniel; LeBlond, Richard F; Alguire, Patrick; Blackwell, Thomas A; Rodak, William E; Nasca, Thomas

    2004-06-01

    A renewed emphasis on clinical competence and its assessment has grown out of public concerns about the safety, efficacy, and accountability of health care in the United States. Medical schools and residency training programs are paying increased attention to teaching and evaluating basic clinical skills, stimulated in part by these concerns and the responding initiatives of accrediting, certifying, and licensing bodies. This paper, from the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education, proposes a new outcomes-based accreditation strategy for residency training programs in internal medicine. It shifts residency program accreditation from external audit of educational process to continuous assessment and improvement of trainee clinical competence.

  8. Performance of women candidates on the American Board of Internal Medicine Certifying Examination, 1973-1982.

    Science.gov (United States)

    Norcini, J J; Fletcher, S W; Quimby, B B; Shea, J A

    1985-01-01

    Trends in the performances of female and male candidates taking the American Board of Internal Medicine Certifying Examination from 1973 through 1982 were examined. The mean scores of female candidates who graduated from medical schools in the United States or Canada and who were taking the examination for the first time improved from 428 to 470, and the percentage of those passing improved from 59% to 76%. The number of women taking the examination also increased markedly, by over 500%. Performance of female candidates remained slightly lower than that of male candidates, regardless of the quality of the residency training program or the medical school from which a candidate had graduated or the rating given a candidate by the director of the candidate's residency program. Except for the oldest candidates, age followed this pattern as well. Our findings suggest that the gender gap in scores on the Certifying Examination in Internal Medicine is narrowing.

  9. Health Anxiety Levels in Patients Admitted to Internal Medicine Outpatient Clinic for Several Times

    Directory of Open Access Journals (Sweden)

    Ali Gul

    2014-12-01

    Full Text Available Aim: Health anxiety (HA in patients consist of incorrect reference to normal bodily sensations as a signs of a serious disease. The aim of this study is to investigate the HA in patients admitted to internal medicine outpatient clinic for several times within one year. Material and Method: 60 patients who admitted more than one time to internal medicine outpatient clinic within one year and the control group consisted of 60 people were enrolled in this study. Short-form of health anxiety inventory (SAE-KF was given to these groups, The results were compared statistically. Results: SAE-KF scores were significantly higher in the patient group (11.17 ± 6.07 than the control group (10.71±4.44 (Z=-5.96, P

  10. Chinese translation of English textbooks on internal medicine from the 1850s to the 1940s.

    Science.gov (United States)

    Hong, Chuang-Ye; Wang, Fu-Mei

    2014-06-01

    During the 100 years from 1850 to 1949, six English textbooks on internal medicine were translated into Chinese and published. Publication of these books was a response to the increased demand for Chinese textbooks after the opening of several Western-style hospitals and medical schools in China where the instruction was in Chinese. Throughout this period, textbooks translated from English were regarded as symbols of mainstream and authority within medical communities in China. There was a shift of translators from British and American medical missionaries to Chinese medical elites. Publishers also changed from missionary hospitals or missionary organizations to the Chinese Medical Association, which was led by ethnic Chinese. After the 1950s, translation activity continued in Taiwan, but it was halted in China until after the Cultural Revolution. This paper provides bibliographic information about these books. The transition of medical authority in China during this 100-year period is also reviewed through the successive publication of translated textbooks on internal medicine.

  11. Using lean methodology to teach quality improvement to internal medicine residents at a safety net hospital.

    Science.gov (United States)

    Weigel, Charlene; Suen, Winnie; Gupte, Gouri

    2013-01-01

    The overall objective of this initiative was to develop a quality improvement (QI) curriculum using Lean methodology for internal medicine residents at Boston Medical Center, a safety net academic hospital. A total of 90 residents and 8 School of Public Health students participated in a series of four, 60- to 90-minute interactive and hands-on QI sessions. Seventeen QI project plans were created and conducted over a 4-month period. The curriculum facilitated internal medicine residents' learning about QI and development of positive attitudes toward QI (assessed using pre- and post-attitude surveys) and exposed them to an interprofessional team structure that duplicates future working relationships. This QI curriculum can be an educational model of how health care trainees can work collaboratively to improve health care quality.

  12. Teaching internal medicine residents to sustain their improvement through the quality assessment and improvement curriculum.

    Science.gov (United States)

    Oyler, Julie; Vinci, Lisa; Johnson, Julie K; Arora, Vineet M

    2011-02-01

    Although sustainability is a key component in the evaluation of continuous quality improvement (CQI) projects, medicine resident CQI projects are often evaluated by immediate improvements in targeted areas without addressing sustainability. AIM/SETTING: To assess the sustainability of resident CQI projects in an ambulatory university-based clinic. During their ambulatory rotation, all second year internal medicine residents use the American Board of Internal Medicine's Clinical Preventive Services (CPS) Practice Improvement Modules (PIM) to complete chart reviews, patient surveys, and a system survey. The residents then develop a group CQI project and collect early post data. Third year residents return to evaluate their original CQI project during an ambulatory rotation two to six months later and complete four plan-do-study-act (PDSA) cycles on each CQI project. From July 2006 to June 2009, 64 (100%) medicine residents completed the CQI curriculum. Residents completed six group projects and examined their success using early (2 to 6 weeks) and late (2 to 6 months) post-intervention data. Three of the projects demonstrated sustainable improvement in the resident continuity clinic. When residents are taught principles of sustainability and spread and asked to complete multiple PDSA cycles, they are able to identify common themes that may contribute to success of QI projects over time.

  13. A national collaboration to disseminate skills for outpatient teaching in internal medicine: program description and preliminary evaluation.

    Science.gov (United States)

    Bowen, Judith L; Clark, Jeanne M; Houston, Thomas K; Levine, Rachel; Branch, William; Clayton, Charles P; Alguire, Patrick; Esham, Richard; Boulware, Dennis W; Ferenchick, Gary; Kern, David E

    2006-02-01

    The shift of clinical care and teaching to outpatient settings has challenged ambulatory and community-based teachers. To address this challenge, U.S. internal medicine organizations devised "Faculty Development for General Internal Medicine: Generalist Faculty Teaching in Ambulatory Settings," a national program to train leaders to create local faculty development projects. In 1999, teams from all 386 internal medicine training institutions were invited to apply. Participation required an acceptable plan for a local project and inclusion of an institutional leader, residency or clerkship director, and a community-based faculty member on the project team. Team members attended one of three national training conferences held in 1999 and 2000 that included plenary sessions, workshops, and team meetings. Participants were invited to a wrap-up conference to present their accomplishments. One hundred ten teams from 57 university and 53 non-university hospitals attended the training conferences; 412 (93%) participants returned conference evaluations. All sessions were rated highly. Participants preferred workshops and team meetings to plenary sessions. Two hundred thirty-five (57%) would have recommended the training conference to colleagues as an outstanding experience; 148 (36%) as a good experience; and 25 (6%) as a satisfactory experience. Forty-nine teams (122 participants) returned for the wrap up conference where 35 teams presented their local faculty development projects. Cost per team trained was US$11,818. This program demonstrated a national desire for training in teaching skills, reached a broad audience of ambulatory-based clinical teachers, provided highly rated faculty development conferences in teaching skills, and facilitated development of a variety of local projects at modest expense. Partnerships were forged between academic leaders and community-based teachers.

  14. Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

    OpenAIRE

    Kassam Narmin; Daniels Vijay J

    2011-01-01

    Abstract Background There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match) and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey. Methods A qualitative study was undertaken to identify factors that det...

  15. Feasibility of an innovative third-year chief resident system: an internal medicine residency leadership study

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2014-07-01

    Full Text Available Introduction: The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Methods: Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Results: Thirteen junior (first- or second-year resident responses reported that the chief residents elicited input from others (mean rating 6.8, were committed to the team (6.8, resolved conflict (6.7, ensured efficiency, organization and productivity of the team (6.7, participated actively (7.0, and managed resources (6.6. Responses from senior residents averaged 1 point higher for each item; this pattern repeated itself in teaching evaluations. Chief resident self-evaluators were more comfortable running a morning report (8.4 than with being chief resident (5.8. Conclusion: The feasibility of preparing internal medicine residents for leadership roles through a rotating PGY-3 (postgraduate year chief residency curriculum was explored at a small internal medicine residency, and we suggest extending the study to include other programs.

  16. The seminal role played by Pierre Marie in Neurology and Internal Medicine

    Directory of Open Access Journals (Sweden)

    Gustavo M Almeida

    2015-10-01

    Full Text Available The authors review the most important contributions of Pierre Marie to the elucidation and description of several neurological diseases, such as Charcot-Marie-Tooth’s disease and hereditary cerebellar ataxia, as well as his contributions to Internal Medicine, including his pioneering studies on acromegaly, ankylosing spondylitis, and hypertrophic pulmonary osteoarthropathy. His works led to incontestable advances in the medical sciences that transcended his time.

  17. Development of a neurology rotation for internal medicine residents in Haiti.

    Science.gov (United States)

    Berkowitz, Aaron L; Martineau, Louine; Morse, Michelle E; Israel, Kerling

    2016-01-15

    In many low-income countries where there are few or no neurologists, patients with neurologic diseases are cared for by primary care physicians who receive no formal training in neurology. Here, we report our experience creating a neurology rotation for internal medicine residents in rural Haiti through a collaboration between a public academic medical center in Haiti and a visiting neurologist. We describe the structure of the rotation and the factors that led to its development.

  18. Mindfulness, burnout, and effects on performance evaluations in internal medicine residents.

    Science.gov (United States)

    Braun, Sarah E; Auerbach, Stephen M; Rybarczyk, Bruce; Lee, Bennett; Call, Stephanie

    2017-01-01

    Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents. Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory. Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the "acting with awareness" facet of dispositional mindfulness significantly predicted meeting burnout criteria χ(2)(5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the "system-based practices" and "professionalism" domains and negative effects on a milestone from the "patient care" domain. Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed.

  19. Advancing Systems Biology in the International Conference on Intelligent Biology and Medicine (ICIBM) 2015

    OpenAIRE

    Zhao, Zhongming; Liu, Yunlong; Huang, Yufei; Huang, Kun; Ruan, Jianhua

    2016-01-01

    The 2015 International Conference on Intelligent Biology and Medicine (ICIBM 2015) was held on November 13?15, 2015 in Indianapolis, Indiana, USA. ICIBM 2015 included eight scientific sessions, three tutorial sessions, one poster session, and four keynote presentations that covered the frontier research in broad areas related to bioinformatics, systems biology, big data science, biomedical informatics, pharmacogenomics, and intelligent computing. Here, we present a summary of the 10 research ...

  20. Endangered Uyghur Medicinal Plant Ferula Identification through the Second Internal Transcribed Spacer

    Directory of Open Access Journals (Sweden)

    Congzhao Fan

    2015-01-01

    Full Text Available The medicinal plant Ferula has been widely used in Asian medicine, especially in Uyghur medicine in Xinjiang, China. Given that various substitutes and closely related species have similar morphological characteristics, Ferula is difficult to distinguish based on morphology alone, thereby causing confusion and threatening the safe use of Ferula. In this study, internal transcribed spacer 2 (ITS2 sequences were analyzed and assessed for the accurate identification of two salable Ferula species (Ferula sinkiangensis and Ferula fukangensis and eight substitutes or closely related species. Results showed that the sequence length of ITS2 ranged from 451 bp to 45 bp, whereas guanine and cytosine contents (GC were from 53.6% to 56.2%. A total of 77 variation sites were detected, including 63 base mutations and 14 insertion/deletion mutations. The ITS2 sequence correctly identified 100% of the samples at the species level using the basic local alignment search tool 1 and nearest-distance method. Furthermore, neighbor-joining tree successfully identified the genuine plants F. sinkiangensis and F. fukangensis from their succedaneum and closely related species. These results indicated that ITS2 sequence could be used as a valuable barcode to distinguish Uyghur medicine Ferula from counterfeits and closely related species. This study may broaden DNA barcoding application in the Uyghur medicinal plant field.

  1. Endangered Uyghur Medicinal Plant Ferula Identification through the Second Internal Transcribed Spacer.

    Science.gov (United States)

    Fan, Congzhao; Li, Xiaojin; Zhu, Jun; Song, Jingyuan; Yao, Hui

    2015-01-01

    The medicinal plant Ferula has been widely used in Asian medicine, especially in Uyghur medicine in Xinjiang, China. Given that various substitutes and closely related species have similar morphological characteristics, Ferula is difficult to distinguish based on morphology alone, thereby causing confusion and threatening the safe use of Ferula. In this study, internal transcribed spacer 2 (ITS2) sequences were analyzed and assessed for the accurate identification of two salable Ferula species (Ferula sinkiangensis and Ferula fukangensis) and eight substitutes or closely related species. Results showed that the sequence length of ITS2 ranged from 451 bp to 45 bp, whereas guanine and cytosine contents (GC) were from 53.6% to 56.2%. A total of 77 variation sites were detected, including 63 base mutations and 14 insertion/deletion mutations. The ITS2 sequence correctly identified 100% of the samples at the species level using the basic local alignment search tool 1 and nearest-distance method. Furthermore, neighbor-joining tree successfully identified the genuine plants F. sinkiangensis and F. fukangensis from their succedaneum and closely related species. These results indicated that ITS2 sequence could be used as a valuable barcode to distinguish Uyghur medicine Ferula from counterfeits and closely related species. This study may broaden DNA barcoding application in the Uyghur medicinal plant field.

  2. [The general physician, essential actor in the medicine of the future].

    Science.gov (United States)

    Sotelo, Julio

    2004-01-01

    In most countries, the number of general practitioners is double that of specialists: This single feature makes evident the fact that the medical profession depends, to a great extent, on the effects that the entire spectrum of professionals devoted to health produces on the society, not only those who, for obvious reasons, have been trained as specialists to acquire knowledge in depth in a specific field of human pathology. In a considerable proportion of cases, the general physician represents the first contact of the patient with the medical profession and in many cases this is the only relationship that the patient requires. The general physician should be the doctor to decide whether the ailment would be better studied by a specialist. During the second part of the 20th Century, great importance was given to the consolidation and expansion of medical specialties; however, in many instances an inadequate image of medicine was produced. The performance of specialists in some cases was seen as excessively reductionistic, complex, detached, and unnecessarily expensive. This vision was frustrating to a large number of patients. The general practice of medicine has a primordial place in medicine, and we all must contribute to its academic progress as well as to the precise delineation of its areas of efficiency, to reintegrate the classical image of kindness, solidarity, and humanism into novel concepts of scientific and technological capabilities from which we all will benefit.

  3. Time-motion studies of internal medicine residents' duty hours: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Leafloor CW

    2015-11-01

    Full Text Available Cameron W Leafloor,1 Heather A Lochnan,2,3,6 Catherine Code,2,4 Erin J Keely,2,3,6 Deanna M Rothwell,5,6 Alan J Forster,2,4–6 Allen R Huang2,6,7 1Faculty of Medicine, 2Department of Medicine, 3Division of Endocrinology and Metabolism, 4Division of General Internal Medicine, 5Performance Measurement and Innovation, 6Ottawa Hospital Research Institute, 7Division of Geriatric Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada Background: Since the mid-1980s, medical residents' long duty hours have been under scrutiny as a factor affecting patient safety and the work environment for the residents. After several mandated changes in duty hours, it is important to understand how residents spend their time before proposing and implementing future changes. Time-motion methodology may provide reliable information on what residents do while on duty.Purpose: The purpose of this study is to review all available literature pertaining to time-motion studies of internal medicine residents while on a medicine service and to understand how much of their time is apportioned to various categories of tasks, and also to determine the effects of the Accreditation Council for Graduate Medical Education (ACGME-mandated duty hour changes on resident workflow in North America.Methods: Electronic bibliographic databases were searched for articles in English between 1941 and April 2013 reporting time-motion studies of internal medicine residents rotating through a general medicine service.Results: Eight articles were included. Residents spent 41.8% of time in patient care activities, 18.1% communicating, 13.8% in educational activities, 19.7% in personal/other, and 6.6% in transit. North American data showed the following changes after the implementation of the ACGME 2003 duty hours standard: patient care activities from 41.8% to 40.8%, communication activities from 19.0% to 22.3%, educational activities from 17.7% to 11.6%, and personal

  4. Development of emotional intelligence in a team-based learning internal medicine clerkship.

    Science.gov (United States)

    Borges, Nicole J; Kirkham, Karen; Deardorff, Adam S; Moore, Jeremy A

    2012-01-01

    Although increasing number of articles have been published on team-based learning (TBL), none has explored team emotional intelligence. We extend the literature by examining changes in team emotional intelligence during a third year clerkship where TBL is a primary instructional strategy. We hypothesized that team emotional intelligence will change in a positive direction (i.e., increase) during the clerkship. With IRB approval, during the 2009-2010 academic year third-year students in their internal medicine clerkship (N = 105, 100% response rate) completed the Workgroup Emotional Intelligence Profile - Short Version (WEIP-S) at the beginning and at the end of their 12-week clerkship. TBL is an instructional strategy utilized during the internal medicine clerkship. Paired t-tests showed that team emotional intelligence increased significantly pre to post clerkship for three of the four areas: awareness of own emotions (p = 0.018), recognizing emotions in others (p = 0.031), and ability to manage other's emotions (p = 0.013). There was no change for ability to control own emotions (p = 0.570). In an internal medicine clerkship, where TBL is utilized as an instructional strategy, team emotional intelligence increases. This supports TBL as an adjunctive tool to traditional medical education pedagogy.

  5. International perspectives on quality assurance and new techniques in radiation medicine: outcomes of an IAEA conference.

    Science.gov (United States)

    Shortt, Ken; Davidsson, Lena; Hendry, Jolyon; Dondi, Maurizio; Andreo, Pedro

    2008-01-01

    The International Atomic Energy Agency organized an international conference called, "Quality Assurance and New Techniques in Radiation Medicine" (QANTRM). It dealt with quality assurance (QA) in all aspects of radiation medicine (diagnostic radiology, nuclear medicine, and radiotherapy) at the international level. Participants discussed QA issues pertaining to the implementation of new technologies and the need for education and staff training. The advantage of developing a comprehensive and harmonized approach to QA covering both the technical and the managerial issues was emphasized to ensure the optimization of benefits to patient safety and effectiveness. The necessary coupling between medical radiation imaging and radiotherapy was stressed, particularly for advanced technologies. However, the need for a more systematic approach to the adoption of advanced technologies was underscored by a report on failures in intensity-modulated radiotherapy dosimetry auditing tests in the United States, which could imply inadequate implementation of QA for these new technologies. A plenary session addressed the socioeconomic impact of introducing advanced technologies in resource-limited settings. How shall the dual gaps, one in access to basic medical services and the other in access to high-quality modern technology, be addressed?

