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Sample records for internal medicine patients

  1. Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

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    Jessica Liu

    Full Text Available When the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as "bedspacing". Whether bedspacing affects quality of patient care has not been previously studied.We reviewed consecutive general internal medicine (GIM admissions for congestive heart failure (CHF, chronic obstructive pulmonary disease (COPD, and pneumonia at St. Michael's Hospital in Toronto, Canada, from 2007 to 2011 and examined whether quality of care differs between bedspaced and nonbedspaced patients. We matched each bedspaced patient with a GIM ward patient admitted on the same call shift with the same diagnosis. The primary outcome was the ratio of the actual to the estimated length of stay (ELOS. General and disease specific measures for CHF, COPD, and pneumonia (e.g. fluid restriction were evaluated, as well as 30-day Emergency Department (ED and hospital readmissions.Overall, 1639 consecutive admissions were reviewed, and 39 matched pairs for CHF, COPD and pneumonia were studied. Differences in both general and disease specific care measures were not detected between groups. For many disease-specific comparisons, ordering and adherence to quality of care indicators was low in both groups.We were unable to detect differences in quality of care between bedspaced and nonbedspaced patients. As high patient volumes and hospital overcrowding remains, bedspacing will likely continue. More research is required in order to determine if quality of care is compromised by this ongoing practice.

  2. Characteristics of Homeopathy Users among Internal Medicine Patients in Germany.

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    Steel, Amie; Cramer, Holger; Leung, Brenda; Lauche, Romy; Adams, Jon; Langhorst, Jost; Dobos, Gustav

    2016-01-01

    Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis. Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high external-social health locus of control were less likely to use homeopathy. Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy. © 2016 S. Karger GmbH, Freiburg.

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

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    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.

  4. [Prevalence of obesity in hospitalized internal medicine patients].

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    Carrasco Sánchez, F J; Díaz Alcaide, F; Marín Fernández, Y; Chaparro Moreno, I; Pujol de la Llave, E

    2002-09-01

    We describe the weight's distribution in a sample of medical patients in hospital. We estimate the global prevalence and the presence between other different clinical variables. A prevalence cross-sectional study was carried out. We determine weight, stature and several clinical variables in 101 patients admit in the internal medicine department of Juan Ramón Jiménez hospital in Huelva. The patients were admitted from 6th to 7th of june in 2000. The Body Mass Index (BMI) > or = 30 Kg/m2 was used to define the obesity. The prevalence of obesity was 32.2% [0.236-0.416]. In the study we find an association with female (prevalente rate -PR- 3.22), HTA (PR 4.72), dislipemia (RP 4.40) and hyperuricacemia (RP 4.28). The prevalence of obesity in our patients was between 23.41%, it was greater than others estimations in general people. We find association with women and classic cardiovascular risk factors.

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

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    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.

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

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    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

  7. Use of non-vitamin, non-mineral (NVNM) supplements by hospitalized internal medicine patients and doctor-patient communication.

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    Samuels, Noah; Zisk-Rony, Rachel Y; Zevin, Shoshana; Becker, Evy L; Yinnon, Amos M; Oberbaum, Menachem

    2012-12-01

    To study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients. A convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel. 280 patients were interviewed (54% female), 15.4% reporting NVNM supplement use. This practice was more prevalent among female patients (p=0.045), more educated (pinternal medicine patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Complex decision making in patients with dementia in an internal medicine department.

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    Kabelka, Ladislav

    2017-10-01

    With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

  9. [Pharmacotherapy follow-up for patients admitted to the Internal Medicine Department of Hospital Infanta Margarita].

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    Campos Vieira, N; Bicas Rocha, K; Calleja Hernández, M A; Faus Dáder, M J

    2004-01-01

    In pharmacotherapeutic follow-up a pharmacist is responsible for drug-related patient needs (DRPN) by detecting, preventing and solving medication-related problems aiming at specific results to improve patient quality of life. Drug-related problems are pharmacotherapy failures leading to failed therapeutic goals or undesirable events. In this study, Daders methodology for pharmacotherapeutic follow-up was used in patients admitted to the Internal Medicine Department of Hospital Infanta Margarita, Cabra-Córdoba, Spain. In all, 85 DRPNs (2.7 DRPNs per patient) were identified, and 36 pharmaceutical procedures were performed, with physicians accepting 92% of said procedures. Forty-nine percent of drug-related problems were related to need, 40% to effectiveness, and 11% to safety. The presence of a pharmacist at the Internal Medicine Department allows the detection of DRPNs that are mostly related to need and effectiveness. Pharmaceutical procedures are widely accepted by medical teams.

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

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    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

  11. 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

  12. Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.

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    Mueller, Paul S; Barrier, Patricia A; Call, Timothy G; Duncan, Alan K; Hurley, Daniel L; Multari, Adamarie; Rabatin, Jeffrey T; Li, James T C

    2006-05-26

    We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average +/- SD, 9.4 +/- 1.0 vs 7.7 +/- 1.2, P communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.

  13. Medical teleconsultation to general practitioners reduces the medical error vulnerability of internal medicine patients.

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    Campanella, Nando; Morosini, Pierpaolo; Sampaolo, Guido; Catozzo, Vania; Caso, Andrea; Ferretti, Maurizio; Giovagnoli, Moreno; Torniai, Mariangela; Antico, Ettore

    2015-11-01

    e-Health strategies are supposed to improve the performance of national health systems. Medical teleconsultation (MT) is an important component of such e-Health strategies. The outcome of MT was evaluated with regard to the impact on the medical error vulnerability (MEV) of internal medicine patients. A team of internal medicine doctors plus a network of forty specialists was set-up in one health district belonging to a unified and universal national health system of a country of Western Europe, in order to provide free-of-charge MT to support general practitioners in solving internal medicine cases. In this observational study, the case series of 2013 is reviewed. a) Only 21% of the MT fell short to the general practitioner's expectations about the case solving focus; b) throughout the medical care process of the patient, 49% of the cases met with one or more of the five MEVs, namely: 1) clinical test mishandling; 2) inaccurate differential diagnosis; 3) inadequate information flow between health providers at different levels of care (transition care); 4) poor coordination between health providers; and 5) poor reconciliation of medications or hazardous therapies. c) MT canceled or prevented MEVs in 56% and mitigate MEVs in 15% of the cases; d) MT canceled or prevented 85% of MEV caused by poor information exchange in transition care, therefore improving patient referral and counter-referral. MT reduces MEV and therefore, whenever implemented to a large extent, may improve the quality of health care delivery and the performance of national health systems. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  14. Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

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    Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

    2013-01-01

    BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

  15. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments.

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    Marco, J; Barba, R; Lázaro, M; Matía, P; Plaza, S; Canora, J; Zapatero, A

    2013-01-01

    Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  16. [Changes in knowledge and carrying out the advance directives of patients admitted to internal medicine].

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    Pérez, M; Herreros, B; Martín, M D; Molina, J; Guijarro, C; Velasco, M

    2013-01-01

    Advance directives (ADs), are documents in which patients express in advance that their wishes are fulfilled when they are unable to communicate them. It is unknown whether patients admitted to internal medicine are more aware of and make ADs. To study the changes in the level of knowledge and implementation of AD among patients admitted to an internal medicine department of a hospital in Madrid since a specific regulation to implement them was introduced. A survey was conducted among patients admitted to internal medicine in two periods: 2008 and 2010. A total of 206 surveys were analysed (84 in 2008 and 122 in 2010). The mean age of the patients was 76.8 years, and 51.5% were women. More than two-thirds (69.4%) had a co-morbidity. and 4.4% had a terminal illness, with no statistical differences between the periods. Only 5.3% knew what ADs are, 1 had implemented ADs, and 46.1%, once informed, would like to implement them. There were no differences between 2008 and 2010 as regards knowledge and implementation of AD. In 2010 there was a greater interest to implement them (would like to implement them: 52.5 vs 36.9%), although in 2010 less respondents believe that AD would change the attitude of the doctor (not change the attitude: 92.6 vs. 69%, P<.001). Knowledge and implementation of AD did not change significantly in the years following the regulation (from 2008-2010). In both periods, their knowledge and implementation are scarce. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  17. Limitation of therapeutic effort in patients hospitalised in departments of internal medicine.

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    García Caballero, R; Herreros, B; Real de Asúa, D; Gámez, S; Vega, G; García Olmos, L

    There is little information on the limitation of therapeutic effort (LTE) in patients admitted to hospital internal medicine units. To describe the indicated LTE regimens in the departments of internal medicine and the characteristics of the patients who undergo them. An observational, descriptive retrospective study was conducted on 4 hospitals of the Community of Madrid. The study collected demographic and comorbidity data and the LTE orders prescribed for all patients who died during a period of 6 months. The study included 382 patients with a mean age of 85±10 years; 204 were women (53.4%) and 222 (58.1%) came from their homes. Some 51.1% of the patients were terminal, 43.2% had moderate to severe dementia, and 95.5% presented at least moderate comorbidity. Some type of LTE was performed in 318 patients (83.7%); the most common orders were "No cardiopulmonary resuscitation" (292 patients, 76.4%; 95% CI 72.1-80.8), "Do not use aggressive measures" (113 patients, 16.4%; 95% CI 13.7-19.4) and "Do not transfer to an intensive care unit" (102 cases, 14.8%, 95% CI 12.3-17.7). Some type of LTE was performed in 318 patients (83.7%); the most common orders were "No cardiopulmonary resuscitation" (292 patients, 76.4%; 95% CI 72.1-80.8), "Do not use aggressive measures" (113 patients, 16.4%; 95% CI 13.7-19.4) and "Do not transfer to an intensive care unit" (102 cases, 14.8%, 95% CI 12.3-17.7). LTE is common among patients who die in Internal Medicine. The most widely used regimens were "No CPR" and the unspecific statement "Do not use aggressive measures". The patients were elderly and had significant comorbidity, terminal illness and advanced dementia. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients.

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    Schouten, Will M; Burton, M Caroline; Jones, LaKisha D; Newman, James; Kashiwagi, Deanne T

    2015-03-01

    Failures in communication at the time of patient handoff have been implicated as contributing factors to preventable adverse events. Examine the relationship between face-to-face handoffs and the rate of patient outcomes, including adverse events. Retrospective cohort. A 1157-bed academic tertiary referral hospital. There were 805 adult patients admitted to general internal medicine services. Retrospective comparison of clinical outcomes, including the rate of adverse events, of patients whose care was transitioned with and without face-to-face handoffs. Rapid response team calls, code team calls, transfers to a higher level of care, death in hospital, 30-day readmission rate, length of stay, and adverse events (as identified using the Global Trigger Tool). There was no significant difference with respect to the frequency of rapid response team calls, code team calls, transfers to a higher level of care, deaths in hospital, length of stay, 30-day readmission rate, or adverse events between patients whose care was transitioned with or without a face-to-face handoff. Face-to-face handoff of patients admitted to general medical services at a large academic tertiary referral hospital was not associated with a significant difference in measured patient outcomes, including the rate of adverse events, compared to a non-face-to-face handoff. Additional study is needed to determine the qualities of patient handoff that optimize efficiency and safety. © 2015 Society of Hospital Medicine.

  19. [Prescription errors in patients admitted to an internal medicine department from the emergency room].

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    Gutiérrez Paúls, L; González Alvarez, I; Requena Caturla, T; Fernández Capitán, M C

    2006-01-01

    To identify and quantify emergency room prescription errors upon patient admission in an internal medicine unit, assess their severity and causes, and evaluate their potential clinical impact. Discrepancies found between emergency room and internal medicine unit prescriptions were analyzed by 4th-year resident pharmacists. Prescription errors were collected and classified according to their severity and potential morbidity, and a medical analysis of service value was performed according to Overhage's method. Furthermore, pharmacist actions regarding therapeutic regimen optimization are described. Of 177 patients, 50 had prescription errors, for a total of 141 errors. Seven percent of prescriptions had an error. Mean errors per patient amounted to 0.8 (SD 1.51). Most commonly involved medications included anti-asthmatic and anti-infectious agents, and fluid therapy agents. On severity assessment 12.8% were considered severe, and 57.4% were considered significant. The main cause was omission of a needed therapy. Potential pharmacotherapeutic morbidity is related to adverse effects and cardiovascular disease. Medical assessment considered 12% very significant, and 52% significant. Pharmacist actions were directed towards effectiveness improvement in 57% of cases, and safety in 43.2% of cases. Emergency departments, as main entry points for patient admission to hospital, should be considered a priority in prescription quality improvement programs.

  20. Experience of an eating disorders out-patient program in an internal medicine hospital.

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    García-García, Eduardo; Rocha-Velis, Ingrid; Vázquez-Velázquez, Verónica; Kaufer-Horwitz, Martha; Reynoso, Ricardo; Méndez, Juan Pablo

    2013-12-01

    The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.

  1. BIPAP protocol usage in patients admitted to the Internal Medicine unit

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    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.

  2. Current trends on internal dosimetry for patient protection in nuclear medicine

    International Nuclear Information System (INIS)

    Rojo, A.M.; Gisone, P.A.; Kunst, J.J.

    2001-01-01

    The associated risk-benefit analyses in nuclear medicine implicitly performed by the clinician have been straightforward. Relatively low administered activity activities yield important diagnostic information, the benefit of which far outweigh any potential risk associated with the attendant normal tissue radiation doses. Such small risk to benefit ratios have been very forgiving of possible inaccuracies in dose estimates. With the ongoing development of new radiopharmaceutical and the increasing therapeutic application of internal radionuclides, radiation dosimetry in nuclear medicine continues to evolve from population- and organ-average to patient-specific dose estimation. Patient-specific dosimetry refers to the estimation of radiation dose to tissues of a specific-patients based on their individual body and measured biokinetics rather than an average anthropomorphic model and hypothetic kinetic. The importance of dosimetry specific-patient considers to avoid the risk of an unsuitable treatment and/or with probability of damage to the patient. This is illustrated by the dosimetric approaches to radioiodine treatment of hyperthyroidism. The most common prescription algorithm to fix the activity administered to a hyperthyroid patient does not consider individual parameters that are highly variable (thyroid uptake, biological half-life, thyroid mass). Its arbitrary approach doesn't permit individually optimized therapy and it may be inappropriate and even hazardous. (author)

  3. [Etiological profile of secondary Raynaud's phenomenon in an internal medicine department. About 121 patients].

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    Ben Salem, T; Tougorti, M; Bziouech, S; Lamloum, M; Khanfir, M; Ben Ghorbel, I; Houman, M H

    2018-02-01

    Raynaud's phenomenon is a reversible episodic vasospastic disorder triggered by cold or emotion. Two types of Raynaud's phenomenon were distinguished: Raynaud's disease and secondary Raynaud's phenomenon. The purpose of this study was to determine the etiologic profile of secondary Raynaud's phenomenon in an internal medicine department. A descriptive retrospective study including patients with secondary Raynaud's phenomenon followed in a tertiary internal medicine department between 2000 and 2013. We included 121 patients. The sex ratio M/F was 0.16. The mean age at the onset of Raynaud's phenomenon was 41.7 years. The average age of patients at the time of the etiologic diagnosis was 47.3 years. The mean delay between Raynaud's phenomenon onset and the first consultation was 41.33 months. Raynaud's phenomenon involved hands in all cases and feet in 16.10% of cases with a typical form in most cases (41.4%). Complications (digital ulcers and scars) were noted in 32.23% of cases. Nail fold capillaroscopy showed scleroderma pattern in 49.52% of patients. Antinuclear antibodies were positive in 88.49% of patients. Interstitial lung disease was reported in 54.04% of cases. Connective tissue diseases were diagnosed in 86.77% of patients. Other secondary Raynaud's phenomenon causes were vasculitis (6.61%), atherosclerosis (1.65%) and medical or professional causes (1.65%). The most frequent one cause systemic sclerosis (n=61, 98%) followed by systemic lupus erythematosus (11.57%) and primary Sjögren syndrome (6.61%). In our study, the Raynaud's phenomenon was most frequently secondary to connective tissue diseases. This may be a selection bias because our department is a third-line unit where patients are often referred for systemic disease suspicion. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments.

    Science.gov (United States)

    Díez-Manglano, J; Arnal-Longares, M J; Al-Cheikh-Felices, P; Garcés-Horna, V; Pueyo-Tejedor, P; Martínez-Rodés, P; Díez-Massó, F; Rubio-Félix, S; Del Corral-Beamonte, E; Palazón-Fraile, C

    2018-03-16

    To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (pscale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (pscale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Estimation of internal exposure to 99Mo in nuclear medicine patients

    International Nuclear Information System (INIS)

    Dantas, B.M.; Silva, C.O.A. da; Dantas, A.L.A.; Lucena, E.A.; Souza, W.O.

    2008-01-01

    99m Tc is the most widely used radionuclide in nuclear medicine. It is obtained by elution of 99 Mo- 99m Tc generators. Depending on the quality of the generator and its integrity, 99 Mo might be extracted from the column during the elution process, becoming a radionuclidic impurity in the 99m Tc eluate. This fact would impart an undesired dose to the patients submitted to diagnostic procedures using 99m Tc. The aims of this work are: to evaluate the incorporation of 99 Mo as a radionuclidic impurity using in vivo and in vitro techniques; to estimate the internal effective doses in nuclear medicine patients and; to provide additional information about the metabolic behavior of molybdenum in humans. A methodology based on in vivo measurements and urine sampling was developed to determine retention and excretion patterns of molybdenum in the human body. In vivo measurements were performed in IRD whole body counter using a NaI(Tl) 8”x4” scintillation detector. The detector is located inside a shielded room with internal dimensions of 2.5 x 2.5 x 2.65 meters. In vitro analysis was based on the collection of urine samples from the patients and was performed in IRD bioassay laboratory using a High Purity Germanium (HPGe) detection system. Four patients have been monitored by in vivo and in vitro measurements showing detectable activities of 99 Mo in whole body and urine samples. Bioassay results were interpreted by using AIDE software version 6. Estimated values of 99 Mo incorporation were compared to predicted values based on the standard metabolic model of molybdenum established by the International Commission of Radiological Protection (ICRP). Internal effective doses were estimated in the order of micro sieverts per examination. Based on the data obtained in this work it is suggested to implement a routine quality control program of radionuclidic impurity of 99 Mo in 99m Tc eluates to be conducted by radiopharmacy laboratories of nuclear medicine centers. (author)

  6. Prevalence of delirium in hospitalized internal medicine and surgical adult patients in Shohadaye ashayer hospital of Khoram abad

    Directory of Open Access Journals (Sweden)

    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.

  7. PHARMACOEPIDEMIOLOGICAL MONITORING OF ANTIDEPRESSANT USAGE IN PATIENTS WITH ANXIOUS AND DEPRESSIVE SYNDROMES IN INTERNAL MEDICINE

    Directory of Open Access Journals (Sweden)

    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.

  8. Pulmonary tuberculosis among diabetic patients in internal medicine at point g hospital, bamako - mali.

    Science.gov (United States)

    Sidibé, At; Dembélé, M; Diarra, As; Cissé, I; Bocoum, A; Traoré, Ak; Traoré, Ha

    2005-01-01

    Summary The depression of cellular immunity among diabetic patients exposes them to tuberculosis considered as one of the major diseases of immune-depressive people. The purpose of our study was to evaluate the frequency, gravity, treatment and evolution of pulmonary tuberculosis among our patients affected with diabetes. For that purpose, two descriptive retrospective and prospective studies were undertaken from January 1982 to December 1992 in the Internal Medicine (Internal medicine) department of Hospital of Point G, the national hospital. Thus, 54 diabetics patients hospitalised out of 1 365 had tuberculosis at a frequency rate of 3,95%. The average age of our patients was 49 years +/- 12 and the sex ratio was 2,18 in favour of men. The infection was also more frequent in diabetes type 1 (51,9%) then in type 2 (48,1%), and concerned mainly men (68.51%) who were more than 37 years old (57.41%). Clinically, the common signs to both affections were prevalent namely asthenia: 85,2%, anorexia: 53,7%, weight loss: 66,7%, associated to cough: 81,5% and to dyspnea: 29,6%. However, for a third of the patients (22,2%), tuberculosis was discovered during a systematic check up. All the patients had a glycemia higher than 8mmol/l, with extremes up to 8mmol/l and 32mmol/l, 63% of patient had a febricula. The intradermo cutaneous reaction to tuberculosis (IDR) was negative in 44,4%. The bacilloscopy during direct testing or through the liquid obtained by casing was positive in 64,82%. Tubercular lesions were localised at the top: 91,8%, with an equal attack of the two lungs. During the treatment six products were mainly used comprising Rifampicine (R) isoniazid (INH or H), Streptomycine (S), Ethambutol (E), Thiacetazone (T), and Pyrazinamide (Z). Insulin treatment was done on all patients until tuberculosis was cured. The evolution was favourable after 2 to 3 months of treatment for 48 patients (88,88%) among whom 4: (8,33%) fell sick again. Six patients out of 54 died, i

  9. [Internal medicine and the holistic approach to the patient between globalization and advanced technologies].

    Science.gov (United States)

    Dammacco, Franco

    2012-06-01

    Although Internal Medicine (IM) has played for many years a crucial role in the medical education and in the diagnostic framing of the most common diseases, starting from the beginning of the 70's the knowledge explosion, the recognition of the multidisciplinary nature of IM and the consequent impossibility for the Internist to master an ever growing array of notions have resulted in the development of specialized disciplines restricted to pathologies of single organs or apparatus. The parcelling out of medical knowledge has thus induced the onset of a number of specializations stemmed from IM and, as a direct consequence, an identity crisis of the same IM. Social transformations and variations in the epidemiology of several diseases have contributed to such crisis, including aging, frailty and disability, polypathology and chronicity. In the last few years, however, IM has regained a central role in medicine, in that the Internist is an expert of "medicine of complexity" and the only specialist able to envisage an holistic approach to the patient. The development of biotechnologies, characterized on one side by nanotechnologies and on the other by the instruments of diagnostic imaging, has provided an important contribution to make clinical medicine more and more precise and reliable. The genomic analysis of novel pharmacological targets has opened new therapeutic horizons, especially in the oncology field. A striking aspect of modern medicine, again based on unreasonable expectations of improvement and recovery, is the progressive increment of malpractice claims leading to an indemnity payment. Defensive medicine has been the answer to face this growing problem: physicians are in fact induced to prescribe a much higher number of often unnecessary examinations and laboratory tests, that result in a wasting rise of health costs. In view of the rapidly changing reality, it seems fair to ask the question as to whether in our country the medical education is abreast

  10. Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them?

    Science.gov (United States)

    Hansberry, David R; Agarwal, Nitin; John, Elizabeth S; John, Ann M; Agarwal, Prateek; Reynolds, James C; Baker, Stephen R

    2017-06-01

    The majority of Americans use the Internet daily, if not more often, and many search online for health information to better understand a diagnosis they have been given or to research treatment options. The average American reads at an eighth-grade level. The purpose of this study is to evaluate the readability of online patient education materials on the websites of 14 professional organizations representing the major internal medicine subspecialties. We used ten well-established quantitative readability scales to assess written text from patient education materials published on the websites of the major professional organizations representing the following subspecialty groups: allergy and immunology, cardiology, endocrinology, gastroenterology, geriatrics, hematology, hospice and palliative care, infectious disease, nephrology, oncology, pulmonology and critical care, rheumatology, sleep medicine, and sports medicine. Collectively the 540 articles analyzed were written at an 11th-grade level (SD 1.4 grade levels). The sleep medicine and nephrology websites had the most readable materials, written at an academic grade level of 8.5 ± 1.5 and 9.0 ± 0.2, respectively. Material at the infectious disease site was written at the most difficult level, with average readability corresponding to grades 13.9 ± 0.3. None of the patient education materials we reviewed conformed to the American Medical Association (AMA) and the National Institutes of Health (NIH) guidelines requiring that patient education articles be written at a third- to seventh-grade reading level. If these online resources were rewritten, it is likely that more patients would derive benefit from reading them.

  11. [Withholding and withdrawing treatment in patients admitted in an Internal Medicine ward].

    Science.gov (United States)

    García Caballero, R; Herreros, B; Real de Asúa, D; Alonso, R; Barrera, M M; Castilla, V

    2016-01-01

    Many of the patients admitted to a general medical ward have a compromised quality of life, or short life expectancy, so they are potential candidates for withhold/withdraw (WH/WD) treatment. The first objectif was to describe which measures were WH/WD among patients who died during their admission in a general medical ward from a tertiary hospital in Madrid. Secondly, to define the clinical characteristics of this population. A cross-sectional descriptive study during 6 months from 2011 and 2012 of all the patients dead while their admission in the Internal Medicine Department. 2007 patients were admitted, 211 died (10.5%). 121 (57%) were female, with 85±9 years of mean age. 103 (48.8%) came from a residential facility and 105 fulfilled terminality criteria (49.8%). One decision to WH/WD treatment was made in 182 patients (86.3%, CI 95%: 81.4-91.1), two in 99 cases (46.9%, CI 95%: 39.9-53.9) and 3 or more in 31 subjects (14.7%, CI 95%: 9.6-19.7). The most frequent decisions involved do-not-resuscitate orders (154, 73.0%), rejection of «aggressive treatment measures» (80, 38.0%), use of antibiotics (19, 9.0%), admission in ICU (18, 8.5%), and/or surgical treatment (11, 5.2%). WH/WD treatment is very frequent among patients who died in a general medical ward. The most frequent involved do-not-resuscitate orders and rejection of «aggressive treatment measures». WH/WD decisions are adopted in an elderly population, with extensive comorbidity and an elevated prevalence of advanced dementia and/or terminal disease. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  12. Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service.

    Science.gov (United States)

    Alim, Uzma; Bates, Duane; Langevin, Ashten; Werry, Denise; Dersch-Mills, Deonne; Herman, Robert J; Mintz, Marcy; Ghosh, Sunita

    2017-01-01

    Thiamine (vitamin B 1 ) is an essential cofactor responsible for the breakdown of glucose, and its deficiency is associated with Wernicke encephalopathy (WE). There is a lack of evidence from systematic studies on the optimal dosing of thiamine for WE. Objectives: The primary objective was to describe the prescribing patterns for IV thiamine in adult patients admitted to a large teaching hospital. The secondary objective was to evaluate the clinical resolution of WE symptoms (confusion, ataxia, and/or ocular motor abnormalities) in relation to the dose of IV thiamine prescribed. A retrospective design was used to review data for adult patients admitted to an internal medicine service from June 1, 2014, to June 30, 2015. All patients included in the study received IV thiamine: low-dose therapy was defined as 100 mg IV daily and high-dose therapy was defined as dosage greater than 100 mg IV daily. A total of 141 patients were included; low-dose thiamine was prescribed for 115 (81.6%) and high-dose thiamine for 26 (18.4%). Patients for whom high-dose thiamine was prescribed were more likely to be those in whom a diagnosis of WE was being considered (12/26 [46.2%] versus 5/115 [4.3%], p < 0.001). Of the total 219 IV thiamine doses ordered, 180 (82.2%) were for 100 mg, and 143 (65.3%) were prescribed for once-daily administration. There was no statistically significant difference in the time to resolution of WE symptoms for patients receiving high-dose versus low-dose thiamine. A wide variety of thiamine prescribing patterns were noted. This study did not show a difference in time to resolution of WE symptoms in relation to the dose of IV thiamine. Additional large-scale studies are required to determine the optimal dosing of thiamine for WE.

  13. Hemoglobin levels and blood transfusion in patients with sepsis in Internal Medicine Departments.

    Science.gov (United States)

    Muady, Gassan Fuad; Bitterman, Haim; Laor, Arie; Vardi, Moshe; Urin, Vitally; Ghanem-Zoubi, Nesrin

    2016-10-13

    Acute reduction in hemoglobin levels is frequently seen during sepsis. Previous studies have focused on the management of anemia in patients with septic shock admitted to intensive care units (ICU's), including aggressive blood transfusion aiming to enhance tissue oxygenation. To study the changes in hemoglobin concentrations during the first week of sepsis in the setting of Internal Medicine (IM) units, and their correlation to survival. Observational prospective study. We recorded hemoglobin values upon admission and throughout the first week of hospital stay in a consecutive cohort of septic patients admitted to IM units at a community hospital, the patients were enrolled into a prospective registry. Data on blood transfusions was also collected, we examined the correlation between hemoglobin concentrations during the first week of sepsis and survival, the effect of blood transfusion was also assessed. Eight hundred and fifteen patients (815) with sepsis were enrolled between February 2008 to January 2009. More than 20 % of them had hemoglobin levels less than 10g/dL on admission, a rate that was doubled during the first week of sepsis. Overall, 68 (8.3 %) received blood transfusions, 14 of them (20.6 %) due to bleeding. Typically, blood transfusion was given to older patients with a higher rate of malignancy and lower hemoglobin levels. While hemoglobin concentration on admission had strong correlation with in-hospital mortality (O.R-0.83 [95 % C.I. 0.74-0.92], blood transfusion was not found to be an independent predicting factor for mortality. Anemia is very common in sepsis. While hemoglobin level on admission exhibit independent correlation with survival, blood transfusion do not.

  14. Pathogen Profile of Patients with Sepsis in Internal Medicine, Dr. Hasan Sadikin General Hospital, Bandung 2013

    Directory of Open Access Journals (Sweden)

    Afiq Syazwan Fauzi

    2016-06-01

    Full Text Available Background: Sepsis is a continuous disease which begins with systemic inflammatory response syndrome (SIRS, seen in association with a large number of clinical conditions. These include infectious insults that produce SIRS, such as pancreatitis, ischemia, multiple traumas and tissue injury, hemorrhagic shock, immunemediated organ injury, and the exogenous administration of such putative mediators of the inflammatory process as tumor necrosis factor and other cytokines. A frequent complication of SIRS is the development of organ system dysfunction, including such well-defined clinical conditions as acute lung injury, shock, renal failure, and multiple organ dysfunction syndrome (MODS. Hence, this study was conducted to identify the pathogen profile that often causes sepsis. Methods: A retrospective study was performed to 152 medical records of patients diagnosed as sepsis from Internal Medicine Department Dr. Hasan Sadikin General Hospital from January 2013 to December 2013. The variables observed from the medical records were age, sex, comorbidity, main infection, culture sample, type of gram bacteria, resistant bacteria, and antibiotic susceptibility test. After data collection was completed, the data were analyzed using computer. The data were presented in percentage. Results: Sepsis in male was higher than female. Highest comorbid was chronic kidney disease (CKD. The main infection was health care acquired pneumonia (HCAP. Highest pathogen that caused sepsis was Escherichia coli and highest multidrug-resistant organism (MDRO was extended spectrum beta-lactamase (ESBL Escherichia coli. Conclusions: The most common pathogen that causes sepsis is Escherichia coli.

  15. Skills of internal medicine residents in disclosing medical errors: a study using standardized patients.

    Science.gov (United States)

    Stroud, Lynfa; McIlroy, Jodi; Levinson, Wendy

    2009-12-01

    To determine internal medicine (IM) residents' ability to disclose a medical error using standardized patients (SPs) and to survey residents' experiences of disclosure. In 2005, 42 second-year IM residents at the University of Toronto participated in the study. Each resident disclosed one medical error (insulin overdose) to an SP. The SP and a physician observer scored performance using a rating scale (1 = not performed, 2 = performed somewhat, and 3 = performed well) that measures error disclosure on five specific component skills and that provides an overall assessment score (scored on a five-point scale, 5 = high). Residents also completed a questionnaire. The mean scores on the five components were explanation of medical facts (2.60), honesty (2.31), empathy (2.47), future error prevention (1.99), and general communication skills (2.47). The residents' mean overall disclosure score was 3.53. Although 27 of 42 residents (64%) reported previous experience in disclosing an error to a patient during their training, only 7 (27%) of these residents reported receiving any feedback about their performance. Of 41 residents, 21 (51%) had received some prior training in disclosure, and 38 (93%) thought additional training would be useful and relevant. Disclosing medical error is now a standard practice. Experience with medical error begins early in training, and preparing trainees to discuss these errors is essential. Areas exist for improvement in residents' disclosure abilities, particularly regarding the prevention of future errors. Curricula to increase residents' skills and comfort in disclosure need to be implemented. Most residents would welcome further training.

  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. [The nature of internal medicine].

    Science.gov (United States)

    Federspil, G; Scandellari, C

    1994-01-01

    We investigate here the problem of the nature of Internal Medicine in the context of the different medical disciplines. After reviewing the origins of Internal Medicine and the changes it has undergone since the early 19th century, we deal with the present crisis of this medical branch and the reasons for it. In Italy, the crisis of Internal Medicine began at the dawn of this century when Neurology became a distinct discipline, isolated from the rest of Clinical Medicine. The present-day crisis is determined by the fact that the different constituent parts of Special Medical Pathology have become autonomous specialist disciplines: this situation has convinced some specialists that Internal Medicine, as a single branch, no longer exists. We thus examine the "justification" for the existence of Internal Medicine. Specialist disciplines were originally created to permit deeper analysis of pathological phenomena; however, the great emphasis on detailed and precise analysis of the different phenomena has paved the way for immense progress in pathophysiology and diagnosis, while the synthetic approach fundamental to Clinical Medicine has been neglected. After referring to Claude Bernard's idea that an organism is greater than the sum of its parts, we note that nowadays considerable importance is given to the "whole", that is, to the global study of very complex systems. We thus examine the thesis of Internal Medicine (which views the organism as a whole) as the specific clinical tool enabling the physician to evaluate each single pathophysiological phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Prevalence of secondary hyperparathyroidism in patients with stage 3 and 4 chronic kidney disease seen in internal medicine.

    Science.gov (United States)

    Bureo, Juan Carlos; Arévalo, Jose Carlos; Antón, Joaquín; Adrados, Gaspar; Jiménez Morales, Jose Luis; Robles, Nicolás Roberto

    2015-01-01

    Despite the high prevalence of chronic kidney disease in the elderly population, few data are available on the frequency of secondary hyperparathyroidism in the Spanish population affected by this problem. We undertook a study on this issue in patients attending the internal medicine departments in our area. An observational, cross-sectional survey performed at internal medicine departments on 415 patients with stage 3 and 4 chronic kidney disease. Clinical history and risk factors were collected using a standardized protocol. Serum creatinine, phosphate, calcium, intact parathormone (PTH) and 25-hydroxy-cholecalciferol (25-OH-vitD) levels were measured in all patients. Among stage 3 patients, 62.9% had PTH levels ≥70pg/mL and 32.7% levels ≥110pg/mL. Median PTH level in stage 4 patients was 120pg/mL (p Hyperparathyroidism is a common complication of stage 3 and 4 chronic kidney disease which is not associated to detectable changes in serum calcium and phosphate levels. It is therefore advisable to measure PTH levels in all patients with decreased glomerular filtration rate. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  19. Index of international publications in aerospace medicine.

    Science.gov (United States)

    2014-05-01

    The 5th edition of the Index of International Publications in Aerospace Medicine is a comprehensive : listing of international publications in clinical aerospace medicine, operational aerospace medicine, : aerospace physiology, environmental medicine...

  20. Index of international publications in aerospace medicine

    Science.gov (United States)

    2001-08-01

    The Index of International Publications in Aerospace Medicine is a comprehensive listing of international publications in clinical aerospace medicine, operational aerospace medicine, aerospace physiology, environmental medicine/physiology, diving med...

  1. Has beta-blocker use increased in patients with heart failure in internal medicine settings? Prognostic implications: RICA registry.

    Science.gov (United States)

    González-García, Andrés; Montero Pérez-Barquero, Manuel; Formiga, Francesc; González-Juanatey, José R; Quesada, M Angustias; Epelde, Francisco; Oropesa, Roberto; Díez-Manglano, Jesús; Cerqueiro, José M; Manzano, Luis

    2014-03-01

    Underuse of beta-blockers has been reported in elderly patients with heart failure. The aim of this study was to evaluate the current prescription of beta-blockers in the internal medicine setting, and its association with morbidity and mortality in heart failure patients. The information analyzed was obtained from a prospective cohort of patients hospitalized for heart failure (RICA registry] database, patients included from March 2008 to September 2011) with at least one year of follow-up. We investigated the percentage of patients prescribed beta-blockers at hospital discharge, and at 3 and 12 months, and the relationship of beta-blocker use with mortality and readmissions for heart failure. Patients with significant valve disease were excluded. A total of 515 patients were analyzed (53.5% women), with a mean age of 77.1 (8.7) years. Beta-blockers were prescribed in 62.1% of patients at discharge. A similar percentage was found at 3 months (65.6%) and 12 months (67.9%) after discharge. All-cause mortality and the composite of all-cause mortality and readmission for heart failure were significantly lower in patients treated with beta-blockers (hazard ratio=0.59, 95% confidence interval, 0.41-0.84 vs hazard ratio=0.64, 95% confidence interval, 0.49-0.83). This decrease in mortality was maintained after adjusting by age, sex, ejection fraction, functional class, comorbidities, and concomitant treatment. The findings of this study indicate that beta-blocker use is increasing in heart failure patients (mainly elderly) treated in the internal medicine setting, and suggest that the use of these drugs is associated with a reduction in clinical events. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  2. Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA.

    Science.gov (United States)

    Gurvits, Grigoriy E; Lan, Gloria; Tan, Amy; Weissman, Arlene

    2017-06-01

    Increasing prevalence of inflammatory bowel disease (IBD) poses significant challenges to medical community. Preventive medicine, including vaccination against opportunistic infections, is important in decreasing morbidity and mortality in patients with IBD. We conduct first study to evaluate general awareness and adherence to immunisation guidelines by primary care physicians in the USA. We administered an electronic questionnaire to the research panel of the American College of Physicians (ACP) assessing current vaccination practices, barriers to vaccination and provider responsibility for administering vaccinations and compared responses with the European Crohn's and Colitis Organization consensus guidelines and expert opinion from the USA. All of surveyed physicians (276) had experience with patients with IBD and spent majority of their time in direct patient care. 49% of physicians took immunisation history frequently or always, and 76% reported never or rarely checking immunisation antibody titres with only 2% doing so routinely. 65% of physicians believed that primary care providers (PCPs) were responsible for determining patient's immunisation. Vaccine administration was felt to be the duty of primary care doctor 80% of the time. 2.5% of physicians correctly recommended vaccinations all the time. Physicians were more likely to recommend vaccination to immunocompetent than immunocompromised patients. Up to 23% of physicians would incorrectly recommend live vaccine to immunocompromised patients with IBD. Current knowledge and degree of comfort among PCPs in the USA in preventing opportunistic infections in IBD population remain low. Management of patients with IBD requires structured approach to their healthcare maintenance in everyday practice, including enhanced educational policy aimed at primary care physicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. 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...

  4. [Infectious diseases - a specialty of internal medicine].

    Science.gov (United States)

    Fätkenheuer, G; Jung, N; Kern, W V; Fölsch, U R; Salzberger, B

    2018-04-01

    Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.

  5. Course on internal dosimetry in nuclear medicine

    International Nuclear Information System (INIS)

    2004-01-01

    This documentation was distributed to the participants in the Course of Internal Dosimetry in Nuclear Medicine organised by the Nuclear Regulatory Authority (ARN) of Argentina and held in Buenos Aires, Argentina, August 9-13, 2004. The course was intended for people from IAEA Member States in the Latin American and Caribbean region, and for professionals and workers in medicine, related with the radiation protection. Spanish and English were the languages of the course. The following subjects were covered: radioprotection of the patient in nuclear medicine; injuries by ionizing radiations; MIRD methodology; radiation dose assessment in nuclear medicine; small scale and microdosimetry; bone and marrow dose modelling; medical internal dose calculations; SPECT and image reconstruction; principles of the gamma camera; scattering and attenuation correction in SPECT; tomography in nuclear medicine

  6. Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic.

    Science.gov (United States)

    Lafreniere, Justin P; Rios, Rebeca; Packer, Hillary; Ghazarian, Sharon; Wright, Scott M; Levine, Rachel B

    2016-02-01

    Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy. To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents. Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland. Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244). Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis. Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.

  7. International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents.

    Science.gov (United States)

    Strapazzon, Giacomo; Reisten, Oliver; Argenone, Fabien; Zafren, Ken; Zen-Ruffinen, Greg; Larsen, Gordon L; Soteras, Inigo

    2018-02-13

    Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  8. Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit.

    Directory of Open Access Journals (Sweden)

    Milena Urfer

    Full Text Available Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice.To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy.We assessed the efficacy and safety of a 5-point checklist to be used by all physicians on the internal medicine wards of a Swiss hospital by comparing outcomes in 450 consecutive patients aged ≥65 years hospitalized after the introduction of the checklist, and in 450 consecutive patients ≥65 years hospitalized before the introduction of the checklist. The main measures were the proportion of patients with prescription of potentially inappropriate medications (PIMs at discharge, according to STOPP criteria, and the number of prescribed medications at discharge, before and after the introduction of the checklist. Secondary outcomes were the prevalence of polypharmacy (≥ 5 drugs and hyperpolypharmacy (≥ 10 drugs, and the prevalence of potentially inappropriate prescribing omissions (PPOs according to START criteria.At admission 59% of the 900 patients were taking > 5 drugs, 13% ≥ 10 drugs, 37% had ≥ 1 PIM and 25% ≥ 1 PPO. The introduction of the checklist was associated with a significant reduction by 22% of the risk of being prescribed ≥ 1 PIM at discharge (adjusted risk ratios [RR] 0.78; 95% CI: 0.68-0.94, but not with a reduction of at least 20% of the number of drugs prescribed at discharge, nor with a reduction of the risk of PPOs at discharge.The introduction of an easy-to-use 5-point checklist aimed at supporting therapeutic reasoning of physicians on internal medicine wards significantly reduced the risk of prescriptions of inappropriate medications at discharge.

  9. PREVALENCE OF DIABETIC RETINOPATHY IN PATIENT TYPE 2 DIABETES MELLITUS AT INTERNAL MEDICINE POLICLINIC SANGLAH HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ni Made Sintia Anggia Sari

    2013-05-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE One of the complications that can occur in microvaskular diabetes mellitus is diabetic retinopathy. This research was carried out to know the prevalence of diabetic retinopathy in patients type 2 diabetes mellitus at internal divison of Sanglah Hospital. The method used is cross sectional by collecting data from the questionnaire and secondary data of medical record patient's type 2 DM. On this research acquired 111 patients (35.1% with diabetic retinopathy and (64,9% nonretinopathy. In the group with good level of HbA1c (<6.5% the prevalence of diabetic retinopathy obtained 53.2%, in the group of patients with moderate level of HbA1c (6.5-8% as much as 22.5%, and in the group of patients with HbA1c bad level (>8% as much as 24.3%. The prevalence of the occurrence of DM complications in the diabetic retinopathy is still high, and a good level of HbA1c does not guarantee a person can’t have complication because the complication can also happens are affected by hypertension, dyslipidemia, age, and duration of DM. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  10. TRACER: an 'eye-opener' to the patient experience across the transition of care in an internal medicine resident program.

    Science.gov (United States)

    Meade, Lauren B; Hall, Susana L; Kleppel, Reva W; Hinchey, Kevin T

    2015-01-01

    A safe patient transition requires a complex set of physician skills within the interprofessional practice. To evaluate a rotation which applies self-reflection and workplace learning in a TRAnsition of CarE Rotation (TRACER) for internal medicine (IM) residents. TRACER is a 2-week required IM resident rotation where trainees join a ward team as a quality officer and follow patients into postacute care. In 2010, residents participated in semistructured, one-on-one interviews as part of ongoing program evaluation. They were asked what they had learned on TRACER, the year prior, and how they used those skills in their practice. Using transcripts, the authors reviewed and coded each transcript to develop themes. Five themes emerged from a qualitative, grounded theory analysis: seeing things from the other side, the 'ah ha' moment of fragmented care, team collaboration including understanding nursing scope of practice in different settings, patient understanding, and passing the learning on. TRACER gives residents a moment to breathe and open their eyes to the interprofessional practice setting and the patient's experience of care in transition. Residents learn about transitions of care through self-reflection. This learning is sustained over time and is valued enough to teach to their junior colleagues.

  11. Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry.

    Science.gov (United States)

    Gullón, Alejandra; Suárez, Carmen; Díez-Manglano, Jesús; Formiga, Francesc; Cepeda, José María; Pose, Antonio; Camafort, Miguel; Castiella, Jesús; Rovira, Eduardo; Mostaza, José María

    2017-03-03

    The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies. Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments. We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants. Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  12. [Medically unexplained symptoms' care in internal medicine: A paradigm of doctor-patient relationship in situation of uncertainty].

    Science.gov (United States)

    Ranque, B; Nardon, O

    2017-07-01

    Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered. Patients with MUS are regularly abused by the doctors, who unwittingly participate in the maintenance of their symptoms and even freeze them, leading to disastrous psychosocial and economic consequences. Yet the doctor-patient relationship is the key to their recovery or, at least, their improvement. The means of a successful patient-centered relationship are not always intuitive but can be learned. It is therefore essential to include SMI in medical school curricula and post-graduate medical education. Finally, if the management of early MUS mainly concerns the family medicine, that of severe MUS, including some fibromyalgia and chronic fatigue syndromes, falls within the scope of the internist doctor, who should be able to deliver a comprehensive care in partnership with the general practitioner and possibly a psychiatrist. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  13. [Direct costs and clinical aspects of adverse drug reactions in patients admitted to a level 3 hospital internal medicine ward].

    Science.gov (United States)

    Tribiño, Gabriel; Maldonado, Carlos; Segura, Omar; Díaz, Jorge

    2006-03-01

    Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. Intensive follow-ups for a cohort of patients were conducted for a five month period in order to detect ADRs; different ways to classify them, according to literature, were considered as well. Information was collected using the INVIMA reporting format, and causal probability was evaluated with the Naranjo algorithm. Direct costs were calculated from the perspective of payer, based on the following costs: additional hospital stay, medications, paraclinical tests, additional procedures, patient displacement to intermediate or intensive care units, and other costs. Of 836 patients admitted to the service, 268 adverse drug reactions were detected in 208 patients (incidence proportion 25.1%, occurence rate 0.32). About the ADRs found, 74.3% were classified as probable, 92.5% were type A, and 81.3% were moderate. The body system most often affected was the circulatory system (33.9%). Drugs acting on the blood were most frequently those ones associated with adverse reactions (37.6%). The costs resulting from medical care of adverse drug reactions varied from COL dollar 93,633,422 (USD dollar 35,014.92) to COL dollar 122,155,406 (USD dollar 45,680.94), according to insurance type, during the study period. Adverse drug reactions have a significant negative health and financial impact on patient welfare. Because of the substantial resources required for their medical care and the significant proportion of preventable adverse reactions, active programs of institutional pharmacovigilance are highly recommended.

  14. [What's new in internal medicine?].

    Science.gov (United States)

    Blétry, O; Sene, T; Kahn, J-E; Ackermann, F; Charles, P; Leport, J; Piette, A-M

    2009-12-01

    Among diagnostic progress over the last three years in internal medicine, Antisynthetase Syndrome is now more easily recognised with the diffusion of laboratory tests for research of antibodies against tRNA synthetases (Anti JO1, anti PL7, Anti PL12). In two third of cases, these antibodies are found despite absence of antinuclear antibodies. Hence, we have to search them specifically in patients with polyarthritis associated with myositis, cutaneous manifestations (Raynaud phenomenom and "mechanic'hands") and interstitial lung disease. Discovery of asymptomatic mutation in the L ferritin coding sequence help us to better understand the "unexplained" hyperferritinemia. Initially described by japonese gastroenterologists, auto immune pancreatitis in fact a part of a systemic sclerosing disease with a biochemical hallmark: in crease of a subclass of immunoglobulins G (IgG4). A new pediatric disease due to a deficiency of the interleukin1 receptor antagonist (multifocal aseptic osteitis, periostitis, stomatitis, disseminated pustulosis) help us to better understand unexplained auto inflammatory diseases. The therapeutic progress is primarily due to an explosion of biological therapies, particularly four of them very useful for internists (in an off label use) : Interleukin 1 inhibitors (anakinra, Canakinumab) to treat some auto inflammatory diseases (cryopirin associated periodic syndromes and deficency of interleukin 1 receptor antagonist), monoclonal antibody against interleukin 5 (mepolizumab) to treat some hypereosinophilic syndromes and Churg and Strauss angiitis, interleukin 6 inhibitiors to treat multifocal Castleman's disease and adult Still disease, a monoclonal antibody against vascular endothelial growth factor (Bevacizumab) to treat hereditary hemorrhagic telangiectasia. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  15. [Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain].

    Science.gov (United States)

    Reig-Rosello, G; Contreras, M M; Suarez-Fernandez, C; Gonzalez-Hernandez, A; Cardona, P; Pons-Amate, J M; Marti-Fabregas, J; Vivancos, J

    2017-10-16

    To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high.

  16. Screening of distress among hospitalized patients in a department of internal medicine.

    Science.gov (United States)

    Rosselli, Massimo; Salimbeni, Maria Vittoria; Bessi, Caterina; Nesi, Elisa; Caruso, Stefania; Arboretti, Daria; Migliorini, Elodie; Caterino, Elvira; Parentini, Elisa; Generini, Sergio; Zipoli, Massimo; Romanelli, Roberto Giulio; Rosselli, Matteo; Marra, Fabio; Laffi, Giacomo; Stasi, Cristina

    2015-12-01

    A psychosomatic approach to the basic screening of distress for patient care in hospitals and other health services is presented. The aims of this study were to verify association between: (1) medical illnesses and distress; (2) patients' needs and distress; (3) type of illness and patients' needs; (4) patients' needs and sense of coherence. One hundred and eighty-nine patients (78 F and 111 M, average age 65 years±8.43) were assessed by self-report questionnaires. We found that higher anxiety and/or depression levels were associated with urogenital (p=0.026), rheumatologic (p=0.006), oncological (p=0.011), neurological (p=0.026) and respiratory (p=0.013) illnesses. Higher distress scoring was associated with rheumatologic illnesses (p=0.024) and illnesses of the liver and digestive system (p=0.037) while a higher severity of distress was associated with oncological illnesses (p=0.011). Depression/anxiety were associated with the need to speak to a psychologist (p=0.050), to a spiritual advisor (p=0.009), to be more reassured by relatives (p=0.017), to feel less abandoned (p=0.036). Only low sense of coherence was associated with the need for greater dialogue with physicians (p=0.012), the need to participate less in treatment decisions (p=0.041), the need to feel less left to one's own devices (p=0.023). Several needs are associated with medical illnesses. In conclusion, these results indicate that early psychological screening could be important to avoid worse or chronic distress. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients.

    Science.gov (United States)

    Duarte, Jurandir Godoy; Azevedo, Raymundo Soares

    2017-06-01

    To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pPatients do not seem to notice much difference to the quality of the consultation done using paper or EHR. It became clear after the third evaluation with the

  18. Internal medicine. An illustrated radiological guide

    Energy Technology Data Exchange (ETDEWEB)

    Al-Tubaikh, Jarrah Ali [Universitaetsklinikum Muenchen, Klinikum Grosshadern (Germany). Inst. fuer Klinische Radiologie; Sabah Hospital, Kuwait (Kuwait). Dept. of Diagnostic Radiology

    2010-07-01

    This book explains how radiology can be a powerful tool for establishing the diagnosis of many internal medicine diseases that are usually diagnosed on the basis of their laboratory or clinical presentation. It is organized in the classic fashion for internal medicine books, with eleven chapters covering the different internal medicine specialties. Within these chapters, more than 450 diseases are considered, some of which are rarely encountered but are nonetheless significant. For each disease, radiological and clinical features are displayed in images and high-quality digital medical illustrations, and those differential diagnoses are identified that can be ruled out by imaging alone. In addition, the pathophysiology underlying the radiological features is described, enabling the reader to understand why a particular sign is seen on MR images, CT scans, or plain radiographs. The book will serve as an excellent radiological atlas for internal medicine practitioners and family physicians, showing disease presentations that may be hard to find in standard medical textbooks and explaining which imaging modalities are likely to be most informative in particular patients. (orig.)

  19. [Recent advances in internal medicine].

    Science.gov (United States)

    Von Düring, Stephan; Mavrakanas, Thomas; Muller, Halima; Primmaz, Steve; Grosgurin, Olivier; Louis Simonet, Martine; Marti, Christophe; Nendaz, Mathieu; Serratrice, Jacques; Stirnemann, Jérome; Carballo, Sebastian; Darbellay Farhoumand, Pauline

    2018-01-17

    In medicine, there are progresses which radically transform practices, change recommendations and win unanimous support in the medical community. There are some which divide, questioning principles that seemed established. There are also small advances, which can answer the questions that internists ask themselves in the daily care of their patients. Here are several articles published in 2017, read and commented for you by hospitalists, selected according to their impact on the medical world.

  20. 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.

  1. Candidemia in Patients with Body Temperature Below 37°C and Admitted to Internal Medicine Wards: Assessment of Risk Factors.

    Science.gov (United States)

    Tascini, Carlo; Falcone, Marco; Bassetti, Matteo; De Rosa, Francesco G; Sozio, Emanuela; Russo, Alessandro; Sbrana, Francesco; Ripoli, Andrea; Merelli, Maria; Scarparo, Claudio; Carmassi, Franco; Venditti, Mario; Menichetti, Francesco

    2016-12-01

    An increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or without fever. We retrospectively review data charts from 3 tertiary care, university hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were identified during the 3-year study period. Patient baseline characteristics and several infection-related variables were examined. Random forest analysis was used, given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia episodes. Factors associated with the lack of fever at onset of candidemia were diabetes, Clostridium difficile infection, and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever, and no differences on 30-day mortality rate were documented in the 2 study groups. Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken, and a timely

  2. Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study

    DEFF Research Database (Denmark)

    Strøm, Camilla; Mollerup, Talie Khadem; Kromberg, Laurits Schou

    2017-01-01

    BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Interna......, unplanned readmission, and nosocomial infection. CONCLUSIONS: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department....

  3. What skills should new internal medicine interns have in july? A national survey of internal medicine residency program directors.

    Science.gov (United States)

    Angus, Steven; Vu, T Robert; Halvorsen, Andrew J; Aiyer, Meenakshy; McKown, Kevin; Chmielewski, Amy F; McDonald, Furman S

    2014-03-01

    The transition from medical student to intern may cause stress and burnout in new interns and the delivery of suboptimal patient care. Despite a formal set of subinternship curriculum guidelines, program directors have expressed concern regarding the skill set of new interns and the lack of standardization in that skill set among interns from different medical schools. To address these issues, the Accreditation Council for Graduate Medical Education's Next Accreditation System focuses on the development of a competency-based education continuum spanning undergraduate, graduate, and continuing medical education. In 2010, the Clerkship Directors in Internal Medicine subinternship task force, in collaboration with the Association of Program Directors in Internal Medicine survey committee, surveyed internal medicine residency program directors to determine which competencies or skills they expected from new medical school graduates. The authors summarized the results using categories of interest. In both an item rank list and free-text responses, program directors were nearly uniform in ranking the skills they deemed most important for new interns-organization and time management and prioritization skills; effective communication skills; basic clinical skills; and knowing when to ask for assistance. Stakeholders should use the results of this survey as they develop a milestone-based curriculum for the fourth year of medical school and for the internal medicine subinternship. By doing so, they should develop a standardized set of skills that meet program directors' expectations, reduce the stress of transitions across the educational continuum, and improve the quality of patient care.

  4. First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study

    Directory of Open Access Journals (Sweden)

    Kajiwara N

    2017-10-01

    Full Text Available Nobuyuki Kajiwara,1 Kazuyuki Hayashi,1 Masahiro Misago,2 Shinichiro Murakami,2 Takato Ueoka2 1Department of Nephrology, Ikeda City Hospital, 2Department of General Medicine, Ikeda City Hospital, Johnan, Osaka, Japan Purpose: We sought to profile first-time patients without a referral who sought medical care at the Department of Internal Medicine at a medium-sized acute care hospital in Japan. We anticipated that the analysis would highlight the demand for medical care needs from acute care hospitals and help confirm one of the problems associated with primary care in Japan. Patients and methods: The study population comprised 765 patients who sought outpatient consultation without a referral at “the Department of General Internal Medicine” at the Ikeda City Hospital on Fridays over 4 years. Data on the following variables were collected: age, sex, examination date, reason for encounter (RFE, diagnosis, as well as history of consultation with or without antibiotic treatment at another medical institution for the same RFE. We used the International Classicication of Primary Care, Revised Second edition (ICPC-2-R codes for RFEs and diagnoses. Results: The main RFE fields were digestive (ICPC-2-R Chapter D, general and unspecified (A, and respiratory (R. The main diagnosis fields were digestive (D, respiratory (R, general and unspecified (A, and musculoskeletal (L. In total, 27.6% of patients had sought consultation at another medical institution for the same RFE. Of these, 64.7% of patients for whom the RFE was cough (ICPC-2-R code, R05, and 72.0% for whom the RFE was fever (A03 were prescribed antibiotics. In total, 62.4% of patients underwent emergency investigations and waited for the results; 4.3% were hospitalized on the same day; and 60.5% were medicated at the initial examination. In 11.5%, the main underlying problem appeared to be psychosomatic. Conclusion: We used the ICPC-2-R to analyze the state of first-visit patients without a

  5. The new UK internal medicine curriculum .

    Science.gov (United States)

    Black, David

    2017-04-01

    Reform of physician education is needed to meet the needs of patients, based on comorbidities, chronic disease management and complexity. The Joint Royal Colleges of Physicians Training Board has developed a new internal medicine curriculum for physician training that aims to not only deliver this expectation, but will simplify competency-based education, smooth the transition to the medical registrar role and hopefully fill some of the current empty funded training posts. However, the change process is complex and requires close working with the General Medical Council and other partners in curriculum delivery. © Royal College of Physicians 2017. All rights reserved.

  6. Rational error in internal medicine.

    Science.gov (United States)

    Federspil, Giovanni; Vettor, Roberto

    2008-03-01

    Epistemologists have selected two basic categories: that of errors committed in scientific research, when a researcher devises or accepts an unfounded hypothesis, and that of mistakes committed in the application of scientific knowledge whereby doctors rely on knowledge held to be true at the time in order to understand an individual patient's signs and symptoms. The paper will deal exclusively with the latter, that is to say the mistakes which physicians make while carrying out their day-to-day medical duties. The paper will deal with the mistakes committed in medicine trying also to offer a classification. It will take into account also examples of mistakes in Bayesian reasoning and mistakes of reasoning committed by clinicians regard inductive reasoning. Moreover, many other mistakes are due to fallacies of deductive logic, logic which they use on a day-to-day basis while examining patients in order to envisage the consequences of the various diagnostic or physiopathologic hypotheses. The existence of a different type of mistakes that are part of the psychology of thought will be also pointed out. We conclude that internists often make mistakes because, unknowingly, they fail to reason correctly. These mistakes can occur in two ways: either because he does not observe the laws of formal logic, or because his practical rationality does not match theoretical rationality and so his reasoning becomes influenced by the circumstances in which he finds himself.

  7. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy.

    Science.gov (United States)

    Meschi, Tiziana; Ticinesi, Andrea; Prati, Beatrice; Montali, Arianna; Ventura, Antonio; Nouvenne, Antonio; Borghi, Loris

    2016-08-01

    Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay managerial attitude, and by elaboration of an early personalized discharge plan anticipating every patient's needs according to lean methodology principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.

  8. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    Science.gov (United States)

    von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

    2018-01-01

    Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  9. Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study.

    Science.gov (United States)

    Gorski, Stanislaw; Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina; Grodzicki, Tomasz

    2017-01-01

    Purpose . Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods . Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy medicine ward.

  10. Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine.

    Science.gov (United States)

    Gómez-Huelgas, R; Pérez-Jiménez, F; Serrano-Ríos, M; González-Santos, P; Román, P; Camafort, M; Conthe, P; García-Alegría, J; Guijarro, R; López-Miranda, J; Tirado-Miranda, R; Valdivielso, P

    2014-05-01

    Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians' decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  11. How to treat a patient with chronic low back pain - methodology and results of the first international case conference of integrative medicine.

    Science.gov (United States)

    Brinkhaus, Benno; Lewith, George; Rehberg, Benno; Heusser, Peter; Cummings, Mike; Michalsen, Andreas; Teut, Michael; Willich, Stefan N; Irnich, Dominik

    2011-02-01

    Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described. The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method. The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment

  12. Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial.

    Science.gov (United States)

    Thomas, Kris G; Thomas, Matthew R; Stroebel, Robert J; McDonald, Furman S; Hanson, Gregory J; Naessens, James M; Huschka, Todd R; Kolars, Joseph C

    2007-12-01

    Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes. To assess the effects of a registry-generated audit, feedback, and patient reminder intervention on diabetes care. Randomized controlled trial conducted in a resident continuity clinic during the 2003-2004 academic year. Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n = 39) received instruction on diabetes registry use; quarterly performance audit, feedback, and written reports identifying patients needing care; and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n = 39) received usual clinic education. Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.

  13. The accelerated internal medicine program at the University of Kentucky.

    Science.gov (United States)

    Thompson, J S; Haist, S A; DeSimone, P A; Engelberg, J; Rich, E C

    1992-06-15

    Concern is growing about the ability of categorical medicine residency programs, structured within academic health centers, to provide balanced, progressive, postgraduate internal medicine education. Detrimental factors, including over-representation of critically ill patients, shortened length of hospitalization, stress, discontinuity between undergraduate and graduate training, rotational assignments driven by hospital service imperatives, and total costs, may all negatively affect internal medicine residency education. Therefore, an experimental accelerated internal medicine (AIM) curriculum combining 3 years of undergraduate with 3 years of graduate internal medicine education has been initiated by the Department of Medicine and the College of Medicine at the University of Kentucky. After completion of the third year and during the first 13 months of the AIM curriculum, selected students are rotated through an integrated series of educational experiences that incorporate all of the requirements for graduation from medical school and progressively advance the students' skills, knowledge, and responsibilities to that of a second-year resident. Thereafter, the curriculum is similar to that of the categorical residents, except that more ambulatory care and off-site rotations are interspersed to better provide the educational experiences representative of the practice of internal medicine. Evaluations of the first groups of AIM residents indicate that their performance has equaled that of the control residents who graduated after 4 years from the College of Medicine. Furthermore, the AIM residents report general acceptance by their fellow residents and attending physicians and report no undue stress in making the transition.

  14. 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. © 2013 Society of Hospital Medicine.

  15. International Journal of Medicine and Health Development ...

    African Journals Online (AJOL)

    Author Guidelines. International Journal of Medicine and Health Development is a peer reviewed journal with the following purposes: To publish contributions in clinical and basic science research, in all field of medicine. To publish contributions in the prevention, care and treatment of diseases, and on the promotion of ...

  16. Cognitive Diagnostic Error in Internal Medicine

    NARCIS (Netherlands)

    C.K.A. van den Berge (Kees)

    2012-01-01

    textabstractThis thesis focuses on the subject of cognitive diagnostic error in internal medicine; mistakes resulting from flaws in physicians’ reasoning processes. More specifically, this thesis addresses errors caused by confirmation and availability bias. Recently, the potential of cognitive

  17. International Journal of Medicine and Biomedical Research

    African Journals Online (AJOL)

    International Journal of Medicine and Biomedical Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 3 (2016) >. Log in or Register to get access to full text downloads.

  18. 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

  19. Internal medicine trainee self-assessments of end-of-life communication skills do not predict assessments of patients, families, or clinician-evaluators.

    Science.gov (United States)

    Dickson, Robert P; Engelberg, Ruth A; Back, Anthony L; Ford, Dee W; Curtis, J Randall

    2012-04-01

    To investigate the strength of association between trainees' self-assessments of the quality of their end-of-life communication skills and the assessments of their patients, patients' families, and clinician-evaluators. As part of a randomized trial, pre-intervention survey data were collected at two sites from internal medicine trainees and their patients, patients' families, and clinician-evaluators. In this observational analysis, comparisons using regression analysis were made between (1) trainees' scores on a scale of perceived competence at communication about end-of-life care and (2) patients', families', and clinician-evaluators' scores on a questionnaire on the quality of end-of-life communication (QOC). Secondary analyses were performed using topic-focused subscales of these measures. Internal medicine trainees (143) were studied with both self-assessment and external assessments. No significant associations were found between trainee perceived competence scores and primary outcome measures (p>0.05). Of the 12 secondary subscale analyses, trainees' self-ratings were significantly associated with external assessments for only one comparison, but the association was in the opposite direction with increased trainee ratings being significantly associated with decreased family ratings on "treatment discussions." We also examined the correlation between ratings by patients, family, and clinician-evaluators, which showed significant correlations (pcommunication. Although these results should be confirmed using the same measures across all raters, in the meantime efforts to improve communication about end-of-life care should consider outcomes other than physician self-assessment to determine intervention success.

  20. Diagnostic imaging in internal medicine

    International Nuclear Information System (INIS)

    Eisenberg, R.L.

    1985-01-01

    This book examines medical diagnostic techniques. Topics considered include biological considerations in the approach to clinical medicines; infectious diseases; disorders of the heart; disorders of the vascular system; disorders of the respiratory system; diseases of the kidneys and urinary tract; disorders of the alimentary tract; disorders of the hepatobiliary system and pancreas; disorders of the hematopoietic system; disorders of bone and bone mineralization; disorders of the joints, connective tissues, and striated muscles; disorders of the nervous system; miscellaneous disorders; and procedures in diagnostic imaging

  1. [Knowledge, attitude and opinion of patients regarding the new German legislation on advance care planning : Results of a survey in a department of general internal medicine].

    Science.gov (United States)

    Elmeadawy, S; Fitzner, C; Elsner, F; Dietrich, C G

    2017-02-01

    In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear. Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation. A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation. Approximately 40 % of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5 % were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21 % of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80 % of the patients voted for pain control in the palliative setting. The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.

  2. Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

    Directory of Open Access Journals (Sweden)

    Paolo Biagi

    2014-03-01

    Full Text Available The incidence and prevalence of chronic heart failure are increasing worldwide, as is the number of very old patients (>85 years affected by this disease. The aim of this sub-analysis of the multicenter, observational CONFINE study was to detect clinical and therapeutic peculiarities in patients with chronic heart failure aged >85 years. We recruited patients admitted with a diagnosis of chronic heart failure and present in the hospital in five index days, in 91 Units of Internal Medicine. The patients’ clinical characteristics, functional and cognitive status, and the management of the heart failure were analyzed. A total of 1444 subjects were evaluated, of whom 329 (23.1% were over 85 years old. Signs and symptoms of chronic heart failure were more common in very old patients, as were severe renal insufficiency, anemia, disability and cognitive impairment. The present survey found important age-related differences (concomitant diseases, cognitive status among patients with chronic heart failure, as well as different therapeutic strategies and clinical outcome for patients over 85 years old. Since these patients are usually excluded from clinical trials and their management remains empirical, specific studies focused on the treatment of very old patients with chronic heart failure are needed.

  3. 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.

  4. [Cross-sectional analysis of heart failure among patients in the Internal Medicine Service at a third-level hospital. Part I: epidemiologic analysis].

    Science.gov (United States)

    Cinza Sanjurjo, S; Cabarcos Ortiz de Barrón, A; Enrique Nieto Pol, E; Torre Carballada, J A

    2007-06-01

    To observe the epidemiologic characteristics of the patients intake during five years in a internal medicine department, with heart failure. A cross-sectional study of the intake patients in the Internal Medicine Service in the Hospital Clínico Universitario de Santiago de Compostela between 1999 to 2003. The variables analized were: sex, age, days of hospital stay, number of intake by failure cardiac, reason for admission (guide symptom), hypertension, diabetes mellitus, cardiac disease, fibrillation atrium, previous treatment with beta-blockers, blood pressure in the admission moment, to make echocardiography, disfunction systolic, etiology, deceased, treatment at the end. The statistical analysis was performed with qualitative and quantitative measures, chi-cuadrado and t-student, and multivariant analyses. 248 patients were accepted for the study. We observed more women than men (55.2%) and bigger median age (79 years old vs. 73 years old in men, p < 0.001). The mean income was 13.61 days and a median of 11 days. The 41,8% of the patients had hypertension, 30.9% diabetes mellitus and 81,9% had someone heart disease. The aetiologies of heart failure most frequent were ischemic cardiopathy (27.2%) and hypertension (24.2%). The most frequent symptom was the dyspnea (68.9%). It made echocardiography in 20.9% of patients and 45.1% showed systolic disfunction. The only factor related with this small percentage of echocardiographies was the incoming time. The most frequent etiology was respiratory infections (39.5%). The 8.6% of patients was deceased. The pharmacologic treatment more prescribed were the diuretics (86.9%) and transcutaneous nitrates (49.5%). It was indicated ECAI or AAR-II in the 86.9% of patients and beta-blockers in 0.9%. The number of echocardiograms practiced to the patients is smaller that the number advised by international associations and smaller to the cardiologist registers. The beta-blockers and ECAI use is smaller too.

  5. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    Directory of Open Access Journals (Sweden)

    Michelle von Babo

    Full Text Available Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.560 physicians of 71 hospitals (64% responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women. 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  6. Hospitalist workload influences faculty evaluations by internal medicine clerkship students.

    Science.gov (United States)

    Robinson, Robert L

    2015-01-01

    The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. The results suggest that

  7. [Low ALT activity amongst patients hospitalized in internal medicine wards is a widespread phenomenon associated with low vitamin B6 levels in their blood].

    Science.gov (United States)

    Ramati, Erez; Israel, Ariel; Tal Kessler; Petz-Sinuani, Naama; Sela, Ben-Ami; Idan Goren; Grinfeld, Atar; Lavi, Bruno; Segal, Gad

    2015-02-01

    Monitoring the activity of ALT (SGPT) in the blood is part of the routine, clinical-laboratory follow-up in hospitalized patients. In most cases, activity levels which are above the normal range are considered pathology, mostly related to lysis of hepatocytes, as in cases of hepatitis. Little has been investigated and published in regard to cases in which the ALT activity level is lower than normal. Since normal ALT activity is regarded essential for normal metabolism and homeostasis, we decided to evaluate the extent to which low ALT levels are found in healthy and hospitalized patient populations and to characterize its circumstances and etiology. Furthermore, we measured the blood concentration of vitamin B6 (being the source for the ALT co-factor, Pyridoxal-5-Phosphate) in a random sample of patients with lower than normal ALT activity level. The results of the current study showed a high prevalence, exceeding a third of hospitalized patients in internal medicine departments have low levels of ALT in the serum, and that a linear correlation (p = 0.0004, r = 0.47) exists between lower than normal ALT activity and low concentrations of vitamin B6 in the serum. The authors attribute these findings to a high prevalence of frailty amongst hospitalized patients. We aim to conduct further investigations intended to better characterize quantifiable parameters of frailty amongst our patient population.

  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. Discrimination and abuse in internal medicine residency. The Internal Medicine Program Directors of Canada.

    Science.gov (United States)

    vanIneveld, C H; Cook, D J; Kane, S L; King, D

    1996-07-01

    To survey the extent to which internal medicine housestaff experience abuse and discrimination in their training. Through a literature review and resident focus groups, we developed a self-administered questionnaire. In this cross-sectional survey, respondents were asked to record the frequency with which they experienced and witnessed different types of abuse and discrimination during residency training, using a 7-point Likert scale. Internal medicine housestaff in Canada. Of 543 residents in 13 programs participating (84% response rate), 35% were female. Psychological abuse, as reported by attending physicians (68%), patients (79%), and nurses or other health workers (77%), was widespread. Female residents experienced gender discrimination by attending physicians (70%), patients (88%), and nurses (71%); rates for males were 23%, 38%, and 35%, respectively. Females reported being sexually harassed more often than males, by attending physicians (35% vs 4%, p discrimination and homophobic remarks in the workplace, perpetrated by all groups of health professionals. Psychological abuse, gender discrimination, sexual harassment, physical abuse, homophobia, and racial discrimination are prevalent problems during residency training. Housestaff, medical educators, allied health workers, and the public need to work together to address these problems in the training environment.

  10. [Cross-sectional study of heart failure of patients intaked in an Internal Medicine Service in the third level hospital in mixed area. Part III: mortality analysis].

    Science.gov (United States)

    Cinza Sanjurjo, S; Cabarcos Ortiz de Barrón, A; Nieto Pol, E; Torre Carballada, J A

    2007-08-01

    To establish the characteristics of the deceased in intaked patients by heart failure. A cross-sectional study of the intaked patients in the Internal Medicine Service in the Hospital Clínico Universitario de Santiago de Compostela between 1999 to 2003. The variables analized were: sex, age, days of hospital stay, number of intaked by failure cardiac, reason for admission (guide symptom), hypertension, diabetes mellitus, cardiac disease, fibrillation atrium, previous treatment with beta-blockers, blood pressure in the admission moment, to make echocardiography, disfunction systolic, etiology, deceased, treatment at the end. The statistical analysis was performed with cualitative and cuantitative measures, chi-cuadrado and t-student. 248 patients were accepted for the study, with the mortality rate rising 8.6% (21 patients). We did not observed differences between sexes, but the median age in death patients was greater than other patients. The median income was 5 days, letter than study population. The hypertension prevalence (30 vs. 42.6%, p = 0.27) and ischemic cardiopathy (30 vs. 27.7%, p = 0.82) did not showed differences with the population. The hypertension prevalence in women (16.7 vs. 35.7%, p = 0.21) and the ischemic cardiopathy prevalence in men (50 vs. 21.4%, p = 0.20) did not showed differences. It made echocardiography in 21.0% of death patients, p = 0.76. The systolic disfunction prevalence was bigger in death patients (80 vs. 41.3%), this difference was not significant statistically. The older patients showed letter survival. We did not observe any influence of sex or left ventricular systolic function on mortality in patients with heart failure.

  11. International congress on aromatic and medicinal plants

    International Nuclear Information System (INIS)

    2009-01-01

    Full Text : In Morocco, medicinal and aromatic plants occupy an important place in the traditional care system of a large number of local people. They are also economically strong potential, but unfortunately they are not valued enough. Indeed, Morocco by its privileged geographical position in the Mediterranean basin and its floristic diversity (with a total of over 4,200 species and subspecies of which over 500 are recognized as medicinal and aromatic plants), is a leading provider of traditional global market. In this context and given the back label of the natural global, group research and studies on Aromatic and Medicinal Plants (GREPAM), the Faculty of Semlalia and University Cadi Ayyad, organize: the International Congress on Medicinal and Aromatic Plants CIPAM 2009. The organization of this conference is part of scientific research developed by the GREPAM. [fr

  12. VIIIth international symposium on nuclear medicine

    International Nuclear Information System (INIS)

    1986-01-01

    The conference proceedings contain 92 abstracts of submitted papers dealing with various applications of radioisotopes in diagnosis and therapy. The papers were devoted to scintiscanning, radioimmunoassay, tomography, the applications of nuclear magnetic resonance and electron microscopy in different branches - oncology, cardiology, neurology, histology, gynecology, internal medicine, etc. (M.D.)

  13. Teaching veterinary internal medicine in China.

    Science.gov (United States)

    Li, Jiakui; Guo, Dingzong; Zhou, Donghai; Wu, Xiaoxiong

    2011-01-01

    Veterinary internal medicine (VIM) is a core subject and important clinical discipline for undergraduate students of veterinary science. The present paper reviews current information about the teaching of VIM, presents a description of the veterinary science curriculum, suggests methods to improve the quality of VIM teaching in China, and describes difficulties, problems, and trends in veterinary education in China.

  14. International Journal of Medicine and Biomedical Research

    African Journals Online (AJOL)

    The International Journal of Medicine and Biomedical Research (IJMBR) is a peer-reviewed scholarly journal by Michael Joanna Publications. It publishes data and information, useful to researchers in all aspects of Clinical and Basic Medical Sciences including Anatomical Sciences, Biochemistry, Dentistry, Genetics, ...

  15. Hospitalist workload influences faculty evaluations by internal medicine clerkship students

    Directory of Open Access Journals (Sweden)

    Robinson RL

    2015-02-01

    Full Text Available Robert L Robinson Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA Background: The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective: The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. Design: A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Participants: Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Measures: Clinical service intensity data in terms of work relative value units (RVUs, patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Results: Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation

  16. Ischemic Heart Disease and Work Disability in Patients Treated at the Internal Medicine Consultation and Assessed by the Expert Medical Labor Commission

    Directory of Open Access Journals (Sweden)

    Belkis Vicente Sánchez

    2016-02-01

    Full Text Available Background: ischemic heart disease represents a major challenge given the large number of people affected by this condition, its increasing contribution to overall mortality, the frequent disability resulting from it, and the complexity and high cost of its treatment. Objective: to describe the work disability caused by ischemic heart disease in patients treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality. Methods: a cross-sectional study was conducted including all patients with ischemic heart disease treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality from October 2012 to July 2013. The variables analyzed were: age, sex, occupation, years of work and accrued salary, clinical diagnosis, length of time the condition had been present and associated chronic diseases; existence of prior assessment by an Expert Medical Labor Commission and decision reached, previous days of sick leave and current decision of the commission. The data were analyzed using SPSS (version 18.0 and the results are shown in tables and graphs as numbers and percentages. Results: a predominance of men was observed. Forty two point nine percent were service workers and the average number of years of work was 24.60. Forty two point nine percent were previously assessed by the commission. Two hundred one point thirteen days of sick leave were granted and social security expenditure in a month was high. Diabetes mellitus was the most common chronic disease followed by hypertension, obesity and dyslipidemia. Of the workers previously assessed, half received permanent and temporary disability benefits. Conclusions: ischemic heart disease causes different degrees of disability. Its costs in terms of social security are increasing.

  17. The CONFINE (Comorbidities and Outcome iN patients with chronic heart Failure: a study in INternal mEdicine units study: a new epidemiologic observational study on heart failure in the internal medicine departments in Italy

    Directory of Open Access Journals (Sweden)

    P. Biagi

    2013-05-01

    Full Text Available BACKGROUND The burden of heart failure (HF is enormous and its prevalence increases sharply with age. It has been estimated that heart failure affects up to 3% of the general population and 10% of the elderly. It contributes to hospital admission for most of them, mainly elder adults (admitted in internal medicine units with more than one comorbidity, cognitive disorders, impairment and so on. Despite the increasing prevalence of heart failure, its exact incidence and prevalence remain largely unknown and probably underestimated due to a lack of accurate epidemiological data and difficulties associated with comorbidities and correct diagnosis: over 40% of recurrent hospitalization causes, either cardiac or extracardiac, cannot be determined due to the lack of data. AIM OF THE STUDY The objective of this study estimated the prevalence and the primary care burden associated with comorbidities in internal medicine units. METHOD The design: a longitudinal multicentric observational study using spot analysis three data sheets were filled in during the hospital stay according to three crucial moments: enrolment (“the index day”, admission and discharge. Will be analyzed the following primary outcomes: total and cardiovascular mortality, intensive unit care admission, recurrent cardiovascular disorders, length of stay, hospital readmission, changes in activities of daily living, need for care. Second outcomes: clinical, therapeutic, instrumental and laboratory changes during the admission process. Deep analysis of the following comorbidities will be also taken into account: acute and chronic kidney failure, anaemia, chronic obstructive pulmonary disease, muscle loss, nutritional status, cirrhosis of the liver, neoplasms, blood cell disorders, chronic inflammatory diseases. Further evalutation items: cognitive impairment, self-sufficiency and perception of quality life.

  18. From patient talk to physician notes-Comparing the content of medical interviews with medical records in a sample of outpatients in Internal Medicine.

    Science.gov (United States)

    Langewitz, Wolf A; Loeb, Yael; Nübling, Matthias; Hunziker, Sabina

    2009-09-01

    An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next. We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS. Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted. The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts

  19. [Day hospital in internal medicine: A chance for ambulatory care].

    Science.gov (United States)

    Grasland, A; Mortier, E

    2018-04-16

    Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  20. TRACER: an ‘eye-opener’ to the patient experience across the transition of care in an internal medicine resident program

    Directory of Open Access Journals (Sweden)

    Lauren B. Meade

    2015-04-01

    Full Text Available Background: A safe patient transition requires a complex set of physician skills within the interprofessional practice. Objective: To evaluate a rotation which applies self-reflection and workplace learning in a TRAnsition of CarE Rotation (TRACER for internal medicine (IM residents. TRACER is a 2-week required IM resident rotation where trainees join a ward team as a quality officer and follow patients into postacute care. Methods: In 2010, residents participated in semistructured, one-on-one interviews as part of ongoing program evaluation. They were asked what they had learned on TRACER, the year prior, and how they used those skills in their practice. Using transcripts, the authors reviewed and coded each transcript to develop themes. Results: Five themes emerged from a qualitative, grounded theory analysis: seeing things from the other side, the ‘ah ha’ moment of fragmented care, team collaboration including understanding nursing scope of practice in different settings, patient understanding, and passing the learning on. TRACER gives residents a moment to breathe and open their eyes to the interprofessional practice setting and the patient's experience of care in transition. Conclusions: Residents learn about transitions of care through self-reflection. This learning is sustained over time and is valued enough to teach to their junior colleagues.

  1. Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.

    Science.gov (United States)

    Tenner, C T; Herzog, K; Chaudhari, S; Bini, E J; Weinshel, E H

    2012-10-01

    Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups. A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination. Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p < 0.001) or HBV (21.9% vs. 10.6%, p < 0.001). FM physicians were also less likely than IM physicians to usually/always test HCV+ patients for immunity against HAV (33.9% vs. 48.6%, p < 0.001) or against HBV (50.8% vs. 68.0%, p < 0.001). There were numerous barriers to HAV and HBV vaccination identified. The median number of barriers was 3 for FM physicians and 2 for IM physicians (p < 0.001). Despite recommendations to vaccinate against HAV and HBV in patients with chronic HCV infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates. © 2012 Blackwell Publishing Ltd.

  2. Assessment of Sleep Quality and Effects of Relaxation Exercise on Sleep Quality in Patients Hospitalized in Internal Medicine Services in a University Hospital: The Effect of Relaxation Exercises in Patients Hospitalized.

    Science.gov (United States)

    Alparslan, Güler Balci; Orsal, Özlem; Unsal, Alaettin

    2016-01-01

    This study aims to assess sleep quality and determine the effects of relaxation exercise on sleep quality in patients hospitalized in internal medicine services. In total, 47 patients comprised the control group and did not engage in the exercise intervention--the progressive muscle relaxation exercise, whereas 235 patients were assigned to the intervention group (N = 282). In this study, Description Questionnaire Form and the Pittsburg Sleep Quality Index (PSQI) were used. Most patients (73.8%) had poor sleep quality. The mean pre- and postexercise PSQI scores of the patients in the interventional group were 8.7 ± 4.0 and 6.1 ± 3.3, respectively. The mean pre- and postexercise PSQI scores of the control patients were 6.6 ± 3.5 and 5.6 ± 2.7, respectively. According to this study, the exercises significantly enhanced the quality of sleep. Patients should be encouraged by nurses to perform relaxation exercises.