  6. Saudi Internal Medicine Residents׳ Perceptions of the Objective Structured Clinical Examination as a Formative Assessment Tool

    Directory of Open Access Journals (Sweden)

    Salwa Alaidarous

    2016-12-01

    Full Text Available The Saudi Commission for Health Specialties first implemented the Objective Structured Clinical Examinations (OSCE as part of the final year Internal Medicine clerkship exam during the 2007–2008 academic year. This study evaluated Internal Medicine residents׳ overall perceptions of the OSCE as a formative assessment tool. It focused on residents׳ perceptions of the OSCE stations׳ attributes, determined the acceptability of the process, and provided feedback to enhance further development of the assessment tool. The main objective was to assess Internal Medicine resident test-takers׳ perceptions and acceptance of the OSCE, and to identify its strengths and weaknesses through their feedback. Sixty six residents were involved in the studied administered on November 8th 2012 at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Overall, resident׳s evaluation of the OSCE was favorable and encouraging. To this end, we recommend that formative assessment opportunities using the OSCE for providing feedback to students should be included in the curriculum, and continuing refinement and localized adaptation of OSCEs in use should be pursued by course directors and assessment personnel.

  7. Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2014-09-01

    Full Text Available In recent decades, in the medical field, criteria and methods of decision-making have radically changed, going from an environment dominated by opinions and knowledge transmitted from experts to a context of evidence-based medicine, that finds its practical realization in the drafting of guidelines (GL. However, GL have a poor implementation in the real world for several factors. In the field of chronic obstructive pulmonary disease (COPD, there are already many GL, international, national, regional and by specific scientific societies. This multiplicity, while it responds to the legitimate needs to respect the diversity of interpretation of the available scientific data, on the other hand, however, can be an element of confusion for physicians. In this varied scenery we have tried to create some new tools, easy and quick to use, in order to improve the local application of existing GL on COPD, by planning a limited number of pathways in the management of acute exacerbation of COPD, which focus on the fundamental diagnostic and therapeutic aspects, as a tool to improve appropriateness in Internal Medicine Departments. These pathways, reported on individual sheets, which can be distributed to medical personnel of wards/units involved in the care of patients with COPD (First Aid, Internal Medicine, Geriatrics, Pulmonology, Intensive Respiratory Care Unit, Resuscitation, are useful to support the physician in the decision-making process and help you to resolve any disputes.

  8. Factors associated with onset of delirium among internal medicine inpatients in Spain.

    Science.gov (United States)

    Díez-Manglano, Jesús; Palazón-Fraile, Claudia; Diez-Massó, Fabiola; Martínez-Álvarez, Rosa; Del Corral-Beamonte, Esther; Carreño-Borrego, Pilar; Pueyo-Tejedor, Pilar; Gomes-Martín, Javier

    2013-01-01

    Delirium increases mortality and length of stay among hospital inpatients. Little is known about the incidence of delirium among inpatients receiving care in internal medicine nursing units in Spain. The aim of this study was to estimate frequency of delirium onset among internal medicine inpatients and identify factors associated with delirium onset using nursing records and administrative databases. Retrospective cohort study of 744 patients hospitalized in an internal medicine department in October 2010 and January, May, and October 2011. Data concerning occurrence of delirium, age, gender, living in a nursing residence, Barthel Index of activities of daily living, Norton scale for pressure ulcer risk, intravenous fluid therapy, urinary catheterization, presence of pressure ulcers, major diagnostic category at discharge, length of stay, and mean weight in the diagnosis-related group were gathered for each patient. Backward stepwise logistic regression was used to identify factors associated with onset of delirium. Ninety-seven (13%) patients experienced delirium. Factors associated with delirium were age (OR = 1.03, 95% CI [1.01, 1.06]), Barthel Index (OR = 0.99. 95% CI [0.98, 0.99]), and urinary catheterization (OR = 2.00, 95% CI [1.19, 3.68]). Increased age and presence of a urinary catheter were associated with increased onset of delirium, whereas higher levels of independence in activities of daily living were protective.

  9. [An intervention program to improve the quality of the medical records in an Internal Medicine Department].

    Science.gov (United States)

    Wikman, A; Safont, P; Merino, J; Martínez Baltanás, A; Matarranz Del Amo, M; López Calleja, E

    2009-09-01

    The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. CONCLUSION. The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students.

  10. An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability.

    Science.gov (United States)

    Akl, Elie A; Mustafa, Reem; Slomka, Thomas; Alawneh, Alia; Vedavalli, Abhishek; Schünemann, Holger J

    2008-11-18

    Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability. We developed the Guide-O-Game(c) in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game(c) consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process. The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable. We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.

  11. Developing a high-performance team training framework for internal medicine residents: the ABC'S of teamwork.

    Science.gov (United States)

    Carbo, Alexander R; Tess, Anjala V; Roy, Christopher; Weingart, Saul N

    2011-06-01

    Effective teamwork and communication can prevent error and mitigate harm. High-performance team training was developed in the aviation industry for flight crews and is being incorporated in health care settings, such as emergency departments, operating rooms, and labor and delivery suites. We translated and adapted high-performance teamwork and communication principles from other industries and other disciplines to an inpatient internal medicine environment. We selected key principles from aviation and anesthesia crew training programs in 2004 and organized them into the ABC'S of teamwork. These included appropriate Assertiveness, effective Briefings, Callback and verification, Situational awareness, and Shared mental models. Based on this content, we developed a training session for internal medicine residents and faculty, and evaluated learners' patient safety attitudes and knowledge before and after training with a written survey. More than 50 residents participated in the module. The percentage of correct answers on a question related to key teamwork principles increased from 35% before training to 67% after training (P = 0.03). Before training, 65% of the residents reported that they "would feel comfortable telling a senior clinician his/her plan was unsafe"; this increased to 94% after training (P = 0.005). After the training session, residents were able to provide examples from their clinical practice that emphasized all of the ABC'S of teamwork. Teamwork principles can be adapted from other disciplines and applied to internal medicine. After a single session, residents displayed greater knowledge of teamwork principles and reported changed attitudes toward key teamwork behaviors.

  12. Understanding resident learning preferences within an internal medicine noon conference lecture series: a qualitative study.

    Science.gov (United States)

    Sawatsky, Adam P; Zickmund, Susan L; Berlacher, Kathryn; Lesky, Dan; Granieri, Rosanne

    2014-03-01

    The lecture remains the most common approach for didactic offerings in residency programs despite conflicting evidence about the effectiveness of this format. The purpose of this study was to explore the perspectives of internal medicine residents toward conferences held in the lecture format. The investigators invited internal medicine residents (N  =  144) to participate in focus groups discussing their perspectives about noon conference lectures. The investigators used a semistructured guide to ask about motivations for attendance and effectiveness of noon conferences, transcribed the recordings, coded the discussions, and analyzed the results. Seven focus groups with a total of 41 residents were held. This identified 4 major domains: (1) motivations for attendance; (2) appropriate content; (3) effective teaching methods; and (4) perspectives on active participation. Residents' motivations were categorized into external factors, including desire for a break and balance to their workload, and intrinsic attributes, including the learning opportunity, topic, and speaker. Appropriate content was described as clinically relevant, practical, and presenting a balance of evidence. Identified effective teaching methods included shorter teaching sessions focused on high-yield learning points structured around cases and questions. While active participation increases residents' perceived level of stress, the benefits of this format include increased attention and learning. This study furthers our knowledge of the learning preferences of internal medicine residents within the changing environment of residency education and can be used in conjunction with principles of adult learning to reform how we deliver core medical knowledge.

  13. Evaluation of an online program to teach microbiology to internal medicine residents.

    Science.gov (United States)

    Guarner, Jeannette; Burd, Eileen M; Kraft, Colleen S; Armstrong, Wendy S; Lenorr, Kenya; Spicer, Jennifer O; Martin, Donna; del Rio, Carlos

    2015-01-01

    Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  14. Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

    Science.gov (United States)

    Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

    2015-12-01

    Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

  15. An Update on Travel Vaccines and Issues in Travel and International Medicine.

    Science.gov (United States)

    Rogers, Bonnie; Bunn, William B; Connor, Bradley A

    2016-08-23

    The fields of travel and international medicine are rapidly changing and growing. The role of occupational and travel health nurses is expanding and should be a focus for the future. At the American Association of Occupational Health Nurses Annual meeting on March 24, 2015, in Boston, five presentations were included in the session, An Update on Travel Vaccines and Issues in Travel and International Medicine. This article summarizes three of the presentations and includes a portion of the information generated by the Centers for Disease Control and Prevention (CDC) included in the fourth presentation. The first section focuses on the Essential Elements of Travel Medicine Programs including the pre-travel care assessment, trip research and risk identification, medication intervention review, non-pharmaceutical and prevention strategies, and post-travel care. The next section is an overview of key issues for business travelers. The growth in the number of international business travelers and unique aspects of business travel are emphasized in a comprehensive travel health program. This section also includes a discussion of expatriates and their special risks identified in recent literature (e.g., an assessment of the significant costs of health events and productivity losses by both business travelers and expatriates). The final section offers a specific example of a vaccine-preventable disease, namely, Japanese encephalitis (JE) virus, and needed changes in JE vaccine recommendations.

  16. [RECALMIN. Patient care in the internal medicine units of the Spanish national health system].

    Science.gov (United States)

    Zapatero Gaviria, A; Barba Martín, R; Román Sánchez, P; Casariego Vales, E; Diez Manglano, J; García Cors, M; Jusdado Ruiz-Capillas, J J; Suárez Fernández, C; Bernal, J L; Elola Somoza, F J

    2016-05-01

    To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. Of the total 260hospitals identified in the SNHS, 142responses were obtained from 139hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14±8, with a mean rate of 7.2±3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2,987±2,066, and those discharged by internists was 232±107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. The 2013 RECALMIN survey revealed a number of important aspects of the organisation, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Internal medicine resident training and provision of diabetes quality of care indicators.

    Science.gov (United States)

    Devkota, Bishnu P; Ansstas, Michael; Scherrer, Jeffrey F; Salas, Joanne; Budhathoki, Chakra

    2015-04-01

    Existing research is inconsistent on whether clinical experience is associated with improved management of type 2 diabetes mellitus. We sought to determine whether meeting diabetes quality indicators improves as general internal medicine physicians progress from first to last year of residency. We performed a chart abstraction of electronic health records data covering the period from September 2008 to August 2011. In all, 352 patient records were abstracted and linked to year of resident provider. Type 2 diabetes quality indicators included glycated hemoglobin (A1C), low-density lipoprotein, diastolic and systolic blood pressure control, obtaining urine microalbumin or prescription for angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and documented foot and eye examinations. Chi-square tests and logistic regression analysis were used to determine whether year of residency was associated with quality of care indices before and after adjusting for patient age, gender, race, body mass index and cigarette smoking. Urine microalbumin was the most often met indicator (76.9%), and the least often met indicator was documented eye examination (37.4%). Results of adjusted analysis indicated that the odds of A1C, low-density lipoprotein control, obtaining urine microalbumin and documented eye and foot examinations were greater among patients of second- and third-year residents compared with those of first-year residents (odds ratios range, 1.26-5.12). Urine microalbumin was the indicator most often in optimal control and least often met indicators were eye and foot examinations. We observed improvement in quality of diabetes care throughout residency. However, the low prevalence of several quality indicators indicates a need for additional training and quality improvement. Copyright © 2015 Canadian Diabetes Association. All rights reserved.

  18. Internal medicine in the bush: a clinical audit of a rural and remote outreach programme.

    Science.gov (United States)

    Foy, A; Tierney, A

    2014-04-01

    Provision of internal medicine services in rural Australia is always problematic. The aim was to undertake an audit of an outreach service operating in Northern New South Wales since 2006. The service is conducted eight times a year, involving a consultant and an advanced trainee who travel by car to the towns of Moree and Mungindi and conduct clinics in a general practice setting, an Aboriginal medical service and a local health district clinic. Since 2008, a cardiology service and a diabetes service have been added on a fly-in fly-out basis. Case records of all patients enrolled in the service between February 2006 and July 2013 were reviewed in determining the demographics, clinical presentations and level of service coverage. The experience of the authors in establishing the service provided insights into the challenges and the success factors involved. Five hundred and eighty-three patients were seen on a total of 1070 occasions relating to a wide variety of clinical presentations. Of these, 31.3% were indigenous compared with 20% in the local statistical area, and both indigenous and non-indigenous patients were seen in all settings. Patients fell into 15 different diagnostic categories with indigenous patients more likely to present for diabetes (P < 0.001) and hepatitis B (P < 0.01), but less likely to present for treatment of hepatitis C (P < 0.01). In providing an outreach service to a mixed community, flexibility in both setting and personnel are essential. Diabetes and liver disease are highly prevalent in indigenous patients, but the low numbers presenting for hepatitis C requires further study.

  19. [Highlights 2008 in a university hospital-based internal medicine: the point of view from the chief residents].

    Science.gov (United States)

    Wilson, P; Bullani, R; Cosma, M; Deriaz, S; Donzé, J; Monney, C; Neuffer, N; Pantet, O; Roduit, J; Schwab, M; Méan, M

    2009-01-28

    Doctors must regularly adjust their patients' care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2008, such as heart failure, diabetes, COPD, and thromboembolic disease. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modem medical practice based on evidence.

  20. An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback.

    Science.gov (United States)

    Gomez, Alexis C; Warburton, Karen M; Miller, Rachel K; Negoianu, Dan; Cohen, Jordana B

    2017-09-01

    While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P<0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  1. Health-related quality of life and happiness within an internal medicine residency training program: a longitudinal follow-up study.

    Science.gov (United States)

    Sobhonslidsuk, Abhasnee; Thakkinstian, Ammarin; Satitpornkul, Patchareeya

    2015-01-01

    While undergoing a hospital residency training program, residents often suffer anxiety and stress. This study aims to evaluate the change in health-related quality of life and happiness among internal medicine residents, and identify prognostic factors. Thirty-eight residents in the Ramathibodi Hospital internal medicine training program completed the World Health Organization Quality of Life-BREF and happiness Measures questionnaires at three time points: commencement, day 100, and the end of the second year of training. Confidence, expectations, anxiety, and general health were rated. Analyses were performed with mixed linear regression. Financial problems were reported for 16 residents (42.1%). At baseline, most residents had moderate-to-very high confidence, expectations, and general health but also moderate-to-very high anxiety. The health-related quality of life score was highest in the social domain followed by the environmental, psychological, and physical domains. Their psychological, physical, social, and environmental scores significantly decreased after enrollment. Their happiness and general health scores were significantly reduced after enrollment. The training program duration was negatively associated with all domains. Residents with greater confidence had higher health-related quality of life scores in the physical, psychological, and environmental domains. Moreover, their general health was positively associated with the social and environmental domains. A reduction in health-related quality of life and happiness under the internal medicine residency program is reported. High confidence and good physical health may counterbalance the decline in health-related quality of life and happiness.

  2. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

    Directory of Open Access Journals (Sweden)

    Wilson Mark C

    2010-03-01

    Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

  3. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey.

    Science.gov (United States)

    Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J

    2010-03-25

    The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

  4. Competency-Based Medical Education in the Internal Medicine Clerkship: A Report From the Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force.

    Science.gov (United States)

    Fazio, Sara B; Ledford, Cynthia H; Aronowitz, Paul B; Chheda, Shobhina G; Choe, John H; Call, Stephanie A; Gitlin, Scott D; Muntz, Marty; Nixon, L James; Pereira, Anne G; Ragsdale, John W; Stewart, Emily A; Hauer, Karen E

    2017-09-14

    As medical educators continue to redefine learning and assessment across the continuum, implementation of competency-based medical education in the undergraduate setting has become a focus of many medical schools. While standards of competency have been defined for the graduating student, there is no uniform approach for defining competency expectations for students during their core clerkship year. The authors describe the process by which an Alliance for Academic Internal Medicine task force developed a paradigm for competency-based assessment of students during their inpatient internal medicine (IM) clerkship. Building on work at the resident and fellowship levels, the task force focused on the development of key learning outcomes as defined by entrustable professional activities (EPAs) that were specific to educational experiences on the IM clerkship, as well as identification of high-priority assessment domains. The work was informed by a national survey of clerkship directors.Six key EPAs emerged: generating a differential diagnosis, obtaining a complete and accurate history and physical exam, obtaining focused histories and clinically relevant physical exams, preparing an oral presentation, interpreting the results of basic diagnostic studies, and providing well-organized clinical documentation. A model for assessment was proposed, with descriptors aligned to the scale of supervision and mapped to Accreditation Council for Graduate Medical Education domains of competence. The proposed paradigm offers a standardized template that may be used across IM clerkships, and which would effectively bridge competency evaluation in the clerkship to fourth-year assessment as well as eventual postgraduate training.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As

  5. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.

    Science.gov (United States)

    Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

    2016-01-01

    Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or

  6. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents

    Science.gov (United States)

    Daniels, Michael N.; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel

    2017-01-01

    Background Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. Methods This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. Results 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). Conclusions The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents’ interest in nephrology

  7. Core addiction medicine competencies for doctors: An international consultation on training.

    Science.gov (United States)

    Ayu, Astri Parawita; El-Guebaly, Nady; Schellekens, Arnt; De Jong, Cor; Welle-Strand, Gabrielle; Small, William; Wood, Evan; Cullen, Walter; Klimas, Jan

    2017-07-18

    Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.

  8. Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward.

    Science.gov (United States)

    Neeman, Marine; Dobrinas, Maria; Maurer, Sophie; Tagan, Damien; Sautebin, Annelore; Blanc, Anne-Laure; Widmer, Nicolas

    2017-03-01

    Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (phospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (phospital admission and discharge, 66% fewer (phospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner. An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  9. Prevalence of obesity according to Edmonton staging in the Internal Medicine consultations. Results of the OBEMI study.

    Science.gov (United States)

    Carretero Gómez, J; Arévalo Lorido, J C; Gómez Huelgas, R; Sánchez Vidal, M T; Suárez Tembra, M; Varela Aguilar, J M; Munielo Voces, I; Fernández Pérez, E; Fernández Rodríguez, J M; Ena Muñoz, J

    2017-03-01

    To estimate the prevalence of obesity in patients treated by departments of Internal Medicine and to classify the patients according to the Edmonton Obesity Staging System (EOSS). An observational, descriptive cross-sectional study included outpatients older than 18 years, with a body mass index (BMI)>30, from 38 hospitals between the 1st and 14th of February, 2016. We classified the patients according to the EOSS and analysed their clinical, laboratory and demographic variables. A value of P2 were significantly older and had significantly more comorbidities. The multivariate analysis related age (OR 1.06; P2. An analysis of correspondence grouped, with an explanatory percentage of 78.2%, the patients according to their EOSS, comorbidity, education level, employment status and functional capacity. The prevalence of obesity in the patients treated by Internal Medicine departments is similar to that of the general population, although the patients are older and have a higher BMI. EOSS is useful for implementing a comprehensive approach for patients with obesity, regardless of the BMI, which can help achieve better health and quality-of-life results. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making.

    Science.gov (United States)

    Duran-Nelson, Alisa; Gladding, Sophia; Beattie, Jim; Nixon, L James

    2013-06-01

    To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC. In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables. A total of 167 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article. The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.

  11. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned.