  3. [Monitoring of a protocol for the adequacy of the pharmaceutical form of the oral medication to the degree of dysphagia in patients hospitalized in an internal medicine service].

    Science.gov (United States)

    García Aparicio, J; Herrero Herrero, J I; Moreno Gómez, A Ma; Martínez Sotelo, J; González del Valle, E; Fernández de la Fuente, Ma A

    2011-01-01

    The oral route is the most convenient way of administering medication, although it may not be safe. Dysphagia is one of the factors rendering difficult a proper feeding and administration of medication. to improve the administration of oral medication in patients with dysphagia by changing the pharmaceutical formulation of the principles prescribed to tolerable textures. Pilot project for the application of a dysphagia protocol that included the patients admitted to the Internal Medicine Unit at Los Montalvos Center for 4 months. After detecting the suspicion of dysphagia, a dysphagia-viscosity test was applied to know the tolerated textures. Then, the pharmaceutical formulations were adapted and the manipulation instructions for the drugs were indicated for their proper administration. 23 out of 627 admitted patients were included, with a mean age of 85 years (σ±7.4). The pathologies implicated in dysphagia were: dementia (65.2%); cerebrovascular disease (30.4%), and Parkinson's disease (4.4%). The best texture for drug intake was a "pudding" in 48.0%. 43 active ingredients were reviewed and 134 interventions were performed: in 41% of the cases, swallowing was made easier by mixing the drug with the food and in 59% water and a thickener were used. 94% of the recommendations were considered to be appropriate. the adaptation of the pharmaceutical formulations to the degree of dysphagia impacts on the improvement of healthcare quality by implementing safety in drug prescription and administration processes.

  4. The international translational regenerative medicine center.

    Science.gov (United States)

    Alexis, Mardi de Veuve; Grinnemo, Karl-Henrik; Jove, Richard

    2012-11-01

    The International Translational Regenerative Medicine Center, an organizing sponsor of the World Stem Cell Summit 2012, is a global initiative established in 2011 by founding partners Karolinska Institutet (Stockholm, Sweden) and Beckman Research Institute at City of Hope (CA, USA) with a mission to facilitate the acceleration of translational research and medicine on a global scale. Karolinska Institutet, home of the Nobel Prize in Medicine or Physiology, is one of the most prestigious medical research institutions in the world. The Beckman Research Institute/City of Hope is ranked among the leading NIH-designated comprehensive cancer research and treatment institutions in the USA, has the largest academic GMP facility and advanced drug discovery capability, and is a pioneer in diabetes research and treatment.

  5. Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment.

    Science.gov (United States)

    Haspel, Richard L; Lin, Yulia; Mallick, Ranjeeta; Tinmouth, Alan; Cid, Joan; Eichler, Hermann; Lozano, Miguel; van de Watering, Leo; Fisher, Patrick B; Ali, Asma; Parks, Eric

    2015-06-01

    Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care. Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine. A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful. Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education. © 2014 AABB.

  6. Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

    Science.gov (United States)

    Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M

    2010-09-01

    Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory

  7. Cognitive Diagnostic Error in Internal Medicine

    OpenAIRE

    Berge, Kees

    2012-01-01

    textabstractThis thesis focuses on the subject of cognitive diagnostic error in internal medicine; mistakes resulting from flaws in physicians’ reasoning processes. More specifically, this thesis addresses errors caused by confirmation and availability bias. Recently, the potential of cognitive factors to cause faults in diagnosis caught the attention of authors and policy-makers, and the topic is pursued in several position papers. Nonetheless, little empirical evidence supporting a relation...

  8. Internal medicine residency training in Turkey.

    Science.gov (United States)

    Sahin, Hatice; Akcicek, Fehmi

    2005-12-01

    Medical school entrance depends on passing a central examination that is given annually by the National Selection and Placement Center. Undergraduate medical education takes 6 years. About 5000 students graduate from medical faculties annually. The central exam necessary for residency training is given by the National Selection and Placement Center. A Specialist Training Regulation regulates residency training. Internal medicine residency training takes 4 years and includes inpatient and outpatient care in wards and rotations. Residents prepare a dissertation that is used in the evaluation of residency competency. At the end of the residency period, residents who have been successful in previous evaluations take an oral exam followed by a written exam, which lead to their certification in internal medicine. Residents' scientific knowledge and skills are assessed by a jury consisting of five people, four from the same department and one from the equivalent department in another training institution. The title of specialist is granted after a certification exam given by training institutions and approved by the Ministry of Health. Internists are mainly employed in state hospitals, which are under the Ministry of Health. Subspecialty areas in internal medicine include gastroenterology, geriatrics, endocrinology, nephrology, hematology, rheumatology, immunology, allergology, and oncology. The training period for a subspecialty is 2 years. A substantial effort is being made all over the country to improve regulations and health care service delivery. These changes will also affect the residency training and manpower planning and employment of internists.

  9. Archives: International Journal of Medicine and Biomedical Research

    African Journals Online (AJOL)

    Items 1 - 15 of 15 ... Archives: International Journal of Medicine and Biomedical Research. Journal Home > Archives: International Journal of Medicine and Biomedical Research. Log in or Register to get access to full text downloads.

  10. How to improve communication for the safe use of medicines?: Discussions on social marketing and patient-tailored approaches at the annual meetings of the WHO Programme for International Drug Monitoring.

    Science.gov (United States)

    Bahri, Priya; Harrison-Woolrych, Mira

    2012-12-01

    Over the past decade, the annual meetings of national centres participating in the WHO Programme for International Drug Monitoring have increasingly included discussions on how to improve communication between national pharmacovigilance centres, patients, healthcare professionals, policy makers and the general public, with the aim of promoting the safe use of medicines. At the most recent meetings, working groups were dedicated to discuss possible applications and implementation of social marketing and patient-tailored approaches. This article provides the history and a summary of the recent discussions and recommendations to support progress in this respect at national and global level. Recommendations are made to investigate and pilot these approaches in small-scale projects at national pharmacovigilance centres. Applying elements from the social marketing and patient-tailored approaches to support behaviours of safe medicines use in patients and healthcare professionals should give the pharmacovigilance community new tools to achieve their goal to minimize risks with medicines and improve patient safety.

  11. Clinical characteristics during diagnosis of a prospective cohort of patients with systemic lupus erythematosus treated in Spanish Departments of Internal Medicine: The RELES study.

    Science.gov (United States)

    Canora, J; García, M; Mitjavila, F; Espinosa, G; Suárez, S; González-León, R; Sopeña, B; Boldova, R; Castro, A; Ruiz-Irastorza, G

    Patient registries are useful tools for assessing rare diseases. Our objective is to present the Spanish registry of patients with systemic lupus erythematosus (Registro español de pacientes con lupus eritematoso sistémico, RELES). RELES was started in 2008 as an observational, prospective, multicentre cohort registry that included patients from the time they were diagnosed. The registry's objective is to analyse the incidence and noninflammatory complications of systemic lupus erythematosus (SLE). The departments of internal medicine of 38 Spanish hospitals participate in this registry. A total of 298 patients with a mean age of 40.8±15.7 years were included, 88.9% of whom were women and 85.6% of whom were white. In the first visit, there was a predominance of joint manifestations (74.5%). One hundred and seventy-seven patients (59.4%) were positive for anti-native DNA. In these patients, there was a higher rate of lupus nephritis (26.7% vs. 14%, p=.009; relative risk [RR], 1.33), haemolytic anaemia (13.6% vs. 4.1%, p=.07; RR, 1.46) and lymphopenia (55.4% vs. 43.8%, p=.05; RR, 1.21). The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K) score was 9.64 points (interquartile range, 4-13). The patients treated with antimalarial drugs before the diagnosis of SLE had a median SLEDAI score in the first visit of 5, compared with 8 for those who were not treated with these drugs (p=.02). RELES constitutes the first Spanish patient cohort with SLE recorded from the time of the diagnosis. The presence of anti-DNA has been related to severe manifestations such as nephritis and haemolytic anaemia. Treatment with antimalarial drugs before the diagnosis was associated with less active disease at the initial presentation. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. [Development and status of intensive care medicine in internal medicine at the Karl Marx University in Leipzig].

    Science.gov (United States)

    Engelmann, L; Schneider, D

    1989-01-15

    Issuing from the accomplishments of Köhler for the development of the intensive medicine in internal medicine-in 1964 he performed the first long-term respiration at the then Medical Clinic of the Karl Marx University, in 1969 he institutionalized the young subdiscipline at the clinic, in 1978 he founded the department for intensive medicine and is at work by his decisions concerning the development of young scientists, by the handbook "Intensive Medicine. Internal Medicine and Adjacent Subjects" as well as a member of the presidium of the GDR Society for Internal Medicine for the development of the internal intensive medicine-a description of the development of the department, its achievements and problems is given. The promotion of the intensive medicine by Köhler results, as we think, also from the comprehension that it has the duty to perform a function integrating the subdisciplines, which the modern internal medicine oriented to organs and systems threatens to lose, which, however, makes its self-apprehension, which the patient wishes and the teaching is demanding. From this and from the charge for a highly specialized care of patients who life-threateningly fell ill with internal diseases as well as from the duty to create a scientific forerunning results the stringent necessity of the development of the non-operative, in reality internal intensive medicine in the clinics for internal medicine of the county hospitals and university institutions as well as the greater identification of the internist with the subdiscipline in the district hospitals dealing with multidisciplinary intensive medicine.

  13. Complementary and Alternative Medicine for Patients

    Science.gov (United States)

    ... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is any medical and ... are based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...

  14. The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

    Science.gov (United States)

    Sakhnini, Ali; Saliba, Walid; Schwartz, Naama; Bisharat, Naiel

    2017-06-01

    Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance

  15. Computers in medicine: patients' attitudes

    Science.gov (United States)

    Cruickshank, P. J.

    1984-01-01

    Data are presented from two surveys where a 26-item questionnaire was used to measure patients' attitudes to diagnostic computers and to medical computers in general. The first group of respondents were 229 patients who had been given outpatient appointments at a hospital general medical clinic specializing in gastrointestinal problems, where some had experienced a diagnostic computer in use. The second group of respondents were 416 patients attending a group general practice where there was no computer. Patients who had experience of the diagnostic computer or a personal computer had more favourable attitudes to computers in medicine as did younger people and males. The two samples of patients showed broadly similar attitudes, and a notable finding was that over half of each group believed that, with a computer around, the personal touch of the doctor would be lost. PMID:6471021

  16. Current trends in nuclear medicine metabolic therapy - international experience

    International Nuclear Information System (INIS)

    Chavdarova, L.; Tsonevska, A.; Piperkova, E.

    2013-01-01

    Full text: Introduction: Modern nuclear medicine (NM) metabolic therapy involves treatment with radionuclides sources mainly β-, and lately more often and α- rays and aims target specificity to the disease process with minimal damage to healthy surrounding tissues. Materials and Methods: We present some of the most important clinically significant contemporary trends in metabolic therapy in the light of international experience, including low-known in Bulgaria peptide radioreceptor therapy, radioimmunotherapy and so called SIRT (Selective internal radiation therapy) for liver metastases. Results: The ability of NM therapy range from definitive treatment of benign thyroid disease and differentiated thyroid cancer by achieving partial response or complete remission to a temporary palliative analgesic and symptom reducing effect in different, mainly cancer, diseases. Conclusion: The principle of 'terradiagnostic' - the interdependence of diagnostic and therapeutic nuclear medicine approaches is crucial for individualizing treatment and achieving better results in extending survival and improving the quality of life of patients

  17. Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire.

    Science.gov (United States)

    Krska, Janet; Katusiime, Barbra; Corlett, Sarah A

    2017-01-01

    Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose. This study validated the LMQ in a sample of adults using regular prescription medicines in the UK. Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions. A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified. The resultant LMQ-2 is a valid and reliable multidimensional measure of

  18. International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine.

    Science.gov (United States)

    Hobgood, Cherri; Anantharaman, Venkataraman; Bandiera, Glen; Cameron, Peter; Halpern, Pinchas; Holliman, James; Jouriles, Nicholas; Kilroy, Darren; Mulligan, Terrence; Singer, Andrew

    2010-10-01

    Currently, there is no internationally recognised, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this, the International Federation for Emergency Medicine convened a committee of international experts in emergency medicine and international emergency medicine development to outline a global curriculum for medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. 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. The content is 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. It is anticipated 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.

  19. The Evolution of General Internal Medicine (GIM)in Canada: International Implications.

    Science.gov (United States)

    Card, Sharon E; Clark, Heather D; Elizov, Michelle; Kassam, Narmin

    2017-05-01

    General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.

  20. India mainstreams medicinal plants | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2011-02-03

    Feb 3, 2011 ... The program is partly sponsored by IDRC's Medicinal and Aromatic Plants Program in Asia (MAPPA). IDRC has supported medicinal plant research in the region since 1992. Improving quality control. R.B.S. Rawat, CEO of India's National Medicinal Plants Board, said people in Chhattisgarh and other ...

  1. Tailoring Morning Reports to an Internal Medicine Residency in Qatar.

    Science.gov (United States)

    Dousa, Khalid Mohamed Ali; Muneer, Mohammed; Rahil, Ali; Al-Mohammed, Ahmed; AlMohanadi, Dabia; Elhiday, Abdelhaleem; Hamad, Abdelrahman; Albizreh, Bassim; Suliman, Noor; Muhsin, Saif

    2014-12-01

    Morning report, a case-based conference that allows learners and teachers to interact and discuss patient care, is a standard educational feature of internal residency programs, as well as some other specialties. Our intervention was aimed at enhancing the format for morning report in our internal medicine residency program in Doha, Qatar. In July 2011, we performed a needs assessment of the 115 residents in our internal medicine residency program, using a questionnaire. Resident input was analyzed and prioritized using the percentage of residents who agreed with a given recommendation for improving morning report. We translated the input into interventions that enhanced the format and content, and improved environmental factors surrounding morning report. We resurveyed residents using the questionnaire that was used for the needs assessment. Key changes to the format for morning report included improving organization, adding variety to the content, enhancing case selection and the quality of presentations, and introducing patient safety and quality improvement topics into discussions. This led to a morning report format that is resident-driven, and resident-led, and that produces resident-focused learning and quality improvement activities. Our revised morning report format is a dynamic tool, and we will continue to tailor and modify it on an ongoing basis in response to participant feedback. We recommend a process of assessing and reassessing morning report for other programs that want to enhance resident interest and participation in clinical and safety-focused discussions.

  2. [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.

  3. Cognitive diagnostic error in internal medicine.

    Science.gov (United States)

    van den Berge, Kees; Mamede, Sílvia

    2013-09-01

    Medical error poses an important healthcare burden and a challenge for physicians and policy makers worldwide. Diagnostic error accounts for a substantial fraction of all medical mistakes. Most diagnostic errors have been associated with flaws in clinical reasoning. Empirical evidence on the cognitive mechanisms underlying such flaws and effectiveness of strategies to counteract them is scarce. Recent experimental studies, reviewed in this article, have increased our understanding of the relationship between cognitive factors and diagnostic mistakes. These studies have explored the role of cognitive biases, such as confirmation and availability bias, in diagnostic mistakes. They have suggested that confirmation bias and availability bias may indeed cause diagnostic errors. The latter bias seems to be associated with non-analytical reasoning, and was neutralized by analytical, or reflective, reasoning. Although non-analytical reasoning is a hallmark of clinical expertise, reflective reasoning was shown to improve diagnoses when cases are complex. Research on cognitive diagnostic mistakes remains a quite novel line of investigation. Follow-up studies that shine more light on the cognitive roots of, and cure for, diagnostic errors are needed. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  4. Therapeutic nuclear medicine (vectorized internal radiotherapy)

    International Nuclear Information System (INIS)

    Herain, C.; Machacek, C.; Menechal, P.; Aubert, B.; Celier, D.; Rehel, J.L.; Vidal, J.P.; Lahaye, T.; Gauron, C.; Barret, C.; Biau, A.; Donnarieix, D.; Gambini, D.; Gondran, C.; Pierrat, N.; Guerin, C.; Marande, J.L.; Mercier, J.; Paycha, F.

    2012-09-01

    After having evoked the authorization for possessing and using radionuclides which is required to perform therapeutic nuclear medicine, this document indicates the various personnel involved in this activity, the radionuclide implementation process, the different associated hazards and risks (for sealed and non-sealed sources), how risk is assessed and exposure levels are determined (elements of risk assessment, delimitation of controlled and surveyed areas, personnel classification, selection of dosimetric control type between external passive, operational or internal dosimetry). It proposes a detailed risk management strategy which comprises different components: risk reduction, technical measures regarding the installation, protection measures, information and training, prevention measures, treatment of incident and dysfunction. It describes the medical control to be performed or measures to be taken for the different type of personnel and for pregnant women, indicates the content and management of the medical file and how personnel follow-up must me performed, how anomalies and incidents must be handled. It comments how risk management is to be assessed, and briefly evokes other risks. An example of workstation study is given in appendix

  5. Clinical Holistic Medicine: Chronic Pain in Internal Organs

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are “holding” or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are “love” and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.

  6. Does clerkship experience influence interest In internal medicine ...

    African Journals Online (AJOL)

    BACKGROUND:The career intention of undergraduate medical students may be influenced by the clerkship experience in the various specialties. AIM:This study was undertaken to assess the medical student's perception of the internal medicine clerkship and determine its influence in the choice of internal medicine as a ...

  7. Hospitalist workload influences faculty evaluations by internal medicine clerkship students

    OpenAIRE

    Robinson, Robert

    2015-01-01

    Robert L Robinson Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA Background: The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective: The study reported here was conducted to explore the rel...

  8. 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.

  9. 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.

  10. Radiological Protection of Patients in Nuclear Medicine

    International Nuclear Information System (INIS)

    Rojo, A.M.

    2011-01-01

    Full text: This lecture aims at presenting the state of the art of radiological protection of patients in nuclear medicine focusing on three aspects of interest where to achieve improvement. The hierarchy of the justification principle of the radiation protection is one of them. There seems for a change to be presented in the paradigm of the radiological protection of patients. The role of the physician who prescribes the medical practice becomes more relevant, together with the nuclear medicine specialist who should be co-responsible for the application of this justification principle. Regarding the doses optimization and the implementation of Dose Reference Level the involvement extends far beyond the physician and radioprotection officer. It is clear that the Medical Physicist is to play a very relevant role in the coordination of actions, as the nuclear medicine technician is to execute them. Another aspect to consider is patient specific dosimetry. It should become a routine practice through calculation of the absorbed dose based on biodistribution data. It should be assessed for each individual patient, as it depends on a number of patient-specific parameters, such as gender, size and the amount of fatty tissue in the body, as well as the extent and nature of the disease. In most cases, dosimetry calculations are not carried out and patients are administered standard levels of activity. There may be situations with a lack of knowledge on internal dosimetry as in many centers either none or only one or two medical physics experts are available. It shows that a formal training for experts in internal dosimetry at national level is required. However up to now, there has been no satisfactory correlation between absorbed dose estimates and patient response. Moreover, the radiation protection for the patient is not assured, as the dose values given are often numbers without connection to radiobiological and/or hematological findings. Pending tasks related to

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

    African Journals Online (AJOL)

    It also publishes valuable studies in areas of Biological Sciences related to health issues, Allied Medicine, Alternative and Complementary Medicine, Nursing, Physiotherapy, and Medical Ethics and Medical Education. Authorship criteria. Authorship should be based on considerable intellectual contributions to the following ...

  12. Attitudes and preferences toward the provision of medication abortion in an urban academic internal medicine practice.

    Science.gov (United States)

    Page, Cameron; Stumbar, Sarah; Gold, Marji

    2012-06-01

    Mifepristone offers internal medicine doctors the opportunity to greatly expand access to abortion for their patients. Almost 70% of pregnancy terminations, however, still occur in specialized clinics. No studies have examined the preferences of Internal Medicine patients specifically. Determine whether patient preference is a reason for the limited uptake of medication abortion among internal medicine physicians. Women aged 18-45 recruited from the waiting room in an urban academic internal medicine clinic. A semi-structured questionnaire was used to determine risk of unintended pregnancy and attitudes toward abortion. Support for provision of medication abortion in the internal medicine clinic was assessed with a yes/no question, followed by the open-ended question, "Why do you think this clinic should or should not offer medication abortion?" Subjects were asked whether it was very important, somewhat important, or not important for the internal medicine clinic to provide medication abortion. Of 102 women who met inclusion criteria, 90 completed the survey, yielding a response rate of 88%. Twenty-two percent were at risk of unintended pregnancy. 46.7% had had at least one lifetime abortion. Among those who would consider having an abortion, 67.7% responded yes to the question, "Do you think this clinic should offer medication abortions?" and 83.9% stated that it was "very important" or "somewhat important" to offer this service. Of women open to having an abortion, 87.1% stated that they would be interested in receiving a medication abortion from their primary care doctor. A clinically significant proportion of women in this urban internal medicine clinic were at risk of unintended pregnancy. Among those open to having an abortion, a wide majority would consider receiving it from their internal medicine doctor. The provision of medication abortion by internal medicine physicians has the potential to greatly expand abortion access for women.

  13. Education in sexual medicine: proceedings from the international consultation in sexual medicine, 2009.

    Science.gov (United States)

    Parish, Sharon J; Rubio-Aurioles, Eusebio

    2010-10-01

    Sexual problems in men and women are common; and physicians endorse many barriers to addressing these issues, including lack of knowledge about the diagnosis and management of sexual problems and inadequate training in sexual health communication and counseling. To update the recommendations published in 2004, from the International Consultation on Sexual Medicine (ICSM) relevant to the educational aspects of sexual health in undergraduate, graduate, and postgraducate medical education. A third international consultation in collaboration with the major sexual health organizations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Three experts from three countries contributed to this committee's review of Education in Sexual Medicine. Expert opinion was based on a comprehensive review of the medical literature, committee discussion, public presentation, and debate. A comprehensive review about the current state of undergraduate, graduate, and postgraduate sexual health education worldwide is provided. Recommendations about ideal sexual health curricula across training levels are provided. Best methods for achieving optimal training approaches to sexual health communication and interviewing, clinical skills and management, and counseling are described. Current sexual health education for undergraduate and practicing physicians is inadequate to meet the advancing science and technology and increasing patient demand for high-quality sexual health care. There is a need for enhanced training in medical institutions responsible for physician sexual health training worldwide. Future training programs at all levels of medical education should incorporate standardized measures of sexual health clinical skills acquisition and assessments of the impact on patient outcomes into the design of educational initiatives. © 2010 International Society for Sexual Medicine.

  14. Building emergency medicine in Ethiopia | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-09-05

    Sep 5, 2014 ... Ethiopia faces a critical gap in emergency medical care. Canadian experts have paired with Addis Ababa University to develop a national research and training facility and graduate the country's first emergency medicine specialists.

  15. International Federation for Emergency Medicine Model Curriculum for Emergency Medicine Specialists.

    Science.gov (United States)

    Hobgood, Cherri; Anantharaman, Venkataraman; Bandiera, Glen; Cameron, Peter; Halpern, Pinchas; Holliman, C James; Jouriles, Nicholas; Kilroy, Darren; Mulligan, Terrence; Singer, Andrew

    2011-10-01

    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 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 programmes 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 programme. 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. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial.

    Science.gov (United States)

    Arakaki, Ryan Y; Strazzula, Lauren; Woo, Elaine; Kroshinsky, Daniela

    2014-10-01

    Cellulitis is a common and costly problem, often diagnosed in the outpatient setting. Many cutaneous conditions may clinically mimic cellulitis, but little research has been done to assess the magnitude of the problem. To determine if obtaining dermatology consultations in the outpatient primary care setting could assist in the diagnosis of pseudocellulitic conditions and reduce the rate of unnecessary antibiotic use. Nonblinded randomized clinical trial of competent adults who were diagnosed as having cellulitis by their primary care physicians (PCPs), conducted at outpatient internal medical primary care offices affiliated with a large academic medical center. Outpatient dermatology consultation. Primary outcomes were final diagnosis, antibiotic use, and need for hospitalization. A total of 29 patients (12 male and 17 female) were enrolled for participation in this trial. Nine patients were randomized to continue with PCP management (control group), and 20 patients were randomized to receive a dermatology consultation (treatment group). Of the 20 patients in the dermatology consultation group, 2 (10%) were diagnosed as having cellulitis. In the control group, all 9 patients were diagnosed as having cellulitis by PCPs, but dermatologist evaluation determined that 6 (67%) of these patients had a psuedocellulitis rather than true infection. All 9 patients (100%) in the control group were treated for cellulitis with antibiotics vs 2 patients (10%) in the treatment group (P Dermatology consultation in the primary care setting improves the diagnostic accuracy of suspected cellulitis and decreases unnecessary antibiotic use in patients with pseudocellulitic conditions. Obtaining an outpatient dermatology consultation may be a cost-effective strategy that improves quality of care. clinicaltrials.gov Identifier:NCT01795092.

  17. 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.

  18. International assistance and cooperation for access to essential medicines.

    Science.gov (United States)

    Mok, Emily A

    2010-06-15

    Access to essential medicines is a critical problem that plagues many developing countries. With a daunting number of domestic constraints - technologically, economically, and otherwise - developing countries are faced with a steep uphill battle to meet the human rights obligation of providing essential medicines immediately. To meet these challenges, the international human rights obligations of international assistance and cooperation can play a key role to help developing countries fulfill the need for access to essential medicines. This article seeks to highlight and expand upon the current understanding of international assistance and cooperation for access to essential medicines through a review of obligations identified in international human rights law and a synthesis of official guidance provided on the matter.

  19. Bronchial asthma in children | Ibe | International Journal of Medicine ...

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 1 (1997) >. Log in or Register to get access to full text downloads.

  20. International women physicians' perspectives on choosing an academic medicine career.

    Science.gov (United States)

    Borges, Nicole J; Grover, Amelia C; Navarro, Anita M; Raque-Bogdan, Trisha L; Elton, Caroline

    2013-06-01

    Concerns about recruiting physicians into academic careers is an international issue. A qualitative study with United States (US) women physicians revealed insights into how, when, and why physicians choose an academic career in medicine. The current study explored international women physicians' perspectives on their career choice of academic medicine and determined if different themes emerged. We expanded the 2012 study of US women physicians by interviewing women physicians in Canada, Pakistan, Mexico, and Sweden to gain an international perspective on choosing an academic career. Interviews were thematically analyzed against themes identified in the previous study. Based on themes identified in the study of US physicians, qualitative analysis of 7 international women physicians revealed parallel themes for the following areas: Why academic medicine? Fit; People; Aspects of academic health centre environment. How the decision to enter academic medicine was made? Decision-making style; Emotionality When the decision to enter academic medicine was made? Practising physician; Fellowship; Medical student. Work-life balance, choosing academic medicine by default, serendipity, intellectual stimulation, mentors, research and teaching were among the areas specifically highlighted. Parallel themes exist regarding how, why, and when US and international women physicians choose academic medicine as a career path.

  1. 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...System in Space and Other Extreme Conditions. England – USA: Harwood Academic Publishers, 1991. Konstantinova IV, Petrov RV. Sistema Immuniteta v

  2. VIIth international symposium on nuclear medicine

    International Nuclear Information System (INIS)

    1983-01-01

    The conference proceedings contain abstracts of 100 presented papers, mainly dealing with radioimmunoassays, radiopharmaceuticals, scintiscanning, computer tomography, radionuclide lymphography, ventriculography, angiography, nuclear cardiology, liquid scintillator techniques, radioisotope generators, radiospirometry and various uses of labelled compounds and tracer techniques in nuclear medicine. (M.D.)

  3. International Journal of Medicine and Health Development

    African Journals Online (AJOL)

    This is the official publication of College of Medicine, University of Nigeria under the supervision of the Directorate for research and publications, . The College consists of three faculties: The Faculty of Medical Sciences, Faculty of Health Sciences and Technology and Faculty of Dentistry. Through excellence in education ...

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

    African Journals Online (AJOL)

    Focus and Scope. IJMBR publishes editorial, original and review papers, case reports, reports and commentaries, letters to editor and conference proceedings in areas of Clinical and Basic Medical Sciences. It also publishes valuable studies in Allied Medicine, Pharmaceutical Chemistry, and Alternative and ...

  5. 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).

  6. Guidelines for patient information in nuclear medicine

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    This guide for patients information in nuclear medicine is organised in the following manner: what is a medical examination in nuclear medicine, the preparation and the duration of the examination, the possible risks and the radiation doses, pregnancy, delayed menstruation and nursing and what to do after the examination. (N.C.)

  7. 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.

  8. The Italian Society of Internal Medicine choosing wisely campaign.

    Science.gov (United States)

    Montano, Nicola; Costantino, Giorgio; Casazza, Giovanni; Sbrojavacca, Rodolfo; Lenti, Marco Vincenzo; Falsetti, Lorenzo; Guzzo, Annasanta; Majo, Raffaele; Perticone, Francesco; Corazza, Gino Roberto

    2016-12-01

    Appropriateness is one of the critical aspects of medicine. For this reason, the Italian Society of Internal Medicine (SIMI) decided to adhere to the Choosing Wisely Campaign. A bottom-up approach was chosen. All the recommendations published in the US and Canadian Choosing Wisely campaign have been screened, and an e-mail was sent to all the SIMI members for new suggestions. The thirty interventions that were judged as the highest priority by a committee were sent to all the SIMI members for voting. The first procedures selected were then revised, and constituted the five points of the SIMI choosing wisely campaign. The identified procedures were: (1) avoid prescribing bed rest unless an acceptable indication exists. Promote early mobilization; (2) Do not perform a D-dimer test without a precise indication; (3) Do not prescribe long term intravenous antibiotic therapy in the absence of symptoms; (4) Do not indefinitely prescribe proton pump inhibitors in the absence of specific indications; (5) Do not place, or leave in place, peripherally inserted central catheters for patient's or provider's convenience. Four of these points were not present in any other campaign, while one, the fifth, was already present. The bottom-up approach of the SIMI "Choosing Wisely" campaign favored the identification of different priorities compared to other campaigns. Future studies should now evaluate if the application of these "not-to-do" recommendations will be associated with an improvement of clinical outcome and a subsequent direct and indirect health care cost reduction.

  9. Enhancing outpatient nephrology experience for internal medicine residents

    Science.gov (United States)

    Jhaveri, Kenar D.; Shah, Hitesh H.

    2017-01-01

    Abstract Interest in nephrology careers continues to remain low in the USA. Educational innovations that enhance interest in nephrology among medical trainees are being actively studied. While internal medicine (IM) residency programs commonly offer the inpatient nephrology elective to the resident, outpatient nephrology experience is lacking. Understanding the provision of care in outpatient and home dialysis and management of patients with glomerular diseases, chronic kidney disease and kidney transplantation are vital components of an outpatient nephrology rotation. In this review article, we share our experiences in incorporating outpatient nephrology to the IM resident’s elective time. We also present the structure of the nephrology rotations at our programs and suggest several learning opportunities in outpatient nephrology that the training community can provide to medical residents. Strategies to effectively set up an outpatient nephrology rotation are also described. While more educational research on the impact of outpatient nephrology on resident learning and career choices are needed, we encourage a collaborative effort between faculty members in nephrology and the medicine residency programs to provide this unique learning opportunity to IM residents. PMID:29479427

  10. Imperial Medicine in a Changing World: The Fourth International Congresses on Tropical Medicine and Malaria, 1948.

    Science.gov (United States)

    Wells, Julia

    2016-01-01

    The close connections between colonialism and tropical medicine have been widely discussed by historians over the last fifty years. However, few authors consider the relationship between tropical medicine and European and North American imperialism in the immediate post-World War II period. This article examines the Fourth International Congresses on Tropical Medicine and Malaria, held jointly in Washington in 1948. Using the research presented during the conference, it questions to what degree the specialisation had changed in the postwar period. It argues that although some changes are discernable, imperial traditions and relationships remained firmly embedded within the tropical medicine of the congress.

  11. International Society for Magnetic Resonance in Medicine

    Science.gov (United States)

    ... Interest Information for Patients Community Facebook LinkedIn Twitter Instagram MR Email Communities Members Membership Dues Online Payment ... Return and Privacy Policies Community Facebook LinkedIn Twitter Instagram MR Email Communities Latest from @ISMRM on @alex_ ...

  12. Analysis of epidemiological and clinical characteristics of patients admitted diagnosed with acute ischemic cerebrovascular event in internal medicine services and neurology of the Hospital Mexico in March 2013 to March 2014

    International Nuclear Information System (INIS)

    Araya Gonzalez, Manuel Alberto

    2014-01-01

    Records of 100 patients were revised with diagnosis of ischemic cerebrovascular event in the neurology and internal medicine at the Hospital Mexico since March 2013 to March 2014. A total of 46 patients were men and 54 were women. The overall mean age was 69 years, for men have been 66 years and for women from 71. Patients of all provinces were entered main of San Jose with 56% followed by 19% Alajuela. The hospital management by specialty was distributed 60% to internal medicine and 40% neurology. The risk factors most frequently found were: hypertension 85%, diabetes mellitus 40%, smoking 35%, and dyslipidemia 35%. Overweight was observed in 23% of patients and 22% obese. As for the initial clinical manifestations documented in the first physical examination, the 6 most frequently found have been: faciobrachiocrural hemiparesis 60%, delirium 22%, dysarthria 22%, headache 20%, nausea and/or vomiting 17% and aphasia 15%. A total of 13% of patients have altered the consciousness and 5% have required ventilatory support for first 24 hours of evolution. 27% of patients have arrived within the first 3 hours of onset of symptoms, 11% between 3 to 4.5 hours and the remaining 62% beyond 4.5 hours of duration. 70% of patients have had 1 or more comorbidities prior to the event, the top 5 have been: ischemic heart disease 31%, 29% atrial fibrillation, cerebrovascular disease 19%, 16% chronic kidney disease and congestive heart failure by 12%. Regarding the topographic classification of stokes, 16% were TACI, PACI 46%, 27% LACI and POCI only 11%. The average NIHSS scale has been 9 points to admission, 10 to 48 hours and 6 points at the time of discharge. Regarding brain scan on admission to 98% of the patients were performed while that between 48-72 hours alone to 74%. The most common initial tomographic CT findings have been: 49% lucency of more than 1/3 of middle cerebral artery territory, without alteration 46%, 8% cerebral edema data and 8% midline deviation. Hemorrhagic

  13. [Cryoglobulinemia in a Tunisian internal medicine department].

    Science.gov (United States)

    Boukhris, I; Azzabi, S; Chérif, E; Ben Hassine, L; Kaouech, Z; Kooli, C

    2015-01-01

    Cryoglobulinemia is characterized by multiple organ involvement, mainly including the skin, liver, kidneys, and peripheral nerves. Our aim was to investigate the demographic, clinical, and serologic features, as well as survival in a group of 16 Tunisian patients with cryoglobulinemia. The study included 12 women and 4 men, and their mean age was 41 years. In all but two, the cryoglobulinemia was associated with another disease. These included lupus for 9, Sjögren syndrome for 2, and polyarteritis nodosa for one. They also included infectious diseases: 3 patients with hepatitis B virus infection, one with hepatitis C virus infection, one with parvovirus B19, and another with lymph node tuberculosis. Only one case of lymphoproliferative disease was noted. General symptoms were present in 81% of the patients, cutaneous vasculitis in 43%, peripheral vascular-Raynaud phenomenon in 37%, joint polyarthralgia or arthritis in 62%, renal involvement in 68%, neuropathy in 25%, lung involvement in 56%, gastrointestinal involvement in 37%, and finally cardiac involvement in 31%. In some cases it was difficult to determine if the clinical signs were attributable to cryoglobulinemia or the underlying pathology. The course was favorable under treatment for 5 patients, while 7 patients became sicker and 5 finally died. Cryoglobulinemia is underdiagnosed. Treatment depends on the severity of the lesions and the underlying disease.

  14. General comments on radiological patient protection in nuclear medicine

    International Nuclear Information System (INIS)

    Tellez de Cepeda, M.; Plaza, R.; Corredoira, E.; Martin Curto, L.M.

    2001-01-01

    In this paper an observation series about different aspects of the radiological protection of the patient in nuclear medicine is provided. It includes: The specific legislation contribution, the justification and, especially, optimization, as a fundamental base of the quality guarantee program, the importance of the fulfillment of the program and the importance of getting done the corresponding internal audits of the pursuit, the communication between the different groups of professionals implicated and between these and the patient, the volunteers who collaborate in the patient's care and the people in the patient's environment, knowing that the patient is a source of external radiation and contamination. (author) [es

  15. Training Internal Medicine Residents in Geriatrics.

    Science.gov (United States)

    Wolf-Klein, Gisele P.; And Others

    1983-01-01

    A four-week geriatric rotation in a nursing home that emphasized rehabilitation for stroke victims, patients with fractured hips, and amputees, and the team approach in care for the elderly is described. Student response was very positive, student sensitivity was improved, and all students felt the team approach could be applied to later practice.…

  16. [Hyper-IgE in internal medicine].

    Science.gov (United States)

    Devilliers, H; Turcu, A; Vernier, N; Muller, G; Bielefeld, P; Bonniaud, P; Besancenot, J-F

    2018-01-31

    Hyper-IgE may be found under many pathological conditions. The role of IgE is essentially associated with the occurrence of allergic manifestations, which may be accompanied by an increase of their serum levels. Elevation of total IgE has also been reported in association with certain rare genetic immune deficiencies called hyper-IgE syndromes. Other circumstances such as infectious diseases, tumors or autoimmune diseases may also be accompanied by an excessive synthesis of IgE. Considering the diversity of these situations, discussion of the prognostic value of total IgE is useful to the internist. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  17. 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.

  18. Importance of international networking in academic family medicine.

    Science.gov (United States)

    Klemenc-Ketiš, Zalika; Kersnik, Janko

    2014-01-01

    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. 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. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  19. [Cross-sectional study of heart failure of patients intaked in an internal medicine service in the third level hospital in mixed area. Part II: prevalence and hypertension control].

    Science.gov (United States)

    Cinza Sanjurjo, S; Cabarcos Ortiz de Barrón, A; Nieto Pol, E; Torre Carballada, J A

    2007-07-01

    To know the arterial hypertension prevalencia and hypertension control in the patients income by heart failure. A cross-sectional study of the intaked patients in the Internal Medicine Service in the Hospital Clínico Universitario de Santiago de Compostela between 1999 to 2003. The variables analysed were: sex, age, days of hospital stay, number of intaked by failure cardiac, reason for admission (guide symptom), hypertension, diabetes mellitus, cardiac disease, fibrillation atrium, previous treatment with beta-blockers, blood pressure in the admission moment, to make echocardiography, disfunction systolic, etiology, deceased, treatment at the end. The statistical analysis was performed with qualitative and quantitative measures, chi-cuadrado and t-student, and multivariant analyses. 248 patients were accepted for the study, and 100 were hypertensive patients (41.8%). We observed more women than men in hypertensive group (63.0%) and in non hypertensive group (51.1%). The median age was 77 years old in both groups. The median income was 11 days. The number of patients with diabetes mellitus and ischemic cardiopathy was bigger in hypertension group (43.0 vs. 22.3%), p < 0.001; (38 vs. 21.6%), p = 0.005. The most frequent symptom was the dyspnea (66,9%), in both groups, p = 0.62. The 62.6% of the patients were bad control of blood pressures. The prevalence of bad control in hypertensive patients was bigger tha non-hypertensive patients (76.9 vs. 59.4%, p = 0.01). The pharmacologic treatment more prescribed in hypertensive patients ECAI or AAR-II (62.6 vs. 26.8%, p < 0.001). And the diuretics wee more prescribed in non-hypertensive patients (91.1 vs. 81.1%, p = 0.03). The prevalence of diabetes mellitus is associated with hypertension in the patients. The ECAI prescription was acceptable. The number of echocardiograms practiced to the patients is smaller that the number advised by international associations and smaller to the cardiologist registers. The beta

  20. [Assessment of cognitive functions in internal medicine].

    Science.gov (United States)

    Capron, J

    2015-12-01

    The evaluation of cognitive functions can be performed using two approaches: a quantitative one, based on screening tools; a qualitative one, based on the examination of specific cognitive functions. The quantitative approach offers a pragmatic process: to screen rapidly for a cognitive dysfunction that may require assistance or treatments. We will present three screening tools and their diagnostic value: the clock test, the Mini Mental State Examination and the Montreal Cognitive Assessment. They help select patients who require a more detailed examination to precisely diagnose their cognitive dysfunction. We propose a way to perform a detailed cognitive examination at the bedside, including the examination of alertness, attention, memory, language, frontal functions, praxis and hemi-neglect. This simple examination indicates the location of the cerebral lesion and sometimes suggests the underlying disease. Copyright © 2015. Published by Elsevier SAS.

  1. International Telemedicine/Disaster Medicine Conference: Papers and Presentations

    Science.gov (United States)

    1991-01-01

    The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.

  2. [Professor MUDr. Frantisek Pór's School of Internal Medicine].

    Science.gov (United States)

    Mydlík, M; Derzsiová, K; Schweitzer, P

    2008-06-01

    The article pays tribute to prof. MUDr. Frantisek Pór and his significant role in the development of internal medicine in Kosice and in Eastern Slovakia, where he actively pursued his profession from 1945 to 1971. He was the founder of the school of internal medicine in the proper sense of the word having laid down its organisation, therapy and prevention, training and research bases. His pupils, and the pupils of his pupils, have carried on his legacy till this day. This fact was remembered on the occasion of the 15th commemoration held by the Kosice Doctors' Association in his honour and memory and on the occasion of the upcoming 60th anniversary of the foundation of the Faculty of Medicine at Pavol Jozef Safárik University in Kosice.

  3. Evaluating M.D.-Level Competence in Internal Medicine.

    Science.gov (United States)

    Anderson, Alexander S.; Botticelli, Max G.

    1981-01-01

    The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented. (Author/MLW)

  4. Child survival revolution | Ibe | International Journal of Medicine and ...

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 1, No 2 (1996) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. DOWNLOAD FULL TEXT ...

  5. Homeopathy - A review | Oji | International Journal of Medicine and ...

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 1, No 2 (1996) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. DOWNLOAD FULL TEXT ...

  6. Residency Programs in Veterinary Internal Medicine. Where Are We Going?

    Science.gov (United States)

    Oliver, J. E., Jr.

    1979-01-01

    Data from the 6th Symposium on Veterinary Medical Education, the Arthur D. Little, Inc. report, and the survey of the American College of Veterinary Internal Medicine are reported as they pertain to the need for more residency programs, program quality and accreditation. Program funding is also discussed. (JMD)

  7. Local tetanus: A case report | Ibe | International Journal of Medicine ...

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 4, No 1 (1999) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. DOWNLOAD FULL TEXT ...

  8. Review of intern preparedness and education experiences in General Medicine.

    Science.gov (United States)

    Gome, J J; Paltridge, D; Inder, W J

    2008-04-01

    Few studies assess the transition from medical student to intern and there is limited understanding of what measures are required to assist intern development. The aim of the study was to assess interns' perception of their preparedness before commencing and on completion of their rotation in General Medicine, and their attitudes towards educational experiences at a tertiary metropolitan teaching hospital. Self-assessed preparedness for the General Medical internship and educational experiences were evaluated using a quantitative 5-point scale (1 = low score and 5 = high score) and qualitatively through interview, on interns based at St Vincent's Hospital (Melbourne). Data were collected at the beginning and at the end of each 10-week rotation (n = 25). Before commencement of the rotation, the interns identified areas where they felt inadequately prepared, particularly resuscitation skills and medico-legal aspects. When resurveyed at the completion of their 10-week rotation, the interns felt they had been better prepared for their role than they initially perceived, both generally and in specific aspects. Nine out of 16 parameters showed a significant increase in preparedness score at week 10 compared to week 1. The educational experiences most valued were peer driven education sessions and informal registrar teaching. Formal consultant teaching and online learning were perceived as being the least useful. Interns at St Vincent's Hospital have been adequately prepared for their role in General Medicine, although many realize this only in retrospect. Deficiencies in educational opportunities for interns have been uncovered that emphasize areas of attention for medical educators.

  9. Narrative medicine and the personalisation of treatment for elderly patients.

    Science.gov (United States)

    Cenci, C

    2016-07-01

    Healthcare organisations, medical knowledge and clinical practice are among the contexts that have most strongly felt the impact of the over 75 population. This is a population of multimorbidity and polypharmacy patients. They are often seen as a conglomeration of juxtaposed guidelines resulting in the intake of more than 10 drugs a day, with absolutely no certainty of their efficacy. The scientific community is increasingly calling into question the current disease-focused approach. Narrative medicine can provide the tools for a treatment plan which is instead more patient-centred. Narrative medicine can promote the development of a systemic, integrated and multi-disciplinary approach to elderly patients. The stories of patients and caregivers, their representations, perceptions, experiences and preferences can reduce the risk of inappropriate tests and treatments. They can promote deprescribing procedures based on a careful analysis of a specific patient's needs. Narration time is treatment time which does not necessarily create a burden on organisations and caregivers. Quite the contrary since by facilitating adherence and team work, it can significantly reduce time and costs. Given their training and the importance of their relationship with elderly patients, internists, together with geriatricians, can play a key role in promoting and coordinating a narrative medicine approach. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  10. [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

  11. 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.

  12. Patient preparation for nuclear medicine studies

    International Nuclear Information System (INIS)

    Stathis, V.J.; Cantrell, D.W.; Cantrell, T.J.

    1987-01-01

    In this chapter are described methods of patient preparation that can favorably affect the outcome of nuclear medicine studies in specific situations. Some of these practices may be considered essential to the success of the nuclear medicine procedure, whereas others may be thought of simply as a means of obtaining more valid or reliable information. Regardless of relative importance, each of the preparatory methods discussed can contribute to the quality of the respective study and can serve as a means of maximizing the value of nuclear medicine procedures. The specific patient preparation techniques discussed in this chapter may not be readily applicable to every practice setting or situation. These or similar procedures can be used or modified as necessary. It is important, however, that when new protocols are developed, the rationale and theoretical basis of each technique be considered

  13. International workshop on non-ionizing radiation protection in medicine.

    Science.gov (United States)

    Sienkiewicz, Zenon

    2013-11-01

    An international workshop brought together a range of stakeholders to consider protection from non-ionizing radiation used in medicine, research and cosmetics. Presentations on specific topics were followed by a general discussion on possible improvements in protection. Participants considered that adherence to science-based, harmonized exposure guidelines to limit exposures for clinical staff and other workers was a key prerequisite to safety in all situations. In addition, to engender an awareness of the risks involved to both the patient as well as the operator, equipment should be operated only by suitably qualified persons who have received appropriate training in the safe use of that device. This training should be carried out under the auspices of an accredited safety provider, and preferably offer a recognized qualification. Specific advice included the necessity for correct eye protection with higher power optical radiation sources, and avoiding the use of ultrasound for all exposures without medical benefit. Finally, the possibility of a harmonized approach to safety for both non-ionizing and ionizing radiation was considered worthy of further discussion.

  14. The cost of prescription medicines to patients

    NARCIS (Netherlands)

    Noyce, PR; Huttin, C; Atella, [No Value; Brenner, G; Haaijer-Ruskamp, FM; Hedvall, MB; Mechtler, R

    The study compares the cost-sharing (co-payment) arrangements for prescribed medicines in a sample of EU countries. Through a set of typical prescription scenarios, the cost burden to individual patients of prescriptions are examined, in the context of drug price, and from the perspective of

  15. Tomography in nuclear medicine. Proceedings of an international symposium

    International Nuclear Information System (INIS)

    1996-01-01

    Single photon emission computed tomography (SPECT) is currently being used universally in clinical practice, while positron emission tomography (PET), originally developed as a technique for research, has also gradually moved from the research laboratory to the clinical environment. However, there are significant differences in nuclear medicine capabilities, especially in tomography, between developed and developing countries. The present status and future prospects of nuclear medicine tomography were the main topics of discussion at this latest international symposium, organized by the IAEA in co-operation with the World Health Organization and held in Vienna from 21 to 25 August 1995. The purpose of the meeting was to share experience and information on new developments and clinical applications of two promising tomographic techniques: SPECT and PET. Eight invited papers and 34 regular papers from 23 countries were presented. In addition, there was a panel discussion on the future and direction of tomography in nuclear medicine for developing countries. Refs, figs, tabs

  16. [Management of stroke in a ward of internal medicine. Limits and prospects].

    Science.gov (United States)

    Negri, Monica; Martignoni, Alessandra; Baccheschi, Jordan; Santilli, Giovanna; Marchesi, Eugenia

    2004-03-01

    Precocious admission to specifically "dedicated" wards proved to improve reduction of mortality and degree of residual disability in patients with stroke, even if their inhomogeneous distribution gets most patients admitted to wards of Internal Medicine. We purposed to evaluate the importance of this problem, to check adhesion to the national guidelines and to show the main problems in management of patients with stroke in the Operative Unit of Internal Medicine, Vascular and Metabolic Diseases of the IRCCS S. Matteo Hospital of Pavia. 143 patients with stroke were admitted in 2001, 126 were ischemic, 17 hemorragic; the mean age was of 73. The most frequent risk factors were hypertension, diabetes, smoke and atrial fibrillation. 59% of patients were admitted within 6 hours from onset of symptoms. Within the ischemic subtypes, 17.5% were atherotrombothic, 16.7% cardioembolic, 23.8% lacunar and 42% with undetermined etiology. Lacunar syndromes were the most part. 80% of patients underwent computed tomography, 50% underwent epiaortic Doppler sonography, 38% echocardiography. 61% of ischemic subtypes underwent acute antiplatelet treatment. Complications were prevalent in oldest patients. Mortality of inpatients was 17%, influenced by age, hypertension, severe sensorial compromission at admission, cardioembolism and complications. This study proved leak of adhesion to national guidelines which brought to inadequate accuracy in diagnosis and difficulty in making correct and coherent therapeutic choices. At least in great hospitals, "dedicated" areas in wards of Internal Medicine with selected, trained and motivated staff should be desirable.

  17. Generic - equivalent drugs use in internal and general medicine patients: distrust, confusion, lack of certainties or of knowledge? Part 3. Clinical issues

    Directory of Open Access Journals (Sweden)

    Roberto Nardi

    2014-05-01

    Full Text Available There are several clinical areas or types of drugs that make prescribing branded drugs preferable, because of potential therapeutic inequivalence or confusion. Bioequivalence criteria may be fine for most drugs, but some conditions may require drug levels with modified variations, like in the case of narrow therapeutic index and critical dose drugs, highly variable drugs and modified-release formulations. Moreover, substitution with generics can be problematic in some patient subpopulations, such as elderly frail people, immunocompromised and transplant patients and patients with epilepsy. We include a list of branded drugs that are considered safer, more effective or with a lower risk of error. The therapeutic substitution is markedly different from therapeutic interchange. The replacement of a brand product with an equivalent has to occur under the control of the physician. At some point in their interaction with individual patients, physicians should let them know that generics are available as substitutes for the more expensive brand-name medications and are equivalent in terms of efficacy and safety. Finally, we hope that a tool like the American Orange book will be also implemented in Italy: it would serve as an accurate reference, that can be useful both to physicians for prescription appropriateness and to patients for their own informed consent.

  18. Internal Medicine Hospitalists' Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures.

    Science.gov (United States)

    Tan, Eng Keong; Loh, Kah Poh; Goff, Sarah L

    2017-12-01

    Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center. The interviews were analyzed with directed content analysis. Internal medicine hospitalists consider secondary osteoporotic hip fracture prevention as the responsibility of outpatient physicians. Identified barriers were stratified based on themes including physicians' perception, patients' characteristics, risks and benefits of osteoporosis treatment, healthcare delivery system, and patient care transition from the inpatient to the outpatient setting. Some of the recommendations include building an integrated system that involves a multidisciplinary team such as the fracture liaison service, initiating a change to the hospital policy to facilitate inpatient care and management of osteoporosis, and creating a smooth patient care transition to the outpatient setting. Our study highlighted how internal medicine hospitalists perceive their role in the secondary prevention of osteoporotic hip fractures and what they perceive as barriers to initiating preventive measures in the hospital. Inconsistency in patient care transition and the fragmented nature of the existing healthcare system were identified as major barriers. A fracture liaison service could remove some of these barriers.

  19. Estimated dose from diagnostic nuclear medicine patients to people outside the Nuclear Medicine department.

    Science.gov (United States)

    Bartlett, Marissa L

    2013-11-01

    Patients undergoing nuclear medicine scans can be a source of radiation exposure for staff, family and the public. In this paper, 12 common nuclear medicine scans are considered. Doses are estimated for a range of scenarios, to hospital staff, to the public and to the patients' co-workers and family. Estimates are based on dose rates measured as patients left the Nuclear Medicine department. Radiopharmaceutical clearance is calculated from biokinetic models described in International Commission on Radiological Protection publications 53, 80 and 106. For all scan types, and all scenarios, doses are estimated to be substantially less than the trigger level of 300 µSv. Within the hospital, Intensive Care Unit staff receive the highest dose (up to 80 µSv) from patients who have had a myocardial scan or a positron emission tomography scan. For out-patients, the highest doses (up to 100 µSv) are associated with travel on public transport (for 4 h) on the same day as the scan.

  20. ADVERSE REACTIONS TO ANTIMICROBIAL AGENTS IN INTERNAL MEDICINE AND ORTHOPEDIC SERVICES. JOSINA MACHEL HOSPITAL, 2014

    OpenAIRE

    Mateus Sebastião João Fernandes; Héctor Lara Fernández; Vladimir Calzadilla Moreira

    2015-01-01

    A descriptive, prospective study was conducted to characterize the incidence and type of Adverse Drug Reactions (ADR) to antimicrobial agents in patients hospitalized in internal medicine and Orthopedic services at “Josina Machel” Central Hospital, in Luanda, in the period from January to February 2014 . The occurrence of adverse drug reactions was assessed by daily review of the clinical history of the patients with active search for potentially adverse effects associated with prescription a...

  1. Integrative medicine and patient-centered care.

    Science.gov (United States)

    Maizes, Victoria; Rakel, David; Niemiec, Catherine

    2009-01-01

    Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

  2. International perspectives on general internal medicine and the case for "globalization" of a discipline.

    Science.gov (United States)

    Ghali, William A; Greenberg, Peter B; Mejia, Raul; Otaki, Junji; Cornuz, Jacques

    2006-02-01

    General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the "globalization" of GIM.

  3. Implantation of a data bank of nuclear medicine patients (DOSIMED)

    International Nuclear Information System (INIS)

    Krempser, Alexandre R.; Oliveira, Silvia M. Velasques de; Silva, Tadeu A.A.

    2009-01-01

    This paper develops a institutional data bank for internal dosimetry and radiological protection of nuclear medicine patents. The data are originating from projects in progress performed by the Group for Research in Internal Dosimetry in Nuclear Medicine of the IRD, Brazil. The DOSIMED data bank was developed on the Linux computer operation system, under PHP and SQL languages, using the Script Case software. Since the investigation is due to medical applications, the data entry is done by projects, after their approval by a committee of local ethics. Projects are associated with equipment used and with studied patients. Patients are associated to and/or appropriated therapeutic protocols. The patient internal dosimetry data are generated by three types of monitoring: image quantification, bio analysis in vitro and external exposure for the patient injected with radioisotope. For the guarantee of data quality, the collected data are imported fro the original documents for the DOSIMED, and the comparison can be done after the final study for data evaluation. Up to the present, the screens for the data entry were developed and the respective consistence data are in progress. The DOSIMED will be available at the IRD intra net for the director and the investigators involved in each project

  4. Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA)

    Science.gov (United States)

    Peix, Amalia; Mesquita, Claudio Tinoco; Paez, Diana; Pereira, Carlos Cunha; Felix, Renata; Gutierrez, Claudia; Jaimovich, Rodrigo; Ianni, Barbara Maria; Soares, Jose; Olaya, Pastor; Rodriguez, Ma. Victoria; Flotats, Albert; Giubbini, Raffaele; Travin, Mark

    2014-01-01

    Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, 123I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease. PMID:24781009

  5. Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA).

    Science.gov (United States)

    Peix, Amalia; Mesquita, Claudio Tinoco; Paez, Diana; Pereira, Carlos Cunha; Felix, Renata; Gutierrez, Claudia; Jaimovich, Rodrigo; Ianni, Barbara Maria; Soares, Jose; Olaya, Pastor; Rodriguez, Ma Victoria; Flotats, Albert; Giubbini, Raffaele; Travin, Mark; Garcia, Ernest V

    2014-08-01

    Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease.

  6. A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.

    Science.gov (United States)

    Garibaldi, Brian Thomas; Niessen, Timothy; Gelber, Allan Charles; Clark, Bennett; Lee, Yizhen; Madrazo, Jose Alejandro; Manesh, Reza Sedighi; Apfel, Ariella; Lau, Brandyn D; Liu, Gigi; Canzoniero, Jenna VanLiere; Sperati, C John; Yeh, Hsin-Chieh; Brotman, Daniel J; Traill, Thomas A; Cayea, Danelle; Durso, Samuel C; Stewart, Rosalyn W; Corretti, Mary C; Kasper, Edward K; Desai, Sanjay V

    2017-10-06

    Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

  7. Factors associated with medical students' career choices regarding internal medicine.

    Science.gov (United States)

    Hauer, Karen E; Durning, Steven J; Kernan, Walter N; Fagan, Mark J; Mintz, Matthew; O'Sullivan, Patricia S; Battistone, Michael; DeFer, Thomas; Elnicki, Michael; Harrell, Heather; Reddy, Shalini; Boscardin, Christy K; Schwartz, Mark D

    2008-09-10

    Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear. To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007. Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice. Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87). Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and

  8. 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…

  9. Focus on transitions of care: description and evaluation of an educational intervention for internal medicine residents.

    Science.gov (United States)

    Aboumatar, Hanan; Allison, Robert D; Feldman, Leonard; Woods, Kevin; Thomas, Patricia; Wiener, Charles

    2014-01-01

    Transitions of care between physicians and from inpatient to outpatient settings leave patients vulnerable to medical errors and adverse events. A transitions of care workshop consisting of 2 sessions, Sign-Out Success (SOS) and Transition To Home (TTH), taught sign-out and discharge skills to incoming internal medicine interns during orientation. The workshop used role-playing exercises, didactics, demonstrations, and peer and self-evaluations. Interns completed a survey at 3 months post workshop. Using pre-post workshop measures, SOS increased the quality of intern-rated sign-outs (P = .004). Interns reported more confidence in their ability to effectively sign out (P = .016) and a greater understanding of problems that might arise while on call (P = .012). TTH increased intern-reported confidence in their ability to communicate discharge instructions (P institutions. © 2013 by the American College of Medical Quality.

  10. International Society for Quality of Life Research commentary on the draft European Medicines Agency reflection paper on the use of patient-reported outcome (PRO) measures in oncology studies.

    Science.gov (United States)

    Kyte, Derek; Reeve, Bryce B; Efficace, Fabio; Haywood, Kirstie; Mercieca-Bebber, Rebecca; King, Madeleine T; Norquist, Josephine M; Lenderking, William R; Snyder, Claire; Ring, Lena; Velikova, Galina; Calvert, Melanie

    2016-02-01

    In 2014, the European Medicines Agency (EMA) released for comment a draft reflection paper on the use of patient-reported outcome (PRO) measures in oncology studies. A twelve-member International Society for Quality of Life Research (ISOQOL) taskforce was convened to coordinate the ISOQOL response. Twenty-one ISOQOL members provided detailed comments and suggestions on the paper: 81 % from academia and 19 % from industry. Taskforce members consolidated and further refined these comments and shared the recommendations with the wider ISOQOL membership. A final response was submitted to the EMA in November 2014. The impending publication of the EMA reflection paper presents a valuable opportunity for ISOQOL to comment on the current direction of EMA PRO guidance and strategy. The EMA paper, although focused on cancer, could serve as a model for using PROs in other conditions, as it provides a useful update surrounding some of the design issues common to all trial research including PRO endpoints. However, we believe there are a number of additional areas in need of greater consideration. The purpose of this commentary is therefore to highlight the strengths of this timely and potentially useful document, but also to outline areas that may warrant further discussion.

  11. Patient acceptability of 3D printed medicines.

    Science.gov (United States)

    Goyanes, Alvaro; Scarpa, Mariagiovanna; Kamlow, Michael; Gaisford, Simon; Basit, Abdul W; Orlu, Mine

    2017-09-15

    Patient-centric medicine is a derivative term for personalised medicine, whereby the pharmaceutical product provides the best overall benefit by meeting the comprehensive needs of the individual; considering the end-user from the beginning of the formulation design process right through development to an end product is a must. One way in which to obtain personalised medicines, on-site and on-demand is by three-dimensional printing (3DP). The aim of this study was to investigate the influence of the shape, size and colour of different placebo 3D printed tablets (Printlets™) manufactured by fused deposition modelling (FDM) 3DP on end-user acceptability regarding picking and swallowing. Ten different printlet shapes were prepared by 3DP for an open-label, randomised, exploratory pilot study with 50 participants. Participant-reported outcome (PRO) and researcher reported outcome (RRO) were collected after picking and swallowing of selected printlet geometries including sphere, torus, disc, capsule and tilted diamond shapes. The torus printlet received the highest PRO cores for ease of swallowing and ease of picking. Printlets with a similar appearance to conventional formulations (capsule and disc shape) were also found to be easy to swallow and pick which demonstrates that familiarity is a critical acceptability attribute for end-users. RRO scores were in agreement with the PRO scores. The sphere was not perceived to be an appropriate way of administering an oral solid medicine. Smaller printlet sizes were found to be preferable; however it was found that the perception of size was driven by the type of shape. Printlet colour was also found to affect the perception of the end-user. Our study is the first to guide the pharmaceutical industry towards developing patient-centric medicine in different geometries via 3DP. Overall, the highest acceptability scores for torus printlets indicates that FDM 3DP is a promising fabrication technology towards increasing patient

  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. How is organ transplantation depicted in internal medicine and transplantation journals.

    Science.gov (United States)

    Durand, Céline; Duplantie, Andrée; Chabot, Yves; Doucet, Hubert; Fortin, Marie-Chantal

    2013-10-02

    In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey's critiques of organ transplantation were still relevant. Using the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis. In our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients' experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage. Our study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey's critiques of the procedure are still relevant.

  14. 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.

  15. Considering patient experience and evidence-based choice of medicines in medicines optimisation.

    Science.gov (United States)

    Kaufman, Gerri; Bellerby, Ann; Kitching, Mike

    2017-06-14

    Medicines optimisation can be used by healthcare professionals to support patients to gain maximum benefit from their medicines, with two of the main principles being understanding the patient experience and ensuring medicines choice is evidence-based. Non-adherence is a significant issue in medicines management. Relational aspects of the patient experience, such as empathetic two-way communication between the healthcare professional and patient, the provision of clear information and shared decision-making, can have a positive influence on whether patients take their medicines as intended. In practice, the degree of influence exerted by evidence-based guidelines may result in tensions between the healthcare professional's choice of medicines and the patient's experience, while the prevalence of multimorbidity may mean that some patients are prescribed medicines from several clinical guidelines. This raises issues in relation to patient morbidity and safety, including the potential for issues with polypharmacy and an increased risk of adverse drug reactions. Medication review is an important tool for identifying the patient's medication burden, and deprescribing - the planned reduction of medicines that may no longer be effective - is emerging as a strategy to reduce polypharmacy. Further progress is required to increase patient involvement in the development of guidance for medicines management to enhance the quality of patient care, particularly in relation to their values and preferences. Similarly, further research is necessary to identify how patients make decisions about their medicines use.

  16. 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 (Pmedication 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.

  17. [Distress and job satisfaction among hospital physicians in internal medicine].

    Science.gov (United States)

    Bauer, J; Groneberg, D A

    2014-10-01

    How physicians within the specialty of internal medicine perceive their stress-related working conditions, especially due to a changing health system with an impact on workflows and working hours, is examined in this study. A total of 1696 online questionnaires completed by internists were analyzed. The questionnaire was based upon the Effort-Reward Imbalance (ERI) model by Siegrist et al. and the Job-Demand-Control model (JDC) by Karasek et al. Working conditions in the specialty of internal medicine seem to have a high risk of leading to distress. As a result 62.1 % [95 % confidence interval (CI): 59.8-64.5] of the respondents described working conditions with unfavorable stress (distress). Analyzing the distress prevalence in subgroups, there were significant differences between gender (65.9 % of female physicians and 58.6 % of male physicians; p = 0.002; odds ratio (OR): 1.37; 95 % CI: 1.12-1.66), age (69.3 % of under 35-year-old to 56.6 % of 35- to 59-year-old), and functional position (38.3 % of chief physician to 69.1 % of junior physicians; OR: 7.17; 95 % CI: 3.91-13.16). Regarding job satisfaction 48.1 % of respondents said, they were very satisfied with their job. This study should be a cause for concern, since current data suggest a future shortage of qualified employers in the specialty of internal medicine. Taking this into account, working conditions in hospitals should be improved in order to bind current employees and attract new employees.

  18. Radiological protection of patients in nuclear medicine

    International Nuclear Information System (INIS)

    Harding, L.K.

    2001-01-01

    The key factor in medical exposure is justification, that is ensuring that the benefit exceeds the risk. Nuclear medicine studies are comparable in cost to more sophisticated radiological tests such as ultrasound, computed tomography or magnetic resonance. Radiation doses are similar from X ray and nuclear medicine procedures. Having justified exposures the next step is optimization, namely using a radiation dose as low as is reasonably practicable. Diagnostic reference levels may be set nationally or locally such that the balance of diagnostic quality and radiation burden is optimized. In therapy the aim is to achieve a therapeutic dose while keeping the dose to non-target tissues as low as reasonably practicable. Variations in activities may be required for overweight patients, those in severe pain, those with certain conditions and in the case of tomography. Any woman who has missed a period should be assumed to be pregnant; there should be notices to patients emphasizing this. Following the administration of longer lived pharmaceuticals it is important to avoid pregnancy for a time such that the dose to a foetus will not exceed 1 mGy. A similar situation applies to a child who is being breastfed when a mother receives a radiopharmaceutical. In the case of children undergoing investigations the activity needs to be reduced to maintain the same count density as in adults. With the administration of an incorrect pharmaceutical an attempt should be made to enhance excretion, and the referring doctor and the patient should be informed. Extravasation usually requires no action. Positron emission tomography results in higher doses both to staff and patients. Research should use subjects over the age of 50, and avoid anyone who is pregnant or is a child. Nuclear medicine procedures result in a very small loss in life expectancy compared with other common risks. (author)

  19. International Social Medicine between the Wars : Positioning a Volatile Concept

    Directory of Open Access Journals (Sweden)

    Borowy, Iris

    2007-12-01

    Full Text Available International health work during the 1930s was influenced by several inter-acting developments which caused general attention to turn away from pathogens and individual diseases to social conditions and their impact on the status of public health. Internationally, the League of Nations Health Organisation became the centre of initiatives in social medicine. After 1932, the search for the health implications of the depression invigorated ongoing social studies. Thus, nutrition, housing and rural hygiene became major issues, followed by discussions on sports. All these topics had important political connotations because they touched sensitive questions of welfare, status and the distribution of wealth and poverty within societies. In the process, they opened discussions on abstract issues like social and moral justice and on tangible questions of political systems.

  20. Transfusion medicine in trauma patients: an update.

    Science.gov (United States)

    Murthi, Sarah B; Stansbury, Lynn G; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-10-01

    In 2008, we reviewed the practical interface between transfusion medicine and the surgery and critical care of severely injured patients. Reviewed topics ranged from epidemiology of trauma to patterns of resuscitation to the problems of transfusion reactions. In the interim, trauma specialists have adopted damage control resuscitation and become much more knowledgeable and thoughtful about the use of blood products. This new understanding and the resulting changes in clinical practice have raised new concerns. In this update, we focus on which patients need damage control resuscitation, current views on the optimal form of damage control resuscitation with blood products, the roles of newer blood products, and appropriate transfusion triggers in the postinjury setting. We will also review the role of new technology in patient assessment, therapy and monitoring.

  1. Associations between subspecialty fellowship interest and knowledge of internal medicine: A hypothesis-generating study of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Haidet Paul

    2011-01-01

    Full Text Available Abstract Background Little is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM. Methods A questionnaire was emailed to 48 categorical postgraduate-year (PGY two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE for the same year was used to determine objective knowledge. Results Forty-five of 48 residents (response rate was 93.8% completed the survey. Twenty-two (49% were PG2 residents and 23(51% were PGY3 residents. Sixty percent of respondents were male. Six (13% residents were graduates of U.S. medical schools. Eight (18% reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75% had training in IM and 6 (75 % reported a training length of 3 years or less. Thirty-seven of 45 (82% residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04 as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p Conclusions More than half of surveyed residents indicated interest in pursuing a subspecialty fellowship. Fellowship interest appears positively associated with general medical knowledge in this study population. Further work is needed to explore motivation and study patterns among internal medicine residents.

  2. The international effort: building the bridge for Translational Medicine: Report of the 1st International Conference of Translational Medicine (ICTM).

    Science.gov (United States)

    Chen, Xiaoming; Andersson, Roland; Cho, William Cs; Christiani, David; Coico, Richard; Drazen, Jeffery; Ege, Markus; Fehniger, Thomas; Gao, Hongwei; Jin, Kunlin; Liebman, Michael N; Lopez, Elena; Marraro, Giuseppe; Marko-Varga, Gyorgy; Marincola, Francesco M; Popescu, Laurentiu M; Spada, Claudio; Shahzad, Aamir; Wang, Ena; Wang, Wei; Wang, Xiangdong; Wang, Yong-Xiao; Xia, Jinglin; Qu, Jia

    2012-08-14

    Supported by the International Society for Translational Medicine (ISTM), Wenzhou Medical College and the First Affiliated Hospital of Wenzhou Medical College, the International Conference on Translational Medicine (ICTM) was held on October 22-23, 2011 in Wenzhou, China. Nearly 800 registrants attended the meeting, primarily representing institutes and hospitals in Europe, The United States of America, And Asia, and China. The meeting was chaired and organized by Dr. Xiangdong Wang, Xiaoming Chen, Richard Coico, Jeffrey M. Drazen, Richard Horton, Francesco M. Marincola, Laurentiu M. Popescu, Jia Qu and Aamir Shahzad. The meeting focused on the communication of the need to foster translational medicine (TM) by building and broadening bridges between basic research and clinical studies at the international level. The meeting included distinguished TM experts from academia, the pharmaceutical and diagnostics industries, government agencies, regulators, and clinicians and provided the opportunity to identify shared interests and efforts for collaborative approaches utilizing cutting edge technologies, innovative approaches and novel therapeutic interventions. The meeting defined the concept of TM in its two-way operational scheme and emphasized the need for bed to bench efforts based directly on clinical observation. It was the meeting participants' realization that the shared main goals of TM include breaking the separation between clinic practice and basic research, establishing positive feedback by understanding the basis of expected and unexpected clinical outcomes and accelerating basic research relevant to human suffering. The primary objectives of the meeting were two-fold: to accelerate the two-way translation by informing the participants representing the different disciplines about the state of art activities around TM approaches; and to identify areas that need to be supported by redirecting limited resources as well as identifying new sources of funding

  3. Real time curriculum map for internal medicine residency.

    Science.gov (United States)

    Wong, Roger Y; Roberts, J Mark

    2007-11-07

    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. 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. 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. 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.

  4. Operationalizing the Internal Medicine Milestones–An Early Status Report

    Science.gov (United States)

    Nabors, Christopher; Peterson, Stephen J.; Forman, Leanne; Stallings, Gary W.; Mumtaz, Arif; Sule, Sachin; Shah, Tushar; Aronow, Wilbert; Delorenzo, Lawrence; Chandy, Dipak; Lehrman, Stuart G.; Frishman, William H.; Holmboe, Eric

    2013-01-01

    Background The internal medicine milestones were developed to advance outcomes-based residency training and will play an important role in the next accreditation system. Innovation As an element of our program's participation in the internal medicine educational innovations project, we implemented a milestones-based evaluation process in our general medicine and pulmonary-critical care rotations on July 1, 2010. Measures Outcomes assessed included survey-rated acceptability to participating faculty, residents, and clinical competency committee members. Results Faculty and residents agreed that the milestones promoted a common understanding of what knowledge, skills, and attitudes should be displayed at particular points in residents' professional development and enhanced evaluators' ability to provide specific performance feedback. Most residents and faculty members agreed that the milestones promoted fairness and uniformity in the evaluation process. Clinical competency committee members agreed the milestones improved the quality of information available for deliberations and resulted in more uniform promotion standards. Faculty rated the use of too many milestones per form/tool at a mean of 7.3 (where 1 was minimally problematic, and 10 was maximally problematic) and the potential for evaluator fatigue (mean, 8.2) as the most significant challenges to the use of milestones. Eight of 12 faculty members would recommend milestones in other programs; 4 were uncertain. Conclusions Despite logistical challenges, educators and trainees found that milestones promoted a common understanding of what knowledge, skills and attitudes should be displayed at particular stages of training; permitted greater specificity in performance feedback; and enhanced uniformity and fairness in promotion decisions. PMID:24404240

  5. Herbal medicine use among Turkish patients with chronic diseases

    Directory of Open Access Journals (Sweden)

    Munevver Tulunay

    2015-09-01

    Conclusions: In this study herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines. [J Intercult Ethnopharmacol 2015; 4(3.000: 217-220

  6. Use Of Chinese Medicine Among Colorectal Cancer Patients: A ...

    African Journals Online (AJOL)

    Use Of Chinese Medicine Among Colorectal Cancer Patients: A Nationwide Population-Based Study. ... African Journal of Traditional, Complementary and Alternative Medicines. Journal Home ... Background: Traditional Chinese medicine (CM) appears to be used worldwide, especially by cancer patients. The aim of the ...

  7. Absorbed Doses to Patients in Nuclear Medicine

    International Nuclear Information System (INIS)

    Leide-Svegborn, Sigrid; Mattsson, Soeren; Nosslin, Bertil; Johansson, Lennart

    2004-09-01

    The work with a Swedish catalogue of radiation absorbed doses to patients undergoing nuclear medicine investigations has continued. After the previous report in 1999, biokinetic data and dose estimates (mean absorbed dose to various organs and tissues and effective dose) have been produced for a number of substances: 11 C- acetate, 11 C- methionine, 18 F-DOPA, whole antibody labelled with either 99m Tc, 111 In, 123 I or 131 I, fragment of antibody, F(ab') 2 labelled with either 99m Tc, 111 In, 123 I or 131 I and fragment of antibody, Fab' labelled with either 99m Tc, 111 In, 123 I or 131 I. The absorbed dose estimates for these substances have been made from published biokinetic information. For other substances of interest, e.g. 14 C-urea (children age 3-6 years), 14 C-glycocholic acid, 14 C-xylose and 14 C-triolein, sufficient literature data have not been available. Therefore, a large number of measurements on patients and volunteers have been carried out, in order to determine the biokinetics and dosimetry for these substances. Samples of breast milk from 50 mothers, who had been subject to nuclear medicine investigations, have been collected at various times after administration of the radiopharmaceutical to the mother. The activity concentration in the breast milk samples has been measured. The absorbed dose to various organs and tissues and the effective dose to the child who ingests the milk have been determined for 17 different radiopharmaceuticals. Based on these results revised recommendations for interruption of breast-feeding after nuclear medicine investigations are suggested

  8. Why not nephrology? A survey of US internal medicine subspecialty fellows.

    Science.gov (United States)

    Jhaveri, Kenar D; Sparks, Matthew A; Shah, Hitesh H; Khan, Seyyar; Chawla, Arun; Desai, Tejas; Iglesia, Edward; Ferris, Maria; Parker, Mark G; Kohan, Donald E

    2013-04-01

    There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology. A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors. 714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology. Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  9. Regenerative Medicine from Protocol to Patient

    Directory of Open Access Journals (Sweden)

    Gustav Steinhoff

    2011-01-01

    (section 12.5 discussed the quality of cells and efficiency of the in vivo viability of transplantation. It would be great to add additional discussions on some other directions, such as improving the integration of the cardiac stem cells with host and combining with tissue engineering to improve transplantation. A new chapter to include the clinical trials of various stem cell therapies: both successful ones and otherwise, as well, the inclusion of the perspectives for some promising cell therapies, which have not been applied in clinic, probably would have done more justice from the perspectives of clinicians and patients. On the whole, this book summarizes the developments and the current trend in regenerative medicine and emphasizes on the stem cell biology and their application. Generally, this book is well-organized and written in lucid style offering a comprehensive review of the advancements in the topics covered. This book is bound to contribute to a thorough understanding of regenerative medicine paving way for great ideas for future research and significant discoveries in the field of Regenerative Medicine.

  10. 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

  11. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

    Science.gov (United States)

    Zeger, Scott L.; Kolars, Joseph C.

    2007-01-01

    BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, −0.2% (95%CI −0.36%, −0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training. PMID:17468889

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

    Science.gov (United States)

    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.

  13. 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.

  14. 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...

  15. 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

    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

  16. A review of international coverage and pricing strategies for personalized medicine and orphan drugs.

    Science.gov (United States)

    Degtiar, Irina

    2017-12-01

    Personalized medicine and orphan drugs share many characteristics-both target small patient populations, have uncertainties regarding efficacy and safety at payer submission, and frequently have high prices. Given personalized medicine's rising importance, this review summarizes international coverage and pricing strategies for personalized medicine and orphan drugs as well as their impact on therapy development incentives, payer budgets, and therapy access and utilization. PubMed, Health Policy Reference Center, EconLit, Google Scholar, and references were searched through February 2017 for articles presenting primary data. Sixty-nine articles summarizing 42 countries' strategies were included. Therapy evaluation criteria varied between countries, as did patient cost-share. Payers primarily valued clinical effectiveness; cost was only considered by some. These differences result in inequities in orphan drug access, particularly in smaller and lower-income countries. The uncertain reimbursement process hinders diagnostic testing. Payer surveys identified lack of comparative effectiveness evidence as a chief complaint, while manufacturers sought more clarity on payer evidence requirements. Despite lack of strong evidence, orphan drugs largely receive positive coverage decisions, while personalized medicine diagnostics do not. As more personalized medicine and orphan drugs enter the market, registries can provide better quality evidence on their efficacy and safety. Payers need systematic assessment strategies that are communicated with more transparency. Further studies are necessary to compare the implications of different payer approaches. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach.

    Science.gov (United States)

    Taylor, David R; Park, Yoon Soo; Smith, Christopher A; Karpinski, Jolanta; Coke, William; Tekian, Ara

    2018-04-17

    Competency-based medical education has not advanced residency training as much as many observers expected. Some medical educators now advocate reorienting competency-based approaches to focus on a resident's ability to do authentic clinical work. To develop descriptions of clinical work for which internal medicine residents must gain proficiency to deliver meaningful patient care (for example, "Admit and manage a medical inpatient with a new acute problem"). A modified Delphi process involving clinical experts followed by a conference of educational experts. The Royal College of Physicians and Surgeons of Canada. In phase 1 of the project, members of the Specialty Committee for Internal Medicine participated in a modified Delphi process to identify activities in internal medicine that represent the scope of the specialty. In phase 2 of the project, 5 experts who were scholars and leaders in competency-based medical education reviewed the results. Phase 1 identified important activities, revised descriptions to improve accuracy and avoid overlap, and assigned activities to stages of training. Phase 2 compared proposed activity descriptions with published guidelines for their development and application in medical education. The project identified 29 activities that qualify as entrustable professional activities. The project also produced a detailed description of each activity and guidelines for using them to assess residents. These activities reflect the practice patterns of the developers and may not fully represent internal medicine practice in Canada. Identification of these activities is expected to facilitate modification of training and assessment programs for medical residents so that programs focus less on isolated skills and more on integrated tasks. Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and Queen's University Department of Medicine Innovation Fund.

  18. Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

    Science.gov (United States)

    Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J

    2017-05-01

    Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.

  19. Patient dose assessment in different diagnostic procedures in nuclear medicine

    International Nuclear Information System (INIS)

    Sena, E. de; Bejar, M.J.; Berenguer, R.; Ruano, R.; Tamayo, P.

    2001-01-01

    Effective doses have been estimated for 314 patients under diagnostic procedures in a Nuclear Medicine Department using data reported in ICRP-80 and RIDIC (Radiation Internal Dose Information Center). Data on administered activity, radiopharmaceutical and administration route, age and sex of the patients have been collected. Doses in the most exposed critical organ for every protocol, doses in uterus, doses in fetus versus the stage of pregnancy (in case the female patient was pregnant) and doses for nursing infants have been also estimated. Ga-67 studies give the highest effective doses per protocol followed by cardiac SPECT procedures using Tl-201 chloride. Ga-67 studies also give the highest absorbed doses in uterus. Due to not administering different activities, depending on height and weight of adults, women receive doses about 20% higher than men. This would be a practice to modify in the future in order to optimise doses. (author)

  20. Morbidity and mortality conference: a survey of academic internal medicine departments.

    Science.gov (United States)

    Orlander, Jay D; Fincke, B Graeme

    2003-08-01

    This study sought to determine the prevalence and characteristics of morbidity and mortality conferences (M&MCs) in U.S. internal medicine training programs. Two hundred ninety-five of 416 (71%) surveys were returned. Ninety percent of programs have an M&MC. Most meet monthly, have a designated leader, and entail case discussions of 3 or fewer patients. Cases are selected on the basis of unexpected bad outcomes, teaching value, and to a lesser extent, suspected medical error. Two thirds of the sites use M&MCs to meet administrative requirements for quality assurance. M&MC, while prevalent in internal medicine training programs, has a heterogeneity of focus. Hence, the goals and role of the conference, as judged by this survey, do not appear to be well defined and may warrant further clarification.

  1. 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

  2. Internal Medicine Residents' Perceptions of Cross-Cultural Training

    Science.gov (United States)

    Park, Elyse R; Betancourt, Joseph R; Miller, Elizabeth; Nathan, Michael; MacDonald, Ellie; Ananeh-Firempong, Owusu; Stone, Valerie E

    2006-01-01

    BACKGROUND Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate = 87%). Interviews were recorded, transcribed, and analyzed. RESULTS Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base. PMID:16704391

  3. 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

  4. 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 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.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.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.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.

  5. 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.