    Science.gov (United States)

    Blumenthal, Daniel M; Bernard, Ken; Fraser, Traci N; Bohnen, Jordan; Zeidman, Jessica; Stone, Valerie E

    2014-11-30

    Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system. The course met weekly for two to three hours during July, 2013. Sessions included large group discussions and small group reflection meetings. Topics included leadership styles, emotional intelligence, and leading clinical teams. Course materials were designed internally and featured "business school style" case studies about everyday clinical medicine which explore how leadership skills impact care delivery. Participants evaluated the course's impact and quality using a post-course survey. Questions were structured in five point likert scale and free text format. Likert scale responses were converted to a 1-5 scale (1 = strongly disagree; 3 = neither agree nor disagree; 5 = strongly agree), and means were compared to the value 3 using one-way T-tests. Responses to free text questions were analyzed using the constant comparative method. All sixteen pilot course participants completed the survey. Participants overwhelmingly agreed that the course provided content and skills relevant to their clinical responsibilities and leadership roles. Most participants also acknowledged that taking the course improved their understanding of their strengths and weaknesses as leaders, different leadership styles, and how to manage interpersonal conflict on clinical teams. 88% also reported that the course increased their interest in pursuing additional leadership training. A clinical leadership course for internal medicine residents designed by colleagues, and utilizing case studies about clinical medicine, resulted in significant self-reported improvements in clinical leadership competencies.

  12. Census of Ligurian Internal Medicine Wards of non-teaching hospitals

    Directory of Open Access Journals (Sweden)

    Micaela La Regina

    2014-12-01

    Full Text Available What is the future of internal medicine in Italy? Which competencies? Which potentialities? To this aim Ligurian FADOI Regional Society performed a census among 18 Internal Medicine Wards (IMWs in non-teaching Ligurian Hospital. We administered, by email, a questionnaire to the heads of IMWs. Data about staffing, equipment, skills, competencies and productivity during 2011 were collected from 1st to 31st November 2012. A total of 15/18 (83.3% chiefs answered to the questionnaire. The number of beds was largely variable among the wards. In 2011, mean diagnosis-related group (DRG-weight was 1.09 (range 0.91-1.6 and that revenues/costs ratio much higher than 1.5. Staff was quite adequate to standards defined by current law, only 33% has got a doctor:patients ratio superior to 1:6.4. However, annual hospitalizations exceed the availability of beds in medicine and the complexity of the patients would require a lower doctor:patients ratio, at least for a group of patients. In fact, 4 wards have a progressive care organization with a defined area for more seriously ill patients. Mean length of stay was 10 days. Expertise was wide, covering almost all medical sub-specialties. Acquired skills such as abdominal, heart and vascular ultrasounds, invasive procedures and their comprehensive knowledge make internists complete and cost-effective specialists. IMWs, as a concentrate of medical knowledge and skills, are the natural destination of current patients with co-morbidities. Staffing and number of beds should be revised according to this new demand. Their revenues/costs ratio resulted favorable and their global approach to patients and not to disease can be useful for resource rationalization. Wider and further studies are needed to improve the awareness of stakeholders about Internal Medicine.

  13. Quality of life: international and domestic students studying medicine in New Zealand.

    Science.gov (United States)

    Henning, Marcus A; Krägeloh, Christian; Moir, Fiona; Doherty, Iain; Hawken, Susan J

    2012-08-01

    International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.

  14. A methodology for auto-monitoring of internal contamination by 131I in nuclear medicine workers.

    Science.gov (United States)

    Vidal, M V S; Dantas, A L A; Dantas, B M

    2007-01-01

    The manipulation of 131I in Nuclear Medicine involves significant risks of internal contamination of the staff. In the event of an accidental contamination, or when the Radiological Protection Program includes routine individual monitoring of internal contamination, it is necessary to implement internal dose estimation through in vivo and in vitro bioassay techniques. Due to the huge extension of the Brazilian country, this type of monitoring becomes unfeasible if all measurements have to be performed at the institutes of the CNEN. Thus, if the Nuclear Medicine Centres (NMC) become able to conduct the monitoring of their employees, this skill would be of great significance. The methodology proposed in this work consists in a simple and inexpensive protocol for auto-monitoring the internal contamination by 131I, using the resources available at the NMC. In order to verify the influence of the phantom in the calibration factor for the measurement of 131I in thyroid, it was performed a comparison among a variety of phantoms commercially available, including the Neck-Thyroid Phantom developed in IRD. A protocol for performing in vivo and in vitro measurements by the NMC was established. The applicability of the individual monitoring techniques was also evaluated by comparing the detection limits with the derived limits associated with the annual dose limits for workers.

  15. [Presence of Nuclear Medicine in the Spanish journals of Internal Medicine and other specialties (2000-2009)].

    Science.gov (United States)

    Durán-Ferreras, A; Sabaté-Díaz, J; Espigares-Jiménez, M

    2014-01-01

    This article aims to provide a quantitative and qualitative description of the publications on Nuclear Medicine (NM) in journals from other disciplines, between 2000 and 2009. A retrospective descriptive study was carried out including the years 2000-2009 in three internal medicine journals (IM) and in three related specialty journals (RS). The criteria used are that some of the authors were located professionally in a Service, Unit or Central MN and/or that the title of the article or at least its content made a reference to some specific aspect of NM. Date of publication, the magazine section, thematic, data of the authors, province and referral hospital were collected. A total of 186 articles were found, 81 in IM journals and 105 in RS. The IM journal articles came from 43 different hospitals. Vall d'Hebron (Barcelona, Spain) was the hospital with the largest volume. Twenty-four provinces were identified, Barcelona and Madrid standing out among them with 20 and 17 articles, respectively. In the RS journals, 59 hospitals/centers had participated, Vall d'Hebron standing out with 51 articles. There were 9 foreign articles. The articles were distributed into 19 provinces, Barcelona and Madrid standing out with 32 papers and 20 papers, respectively. There are at least twice as many articles in the RS Journals than in the IM ones. «Original» articles are the most frequent. The Clinical and Translational Oncology journal in RS and Medicina Clínica in IM stand out with the highest number of articles. No specific topic prevailed. Copyright © 2013 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  16. Selection criteria for internal medicine residency applicants and professionalism ratings during internship.

    Science.gov (United States)

    Cullen, Michael W; Reed, Darcy A; Halvorsen, Andrew J; Wittich, Christopher M; Kreuziger, Lisa M Baumann; Keddis, Mira T; McDonald, Furman S; Beckman, Thomas J

    2011-03-01

    To determine whether standardized admissions data in residents' Electronic Residency Application Service (ERAS) submissions were associated with multisource assessments of professionalism during internship. ERAS applications for all internal medicine interns (N=191) at Mayo Clinic entering training between July 1, 2005, and July 1, 2008, were reviewed by 6 raters. Extracted data included United States Medical Licensing Examination scores, medicine clerkship grades, class rank, Alpha Omega Alpha membership, advanced degrees, awards, volunteer activities, research experiences, first author publications, career choice, and red flags in performance evaluations. Medical school reputation was quantified using U.S. News & World Report rankings. Strength of comparative statements in recommendation letters (0 = no comparative statement, 1 = equal to peers, 2 = top 20%, 3 = top 10% or "best") were also recorded. Validated multisource professionalism scores (5-point scales) were obtained for each intern. Associations between application variables and professionalism scores were examined using linear regression. The mean ± SD (minimum-maximum) professionalism score was 4.09 ± 0.31 (2.13-4.56). In multivariate analysis, professionalism scores were positively associated with mean strength of comparative statements in recommendation letters (β = 0.13; P = .002). No other associations between ERAS application variables and professionalism scores were found. Comparative statements in recommendation letters for internal medicine residency applicants were associated with professionalism scores during internship. Other variables traditionally examined when selecting residents were not associated with professionalism. These findings suggest that faculty physicians' direct observations, as reflected in letters of recommendation, are useful indicators of what constitutes a best student. Residency selection committees should scrutinize applicants' letters for strongly favorable

  17. Results of prospective multicenter study on heart failure on Campania Internal Medicine wards: the FASHION study

    Directory of Open Access Journals (Sweden)

    Fernando Gallucci

    2017-06-01

    Full Text Available Heart failure (HF is characterized by a high prevalence and hospitalization rate with considerable health and social impact; the knowledge of its epidemiological features remains the mainstay to assess adequacy of the health care needs. The aim of this study was to evaluate the prevalence of HF in Internal Medicine Units of the Campania region (Italy and patients’ characteristics. We recruited all patients with HF admitted between April 1 and June 30, 2014, in 23 Units of Internal Medicine: 975 patients (19.5% of 5000 admissions, 518 women and 457 men, mean age 76.9±9.9 (range 34-100 with 741 (76% older than 70 years. The mean age was higher in women than men; 35.8% of patients had atrial fibrillation, with higher prevalence in women than in men. Coronary artery disease represented the leading etiology while prevalence of non-ischemic heart failure was higher in women. New York Heart Association class was indicated in 926 patients. Left ventricular ejection fraction (LVEF was measured in 503 patients; 18.4% of patients had a severely reduced LVEF<35%, mostly men (P=0.0001 and 67.4% presented a LVEF>40%. At least one hospital admission in the previous 12 months was registered in 39.6% of patients. One, two and more than two relevant comorbidities were present in 8.6%, 24.7% and 64.8% of patients, respectively. Arterial hypertension and coronary artery disease were more frequent in female. In conclusion, advanced age and clinical complexity were the main characteristics of HF patients hospitalized in the Internal Medicine Units in Campania. Gender differences also emerged from the analysis of demographic parameters and etiopathogenetic features. Some diagnostic and therapeutic aspects not in line with that recommended by the most recent HF international guidelines were registered.

  18. An Investigation of the Variety and Complexity of Statistical Methods Used in Current Internal Medicine Literature.

    Science.gov (United States)

    Narayanan, Roshni; Nugent, Rebecca; Nugent, Kenneth

    2015-10-01

    Accreditation Council for Graduate Medical Education guidelines require internal medicine residents to develop skills in the interpretation of medical literature and to understand the principles of research. A necessary component is the ability to understand the statistical methods used and their results, material that is not an in-depth focus of most medical school curricula and residency programs. Given the breadth and depth of the current medical literature and an increasing emphasis on complex, sophisticated statistical analyses, the statistical foundation and education necessary for residents are uncertain. We reviewed the statistical methods and terms used in 49 articles discussed at the journal club in the Department of Internal Medicine residency program at Texas Tech University between January 1, 2013 and June 30, 2013. We collected information on the study type and on the statistical methods used for summarizing and comparing samples, determining the relations between independent variables and dependent variables, and estimating models. We then identified the typical statistics education level at which each term or method is learned. A total of 14 articles came from the Journal of the American Medical Association Internal Medicine, 11 from the New England Journal of Medicine, 6 from the Annals of Internal Medicine, 5 from the Journal of the American Medical Association, and 13 from other journals. Twenty reported randomized controlled trials. Summary statistics included mean values (39 articles), category counts (38), and medians (28). Group comparisons were based on t tests (14 articles), χ2 tests (21), and nonparametric ranking tests (10). The relations between dependent and independent variables were analyzed with simple regression (6 articles), multivariate regression (11), and logistic regression (8). Nine studies reported odds ratios with 95% confidence intervals, and seven analyzed test performance using sensitivity and specificity calculations

  19. General covariant conservative angular momentum as internal charges

    Institute of Scientific and Technical Information of China (English)

    赵德品

    1996-01-01

    The usual approach to internal conservative charges is used to obtain the conservation laws of angular-momentum in both Einstein gravity and gravitational anyons.The results are in complete agreement with those of references.

  20. LATIN AS A LANGUAGE OF INTERNATIONAL COMMUNICATIVE STATUS: MEDICINE OF THE 16TH-17TH CENTURIES.

    Science.gov (United States)

    Bieliaieva, O; Lysanets, Yu; Melaschenko, M

    2017-01-01

    The research paper is of interdisciplinary nature, written at the crossroads of the history of medicine, functional stylistics and terminology science. The choice of the 16th century as a starting point of the study is due to the fact that quality changes in book and manuscript writing that took place during this period led to unprecedented development and dissemination of scientific knowledge, including biomedical. The 16th century embraces the life and work of such prominent figures in the history of medicine, as Andreas Vesalius, Gabriele Fallopian, Bartolomeo Eustachi, and Girolamo Fracastoro. The 17th century, which is called the century of "scientific revolution", left not less honourable names in the history of medicine - William Harvey, Marcello Malpighi, Thomas Willis, Jean Pecquet, Francis Glisson, Thomas Sydenham. In the context of this study, these prominent figures are interesting due to the fact that their works were written in Latin and constitute the prototypes of modern scientific style, in particular of such genres as thesis, monograph, scientific article, scientific report, polemic presentation, textbook. On the basis of extensive factual material, it has been demonstrated that during 16th-17th centuries, Latin acted as a fully developed language with a clearly oriented international status. As one of basic tools in scientific knowledge, Latin not only performed the epistemological function which was the priority for the development of medicine, but also served as a means of accumulation, reception, transmission and popularization of achievements in various areas of medical science.

  1. Price discrimination in essential medicines: evidence from International Drug Price Indicator Guide data.

    Science.gov (United States)

    Hanlon, Michael; Zhang, Raymond

    2013-03-01

    Few data are available on what donors, governments and other implementing organisations pay for the medicines they procure. To partly address this shortcoming, we analyse transactions of pharmaceuticals on the WHO's essential medicines list. Our objective was to identify the determinants of prices paid for these drugs. We used data from the 2008 version of the International Drug Price Indicator Guide. We normalised transactions by representing their value as a 'price per daily dose'. We used a mixed-effects regression model to quantify the impact of observable characteristics on prices paid. We present evidence of first-degree price discrimination in the market for essential medicines. We find that as a country's per capita wealth doubles, prices paid for the same pharmaceutical increase by 33%. These data indicate that purchasing agents from wealthier countries pay more for essential medicines, all factors constant. This behaviour is not a form of development assistance for health but rather is indicative of inefficient markets in which buyers' lack of information enables suppliers to charge higher prices than they could otherwise.

  2. A GENERAL ASSESSMENT OF THE INTERNAL CONTROL IN MINING COMPANIES

    Directory of Open Access Journals (Sweden)

    BOGDAN RĂVAŞ

    2015-10-01

    Full Text Available The role of the internal auditor is to examine whether persons exercising internal control are able to carry out checks with ambition, with responsibility and be involved in some cases of fraud. To achieve the proper conditions, the side observant and constructive side of control is necessary to ensure the independence and authority or control bodies with responsibilities for control of the operation.

  3. General Aspects Regarding the Management Activity in International Business

    OpenAIRE

    Mihaela Loredana LĂPĂDUŞI; CARUNTU CONSTANTIN

    2010-01-01

    The strategy of penetrating and developing the external markets is an important objective of the international enterprises management. This involves a specific analysis of the business environment for illustrating the opportunities of business and risks and the business potential of a particular enterprise in order to establish the internalisation objectives and types. The international management is individualised by the environment where the enterprises develop their...

  4. How to rationally use information diagnostic technologies in family and general medicine practice.

    Science.gov (United States)

    Sivić, Suad; Masic, Izet; Petkovic, Darko; Huseinagic, Senad; Tandir, Salih; Zunic, Lejla

    2009-01-01

    NONE DECLARED New discoveries in technology indeed enabled significant improvement of health care in the last three decades. Only during the last few years a significant breakthrough is achieved in the field of antiviral drugs, biotechnology, digital diagnostic technology, molecular diagnosis, tissues and organs transplantation as well as surgical and information technologies, which all contributed to the improvement of health care. Rapid growth of medical technology has led to the increase in costs of health care, increased access to these technologies and improvement of health care that is permanently encouraging the further development of technology. Technology encompasses the skills, knowledge and ability to understand, use and create useful things. It is the practical application of knowledge. Evaluation of health technology is the systematic evaluation of characteristics, results or impact of health technologies. The primary purpose of evaluation is to provide information to responsible parties for the technology in the health care system, which will be used in decision-making and introduction of these technologies. Information technology in medicine and health care represents all medical and health technology in the process of work, monitoring and evaluation done using computer technology. Progress of medical science in recent years especially needs to thank to the development of information technologies. The health care system of Bosnia and Herzegovina is currently operating in the two sub-systems of primary health care. One is inherited from the past system, in which the primary health care is provided by general practitioners, specialists in general practice, as well as gynecologists, pediatricians and pulmologists, and the second subsystem occurs when in PHC is introduced the system of family medicine doctors and family medicine specialists. Family medicine, based on the concept of orientation towards the methods which are more effective, rational and

  5. Introduction to the 1st International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015).

    Science.gov (United States)

    Zheng, Yafeng; Jassbi, Amir Reza; Xiao, Jianbo

    2016-03-30

    The 1st International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015) was held in Shanghai, China, from June 26th to 29th, 2015. The 1st ISPMF was organized by the Phytochemical Society of Europe (PSE) and the Phytochemical Society of Asia (PSA). More than 270 scientists from 48 countries attended this meeting. The program of ISPMF 2015 consisted of 12 plenary lectures, 20 invited talks, and 55 short oral presentations in 16 sessions, including phytochemistry, phytomedicine, pharmacology, and application of phytochemicals in medicine and food. The 1st ISPMF has obtained support from Critical Reviews in Food Science and Nutrition, Food Chemistry, Phytochemistry Reviews, and Nutrients. As supported by Prof. Thomas F. Hofmann, a special issue on Journal of Agricultural and Food Chemistry (ACS) for the 1st ISPMF was initiated in January 2015.

  6. Quality evaluation of health care offered by an Internal Medicine Department.

    Science.gov (United States)

    Bilora, F; Petrobelli, F; Leo, T; Fioretti, M; Boccioletti, V

    2001-03-01

    The aim of this work is to evaluate the quality and patients satisfaction for given services in an Internal Medicine Department during three months. A questionnaire was given to all the patients admitted to our Medicine Department to evaluate our strength and to correct weakness. Our patients assessed doctors and nursing staff for skill and dedication. They gave suggestions about hotel management: bathroom cleaning and number of beds in the same room. They also asked for a pharmacy and a post office inside the hospital. It appears that our ward gives a satisfactory health care situation. Some of our patients suggestions can be put into practice in a short time, while others require longer, depending on public resources and not on private, such as happens, on the contrary, in the United States.

  7. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department.

    Science.gov (United States)

    Testa, Americo; Francesconi, Andrea; Giannuzzi, Rosangela; Berardi, Silvia; Sbraccia, Paolo

    2015-12-01

    The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets

  8. [Prevalence of delirium in hospitalized patients from an internal medicine service].

    Science.gov (United States)

    González Pezoa, Ana Carolina; Carrillo Venezian, Bernardita Claudia; Castillo Rojas, Sandra

    2015-11-11

    Delirium is a common neurocognitive syndrome that takes place during hospitalizations, associated with worse global outcomes in patients who present it. Despite this, it is usually under-recognized as a disease that needs specific treatment. To determine the rate of prevalence of delirium in Internal Medicine Service patients and evaluate missed diagnosis of the syndrome made by attending physicians, medical residents or interns in charge. This is a descriptive observational study carried out in the Internal Medicine Service of Dr. Eduardo Pereira Hospital (April 12 - May 12, 2014) evaluating 125 patients who were admitted to this service. Through the Confusion Assessment Method Instrument, the prevalence of delirium disease and the number of missed diagnosis was established. One hundred and two (102) patients met the inclusion criteria. Nineteen (19) (18.6%) of them were diagnosed with delirium. In the diagnosed patient group, 13 (68.4%) were women. Delirium diagnosis was missed in eight patients (42.1%). The prevalence of delirium in this specific Hospital is as expected, according to the literature. Considering the diagnostic tools available, it is crucial to train health workers to improve recognition and management of this syndrome.