  6. Development and Implementation of a Novel HIV Primary Care Track for Internal Medicine Residents.

    Science.gov (United States)

    Fessler, David A; Huang, Grace C; Potter, Jennifer; Baker, Joseph J; Libman, Howard

    2017-03-01

    Declining mortality has led to a rising number of persons living with HIV (PLWH) and concerns about a future shortage of HIV practitioners. To develop an HIV Primary Care Track for internal medicine residents. Academic hospital and community health center with a history of caring for PLWH and lesbian, gay, bisexual, and transgender (LGBT) patients. Internal medicine residents. We enrolled four residents annually in a 3-year track with the goal of having each provide continuity care to at least 20 PLWH. The curriculum included small group learning sessions, outpatient electives, a global health opportunity, and the development of a scholarly project. All residents successfully accrued 20 or more PLWH as continuity patients. Senior residents passed the American Academy of HIV Medicine certification exam, and 75 % of graduates took positions in primary care involving PLWH. Clinical performance of residents in HIV care quality measures was comparable to those reported in published cohorts. We developed and implemented a novel track to train medical residents in the care of PLWH and LGBT patients. Our results suggest that a designated residency track can serve as a model for training the next generation of HIV practitioners.

  7. 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.

  8. 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…

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

    Science.gov (United States)

    2009-05-28

    Africa, Asia, and Latin America have areas where 10% to 30% of medicines sold are counterfeit . In contrast, in...diversion. 49 Jillian Clare Cohen, “Expanding Drug Access in Brazil: Lessons for Latin America and... counterfeit medicines , generic medicines are distinguished from counterfeit medicines in that they are legitimately produced, generally copies of off-patent

  10. 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. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  11. 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

  12. An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients.

    Science.gov (United States)

    Yeh, Mei-Ling; Chiu, Wei-Ling; Wang, Yu-Jen; Lo, Chyi

    This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.

  13. 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?

  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. Internal dosimetry for occupationally exposed personnel in nuclear medicine

    International Nuclear Information System (INIS)

    Garcia, M.T.; Alfaro, L.M.M.; Angeles, C.A.

    2013-01-01

    Internal dosimetry plays an important role in nuclear medicine dosimetry control of personnel occupationally exposed, and that in recent years there has been a large increase in the use of radionuclides both in medical diagnosis as radiotherapy. But currently, in Mexico and in many parts of the world, this internal dosimetry control is not performed. The Instituto Nacional de lnvestigaciones Nucleares de Mexico (ININ) together with the Centro Oncologico de Toluca (ISEMMYM) have developed a simple and feasible methodology for monitoring of personnel working in these facilities. It was aimed to carry out the dosimetry of the personnel, due to the incorporation of I-131, using the spectrometric devices that the hospital has, a gamma camera. The first step in this methodology was to make a thyroid phantom to meet the specifications of the ninth ANSI. This phantom is compared under controlled conditions with RMC- II phantom used for system calibration of the ININ internal dosimetry (ACCUSCAN - Ll), and with another phantom developed in Brazil with ANSI specifications, in order to determine the variations in measurements due to the density of the material of each of the phantoms and adjust to the system ACCUSCAN, already certificate. Furthermore, necessary counts were performed with the gamma camera of the phantom developed at ININ, with a standard source of 133 Ba which simulates the energy of 131 I. With these data, were determined the counting efficiencies for a distance of 15 to 20 cm between the surface of the phantom and the the plate of the detectors. Another important aspect was to determine the lower limit of detection (LLD). In this paper we present the results obtained from the detectors calibration of the gamma camera of the hospital.

  16. 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.

  17. [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

    2015-11-04

    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.

  18. Alternative and complementary medicine in cancer patient

    International Nuclear Information System (INIS)

    Reckova, M.

    2009-01-01

    The use of alternative and complementary medicine (CAM) in cancer patients is widespread and it is not surprising as the results gained by conventional treatments are not sufficient. However, the results from the studies with CAM are not always sufficient according to their testing in appropriate clinical studies. Another problem that is present in the use of CAM is the possibility of drug-drug interactions between conventional therapies and CAM. Thus, it is of utmost importance that the oncologist possess a good knowledge of available CAM and provide a sufficient time for discussion with the patient and his/her family about possible alternative treatments and any downside risks. The cornerstone for pertinent discussion is sufficient knowledge on the part of the oncologist about those alternative treatments that are usually presented in the media with incomplete information about their relevant clinical tests and side effects. The following article presents a review of the current alternative treatment methods with a focus on the alternative drugs that have already been clinically tested, and secondarily on the alternative drugs that have been used even without sufficient testing in clinical trials. (author)

  19. Number of patients studied prior to approval of new medicines: a database analysis.

    Directory of Open Access Journals (Sweden)

    Ruben G Duijnhoven

    Full Text Available BACKGROUND: At the time of approval of a new medicine, there are few long-term data on the medicine's benefit-risk balance. Clinical trials are designed to demonstrate efficacy, but have major limitations with regard to safety in terms of patient exposure and length of follow-up. This study of the number of patients who had been administered medicines at the time of medicine approval by the European Medicines Agency aimed to determine the total number of patients studied, as well as the number of patients studied long term for chronic medication use, compared with the International Conference on Harmonisation's E1 guideline recommendations. METHODS AND FINDINGS: All medicines containing new molecular entities approved between 2000 and 2010 were included in the study, including orphan medicines as a separate category. The total number of patients studied before approval was extracted (main outcome. In addition, the number of patients with long-term use (6 or 12 mo was determined for chronic medication. 200 unique new medicines were identified: 161 standard and 39 orphan medicines. The median total number of patients studied before approval was 1,708 (interquartile range [IQR] 968-3,195 for standard medicines and 438 (IQR 132-915 for orphan medicines. On average, chronic medication was studied in a larger number of patients (median 2,338, IQR 1,462-4,135 than medication for intermediate (878, IQR 513-1,559 or short-term use (1,315, IQR 609-2,420. Safety and efficacy of chronic use was studied in fewer than 1,000 patients for at least 6 and 12 mo in 46.4% and 58.3% of new medicines, respectively. Among the 84 medicines intended for chronic use, 68 (82.1% met the guideline recommendations for 6-mo use (at least 300 participants studied for 6 mo and at least 1,000 participants studied for any length of time, whereas 67 (79.8% of the medicines met the criteria for 12-mo patient exposure (at least 100 participants studied for 12 mo. CONCLUSIONS: For

  20. International development of traditional medicine / complementary and alternative medicine research--what can Europe learn?

    Science.gov (United States)

    Hök, Johanna; Lewith, George; Weidenhammer, Wolfgang; Santos-Rey, Koldo; Fønnebø, Vinjar; Wiesener, Solveig; Falkenberg, Torkel

    2012-01-01

    The aim of this study was to analyse global research and development (R&D) strategies for traditional medicine (TM) and complementary and alternative medicine (CAM) across the world to learn from previous and on-going activities. 52 representatives within CAMbrella nominated 43 key international stakeholders (individuals and organisations) and 15 of these were prioritised. Information from policy documents including mission statements, R&D strategies and R&D activities were collected in combination with personal interviews. Data were analysed using the principles of content analysis. Key stakeholders vary greatly in terms of capacity, mission and funding source (private/public). They ranged from only providing research funding to having a comprehensive R&D and communication agenda. A common shift in R&D strategy was noted; whereas 10 years ago research focused mainly on exploring efficacy and mechanisms, today the majority of stakeholders emphasise the importance of a broad spectrum of research, including methodologies exploring context, safety and comparative effectiveness. The scarce public investment in this field in Europe stands in stark contrast to the large investments found in Australia, Asia and North America. There is an emerging global trend supporting a broad research repertoire, including qualitative and comparative effectiveness research. This trend should be considered by the EU given the experience and the substantial research funding committed by the included stakeholders. To facilitate international collaborative efforts and minimise the risk of investment failure, we recommend the formation of a centralised EU CAM research centre fostering a broad CAM R&D agenda with the responsibility for implementing the relevant findings of CAMbrella.

  1. Active Student Participation May Enhance Patient Centeredness: Patients' Assessments of the Clinical Education Ward for Integrative Medicine

    Directory of Open Access Journals (Sweden)

    Christian Scheffer

    2013-01-01

    Full Text Available Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM, where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG. General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.

  2. Hemoglobin transfusion trigger in an internal medicine department - A "real world" six year experience.

    Science.gov (United States)

    Rahimi-Levene, Naomi; Ziv-Baran, Tomer; Peer, Victoria; Golik, Ahuva; Kornberg, Abraham; Zeidenstein, Ronit; Koren-Michowitz, Maya

    2018-01-01

    Transfusion guidelines advocate restrictive rather than liberal use of red blood cells (RBC) and are based mostly on randomized trials in intensive care and surgical departments. We aimed to study RBC transfusion practice in the medical patients' population. The data in this study were collected from patients over the age of 18 years admitted to an Internal Medicine department between 2009 and 2014 who received at least one unit of packed red blood cells (RBC). In addition, data on demographics, patients' diagnoses, laboratory tests and number of transfused RBC units were extracted from the electronic health records. One thousand three hundred and twenty eight patients were included, having mean age of 75 ± 14 years. The median hemoglobin (Hb) trigger for RBC transfusion was 8.0 g/dl (IQR 7.3-8.7g/dl), and most patients received either one (43.4%) or two (33.4%) RBC units. There was no significant difference in Hb trigger between males and females (Hb 8.0 g/dl and 7.9 g/dl, respectively, p = 0.098), and a weak correlation with age (r = 0.108 p = 0.001). Patients with cardiovascular and lung diseases had a statistically significant higher Hb trigger compared to patients without those diagnoses, however the median difference between them was 0.5 g/dl or less. These "real world" data we collected show a Hb trigger compliant with the upper limit of published guidelines and influenced by medical patients' common diagnoses. Prospective trials addressing patients hospitalized in internal medicine departments could further contribute to transfusion decision algorithms.

  3. 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.

  4. Why evidence-based medicine failed in patient care and medicine-based evidence will succeed.

    Science.gov (United States)

    Horwitz, Ralph I; Singer, Burton H

    2017-04-01

    Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Radiation risk to patients from nuclear medicine procedures in Cuba

    International Nuclear Information System (INIS)

    Brigido, O.; Montalván, A.; Barreras, A.; Hernández, J.

    2015-01-01

    Man-made radiation exposure to the Cuban population predominantly results from the medical use of ionizing radiation. It was therefore the aim of the present study, to provide public health information concerning diagnostic nuclear medicine procedures carried out in Camagüey and Ciego de Ávila provinces between 2000 and 2005. Population radiation dose estimation due to administration of radiopharmaceuticals in Camagüey and Ciego de Ávila provinces was carried out using Medical Internal Radiation Dose scheme (MIRD). Data were gathered on the type of radiopharmaceuticals used, the administered activity, the numbers of each kind of examination, and the age and sex of the patients involved during the period 2000 – 2005. The average annual frequency of examinations was estimated to be 3.34 per 1000 population. The results show that imaging nuclear medicine techniques of thyroid and bone explorations with 13.3 and 12.9%, respectively and iodide uptake with 50% are the main techniques implicated in the relative contribution to the total annual effective collective dose which averaged 95 man⋅Sv for the studied period. Radiation risks for the Camagüey-Ciego de Avila population caused by nuclear medicine examinations in the period studied were calculated: the total number of fatal and non-fatal cancers was 34.2 and the number of serious hereditary disturbance was 7.4 as a result of 24139 nuclear medicine procedures, corresponding a total detriment of 1.72 per 1000 examination. (authors)

  6. Addressing health literacy through clear health communication: a training program for internal medicine residents.

    Science.gov (United States)

    Green, Jamie A; Gonzaga, Alda Maria; Cohen, Elan D; Spagnoletti, Carla L

    2014-04-01

    To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy. Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist. Mean knowledge scores increased significantly from 60.3% to 77.6% (pcommunicating with low literacy patients (3.3 vs. 4.1) (all pcommunication improves resident knowledge, attitudes, and skills regarding health literacy. The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Travel medicine advice to UK based international motor sport teams.

    Science.gov (United States)

    Walters, A

    2000-01-01

    International motor sport teams travel extensively. Over the years, the design and build of racing cars has improved so that morbidity and mortality in motor sport has been lessened. Those team members supporting the competitors need to be physically and mentally fit to perform complicated tasks, despite having traveled. This group of travelers has not been studied to any extent previously. An anonymous questionnaire asking some basic travel medicine related questions was distributed to the support team members of a Rally team, and Formula One Grand Prix team. Both teams were based in the UK, and competed in all the rounds of their respective world championships. Ten Rally team members and 18 Formula One team members responded to the questionnaire. The results showed moderate coverage of commonly used vaccinations; appropriate use of antimalarials and insect repellents, but by no means by all team members; little or no problems with traveler's diarrhea; some tendencies to problems related to jet lag, but no real attempt to prevent the problem; and finally some attempt at skin protection against solar damage. Support teams are reasonably well prepared for the combination of, the rigors of frequent travel, and a demanding job. There is a deficit in vaccine coverage, especially of both hepatitis A and B, some education is needed in preventing skin problems later in life due to sun exposure, and further study of jet lag and its implications might be appropriate.

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

    Science.gov (United States)

    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.

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

    DEFF Research Database (Denmark)

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

    2003-01-01

    .22), difficulties in getting to sleep 0.96 (0.91 to 1.00), and nervousness 1.04 (0.99 to 1.08). CONCLUSIONS: Substantial proportions of adolescents used medicine for common health problems. The prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender......, stomachache, difficulties in getting to sleep, and nervousness during the past month. RESULTS: The magnitude of the adolescents' medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness varied substantially across countries. In each of the 28 countries, more girls than boys...... used medicine for pain. Use of medicine for headache increased by age; use of medicine for stomachache increased by age among girls, but decreased among boys; and use of medicine for difficulties in getting to sleep and nervousness decreased from the age of 11 to 15 years. There was an increase...

  10. [Medicinal plants in cancer patients: current practices and evaluation data].

    Science.gov (United States)

    Huet, Matthieu

    2013-05-01

    Many complementary and alternatives medicines are offered to patients with cancer. Among them, herbal medicines have a substantial place. These plants are mainly used to reduce adverse effects of anticancer treatments and for specific anticancer properties. Our review shows that only few clinical data support medicinal plants effectiveness in cancer patients. Arguments rely mainly on usual indications and pharmacological data for minimization of treatments toxicity while for the anticancer properties, on epidemiological and preclinical data. To inform and counsel patients and people around, healthcare professionals need to evaluate benefit-risk balance on evidence-based information. Because the medical decision should be shared with the patient, his beliefs and preferences have to be considered. When no adverse effect or drug interaction is associated with herbal medicine, we state that their use is acceptable. This paper discuss of potential risk and benefit of the most used medicinal plants by cancer patients.

  11. Morbidity and Mortality Conference: A Survey of Academic Internal Medicine Departments

    OpenAIRE

    Orlander, Jay D; Fincke, B Graeme

    2003-01-01

    This study sought to determine the prevalence and characteristics of morbidity and mortality conferences (M&MCs) in U.S. internal medicine training programs. Two hundred ninety-five of 416 (71%) surveys were returned. Ninety percent of programs have an M&MC. Most meet monthly, have a designated leader, and entail case discussions of 3 or fewer patients. Cases are selected on the basis of unexpected bad outcomes, teaching value, and to a lesser extent, suspected medical error. Two thirds of th...

  12. Developing a Comprehensive Perioperative Education Curriculum for Internal Medicine Residency Training.

    Science.gov (United States)

    Raslau, David; Kasten, Mary Jo; Kebede, Esayas; Mohabbat, Arya; Ratrout, Basem; Mikhail, Michael

    2017-01-01

    Patients undergoing surgery are becoming increasingly complex and internists are becoming more involved in their perioperative care. Therefore, new requirements from the ACGME/ABIM necessitate education in this area. We aim to discuss how our institution adapted a perioperative curriculum to fill this need. Perioperative education is primarily given to the residents during their one month rotation through the General Internal Medicine Consult Service rotation. This is an inpatient rotation that provides perioperative expertise to surgical teams, medicine consultation to medical subspecialty teams, and outpatient preoperative evaluations. Our implementation complies with ACGME/ABIM requirements and ensures that the educational and clinical needs of our institution are met. Developing a new curriculum can be daunting. We hope that this explanation of our approach will aid others who are working to develop an effective perioperative curriculum at their institutions.

  13. A Survey of Clinical Skills Evaluation Practices in Internal Medicine Residency Programs.

    Science.gov (United States)

    Blank, Linda L.; And Others

    1984-01-01

    The evaluation processes of 75 internal medicine residencies visited by the American Board of Internal Medicine (ABIM) in 1978-82 are reviewed. The methods of evaluation used by the residencies are described and compared with the findings from an earlier cycle of visits in 1972-75. (Author/MLW)

  14. 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…

  15. Factors associated with the subspecialty choices of internal medicine residents in Canada

    Directory of Open Access Journals (Sweden)

    Thorpe Kevin

    2008-06-01

    Full Text Available Abstract Background Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. Methods In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4 subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. Results 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate. 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations

  16. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

    Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  17. International differences in sport medicine access and clinical management

    Science.gov (United States)

    Heron, Neil; Malliaropoulos, Nikolaos G.

    2012-01-01

    Summary I undertook the 2012 ECOSEP travelling fellowship, sponsored by Bauerfeind, between May and August 2012, which involved visiting 5 European sport medicine centres and spending approximately one week in each centre. The 5 centres included: National Track and Field Centre, SEGAS, Thessaloniki, Greece; Professional School in Sport & Exercise Medicine, University of Barcelona, Spain; Sport Medicine Frankfurt Institute, Germany; Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy, and Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, England. Throughout the fellowship, the clinical cases which were routinely encountered were documented. The following sections detail my experiences throughout the fellowship, the sports of the athletes and the injuries which were treated at each of the sport medicine centres during the fellowship visit and the different forms of management employed. PMID:23738305

  18. Patients with COPD have low adherence to inhaled medicine

    DEFF Research Database (Denmark)

    Lange, Peter; Toettenborg, Sandra; Topp, Marie

    2014-01-01

    describe results of previous studies on prevalence of adherence to inhaled medicine in COPD, and define characteristics of the patients and treatment associated with degree of adherence. We conclude that health professionals should always consider non-adherence, strive to simplify regiments......Medicine adherence in patients with obstructive pulmonary disease (COPD), has not been studied in Denmark. Studies from other countries, however, unequivocally report low prevalence of patients who follow their doctor's advice and have sufficient adherence to inhaled medicine. In this review we......, and that there is an urgent need of studies aiming at improving adherence in patients with COPD....

  19. 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.

  20. Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey.

    Science.gov (United States)

    Abunahlah, Nibal; Elawaisi, Anfal; Velibeyoglu, Fatih Mehmet; Sancar, Mesut

    2018-01-29

    Background Drug-related problems (DRPs) interfere with patient optimal therapeutic outcomes and may be associated with higher morbidity, mortality and healthcare expenditures. Objective This study aimed to identify DRPs and their causes in a Turkish hospital. Setting Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Internal Medicine Ward, Istanbul, Turkey. Method Cross-sectional study included a total of 100 patients. Patient demographics, medications, and history were evaluated. Data regarding recent medications were analyzed by two clinical pharmacists and an Internal Medicine physician. The DRPs were identified via V7.0 PCNE classification. Lexicomp ® was used to assess the drug-drug interactions. UpToDate ® recommendations and national guidelines were applied in the assessment of compliance with approved medication procedures. Main outcome measures Number and causes of the potential DRPs. Results At least one potential DRP was seen in 80% of the patients and 163 potential DRPs were identified (average = 1.6 DRPs/patient). The most common causes of DRPs were errors in drug selection (44.78%), dose selection (27.61%) and medication procedures (21.47%). There were significant correlations (p < 0.05) between DRPs and age (r = 0.4), number of drugs used (r = 0.32), duration of hospitalization (r = 0.25), renal impairment (r = - 0.34) and inflammation (r = 0.31). Conclusion The majority of the patients had DRPs. Patients with renal impairment, inflammation, polypharmacy or an extended hospital stay had a much higher chance of developing DRPs.

  1. Internal medicine and the training of international medical graduates: a time for open discussion and new approaches.

    Science.gov (United States)

    Levey, G S

    1992-09-01

    The number of foreign national medical graduates entering internal medicine residency training programs in the United States has doubled since 1986. A rigorous, standardized preresidency evaluation of the basic clinical skills and language abilities of international medical graduates should be implemented. Those found to have significant deficits should undertake a preparatory curriculum designed to meet special educational needs before entry into the formal training program. A relevant curriculum might include formal lectures, reading assignments, physical diagnosis sessions, language classes, patient encounter sessions, and a tutorial on U.S medical culture that includes medical ethics and the basics of the our health care system. All or only some of these may be required for any given individual. The Educational Commission for Foreign Medical Graduates (ECFMG) could provide many of the methods needed for an evaluation program and work collaboratively with program directors. This new approach to training of international medical graduates will require an evaluation system to to measure its effectiveness. Important questions about the funding of graduate medical education for international medical graduates must also be addressed.

  2. 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

  3. 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.

  4. Application of alternative medicine in gastrointestinal cancer patients

    Directory of Open Access Journals (Sweden)

    Nikolić Ivan

    2012-01-01

    Full Text Available Bacground/Aim. Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. Methods. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. Results. A total of 48 (24.9% patients did not use any type of alternative therapy; 145 (75.1% patients used at least one product and 124 (64.25% patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients; 136 (70.5% patients were informed about alternative therapies by other patients.; 145 (75.1% used alternative medicine to increase the chances for cure; 88 (45.6% of interviewed patients would like to participate in future research in this field. Conclusion. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.

  5. Resident Career Planning Needs in Internal Medicine: A Qualitative Assessment

    Science.gov (United States)

    Garcia, Rina L.; Windish, Donna M.; Rosenbaum, Julie R.

    2010-01-01

    Background Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning. Objective To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying. Methods In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus. Results A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency. Conclusions This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training. PMID:22132271

  6. Resident career planning needs in internal medicine: a qualitative assessment.

    Science.gov (United States)

    Garcia, Rina L; Windish, Donna M; Rosenbaum, Julie R

    2010-12-01

    Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning. To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying. In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus. A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency. This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.

  7. Internal Medicine residents use heuristics to estimate disease probability.

    Science.gov (United States)

    Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

    2015-01-01

    Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

  8. Admission of nursing home residents to a hospital internal medicine department.

    Science.gov (United States)

    Barba, Raquel; Zapatero, Antonio; Marco, Javier; Perez, Alejandro; Canora, Jesús; Plaza, Susana; Losa, Juan

    2012-01-01

    Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. In this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs. Between January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02-1.03), female gender (OR 1.13, 95% CI 1.13-1.17), dementia (OR 1.09, 95% CI 1.03-1.16), previous feeding tube (OR 1.34, 95% CI 1.09-1.79), malignant disease (OR 2.03, 95% CI 1.86-2.23), acute infectious disease (OR 1.18, 95% CI 1.12-1.25), pressure sores (OR 1.88, 95% CI 1.62-1.95), acute respiratory failure (OR 2.00, 95% CI 1.90-2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23-2.72). Two of every 100 patients admitted to internal medicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  9. Performance of internal medicine residents in the primary interpretation of musculoskeletal radiographs in an ambulatory care setting

    International Nuclear Information System (INIS)

    Mann, F.A.; Stewart, N.R.; Terrell, C.B.

    1990-01-01

    This paper determines the characteristics of misinterpretations of musculoskeletal radiographs by internal medicine residents (IMRs) in an ambulatory care setting. Discordances between IMRs and staff radiologists were prospectively identified and retrospectively reviewed to assess type of error and patient outcome. The setting was an acute ambulatory care clinic at a large university hospital staffed by board-certified emergency medicine faculty and IMRs. Of 541 patients radiographed, 321 (59%) had adequate follow-up to establish outcome. Error characteristics examined included nature and site, type (false negative ([F-] or false positive [F+]), clinical significance, interpreter responsible, and level of interpreter training

  10. 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.

  11. International Journal of Medicine and Health Development: Editorial ...

    African Journals Online (AJOL)

    ... education and research and clinical service, College of Medicine, University of Nigeria will achieve ever-increasing national distinction as a health sciences college.College of Medicine, University of Nigeria will provide outstanding medical education through its faculty, staff, programs, centers of excellence and affiliates.

  12. 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.

  13. ADVERSE REACTIONS TO ANTIMICROBIAL AGENTS IN INTERNAL MEDICINE AND ORTHOPEDIC SERVICES. JOSINA MACHEL HOSPITAL, 2014

    Directory of Open Access Journals (Sweden)

    Mateus Sebastião João Fernandes

    2015-10-01

    Full Text Available A descriptive, prospective study was conducted to characterize the incidence and type of Adverse Drug Reactions (ADR to antimicrobial agents in patients hospitalized in internal medicine and Orthopedic services at “Josina Machel” Central Hospital, in Luanda, in the period from January to February 2014 . The occurrence of adverse drug reactions was assessed by daily review of the clinical history of the patients with active search for potentially adverse effects associated with prescription antimicrobial agents. Of a total of 206 hospitalized patients, 21 were affected by ADR, corresponding to an incidence rate of 10.2%. The incidence was significantly higher in the internal medicine service, occurring in 11.7% of 137 patients admitted, while in the orthopedic service the incidence was 7.2% (5/69. The highest incidence of ADR was recorded in patients aged 30-39 years in 10 patients (4.9%, and in the female gender (7.8%. The most common clinical manifestations of ADR were rash (17.2%, followed by headache, pruritus and nausea and vomiting (13.8%. The antimicrobials most frequently associated with the occurrence of ADR were the antimalarial, related to more than half the cases. Among the antibacterial agents cephalosporins were associated to five cases of ADR (23.8%. Most ADR were classified according to severity as mild (52.4% and as probable (57.1% regarding the attribution of causality. Given the growing impact of the occurrence of ADR we recommend pursuing this research, in order to further deepen this problem.

  14. The Effect on Mortality of Fluconazole or Echinocandins Treatment in Candidemia in Internal Medicine Wards

    Science.gov (United States)

    Filippini, Claudia; Raviolo, Stefania; Fossati, Lucina; Montrucchio, Chiara; Aldieri, Chiara; Petrolo, Alessia; Cavallo, Rossana; Di Perri, Giovanni

    2015-01-01

    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. PMID:25938486

  15. Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents.

    Science.gov (United States)

    Rhodes, Ramona L; Tindall, Kate; Xuan, Lei; Paulk, M Elizabeth; Halm, Ethan A

    2015-05-01

    Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient's best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Modest improvements were made over time in trainees' exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. © The Author(s) 2014.

  16. Herbal medicine use among patients with chronic diseases.

    Science.gov (United States)

    Tulunay, Munevver; Aypak, Cenk; Yikilkan, Hulya; Gorpelioglu, Suleyman

    2015-01-01

    Complementary and alternative medicine (CAM) is commonly used all over the world, and herbal medicines are the most preferred ways of CAM. The aim of this study was to determine the frequency of herbal medicine use among patients with chronic diseases. A cross-sectional descriptive study was conducted from April 2014 to December 2014 among patients who had been diagnosed with diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL) in Family Medicine Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital, in Ankara. A questionnaire about herbal drug use was applied by face to face interview to the participants. A total of 217 patients were included in this study. The mean age of the participants was 56.6 ± 9.7 years (55 male and 162 female). The rate of herbal medicine use was 29%. Herbal medicine use among female gender was significantly higher (P = 0.040). Conventional medication use was found to be lower among herbal medicine consumers. There was no relationship between herbal medicine use and type of chronic disease, living area, and occupation or education level. Most frequently used herbs were lemon (39.6%) and garlic (11.1%) for HT, cinnamon (12.7%) for DM, and walnut (6.3%) for HL. In this study, herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore, physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines.

  17. Nurses' Experiences in a Turkish Internal Medicine Clinic With Syrian Refugees.

    Science.gov (United States)

    Sevinç, Sibel

    2018-05-01

    The increasing flow of Syrian refugees to Turkey, coupled with their extended stay, highlights the need for culturally competent health care, which includes nursing interventions. The purpose of this study was to describe the experiences of nurses who provide care for Syrian refugees in internal medicine clinics in a hospital located in Turkey. This descriptive study was based on qualitative content analysis using an inductive approach and involved discovery and description of the data. The study sample consisted of 10 nurses who work at the internal medicine clinic of a State Hospital in Turkey. Data were collected using semistructured interviews. Three themes with related subthemes were derived from the data. Nurses who participated in the study experienced: (a) Nurses found communicating with Syrian refugees and their families difficult in the clinic. (b) Nurses observed and experienced differences and similarities in caring for Turkish and Syrian patients. (c) Nurses expressed and displayed compassion toward Syrian refugees during the caring process. In order for nurses to provide the best care for Syrian refugee patients, it is important to identify cultural caring behaviors observed by nurses in the promotion of culturally congruent nursing and health care.

  18. [Analises of the mortality in aged in an Internal Medicine Department].

    Science.gov (United States)

    Cinza Sanjurjo, S; Cabarcos Ortiz de Barrón, A; Nieto Pol, E; Torre Carballada, J A

    2007-02-01

    To establish the characteristics of the deceased and the death causes. Transversal study descriptive, with intake patients elder than 65 years old in an Internal Medicine Department. The variables analized were: age, sex, intake date, discharge date, days of hospital stay, chronic disease previous, admission cause, deceased, diagnoses. The statistical analysis was performed with measures of central tendency and of standard deviation, Chi-cuadrado, Mann-Whitney-Wilcoxon and Kruskal-Wallis. During the revised year, there are 770 patients intaked in Internal Medicine Department and 128 exitus (16.6%). The global average death age was 78.3 +/- 1.3 years: 53.1% (0.44-0.62; p = 0.48) were men and 46.9% were women. The average death intake days was 13.3 +/- 1.7 days (p < 0.001), 3.9% died in less than forty-eight hours after hospitalization. The most frequent admission cause was: dyspnea (46.1%). The most frequent chronic diseases were: ischemic and hypertensive heart disease (18.8%) and chronic obstructive pulmonary disease. The most frequent death cause was respiratory tract infection (43.8%). The prevalence cardiac and pulmonary disease prevalence is high, these diseases are the of the most frequent causes hospital mortality.

  19. [International reference prices and cost minimization analysis for the regulation of medicine prices in Colombia].

    Science.gov (United States)

    Vacca, Caludia; Acosta, Angela; Rodriguez, Ivan

    2011-01-01

    To suggest a scheme of decision making on pricing for medicines that are part of Free Regulated Regime, a regulation way of the pharmaceutical pricing policy in Colombia. It includes two regulation tools: international reference prices and a cost minimization analysis methodology. Following the current pricing policy, international reference prices were built with data from five countries for selected medicines, which are under Free Regulated Regime. The cost minimization analysis methodology includes selection of those medicines under Free Regulated Regime with possible comparable medicines, selection of comparable medicines, and treatment costs evaluation. As a result of the estimate of International Reference Prices, four medicines showed in the domestic pharmaceutical market a bigger price than the Reference Price. A scheme of decision-making was design containing two possible regulation tools for medicines that are part of Free Regulated Regime: estimate of international reference prices and cost minimization analysis methodology. This diagram would be useful to assist the pricing regulation of Free Regulated Regime in Colombia. As present results shows, international reference prices make clear when domestic prices are higher than those of reference countries. In the current regulation of pharmaceutical prices in Colombia, the international reference price has been applied for four medicines. Would be suitable to extend this methodology to other medicines of high impact on the pharmaceutical expenditure, in particular those covered by public funding. The availability of primary sources about treatment costs in Colombia needs to be improved as a requirement to develop pharmaco-economic evidence. SISMED is an official database that represents an important primary source of medicines prices in Colombia. Nevertheless, having into account that SISMED represents an important advantage of transparency in medicines prices, it needs to be improved in quality and data

  20. [Undesirable effects of medicine in the Internal Medicine Service of the University Hospital Center du Point G].

    Science.gov (United States)

    Soukho-Kaya, A; Minta, D K; Diarra, M T; Konaté, A; Diallo, B; Sidibé, A T; Dembélé, M; Bah, M; Doumbia, A A; Dao, K; Tolo, N; Camara, B D; Sy, D; Maiga, M Y; Traoré, H A

    2010-01-01

    The aim of this study was to determine the frequency of adverse reactions to drugs, the WHO grade, describe the clinical features and identify the drug responsible. This was a descriptive cross-sectional study which took place from February 2005 to January 2006 in the Internal Medicine Department at the hospital point G. Were included in this study, all patients hospitalized during the study period, which presented adverse drug reactions (ADRs) that the relation of cause and effect was certain or likely. Thus, 47 ADRs were identified in 39 patients of 426 admitted during the same period a frequency of 9.2%. The average age of our patients was 48.5 ± 16.5 years. The sex-ratio was 1.6 for women. Eighty-two percent of our patients had an ADR and 18% more than one. The WHO grade 1 was the most met or 36.2%, followed by grades 4 and 2 respectively 27.7% and 25.5%. Antidiabetics were responsible for adverse reactions in 46.8% and 21.3% in TB. Adverse events were neurological in 53.2% and type of manifestations of hypoglycemia 46.8% (22/47 cases), polyneuritis 6.4% (3 / 47 cases) and 29.8% in digestive cases dominated by vomiting 12.8% (6 / 47 cases), the epigastria pain 6.4% (3 / 47 cases). The outcome was favorable in 87.2% of cases, however, 3 cases of death among those over 60 years all grade 4 WHO. ADRs deserve special attention to this high death rate (6.4% 3/47 cases) where the interest to search systematically for all patients under medical treatment with a good clinical examination and questioning some thoroughly.

  1. Nuclear medicine and the pregnant patient

    International Nuclear Information System (INIS)

    Collins, L.

    1988-01-01

    Estimates of the risks of exposing an embryo or fetus to radiation are discussed. Recommendations are made about the policies a nuclear medicine department should develop for handling cases of accidental irradiation of an embryo or fetus. The choices available where a known pregnancy is involved and diagnostic radiology is required are outlined. Only necessary examinations should be performed and care taken to avoid or minimise irradiation of the fetus. The nuclear medicine physician must be prepared to make (and defend if necessary) an informed decision on whether to proceed with an examination and must also be in a position to discuss the risks with anxious parents

  2. [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.

  3. Medication errors in an internal medicine department. Evaluation of a computerized prescription system.

    Science.gov (United States)

    Mirco, Ana; Campos, Luís; Falcão, Fátima; Nunes, João Silva; Aleixo, Ana

    2005-08-01

    Evaluation of a computerized physician order entry in an Internal Medicine Department, with a unit-dose distribution system. Pharmacy Department, Internal Medicine Department. S. Francisco Xavier Hospital, Lisbon, Portugal. This study was carried out in December 2001 and January 2002. After two years experience of the CPOE system, medication errors were evaluated prospectively, in an internal medical department of a 360-bed academic hospital. Data were collected once a week. Pharmacists reviewed all medical prescriptions as part of their routine work. Medication errors detected were recorded on a data collection form with a design based on the types of errors as defined by the American Society of Hospital Pharmacists (ASHP). Completed forms were reviewed and medication errors were classed according to ASHP guidelines. A total of 2268 orders were monitored (162 patients). In these orders, 73 medication errors (22.4% of the patients) were detected and documented (59 prescribing errors and 14 monitoring errors). The most common prescribing errors were deficiencies related to the right class but wrong drug (28.3%): omeprazole vs. ranitidine/sucralfate in stress ulcer prophylaxis; incorrect dose (30%) and unclear orders (13.3%). Errors related to incorrect frequency of administration (5%); maintenance of IV route (5%); duplicated drug therapy (11.7%); drug interactions (1.7%) and length of therapy (3.3%) were also detected. The 14 monitoring errors detected were failures to review a prescribed regimen for appropriateness and detection of problems. Computerized prescription order entry has demonstrated effectiveness in eliminating medication errors related to transcribing and patient identification. Nevertheless, medication errors related to prescription and monitoring still occur. The use of clinical decision support systems and pharmacist involvement is vital to achieve maximum medication safety and reduce medication error rates.

  4. [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

  5. 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 standardized questionnaire was completed during school hours. SETTING: Canada, US, Greenland, Israel, and 24 European countries. PARTICIPANTS: 123 227 participants equally distributed by gender and by 3 age groups (mean 11.7, 13.6, 15.6 y). MAIN OUTCOME MEASURES: Self-reported medicine use for headache.......22), difficulties in getting to sleep 0.96 (0.91 to 1.00), and nervousness 1.04 (0.99 to 1.08). CONCLUSIONS: Substantial proportions of adolescents used medicine for common health problems. The prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender...

  6. Global trends in center accreditation by the Joint Commission International: growing patient implications for international medical and surgical care.

    Science.gov (United States)

    Mehta, Ambar; Goldstein, Seth D; Makary, Martin A

    2017-09-01

    Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    Science.gov (United States)

    Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

    2015-01-01

    Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

  8. Patients' concern about their medicine after a generic switch

    DEFF Research Database (Denmark)

    Østergaard Rathe, Jette; Søndergaard, Jens; Jarbøl, Dorte E

    2014-01-01

    PURPOSE: This study aims to investigate the possible association between patients' concerns about their medicine and generic switch. METHODS: Cross-sectional survey was carried out comprising responses from 2217 randomly selected persons aged 20 years or older and living in the Region of Southern...... Denmark, who had redeemed generically substitutable drugs in September 2008. For each patient, we focused on the purchase of one generically substitutable drug (index drug). We applied the specific concerns subscale from the Beliefs about Medicine Questionnaire (BMQ) to analyse lack of confidence...... in treatment. We also included general beliefs about medicine (BMQ), views on generic medicine and confidence in the health-care system. The information about the patients' generic switch was obtained from a prescription database and not provided by the patients. Data were analysed using linear regression...

  9. Framing and measuring international patient management.

    Science.gov (United States)

    Mainil, Tomas; Van Loon, Francis; Botterill, David; Dinnie, Keith; Platenkamp, Vincent; Meulemans, Herman

    2012-01-01

    Hospitals need to determine if an international patient department is a necessity to communicate with and manage international patients. A benchmarking instrument was created to assess the level of professionalism in managing international patients, including reviewing and validating processes by two university hospitals, professionals, and an expert panel. First, the differences between the hospitals depended on the will of the hospital to engage in such activities. Second, the differences depended on the embedding national context in which the hospital was situated. Further validation revealed the importance of other supportive services, such as cultural sensitivity and language. Finally, the microlevel phenomenon of international patient departments is placed within a macrolevel transnational health region development scheme. This study focused on the supply of services with respect to international patient departments, which could be related to efficiency and sustainability on a public health and health systems level.

  10. Improvements for international medicine donations: a review of the World Health Organization Guidelines for Medicine Donations, 3rd edition.

    Science.gov (United States)

    Cañigueral-Vila, Nuria; Chen, Jennifer C; Frenkel-Rorden, Lindsey; Laing, Richard

    2015-01-01

    Some humanitarian and development organizations respond to major natural disasters and emergencies by donating medicines. Many provide medicines on a routine basis to support health systems, particularly those run by Faith-Based Organizations. Although such donations can provide essential medicines to populations in great need, inappropriate donations also take place, with burdensome consequences. The World Health Organization (WHO) has developed the interagency Guidelines for Medicine Donations for use by donors and recipients in the context of emergency aid and international development assistance. Although comprehensive in nature and transferable to various emergency situations, adjustments to both content and formatting would improve this resource. Recommendations for the next version of these guidelines include: specific wording and consistent formatting; definition of who is a recipient, clear distinction between acute and long-term emergencies, and proper donation procedures pertaining to each; inclusion of visual aides such as flowcharts, checklists, and photos; and improving the citations system.

  11. 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

  12. 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.

  13. Impact of Protected Sleep Period for Internal Medicine Interns on Overnight Call on Depression, Burnout, and Empathy

    Science.gov (United States)

    Shea, Judy A.; Bellini, Lisa M.; Dinges, David F.; Curtis, Meredith L.; Tao, Yuanyuan; Zhu, Jingsan; Small, Dylan S.; Basner, Mathias; Norton, Laurie; Novak, Cristina; Dine, C. Jessica; Rosen, Ilene M.; Volpp, Kevin G.

    2014-01-01

    Background Patient safety and sleep experts advocate a protected sleep period for residents. Objective We examined whether interns scheduled for a protected sleep period during overnight call would have better end-of-rotation assessments of burnout, depression, and empathy scores compared with interns without protected sleep periods and whether the amount of sleep obtained during on call predicted end-of-rotation assessments. Methods We conducted a randomized, controlled trial with internal medicine interns at the Philadelphia Veterans Affairs Medical Center (PVAMC) and the Hospital of the University of Pennsylvania (HUP) in academic year 2009–2010. Four-week blocks were randomly assigned to either overnight call permitted under the 2003 duty hour standards or a protected sleep period from 12:30 am to 5:30 am. Participants wore wrist actigraphs. At the beginning and end of the rotations, they completed the Beck Depression Inventory (BDI-II), Maslach Burnout Inventory (MBI-HSS), and Interpersonal Reactivity Index (IRI). Results A total of 106 interns participated. There were no significant differences between groups in end-of-rotation BDI-II, MBI-HSS, or IRI scores at either location (P > .05). Amount of sleep while on call significantly predicted lower MBI-Emotional Exhaustion (P < .003), MBI-Depersonalization (P < .003), and IRI-Personal Distress (P < .006) at PVAMC, and higher IRI-Perspective Taking (P < .008) at HUP. Conclusions A protected sleep period produced few consistent improvements in depression, burnout, or empathy, although depression was already low at baseline. Possibly the amount of protected time was too small to affect these emotional states or sleep may not be directly related to these scores. PMID:24949128

  14. What are internal medicine residents missing? A communication needs assessment of outpatient clinical encounters.

    Science.gov (United States)

    Lundberg, Kristina L

    2014-09-01

    In order to guide curricular innovation, we looked at the feasibility and utility of performing a targeted needs assessment of the communication skills of PGY2 internal medicine (IM) residents in their continuity clinic, utilizing faculty direct observation with a validated instrument for communication skills evaluation. A convenience sample of PGY2 residents in the Emory University School of Medicine IM Residency Program was invited to participate. Using the SEGUE Framework, a checklist of medical communication tasks, faculty assessed residents during a clinic encounter. Thirty out of 53 (57%) PGY2 residents were assessed. SEGUE results indicate residents were most likely to "maintain patient's privacy" (100%), "greet patient appropriately" (97%) and "check/clarify information" (100%). Residents were least likely to "acknowledge waiting time" (7%), "explore psychosocial/emotional factors" (27%) and "outline agenda for visit" (33%). The SEGUE Framework is a feasible tool to evaluate the communication skills of IM residents in a clinic setting. Many PGY2 IM residents in a large, urban practice do not elicit important psychosocial information during outpatient clinic visits. More observation and evaluation of residents' communication skills are needed, with emphasis on building skills to "Understand the Patient's Perspective." Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Complementary and Alternative Medicine Usage in Cancer Patients ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the frequency of complementary and alternative medicine (CAM) methods and clinical characteristics in cancer patients in southeast of Turkey. A total of 324 patients (173 female) were enrolled to this study. Questionnaire was applied to all patients individually for approximately 15 ...

  16. Radiological protection of patients in diagnostic and interventional radiology, nuclear medicine and radiotherapy. Contributed papers

    International Nuclear Information System (INIS)

    2001-01-01

    An International Conference on the Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization was held in Malaga, Spain, from 26 to 30 March 2001. The Government of Spain hosted this Conference through the Ministerio de Sanidad y Consumo, the Consejo de Seguridad Nuclear, the Junta de Andalucia, the Universidad de Malaga and the Grupo de Investigacion en Proteccion Radiologica de la Universidad de Malaga (PRUMA). The Conference was organized in co-operation with the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the International Commission on Radiological Protection (ICRP) and the following professional societies: International Organization of Medical Physicists (IOMP), International Radiation Protection Association (IRPA), International Society of Radiation Oncology (ISRO), International Society of Radiology (ISR), International Society of Radiographers and Radiological Technologists (ISRRT) and World Federation of Nuclear Medicine and Biology (WFNMB). This publication contains contributed papers submitted to the Conference Programme Committee. The papers are in one of the two working languages of this Conference, English and Spanish. The topics covered by the Conference are as follows: Radiological protection of patients in general diagnostic radiology (radiography), Radiological protection of patients in general diagnostic radiology (fluoroscopy), Radiological protection issues in specific uses of diagnostic radiology, such as mammography and computed tomography (with special consideration of the impact of digital techniques), Radiological protection in interventional radiology, including fluoroscopy not carried out by radiologists, Radiological protection of patients in nuclear medicine, Developing and

  17. Use of complementary/alternative medicine among paediatric patients

    DEFF Research Database (Denmark)

    Madsen, Hanne; Andersen, Susie; Nielsen, Rasmus Gaardskaer

    2003-01-01

    Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal......UNLABELLED: The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University...... patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines. CONCLUSION...

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

    OpenAIRE

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

    2010-01-01

    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 Stat...

  19. Using television shows to teach communication skills in internal medicine residency.

    Science.gov (United States)

    Wong, Roger Y; Saber, Sadra S; Ma, Irene; Roberts, J Mark

    2009-02-03

    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. 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. 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. 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.

  20. Faculty staff-guided versus self-guided ultrasound training for internal medicine residents.

    Science.gov (United States)

    Alba, George A; Kelmenson, Daniel A; Noble, Vicki E; Murray, Alice F; Currier, Paul F

    2013-11-01

    Ultrasonography is of growing importance within internal medicine (IM), but the optimal method of training doctors to use it is uncertain. In this study, the authors provide the first objective comparison of two approaches to training IM residents in ultrasonography. In this randomised trial, a simulation-based ultrasound training curriculum was implemented during IM intern orientation at a tertiary care teaching hospital. All 72 incoming interns attended a lecture and were given access to online modules. Interns were then randomly assigned to a 4-hour faculty-guided (FG) or self-guided (SG) ultrasound training session in a simulation laboratory with both human and manikin models. Interns were asked to self-assess their competence in ultrasonography and underwent an objective structured clinical examination (OSCE) to assess their competence in basic and procedurally oriented ultrasound tasks. The primary outcome was the score on the OSCE. Faculty-guided training was superior to self-guided training based on the OSCE scores. Subjects in the FG training group achieved significantly higher OSCE scores on the two subsets of task completion (0.9-point difference, 95% confidence interval [CI] 0.27-1.54; p = 0.008) and ultrasound image quality (2.43-point difference, 95% CI 1.5-3.36; p training groups demonstrated an increase in self-assessed competence after their respective training sessions and there was little difference between the groups. Subjects rated the FG training group much more favourably than the SG training group. Both FG and SG ultrasound training curricula can improve the self-reported competence of IM interns in ultrasonography. However, FG training was superior to SG training in both skills acquisition and intern preference. Incorporating mandatory ultrasound training into IM residencies can address the perceived need for ultrasound training, improve confidence and procedural skills, and may enhance patient safety. However, the optimal training method

  1. A Course for Teaching Patient-Centered Medicine to Family Medicine Residents.

    Science.gov (United States)

    Yeheskel, Ayala; Biderman, Aya; Borkan, Jeffrey M.; Herman, Joseph

    2000-01-01

    Describes a three-year course at Ben Gurion University (Israel) to develop attitudes and skills necessary for patient-centered medicine. The course uses directed reading, open discussion, case presentations, role-playing, and Balint groups to develop skills at four levels: doctor-patient communication; family systems theory; family systems…

  2. 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…

  3. Patient's medicines brought to hospital: an overlooked resource?

    Science.gov (United States)

    Ware, G J

    1993-10-27

    To quantify potential cost advantages and identify practical safeguards required for utilising patients own medicines while in hospital, and returning them on discharge. All medicines brought in by patients in two wards of a geriatric assessment and rehabilitation unit at Auckland Hospital were examined by the pharmacist, and their suitability for re-issue assessed. Medicines were regarded as suitable for use where they could be positively identified, had been dispensed within 3 months of admission, or if packed in foil, provided the expiry date and manufacturer identification were on the foil. Medicines (260 items) totalling $2,976, assessed over a 6 month period, were regarded as suitable for use by the patient, with a mean value of $11.36 per patient. Patients own medicines used within the hospital with a unit-of-issue distribution system, and taken home by them on discharge, would provide appreciable savings for the hospital medicine budget and reduction in waste of the overall health dollar.

  4. Development of a personalized dosimetric tool for radiation protection in case of internal contamination and targeted radiotherapy in nuclear medicine

    International Nuclear Information System (INIS)

    Chiavassa, S.

    2005-12-01

    Current internal dosimetric estimations are based on the M.I.R.D. formalism and used standard mathematical models. These standard models are often far from a given patient morphology and do not allow to perform patient-specific dosimetry. The aim of this study was to develop a personalized dosimetric tool, which takes into account real patient morphology, composition and densities. This tool, called O.E.D.I.P.E., a French acronym of Tool for the Evaluation of Personalized Internal Dose, is a user-friendly graphical interface. O.E.D.I.P.E. allows to create voxel-based patient-specific geometries and associates them with the M.C.N.P.X. Monte Carlo code. Radionuclide distribution and absorbed dose calculation can be performed at the organ and voxel scale. O.E.D.I.P.E. can be used in nuclear medicine for targeted radiotherapy and in radiation protection in case of internal contamination. (author)

  5. 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

  6. Full text publication rates of studies presented at an international emergency medicine scientific meeting.

    Science.gov (United States)

    Chan, Jannet W M; Graham, Colin A

    2011-09-01

    The publication rate of full text papers following an abstract presentation at a medical conference is variable, and few studies have examined the situation with respect to international emergency medicine conferences. This retrospective study aimed to identify the publication rate of abstracts presented at the 2006 International Conference on Emergency Medicine (ICEM) held in Halifax, Canada. The full text publication rate was 33.2%, similar to previous emergency medicine meetings. English language barriers may play a role in the low publication rate seen.

  7. 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.

  8. Evaluating the impact of emergency medicine education on medical interns' knowledge scores.

    Science.gov (United States)

    Afzalimoghaddam, Mohammad; Hoseinidavarani, Hosein; Hossein-nejad, Hooman

    2011-10-01

    Emergency medicine is a young specialty in Iran. Since 2005, a 4-week rotation has been allocated to emergency medicine instruction for all medical interns during their medical internship in Tehran University of Medical Sciences. In this study, we have evaluated the impact of emergency medicine rotation on medical interns' knowledge in the field of emergency medicine. From October 2005 to May 2006, 10 medical interns of emergency medicine rotation were randomly enrolled in this study each month. They were administered a pretest assessing their emergency medicine knowledge. Then, they attended a theoretical and practical course. Finally, they were reassessed by a post-test similar to the pretest. There were 98 medical interns, including 53 male (54.08%) and 45 female (45.91%) participants. The mean of participants' age was 25.50 (±1.47) years. Their internship duration spanned from 1 to 18 months, with a mean of 5.40 (±4.71) months. The difference between participants' pretest and post-test scores was statistically significant (Pknowledge in the field of emergency medicine; and their sex, passed medical blocks and the duration of internship do not affect this knowledge. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  9. Representations of Patients' Experiences of Autonomy in Graphic Medicine.

    Science.gov (United States)

    Tschaepe, Mark

    2018-02-01

    I advocate using graphic medicine in introductory medical ethics courses to help trainees learn about patients' experiences of autonomy. Graphic narratives about this content offer trainees opportunities to gain insights into making diagnoses and recommending treatments. Graphic medicine can also illuminate aspects of patients' experiences of autonomy differently than other genres. Specifically, comics allow readers to consider visual and text-based representations of a patient's actions, speech, thoughts, and emotions. Here, I use Ellen Forney's Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir and Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's as two examples that can serve as pedagogical resources. © 2018 American Medical Association. All Rights Reserved.

  10. 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

    2017-11-01

    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; pde Medicina Interna (SEMI). All rights reserved.

  11. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for... notification of voluntary relinquishment from Emergency Medicine Patient Safety Foundation of its status as a...

  12. Quality management in nuclear medicine for better patient care: the IAEA program.

    Science.gov (United States)

    Dondi, Maurizio; Kashyap, Ravi; Pascual, Thomas; Paez, Diana; Nunez-Miller, Rodolfo

    2013-05-01

    The International Atomic Energy Agency promotes the practice of nuclear medicine among its Member States with a focus on quality and safety. It considers quality culture as a part of the educational process and as a tool to reduce heterogeneity in the practice of nuclear medicine, and in turn, patient care. Sensitization about quality is incorporated in all its delivery mechanisms. The Agency has developed a structured peer-review process called quality management (QM) audits in nuclear medicine practices to help nuclear medicine facilities improve their quality through this voluntary comprehensive audit process. The process is multidisciplinary, covering all aspects of nuclear medicine practice with a focus on the patient. It complements other QM and accreditation approaches developed by professional societies or accreditation agencies. The Agency is committed to propagate its utility and assist in the implementation process. Similar auditing programs for practice in diagnostic radiology and radiotherapy, called QUADRIL and QUATRO, respectively, are also in place. Necessary amendments in the auditing process and content are incorporated based on technological and practice changes with time. The reader will become familiar with the approach of the Agency on QM in nuclear medicine and its implementation process to improve patient care. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Quality of discharge summaries prepared by first year internal medicine residents.

    Science.gov (United States)

    Legault, Kimberly; Ostro, Jacqueline; Khalid, Zahira; Wasi, Parveen; You, John J

    2012-08-15

    Patients are particularly susceptible to medical error during transitions from inpatient to outpatient care. We evaluated discharge summaries produced by incoming postgraduate year 1 (PGY-1) internal medicine residents for their completeness, accuracy, and relevance to family physicians. Consecutive discharge summaries prepared by PGY-1 residents for patients discharged from internal medicine wards were retrospectively evaluated by two independent reviewers for presence and accuracy of essential domains described by the Joint Commission for Hospital Accreditation. Family physicians rated the relevance of a separate sample of discharge summaries on domains that family physicians deemed important in previous studies. Ninety discharge summaries were assessed for completeness and accuracy. Most items were completely reported with a given item missing in 5% of summaries or fewer, with the exception of the reason for medication changes, which was missing in 15.9% of summaries. Discharge medication lists, medication changes, and the reason for medication changes--when present--were inaccurate in 35.7%, 29.5%, and 37.7% of summaries, respectively. Twenty-one family physicians reviewed 68 discharge summaries. Communication of follow-up plans for further investigations was the most frequently identified area for improvement with 27.7% of summaries rated as insufficient. This study found that medication details were frequently omitted or inaccurate, and that family physicians identified lack of clarity about follow-up plans regarding further investigations and visits to other consultants as the areas requiring the most improvement. Our findings will aid in the development of educational interventions for residents.

  14. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction.

    Science.gov (United States)

    Kessler, Chad S; Stallings, Leonard A; Gonzalez, Andrew A; Templeman, Todd A

    2009-09-01

    This study was designed to provide an update on the career outcomes and experiences of graduates of combined emergency medicine-internal medicine (EM-IM) residency programs. The graduates of the American Board of Emergency Medicine (ABEM) and American Board of Internal Medicine (ABIM)-accredited EM-IM residencies from 1998 to 2008 were contacted and asked to complete a survey concerning demographics, board certification, fellowships completed, practice setting, academic affiliation, and perceptions about EM-IM training and careers. There were 127 respondents of a possible 163 total graduates for a response rate of 78%. Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Thirty-one graduates (24%) pursued formal fellowship training in either EM or IM. Graduates spend the majority of their time practicing clinical EM in an urban (72%) and academic (60%) environment. Eighty-seven graduates (69%) spend at least 10% of their time in an academic setting. Most graduates (64%) believe it practical to practice both EM and IM. A total of 112 graduates (88%) would complete EM-IM training again. Dual training in EM-IM affords a great deal of career opportunities, particularly in academics and clinical practice, in a number of environments. Graduates hold their training in high esteem and would do it again if given the opportunity.

  15. The International Certification of Addiction Medicine: Validating Clinical Knowledge across Borders

    Science.gov (United States)

    el-Guebaly, Nady; Violato, Claudio

    2011-01-01

    The experience of the International Society of Addiction Medicine in setting up the first international certification of clinical knowledge is reported. The steps followed and the results of a psychometric analysis of the tests from the first 65 candidates are reported. Lessons learned in the first 5 years and challenges for the future are…

  16. Improving Outpatient’s Quality of Life Through Patient Adherence of Antihypertensive Therapy Using “Mobile Phone (SMS and Brief Counseling‑5A” in Polyclinic of Internal Medicine at PKU Muhammadiyah Bantul Hospital, Yogyakarta

    Directory of Open Access Journals (Sweden)

    Ginanjar Z. Saputri

    2017-06-01

    Full Text Available The Health-Related Quality of Life (HRQoL is one of the important psycho-social characteristics that can affect patient’s ability to manage therapy. Poor of knowledge of hypertension and the changing lifestyle can affect the quality of life of patients. One of the pharmacist’s interventions in hypertension management is to conduct counseling. Motivational counseling helps health service to assess patient’s understanding and patient’s readiness to change patient’s behavior. Some motivational counseling methods still need to be developed. Therefore, this study aims to find the influence of the “brief counseling-5A” and “motivational SMS” by a pharmacist on the quality of life and blood pressure control in hypertension patients in the internal disease polyclinic, PKU Muhammadiyah Bantul Hospital, Yogyakarta. The study has been done by using the quasi-experimental method with prospective data collection during the period of January until April 2013. Sixty patients have met inclusion criteria and were divided into two groups. Thirty patients (50% received “brief counseling-5A” and “motivational SMS” as intervention group and the other thirty patients (50% received usual care as a control group. The data collection was done by interviewing patients. Medication adherence and QoL were assessed by using Morisky Medication Adherence Scale (MMAS and SF-36. The values of blood pressure are taken from patient’s medical records. Patient’s quality of life showed a good improvement during post study. It is shown in 8 different domains including pain, fatigue, physical function, emotional function, social function, role physical, mental health, and general health. In intervention group, physical function, emotional function, and pain showed highly significant improvement (p<0.05. Systolic and diastolic blood pressure in the intervention group decreased significantly (p<0.05 (systolic p=0.001 and diastolic p=0.018 in the post study

  17. 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. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  18. 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.

  19. Internal radiation therapy: a neglected aspect of nuclear medicine in the molecular era.

    Science.gov (United States)

    Lin, Yansong

    2015-09-01

    With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era. In this paper, recent developments regarding internal radiation therapy, including developments in radioiodine-131 ((131)I) and thyroid, radioimmunotherapy (RIT) for non-Hodgkin lymphoma (NHL), and radiopharmaceuticals for bone metastases. Relevant differences and status of their applications in China were mentioned as well. These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.

  20. 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.

  1. [PERSONALIZED MEDICINE: ALL BENEFITS FOR THE PATIENT BUT NEW CHALLENGE IN THE PHYSICIAN-PATIENT RELATIONSHIP].

    Science.gov (United States)

    Scheen, A J; Giet, D

    2015-01-01

    Personalized medicine should lead to major advances for patient care since it contributes to deliver the . In curative medicine, this approach should improve the efficacy of medications by initial selection of "good responders", and should reduce adverse events due to poor tolerance or toxicity by a better pharmacological choice and a more appropriate individualized dose adjustment. Over recent years, considerable technical advances have increasingly linked personalized medicine with predictive and preventive medicine. This progress raises hopes for major advancements in medicine, but may also cause some concern among the lay public. The patient should actively be involved in the decisions related to his/her health, in a true model of participatory medicine. Finally, personalized medicine should leave its strict technical nature and become more interested in the person as a whole, within a holistic approach also integrating psychosocial aspects that are so important in the physician-patient relationship.

  2. Public health interventions to protect against falsified medicines: a systematic review of international, national and local policies.

    Science.gov (United States)

    Hamilton, William L; Doyle, Cormac; Halliwell-Ewen, Mycroft; Lambert, Gabriel

    2016-12-01

    Falsified medicines are deliberately fraudulent drugs that pose a direct risk to patient health and undermine healthcare systems, causing global morbidity and mortality. To produce an overview of anti-falsifying public health interventions deployed at international, national and local scales in low and middle income countries (LMIC). We conducted a systematic search of the PubMed, Web of Science, Embase and Cochrane Central Register of Controlled Trials databases for healthcare or pharmaceutical policies relevant to reducing the burden of falsified medicines in LMIC. Our initial search identified 660 unique studies, of which 203 met title/abstract inclusion criteria and were categorised according to their primary focus: international; national; local pharmacy; internet pharmacy; drug analysis tools. Eighty-four were included in the qualitative synthesis, along with 108 articles and website links retrieved through secondary searches. On the international stage, we discuss the need for accessible pharmacovigilance (PV) global reporting systems, international leadership and funding incorporating multiple stakeholders (healthcare, pharmaceutical, law enforcement) and multilateral trade agreements that emphasise public health. On the national level, we explore the importance of establishing adequate medicine regulatory authorities and PV capacity, with drug screening along the supply chain. This requires interdepartmental coordination, drug certification and criminal justice legislation and enforcement that recognise the severity of medicine falsification. Local healthcare professionals can receive training on medicine quality assessments, drug registration and pharmacological testing equipment. Finally, we discuss novel technologies for drug analysis which allow rapid identification of fake medicines in low-resource settings. Innovative point-of-purchase systems like mobile phone verification allow consumers to check the authenticity of their medicines. Combining anti

  3. Changes in outcomes for internal medicine inpatients after work-hour regulations.

    Science.gov (United States)

    Horwitz, Leora I; Kosiborod, Mikhail; Lin, Zhenqiu; Krumholz, Harlan M

    2007-07-17

    Limits on resident work hours are intended to reduce fatigue-related errors, but may raise risk by increasing transfers of responsibility for patients. To examine changes in outcomes for internal medicine patients after the implementation of work-hour regulations. Retrospective cohort study. Urban, academic medical center. 14,260 consecutive patients discharged from the teaching (housestaff) service and 6664 consecutive patients discharged from the nonteaching (hospitalist) service between 1 July 2002 and 30 June 2004. Outcomes included intensive care unit utilization, length of stay, discharge disposition, 30-day readmission rate to the study institution, pharmacist interventions to prevent error, drug-drug interactions and in-hospital death. The teaching service had net improvements in 3 outcomes. Relative to changes experienced by the nonteaching service, the rate of intensive care unit utilization decreased by 2.1% (95% CI, -3.3% to -0.7%; P = 0.002), the rate of discharge to home or rehabilitation facility versus elsewhere improved by 5.3% (CI, 2.6% to 7.6%; P error were reduced by 1.92 interventions per 100 patient-days (CI, -2.74 to -1.03 interventions per 100 patient-days; P < 0.001). Teaching and nonteaching services had similar changes over time in length of stay, 30-day readmission rate, and adverse drug-drug interactions. In-hospital death was uncommon in both groups, and change over time was similar in the 2 groups. The study was a retrospective, nonrandomized design that assessed a limited number of outcomes. Teaching and nonteaching cohorts may not have been affected similarly by secular trends in patient care. After the implementation of work-hour regulations, 3 of 7 outcomes improved for patients in the teaching service relative to those in the nonteaching service. The authors found no evidence of adverse unintended consequences after the institution of work-hour regulations.

  4. Development and utilization of the Medicines Use Review patient satisfaction questionnaire

    Directory of Open Access Journals (Sweden)

    Hindi A

    2017-10-01

    Full Text Available Ali Hindi,1 Caroline Parkhurst,1,2 Yasamin Rashidi,1 Shun Yan Ho,1 Nilesh Patel,1 Parastou Donyai11Department of Pharmacy, University of Reading, Berkshire, UK; 2Professional Services Department, Day Lewis Pharmacy Group, Croydon, London, UK Abstract: The Medicines Use Review is a community pharmacy service funded in the United Kingdom to improve patients’ adherence to medication and reduce medicines waste. The objective was to develop, pilot, and utilize a new Medicines Use Review patient satisfaction questionnaire. A questionnaire for patient self-completion was developed using a published framework of patient satisfaction with the Medicines Use Review service. The questions were validated using the content validity index and the questionnaire piloted through three pharmacies (February–April 2016. The revised questionnaire contained 12 questions with responses on a 5-point Likert scale, and a comments box. The questionnaire was distributed to patients following a Medicines Use Review consultation via community pharmacies (June–October 2016. Exploratory factor analysis and Cronbach’s α were performed to investigate the relationships between the items and to examine structural validity. The survey results were examined for patients’ reported satisfaction with Medicines Use Reviews, while the handwritten comments were thematically analyzed and mapped against the questionnaire items. An estimated 2,151 questionnaires were handed out, and a total of 505 responses were received indicating a 24% response rate. Exploratory factor analysis revealed two factors with a cumulative variance of 68.8%, and Cronbach’s α showed high internal consistency for each factor (α=0.90 and α=0.89, respectively. The survey results demonstrated that patients could show a high degree of overall satisfaction with the service, even if initially reluctant to take part in a Medicines Use Review. The results support the Medicines Use Review patient satisfaction

  5. Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Saltzman, Bryan M; Cotter, Eric J; Wang, Kevin C; Epley, Chad T; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2017-08-01

    The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician. To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician. Case series; Level of evidence, 4. A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement. Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient

  6. 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.

  7. 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...... for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. METHOD: A comprehensive literature review was performed. RESULTS: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous...... of their patients. CONCLUSION: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual...

  8. Painters and patients: how art informs medicine.

    Science.gov (United States)

    Wear, D

    1991-01-01

    This essay describes three movements in art--impressionism, cubism, and abstract expressionism--and how artists within each movement differed in their portrayal of reality. With this background, the author proposes that inquiry into the motives and methods of artists within each movement may help in our understanding of how a person experiences, interprets, and portrays reality. This, in turn, may translate into a recognition of the multiplicity of perspectives and the uniqueness of each patient's lived experience of his or her illness and that the doctor's vantage point on reality may not mesh with that of the patient.

  9. 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

  10. Communication Adaptations for a Diverse International Patient Population.

    Science.gov (United States)

    Ghosh, Aditya; Joshi, Shashank; Ghosh, Amit K

    2017-11-01

    We live in an age of hyper connectivity, people from around the world are looking outside their own national borders to receive medical care. As more people are learning about the quality that the elite Indian hospitals provide at a competitive, and often more affordable, price compared to other institutions around the world, they are becoming increasingly interested in receiving their medical care in Indian hospitals. It is for this exact reason that it is very important to learn the importance of communicating effectively with people from a diverse background. Over the next decade, the number of international patients that Indian hospitals will provide care for is set to dramatically increase. In this new age of medicine in India, it is imperative that doctors are adequately equipped with the communication skills to appropriately connect with patients coming from very different cultural backgrounds. The interaction with an international patient can be tremendously deepened through effective communication that adheres to the cultural beliefs of the patient. In this article, we detail how to effectively communicate with people from different backgrounds. We explore how to speak with patients and connect on a deeper level and respect the cultural differences that exist. We will also discuss how to avoid offending your patients or miscommunicating your plans to them. Overall, improved awareness of cultural differences will ensure higher patient satisfaction as well as an improved doctor patient interaction. © Journal of the Association of Physicians of India 2011.

  11. Clinical exposures during internal medicine acting internship: profiling student and team experiences.

    Science.gov (United States)

    Smith, Todd I; LoPresti, Charles M

    2014-07-01

    The clinical learning model in medical education is driven by knowledge acquisition through direct patient-care experiences. Despite the emphasis on experiential learning, the ability of educators to quantify the clinical exposures of learners is limited. To utilize Veterans Affairs (VA) electronic medical record information through a data warehouse to quantify clinical exposures during an inpatient internal medicine rotation. We queried the VA clinical data warehouse for the patients encountered by each learner completing an acting internship rotation at the Cleveland VA Medical Center from July 2008 to November 2011. We then used discharge summary information to identify team exposures-patients seen by the learner's inpatient team who were not primarily assigned to the learner. Based on the learner and team exposures, we complied lists of past medical problems, medications prescribed, laboratory tests that resulted, radiology evaluated, and primary discharge diagnoses. Primary learner and team-based clinical exposures were evaluated for a total of 128 acting internship students. The percentage of learners who had a primary exposure to a medication/lab value/imaging result/diagnosis was calculated. The percentage of learners with at least 1 primary or team-based exposure to an item was also calculated. The most common exposures in each category are presented. Analysis of the clinical exposures during an inpatient rotation can augment the ability of educators to understand learners' experiences. These types of analyses could provide information to improve learner experience, implement novel curricula, and address educational gaps in clinical rotations. © 2014 Society of Hospital Medicine.

  12. [The citation analysis of Chinese Journal of Internal Medicine from 2005 to 2011].

    Science.gov (United States)

    Shen, Zhi-Wei; Shen, Xi-Bin; Hou, Jian-Jun; Ding, Yun-Qiu; Hu, Zhao-Hui; He, Hue-Mei

    2013-02-01

    To evaluate the academic level of Chinese Journal of Internal Medicine by analyzing its citation status by using bibliometrics method. The distribution of articles published in Chinese Journal of Internal Medicine from January, 2005 to December, 2011 indexed by Chinese Science Citation Database (CSCD) was analyzed. A total of 2809 articles were published in Chinese Journal of Internal Medicine between January,2005 and December, 2011. Among them, 832(29.62%) articles were cited for totally 1993 times. There were 14 authors whose total citation number in 2005-2011 was > or = 10 times. Authors of the cited articles came from 25 provinces, autonomous regions and municipalities. The regions from where the articles had the highest citation were Beijing (341 articles), Shanghai (87 articles), Guangdong (64 articles), Jiangsu (45 articles) and Zhejiang (43 articles). The medical institutions with the highest citation were Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences (205 times), Peking University People's Hospital (77 times), and Chinese PLA General Hospital (76 times). Quite a few high level academic papers had been published in Chinese Journal of Internal Medicine in recent years. Chinese Journal of Internal Medicine plays a good role in enhancing academic exchange.

  13. Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training

    Science.gov (United States)

    Green, Michael L.; Aagaard, Eva M.; Caverzagie, Kelly J.; Chick, Davoren A.; Holmboe, Eric; Kane, Gregory; Smith, Cynthia D.; Iobst, William

    2009-01-01

    Background The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice. Intervention In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency. Outcomes The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the “competency” level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones. Discussion The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training. PMID:21975701

  14. Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine

    NARCIS (Netherlands)

    Laan, Ellen; Rellini, Alessandra H.; Barnes, Tricia

    2013-01-01

    As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment

  15. Reflective practice and social responsibility in family medicine: Effect of performing an international rotation in a developing country.

    Science.gov (United States)

    Loignon, Christine; Gottin, Thomas; Valois, Carol; Couturier, François; Williams, Robert; Roy, Pierre-Michel

    2016-11-01

    To explore the perceived effect of an elective international health rotation on family medicine resident learning. Qualitative, collaborative study based on semistructured interviews. Quebec. A sample of 12 family medicine residents and 9 rotation supervisors (N = 21). Semistructured interviews of residents and rotation supervisors. Residents and supervisors alike reported that their technical skills and relationship skills had benefited. All increased their knowledge of tropical pathologies and learned to expand their clinical examinations. They benefited from having very rich interactions in other care settings, working with vulnerable populations. The rotations had their greatest effect on relationship skills (communication, empathy, etc) and the ability to work with vulnerable patients. All of the participants were exposed to local therapies and local interpretations of disease symptoms and pathogenesis. The findings of this study will have a considerable effect on pedagogy. The residents' experiences of their international health rotations and what they learned in terms of medical skills and pedagogic approaches in working with patients are described. Using a collaborative approach with the rotation supervisors, the data were triangulated and the benefits of an international rotation on academic training were more accurately defined. The findings can now be used to enrich academic programs in social and preventive medicine and more adequately prepare future family physicians for work in various social and cultural settings. Copyright© the College of Family Physicians of Canada.

  16. [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 (Ponline, 66% wish to have a practical evaluation at the bedside and 70% in simulation centers. Finally, 91% of fellows support the establishment of a national program for the training of Internal 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.

  17. Complementary medicine use in cancer patients receiving intravenous antineoplastic treatment.

    Science.gov (United States)

    Juanbeltz Zurbano, Regina; Pérez-Fernández, Mª Dolores; Tirapu Nicolás, Bianka; Vera García, Ruth; De la Cruz Sánchez, Susana; Sarobe Carricas, María Teresa

    2017-09-01

    Complementary and alternative medicine (CAM) use has grown considerably, although there is little research on the topic in Spain. The aim of this study was to determine the prevalence of complementary medicine use in adult cancer patients at the same time as they were receiving conventional treatment in a Spanish referral cancer centre. An observational, descriptive, cross-sectional study was conducted in the Ambulatory Treatment Unit during 2 consecutive weeks in March 2015. Adult patients who were receiving intravenous chemotherapy were included. Study variables were obtained from a questionnaire and medical records. 316 patients were included. 32.3% of the patients reported complementary medicine use during this period and 89% were ingesting products by mouth, herbs and natural products being the most commonly used. 81% of patients started to use complementary medicine after diagnosis, and family/friends were the main source of information. 65% of the patients reported improvements, especially in their physical and psychological well-being. Significant predictors of CAM use were female gender (P=0.028), younger age (P<0.001), and secondary education (P=0.009). A large proportion of cancer patients receiving intravenous chemotherapy also use complementary medicine, which they mainly take by mouth. Due to the risk of chemotherapy-CAM interactions, it is important for health-professionals to keep abreast of research on this issue, in order to provide advice on its potential benefit and risks. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  18. Functional Neuroimaging Correlates of Burnout among Internal Medicine Residents and Faculty Members.

    Science.gov (United States)

    Durning, Steven J; Costanzo, Michelle; Artino, Anthony R; Dyrbye, Liselotte N; Beckman, Thomas J; Schuwirth, Lambert; Holmboe, Eric; Roy, Michael J; Wittich, Christopher M; Lipner, Rebecca S; van der Vleuten, Cees

    2013-01-01

    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 (USUHS) 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.

  19. Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

    2018-04-01

    Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

  20. Nuclear medicine in patients with prolonged fever

    International Nuclear Information System (INIS)

    Meller, J.

    2007-01-01

    Fever of unknown origin (FUO) was originally defined as recurrent fever of 38.2 C or higher, lasting 2-3 weeks or longer, and undiagnosed after 1 week of hospital evaluation. The last criterion has undergone modification and is now generally interpreted as no diagnosis after appropriate inpatient or outpatient evaluation. The three major categories that account for the majority of fever of unknown origin (FUO) are infections, malignancies and non infectious inflammatory diseases. In this respect FOU in its original definition is clearly separated from nosocomial, post-operative and neutropenic fever, where acute infection is more common. Although in-vitro- or in-vivo-labelled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, these methods are only of limited value in patients with 'classic' FUO in establishing the final diagnosis due to the low prevalence of acute infection in this group. Labelled WBCs therefore seem to be more useful in patients with nosocomial, post-operative and neutropenic fever. 67 Ga citrate is the only commercially available gamma emitter in imaging acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore 67 Ga citrate was for a long time considered to be the tracer of choice in the diagnostic work-up of FUO. The number of 67 Ga scans contributing to the final diagnosis was found to be higher than it has been reported for labelled WBCs. The positron emitter [ 18 F]-2-fluoro-2'-deoxy-D-glucose (FDG) have been systematically evaluated in the context of classic FUO by several groups within last 5 years. This data, although limited, indicate that FDG-imaging should considered as the most promising procedure in patients with undetermined fever. FDG-PT seems to be more sensitive than other techniques, offers a more rapid diagnosis without an increase of the patients radioactive burden. It is expected that the PET/CT technology will

  1. A multimethod approach for cross-cultural training in an internal medicine residency program.

    Science.gov (United States)

    Staton, Lisa J; Estrada, Carlos; Panda, Mukta; Ortiz, David; Roddy, Donna

    2013-01-01

    Background Cultural competence training in residency is important to improve learners' confidence in cross-cultural encounters. Recognition of cultural diversity and avoidance of cultural stereotypes are essential for health care providers. Methods We developed a multimethod approach for cross-cultural training of Internal Medicine residents and evaluated participants' preparedness for cultural encounters. The multimethod approach included (1) a conference series, (2) a webinar with a national expert, (3) small group sessions, (4) a multicultural social gathering, (5) a Grand Rounds presentation on cross-cultural training, and (6) an interactive, online case-based program. Results The program had 35 participants, 28 of whom responded to the survey. Of those, 16 were white (62%), and residents comprised 71% of respondents (n=25). Following training, 89% of participants were more comfortable obtaining a social history. However, prior to the course only 27% were comfortable caring for patients who distrust the US system and 35% could identify religious beliefs and customs which impact care. Most (71%) believed that the training would help them give better care for patients from different cultures, and 63% felt more comfortable negotiating a treatment plan following the course. Conclusions Multimethod training may improve learners' confidence and comfort with cross-cultural encounters, as well as lay the foundation for ongoing learning. Follow-up is needed to assess whether residents' perceived comfort will translate into improved patient outcomes.

  2. 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.

  3. Early Patient Access to Medicines: Health Technology Assessment Bodies Need to Catch Up with New Marketing Authorization Methods.

    Science.gov (United States)

    Leyens, Lada; Brand, Angela

    National and international medicines agencies have developed innovative methods to expedite promising new medicines to the market and facilitate early patient access. Some of these approval pathways are the conditional approval and the adaptive pathways by the European Medicines Agency (EMA); the Promising Innovative Medicine (PIM) designation and the Early Access to Medicines Scheme (EAMS) by the Medicines and Healthcare Products Regulatory Agency (MHRA), as well as the Fast Track, Breakthrough or Accelerated Approval methods by the Food and Drug Administration (FDA). However, at least in Europe, these methods cannot achieve the goal of improving timely access for patients to new medicines on their own; the reimbursement process also has to become adaptive and flexible. In the past 2 years, the effective access (national patient access) to newly approved oncology drugs ranged from 1 to 30 months, with an extremely high variability between European countries. The goal of early patient access in Europe can only be achieved if the national health technology assessment bodies, such as NICE (ENG), HAS (FR), G-BA (DE) or AIFA (IT), provide harmonized, transparent, flexible, conditional and adaptive methods that adopt the level of evidence accepted by the medicines agencies. The efforts from medicines agencies are welcome but will be in vain if health technology assessments do not follow with similar initiatives, and the European 'postcode' lottery will continue. © 2016 S. Karger AG, Basel.

  4. Internal dosimetry in nuclear medicine procedures; Dosimetria interna por procedimientos en medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Carrera Magarino, F.; Salgado Garcia, C.; Ruiz Manzano, P.; Rivas Ballarin, M. A.; Jimenez Hefernan, A.; Sanchez Segovia, J.

    2011-07-01

    The Department of Radio Physics and Radiation Protection, University Hospital Lozano Blesa Zaragoza presented a calculus textbook to estimate patient doses in diagnostic nuclear medicine. In this paper present an updated version referred Book of calculation.

  5. 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.

  6. Internationalization of traditional Chinese medicine: current international market, internationalization challenges and prospective suggestions.

    Science.gov (United States)

    Lin, Annie Xianghong; Chan, Ging; Hu, Yuanjia; Ouyang, Defang; Ung, Carolina Oi Lam; Shi, Luwen; Hu, Hao

    2018-01-01

    Through reviewing the current international market for traditional Chinese medicine (TCM), this paper identified the internationalization challenges for TCM, including unclear therapeutic material basis and mechanism, difficulty of quality control, low preparation level, registration/policy barriers, and shortage of intellectual property. To deal with these challenges, suggestions were given including: (1) product innovation of TCM (study the TCM by using the methods and means of western medicine; innovate the basic theory of TCM; develop TCM health product); (2) standard innovation of TCM; (3) building big data platform of Chinese medicine (big data platform of TCM preparation; big data platform on the quality of TCM).

  7. Herbal Medicine in Primary Healthcare in Germany: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Stefanie Joos

    2012-01-01

    Full Text Available Herbal medicine (HM is one of the most widely used Complementary and Alternative Medicine (CAM therapies throughout the world. The WHO has recognized HM as an essential component of primary healthcare. The aim of this study was to explore patients' attitudes towards using HM, their sources of information and the role of costs. Within a qualitative research approach, semi-standardized interviews with 18 patients using HM were conducted and analyzed according to Mayring's content analysis. Patients highlighted their active role and perceived autonomy choosing HM. Most interviewees experienced HM as better, with more sustainable effects and fewer side effects compared to conventional medicine. All media, family, friends, and healthcare professionals were reported as sources of information. Some patients complained that doctors and pharmacists have insufficient knowledge of HM. Most patients expressed their regret that HM is not reimbursed by statutory health insurances but also their general willingness to pay extra for HM. The main challenge for German primary care, besides the reintroduction of reimbursement, is the promotion of knowledge and skill development in HM. This is to ensure patient safety and work in partnership with patients. Appropriate strategies for education must be tailored to the specific needs of health professional groups.

  8. Physician Communication to Enhance Patient Acupuncture Engagement in Family Medicine.

    Science.gov (United States)

    Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul

    2018-04-09

    Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.

  9. Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Higgins Angela Y

    2012-03-01

    Full Text Available Abstract Background The benefit of screening for decreasing the risk of death from colorectal cancer (CRC has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs vs. internal medicine (internists physicians. Methods Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey. The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening. Results Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%, or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81 or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94. Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%, while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%. Conclusion Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.

  10. 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.

  11. Importance of and satisfaction with work and professional interpersonal issues: a survey of physicians practicing general internal medicine in Ontario.

    Science.gov (United States)

    Cook, D J; Griffith, L E; Sackett, D L

    1995-09-15

    To explore the importance of and satisfaction with clinical responsibilities, teaching, research and interpersonal issues among general internists; to understand the barriers to satisfaction in these domains and the usefulness of potential solutions to these problems. Cross-sectional survey conducted from November 1992 to June 1994. Ontario. General internists who were fellows of the Royal College of Physicians and Surgeons of Canada and members of the Ontario Medical Association. Of 1192 physicians, 1007 (84.5%) returned a completed questionnaire; only the 199 who devoted at least 50% of their time to the practice of general internal medicine were included in this analysis. The respondents were satisfied with their primary role as clinicians dealing with complex, undifferentiated problems caring for the total patient and providing consultation. Guidelines for the referral of patients to general internists, computerization of test results, recruitment of general internal medicine fellows and more confidence in the future of general internal medicine were some of the solutions considered likely to increase professional satisfaction. The respondents involved in teaching suggested additional solutions, such as an opportunity to improve their teaching and evidence-based medicine skills and a greater recognition for their teaching efforts. Few of the general internists conducted research, barriers included lack of personal and project funding, and pressure to generate clinical earnings. In the domain of professional interpersonal issues, women were significantly more likely than men to rate having a mentor, peer support groups, ongoing career counselling, promotion and tenure guidelines for parental leave, availability of on-site day care, addressing gender discrimination and adoption of gender-neutral language as likely to improve the work environment. The primary role of general internists is that of patient-centred clinician. Our findings suggest that general

  12. Use of complementary and alternative medicine by cancer patients ...

    African Journals Online (AJOL)

    Complementary and alternative medicine (CAM) is garnering increasing interest and acceptance among the general population throughout the world. The use of CAM by cancer patients is very common in China. The referenced English literature has no rural community-based study from China on this subject. This study ...