  9. Assessment of general public perceptions toward traditional medicines used for aphrodisiac purpose in state of Penang, Malaysia.

    Science.gov (United States)

    Hassali, Mohamed Azmi; Saleem, Fahad; Shafie, Asrul Akmal; Al-Qazaz, Harith Khalid; Farooqui, Maryam; Aljadhey, Hisham; Atif, Muhammad; Masood, Imran

    2012-11-01

    The study aims to evaluate general public perceptions regarding the use of Traditional and Complementary Medicines (TCM) for aphrodisiac purposes. A questionnaire based, cross-sectional study was undertaken. Respondents were selected in the state of Penang, Malaysia. A total of 392 respondents were included in the study. Descriptive statistics were used for data analysis. Chi Square/Fischer Exact tests were used where appropriate. Out of 392 respondents, 150 (38.26%) reported using specific Traditional medicines for aphrodisiac purposes. Most respondents (46.94%) agreed that aphrodisiac medicines were easily available t. Moreover, 40.31% of the respondents reported that traditional aphrodisiac medicines were cheaper than modern (prescription) medicines. This study highlights limited public knowledge regarding the use of traditional aphrodisiac medicine. Healthcare professionals should be aware of informal TCM usage when prescribing allopathic medicines. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Sherbrooke - Montevideo: a socially responsible international collaboration to foster family medicine.

    Science.gov (United States)

    Morin, Martine; Grand'Maison, Paul; Henderson, Eduardo; Vignolo, Julio

    2014-01-01

    The World Health Organization advocates for faculties of medicine to orient health professional education toward the needs of the populations graduates are to serve and to include a greater emphasis on primary health care. It was in this framework that in 2007, the Faculty of Medicine and Health Sciences at the Université de Sherbrooke (FMHS-UdeS) in Canada and the Facultad de Medicina de la Universidad de la Republica (FMUdelaR) in Montevideo, Uruguay developed a comprehensive collaboration to sustain the development of family medicine in both universities through education, practice and research. ACTIVITIES AND OUTCOMES: In addition to information sharing through email and teleconferencing, this five year collaboration has included 28 bilateral visits by the two institutions' teachers and leaders. During these visits, Uruguayan members participated in workshops and benefited from exchanges during educational and clinical activities. Interactions led to the improvement of their skills as teachers of family medicine with an emphasis on clinical teaching, supervision, feedback to learners in clinical evaluations, use of various educational methods, use of standardized patients for teaching and evaluation, and research. FMHS-UdeS members learned about the community aspects of family medicine in Uruguay and reflected on how these could be implemented to the benefit of Canadians. The international collaboration forged between the FMHS-UdeS and the FMUdelaR represents a socially responsible endeavor that has been highly rewarding for all involved. It represents a significant learning opportunity for each group aiming to better prepare physicians to serve as primary health care providers in their communities.

  11. Oxygen therapy multicentric study--a nationwide audit to oxygen therapy procedures in internal medicine wards.

    Science.gov (United States)

    Neves, J T; Lobão, M J

    2012-01-01

    Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it isn't provided accordingly with the best of care. The goal of this work is to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS) in its consensus statement "BTS guideline for emergency oxygen use in adult patients". Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring. Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93,4%. Most prescriptions were by a fixed dose (82,4%), but only 11,6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors. Oxygen was administered to only 77,0% of the patients with fixed dose prescriptions. FiO(2) or flow rate and the delivery device were the same as prescribed in 70,9 and 89,2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO(2) range, 82,7% were on the prescribed SatO(2) objective range. Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO(2) range are still a minority.

  12. Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality.

    Science.gov (United States)

    Díez-Manglano, J; Fernández-Jiménez, C; Lambán-Aranda, M P; Landa-Santesteban, M C; Isasi de Isasmendi-Pérez, S; Moreno-García, P; Bejarano-Tello, E; Barranco-Usón, J; Munilla-López, E; Del Corral-Beamonte, E

    2016-12-01

    To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

    Science.gov (United States)

    Hamasaki, Tomoko; Hagihara, Akihito

    2015-10-24

    The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain

  14. UFOs, NGOs, or IGOs: Using International Documents for General Reference.

    Science.gov (United States)

    Shreve, Catherine

    1997-01-01

    Discusses accessing and using documents from international (intergovernmental) organizations. Profiles the United Nations, the European Union and other Intergovernmental Organizations (IGOs). Discusses the librarian as "Web detective," notes questions to focus on, and presents examples to demonstrate navigation of IGO sites. Lists basic tools for…

  15. UFOs, NGOs, or IGOs: Using International Documents for General Reference.

    Science.gov (United States)

    Shreve, Catherine

    1997-01-01

    Discusses accessing and using documents from international (intergovernmental) organizations. Profiles the United Nations, the European Union and other Intergovernmental Organizations (IGOs). Discusses the librarian as "Web detective," notes questions to focus on, and presents examples to demonstrate navigation of IGO sites. Lists basic…

  16. Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

    Directory of Open Access Journals (Sweden)

    Shanmugam Victoria K

    2012-10-01

    Full Text Available Abstract Background The American Board of Internal Medicine Certification Examination (ABIM-CE is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores. Methods ABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152. Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS. Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows. Results Paired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051. Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS. Conclusions This study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta

  17. BIPAP protocol usage in patients admitted to the Internal Medicine unit

    Directory of Open Access Journals (Sweden)

    Óscar Bautista Villaécija

    2013-06-01

    Full Text Available The use of noninvasive mechanical ventilation equipment becomes more common in internal medicine units. Due to its indications, such as severe respiratory failure, or hypoxemic respiratory failure, it means a great help in these units. Within the multidisciplinary team, the medical staff is responsible for the prescription and programming of the device parameters, and the nursing staff handles such equipment and provides care to the patients requiring noninvasive mechanical ventilation.The objective of this protocol is to show in a clear and simple way, the noninvasive mechanical ventilation system, as well as its advantages and complications, and the nursing diagnoses that should be considered.

  18. Report of the International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015).

    Science.gov (United States)

    Xiao, Jianbo

    2016-08-01

    The International Symposium on Phytochemicals in Medicine and Food (ISPMF2015) was held June 26-29, 2015, in Shanghai, China. This is the first time that a PSE meeting has been held in Asia and a PSE-PSA joint symposium provided an opportunity for communication between scientists from European and Asian countries. More than 270 scientists from 48 countries attended this meeting. ISPMF2015 assembled an exciting and diverse programme with 16 sessions, consisting of 12 plenary lectures, 20 invited talks, 55 short oral presentations, and in excess of 130 posters, dedicated to creating a podium for exchanging the latest research results on phytochemicals for food and human health.

  19. Emotional Intelligence in Internal Medicine Residents: Educational Implications for Clinical Performance and Burnout.

    Science.gov (United States)

    Satterfield, Jason; Swenson, Sara; Rabow, Michael

    2009-01-01

    We measured emotional intelligence (EQ; the ability to perceive, understand, and manage emotions in the self and others) in a sample of 28 internal medicine residents at the beginning and end of an academic year. EQ scores increased significantly over the course of the year. Higher EQ scores at the end of the year were significantly related to higher ratings for overall clinical performance and medical interviewing. Higher EQ scores also correlated with lower levels of burnout. Results suggest that clinically significant changes in EQ can occur over the course of medical training. Further study should determine if and how educational interventions can affect EQ, EQ-related performance, and burnout.

  20. Impact of a competency based curriculum on quality improvement among internal medicine residents.

    Science.gov (United States)

    Fok, Mark C; Wong, Roger Y

    2014-11-28

    Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency

  1. Internal Medicine Residents' Perceived Responsibility for Patients at Hospital Discharge: A National Survey.

    Science.gov (United States)

    Young, Eric; Stickrath, Chad; McNulty, Monica C; Calderon, Aaron J; Chapman, Elizabeth; Gonzalo, Jed D; Kuperman, Ethan F; Lopez, Max; Smith, Christopher J; Sweigart, Joseph R; Theobald, Cecelia N; Burke, Robert E

    2016-12-01

    Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was

  2. Is the efficacy of psychopharmacological drugs comparable to the efficacy of general medicine medication?

    Directory of Open Access Journals (Sweden)

    Seemüller Florian

    2012-02-01

    Full Text Available Abstract There is an ongoing debate concerning the risk benefit ratio of psychopharmacologic compounds. With respect to the benefit, recent reports and meta-analyses note only small effect sizes with comparably high placebo response rates in the psychiatric field. These reports together with others lead to a wider, general critique on psychotropic drugs in the scientific community and in the lay press. In a recently published article, Leucht and his colleagues compare the efficacy of psychotropic drugs with the efficacy of common general medicine drugs in different indications according to results from reviewed meta-analyses. The authors conclude that, overall, the psychiatric drugs were generally not less effective than most other medical drugs. This article will highlight some of the results of this systematic review and discuss the limitations and the impact of this important approach on the above mentioned debate.

  3. International Conference on Harmonisation; guidance on E11 clinical investigation of medicinal products in the pediatric population; availability. Notice.

    Science.gov (United States)

    2000-12-15

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "E11 Clinical Investigation of Medicinal Products in the Pediatric Population." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance sets forth critical issues in pediatric drug development and approaches to the safe, efficient, and ethical study of medicinal products in the pediatric population. The guidance is intended to encourage and facilitate the timely development of pediatric medicinal products internationally.

  4. Current Perspective in the International Trade of Medicinal Plants Material: An Update.

    Science.gov (United States)

    Vasisht, Karan; Sharma, Neetika; Karan, Maninder

    2016-01-01

    The recent years have seen an increased interest in medicinal plants together with the therapeutic use of phytochemicals. Medicinal plants are utilized by the industry for the production of extracts, phytopharmaceuticals, nutraceuticals and cosmeceuticals and their use is expected to grow faster than the conventional drugs. The enormous demand of medicinal plant material has resulted in huge trade both at domestic and international levels. The trade data of medicinal plant material with commodity code HS 1211 (SITC.4, code 292.4) and their derived/related products which are traded under different commodity codes has been acquired from COMTRADE, Trade Map, country reports, technical documents etc for the period 2001 to 2014. The data was analyzed using statistical tools to draw conclusions. The significant features of the global trade; the leading source, consumer, import and export countries; and the striking trends are presented. The trade of the ten key countries and the selected important items is also discussed in detail. The conservative figure of trade of medicinal plants materials and their derived/related products including extracts, essential oils, phytopharmaceuticals, gums, spices used in medicine, tannins for pharmaceutical use, ingredients for cosmetics etc. as calculated from the global export data for the year 2014 is estimated at USD 33 billion. The average global export in medicinal plants under HS 1211 for the fourteen year period was USD 1.92 billion for 601,357 tons per annum and for the year 2014 it stood at 702,813 tons valued at USD 3.60 billion. For the studied period, an annual average growth rate (AAGR) of 2.4% in volumes and 9.2% in values of export was observed. Nearly 30% of the global trade is made up by top two countries of the import and export. China and India from Asia; Egypt and Morocco from Africa; Poland, Bulgaria and Albania from Europe; Chile and Peru from South America are important supply sources. The USA, Japan and Europe

  5. The International Atomic Energy Agency's activities in radiation medicine and cancer: promoting global health through diplomacy.

    Science.gov (United States)

    Deatsch-Kratochvil, Amanda N; Pascual, Thomas Neil; Kesner, Adam; Rosenblatt, Eduardo; Chhem, Rethy K

    2013-02-01

    Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries' national security. Recently, health has experienced a "political revolution" or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the "overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015." These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to "accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world." This article discusses global health diplomacy, reviews the IAEA's program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy.

  6. Using direct observation, formal evaluation, and an interactive curriculum to improve the sign-out practices of internal medicine interns.

    Science.gov (United States)

    Gakhar, Bhavna; Spencer, Abby L

    2010-07-01

    The safe transfer (handoff) of responsibility for patient care from one physician to another requires that health care facilities have rigorous sign-out systems and that physicians develop effective communication skills. In 2007 and 2008, to improve the spoken and written sign-out practices of the 25 interns at Allegheny General Hospital (Pittsburgh, Pennsylvania), the authors designed and administered Likert scale surveys about training in and satisfaction with current sign-out practices; directly observed and evaluated interns performing spoken sign-outs; assessed and graded interns' sign-out sheets; and compared sign-out sheets with patient records to evaluate their accuracy. On the basis of their findings, the authors developed a new curriculum with didactic and interactive components to target intern-level and system-level problems. The curriculum emphasized the importance of complete and accurate sign-outs, provided examples of good and poor sign-outs, and assigned interns to work in small groups to practice sign-out skills and receive feedback from peers and program leaders. Reevaluation of interns two months after curriculum implementation revealed not only better performance on each of the seven items evaluated for spoken sign-out but also substantial improvement in the completeness of sign-out sheets and the accuracy of reporting of identification data, code status, and medications data. The curriculum was well received by interns, and it helped them develop skills required by the Accreditation Council for Graduate Medical Education, including competencies in communication, practice-based learning, and systems-based practice.

  7. Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine.

    Science.gov (United States)

    Mola, Ernesto

    2013-06-01

    Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.

  8. Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study.

    Science.gov (United States)

    Houchens, Nathan; Harrod, Molly; Moody, Stephanie; Fowler, Karen; Saint, Sanjay

    2017-07-01

    Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds.

  9. Lead optimization attrition analysis (LOAA): a novel and general methodology for medicinal chemistry.

    Science.gov (United States)

    Munson, Mark; Lieberman, Harvey; Tserlin, Elina; Rocnik, Jennifer; Ge, Jie; Fitzgerald, Maria; Patel, Vinod; Garcia-Echeverria, Carlos

    2015-08-01

    Herein, we report a novel and general method, lead optimization attrition analysis (LOAA), to benchmark two distinct small-molecule lead series using a relatively unbiased, simple technique and commercially available software. We illustrate this approach with data collected during lead optimization of two independent oncology programs as a case study. Easily generated graphics and attrition curves enabled us to calibrate progress and support go/no go decisions on each program. We believe that this data-driven technique could be used broadly by medicinal chemists and management to guide strategic decisions during drug discovery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Selected papers from the 7th International Conference on Microtechnologies in Medicine and Biology (MMB 2013)

    Science.gov (United States)

    Meng, Ellis; Takayama, Shuichi

    2014-03-01

    In this special section of Journal of Micromechanics and Microengineering are a collection of the best microengineering papers presented at the 7th International Conference on Microtechnologies in Medicine and Biology (MMB 2013) which took place in the seaside town of Marina del Rey, California, USA on 10-12 April, 2013. During the 3-day conference, participants enjoyed talks from 6 invited keynote speakers and 125 flash oral/poster presentations. The MMB conference is a biennial meeting with the primary purpose of fostering interactions between biologists and medical researchers, clinicians, chemists, physicists and engineers to enhance and strengthen the potential microtechnologies that will revolutionize the fields of medicine and biological sciences. The conference possesses a unique format where all poster presenters provide a brief 60 s oral presentation highlighting their research. This format was devised to provide training and exposure for young researchers, especially PhD students and postdocs, in the field and stimulate interdisciplinary exchanges. Therefore, MMB provides an intimate intellectual venue the facilitate discussions and collaborations to advance new research tools and technologies for medicine and biological sciences. The MMB conference series was co-founded by Professor David Beebe (University of Wisconsin—Madison) and Professor André Dittmar (University of Lyon) and was the first international meeting to provide a forum focusing on emerging applications of microtechnologies to unmet needs in medicine and biology. The series was held for the first time in 2000, in Lyon, France and followed by Madison, USA (2002), Oahu Island in Hawaii, USA (2005), Okinawa, Japan (2006), Québec City, Canada (2009), Lucerne, Switzerland (2011), and Marina del Rey, USA (2013). The next conference will be held in Seoul, Korea in 2015. This collection of articles highlights recent progress in microtechnologies with medical and biological applications. We are

  11. Chinese translation of English textbooks on internal medicine from the 1850s to the 1940s

    Directory of Open Access Journals (Sweden)

    Chuang-Ye Hong

    2014-06-01

    Full Text Available During the 100 years from 1850 to 1949, six English textbooks on internal medicine were translated into Chinese and published. Publication of these books was a response to the increased demand for Chinese textbooks after the opening of several Western-style hospitals and medical schools in China where the instruction was in Chinese. Throughout this period, textbooks translated from English were regarded as symbols of mainstream and authority within medical communities in China. There was a shift of translators from British and American medical missionaries to Chinese medical elites. Publishers also changed from missionary hospitals or missionary organizations to the Chinese Medical Association, which was led by ethnic Chinese. After the 1950s, translation activity continued in Taiwan, but it was halted in China until after the Cultural Revolution. This paper provides bibliographic information about these books. The transition of medical authority in China during this 100-year period is also reviewed through the successive publication of translated textbooks on internal medicine.

  12. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    Science.gov (United States)

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies.

  13. The pluralization of the international: Resistance and alter-standardization in regenerative stem cell medicine.

    Science.gov (United States)

    Rosemann, Achim; Chaisinthop, Nattaka

    2016-02-01

    The article explores the formation of an international politics of resistance and 'alterstandardization' in regenerative stem cell medicine. The absence of internationally harmonized regulatory frameworks in the clinical stem cell field and the presence of lucrative business opportunities have resulted in the formation of transnational networks adopting alternative research standards and practices. These oppose, as a universal global standard, strict evidence-based medicine clinical research protocols as defined by scientists and regulatory agencies in highly developed countries. The emergence of transnational spaces of alter-standardization is closely linked to scientific advances in rapidly developing countries such as China and India, but calls for more flexible regulatory frameworks, and the legitimization of experimental for-profit applications outside of evidence-based medical care, are emerging increasingly also within more stringently regulated countries, such as the United States and countries in the European Union. We can observe, then, a trend toward the pluralization of the standards, practices, and concepts in the stem cell field.

  14. The resident scholar program: a research training opportunity for internal medicine house staff.

    Science.gov (United States)

    Byrnes, Abigail B; McCormack, Francis X; Diers, Tiffiny; Jazieh, Abdul-Rahman

    2007-01-01

    Housestaff research training is a challenging task that is complicated by the lack of a structured process and dedicated time. The Resident Scholar Program (RSP) at the University of Cincinnati, Department of Internal Medicine was created to overcome these challenges. Interested internal medicine house staff are required to submit an application to the residency research director including a project description signed by a faculty mentor. If the project is approved, a 4-month elective rotation is scheduled for the following year. Residents spend the first month on a consult service in the subspecialty area of their research and the remaining 3 months performing their research project. The RSP was launched in July 2003. The percentage of residents participating in research more than tripled. The subspecialty areas represented by RSP research were more diverse than those represented in prior years. Most participants participated in clinical research projects (84%), with 63% of projects being prospective in design. The RSP residents were twice as likely to obtain subspecialty fellowship positions compared to non-RSP residents (89% vs 46%, respectively). The RSP enables house staff to participate in research opportunities in their areas of interest. Development of a more systematic assessment method to study the impact of the program is underway, but the high participation rate reflects resident interest in such a program, particularly for residents with aspirations in pursuing fellowship training.

  15. Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy.

    Science.gov (United States)

    Tedeschi, Sara; Tumietto, Fabio; Giannella, Maddalena; Bartoletti, Michele; Cristini, Francesco; Cioni, Giorgio; Ambretti, Simone; Carretto, Edoardo; Sambri, Vittorio; Sarti, Mario; Viale, Pierluigi

    2016-10-01

    More than one-third of candidemia episodes occur in Internal Medicine Wards (IMWs) but only few studies have focused on this setting and specific data about epidemiology, clinical characteristics and risk factors for mortality are scant. To describe epidemiology and to assess risk factors for in-hospital mortality among patients with candidemia in IMWs. Multicenter retrospective cohort study on patients with candidemia cared for in IMWs of an Italian region (Emilia Romagna) from January 2012 to December 2013. Non survivors were compared with survivors; variables with p≤0.1 at univariate analysis were entered into a multivariate Cox regression model. 232 patients were included. Overall candidemia incidence was 2.2 cases/1000 admissions. Candida albicans accounted for 59% of cases. Antifungal treatment was started 72h from blood cultures in 47%, 27% and 12% of patients, respectively; 13.8% of patients received no antifungal treatment. In-hospital mortality was 40%. At multivariate analysis, chronic-obstructive-pulmonary-disease (HR 2.72, 95%CI 1.66-4.45, pcandidemia in IMWs, with a worrisome rate of inappropriateness in patient management. Specific interventions aimed to increase awareness of IMWs about candidemia are needed. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  16. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  17. Internal medicine progress note writing attitudes and practices in an electronic health record.

    Science.gov (United States)

    Stewart, Elizabeth; Kahn, Daniel; Lee, Edward; Simon, Wendy; Duncan, Mark; Mosher, Hilary; Harris, Katherine; Bell, John; El-Farra, Neveen; Sharpe, Bradley

    2015-08-01

    The electronic health record (EHR) has been viewed with both praise and skepticism. Multiple editorials have expressed concerns that EHR implementation and "efficiency tools" such as copy forward and auto population have resulted in a decrement in note accuracy, relevance, and critical thinking. To evaluate the perceptions of internal medicine housestaff and attendings on inpatient progress note quality at 4 academic institutions after the implementation of an EHR. Cross-sectional survey. We developed surveys that assessed housestaff and attendings opinion of current progress note quality, the impact of the EHR on quality, and the purposes of a progress note. We received 99 completed surveys from interns (66%), 155 from residents (49%), and 153 from attendings (70%) across 4 institutions. The majority of housestaff responded that the quality of notes was "unchanged" or "better" following the implementation of an EHR, whereas attendings believed note quality was "unchanged" or "worse." Attendings' perceptions of housestaff notes were significantly lower than housestaff perceptions of their own notes across all domains. With regard to the effect of copy forward and autopopulation, the majority of housestaff viewed these to be "neutral" or "somewhat positive," whereas attendings viewed these as "neutral" or "somewhat negative." Housestaff and attendings had nearly perfect agreement regarding the purpose of the progress note. Attendings and housestaff disagree on the current quality of progress notes and the impact of an EHR on note quality, but agree on the purpose of a progress note. © 2015 Society of Hospital Medicine.

  18. Complexity in hospital internal medicine departments: what are we talking about?

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    Roberto Nardi

    2013-09-01

    Full Text Available Internal medicine (IM patients are mostly elderly, with multiple complex co-morbidities, usually chronic. The complexity of these patients involves the intricate entanglement of two or more systems (e.g. body and disease, family-socio-economic and environmental status, coordination of care and therapies and this requires comprehensive, multi-dimensional assessment (MDA. Despite attempts to improve management of chronic conditions, and the availability of several MDA tools, defining the complex patient is still problematic. The complex profile of our patients can only be described through the best assessment tools designed to identify their characteristics. In order to do this, the Federation of Associations of Hospital Doctors on Internal Medicine FADOI has created its own vision of IM. This involves understanding the different needs of the patient, and analyzing diseases clusters and the possible relationships between them. By exploring the real complexity of our patients and selecting their real needs, we can exercise holistic, anthropological and appropriate choices for their treatment and care. A simpler assessment approach must be adopted for our complex patients, and alternative tools should be used to improve clinical evaluation and prognostic stratification in a hierarchical selection of priorities. Further investigation of complex patients admitted to IM wards is needed.

  19. Impact of pharmaceutical company representatives on internal medicine residency programs. A survey of residency program directors.

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    Lichstein, P R; Turner, R C; O'Brien, K

    1992-05-01

    To survey internal medicine residency program directors regarding interactions between their residents and pharmaceutical company (PC) representatives (PCRs) a questionnaire was sent to the directors of all Accreditation Council for Graduate Medical Education-approved internal medicine residency programs. The survey included 444 program directors, of whom 272 (61.16%) responded. The majority of program directors, 228 (83.8%), allowed PCRs to meet with residents during working hours and 241 (88.6%) permitted PC sponsorship of conferences. About half of the program directors were "moderately" or "very" concerned about the potential adverse effects of PC marketing on resident attitudes and prescribing practices. Seventy percent "agreed" or "strongly agreed" that the benefits of PC sponsorship outweigh the adverse effects and 41.5% believed that refusal to allow PCRs to meet with residents would jeopardize PC funding of other departmental activities. Most program directors reported that alternate funds for conferences were available if PC support was withdrawn. "Unethical" marketing activities were observed by 14.3% of program directors and 37.5% reported that residents had participated in PC-sponsored trips during the 3 years prior to the survey. At the time of this survey, only 35.3% of programs had developed formal policies regulating PCR activities and 25.7% provided residents with formal instruction on marketing issues. Knowledge of the current extent of PCR interactions with residents may be helpful to program directors in developing policies regulating PC-marketing activities.

  20. Using television shows to teach communication skills in internal medicine residency

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    Ma Irene

    2009-02-01

    Full Text Available Abstract Background To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Results Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

  1. [Nursing Internship Internal Medicine: Evaluation and Influences on the Attitude towards the Specialization].

    Science.gov (United States)

    Wirkner, Janine; Stracke, Sylvia; Lange, Anja; Dabers, Thomas; Merk, Harry; Kasch, Richard

    2017-08-01

    Background German medical students have to perform a nursery internship of three month duration. While this internship is widely discussed, there is a lack of student evaluation data. Objectives Here, for the first time, student evaluation of a nursery internship in internal medicine (IM) is investigated. Moreover, the question was raised, whether the early experience during this internship may influence students' attitude towards the specialty. Methods In a nation-wide online-survey, 767 German medical students (mean age 22.8 years; 58 % female) evaluated a nursery internship on an IM ward concerning integration in medical teams, teachers, structure and quality of teaching, and satisfaction. Multivariate comparisons were conducted following the question, whether students could imagine choosing IM for a clinical elective after this nursery internship. Results 71 % of the students felt well integrated in the medical team, most was learned from the nurses, and most students indicated having acquired nursing skills. Only 19 % evaluated the structure of the internship as good, and 40 % indicated that they reached the learning goals. Students who could imagine performing an IM clinical elective (52 %) gave best evaluations on all items. Conclusions A successful nursery internship can promote students' interest in the specialty of internal medicine. But, there is a strong need for improvement in structure and content, including the, to date missing, definition of learning targets, regarding this first practical experience in medical studies. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Internal medicine resident knowledge, attitudes, and barriers to naloxone prescription in hospital and clinic settings.

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    Wilson, J Deanna; Spicyn, Natalie; Matson, Pamela; Alvanzo, Anika; Feldman, Leonard

    2016-01-01

    The United States is facing an epidemic of opioid use and misuse leading to historically high rates of overdose. Community-based overdose education and naloxone distribution has effectively trained lay bystanders to recognize signs of overdose and administer naloxone for reversal. There has been a movement to encourage physicians to prescribe naloxone to all patients at risk of overdose; however, the rate of physician prescribing remains low. This study aims to describe resident knowledge of overdose risk assessment, naloxone prescribing practices, attitudes related to naloxone, and barriers to overdose prevention and naloxone prescription. The HOPE (Hospital-based Overdose Prevention and Education) Initiative is an educational campaign to teach internal medicine residents to assess overdose risk, provide risk reduction counseling, and prescribe naloxone. As part of a needs assessment, internal medicine residents at an academic medical center in Baltimore, Maryland, were surveyed in 2015. Data were collected anonymously using Qualtrics. Ninety-seven residents participated. Residents were overwhelmingly aware of naloxone (80%) and endorsed a willingness to prescribe (90%). Yet despite a high proportion of residents reporting patients in their panels at increased overdose risk (79%), few had prescribed naloxone (15%). Residents were willing to discuss overdose prevention strategies, although only a minority reported doing so (47%). The most common barriers to naloxone prescribing were related to knowledge gaps in how to prescribe and how to assess risk of overdose and identify candidates for naloxone (52% reporting low confidence in ability to identify patients who are at risk). Medicine residents are aware of naloxone and willing to prescribe it to at-risk patients. Due to decreased applied knowledge and limited self-efficacy, few residents have prescribed naloxone in the past. In order to improve rates of physician prescribing, initiatives must help physicians

  3. Sources of Law in Transition - Re‐visiting General Principles of International Law

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    Maria Panezi

    2007-12-01

    Full Text Available General Principles of International Law have been a much contested source among International Law scholars. The ambiguity that surrounds their interpretation has resulted to a vivid dialogue around their legal nature, and their use in contemporary judicial practice of domestic and international tribunals. Globalization and the ever‐increasing complexity of International Economics affected the position of General Principles within the international legal system, and resulted to their progressive consolidation in the area of International Economic Law. Further examination of issues arising vis‐à‐vis General Principles could prove to be useful in other areas of law, in the same manner they addressed legal issues in International Economic Law.

  4. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI).

    Science.gov (United States)

    Arienti, Vincenzo; Di Giulio, Rosella; Cogliati, Chiara; Accogli, Esterita; Aluigi, Leonardo; Corazza, Gino Roberto

    2014-10-01

    In recent years, thanks to the development of miniaturized ultrasound devices, comparable to personal computers, tablets and even to smart phones, we have seen an increasing use of bedside ultrasound in internal medicine departments as a novel kind of ultrasound stethoscope. The clinical ultrasound-assisted approach has proved to be particularly useful in assessing patients with nodules of the neck, dyspnoea, abdominal pain, and with limb edema. In several cases, it has allowed a simple, rapid and precise diagnosis. Since 2005, the Italian Society of Internal Medicine and its Ultrasound Study Group has been holding a Summer School and training courses in ultrasound for residents in internal medicine. A national network of schools in bedside ultrasound was then organized for internal medicine specialists who want to learn this technique. Because bedside ultrasound is a user-dependent diagnostic method, it is important to define the limits and advantages of different new ultrasound devices, to classify them (i.e. Echoscopy and Point of Care Ultrasound), to establish appropriate different levels of competence and to ensure their specific training. In this review, we describe the point of view of the Italian Internal Medicine Society on these topics.

  5. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

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    Kinoshita K

    2015-10-01

    Full Text Available Kensuke Kinoshita,1 Yusuke Tsugawa,2 Taro Shimizu,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Toshiaki Shiojiri,7 Yasuharu Tokuda8 1Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Tokyo Joto Hospital, Koto-ku, Tokyo, 4Good Medicine Japan, Miyagi, 5Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, 6Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, 7Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, 8Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan Background: Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. Methods: We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE. An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. Results: A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater Up

  6. Drawing on International Experiences to Build General Practitioner System

    Institute of Scientific and Technical Information of China (English)

    Liu; Chang

    2015-01-01

    stablished in 1849,the Royal Dutch Medical Association seeks to promote the academic research and development in medical care to provide high-quality service.At the invitation of the CPAFFC,a 25-member RDMA delegation visited Beijing from March 15 to 20 for in-depth discussions on the general practitioner system with China’s National Health and Family Planning Commission,Beijing Municipal Health and Family Planning Commission,Peking University Health E

  7. Evaluation of pharmacy students’ clinical interventions on a general medicine practice experience

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    Jones JD

    2011-03-01

    Full Text Available As colleges of pharmacy prepare a new generation of practitioners, it is important that during practice experiences students learn the impact of clinical interventions. For over ten years, pharmacy students have been a vital part of the multidisciplinary team at the military treatment facility. The overall impact of the student interventions on patient care has not been evaluated. To evaluate the impact, the students began documenting their clinical interventions in Medkeeper RxInterventions™, an online database. The program is used to document faculty and fourth year pharmacy students’ pharmaceutical interventions.Objective: The objective of this study was to analyze the interventions completed by fourth year pharmacy students during a general medicine advanced pharmacy practice experience at a military treatment facility.Methods: The students completing their general medicine advanced pharmacy practice experience at the military treatment facility are responsible for self reporting all interventions made during clinical rounds into the Medkeeper RxIntervention™ database. The researchers retrospectively collected and analyzed interventions made from June 2008 to June 2009.Results: The total number of interventions recorded by 8 fourth year pharmacy students was 114. Students averaged a number of 14.3 interventions during an eight week practice experience. Students spent an average of 5 minutes per intervention. Ninety- five percent of the interventions were accepted.Conclusion: Fourth year pharmacy students’ recommendations were accepted at a high rate by resident physicians. The high acceptance rate may have the ability to positively impact patient care.

  8. Prevalence of delirium in hospitalized internal medicine and surgical adult patients in Shohadaye ashayer hospital of Khoram abad

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    raheleh Asaee

    2008-10-01

    Full Text Available Asaee R1, Nasari H2,Hoseini S3 1. Assistant professor, Department of Physiology, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 1. Assistant professor, Department of Psychiatry, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 2. G.P, Khorramabad, Iran Abstract Background: Delirium is common in elderly persons and in hospitalized patients especially after surgical procedures. But many of them are undetected and don’t receive treatment so they involve with increased mortality and morbidity, adverse outcomes, length of hospital stay and mental disability sequels. Unfortunetly , despite the importance of this syndrom , physicians and staff are able to diagnose only one thirth of the patients. Material and methods: In this cross sectional study, 240 inpatiants (120 from surgery ward and 120 from miernal medicine ward from Shohadaye Ashayer hospital of Khorramabad were selected randomly. The diagnostic criteria for delirium were Mini-Mental state examination (MMSE questionnaire, and patients daily examination for 4 days by MMSE. Results: Delirium was observed in 37 (30.8% of the patients of internal medicine ward and 25 (20.8% of the patients of surgery ward. 27 (22.5% of the patients of internal medicine ward and 37 (30.8% of the patients of surgery ward were suspicious for delirium. In age group of 58-77 years in surgery ward and patients over 77 years in internal medicine ward had the most frequency of delirium. There was significant relationship (p=0.01 between two sex in surgery ward. But there was not significant difference (p=0.92 between two sex in internal medicine ward for delirium. Conclusion: Reading the results of this study and frequency of delirum in surgery and internal medicine wards, presence of a psychiatrist in mentioned wards is necessary of early diagnosis and control of delirium.

  9. Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

    Science.gov (United States)

    Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

    2015-09-01

    In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in

  10. [Is computed interpretation of electrocardiograms suitable for a general medicine department?].

    Science.gov (United States)

    Besançon, F; Cousteau, J P; Bodiou, C; Bodiou, P

    1984-02-23

    Computed interpretation of electrocardiograms may be needed as French hospitals are divided into units in which physicians belonging to other specialities than cardiology may be in charge of internal medicine patients. We experimented two rival systems: SADE and CARDIONICS. Recordings were taken in the wards, on paper and magnetic tape. The computer, called by telephone, read the tape, interpreted the data, and printed conclusions and measurements. No useful information was provided in any of the 32 first patients studied (mean age: 71). The machine made our situation worse, as we were repeatedly prompted to call in a cardiologist without sufficient reason. A rejection reaction was observed. Telephone problems in French hospitals, losses of time, errors of manipulation, sometimes unintelligible language, and inappropriate material are discussed from the point of view of the internist. We did not consider the problems of cardiologists, screeners and archivists. In non-universitary hospitals, the needs may be greater, calling for improvements in software and hardware.

  11. [The general internist--an endangered species?].

    Science.gov (United States)

    Ergas, David

    2013-07-01

    The status of general internal medicine is in a state of decay, and along with it, the position of general internists is declining. Nowadays, most internists depart from general internal medicine to the sub-specialties. The expected future shortage of general internists threatens the medical profession, endangers the future care of hospitalized medical patients and calls for a change in policy.

  12. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

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    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  13. Transplant tourism or international transplant medicine? A case for making the distinction.

    Science.gov (United States)

    Chin, J J L; Campbell, A V

    2012-07-01

    Transplant tourism is routinely denounced by influential voices such as the World Health Organization, the Declaration of Istanbul and the Madrid Resolution as an unethical solution to worldwide organ shortages. Instead, it is suggested that national deceased donor schemes and multinational organ-sharing programs are the only acceptable avenues for addressing the organ shortage crisis. The present demand for self-sufficiency in organ supply responds to risks such as poor clinical outcomes, and exploitation of the poor through the various commercial practices of transplant tourism. However, opponents of transplant tourism say little about what governments should do to ensure that their citizens have real and comprehensive access to all forms of transplantation. To address this complex question, we describe a current practice of international transplant medicine in Singapore. It addresses salient concerns with transplant tourism and supports the principle of national self-sufficiency in organ supply, even as its health care system thrives and expands comprehensive transplant services to its citizens by catering to international patients. We offer a critical appraisal of the Singaporean system, and some suggestions to minimize the risk of abuse by international patients or operatives of illegal organ markets.

  14. Explaining the Learning Experiences of Clinical Procedures of the Internal Medicine Residents at Department of Gastroenterology

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    Mansoureh Taghavinia

    2012-07-01

    Full Text Available Introduction: the method and way of learning and teaching are effective in acquiring clinical skills, and identifying the shortcomings of learning and teaching will lead to better planning. The purpose of this study was to explain the experiences of the learning clinical procedures of the internal medicine residents in gastroenterology department. Methods: qualitative study using content thematic analysis was done. Six fourth-year residents were selected and interviewed considering purposive sampling. The data of the interviews were transcribed and analyzed after rereading. Results: the collected data are divided into three categories: learning and experience with the following four categories (learning time and experiencing, leaning and experiencing times, learning and experiencing opportunities, training and the lack of the training of some procedures. These categories are explained by using some quotes derived from the data. Conclusion: the results of this study suggest that the administrative management of internal residency is poor and should get seriously in implementation and application of intended instructions existing in the prepared program of Medical Education and Specialized Council of internal residency period. The attending physicians and residents must be aware of the content of education program at the beginning of the residency periods and the trainers must try to supervise the residents’ education.

  15. Comprehensive Auditing in Nuclear Medicine Through the International Atomic Energy Agency Quality Management Audits in Nuclear Medicine (QUANUM) Program. Part 1: the QUANUM Program and Methodology.