  13. Nuclear medicine procedures for monitoring patient therapy

    International Nuclear Information System (INIS)

    Gobuty, A.H.

    1987-01-01

    The demands of present biomedical technology are not trivial. Such technology has placed unaccustomed demands on clinicians. NM has been no exception. A large number of new tests which have the potential for contributing to patient management in ways unknown until recently are available. This chapter was designed to provide assistance in test assessment with the following temporal sequence: (a) What questions can these test answer? (b) Which test appears to be most appropriate for the question at hand? (c) Is the selected test cost effective? (d) Does the selected test stand on solid experiential and/or factual ground? (e) How can the data obtained best be handled? The widespread acceptance of these monitoring tests indicates that the available rewards are greater than the demands placed on us in using them. Judiciously used, these tests should continue to be important for both the provider and the recipient of health care

  14. Cardiovascular oncology: a new discipline inside internal medicine?

    Science.gov (United States)

    Prisco, Domenico; D'Elios, Mario Milco; Cenci, Caterina; Ciucciarelli, Lucia; Tamburini, Carlo

    2014-06-01

    Cardiovascular disease and cancer incidence and prevalence have risen over the past few decades to become the leading causes of death. On the one hand, cancer patients will be treated with cardiotoxic chemotherapies; on the other, cardiovascular patients will receive a new diagnosis of cancer and will have to face treatments that may worsen their disease. Moreover, venous thromboembolism can commonly complicate the natural course of patients with cancer in an apparently spontaneous manner or can be triggered by a clinical event such as surgery, invasive procedures, a course of chemotherapy or radiotherapy and is known to be the second cause of death in these patients who also may need to be treated for pre-existing medical conditions or comorbidities. Thus, we introduce the concept of cardiovascular oncology (in the place of cardiooncology) to underline that the problems in this field are not limited to cardiotoxicity of chemotherapies and to the interaction between cardiologists and oncologists, and we focus on the role of the Internist, the only health care giver able to face the multiple problems that cancer patients may undergo.

  15. Nutritional Advice for Patients with Melasma in Iranian Traditional Medicine

    Directory of Open Access Journals (Sweden)

    Mahdis Mojtabaee

    2016-03-01

    Full Text Available Background Melasma (called Kalaf in Iranian traditional medicine is a common acquired hypermelanosis that affects sun-exposed areas of skin. Several factors including exposure to sunlight, pregnancy, and endocrine diseases increase the risk for Melasma. In traditional medicine, antecedent philosophers and physicians have tried to understand the nature and mechanisms of different systems of the human body for the diagnosis and management of Melasma; they have offered different solutions for it. This study is important since Melasma is a disease causing mental side effects in patients, due to darkness and opacity of the skin; therefore, the treatment of Melasma in terms of its psychological complications is of particular importance. In addition, texts of Iranian traditional medicine contain a wealth of nutritional advice for patients with Melasma. These texts have, until now, not yet been reviewed. The present study has considered the most important references of Iranian traditional medicine texts. Objectives The objective of this study was to extract and categorize the nutritional advice of Iranian traditional medicine texts for the treatment of Melasma. Results Dietary recommendations, not only for treatment but also for prevention of diseases and staying healthy, are very efficient. Conclusions Based on the traditional medicine texts, it is helpful to avoid Soda-producing food as well as to identify appropriate food in order to eliminate the accumulation of Soda or black bile from the blood. This study offers a set of analytical and clinical research on food, which in traditional medicine is called Soda-producing as well as Soda reducing.

  16. Patient-related pitfalls and artifacts in nuclear medicine imaging.

    Science.gov (United States)

    Howarth, D M; Forstrom, L A; O'Connor, M K; Thomas, P A; Cardew, A P

    1996-10-01

    Quality control in nuclear medicine is all important. This applies not only to preparation of the patient and acquisition of the image, but also to interpretation of the study. Although it may seem self-evident, it is important to remain aware of artifacts that are directly related to the patient and need special consideration. Furthermore, at times the distinction between normal variants and artifacts can be difficult. Commonly encountered patient-related artifacts include artifacts caused by attenuation, contamination artifacts, and artifacts caused by intravenous lines, tubes, and catheters. Less commonly, artifacts arise because of the use of multiple isotopes, the presence of fistulas or surgically altered anatomy, and pharmaceuticals and other substances interfering with expected radiopharmaceutical uptake and distribution. The diagnostic accuracy of nuclear medicine reporting can be improved by awareness of these patient-related artifacts. Both awareness and experience are also important when it comes to detecting and identifying normal (and abnormal) variants.

  17. Towards an outcome documentation in manual medicine: a first proposal of the International Classification of Functioning, Disability and Health (ICF) intervention categories for manual medicine based on a Delphi survey.

    Science.gov (United States)

    Kirchberger, I; Stucki, G; Böhni, U; Cieza, A; Kirschneck, M; Dvorak, J

    2009-09-01

    The International Classification of Functioning, Disability and Health (ICF) provides a useful framework for the comprehensive description of the patients' functional health. The aim of this study was to identify the ICF categories that represent the patients' problems treated by manual medicine practitioners in order to facilitate its application in manual medicine. This selection of ICF categories could be used for assessment, treatment documentation and quality management in manual medicine practice. Swiss manual medicine experts were asked about the patients' problems commonly treated by manual medicine practitioners in a three-round survey using the Delphi technique. Responses were linked to the ICF. Forty-eight manual medicine experts gave a total of 808 responses that were linked to 225 different ICF categories; 106 ICF categories which reached an agreement of at least 50% among the participants in the final Delphi-round were included in the set of ICF Intervention Categories for Manual Medicine; 42 (40%) of the categories are assigned to the ICF component body functions, 36 (34%) represent the ICF component body structures and 28 (26%) the ICF component activities and participation. A first proposal of ICF Intervention Categories for Manual Medicine was defined and needs to be validated in further studies.

  18. International Journal of Medicine and Health Development - Vol 16 ...

    African Journals Online (AJOL)

    Efficacy and safety of telmisartan monotherapy in the black hypertensive patient at a tertiary Centre in eastern Nigeria · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. CK Ijoma, II Ulasi, UN Ijoma, 17-23. http://dx.doi.org/10.4314/jcm.v16i1.3 ...

  19. International Journal of Medicine and Biomedical Research - Vol 2 ...

    African Journals Online (AJOL)

    Diabetes distress among type 2 diabetic patients · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT ... Dental pulp-derived stem cells (DPSC) differentiation in vitro into odontoblast and neuronal progenitors during cell passaging is associated with alterations in cell survival and viability · EMAIL FREE FULL TEXT EMAIL ...

  20. When Old Habits Train a New Generation: Findings From a National Survey of Internal Medicine Program Directors on Procedural Training.

    Science.gov (United States)

    Ricotta, Daniel N; Smith, C Christopher; McSparron, Jakob I; Chaudhry, Saima I; McDonald, Furman S; Huang, Grace C

    2017-11-01

    Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk.

  1. ROLE OF THE INTERNATIONAL ORGANIZATIONS IN PREVENTING THE COUNTERFEIT MEDICINES ENTRY INTO THE WORLD MARKETS.

    Science.gov (United States)

    Stukina, Valeryia; Dohnal, Jiri; Saloun, Jan

    2016-09-01

    30 years have passed since Conference of Experts on the Rational Use of Drugs was held in Nairobi, Kenya, from 25 to 29 November 1985, where the problem of counterfeit medicines was mentioned as the international for the first time. The problem of counterfeit medicines is not only a major threat to public health and national and private economy, but also it is of great interest for key decision-making actors at the international level. The authors analyzed what has been done since that time by international organizations. Combating the counterfeiting of medicines cannot be successfully achieved by the health sector alone - World Health Organization (WHO), - so the efforts of the other United Nations (UN) organizations relevant to counterfeiting were in need and were studied in the article: World Intellectual Property Organization (WIPO), World Trade Organization (WTO), World Customs Organization (WCO), United Nations Office on Drugs and Crime (UNODC), etc. Today WHO is unable to coordinate all their activities, so the few existing proposals for establishing a new mechanism of international cooperation have been examined. Will the MEDICRIME Convention that will enter into force on January 1, 2016 be the start of the new era in the combating with the counterfeit medicines? - the authors offered their vision on the international developments.

  2. [Output strategies for publication of international papers on clinical trials of Chinese medicine].

    Science.gov (United States)

    Wang, Qing; Ma, Hong-Li; Wu, Xiao-Ke

    2014-09-01

    Scientific research output of clinical trials in Chinese medicine (CM) is insufficient, but international papers hold an important scientific position in China. Based on the current situation, we analyzed the present publication situation of international medical papers in our country, and the feasibility and urgency of publishing international papers on clinical trials of CM. Finally, we proposed to use the PDCA (plan-do-check-action) cycle method to improve the quality control and management of CM clinical trials. Moreover, by combining our experience in relevant scientific research launched at our department, we expounded strategies for improving the quantity and quality of international papers in CM.

  3. Empowerment of patients in online discussions about medicine use.

    Science.gov (United States)

    van Berkel, Jasper J; Lambooij, Mattijs S; Hegger, Ingrid

    2015-04-08

    Patient empowerment is crucial in the successful self-management of people with chronic diseases. In this study, we investigated whether discussions about medicine use taking place on online message boards contribute to patient empowerment and could subsequently result in the more effective use of medicines. We discuss the extent to which patient empowerment processes occur in discussions on online message boards, focusing on patients with three disorders with different characteristics: diabetes, Amyotrophic Lateral Sclerosis (ALS) and Attention Deficit / Hyperactivity Disorder (ADHD). Because information is an important factor in both patient empowerment and self-management, we also evaluate the quality of the information being exchanged. We used a deductive thematic analysis method based on pre-existing categories. We gathered and analysed 5532 posts related to the conditions ADHD, ALS and diabetes from seven message boards (three for ADHD, three for diabetes, and one for ALS). We coded the posts for empowerment processes and the quality of the information exchanged. We identified patient empowerment processes in posts related to all three disorders. There is some variation in the frequency of these processes, but they show a similar order in the results: patients used the online message boards to exchange information, share personal experiences and for empathy or support. The type of information shared in these processes could contribute to the patient's self-efficacy when it comes to medicine use. The exchanged information was either correct or largely harmless. We also observed a tendency whereby participants correct previously posted incorrect information, and refer people to a healthcare professional following a request for medical advice, e.g. concerning the choice of medicines or dosage. Our findings show that patient empowerment processes occur in posts related to all three disorders. The type of information shared in these processes can contribute to the

  4. Developing a Communication Curriculum and Workshop for an Internal Medicine Residency Program.

    Science.gov (United States)

    Salib, Sherine; Glowacki, Elizabeth M; Chilek, Lindsay A; Mackert, Michael

    2015-06-01

    Learning effective communication is essential for physicians. Effective communication has been shown to affect healthcare outcomes, including patient safety, adherence rates, patient satisfaction, and enhanced teamwork. The importance of these skills has become even more apparent in recent years, with value-based purchasing programs and federal measures of patient satisfaction in the form of Hospital Consumer Assessment of Healthcare Providers and Systems scores becoming an important part of measuring the performance of a healthcare facility. We conducted a communication workshop for internal medicine residents at the University of Texas. Topics covered included the Acknowledge, Introduce, Duration, Explanation, Thank You framework; managing up; resolving conflicts; error disclosure; new medication and discharge counseling; intercultural communication; understanding Hospital Consumer Assessment of Healthcare Providers and Systems scores; and avoiding burnout. Because it would have been logistically difficult to block whole days for the workshop, the various topics were offered to residents during their regular noon conference hour for several consecutive days. After the workshop, the residents completed an anonymous questionnaire regarding their perception of the importance of various aspects of communication in patient care. The majority of the participating residents perceived the various communication skills explored during the workshop to be highly important in patient care. Concurrently, however, most residents believed that they had initially overestimated their knowledge about these various communication issues. Some demographic differences in the responses also were noted. Our findings demonstrate a needs gap and an area of potential improvement in medical education. We anticipate that with the growing understanding of the importance of communication skills in the healthcare setting, there will be an enhanced role for teaching these skills at all levels of

  5. Radiation exposure to sonographers from nuclear medicine patients: A review.

    Science.gov (United States)

    Earl, Victoria Jean; Badawy, Mohamed Khaldoun

    2018-02-25

    Following nuclear medicine scans a patient can be a source of radiation exposure to the hospital staff, including sonographers. Sonographers are not routinely monitored for occupational radiation exposure as they do not commonly interact with radioactive patients or other sources of ionizing radiation. This review aims to find evidence relating to the risk and amount of radiation the sonographer is exposed to from nuclear medicine patients. It is established in the literature that the radiation exposure to the sonographer following diagnostic nuclear medicine studies is low and consequently the risk is not significant. Nevertheless, it is paramount that basic radiation safety principles are followed to ensure any exposure to ionizing radiation is kept as low as reasonably achievable. Practical recommendations are given to assist the sonographer in radiation protection. Nuclear medicine therapy procedures may place the sonographer at higher risk and as such consultation with a Radiation Safety Officer or Medical Physicist as to the extent of exposure is recommended. © 2018 The Royal Australian and New Zealand College of Radiologists.

  6. Specimen rejection in laboratory medicine: Necessary for patient safety?

    Science.gov (United States)

    Dikmen, Zeliha Gunnur; Pinar, Asli; Akbiyik, Filiz

    2015-01-01

    The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas. The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected. Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics. We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.

  7. Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations.

    Science.gov (United States)

    Iserson, Kenneth V; Biros, Michelle H; James Holliman, C

    2012-06-01

    While personal and organizational challenges occur in every area of health care, practitioners of international medicine face unique problems and dilemmas that are rarely discussed in training programs. Health professions schools, residency and fellowship programs, nongovernmental organizations (NGOs), and government programs have a responsibility to make those new to international medicine aware of the special circumstances that they may face and to provide methods for understanding and dealing with these circumstances. Standard "domestic" approaches to such challenges may not work in international medicine, even though these challenges may appear to be similar to those faced in other clinical settings. How should organizations ensure that well-meaning health intervention efforts do not cause adverse unintended sequelae? How should an individual balance respect for cultural uniqueness and local mores that may profoundly differ from his or her own beliefs, with the need to remain a moral agent true to one's self? When is acceptance the appropriate response to situations in which limitations of resources seem to preclude any good solution? Using a case-based approach, the authors discuss issues related to the four major international medicine domains: clinical practice (postdisaster response, resource limitations, standards of care), medical systems and systems development (prehospital care, wartime casualties, sustainable change, cultural awareness), teaching (instruction and local resources, professional preparation), and research (questionable funded studies, clinical trials, observational studies). It is hoped that this overview may help prepare those involved with international medicine for the challenges and dilemmas they may face and help frame their responses to these situations. © 2012 by the Society for Academic Emergency Medicine.

  8. [From the History of the German Society of Internal Medicine (DGIM) - Part 1: The DGIM in the Nazi era].

    Science.gov (United States)

    Forsbach, Ralf; Hofer, Hans-Georg

    2017-12-01

    51 years after its founding in 1882, the "Congress for Internal Medicine", 1920 renamed "German Society for Internal Medicine (DGIM)", fell into heavy water. While during the Kaiserreich and the Weimar Republic the medical care for the individual patient had never been seriously questioned, the proclaimed "Third Reich" brought fundamental changes. The 1164 male and 13 female physicians, who had been organized in the DGIM 1933, had to position themselves in the Nazi dictatorship. The same applied for the society as a whole.The behavior of the German Society of Internal Medicine during the Nazi period is disenchanting. The society completely subordinated to the Nazi regime. The scientific program of the meetings was oriented to the ideological interests of the regime. Solidarity with nazi-persecuted people is only apparent in rare cases. On the contrary, even DGIM chairmen were involved in expulsions and NS-medical crimes. Cautious criticism was limited to a few areas, such as the "Neue Deutsche Heilkunde" ("New German Healing") and the study conditions at the universities. Only individual DGIM members developed oppositional behavior on the basis of personal conviction.In accordance with the more recent research on the Nazi era, these results both clarify and broaden the picture of scientific organizations in general and medical societies in particular. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Local resistance patterns to antimicrobials in internal medicine: a focused report from the REGIMEN (REGistro Infezioni in MEdicina INterna) study.

    Science.gov (United States)

    Cei, Marco; Pardelli, Riccardo; Sani, Spartaco; Mumoli, Nicola

    2014-02-01

    The treatment for infections in hospitalized patients can be summarized in the timely start of empirical therapy, followed by adjustment on the basis of isolates and microbial susceptibilities. Initial therapy may be based on international guidelines. However, to know local frequencies of bacterial and fungal strains together with patterns of drug resistance should be a better approach to therapy. REGIMEN is a retrospective observational study of all consecutive recorded bacterial and fungal isolates, collected between October 2009 and August 2011 from patients admitted in a 53-bedded ward of internal medicine of a non-teaching Italian hospital. We investigated type of samples and of microorganisms, patterns of susceptibility and resistance to antibiotics, and in-hospital mortality. A total of 504 samples were examined (244 from urine, 189 from blood and 71 from skin and various exudates). Participants were old (mean age, 83 years), and so overall mortality was high (20 %). There were high frequencies of drug resistance; only 27.9 % of urinary gram-negatives and 52.6 % of blood gram-negatives were susceptible to levofloxacin. Susceptibility profiles compatible with the presence of extended-spectrum beta-lactamases were present in 64.2 % of gram-negative strains, and 10.1 % were also resistant to carbapenems. ESKAPE organisms account for a third of all bacterial infections. Local patterns of drug resistance should influence empirical antibiotic therapy for patients admitted in internal medicine wards, where mortality is high.

  10. Viewpoints of Patients in Qazvin Towards Complementary and Alternative Medicine

    Directory of Open Access Journals (Sweden)

    Barikani

    2016-02-01

    Full Text Available Background We have little information on the degree of individuals’ in Iran and their use of complementary and alternative medicine, its variations and the causes of people’s tendency towards the treatments used in the methods mentioned above. Objectives In 2012, we set out to study the viewpoints of patients in Qazvin, Iran, examining how they feel about complementary and alternative medicine. Patients and Methods In a cross-sectional study, data were collected through the use of a questionnaire. A total of 293 patients who had been referred to the complementary and alternative medicine centers were surveyed. These centers practice methods such as cupping, homeopathy and acupuncture. The questionnaire was divided in two parts, demographic questions and main questions, in this particular study. The data were analyzed using SPSS software version 19 with P < 0.05. Results The mean age of the participants was 37.2 ± 13.3, and 60.8 percent of them were men. In all, 70.6 percent and 24.4 percent of respondents were married and single, respectively. About 58 percent had completed their undergraduate education. The cause of 31.3 percent of the participants’ visits was mental sicknesses, 20.2 percent attended due to rheumatologic diseases, and 8.2 percent applied to the mentioned treatment centers seeking relief from skin-related diseases. Ninety-one percent of the participants reported using alternative and complementary medicine for its efficiency. The levels of high satisfaction they reported gaining from the center’s homeopathy, acupuncture, and phlebotomy services were 17.2%, 16.5%, and 18.2%, respectively. In addition, 70 percent of the patients found the new treatment method to be quite successful, while 27 percent found it to be less effective than other approaches they had tried. Conclusions The people were receptive to the use of alternative and complementary medicine and their satisfaction level was high.

  11. The hateful patient revisited: Relevance for 21st century medicine.

    Science.gov (United States)

    Strous, Rael D; Ulman, Anne-Marie; Kotler, Moshe

    2006-10-01

    While the practice of medicine has changed over the years, including technological advances, access to medical information, and the narrowing of socio-economic and educational gaps between the clinician and his/her patients, the importance of the doctor-patient relationship has not diminished over time. This can be a very rewarding interaction. However, many physicians experience a great deal of anger, inadequacy and frustration, and much of the actual practice of medicine may become a burden rather than a source of satisfaction. Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the "hateful patient" can therefore be very informative to the physician. Several categories of such patients may be described, and sensitivity to the phenomenon will lead to improved physician well-being, less self-destructive patient behavior and a lower risk of litigation. Several factors may assist the 21st century physician in managing the "hateful patient" in an empathic manner and in making some sense of why the patient has resorted to negative response patterns. Ultimately, a failure to consider these issues will result in poorer medical care and, no less important, reduced satisfaction of both patients and doctors. The intention of this article is to revisit the concept and to place it in the context of contemporary medical practice.

  12. Implementation strategies of Systems Medicine in clinical research and home care for cardiovascular disease patients.

    Science.gov (United States)

    Montecucco, Fabrizio; Carbone, Federico; Dini, Frank Lloyd; Fiuza, Manuela; Pinto, Fausto J; Martelli, Antonietta; Palombo, Domenico; Sambuceti, Gianmario; Mach, François; De Caterina, Raffaele

    2014-11-01

    Insights from the "-omics" science have recently emphasized the need to implement an overall strategy in medical research. Here, the development of Systems Medicine has been indicated as a potential tool for clinical translation of basic research discoveries. Systems Medicine also gives the opportunity of improving different steps in medical practice, from diagnosis to healthcare management, including clinical research. The development of Systems Medicine is still hampered however by several challenges, the main one being the development of computational tools adequate to record, analyze and share a large amount of disparate data. In addition, available informatics tools appear not yet fully suitable for the challenge because they are not standardized, not universally available, or with ethical/legal concerns. Cardiovascular diseases (CVD) are a very promising area for translating Systems Medicine into clinical practice. By developing clinically applied technologies, the collection and analysis of data may improve CV risk stratification and prediction. Standardized models for data recording and analysis can also greatly broaden data exchange, thus promoting a uniform management of CVD patients also useful for clinical research. This advance however requires a great organizational effort by both physicians and health institutions, as well as the overcoming of ethical problems. This narrative review aims at providing an update on the state-of-art knowledge in the area of Systems Medicine as applied to CVD, focusing on current critical issues, providing a road map for its practical implementation. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  13. Consultant perception of general internal medicine: a survey of consultant physicians.

    Science.gov (United States)

    Moore, Abigail; Newbery, Nina; Goddard, Andrew F

    2015-12-01

    The Future Hospital Commission has highlighted the need for increased general medical skills in the medical workforce in order to meet the increasing demands on the NHS in terms of patients with increasing age, frailty and complex comorbidities. However there continues to be a lack of clarity around the concept of generalism and general internal medicine (GIM), with differing views on the physician's role in GIM. This survey sought to explore further the roles in which current physicians perceive they are practising GIM as well as views on training in GIM. The survey highlights three key points: (i) that consultant perception and practice of GIM continues to vary dependent on physician specialty; (ii) that the practice of GIM is not limited to the front door but includes the management of patients under the care of a specialty team with general medical needs, be that in an inpatient, outpatient or acute care setting; and (iii) that training in GIM needs to reflect this variation in roles and practice. © Royal College of Physicians 2015. All rights reserved.

  14. Reliance on medicinal plant therapy among cancer patients in Jamaica.

    Science.gov (United States)

    Foster, Kimberley; Younger, Novie; Aiken, William; Brady-West, Doreen; Delgoda, Rupika

    2017-11-01

    Patients' perspective of their treatment regime plays a vital role in its success. Recognizing the high prevalence of medicinal plant usage among Jamaicans at large, we investigated the engagement of such remedies by cancer patients, with the aim of uncovering self-medicating habits, perceptions and details of utilized plants. A structured, interviewer-based questionnaire was administered to 100 patients attending the oncology and urology clinics at the University Hospital of the West Indies in Kingston, Jamaica. A method of convenience sampling was employed and the data were analyzed using summary statistics and statistical significance tests. A large proportion (n = 80, 80%) of interviewed patients, engaged medicinal plants in their treatment regimes. Such habits were independent of person's education, economic status and were higher among the 55-74 age groups (p Petiveria alliacea L. were the most commonly used plants for treating breast and prostate cancers, respectively. A large proportion of Jamaican cancer patients use medicinal plants in self-medicating practices and their perceptions and habits need to be considered by physicians, in the design of safe and effective care regimes.

  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. 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.

  17. Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2015-01-01

    Full Text Available Controlled trials demonstrated efficacy and safety of non-invasive ventilation (NIV in treatment of acute respiratory failure, initially in Intensive Care Units, then in other care settings (semi-intensive care units, emergency departments, and also in the wards, more often pneumological ones. Few studies have been published about NIV in Italian wards of Internal Medicine with full self-management of NIV by internists in a normal ward setting. We performed a prospective real-life study about the use of NIV in Internal Medicine ward devoid of a critical area of semi-intensive therapy, with the aim of confirming, in this setting, the effectiveness of NIV. During a period of 13 months, 42 patients with hypercapnic respiratory failure of different etiology and acidosis (pH<7.25were treated by NIV. NIV was successful in 81% of patients. In-hospital mortality was 9.5%. Safety of NIV is demonstrated by the absence of serious complications: only 7 patients showed poor compliance and 2 patients had facial pressure ulcer due to the mask. There were not statistical differences in success rate of NIV according to severity of acidosis at admission (pH<7.25 vs pH>7.25, neither according to the acute physiology and chronic health evaluation II score and the national early warning score, but the modified early warning score only showed statistically significant difference with lower values in the success group: 2.82±1.57 vs 4.13±1.46 (P<0.05. NIV has proven to be effective and safe in Internal Medicine ward.

  18. The Value of Narrative Medical Writing in Internal Medicine Residency.

    Science.gov (United States)

    Liao, Joshua M; Secemsky, Brian J

    2015-11-01

    Narrative medical writing can be utilized to help increase the value and patient-centeredness of health care. By supporting initiatives in areas such as population health management, quality improvement and health disparities, it provides benefits that are particularly relevant to physicians focused on health care improvement, reform and redesign. Graduate medical education (GME) represents a key time and opportunity for internists to learn and practice this form of writing. However, due to a number of local and systems factors, many have limited opportunities to engage in narrative medical writing compared to other non-clinical activities. By capitalizing on the momentum created by recent GME reform, several strategies can be utilized to overcome these barriers and establish narrative medical writing as a viable professional and communication skill.

  19. Delphi survey of international pharmacology experts: an attempt to derive international recommendations for use of medicine in breastfeeding women.

    Science.gov (United States)

    Amir, Lisa H; Ryan, Kath; Barnett, Clare

    2015-04-01

    There are currently no common guidelines used by health professionals to aid decision-making around the use of medicines during breastfeeding. Several specialized books, Web sites, and drug information services exist; however, all use slightly different criteria to derive their "safety hierarchy." The aim of this study was to build consensus among international experts in pharmacology and breastfeeding to develop an agreed-upon classification system for safety of medicine use in breastfeeding women. A three-round Web-based Delphi qualitative research design was used. Seventeen experts in pharmacy/pharmacology and breastfeeding identified 15 key parameters that are used to inform decisions about medicines and breastfeeding. The most important parameters about the infant were the age and health of the child, and those of the medicine were the safety profile and experience of use in infants. The experts had a clear understanding of the complexity of decision-making when prescribing for breastfeeding women. Although the current number or letter classification systems do not incorporate important considerations such as infant age, a longer "descriptive text" incorporating all considerations may be impractical in busy clinical practice. Although clinicians and lay people would appreciate a simple classification scheme, in practice, decision-making about the safety of medicines for breastfeeding women is complex.

  20. [The euthyroid sick syndrome. Its incidence and clinical significance in an internal medicine department].

    Science.gov (United States)

    Di Napoli, M; Reda, G; Zannoni, G; Russo, S; Morace, G; Vasselli, C

    1994-04-01

    In this paper the authors have evaluated the incidence and the clinical implications of sick euthyroid syndrome (SES) in a group of 144 patients in a department of internal medicine. SES is an alteration of thyroid hormone values in the absence of a thyroid disease, which is seen in patients suffering from serious diseases. Having classified SES into 3 subgroups according to the different alterations seen in the values of T3, T4, FT3, FT4, TSH, rT3 and TBG, they show the hypotheses that explain the biochemical mechanisms which are at the basis of these hormonal alterations. Fourteen of the 144 patients under observation were excluded as they were suffering from ascertained or subclinical thyroid disease. Thirty (23% of cases) of the remaining 130 patients had alterations of the thyroid hormones in accordance with SES diagnosis. Of these 30 patients, 19 had hormone values found in SES type I (63%), 2 in SES type II (6.5%) and 9 in SES type III (30.5%). In SES type I the diseases seen, in order of frequency, were: obstructive chronic bronchopneumopathy with acute respiratory failure, diabetic ketoacidosis, neoplasms, ischemic heart disease, cardiac failure, chronic renal failure, liver diseases, acute cerebral vasculopathies, sepsis and collagenopathies. The disease seen in the 2 cases of SES type II was obstructive chronic bronchopneumopathy with acute respiratory failure. In SES type III the diseases seen were, in order of frequency: diabetic ketoacidosis, lung diseases, ischemic heart disease, cardiac failure, peripheral arteriopathies, acute cerebral vasculopathies, neoplasms, liver diseases, acute renal failure. The incidence of SES in 23% of the admitted to hospital patients was found to be slightly higher than in other studies; this could be explained by a stricter selection of inpatients: in fact self-sufficient patients or those not needing urgent admission, were sent to an efficient out patient clinic where necessary examinations were quickly carried out

  1. 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. Copyright © 2010 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  2. Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

    Science.gov (United States)

    Favrat, B; Pécoud, A; Jaussi, A

    2004-01-01

    Background The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. Methods 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible. 2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). Results 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. Conclusions The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching. PMID:15056393

  3. Use of 360-degree assessment of residents in internal medicine in a Danish setting

    DEFF Research Database (Denmark)

    Allerup, Peter

    2007-01-01

    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 learning...

  4. 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.

  5. 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…

  6. Choices of Training Programs and Career Paths by Women in Internal Medicine.

    Science.gov (United States)

    Carr, Phyllis; And Others

    1993-01-01

    Using data on 3,569 women and 15,582 men trained in internal medicine, this study investigated gender differences in choice of primary care practice and their possible relationship to training program type, traditional or primary care. Results indicate women pursued primary care more often than did men, regardless of training program completed.…

  7. 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

  8. 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.

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

    Science.gov (United States)

    Kolade, Victor O; Staton, Lisa J; Jayarajan, Ramesh; Bentley, Nanette K; Huang, Xiangke

    2014-01-01

    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. 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. 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). 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.

  10. 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.

  11. 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

  12. Meeting the demand of the future: a curriculum to stimulate interest in careers in primary care internal medicine.

    Science.gov (United States)

    Hawthorne, Mary R; Dinh, An

    2017-01-01

    There is a growing need for primary care physicians, but only a small percentage of graduating medical students enter careers in primary care. To assess whether a Primary Care Intraclerkship within the Medicine clerkship can significantly improve students' attitudes by analyzing scores on pre- and post-tests. Students on the Medicine clerkship at the University of Massachusetts Medical School participated in full-day 'intraclerkships',to demonstrate the importance of primary care and the management of chronic illness in various primary care settings. Pre-and post-tests containing students' self-reported, five-point Likert agreement scale evaluations to 26 items (measuring perceptions about the roles of primary care physicians in patient care and treatment) were collected before and after each session. Eleven intraclerkships with 383 students were held between June 2010 and June 2013. Responses were analyzed using the GLM Model Estimate. Results from the survey analysis showed significantly more positive attitudes toward primary care in the post-tests compared to the pre-tests. Students who were satisfied with their primary care physicians were significantly more likely to show an improvement in post-test attitudes toward primary care in the areas of physicians improving the quality of patient care, making a difference in overall patient health, finding primary care as an intellectually challenging field, and in needing to collaborate with specialists. Older students were more likely than younger students to show more favorable answers on questions concerning the relative value of primary care vs. specialty care. A curriculum in Primary Care Internal Medicine can provide a framework to positively influence students' attitudes toward the importance of primary care, and potentially to influence career decisions to enter careers in Primary Care Internal Medicine. Ensuring that medical students receive excellent primary care for themselves can also positively influence

  13. An "education for life" requirement to promote lifelong learning in an internal medicine residency program.

    Science.gov (United States)

    Panda, Mukta; Desbiens, Norman A

    2010-12-01

    Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing. To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities. Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004. Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P  =  .04) but not with their career choice of subspecialization. The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.

  14. Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis.

    Science.gov (United States)

    Tartaglia, Kimberly M; Kman, Nicholas; Ledford, Cynthia

    2015-10-01

    Although as much as 87 % of all healthcare spending is directed by physicians, studies have demonstrated that they lack knowledge about the costs of medical care. Similarly, learners have not traditionally received instruction on cost-conscious care. To examine medical students' perceptions of healthcare delivery as it relates to cost consciousness Retrospective qualitative analysis of medical student narratives Third-year medical students during their inpatient internal medicine clerkship Students completed a reflective exercise wherein they were asked to describe a scenario in which a patient experienced lack of attention to cost-conscious care, and were asked to identify solutions and barriers. We analyzed these reflections to learn more about students' awareness and perceptions regarding the practice of cost-conscious care within our medical center. Eighty students submitted the assignment between July and December 2012. The most common problems identified included unnecessary tests and treatments (n = 69) and duplicative tests and treatments (n = 20.) With regards to solutions, students described 82 scenarios, with 125 potential solutions identified. Students most commonly used discussion with the team (speak up, ask why) as the process they would use (n = 28) and most often wanted to focus lab testing (n = 38) as the intervention. The most common barriers to high-value care included increased time and effort (n = 19), ingrained practices (n = 17), and defensive medicine or fear of missing something (n = 18.) Even with minimal clinical experience, medical students were able to identify instances of lack of attention to cost-conscious care as well as potential solutions. Although students identified the hierarchy in healthcare teams as a potential barrier to improving high value care, most students stated they would feel comfortable engaging the team in discussion. Future efforts to empower learners at all levels to question value

  15. Leadership for All: An Internal Medicine Residency Leadership Development Program.

    Science.gov (United States)

    Moore, Jared M; Wininger, David A; Martin, Bryan

    2016-10-01

    Developing effective leadership skills in physicians is critical for safe patient care. Few residency-based models of leadership training exist. We evaluated residents' readiness to engage in leadership training, feasibility of implementing training for all residents, and residents' acceptance of training. In its fourth year, the Leadership Development Program (LDP) consists of twelve 90-minute modules (eg, Team Decision Making and Bias, Leadership Styles, Authentic Leadership) targeting all categorical postgraduate year (PGY) 1 residents. Modules are taught during regularly scheduled educational time. Focus group surveys and discussions, as well as annual surveys of PGY-1s assessed residents' readiness to engage in training. LDP feasibility was assessed by considering sustainability of program structures and faculty retention, and resident acceptance of training was assessed by measuring attendance, with the attendance goal of 8 of 12 modules. Residents thought leadership training would be valuable if content remained applicable to daily work, and PGY-1 residents expressed high levels of interest in training. The LDP is part of the core educational programming for PGY-1 residents. Except for 2 modules, faculty presenters have remained consistent. During academic year 2014-2015, 45% (13 of 29) of categorical residents participated in at least 8 of 12 modules, and 72% (21 of 29) participated in at least 7 of 12. To date, 125 categorical residents have participated in training. Residents appeared ready to engage in leadership training, and the LDP was feasible to implement. The attendance goal was not met, but attendance was sufficient to justify program continuation.

  16. 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…

  17. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    Science.gov (United States)

    Narouze, Samer; Benzon, Honorio T; Provenzano, David; Buvanendran, Asokumar; De Andres, José; Deer, Timothy; Rauck, Richard; Huntoon, Marc A

    2018-04-01

    The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated

  18. Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

    Directory of Open Access Journals (Sweden)

    Bill Tu

    2008-07-01

    Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

  19. 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

  20. Nuclear medicine in the management of the aids patient

    International Nuclear Information System (INIS)

    Kramer, E.L.; Sanger, J.J.

    1995-01-01

    For the medical diagnostic imaging specialist in general, and for the nuclear medicine physician specifically, the AIDS epidemic has generated an enormous demand to develop a means of making early diagnoses of the complications of AIDS. For the most part this has meant the early detection, and when possible, the characterization of the opportunistic infections and neoplasms that are a major source of morbidity and mortality for the AIDS patient. Detection of opportunistic infections has been helpful in reclassifying HIV-seropositive patients as having AIDS. This paper reports on nuclear medicine used to evaluate the efficacy and the complications of treatment in human immunodeficiency virus infection. Most recently, functional brain imaging has been used for the diagnosis and follow-up of the AIDS dementia complex. (author). 77 refs., 8 figs

  1. Nuclear medicine in the management of the AIDS patient

    International Nuclear Information System (INIS)

    Kramer, E.L.; Sanger, J.J.

    1990-01-01

    For the medical diagnostic imaging specialist in general, and for the nuclear medicine physician specifically, the AIDS epidemic has generated an enormous demand to develop a means of making early diagnoses of the complications of AIDS. For the most part this has meant the early detection, and when possible, the characterization of the opportunistic infections and neoplasms that are a major source of morbidity and mortality for the AIDS patient. Detection of opportunistic infections has been helpful in reclassifying HIV-seropositive patients as having AIDS. This paper reports on nuclear medicine used to evaluate the efficacy and the complications of treatment in human immunodeficiency virus infection. Most recently, functional brain imaging has been used for the diagnosis and follow-up of the AIDS dementia complex

  2. Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation.

    Science.gov (United States)

    Barrie, Michael G; Amick, Christopher; Mitzman, Jennifer; Way, David P; King, Andrew M

    2018-01-01

    Most emergency medicine (EM) residency programs provide an orientation program for their incoming interns, with the lecture being the most common education activity during this period. Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format.

  3. Individualized adjustments to reference phantom internal organ dosimetry - scaling factors given knowledge of patient internal anatomy.

    Science.gov (United States)

    Wayson, Michael B; Bolch, Wesley E

    2018-03-16

    Various computational tools are currently available that facilitate patient organ dosimetry in diagnostic nuclear medicine, yet they are typically restricted to reporting organ doses to ICRP-defined reference phantoms. The present study, while remaining computational phantom based, provides straightforward tools to adjust reference phantom organ dose for both internal photon and electron sources. A wide variety of monoenergetic specific absorbed fractions (SAFs) were computed using radiation transport simulations for tissue spheres of varying size and separation distance. Scaling methods were then constructed for both photon and electron self-dose and cross-dose, with data validation provided from patient-specific voxel phantom simulations, as well via comparison to the scaling methodology given in MIRD Pamphlet No. 11. Photon and electron self-dose was found to be dependent on both radiation energy and sphere size. Photon cross-dose was found to be mostly independent of sphere size. Electron cross-dose was found to be dependent on sphere size when the spheres were in close proximity, owing to differences in electron range. The validation studies showed that this dataset was more effective than the MIRD 11 method at predicting patient-specific photon doses for at both high and low energies, but gave similar results at photon energies between 100 keV and 1 MeV. The MIRD 11 method for electron self-dose scaling was accurate for lower energies but began to break down at higher energies. The photon cross-dose scaling methodology developed in this study showed gains in accuracy of up to 9% for actual patient studies, and the electron cross-dose scaling methodology showed gains in accuracy up to 9% as well when only the bremsstrahlung component of the cross-dose was scaled. These dose scaling methods are readily available for incorporation into internal dosimetry software for diagnostic phantom-based organ dosimetry. © 2018 Institute of Physics and Engineering in

  4. ASSOCIATION BETWEEN BURNOUT SYNDROME IN INTERNAL MEDICINE RESIDENTS, THEIR REPORT OF THE SUBOPTIMAL CARE PRACTICES AND PATIENTS’ REPORT

    Directory of Open Access Journals (Sweden)

    ISABEL CASTAÑO

    2006-10-01

    Full Text Available This investigation pretended to establish the association between the Burnout Syndrome in internal medicine residents,the report of their sub optimal medical practices and the report of their hospitalized patients in charge, by using amultitrait-multimethod with a concurrent design that allows the research of two objects in the same investigation withconvergent results. The translated version by Moreno (2004 of the Maslach Burnout Inventory (MBI and the semistructured interview were used in medical residents, and a questionnaire to patients based on the scales proposed byMcKinley, Manku-Scott, Hastings, French and Baker (1997 in their research. The results showed no associationbetween the Burnout Syndrome and the report of the sub optimal practices from residents and patients. On thecontrary, it was found a significant association between the communication category and the report of patients. Finally,suggestions are formulated for improvements of these sub optimal practices and complementary studiesare proposed.

  5. A Research and Implementation of Internal Medicine Diagnosis Assisted by Intelligence Knowledge Base

    Directory of Open Access Journals (Sweden)

    Zhang Xiaohui

    2015-01-01

    Full Text Available Intelligent knowledge system is an important knowledge base for internal medicine diagnosis. Intelligent diagnosis of the knowledge base can be realized by establishing appropriate expert models to assist diagnosis and treatment. By building the hierarchical model of internal diseases, this paper established an internal medicine diagnostic system assisted by intelligence knowledge base with the mathematical model of analytic hierarchy. The hierarchical model is able to summarize characteristics of diseases and quantize the determinant criterion of diseases. The weighted value of a possible disease can be obtained through the judgment of physicians on the weight of factors of the criterion layer and the compared calculation of database. It is concluded that the analytic hierarchy model can realize the auxiliary diagnosis function of intelligence knowledge base and the weight of a disease providing diagnostic reference for physicians.