    Science.gov (United States)

    Dondi, Maurizio; Torres, Leonel; Marengo, Mario; Massardo, Teresa; Mishani, Eyal; Van Zyl Ellmann, Annare; Solanki, Kishor; Bischof Delaloye, Angelika; Lobato, Enrique Estrada; Miller, Rodolfo Nunez; Paez, Diana; Pascual, Thomas

    2017-11-01

    An effective management system that integrates quality management is essential for a modern nuclear medicine practice. The Nuclear Medicine and Diagnostic Imaging Section of the International Atomic Energy Agency (IAEA) has the mission of supporting nuclear medicine practice in low- and middle-income countries and of helping them introduce it in their health-care system, when not yet present. The experience gathered over several years has shown diversified levels of development and varying degrees of quality of practice, among others because of limited professional networking and limited or no opportunities for exchange of experiences. Those findings triggered the development of a program named Quality Management Audits in Nuclear Medicine (QUANUM), aimed at improving the standards of NM practice in low- and middle-income countries to internationally accepted standards through the introduction of a culture of quality management and systematic auditing programs. QUANUM takes into account the diversity of nuclear medicine services around the world and multidisciplinary contributions to the practice. Those contributions include clinical, technical, radiopharmaceutical, and medical physics procedures. Aspects of radiation safety and patient protection are also integral to the process. Such an approach ensures consistency in providing safe services of superior quality to patients. The level of conformance is assessed using standards based on publications of the IAEA and the International Commission on Radiological Protection, and guidelines from scientific societies such as Society of Nuclear Medicine and Molecular Imaging (SNMMI) and European Association of Nuclear Medicine (EANM). Following QUANUM guidelines and by means of a specific assessment tool developed by the IAEA, auditors, both internal and external, will be able to evaluate the level of conformance. Nonconformances will then be prioritized and recommendations will be provided during an exit briefing. The

  16. PREFACE: International Conference on Image Optimisation in Nuclear Medicine (OptiNM)

    Science.gov (United States)

    Christofides, Stelios; Parpottas, Yiannis

    2011-09-01

    Conference logo The International Conference on Image Optimisation in Nuclear Medicine was held at the Atlantica Aeneas Resort in Ayia Napa, Cyprus between 23-26 March 2011. It was organised in the framework of the research project "Optimising Diagnostic Value in SPECT Myocardial Perfusion Imaging" (YΓΕΙΑ/ΔYΓΕΙΑ/0308/11), funded by the Cyprus Research Promotion Foundation and the European Regional Development Fund, to present the highlights of the project, discuss the progress and results, and define future related goals. The aim of this International Conference was to concentrate on image optimization approaches in Nuclear Medicine. Experts in the field of nuclear medicine presented their latest research results, exchanged experiences and set future goals for image optimisation while balancing patient dose and diagnostic value. The conference was jointly organized by the Frederick Research Centre in Cyprus, the Department of Medical and Public Health Services of the Cyprus Ministry of Health, the Biomedical Research Foundation in Cyprus and the AGH University of Science and Technology in Poland. It was supported by the Cyprus Association of Medical Physics and Biomedical Engineering, and the Cyprus Society of Nuclear Medicine. The conference was held under the auspices of the European Federation of Organisations for Medical Physics and the European Association of Nuclear Medicine. The conference scientific programme covered several important topics such as functional imaging; image optimization; quantification for diagnosis; justification; simulations; patient dosimetry, staff exposures and radiation risks; quality assurance and clinical audit; education, training and radiation protection culture; hybrid systems and image registration; and new and competing technologies. The programme consisted of 13 invited and keynote presentations as well as workshops, round table discussions and a number of scientific sessions. A total of 51 speakers presented their

  17. Citation analysis of The Korean Journal of Internal Medicine from KoMCI, Web of Science, and Scopus.

    Science.gov (United States)

    Huh, Sun

    2011-03-01

    The Korean Journal of Internal Medicine (KJIM) is the international journal published in English by the Korean Association of Internal Medicine. To understand the position of the journal in three different databases, the citation indicators were elucidated. From databases such as Korean Medical Citation Index (KoMCI), Web of Science, and Scopus, citation indicators such as the impact factor, SCImago journal rank (SJR), or Hirsch Index were calculated according to the year and the results were drawn. The KJIM 2010 impact factor increased to 0.623 in Web of Science. That of year 2009 in KoMCI was a 0.149. The 2009 SJR in Scopus was 0.073, with a ranking of 27/72 (37.5%) in the category of internal medicine and 414/1,618 (25.6%) in the category of medicine, miscellaneous. The Hirsch Index from KoMCI, Web of Science and Scopus were 5, 14, and 16, respectively. The KJIM is now cited more by international researchers than Korean researchers, indicating that the content of the journal is now valued at the international level.

  18. Generally Applicable Transformation Protocols for Fluorescent Nanodiamond Internalization into Cells.

    Science.gov (United States)

    Hemelaar, Simon R; van der Laan, Kiran J; Hinterding, Sophie R; Koot, Manon V; Ellermann, Else; Perona-Martinez, Felipe P; Roig, David; Hommelet, Severin; Novarina, Daniele; Takahashi, Hiroki; Chang, Michael; Schirhagl, Romana

    2017-07-19

    Fluorescent nanodiamonds (FNDs) are promising nanoprobes, owing to their stable and magnetosensitive fluorescence. Therefore they can probe properties as magnetic resonances, pressure, temperature or strain. The unprecedented sensitivity of diamond defects can detect the faint magnetic resonance of a single electron or even a few nuclear spins. However, these sensitivities are only achieved if the diamond probe is close to the molecules that need to be detected. In order to utilize its full potential for biological applications, the diamond particle has to enter the cell. Some model systems, like HeLa cells, readily ingest particles. However, most cells do not show this behavior. In this article we show for the first time generally applicable methods, which are able to transport fluorescent nanodiamonds into cells with a thick cell wall. Yeast cells, in particular Saccharomyces cerevisiae, are a favored model organism to study intracellular processes including aging on a cellular level. In order to introduce FNDs in these cells, we evaluated electrical transformation and conditions of chemical permeabilization for uptake efficiency and viability. 5% DMSO (dimethyl sulfoxide) in combination with optimized chemical transformation mix leads to high uptake efficiency in combination with low impact on cell biology. We have evaluated all steps in the procedure.

  19. [Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006].

    Science.gov (United States)

    Arnau I Figueras, J; Torán Monserrat, P; Martínez-Carretero, J M; Forteza-Rey, J; Pinilla Llorente, B; Brailovsky, C A

    2008-10-01

    Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

  20. Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey.

    Science.gov (United States)

    Goren, Eric N; Leizman, Debra S; La Rochelle, Jeffrey; Kogan, Jennifer R

    2015-09-01

    Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not been described. We aimed to determine the current status of medical students' overnight experiences in Internal Medicine clerkships and sub-internships, and to assess internal medicine educators' perceptions of the importance of overnight work during internal medicine rotations. In May 2014, the Clerkship Directors in Internal Medicine (CDIM) conducted its annual survey. Twenty-eight questions about student participation in overnight work and perceptions of the importance of overnight work (rated on 1-5 Likert scale, 1 = very unimportant and 5 =  ery important) were included. Descriptive statistics were used to summarize responses. Free text results were analyzed qualitatively. The response rate was 78 %. A minority of respondents reported students having any overnight experience during the clerkship (38.7 %) or the sub-internship (40.7 %). Only 5 % of respondents reported having students assigned to night-float rotations outside of clerkships or sub-internships. Respondents agreed that overnight experiences were more important during the sub-internship than the clerkship, 4.0 ± 1.1 vs. 3.2 ± 1.2, p rated as important overnight tasks for both clerkship and sub-internship students. Overnight experiences offer students additional educational opportunities. Clerkship directors felt that the overnight experience for the sub-intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences for medical students.

  1. RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed?

    Science.gov (United States)

    Zapatero-Gaviria, A; Barba-Martín, R; Canora Lebrato, J; Fernández-Pérez, C; Gómez-Huelgas, R; Bernal-Sobrino, J L; Díez-Manglano, J; Marco-Martínez, J; Elola-Somoza, F J

    2017-08-30

    To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; pMedicina Interna (SEMI). All rights reserved.

  2. A multi-institutional survey of internal medicine residents' learning habits.

    Science.gov (United States)

    Edson, Randall S; Beckman, Thomas J; West, Colin P; Aronowitz, Paul B; Badgett, Robert G; Feldstein, David A; Henderson, Mark C; Kolars, Joseph C; McDonald, Furman S

    2010-01-01

    Resident physicians are expected to demonstrate medical knowledge. However, little is known about the residents' reading habits and learning preferences. To assess residents' reading habits and preferred educational resources. Residents at five internal medicine training programs were surveyed regarding their reading and learning habits and preferences. The majority (77.7%) of residents reported reading less than 7 h a week. Most residents (81.4%) read in response to patient care encounters. The preferred educational format was electronic; 94.6% of residents cited UpToDate as the most effective resource for knowledge acquisition, and 88.9% of residents reported that UpToDate was their first choice for answering clinical questions. Residents spent little time reading and sought knowledge primarily from electronic resources. Most residents read in the context of patient care. Future research should focus on strategies for helping resident physicians learn in the electronic age.

  3. Application of case analysis teaching method in nursing teaching in Department of Internal Medicine

    Directory of Open Access Journals (Sweden)

    Zhang-xiu SHENG

    2014-04-01

    Full Text Available Objective:In order to adapt to the modern occupation education teaching idea, to stimulate students’ interest in learning, training students' comprehensive quality, improve the students' active participation, understanding, analysis and problem solving skills. Methods: I In the course of different stages using teaching methods of case analysis: case introduction before class teaching method, case analysis during and after class teaching method, and case analysis of the whole chapter after class teaching method.  Results and Conclusion: Through the course of different stages of using case analysis teaching method, we can launch the students’ active learning, stimulate the students' interest in learning, activate classroom atmosphere, train students' independent thinking, strengthen the problems solving ability, improve the self-learning ability of students, activate their participation and awareness, analysis, judgment, introduction, and strengthen students' exam ability, improve the test scores of students and the teaching effect of nursing in Department of internal medicine.

  4. Validation of a checklist to assess ward round performance in internal medicine

    DEFF Research Database (Denmark)

    Nørgaard, Kirsten; Ringsted, Charlotte; Dolmans, Diana

    2004-01-01

    BACKGROUND: Ward rounds are an essential responsibility for doctors in hospital settings. Tools for guiding and assessing trainees' performance of ward rounds are needed. A checklist was developed for that purpose for use with trainees in internal medicine. OBJECTIVE: To assess the content...... construct validity, an observer assessed 4 groups of doctors during performance of a complete ward round (n = 32). The nurse who accompanied the doctor on rounds made a global assessment of the performance. RESULTS: The response rate to the questionnaire was 80.7%. The respondents found that all 10 items...... on the checklist were relevant to ward round performance and that the item collection was comprehensive. Checklist mean-item scores differed between levels of expertise: junior house officers 1.4 (1.0-1.9); senior house officers 2.0 (1.5-2.9); specialist trainees 2.5 (1.8-2.8), and specialists 2.7 (2...

  5. Knowledge about cancer screening among medical students and internal medicine residents in Mexico City.

    Science.gov (United States)

    Villarreal-Garza, Cynthia; García-Aceituno, Luis; Villa, Antonio R; Perfecto-Arroyo, Miguel; Rojas-Flores, Miriam; León-Rodríguez, Eucario

    2010-12-01

    It is extremely important that physicians are aware of cancer screening precise indications. We sought to explore its knowledge among Mexican medical students and internal medicine residents. Students and residents completed a questionnaire-based survey about breast, cervical, colon, and prostate cancer screening. Four hundred fifty-one individuals answered the survey: 64.52% students and 35.48% residents. Mean knowledge score was 63.97 ± 14.97. Residents scored higher than students (p = 0.0001). No difference in the education concerning cervical and colon cancer screening was found. Knowledge of screening guidelines is suboptimal among medical students and residents. Further efforts should be targeted to educational and training programs in this country.

  6. [Delivering bad news in a Swiss internal medicine ward: a medical and nurse partnership].

    Science.gov (United States)

    Castioni, J; Teike Lüthi, F; Boretti, S Moser; Vollenweider, P

    2015-11-01

    Delivering bad news to a patient has a major impact for patients, their relatives and caregivers. The way this information is delivered can affect the way the patient sees his disease and potentially how he adheres to its treatment. To improve this communication with the patient the service of internal medicine at the Swiss university hospital of Lausanne set up a process including the coordination between all involved caregivers, and to break the bad news in a setting including a medical and nurse partnership. It also underscores that the resident in charge of the patient remains the coordinator of delivering new information. Moreover, the service provides communication tools to the caregivers to improve the communication skills.

  7. Acute bacterial skin and skin structure infections in internal medicine wards: old and new drugs.

    Science.gov (United States)

    Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco

    2016-08-01

    Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed.

  8. Teaching internal medicine resident physicians about Alcoholics Anonymous: a pilot study of an educational intervention.

    Science.gov (United States)

    Rose, Adam J; Stein, Melissa R; Arnsten, Julia H; Saitz, Richard

    2006-09-01

    Greater physician confidence in treating alcoholism is associated with a higher frequency of referring alcoholic patients for treatment, but many physicians have limited experience with Alcoholics Anonymous. We implemented a brief, didactic and experiential educational intervention about AA and evaluated its effect on knowledge and attitudes, using a before-after repeated measures study design. Thirty-six first-year internal medicine resident physicians received an educational intervention, which consisted of a 45-minute lecture about AA, a visit to an AA meeting, and a 30-minute debriefing session the next day. Residents' knowledge and attitudes were assessed by a brief written anonymous survey before and after the educational intervention. Residents reported increases in self-perceived knowledge about AA and had more favorable attitudes towards AA after the intervention. Our pilot study shows that a brief, didactic and experiential course can improve physician knowledge and attitudes about AA, and holds promise for improving physician interface with this commonly used intervention.

  9. Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes.

    Science.gov (United States)

    Cheng, Huai Yong; Davis, Molly

    2017-02-01

    Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.

  10. Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study.

    Science.gov (United States)

    Kurtzman, Gregory; Dine, Jessica; Epstein, Andrew; Gitelman, Yevgenly; Leri, Damien; Patel, Miltesh S; Ryskina, Kyra

    2017-09-01

    The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard, a link to the online dashboard, and text summarizing the resident and service utilization averages. We measured resident engagement using e-mail read-receipts and web-based tracking. We also conducted 3 hour-long focus groups with residents. Using grounded theory approach, the transcripts were analyzed for common themes focusing on barriers and facilitators of dashboard use. Among 80 residents, 74% opened the e-mail containing a link to the dashboard and 21% accessed the dashboard itself. We did not observe a statistically significant difference in routine laboratory ordering by dashboard use, although residents who opened the link to the dashboard ordered 0.26 fewer labs per doctor-patient-day than those who did not (95% confidence interval, -0.77 to 0.25; = 0 .31). While they raised several concerns, focus group participants had positive attitudes toward receiving individualized feedback delivered in real time. © 2017 Society of Hospital Medicine.

  11. [Drug-food interactions in internal medicine: What physicians should know?].

    Science.gov (United States)

    Mouly, S; Morgand, M; Lopes, A; Lloret-Linares, C; Bergmann, J-F

    2015-08-01

    Orally administered medications may interact with various fruits, vegetables, herbal medicines, functional foods or dietary supplements. Drug-food interactions, which are mostly unknown from prescribers, including internists, may be responsible for changes in drug plasma concentrations, which may decrease efficacy or led to sometimes life-threatening toxicity. Aging, concomitant medications, transplant recipients, patients with cancer, malnutrition, HIV infection and those receiving enteral or parenteral feeding are at increased risk of drug-food interactions. This review focused on the most clinically relevant drug-food interactions, including those with grapefruit juice, Saint-John's Wort, enteral or parenteral nutrition, their respective consequences in the clinical setting in order to provide thoughtful information for internists in their routine clinical practice. Specific clinical settings are also detailed, such as the Ramadan or multiple medications especially in elderly patients. Drug-food interactions are also presented with respect to the main therapeutic families, including the non-steroidal anti-inflammatory drugs, analgesics, cardiovascular medications, warfarin as well as new oral anticoagulants, anticancer drugs and immunosuppressant medications. Considerable effort has been achieved to a better understanding of food-drug interactions and increase clinicians' ability to anticipate their occurrence and consequences in clinical practice. Describing the frequency of relevant food-drug interactions in internal medicine is paramount in order to optimize patient care and drug dosing on an individual basis as well as to increase patients and doctors information.

  12. Access to essential medicines for sexual and reproductive health care: the role of the pharmaceutical industry and international regulation.

    Science.gov (United States)

    Cottingham, Jane; Berer, Marge

    2011-11-01

    The range of medicines and technologies that are essential for sexual and reproductive health care is well established, but access to them is far from universally assured, particularly in less developed countries. This paper shows how the pharmaceutical industry plays a major role in the lack of access to essential medicines for sexual and reproductive health care, by a) investing in products for profit-making reasons despite their negative health impact (e.g. hormone replacement therapy), b) marketing new essential medicines at prices beyond the reach of countries that most need them (e.g. HPV vaccines), and c) failing to invest in the development of new products (e.g. microbicides and medical abortion pills). Small companies, some of them non-profit-making, struggle to fill some of that demand (e.g. for female condoms). International patent protection contributes to high prices of medicines, and while international agreements such as compulsory licensing under TRIPS and the Medicines Patent Pool allow for mechanisms to enable poorer countries to get access to essential medicines, the obstacles created by "big pharma" are daunting. All these barriers have fostered a market in sub-standard medicines (e.g. fake medical abortion pills sold over the internet). An agenda driven by sexual and reproductive health needs, based on the right to health, must focus on universal access to essential medicines at prices developing countries can afford. We call for greater public investment in essential medicines, expanded production of affordable generic drugs, and the development of broad strategic plans, that include affordable medicines and technologies, for addressing identified public health problems, such as cervical cancer.

  13. Health-related quality of life and happiness within an internal medicine residency training program: a longitudinal follow-up study

    Directory of Open Access Journals (Sweden)

    Abhasnee Sobhonslidsuk

    2015-02-01

    Full Text Available Purpose: While undergoing a hospital residency training program, residents often suffer anxiety and stress. This study aims to evaluate the change in health-related quality of life and happiness among internal medicine residents, and identify prognostic factors. Methods: Thirty-eight residents in the Ramathibodi Hospital internal medicine training program completed the World Health Organization Quality of Life-BREF and happiness Measures questionnaires at three time points: commencement, day 100, and the end of the second year of training. Confidence, expectations, anxiety, and general health were rated. Analyses were performed with mixed linear regression. Results: Financial problems were reported for 16 residents (42.1%. At baseline, most residents had moderate-to-very high confidence, expectations, and general health but also moderate-to-very high anxiety. The health-related quality of life score was highest in the social domain followed by the environmental, psychological, and physical domains. Their psychological, physical, social, and environmental scores significantly decreased after enrollment. Their happiness and general health scores were significantly reduced after enrollment. The training program duration was negatively associated with all domains. Residents with greater confidence had higher health-related quality of life scores in the physical, psychological, and environmental domains. Moreover, their general health was positively associated with the social and environmental domains. Conclusion: A reduction in health-related quality of life and happiness under the internal medicine residency program is reported. High confidence and good physical health may counterbalance the decline in health-related quality of life and happiness.