  6. Communication About Behavioral Health Risks: A Study of Videotaped Encounters in 2 Internal Medicine Practices

    Science.gov (United States)

    Makoul, Gregory; Dhurandhar, Anjali; Goel, Mita Sanghavi; Scholtens, Denise; Rubin, Alan S

    2006-01-01

    BACKGROUND As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate. OBJECTIVES To assess the scope of health risk screening and characterize the communication content of counseling for health behavior change in 2 general internal medicine practices. DESIGN AND PARTICIPANTS We studied videotapes of 125 new patient visits to General Internists affiliated with academic medical centers in Chicago, IL (70%) and Burlington, VT (30%). All videotapes were content analyzed to examine (1) the incidence and outcome of screening for diet, exercise, tobacco, alcohol, drugs, sex, seatbelt use, helmet use, firearms, smoke detectors, and sun exposure; (2) the content of counseling for at-risk behaviors, with a focus on 11 counseling tasks associated with health behavior change. RESULTS Patient age in these 125 initial visits ranged from 22 to 85 years. Within the 91 visits that included at least 1 screening attempt, there were a total of 361 distinct screening discussions (mean = 3.9, SD = 2.2, range = 1 to 9). Seventy-four (20.5%) of the 361 screening discussions revealed an at-risk behavior. On average, 2.4 of the 11 counseling tasks were accomplished for each of the 74 behavioral health risks (SD = 2.2, range 0 to 9); only education about the problem (56.8%) and general advice about the solution (62.2%) were evident in more than half of the counseling attempts. CONCLUSIONS This observational study reveals that communication tasks associated with successful counseling were relatively infrequent occurrences during initial visits in 2 primary care practices. PMID:16808769

  7. Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

    Science.gov (United States)

    Elshove-Bolk, Jolande; Mencl, Francis; van Rijswijck, Bas T F; Weiss, Ilanit M; Simons, Maarten P; van Vugt, Arie B

    2006-12-01

    We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. From May 27 to July 4 2001, the following data were recorded from the charts of all patients presenting to the emergency department: age, time and form of presentation, diagnostics, treatment, disposition and the single best diagnosis (International Classification of Disease-10 classification). The majority (84%) of the 5234 patients (134/day) patients seen were self-referred and treated by the emergency department physician. The remaining 16% were referred, usually by their general practitioner, directly to a specialty service, which saw them in the emergency department. Self-referred patients tended to be younger (average 33 years), with minor trauma, and infrequently required diagnostics (37%), treatment (49%) or admission (4%). The referred patients were older (average 50 years), with 41% needing admission. Only 16% of all patients were under 16 years of age. In all, there were five deaths (referred patients), 12 resuscitations, seven intubations, seven chest tube insertions and no lumbar punctures performed during the study period. The acuity of self-referred patients seen by the emergency physicians is low, with little diagnostic testing and few interventions and resuscitations, even in a busy center. This has both training and practise implications and it may be inappropriate to take an emergency medicine practise model or curriculum from another country based on its emergency department population.

  8. Internal medicine network: a new way of thinking hospital-territory integration and public-private partnership

    Directory of Open Access Journals (Sweden)

    Filomena Pietrantonio

    2016-10-01

    Full Text Available This working proposal aims to establish an Internal Medicine Network (IMN model for the appropriate management of the poly-pathological complex patient in the different phases of his illness natural hystory. The IMN is based on an organization recalling the Hub and Spoke system already used for existing specialized networks. The Internal Medicine Unit (IMU is the natural destination of acutely ill patients suffering from systemic or multi-organ diseases. Three are the IMU specific tasks: i to stabilize acute, severe, poly-pathologic and complex patients; ii to develop difficult etiological diagnosis in these patients and in those who should necessarily be admitted to the hospital, not being possible, for different reasons, alternative routes; iii to select the acute poly-pathological complex patient’s priorities. The expected results of a new model of integration system inside the IMN are: i reduction and rationalization of expenditure in the medical area, increasing effectiveness, quality and safety guaranteeing patient centrality; ii patients stratification based on characteristics of gravity, acute illness, estimated duration of hospitalization; iii reduction of inappropriate hospital admissions ensuring connections between hospital and primary care units; iv definition of different care pathways for patients hospitalized due to non-communicable diseases; v implementation of new common medical records. The public-private partnership inside the IMN could be able to increase appropriateness reducing health costs. Patient-centered problems assessment, together with integration, cooperation, coordination and effective communication are some simple rules useful to achieve tangible results in a complex system and the IMN model represents its practical application.

  9. 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.

  10. Can we predict final outcome of internal medicine residents with in-training evaluation.

    Science.gov (United States)

    Chierakul, Nitipatana; Pongprasobchai, Supot; Boonyapisit, Kanokwan; Chinthammitr, Yingyong; Pithukpakorn, Manop; Maneesai, Adisak; Srivijitkamol, Apiradee; Koomanachai, Pornpan; Koolvisoot, Ajchara; Tanwandee, Tawesak; Shayakul, Chairat; Kachintorn, Udom

    2011-02-01

    To assess the predictive value of in-training evaluation for determining future success in the internal medicine board certifying examination. Ninety-seven internal medicine residents from Faculty of Medicine Siriraj Hospital who undertake the Thai Board examination during the academic year 2006-2008 were enrolled. Correlation between the scores during internal medicine rotation and final scores in board examination were then examined. Significant positive linear correlation was found between scores from both written and clinical parts of board certifying examination and scores from the first-year summative written and clinical examinations and also the second-year formative written examination (r = 0.43-0.68, p evaluation by attending staffs was less well correlated (r = 0.29-0.36) and the evaluation by nurses or medical students demonstrated inverse relationship (r = -0.2, p = 0.27 and r = -0.13, p = 0.48). Some methods of in-training evaluation can predict successful outcome of board certifying examination. Multisource assessments cannot well extrapolate some aspects of professional competences and qualities.

  11. 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 medicine training and practice. © 2014 by the American Institute of Ultrasound in Medicine.

  12. [Nuclear medicine in radiotherapy planning for patients with malignant neoplasms of different locations].

    Science.gov (United States)

    Kanaev, S V; Novikov, S N; Girshovich, M M; Krivorot'ko, P V; Beĭnusov, D S; Krzhivitskiĭ, P I

    2012-01-01

    The performance of nuclear medicine methods in radiation therapy tactics determination was analyzed in patients receiving therapy for Hodgkin lymphoma (HL, n=556), breast cancer (BC, n=230), treatment-naive patients with non-small cell lung cancer (NSCLC, n=86). In HL patients the nuclear medicine methods were used to determine the irradiation fields for spleen irradiation (67%) and abdominal lymph nodes (27%). The bone marrow scan data had significant influence on radiation therapy tactics in 10-27% of cases. The visualization of primary tumor lymphatic drainage lead to changing the irradiation field topography in 75% cases of external BC and 85% of internal BC localization. Tumorotropic isotope mammal scan data lead to the changes in planned irradiation volume in 16% of BC patietns. In NSLC patients the results of "positive" scintigraphy with lipophilic 99mTc-marked cations lead to the change in irradiation tactics in 16% of cases. Therefore, the results of diagnostic investigations suggest the important role of nuclear medicine diagnostic methods in patients with various tumors of different localizations.

  13. Evaluation of the effectiveness of an international diploma course in tropical medicine.

    Science.gov (United States)

    Casebeer, L L; Grimes, J; Kristofco, R E; Freeman, B; Gotuzzo, E; Freedman, D O

    2001-01-01

    Numerous impediments to conducting continuing education (CE) courses in remote sites, particularly those courses that take place in developing countries, can include challenges associated with planning, infrastructure, and financial risk. This study reports the effectiveness of a course planned in the United States and executed in Peru, the Gorgas Course in clinical tropical medicine. A survey was conducted of participants who had completed the Gorgas Course as recently as 6 months and as long as 3 years earlier. The questionnaire sought to determine each participant's reason for participation, whether the course was instrumental in the participant's reaching the personal goal associated with participation, and whether the participant considered the course to be worth the time and money spent to enable participation. Forty-nine participants responded to the questionnaire, all of whom indicated that the Gorgas Course enabled achievement of the personal goal associated with participation. Fully 100% of course participants stated that participation was worth the time and monetary expenditure, most often citing their having access to patients with tropical diseases and the personal enrichment of living overseas as reasons the course was worth its high cost. It is logistically and financially feasible to conduct CE courses in developing countries, provided that the organization in the planning country has strong, pre-established relationships with the host institution(s). Continued collaboration between planning partners and frequent, rigorous course evaluations are necessary to enable an international CE course to become a stable, continuous academic offering.

  14. An attempt to motivate internal medicine housestaff to obtain consent for autopsies.

    Science.gov (United States)

    Sidorov, J

    1990-10-01

    The impact that a 50-minute lecture on the value of the autopsy had on the subsequent obtaining of autopsies by housestaff training in internal medicine at a teaching hospital was examined in a prospective one-year clinical trial from mid-1987 to mid-1988. The group that attended the lecture (n = 27) did not subsequently obtain a greater mean number or frequency of permissions for autopsies than did the control group (n = 26), whose members did not attend, and did not indicate more frequently in the patients' charts that autopsies had been sought. In addition, in the total group of 53 housestaff, five (9.4%) did not write a pronunciation-of-death entry, and 26 (49%) did not obtain permission for a single autopsy during the study period. Future efforts to enhance the appreciation for the autopsy among physicians in training may need to use more sophisticated techniques than a lecture in order to increase housestaff motivation to obtain consent for autopsies.

  15. [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

  16. 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.

  17. 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 (pprescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (pprescriptions. Altogether, this improves continuity of care. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  18. 3rd International Arab Forensic Sciences & Forensic Medicine Conference, ASFSFM 2017: Conference Report

    Directory of Open Access Journals (Sweden)

    Abdulsallam A. Bakdash

    2017-12-01

    Full Text Available The Arab Society for Forensic Sciences and Forensic Medicine (ASFSFM at Naif Arab University for Security Sciences seeks to present the latest developments in all fields of forensic sciences through holding specialized scientific events and academic activities. This is also achieved through its periodic scientific peer-reviewed journal, the Arab Journal of Forensic Sciences and Forensic Medicine. It also seeks to promote scientific research in all fields of forensic science and forensic medicine, and seeks actively to contribute in holding scientific meetings in accordance with advanced scientific standards, including the 3rd International Arab Forensic Sciences & Forensic Medicine Conference. This important event was attended by scientists and experts from various fields of criminal and forensic sciences from both Arab and non-Arab countries. This conference was a significant scientific accomplishment that contributed to the advancement of forensic sciences and forensic medicine in the Arab world. The conference aimed, in accordance with the vision of Naif Arab University for Security Sciences, to enhance peace, security and justice in Arab societies.  Naif Arab University for Security Sciences, represented by the Arab Society for Forensic Sciences and Forensic Medicine, held the 3rd International Arab Forensic Sciences & Forensic Medicine Conference on the University's campus during the period from 21st to 23rd November 2017. The event included the participation of more than 720 experts in forensic sciences and forensic medicine from 33 countries all over the world. Experts discussed and presented the latest developments in their fields. The conference provided a creative environment for students from both local and international universities to benefit from experts and specialists, and to access the most recent research.  On behalf of His Excellency the president of Naif Arab University for Security Sciences, and the Arab Society for

  19. 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

  20. 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

  1. 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.

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

    Science.gov (United States)

    Lubberding, Sanne; Zwaan, Laura; Timmermans, Daniëlle R M; Wagner, Cordula

    2011-12-01

    This study aimed to examine the nature and causes of unintended events (UEs) at internal medicine departments (IMD). 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 were asked to report all UEs concerning patient safety. To identify underlying root causes, experienced researchers analyzed the reports using a standardized root cause analysis method called PRISMA medical. Hospital staff reported 625 UEs. Medication-related UEs were the most reported events (42%). Of all reported UEs, 12% involved the collaboration between the IMD and other departments within the hospital.On the basis of the 625 UEs, 920 root causes were identified. The mean (SD) number of root causes per incident was 1.47 (0.68). Human root causes were related to 83.2% of the UEs, organizational root causes were related to 15.7%, technical root causes were related to 7%, and other root causes were related to 8.6% of the UEs.More than half of the reported UEs reached the patient (62%), with suboptimal care as the most frequently occurring consequence (44.7%). Physical injury occurred in 10.3% of the UEs. Hospital staff reporting UEs seems to be a good method for gaining insight into the types of UEs that occur at hospital departments. Although many UEs had human causes, identifying technical and organizational causes is important for the development of successful improvement strategies considering their contribution to human error. Important targets for these strategies are the medication process and collaboration within the hospital.

  3. Severe acute pancreatitis: clinical findings and therapeutic tools in Internal Medicine practice

    Directory of Open Access Journals (Sweden)

    Generoso Uomo

    2013-04-01

    Full Text Available BACKGROUND Recent advances in pathophysiology and therapeutic measures suggest that patients suffering from acute pancreatitis (AP should undergo an early evaluation and treatment in Internal Medicine wards. Severe AP, usually associated with pancreatic necrosis and peripancreatic fluid collections, may be frequently complicated by distant organ(s involvement. RESULTS The dreadful multi-organ failure may occur as an early event (during the first week of the disease or in association with the infection of pancreatic necrosis in a later stage. So, during the clinical outcome, physicians may be compelled to counteract cardio-circulatory, pulmonary, renal, hepatic, haematological and hydro-electrolytic complex derangements. Arterial hypotension and shock may be consequence of hypovolemia and/or hearth failure or septic shock syndrome. Pleural effusions are frequent in the early phase of the disease as well as pulmonary densifications and renal insufficiency. Urinary, pulmonary, and biliary infections may intervene during all phases of the disease whereas pancreatic necrosis and fluid collections infections are more frequent after the second week of hospitalization. Prognostic evaluation should be obtained by simple and precise scoring system such as the modified Marshall score and CT-scan severity index. CONCLUSIONS Treatment must be initiated as soon as possible with special focusing on fluid and nutritional supplementation, pain control, cardio-respiratory support, antiproteases and antibiotics. Invasive procedures such as endoscopic sphincterotomy in biliary AP with cholangitis and/or obstruction and percutaneous drainage should be utilized in specific cases. Surgical necrosectomy is mandatory in patients with documented infection of pancreatic necrosis.

  4. [Computer-assisted analysis of the results of training in internal medicine].

    Science.gov (United States)

    Vrbová, H; Spunda, M

    1991-06-01

    Analysis of the results of teaching of clinical disciplines has in the long run an impact on the standard and value of medical care. It requires processing of quantitative and qualitative data. The selection of indicators which will be followed up and procedures used for their processing are of fundamental importance. The submitted investigation is an example how to use possibilities to process results of effectiveness analysis in teaching internal medicine by means of computer technique. As an indicator of effectiveness the authors selected the percentage of students who had an opportunity during the given period of their studies to observe a certain pathological condition, and as method of data collection a survey by means of questionnaires was used. The task permits to differentiate the students' experience (whether the student examined the patient himself or whether the patient was only demonstrated) and it makes it possible to differentiate the place of observation (at the university teaching hospital or regional non-teaching hospital attachment). The task permits also to form sub-groups of respondents to combine them as desired and to compare their results. The described computer programme support comprises primary processing of the output of the questionnaire survey. The questionnaires are transformed and stored by groups of respondents in data files of suitable format (programme SDFORM); the processing of results is described as well as their presentation as output listing or on the display in the interactive way (SDRESULT programme). Using the above programmes, the authors processed the results of a survey made among students during and after completion of the studies in a series of 70 recommended pathological conditions. As an example the authors compare results of observations in 20 selected pathological conditions important for the diagnosis and therapy in primary care in the final stage of the medical course in 1981 and 1985.

  5. Patient absorbed dose and radiation risk in nuclear medicine

    International Nuclear Information System (INIS)

    Hetherington, E.; Cochrane, P.

    1992-01-01

    Since the introduction of technetium-99m labelled radiopharmaceuticals used as imaging agents in the nuclear medicine departments of Australian hospitals, patients have voiced concern about the effect of having radioactive materials injected into their bodies. The danger of X-ray exposure is widely known and well accepted, as is exposure to ultrasound, computed tomography scans and other imaging techniques. However, radioactivity is an unknown, and fear of the unknown can occasionally lead to patients refusing to undergo a nuclear medicine procedure. The authors emphasised that the radiation dose to a patient from a typical procedure would depend on the patient's medical history and treatment; the average dose being approximately 50 times the exposure received from the natural environmental background radiation. Furthermore, over an extended period the body can repair most minor damage caused by radiation, just as the body can repair the damage caused by sunburn resulting from too much exposure to sunlight. The risk of genetic effects as a result of a medical radiation dose is than very small

  6. Evaluation of internal exposure of nuclear medicine staff through in vivo and in vitro bioassay techniques

    Energy Technology Data Exchange (ETDEWEB)

    Lucena, E.A.; Araujo, F.; Sousa, W.O.; Dantas, A.L.A.; Dantas, B.M. [Instituto de Radioprotecao e Dosimetria, CNEN, Av. Salvador Allende s/n, CEP 22780-160 Rio de Janeiro (Brazil); Rebelo, A.M.O.; Corbo, R. [Hospital Universitario Clementino Fraga Filho, HU-UFRJ, Av. Brigadeiro Trompowsky, s/n, ILHA do Fundao, CEP 21945-560, Rio de Janeiro, RJ (Brazil)

    2007-07-01

    The manipulation of a wide variety of unsealed sources in Nuclear Medicine results in a significant risk of internal exposure of the workers. {sup 131}I should be highlighted among the most frequently used radionuclides because of its large application for diagnosis and therapy of thyroid diseases. The increasing use of radionuclides for medical purposes creates a demand for feasible methodologies to perform occupational control of internal contamination. Currently in Brazil, there are {approx}300 nuclear medicine centres in operation but individual monitoring is still restricted to the control of external exposure. This work presents the development of in vivo and in vitro bioassay techniques aimed to quantify incorporation of radionuclides used in Nuclear Medicine. It is also presented the results of a preliminary survey of internal exposure of a group of workers involved in the preparation of therapeutic doses of {sup 131}I. Workers were monitored with a gamma camera available in the Nuclear Medicine Service of the University Hospital of Rio de Janeiro and at the Institute of Radiation Protection and Dosimetry Whole-Body Counter (IRDWBC). The in vivo detection systems were calibrated with a neck-thyroid phantom developed in IRD. Urine samples from radiopharmacy workers were collected after preparation and administration of therapeutic doses (10-250 mCi) of {sup 131}I and measured with a HPGe detection system available in the Bioassay Laboratory of IRD. The results show that the bioassay methods developed in this work present enough sensitivity for routine monitoring of nuclear medicine workers. All workers monitored in this survey presented positive results for {sup 131}I in urine samples and two workers presented detectable activities in thyroid when measured at the IRD-WBC. The highest committed effective dose per preparation was estimated to be 17 {mu}Sv. (authors)

  7. Role of international organizations in promoting nuclear medicine in the developing countries

    International Nuclear Information System (INIS)

    Nofal, M.

    1992-01-01

    Today, because of the diversity of its applications - radiation and radionuclides for medical and biological purposes are used in more countries and in more laboratories than any other application of atomic energy. International organizations, mainly the IAEA and the WHO, have played a significant role in the spread of this nuclear technology in developing countries. There are altogether 112 member states of the Agency, about 71 of them can be classified as developing countries. Out of them, nearly 56 have some kind of nuclear medicine. By that I mean there is some medical use of radioisotopes, be it imaging, radioimmunoassay or the old thyroid uptake. In most of these countries, the personnel working in nuclear medicine has been trained abroad. Training can be as short as few weeks abroad in the form of attendance at one of the four or six week training courses offered by an international organization. Occasionally it is through a fellowship offered by the same organizations. In terms of technology and training, Nuclear Medicine, in its present form, can thus be considered a high technology imported medicine in many of these countries

  8. 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.

  9. Use of Traditional Indigenous Medicine and Complementary Medicine Among Indigenous Cancer Patients in Queensland, Australia.

    Science.gov (United States)

    Adams, Jon; Valery, Patricia C; Sibbritt, David; Bernardes, Christina M; Broom, Alex; Garvey, Gail

    2015-07-01

    The cancer toll on Indigenous Australians is alarming with overall cancer incidence and mortality rates higher and the 5-year survival rate lower for Indigenous Australians compared with non-Indigenous Australians. Meanwhile, a range of approaches to health and illness-including both complementary and alternative medicine (CAM) and traditional Indigenous medicine (TM)-are used by cancer patients. Little work has focused on Indigenous cancer patients with regard to CAM/TM use. This article reports findings from the first examination of the prevalence and profile of TM/CAM use and users among Indigenous Australians with cancer. A structured questionnaire was administered via face-to-face interviews to 248 Indigenous Australian cancer patients diagnosed with a range of cancer types. All received treatment and were recruited from 1 of 4 large hospitals located in Queensland, Australia. A substantial percentage (18.7%) of Indigenous cancer patients use at least one TM/CAM for support with their care, including traditional Indigenous therapy use (2.8%), visiting a traditional Indigenous practitioner (2.8%), CAM use (10.7%), visiting a CAM practitioner (2.4%), and attending relaxation/meditation classes (4.0%). Having a higher level of educational attainment was positively associated with CAM practitioner consultations (P = .015). Women with breast cancer were more likely to attend relaxation/meditation classes (P = .019). Men with genital organ cancer were more likely to use traditional Indigenous therapies (P = .017) and/or CAM (P = .002). A substantial percentage of Indigenous Australians reported using TM/CAM for their cancer care, and there is a need to expand examination of this area of health care using large-scale studies focusing on in-depth specific cancer(s). © The Author(s) 2015.

  10. Current situation of International Organization for Standardization/Technical Committee 249 international standards of traditional Chinese medicine.

    Science.gov (United States)

    Liu, Yu-Qi; Wang, Yue-Xi; Shi, Nan-Nan; Han, Xue-Jie; Lu, Ai-Ping

    2017-05-01

    To review the current situation and progress of traditional Chinese medicine (TCM) international standards, standard projects and proposals in International Organization for Standardization (ISO)/ technical committee (TC) 249. ISO/TC 249 standards and standard projects on the ISO website were searched and new standard proposals information were collected from ISO/TC 249 National Mirror Committee in China. Then all the available data were summarized in 5 closely related items, including proposed time, proposed country, assigned working group (WG), current stage and classifification. In ISO/TC 249, there were 2 international standards, 18 standard projects and 24 new standard proposals proposed in 2014. These 44 standard subjects increased year by year since 2011. Twenty-nine of them were proposed by China, 15 were assigned to WG 4, 36 were in preliminary and preparatory stage and 8 were categorized into 4 fifields, 7 groups and sub-groups based on International Classifification Standards. A rapid and steady development of international standardization in TCM can be observed in ISO/TC 249.

  11. 1st college of physicians lecture: the role of internal medicine as a specialty in the era of subspecialisation.

    Science.gov (United States)

    Chee, Y C

    2004-11-01

    This paper is divided into 4 parts. The first deals with the definition of specialties and traces its roots from the early 20th century in the United States of America with the formation and growth of Specialty Boards. The second is a reflection on the scene in Singapore from the 1960s to the present, describing the change from public healthcare institutions run by the civil service to the autonomous restructured public service hospitals towards the end of the 20th century. The third section deals with what the 4ps have expressed about changes necessary to the Singapore system in the 21st century. The 4ps are the politicians, the payers, the patients and the public. It is about value for money, better coordination and better communication. Finally, just what is Internal Medicine - its competencies and its practice. A review of the systems in Australia, New Zealand, and the USA is presented. The idea of the "hospitalist" is discussed. Concluding remarks deal with the viability of Internal Medicine because of low reimbursement, administrative burdens and brief patient visits.

  12. 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.

  13. How is organ transplantation depicted in internal medicine and transplantation journals

    Science.gov (United States)

    2013-01-01

    Background In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant. Methods Using the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis. Results In our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients’ experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage. Conclusion Our study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey’s critiques of the procedure are still relevant. PMID:24219177

  14. 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.

  15. How is organ transplantation depicted in internal medicine and transplantation journals

    OpenAIRE

    Durand, C?line; Duplantie, Andr?e; Chabot, Yves; Doucet, Hubert; Fortin, Marie-Chantal

    2013-01-01

    Background In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey?s critiques of organ transplantation...

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

    OpenAIRE

    Almeida,Renan Moritz Varnier Rodrigues de; Catelani,Fernanda; Fontes-Pereira,Aldo José; Gave,Nárrima de Souza

    2016-01-01

    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 Thomso...

  17. SUCCESSFUL TREATMENT OF OSTEOMYELITIS IN LEPROSY PATIENTS BY HOMEOPATHIC MEDICINE

    Directory of Open Access Journals (Sweden)

    D. Chakraborty

    2013-12-01

    Full Text Available Osteomyelitis, a major complication of neuropathic feet in leprosy may occur as a result of infiltration of Mycobacterium leprae in the periosteum of bones or due to secondary bacterial infection of chronic plantar ulcer. There is no effective treatment for healing of planter ulcer and osteomyelitis. Keeping in mind of the limitation of conservative treatment, twenty patients who completed with multi drug therapy but suffering from neuropathic foot with ulcer was treated with Mercurius solubilis, a homoeopathic medicine in 200 potency for one year. All these patients had different degrees of osteomyelitic changes and after treatment showed regeneration and remodeling of bones which may be considered as significant improvement. Based on the radiological finding it may be concluded that Mercurius solubilis found to be effective in the treatment of osteomyelitis in leprosy affected patients.

  18. Estimation of Internal Radiation Dose to Nuclear Medicine Workers at Siriraj Hospital

    International Nuclear Information System (INIS)

    Asawarattanapakdee, J.; Sritongkul, N.; Chaudakshetrin, P.; Kanchanaphiboon, P.; Tuntawiroon, M.

    2012-01-01

    Every type of work performed in a nuclear medicine department will make a contribution to both external and internal exposure of the worker. The purpose of this study is to evaluate the potential risks of internal contamination to staff members during nuclear medicine practices and to conclude about the requirement of a routine internal monitoring. Following the method describes in the ICRP Publication 78 and the IAEA Safety Standard Series No. RS- G-1.2, in vivo thyroid bioassays using NaI(Tl) thyroid probe were performed to determine the intake estimates on 7 groups of nuclear medicine personnel working with I-131 and Tc-99m, based on working conditions and amount of radionuclides being handled. Frequency of measurements was between 7 and 14 days. These include (1) physicians and physicists, (2) radiochemists (3) technologists, (4) nurses and assistant nurses, (5) imaging room assistants, (6) hot lab workers and (7) hospital ward housekeepers/cleaners. Among all workers, the intake estimates of I-131 in the thyroid ranged from 0 to 76.7 kBq and of the technetium-99m from 0 to 35.4 MBq. The mean committed effective dose equivalent (CEDE) from both I-131 and Tc-99m were 0.63, 1.44 0.53, 0.57, 0.73, 0.98, and 1.36, mSv, for group 1 through group 7 respectively. However, the highest mean CEDE of 1.44 (max. 1.75) and 1.36 (max. 2.11) mSv observed in groups of radiochemists and hospital ward housekeepers were within the permissible level. Our results showed that CEDE for internal exposure in this study were less than investigate level of 5 mSv according to the ICRP Publication 78 and the IAEA Basic Safety Standards. However, the mean CEDE for radiochemists and hospital ward housekeepers were considered in exceed of the limits of recording level (1 mSv).The increasing use of I-131 and Tc-99m in nuclear medicine poses significant risks of internal exposure to the staff. This study suggests that a routine monitoring program for internal exposures should be implemented for

  19. Preface to the 2nd issue of the International Journal of Medicine and ...

    African Journals Online (AJOL)

    McRoy

    One of the controversial issues facing the practice of medicine is the use of herbal products. Dickson et al. evaluated the ... ELISPOT assays are an integral part of many clinical trials. Sudha et al. used ELISPOT ... prevalence and factors associated with self- perceived oral malodour in periodontal patients. Data from this.

  20. Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine.

    Science.gov (United States)

    DeZee, Kent J; Thomas, Matthew R; Mintz, Matthew; Durning, Steven J

    2009-01-01

    Letters of Recommendations (LORs) are used for applications to medical school and graduate medical education, but how they are used by current internal medicine educators is unknown. In 2006, the Clerkship Directors of Internal Medicine conducted its annual, voluntary survey, and one section pertained to LORs. Survey items were categorized into questions regarding rating, writing, and reading LORs with answers on 3- to 5-point scales. The response rate for the 110 institution members was 75%. When rating LORs, the most important factor was depth of understanding of the trainee (98% essential or important), followed by a numerical comparison to other students (94%), grade distribution (92%), and summary statement (91%). Although most (78%) agreed that reading LORs in general were important for trainee selection, few agreed that this was because of the ability to discern marginal performance (31%) or predict future performance (25%). LORs remain an important part of the application process for medical school and internal medicine residency. Letter writers should convey a great depth of understanding of the applicant, provide a numerical comparison with other students (including a denominator), and give a specific summary statement.

  1. 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. © 2016 The Author(s).

  2. 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.

  3. [An analysis of impact factor of Chinese Journal of Internal Medicine from 2008 to 2010].

    Science.gov (United States)

    Shen, Xi-Bin; Shen, Zhi-Wei; Hou, Jian-Jun; Ding, Yun-Qiu; Hu, Zhao-Hui; He, Hue-Mei

    2013-02-01

    To analyze the articles and citation published in the Chinese Journal of Internal Medicine from 2008 to 2010, in order to investigate the influence factors of impact factor (IF). All articles published in the Chinese Journal of Internal Medicine covered by Chinese Medical Citation Index(CMCI) from 2008 to 2010 were searched and downloaded. Some article related attributions were manual added and their influences to IF were analyzed. A total of 1164 academic papers were published in the journal in 3 years, with 9.95 references per paper. The total citation was 1029 times, with 0.93 time per paper and 0.31 time per page. Among them, 736 articles were not cited, accounting for 63.2%. Original articles, pure clinical articles had good citation output. For fund supporting, the citation of articles without fund was higher than those with fund. The articles on hematology, cardiology and gastroenterology accounted the most, while ICU, emergency and nephrology were the least internal medicine reported specialties. Although there exists citation difference among different subjects, for considering the absolute values, neurology/psychiatry (0.73 time per paper), cardiology (0.65 time per paper) and gastroenterology (0. 54 time per paper) had better citation output, while hematology, basic research and rheumatology had no good performance to IF. We should further strengthen acquisition and dissemination of excellent articles, reduce the number of non-cited paper, expand periodical visibility, and provide a quick and convenient way of literature reading.

  4. 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.

  5. 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.

  6. International textbook of family medicine: the application of EURACT teaching agenda.

    Science.gov (United States)

    Švab, Igor; Katić, Milica

    2014-01-01

    The paper describes experiences in the development of an international textbook of family medicine. The process of its development has started in Slovenia, where the Slovenian authors have written a textbook, adhering strictly to the European definition of family medicine and its core competencies. The format and the approach were also adopted by Croatian authors, who have used most of the material from the Slovenian book, but have modified some of the chapters according to the situation in the country and have added some of their own. This activity has created an opportunity for a truly international collaboration in the area of education of family medicine, with a creation of an international consortium, which would be responsible for the core content of the book and local adaptations of the book according to the specificities and needs of different countries. This innovative approach in the development of teaching material may be interesting for a variety of smaller countries in Europe and worldwide. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  7. Trends in market demand for internal medicine 1999 to 2004: an analysis of physician job advertisements.

    Science.gov (United States)

    Auerbach, Andrew D; Chlouber, Richard; Singler, Jennifer; Lurie, Jon D; Bostrom, Alan; Wachter, Robert M

    2006-10-01

    The health care marketplace has changed substantially since the last assessment of demand for internal medicine physicians in 1996. We reviewed internal medicine employment advertisements published in 4 major medical journals between 1996 and 2004. The number of positions, specialty, and other practice characteristics (e.g., location) were collected from each advertisement. Four thousand two hundred twenty-four advertisements posted 4,992 positions. Of these positions, jobs in the Northeast (31% of positions) or single specialty groups (36.8% of positions) were most common. The relative proportion of advertisements for nephrologists declined (P Internal Medicine) declined (-2.7% relative annual change, 95% confidence interval [95% CI] -4.1%, -1.2%) between 1996 and 2004, a decrease largely due to a substantial decline in advertisements noted between 1996 and 1998. However, over the entire time period, the combined proportion of advertisements for all generalists (hospitalists and outpatient-based generalists) did not change (0.5% relative annual change, 95% CI -0.8% to 2.0%). Since 1996, demand for the majority of medical subspecialties has remained constant while relative demand has decreased for primary care and increased for hospitalists and critical care. Increase in demand for generalist-trained hospitalists appears to have offset falling demand for outpatient generalists.

  8. The international distribution of authorship in the Nuclear Medicine literature: a bibliometric analysis

    International Nuclear Information System (INIS)

    Hannigan, G.G.; Bartold, S.P.

    2002-01-01

    Aim: This study profiles the increasingly diverse international contributions to the specialty of Nuclear Medicine as measured by publication in the European Journal of Nuclear Medicine (Springer) and the Journal of Nuclear Medicine (Society of Nuclear Medicine). These are the leading journals in the field, with 2001 impact factor scores of 3.617 and 3.772 respectively.1 Materials and Methods: We searched the MEDLINE database from 1988-2001, using the Limits (Journal) feature. 1988 is the first year that author affiliation information is reliably included on the MEDLINE record. The retrieved set of articles from the European Journal of Nuclear Medicine and the Journal of Nuclear Medicine was limited to articles with abstracts, the goal being to count only substantive articles and to eliminate editorials, letters, and other brief communications. Since author affiliation information is neither standardized nor can it be sorted in MEDLINE, we manually counted and categorized publications by country of the first author as listed in the article. Microsoft Excel was used to tabulate and analyze the data. Results: 2,634 articles were analyzed for six years (1988, 1991, 1992, 1993, 1996, 2001). Authors from 40 countries published in these two journals. In 1988, authors from seven countries (US, Japan, UK, France, Germany, the Netherlands, Canada) contributed ten or more articles, accounting for 80% of the articles . In 2001, authors from eleven countries contributed ten or more articles, accounting for 86% of the total (US, Germany, Japan, Netherlands, Italy, Belgium, Australia, France, UK, Spain, Finland); Conclusions: A previous study showed that, from 1980-97, seven countries accounted for 86% of the research articles in the Journal of Nuclear Medicine: US 60.2%, Japan 8.6%, and Canada, France, Germany, UK, Netherlands each 3.4%.2. In this study, for the six years included, authors from ten countries accounted for 86% of the research articles in the European Journal of

  9. Radiation dose rates from adult patients undergoing nuclear medicine investigations

    Energy Technology Data Exchange (ETDEWEB)

    Mountford, P.J.; O' Doherty, M.J.; Forge, N.I.; Jeffries, A.; Coakley, A.J. (Kent and Canterbury Hospital (United Kingdom))

    1991-09-01

    Adult patients undergoing nuclear medicine investigations may subsequently come into close contact with members of the public and hospital staff. In order to expand the available dosimetry and derive appropriate recommendations, dose rates were measured at 0.1, 0.5 and 1.0 m from 80 adult patients just before they left the nuclear medicine department after undergoing one of eight {sup 99}Tc{sup m} studies, an {sup 123}I thyroid, an {sup 111}In leucocyte or a {sup 201}Tl cardiac scan. The maximum departure dose rates at these distances of 150, 30 and 7.3 {mu}Sv h{sup -1} were greater than those found in similar published studies of adult and paediatric patients. To limit the dose to an infant to less than 1 mSv, an {sup 111}In leucocyte scan is the only investigation for which it may be necessary to restrict close contact between the infant and a radioactive parent, depending on the dose rate near the surface of the patient, the parent's habits and how fretful is the infant. It is unlikely that a ward nurse will receive a dose of 60 {mu}Sv in a working day if caring for just one radioactive adult patient, unless the patient is classified as totally helpless and had undergone a {sup 99}Tc{sup m} marrow, bone or brain scan. The data and revised calculations of effective exposure times based on a total close contact time of 9 h in every 24 h period should allow worst case estimates of radiation dose to be made and recommendations to be formulated for other circumstances, including any future legislative changes in dose limits or derived levels. (author).

  10. Actual versus recommended storage temperatures of oral anticancer medicines at patients' homes.

    Science.gov (United States)

    Vlieland, N D; van den Bemt, Bjf; van Riet-Nales, D A; Bouvy, M L; Egberts, Acg; Gardarsdottir, H

    2017-01-01

    Background Substantial quantities of unused medicines are returned by patients to the pharmacy each year. Redispensing these medicines would reduce medicinal waste and health care costs. However, it is not known if medicines are stored by patients as recommended in the product label. Inadequate storage may negatively affect the medicine and reduce clinical efficacy whilst increasing the risk for side effects. Objective To investigate the proportion of patients storing oral anticancer medicines according to the temperature instructions in the product label. Methods Consenting adult patients from six Dutch outpatient hospital pharmacies were included in this study if they used an oral anticancer medicine during February 2014 - January 2015. Home storage temperatures were assessed by inclusion of a temperature logger in the original cancer medicines packaging. The primary outcome was the proportion of patients storing oral anticancer medicines as specified in the Summary of Product Characteristics, either by recalculating the observed temperature fluctuations to a single mean kinetic temperature or by following the temperature instructions taking into account a consecutive 24-h tolerance period. Results Ninety (81.1%) of the 111 included patients (47.8% female, mean age 65.2 (SD: 11.1)) returned their temperature loggers to the pharmacy. None of the patients stored oral anticancer medicines at a mean kinetic temperature above 25℃, one patient stored a medicine requiring storage below 25℃ longer than 24 h above 25℃. None of the patients using medicines requiring storage below 30℃ kept their medicine above 30℃ for a consecutive period of 24 h or longer. Conclusion The majority of patients using oral anticancer medicines store their medicines according to the temperature requirements on the product label claim. Based on our results, most oral anticancer medicines will not be negatively affected by temperature conditions at patients' homes for a maximum of

  11. The Role of Patients' Stories in Emergency Medicine Triage.

    Science.gov (United States)

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience.

  12. Towards personalized medicine: leveraging patient similarity and drug similarity analytics.

    Science.gov (United States)

    Zhang, Ping; Wang, Fei; Hu, Jianying; Sorrentino, Robert

    2014-01-01

    The rapid adoption of electronic health records (EHR) provides a comprehensive source for exploratory and predictive analytic to support clinical decision-making. In this paper, we investigate how to utilize EHR to tailor treatments to individual patients based on their likelihood to respond to a therapy. We construct a heterogeneous graph which includes two domains (patients and drugs) and encodes three relationships (patient similarity, drug similarity, and patient-drug prior associations). We describe a novel approach for performing a label propagation procedure to spread the label information representing the effectiveness of different drugs for different patients over this heterogeneous graph. The proposed method has been applied on a real-world EHR dataset to help identify personalized treatments for hypercholesterolemia. The experimental results demonstrate the effectiveness of the approach and suggest that the combination of appropriate patient similarity and drug similarity analytics could lead to actionable insights for personalized medicine. Particularly, by leveraging drug similarity in combination with patient similarity, our method could perform well even on new or rarely used drugs for which there are few records of known past performance.

  13. Secondary hyperparathyroidism prevalence and profile, between diabetic and non-diabetic patients with stage 3 to 4 chronic kidney disease attended in internal medicine wards. MiPTH study.

    Science.gov (United States)

    Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; García-Sánchez, Francisco; Maciá-Botejara, Enrique; Ramiro-Lozano, José Manuel; Masero-Carretero, Antonio; Robles, Nicolás Roberto; Bureo-Dacal, Juan Carlos

    2016-01-01

    Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independent risk factor for all-cause and cardiovascular mortality. Our aim is to establish differences in prevalence and profile of SHPTH, regarding diabetics or non-diabetics with chronic kidney disease (CKD). Cross-sectional multicenter study which included patients with stages 3 to 4 CKD. SHPTH was considered when the intact PTH levels (iPTH) were equal or higher than 70pg/ml. We divided the sample into two groups (diabetics and non-diabetics). We used robust statistical methods. 409 patients (214 diabetics) were studied. HPTH was found in 60.4% of diabetics vs 65% of non-diabetics (P=0.42). Diabetics with HPTH were younger (79.5 vs 82.3 years-old, P=0.005), and had more hypertension (P=0.0014), dyslipidemia (P=0.0001) and comorbidities. In multivariate analysis, we found a significant relationship in case of diabetics, with age (OR: 1.04, 95%CI 1.005-1.09 P=0.02 ), and with statins treatment (OR 2.3, 95%CI 1.17-4.54, P=0.01). The prevalence of SHPTH between the groups was similar, however, diabetics had more presence of hypertension and dyslipidemia, and SHPTH in this case was also related with moderate microalbuminuria and lower levels of vitamin D. An association with statins was also found in this group. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  14. Physical and rehabilitation medicine (PRM) care pathways: "patients after total hip arthroplasty".

    Science.gov (United States)

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  15. Physical and rehabilitation medicine (PRM) care pathways: "patients after total knee arthroplasty".

    Science.gov (United States)

    Ribinik, P; Le Moine, F; de Korvin, G; Coudeyre, E; Genty, M; Rannou, F; Yelnik, A; Calmels, P

    2012-11-01