  14. Knowledge and risk behaviors related with HIV infect in Communitarian General Medicine students.

    Directory of Open Access Journals (Sweden)

    Luis Manuel Padrón Velázquez

    2009-03-01

    Full Text Available Background: The worldwide epidemic outburst cause by the HIV and lack of effective vaccines against it make of human sexual behavior the most important element to fight this disease. Objective: To identify knowledge level and risk behaviors associated with the infection with this virus in students of second year of Community General Medicine. Methods: A cross-sectional, descriptive, epidemiological, observational study was developed from July to December 2006 including 44 Venezuelan Medicine students, from Giradot municipality, Aragua state, who referred having had sexual intercourse in the last semester of 2006. Results: Most of the students (77,3 % were females. More that half of them was between 20 and 29 years of age and 61, 4% admitting having knowledge about the different ways of infection. 255 recognized that every sexual orientation could be risky, with less percentage for females. All the surveyed persons agreed to through the test to identify the virus and only 2 of them (4, 5% referred not confidentiality. young males showed higher percentage of unprotected intercourse and couple stability. Conclusions: Results show that it is important to stress preventive activities to avoid HIV infection in male students and to raise their responsibility regarding safe sexual relations.

  15. The Effect on mortality of fluconazole or echinocandins treatment in candidemia in internal medicine wards [corrected].

    Directory of Open Access Journals (Sweden)

    Francesco G De Rosa

    Full Text Available The incidence of candidemia has increased over the past two decades, with an increased number of cases in Internal Medicine and a prevalence ranging from 24% to 57%. This single-center retrospective study was performed to evaluate the epidemiology and the risk factors associated with mortality of candidemia in patients admitted to Internal Medicine wards (IMWs of the City of Health and Sciences, Molinette Hospital, Turin, from January 2004 to December 2012. For each patient, demographic, clinical and microbiological data were collected. A case of candidemia was defined as a patient with at least one blood culture positive for Candida spp. Amongst 670 episodes of candidemia, 274 (41% episodes occurred in IMWs. The mortality was 39% and was associated at multivariate analysis with sepsis, cirrhosis and neurologic diseases, whilst removal of central venous catheter ≤48h was significantly associated with survival. In the 77 patients treated with early antifungal therapy the mortality was 29% and was not significantly different with caspofungin or fluconazole, whilst in patients with definitive therapy the mortality was significantly lower with echinocandins compared to fluconazole (11.7% Vs. 39%; p=0.0289, a finding confirmed by multivariate analysis. The mortality was significantly associated with sepsis, cirrhosis and neurologic diseases, whilst CVC removal ≤48h was associated with survival. In patients with early therapy, fluconazole or caspofungin were equally effective. However, echinocandins were significantly more effective as definitive treatment, a finding not explained by differences in treatment delays. Further studies are needed to understand the full potential of these different therapeutic strategies in IMWs.

  16. Functional Neuroimaging Correlates of Burnout among Internal Medicine Residents and Faculty Members

    Directory of Open Access Journals (Sweden)

    Steven J Durning

    2013-10-01

    Full Text Available Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI, brain activity was assessed in internal medicine residents (n=10 and board-certified internists (faculty, n=17 from the Uniformed Services University (USU while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory.

  17. Depressive symptoms and disability in acute patients with comorbidities in departments of internal medicine

    Directory of Open Access Journals (Sweden)

    Salvatore La Carrubba

    2012-01-01

    Full Text Available Introduction: There are few data on the prevalence of depression among acute patients with comorbidities. The current study aimed to determine the prevalence of depressive symptoms in hospitalized patients admitted to Internal Medicine Units and the correlation between these symptoms and comorbidities and disability indexes. Materials and methods: All consecutive patients admitted to 26 Internal Medicine Units of the Italian National Public Health System in Sicily, Italy, from September 2001 to March 2002 were screened. Within 24 hours of admission, patients were administered the Geriatric Depression Scale (GDS, Mini-Mental State Examination, Activities of Daily Living (ADL, Instrumental Activities of Daily Living (IADL and Charlson’s Comorbidity Index. Results: 1,947 subjects were included in the analyses. Of the patients, 509 (26.1% showed depressive symptoms (indicated by GDS score > 15. Depression was significantly associated (univariate analyses with hypertension (OR 1.45; CI 95% 1.18-1.79, diabetes (OR 1.48, CI 95% 1.17-1.87, cerebrovascular disease (OR 1.50, CI 95% 1.08-2.07, cirrhosis (OR 1.49, CI 95% 1.01- 2.19, ADL score (OR 0.72: CI 95% 0.63-0.82, and IADL score (OR 0.83; CI 95% 0.78-0.87, but not with Charlson’s Comorbidity Index (OR 1.04; CI 95% 0.98-1.10. Multivariate analysis showed that independent predictive factors for depression were age (OR 1.02, CI 95% 1.01-1.02, female gender (OR 2.29, CI 95% 1.83 - 2.87, and IADL score (OR 0.86, CI 95% 0.81 - 0.93. Conclusions: The data suggest that depressive symptoms are not linked to worse clinical conditions but are associated with the loss of autonomy in Instrumental Activities of Daily Living.

  18. Development of a high-value care subscore on the internal medicine in-training examination.

    Science.gov (United States)

    Ryskina, Kira L; Korenstein, Deborah; Weissman, Arlene; Masters, Philip; Alguire, Patrick; Smith, Cynthia D

    2014-11-18

    Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. U.S. IM residency programs. 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. None.

  19. Internal Medicine Residents' Acceptance of Self-Directed Learning Plans at the Point of Care

    Science.gov (United States)

    Smith, Susan J; Kakarala, Radhika R; Talluri, Siva K; Sud, Parul; Parboosingh, J

    2011-01-01

    Objectives We implemented a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the residents' practice, and we report on perceptions and attitudes from residents in internal medicine regarding the use of SDLPs conceived at point of care. Methods Internal medicine residents at a single community hospital in the Midwest were surveyed in 2006 regarding SDLPs. We report their perceived effectiveness in identifying knowledge gaps, the processes used to fill those gaps, and the resident outcomes using descriptive statistics. Results A total of 26 out of 37 residents (70%) responded. Most (24 of 26; 92%) perceived SDLPs helped them to identify and fill knowledge gaps and that their skills in framing questions (23 of 26; 88%), identifying resources (21 of 26; 81%), and critically appraising the evidence (20 of 26; 77%) improved through regular use. They also felt these plans led to a meaningful change in their practice or provided further direction for learning (17 of 26; 65%). Most (21 of 26; 81%) reported their intent to include point-of-care learning in their continuing education after residency. We found no significant differences in the responses of first-year compared with second- or third-year residents. Conclusions Questions arising during patient care are strong motivators for physician self-directed learning. The residents' responses indicated that they accepted the SDLPs and intend to use them in practice. Embedding the discussion of the SDLPs in preclinic conferences has ensured sustainability during the past 5 years and has enabled us to demonstrate teaching of practice-based learning and improvement. PMID:22942979

  20. The research rotation: competency-based structured and novel approach to research training of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Dimitrov Vihren

    2006-10-01

    Full Text Available Abstract Background In the United States, the Accreditation Council of graduate medical education (ACGME requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

  1. Communication Skills Curriculum for Foreign Medical Graduates in an Internal Medicine Residency Program

    Science.gov (United States)

    Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M.; Kelley, Amy S.

    2014-01-01

    Background Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. Methods The workshop consisted of 2 interactive sessions, in a small group with 2 learners and 1-2 facilitators, during the Geriatrics block of the internship year. Twenty-three IM interns were surveyed at the beginning and at the end of the 4-week block and at 3 months after completion of the workshop about their knowledge, confidence and skill in communication, and asked about any challenges to effective communication with older patients. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. Results On a 4-point Likert scale, there was an average improvement of 0.70 in self-reported confidence in communication, which sustained at 3 months after completion of the workshop. Participants reported several patient, physician and system barriers to effective communication. Conclusion Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in sustained increase in overall confidence among IM interns in communication with older adults, and may help overcome certain patient and physician-specific communication barriers. PMID:25354834

  2. Communication skills curriculum for foreign medical graduates in an internal medicine residency program.

    Science.gov (United States)

    Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M; Kelley, Amy S

    2014-11-01

    Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy, and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. The workshop consisted of two interactive sessions in a small group with two learners and one or two facilitators, during the 4-week geriatrics block in IM internship training year. Twenty-three IM interns at an urban Veterans Affairs Medical Center were surveyed at the beginning and at the end of the 4-week block and 3 months after completion of the workshop about their knowledge, confidence, and skill in communication and asked about challenges to effective communication with older adults. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. On a 4-point Likert scale, there was average improvement of 0.70 in self-reported confidence in communication, which was sustained 3 months after completion of the workshop. Participants reported several patient, physician, and system barriers to effective communication. Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in a sustained increase in overall confidence in IM interns in communication with older adults and may help overcome certain patient- and physician-specific communication barriers.

  3. Traditional Chinese Medicine Playing a More Important Role in the World's Complementary Medicine Research——Minutes of the 3rd International Congress on Complementary Medicine Research

    Institute of Scientific and Technical Information of China (English)

    FEI Yu-tong; LIU Jian-ping

    2008-01-01

    @@ Outline The 3rd Intemational Congress on Complementary Medicine Research(ICCMR 2008)was held on 29-31 March,2008 in Sydney,Australia.More than 550 participants from over 30 countries in the diverse field of complementary medicine attended this great event.

  4. Internal dosimetry of nuclear medicine workers through the analysis of {sup 131}I in aerosols

    Energy Technology Data Exchange (ETDEWEB)

    Gomes C, L.; Lucena, E. A.; Da Silva S, C.; Almeida D, A. L.; Oliveira S, W.; Souza S, M.; Maranhao D, B., E-mail: carneiro@ird.gov.br [Instituto de Radioprotecao e Dosimetria - CNEN, Av. Salvador Allende s/n, 22783-127 Rio de Janeiro (Brazil)

    2014-08-15

    {sup 131}I is widely used in nuclear medicine for diagnostic and therapy of thyroid diseases. Depending of workplace safety conditions, routine handling of this radionuclide may result in a significant risk of exposure of the workers subject to chronic intake by inhalation of aerosols. A previous study including in vivo and in vitro measurements performed recently among nuclear medicine personnel in Brazil showed the occurrence of {sup 131}I incorporation by workers involved in the handling of solutions used for radioiodine therapy. The present work describes the development, optimization and application of a methodology to collect and analyze aerosol samples aiming to assess internal doses based on the activity of {sup 131}I present in a radiopharmacy laboratory. Portable samplers were positioned at one meter distant from the place where non-sealed liquid sources of {sup 131}I are handled. Samples were collected over one hour using high-efficiency filters containing activated carbon and analyzed by gamma spectrometry with a high purity germanium detection system. Results have shown that, although a fume hood is available in the laboratory, {sup 131}I in the form of vapor was detected in the workplace. The average activity concentration was found to be of 7.4 Bq /m{sup 3}. This value is about three orders of magnitude below the Derived Air Concentration (Dac) of 8.4 kBq/m{sup 3}. Assuming that the worker is exposed by inhalation of iodine vapor during one hour, {sup 131}I concentration detected corresponds to an intake of 3.6 Bq which results in a committed effective dose of 7.13 x 10{sup -5} mSv. These results show that the radiopharmacy laboratory evaluated is safe in terms of internal exposure of the workers. However it is recommended that the presence of {sup 131}I should be periodically re-assessed since it may increase individual effective doses. It should also be pointed out that the results obtained so far reflect a survey carried out in a specific

  5. Das Lübecker Repetitorium "Innere Kompakt" [The Luebeck compact revision course in Internal Medicine

    Directory of Open Access Journals (Sweden)

    Kühn, Johanna

    2007-08-01

    Full Text Available [english] Introduction: The initiation of the amended second state examination in human medicine in autumn 2006 made many students feel insecure. Aim of the Luebeck compact revision course in Internal Medicine was to reassure the students by optimal preparation. Project description: In September 2006, for the first time, 75 students in their final practical year of study participated in the revision course. During eight days, the relevant topics for the second state examination in Internal Medicine were discussed – as lectures in the morning and in small working groups with case presentations in the afternoon. Results: Daily evaluation as well as a detailed evaluation at the end of the course point out the positive and negative aspects of the project. A final grade of 1.92 and a level of recommendation of 100% reflect a very positive feedback. Discussion and conclusion: To ensure a successful realisation of such a course, time and effort may not be underrated: it takes i.e. a structured time-table and motivated tutors as well as a detailed planning and administrative tasks to realise such a project. However, the students´ better preparation for their examinations and jobs compensate the additional time and effort. Therefore, we decided to establish comparable revision courses in Internal Medicine annually, and other clinical areas like Surgery will follow. [german] Einleitung: Die Einführung des neuen zweiten Staatsexamens im Herbst letzten Jahres führte bei vielen Medizinstudenten zu Verunsicherung. Diesem so genannten „Hammerexamen“ durch optimale Vorbereitung seinen Schrecken zu nehmen, war Ziel des neu eingeführten Repetitoriums der Inneren Medizin in Lübeck. Projektbeschreibung: Erstmals im September letzten Jahres nahmen 75 Studierende im Praktischen Jahr am Repetitorium „Innere kompakt“ teil. Innerhalb von acht Tagen wurden die wesentlichen prüfungsrelevanten Inhalte der Inneren Medizin behandelt – vormittags als

  6. Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study

    Directory of Open Access Journals (Sweden)

    Moheet Amir

    2009-09-01

    Full Text Available Abstract Background Teaching the content of clinical practice guidelines (CPGs is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States. Methods We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs. Results Of 434 programs responding (out of 839, 52%, 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%. The top two educational strategies used were didactic sessions (76% and journal clubs (64%. Auditing for adherence by residents was the primary evaluation strategy (44%, although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54% while the most important barrier was time constraints on faculty (56%. Conclusion Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.

  7. Efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy in the treatment of generalized anxiety disorders

    Institute of Scientific and Technical Information of China (English)

    Ting Wang; Jing-Yuan Ding; Guang-Xing Xu; Yu Zeng; San-Rong Xiao

    2012-01-01

    Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders. Methods: A total of 202 generalized anxiety disorders patients were randomly allocated to a control condition (Paroxetine combined with cognitive therapy) or a treatment condition (Yiqiyangxin Chinese medicine compound combined with cognitive therapy). Subsequently, scores of Hamilton Anxiety Scale (HAMA), Zung Self-rating Anxiety Scale (SAS) and blood routine, urine routine, liver function, renal function, electrocardiogram were detected before treatment, 3 months, 6 months after treatment and 6 months after medicine withdrawal, respectively. Results: HAMA and SAS scores were significantly reduced in two groups (P0.05). HAMA and SAS scores were significantly increased in two groups (P<0.05) after medicine withdrawal, and there were significant differences in HAMA and SAS scores, recurrent disease and adverse reaction (P<0.001). The incidence of recurrent disease and adverse reaction in treatment group was low. Both two groups showed no apparent abnormality in blood routine, urine routine, liver and renal function, and electrocardiogram. Conclusions: Yiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders. Furthermore, the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.

  8. PHARMACOEPIDEMIOLOGICAL MONITORING OF ANTIDEPRESSANT USAGE IN PATIENTS WITH ANXIOUS AND DEPRESSIVE SYNDROMES IN INTERNAL MEDICINE

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    N. V. Ivanova

    2015-12-01

    Full Text Available Aim. To study antidepressant usage in treatment of anxious and depressive disorders in real internal medicine practice.Material and methods. Retrospective analysis of 290 charts of patients, which were observed in Pskov region hospital from 2004 to 2005 was held. All patients suffered from different internal diseases and were treated with antidepressants because of anxious and depressive concomitant disorders.Results. Arterial hypertension observed in 28% of patients, ischemic heart disease – in 20%, heart failure – in 14%, cerebrovascular and peripheral nervous system diseases – in 18% and gastroduodenal diseases – in 20% of patients. Amitriptyline took the first place (49% among antidepressant prescriptions. Next antidepressants according to prescription popularity were paroxetine (22% and tianeptine (12%. Rate of other antidepressant prescriptions were not higher than 5%. There were differences in antidepressant prescriptions between physicians of different specialties.Conclusion. Reasonable approaches should be used to choose antidepressants. Selective serotonin reuptake inhibitors have benefit for the therapy of concomitant anxious and depressive disorders due to their good tolerability. Nevertheless tricyclic antidepressants are essential in some clinical situations.

  9. PHARMACOEPIDEMIOLOGICAL MONITORING OF ANTIDEPRESSANT USAGE IN PATIENTS WITH ANXIOUS AND DEPRESSIVE SYNDROMES IN INTERNAL MEDICINE

    Directory of Open Access Journals (Sweden)

    N. V. Ivanova

    2007-01-01

    Full Text Available Aim. To study antidepressant usage in treatment of anxious and depressive disorders in real internal medicine practice.Material and methods. Retrospective analysis of 290 charts of patients, which were observed in Pskov region hospital from 2004 to 2005 was held. All patients suffered from different internal diseases and were treated with antidepressants because of anxious and depressive concomitant disorders.Results. Arterial hypertension observed in 28% of patients, ischemic heart disease – in 20%, heart failure – in 14%, cerebrovascular and peripheral nervous system diseases – in 18% and gastroduodenal diseases – in 20% of patients. Amitriptyline took the first place (49% among antidepressant prescriptions. Next antidepressants according to prescription popularity were paroxetine (22% and tianeptine (12%. Rate of other antidepressant prescriptions were not higher than 5%. There were differences in antidepressant prescriptions between physicians of different specialties.Conclusion. Reasonable approaches should be used to choose antidepressants. Selective serotonin reuptake inhibitors have benefit for the therapy of concomitant anxious and depressive disorders due to their good tolerability. Nevertheless tricyclic antidepressants are essential in some clinical situations.

  10. The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

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    Shimizu T

    2013-07-01

    Full Text Available Taro Shimizu,1 Yusuke Tsugawa,2,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Mitsumasa Kishimoto,7 Toshiaki Shiojiri,8 Yasuharu Tokuda9 1Hospitalist Division, Department of Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 2Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 3Center for Clinical Epidemiology, St Luke's Life Science Institute, 4Department of Vascular and Oncological Surgery, Hospital of Tokyo University, 5Department of General Internal Medicine, Kanto Rousai Hospital, 6Department of Cardiology, Juntendo University School of Medicine, 7Division of Rheumatology, St Luke's International Hospital, Tokyo, Japan; 8Asahi Chuo Hospital, Chiba, Japan; 9Department of Medicine, Tsukuba University Mito Kyodo General Hospital, Mito City, Ibaraki, Japan Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women participated and

  11. General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association of Predictive, Preventive and Personalised Medicine

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    Golubnitschaja Olga

    2012-11-01

    Full Text Available Abstract This report is the collective product of word-leading experts working in the branches of integrative medicine by predictive, preventive and personalised medicine (PPPM under the coordination of the European Association for Predictive, Preventive and Personalised Medicine. The general report has been prepared as the consortium document proposed at the EPMA World Congress 2011 which took place in Bonn, Germany. This forum analyzed the overall deficits and trends relevant for the top-science and daily practice in PPPM focused on the patient. Follow-up consultations resulted in a package of recommendations for consideration by research units, educators, healthcare industry, policy-makers, and funding bodies to cover the current knowledge deficit in the field and to introduce integrative approaches for advanced diagnostics, targeted prevention, treatments tailored to the person and cost-effective healthcare.

  12. JETSET: Physics at LEAR with an Internal Gas Jet Target and an Advanced General Purpose Detector

    CERN Multimedia

    2002-01-01

    This experiment involves an internal gas cluster jet target surrounded by a compact general-purpose detector. The LEAR beam and internal jet target provide several important experimental features: high luminosity $ ( 10 ^{3} ^0 $ cm$^- ^{2} $ sec$^- ^{1} ) $, excellent mass resolution ($\\Delta

  13. General public perceptions towards medicines in the state of penang Malaysia

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    Mahmoud Sa′di Al-Haddad

    2012-01-01

    Conclusion: Results of this study urge for a national awareness program to the public regarding medicines. Decision makers have to consider these findings since high proportion of the public perceive and consume medicines irrationally.

  14. Evaluation of the effectiveness of postgraduate general medicine training by objective structured clinical examination---pilot study and reflection on the experiences of Kaohsiung Medical University Hospital.

    Science.gov (United States)

    Tsai, Jer-Chia; Liu, Keh-Min; Lee, Kun-Tai; Yen, Jo-Chu; Yen, Jeng-Hsien; Liu, Ching-Kuan; Lai, Chung-Sheng

    2008-12-01

    Objective structured clinical examination (OSCE) is an effective assessment method to evaluate medical students' clinical competencies performance. Postgraduate year 1 (PGY1) residents have been initiated in a general medicine training program in Taiwan since 2003. However, little is known about the learning effectiveness of trainees from this program. This pilot study aimed to evaluate the clinical core competencies of PGY1 residents using OSCE, and to reflect on the strengths and weaknesses of this pilot assessment project. OSCE was conducted for five PGY1 examinees (4 men, 1 woman) with five stations covering core themes, including history taking, physical examination, clinical procedure of airway intubation, clinical reasoning, and communication skills for informing bad news. Itemized checklists and five-point Likert scale global ratings were used for evaluating performance. The results showed that the performance of our PGY1 residents on history taking was significantly better after about 2 months of postgraduate training on general internal medicine. Self-evaluation on performance by examinees revealed significantly lower global ratings on post-course OSCE (4.14 +/- 0.80 vs. 3.68 +/- 0.66; p OSCEs showed consistently favorable responses on the purposes, content, process, and environment of this assessment (4.0 +/- 0.17 vs. 4.0 +/- 0.12, nonsignificant). However, a survey of the examinees completed at pre- and post-course OSCEs showed relatively unfavorable responses to the same aspects, and to tutors and SPs (4.1 +/- 0.09 vs. 3.7 +/- 0.18; p clinical reasoning performance, communication skills (giving bad news) and self-confidence were unsatisfactory. In conclusion, this pilot study has demonstrated that OSCE is a rational and feasible assessment method for evaluating the effectiveness of our PGY general medicine training program. The quantitative data and qualitative information provide a foundation to improve the quality of the program design and evaluation

  15. [Recent progress of international harmonization of crude drugs and medicinal plants--activity of FHH (The Western Pacific Regional Forum for the Harmonization of Herbal Medicines)].

    Science.gov (United States)

    Kawahara, Nobuo

    2011-03-01

    The Western Pacific Regional Forum for the Harmonization of Herbal Medicines (FHH) was established in 2002. The general proposed objective of the FHH is to promote public health by recognizing and developing standards and technical guidelines that aim to improve the quality, safety and efficacy of herbal medicines. At a sub-committee meeting of FHH nomenclature and standardization held in Tokyo, all the participants recognized the importance of comparing the descriptions of herbal medicines contained in member countries' pharmacopoeias or monograph standards as the first step in the harmonization of nomenclature and standardization. It was agreed to set up five expert working groups (EWG) to carry out the following specific tasks: 1) Nomenclature, 2) Testing Methods in Monographs, 3) List of Chemical Reference Standards (CRS) and Reference of Medicinal Plant Materials (RMPM), 4) List of Analytically Validated Methods, and 5) Information on General Tests. In this review, we report four topics of FHH activities from 2002-2009 as follows: 1) Comparative study on testing methods and specification values for crude drugs used in monographs among four Western Pacific regional countries (Japan, China, Korea and Vietnam), 2) Comparative study on TLC conditions for identification, chemical assay conditions for component quantification used in monographs among the four countries, 3) Comparative study on general testing methods for crude drugs among the four countries, 4) Comparative study on TLC identification for crude drugs used in monographs among the four countries considering harmonization and clean analysis.

  16. International Disability Educational Alliance (IDEAnet)

    Science.gov (United States)

    2011-03-23

    Professionalism. Journal of General Internal Medicine . July; 23(7): 954-957. 34 Ibid. 35 Kamel Boulous, Maged N. and Wheeler, Steve (2007). Page 11 of 57...Paradise (2008). The Intersection of Online Social Networking with Medical Professionalism. Journal of General Internal Medicine . July; 23(7): 954

  17. Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

    Science.gov (United States)

    Clay, Ryan D; Lee, Elizabeth C; Kurtzman, Marc F; Dversdal, Renee K

    2016-12-01

    A growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach. To implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures. The study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns. This was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention. Thirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099. A single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

  18. THERAPEUTIC BENEFITS OF HOLY BASIL (TULSI IN GENERAL AND ORAL MEDICINE: A REVIEW

    Directory of Open Access Journals (Sweden)

    Bhateja Sumit

    2012-12-01

    Full Text Available Nature has bestowed on us a very rich botanical wealth and a large number of diverse types of plants grow in different parts of the country. Plants are the richest resource of drugs in traditional systems of medicine, modern medicines, nutraceuticals, food supplements, folk medicines, pharmaceutical intermediates and chemical entities for synthetic drugs. Medicinal plants are a source of great economic value all over the world. Ocimum sanctum Linn (Tulsi is a well-known plant used in the Indian system of medicine. This paper reviews the therapeutic potential of this plant in treatment of various medical and oral disorders.

  19. Individual monitoring of internal exposure for nuclear medicine workers in Switzerland.

    Science.gov (United States)

    Baechler, S; Stritt, N; Bochud, F O

    2011-03-01

    Monitoring of internal exposure for nuclear medicine workers requires frequent measurements due to the short physical half-lives of most radionuclides used in this field. The aim of this study was to develop screening measurements performed at the workplace by local staff using standard laboratory instrumentation, to detect whether potential intake has occurred. Such measurements do not enable to determine the committed effective dose, but are adequate to verify that a given threshold is not exceeded. For radioiodine, i.e. (123)I, (124)I, (125)I and (131)I, a calibrated surface contamination monitor is placed in front of the thyroid to detect whether the activity threshold has been exceeded. For radionuclides with very short physical half-lives (≤ 6 h), such as (99m)Tc and those used in positron emission tomography imaging, i.e. (11)C, (15)O, (18)F and (68)Ga, screening procedures consist in performing daily measurements of the ambient dose rate in front of the abdomen. Other gamma emitters used for imaging, i.e. (67)Ga, (111)In and (201)Tl, are measured with a scintillation detector located in front of the thorax. For pure beta emitters, i.e. (90)Y and (169)Er, as well as beta emitters with low-intensity gamma rays, i.e. (153)Sm, (177)Lu, (186)Re and (188)Re, the procedure consists in measuring hand contamination immediately after use. In Switzerland, screening procedures have been adopted by most nuclear medicine services since such measurements enable an acceptable monitoring while taking into account practical and economic considerations.

  20. Training satisfaction for subspecialty fellows in internal medicine: Findings from the Veterans Affairs (VA Learners' Perceptions Survey

    Directory of Open Access Journals (Sweden)

    Byrne John M

    2011-05-01

    Full Text Available Abstract Background Learner satisfaction assessment is critical in the design and improvement of training programs. However, little is known about what influences satisfaction and whether trainee specialty is correlated. A national comparison of satisfaction among internal medicine subspecialty fellows in the Department of Veterans Affairs (VA provides a unique opportunity to examine educational factors associated with learner satisfaction. We compared satisfaction across internal medicine fellows by subspecialty and compared factors associated with satisfaction between procedural versus non-procedural subspecialty fellows, using data from the Learners' Perceptions Survey (LPS, a validated survey tool. Methods We surveyed 2,221 internal medicine subspecialty fellows rotating through VA between 2001 and 2008. Learners rated their overall training satisfaction on a 100-point scale, and on a five-point Likert scale ranked satisfaction with items within six educational domains: learning, clinical, working and physical environments; personal experience; and clinical faculty/preceptor. Results Procedural and non-procedural fellows reported similar overall satisfaction scores (81.2 and 81.6. Non-procedural fellows reported higher satisfaction with 79 of 81 items within the 6 domains and with the domain of physical environment (4.06 vs. 3.85, p Conclusions Internal medicine fellows are highly satisfied with their VA training. Nonprocedural fellows reported higher satisfaction with most items. For both procedural and non-procedural fellows, clinical faculty/preceptor and personal experience have the strongest impact on overall satisfaction.

  1. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

    DEFF Research Database (Denmark)

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D

    2014-01-01

    INTRODUCTION: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and pa...

  2. Prevalence of potential drug–drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

    Directory of Open Access Journals (Sweden)

    Akshaya Srikanth Bhagavathula

    2014-05-01

    Conclusion: We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.

  3. Academic Relationships and Teaching Resources. Fogarty International Center Series on the Teaching of Preventive Medicine, Volume 6.

    Science.gov (United States)

    Clark, Duncan W., Ed.

    The monograph is one of the Fogarty International Center Series on the Teaching of Preventive Medicine, undertaken to: (1) review and evaluate the state of the art of prevention and control of human diseases; (2) identify deficiences in knowledge requiring further research (including analysis of financial resources, preventive techniques, and…

  4. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

    NARCIS (Netherlands)

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D; Serefoglu, Ege Can; Shindel, Alan W; Adaikan, P Ganesan; Becher, Edgardo; Dean, John; Giuliano, Francois; Hellstrom, Wayne J G; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

    2014-01-01

    INTRODUCTION: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partn

  5. Use of 360-degree assessment of residents in internal medicine in a Danish setting: a feasibility study

    DEFF Research Database (Denmark)

    Allerup, P; Aspegren, K; Ejlersen, E

    2007-01-01

    BACKGROUND: The aim of the study was to explore the feasibility of 360 degree assessment in early specialist training in a Danish setting. Present Danish postgraduate training requires assessment of specific learning objectives. Residency in Internal Medicine was chosen for the study. It has 65 l...

  6. Structure analysis of aromatic medicines containing nitrogen using near-infrared spectroscopy and generalized two-dimensional correlation spectroscopy

    Science.gov (United States)

    Liu, Hao; Gao, Hongbin; Qu, Lingbo; Huang, Yanping; Xiang, Bingren

    2008-12-01

    Four aromatic medicines (acetaminophen; niacinamide; p-aminophenol; nicotinic acid) containing nitrogen were investigated by FT-NIR (Fourier transform near-infrared) spectroscopy and generalized two-dimensional (2D) correlation spectroscopy. The FT-NIR spectra were measured over a temperature range of 30-130 °C. By combining near-infrared spectroscopy, generalized 2D correlation spectroscopy and references, the molecular structures (especially the hydrogen bond related with nitrogen) were analyzed and the NIR band assignments were performed. The results will be helpful to the understanding of aromatic medicines containing nitrogen and the utility of these substances.

  7. A general nuclear motion Hamiltonian and non-internal curvilinear coordinates.

    Science.gov (United States)

    Strobusch, D; Scheurer, Ch

    2013-03-07

    An exact Hamiltonian for nuclear motions in general curvilinear coordinates is derived. It is demonstrated how this Hamiltonian transforms into well-established expressions, such as the Wilson Howard Hamiltonian or the Meyer Günthard Hamiltonian, if the general coordinates are restricted to be rectilinear or internal. Furthermore, a compact expression for the Hamiltonian expressed in non-internal curvilinear coordinates is provided, which makes this coordinate class available for applications in a simple way, since only the Jacobian matrix with respect to the rotating frame coordinates must be calculated. An example, employing a water model potential, exemplifies how different coordinate systems from all three coordinate classes (rectilinear, internal, and non-internal) lead to vibrational spectra, which are in excellent agreement. Thereby, the applicability of the general Hamiltonian is demonstrated and also its correctness is confirmed.

  8. Toward a sustainable and wise healthcare approach: potential contributions from hospital Internal Medicine Departments to reducing inappropriate medical spending

    Directory of Open Access Journals (Sweden)

    Roberto Nardi

    2013-04-01

    Full Text Available All countries are facing the question of how to maintain quality of care with shrinking health budgets, in the presence of a persistent increase in life expectancy, and with a significant growing demand for health care from aging populations and chronically ill patients. Current implementation of legislative measures is largely presented as a cost-cutting policy. With this political approach, there is a risk of services and the number of hospital beds being drastically reduced, mainly to detriment of the most vulnerable groups of the population and without considering the results obtained by each regional healthcare organization according to explicit evaluation markers. In our Scientific Society of Internal Medicine (the Federation of Associations of Hospital Doctors on Internal Medicine, FADOI, we want to support good medical practice because essential medicine is still a goal to be achieved throughout medical hospital care. We are looking for original ways to implement a sustainable and frugal hospital Internal Medicine policy by searching for wise and efficient clinical methodology to be applied in the care of patients admitted to internal medicine wards according to their real needs. We firmly believe that reinforcing a common agenda between medicine and public health, and sharing a common vision among professionals and decision makers in the planning of care, may be the greatest opportunity for any every health care reform. The future of the health care system cannot be restricted to mere cost reduction, but should aim to deliver better health care in relation to the money spent. Even in this period of austerity, new opportunities can still be found and doctors must lead efforts to meet this challenge.

  9. Access to complementary medicine in general practice: survey in one UK health authority.

    Science.gov (United States)

    Wearn, A M; Greenfield, S M

    1998-09-01

    Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.

  10. End-of-life care for cancer patients in an Internal Medicine department

    Directory of Open Access Journals (Sweden)

    Luigi Lusiani

    2013-03-01

    Full Text Available Introduction Many cancer patients die in the hospital, in spite of their preference to end their lives at home. Internal Medicine wards are poorly equipped to care for dying patients. Staff members have no specific training in palliative care, and the organization of the ward lacks flexibility. The entire staff (physicians and nurses of the Internal Medicine ward of our hospital took part in a specially designed training program, and a protocol for end-of-life care (EOL-care was implemented to improve the comfort of patients with terminal cancer. The aim of this study was to analyze the impact of this protocol on clinical practice in the ward, in terms of the number of interventions and the degree of control of key symptoms. Materials and methods The EOL-care protocol, which was established in cooperation with the Sue Ryder Foundation, was a modified version of the Liverpool Care Pathway. The main objective was to ensure the comfort of the dying patient through judicious discontinuation of all non-essential medications and interventions, frequent and systematic assessment of the key symptoms, and greater emphasis on communication with the patient and his/her caregivers. We compared 82 unselected cases managed with conventional care, representing the 20% of the deaths that occurred in 2007-2008 in our ward (controls, and 27 consecutive cancer patients cared for with the EOL-care protocol between May 2009 and February 2010 (cases. Results Patients in the case group received fewer interventions than controls (catheterization rate: 0% vs 19.4%; invasive procedure rate: 0% vs 8.5%; parenteral nutrition: 0% vs 3.6%, but they obtained almost complete relief of symptoms (pain, dyspnea, respiratory tract obstruction by secretions, agitation, nausea/vomiting. The most prominent result was pain relief: systematic checks revealed persistent pain in only 2.9% of the EOL-care group versus 59.7% of the controls during the last 48 hours of life. Discussion This

  11. Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine.

    Science.gov (United States)

    Dendl, Lena-Marie; Teufel, Andreas; Schleder, Stephan; Rennert, Janine; Stroszczynski, Christian; Mueller-Schilling, Martina; Schreyer, Andreas G

    2017-03-01

    Purpose Evaluation of clinical impact regarding diagnostic and therapeutic changes influenced by interdisciplinary radiological case presentations. Materials and Methods Prospective evaluation of radiological-gastrointestinal clinical case conferences over a 1-year period at a tertiary care center. We documented the preparation (phase 1) and clinical case conference (phase 2) regarding their impact on the radiology report and further diagnostic work-up and therapy. Results 1067 examinations were evaluated in 69 clinical case conferences including 487 cases. We calculated a mean time of 35.8 minutes per conference with 5.1 minutes per case for preparation. During phase 1, major changes compared to the previous report were found in 1.2 % of cases, and no change was found in 91.4 % of cases. In phase 2 an additional relevant finding was found in 0.6 % of cases, while there was no major change to the reports in 99 % of cases. We recommended further radiological diagnostic workup in 9 % of cases and interventional radiological examination in 2.7 % of cases, while no change was documented in 83.2 %. Further radiological or surgical therapy was recommended in 7 % and 6.8 % of cases, respectively. There was no change in therapy in 78.5 % of cases. Conclusion The analysis of an interdisciplinary radiological case presentation in internal medicine shows that the case discussion with the radiologist results in a change in patient management in 37.3 % of cases (16.8 % diagnosis, 21.5 % therapy). Overall, interdisciplinary radiological clinical case conferences help to improve the management and quality of patient care. Our data support the broad implementation of radiological clinical case conferences. Key Points · The second opinion obtained during the preparation of a radiological case presentation does not change the written report in most cases.. · "Talking radiology" in radiological case presentations results in a significant change in

  12. Study on the Orchestration Method of Physician Allocation in Internal Medicine Department of a Large General Tertiary Hospital%某大型三级甲等综合医院内科科室医师编配方法研究

    Institute of Scientific and Technical Information of China (English)

    蔡林; 李德鹏; 祝梅; 郭阿娟; 潘梁军

    2013-01-01

    目的:从医师实际工作量出发,结合专家咨询,算出医师的理论编配值。方法:通过自行设计调查问卷调查临床医师工作量,结合专家咨询标准工作时间,算出医师理论编配值。结果:所调查的内分泌科、血液病科和呼吸一科3个科室目前共开放床位197张,临床医师49人,理论应当编配110~132人,应增加61~83人;从床医比来看,内分泌科床医比为1∶0.19,血液病科为1∶0.26,呼吸一科为1∶0.37,均比较低,通过研究得出三个科室的理想床医比分别为,内分泌科1∶0.47~1∶0.58,血液病科1∶0.59~1∶0.71,呼吸一科为1∶0.72~1∶0.85。结论:目前医师编配不足,工作量大,医疗质量难以保证,应增加医师的编配。%Objective: To get the theoretical number of physician allocation by measuring the physician’s current workloads and expert advices. Methods: Measuring the physician’s workload by self-designed questionnaire, combined with standard working time given by experts, get the theoretical number of physician allocation. Results: There are 197 sickbeds and 49 physicians in the three departments (endocrinology, hematology and respiratory medicine department) which are surveyed at present. The theoretical number of physicians is 110-132, and 61-83 need to be increased. The bed-physician ratio in endocrine departments is 1:0.19, in hematology departments is 1:0.26, and that in respiratory medicine departments 1 is 1:0.37. All the results are relatively low. The research results also show that, the ideal ratio of the sickbed number and the physician number in endocrine departments is 1:0.47-1:0.58, in hematology departments is 1:0.59-1:0.71, and that in respiratory medicine departments 1 is 1:0.72-1:0.85. Conclusion: Physicians are currently insufficient allocated and workload overload, quality of care can not be guaranteed. The number of physicians should be increased.

  13. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

    Science.gov (United States)

    Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

    2017-04-18

    Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

  14. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated