WorldWideScience

Sample records for internal medicine practices

  1. Grading Practices and Distributions Across Internal Medicine Clerkships.

    Science.gov (United States)

    Fazio, Sara B; Torre, Dario M; DeFer, Thomas M

    2016-01-01

    Clerkship evaluation and grading practices vary widely between U.S. medical schools. Grade inflation continues to exist, and grade distribution is likely to be different among U.S. medical schools. Increasing the number of available grades curtails "grade inflation." A national survey of all Clerkship Directors in Internal Medicine members was administered in 2011. The authors assessed key aspects of grading. Response rate was 76%. Among clerkship directors (CDs), 61% of respondents agreed that grade inflation existed in the internal medicine clerkship at their school, and 43% believed that it helped students obtain better residency positions. With respect to grading practices, 79% of CDs define specific behaviors needed to achieve each grade, and 36% specify an ideal grade distribution. In addition, 44% have a trained core faculty responsible for evaluating students, 35% describe formal grading meetings, and 39% use the Reporter-Interpreter-Manager-Educator (RIME) scheme. Grading scales were described as follows: 4% utilize a pass/fail system, 13% a 3-tier (e.g., Honors/Pass/Fail), 45% 4-tier, 35% 5-tier, and 4% 6+-tier system. There was a trend to higher grades with more tiers available. Grade inflation continues in the internal medicine clerkship. Almost half of CDs feel that this practice assists students to obtain better residency positions. A minority of programs have a trained core faculty who are responsible for evaluation. About one third have formal grading meetings and use the RIME system; both have been associated with more robust and balanced grading practices. In particular, there is a wide variation between schools in the percentage of students who are awarded the highest grade, which has implications for residency applications. Downstream users of clinical clerkship grades must be fully aware of these variations in grading in order to appropriately judge medical student performance.

  2. The practice of internal medicine in Europe: organisation, clinical conditions and procedures.

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    Cranston, Mark; Semple, Colin; Duckitt, Roger; Vardi, Moshe; Lindgren, Stefan; Davidson, Christopher; Palsson, Runolfur

    2013-10-01

    Current information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. Twenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. Many similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level. © 2013.

  3. Knowledge, attitudes, and practices evaluation about travel medicine in international travelers and medical students in Chile.

    Science.gov (United States)

    Guerrero-Lillo, Lisette; Medrano-Díaz, Jorge; Pérez, Carmen; Chacón, Rodrigo; Silva-Urra, Juan; Rodriguez-Morales, Alfonso J

    2009-01-01

    Because information about travel medicine in Chile is lacking, a knowledge, attitudes, and practices evaluation in international travelers and medical students was done. The travelers and medical students did not know the travel medicine and sanitary conditions of their destinations, although they perceived travel-associated health risks, but <10% had any vaccination and 5% got sick during international trips.

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

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

    2015-10-01

    The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017.

    Science.gov (United States)

    Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F

    2018-02-26

    Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-08-01

    Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Psychosocial Training in U.S. Internal Medicine and Family Practice Residency Programs.

    Science.gov (United States)

    Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.

    2001-01-01

    Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…

  8. Study of nuclear medicine practices in Portugal from an internal dosimetry perspective

    International Nuclear Information System (INIS)

    Bento, J.; Teles, P.; Neves, M.; Santos, A. I.; Cardoso, G.; Barreto, A.; Alves, F.; Guerreiro, C.; Rodrigues, A.; Santos, J. A. M.; Capelo, C.; Parafita, R.; Martins, B.

    2012-01-01

    Nuclear medicine practices involve the handling of a wide range of pharmaceuticals labelled with different radionuclides, for diagnostic and therapeutic purposes. This work intends to evaluate the potential risks of internal contamination of nuclear medicine staff in several Portuguese nuclear medicine services and to conclude about the requirement of a routine internal monitoring. A methodology proposed by the International Atomic Energy Agency (IAEA), providing a set of criteria to determine the need, or not, for an internal monitoring programme, was applied. The evaluation of the risk of internal contaminations in a given set of working conditions is based on the type and amount of radionuclides being handled, as well as the safety conditions with which they are manipulated. The application of the IAEA criteria showed that 73.1 % of all the workers included in this study should be integrated in a routine monitoring programme for internal contaminations; more specifically, 100 % of workers performing radioimmunoassay techniques should be monitored. This study suggests that a routine monitoring programme for internal exposures should be implemented in Portugal for most nuclear medicine workers. (authors)

  9. [Practice of Internal Medicine in Latin America. Role of the internist].

    Science.gov (United States)

    Varela, Nacor

    2002-01-01

    This article explores the causes of the crisis in the role of internists. As in the United States, the progressive specialization of internists lead to a dehumanized, expensive and technical practice of medicine. Aiming to better incomes and prestige, more than 60% of internists practice as specialists. Primary care physicians, with a very low rate of problem solving, cover 75% of consultations. Specialists, with increasing costs, cover the rest of consultations. Patients, medical schools and health organizations are claiming the return of the general internal medicine specialist. To increase the interest for general internal medicine, several strategies are applicable. Medical students interested in general internal medicine could receive a focused training, provided by these specialists. A greater emphasis should be put on primary care. More independent, secondary care diagnostic and treatment centers, should be created. Continuous medical education should be done with periodical re certification of physicians. The public health system should increase its wages and the generalist view should be maintained by physicians when practicing at their private offices.

  10. [What is Internal Medicine?].

    Science.gov (United States)

    Reyes, Humberto

    2006-10-01

    Internal Medicine can be defined as a medical specialty devoted to the comprehensive care of adult patients, focused in the diagnosis and non surgical treatment of diseases affecting internal organs and systems (excluding gyneco-obstetrical problems) and the prevention of those diseases. This position paper reviews the history of Internal Medicine, the birth of its subspecialties and the difficulties faced by young physicians when they decide whether to practice as internist or in a subspecialty. In Chile as in most occidental countries formal training in a subspecialty of internal medicine requires previous certification in internal medicine but the proportion of young physicians who remain in practice as general internists appears to be considerably lower than those who choose a subspecialty. The main reasons for this unbalance can be related to financial advantages (by the practice of specialized technologies) and the patients' tendency to request direct assistance by a professional thought to be better qualified to take care of their specific problems. Training programs in internal medicine should consider a greater emphasis in comprehensive outpatient care instead of the traditional emphasis for training in hospital wards.

  11. 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.

  12. 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)

  13. 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.

  14. Monitoring stress among internal medicine residents: an experience-driven, practical and short measure.

    Science.gov (United States)

    Myszkowski, Nils; Villoing, Barbara; Zenasni, Franck; Jaury, Philippe; Boujut, Emilie

    2017-07-01

    Residents experience severely high levels of stress, depression and burnout, leading to perceived medical errors, as well as to symptoms of impairment, such as chronic anger, cognitive impairment, suicidal behavior and substance abuse. Because research has not yet provided a psychometrically robust population-specific tool to measure the level of stress of medicine residents, we aimed at building and validating such a measure. Using an inductive scale development approach, a short, pragmatic measure was built, based on the interviews of 17 medicine residents. The Internal Medicine Residency Stress Scale (IMRSS) was then administered in a sample of 259 internal medicine residents (199 females, 60 males, M Age  = 25.6) along with the Hospital Anxiety and Depression Scale, Maslach Burnout Inventory, Satisfaction With Life Scale and Ways of Coping Checklist. The IMRSS showed satisfactory internal reliability (Cronbach's α = .86), adequate structural validity - studied through Confirmatory Factor Analysis (χ 2 /df = 2.51, CFI = .94; SRMR = .037, RMSEA = .076) - and good criterion validity - the IMRSS was notably strongly correlated with emotional exhaustion (r = .64; p is recommended to quickly and frequently assess and monitor stress among internal medicine residents.

  15. Management of prediabetes: a comparison of the treatment approaches utilized by a family practice clinic and an internal medicine/endocrinology practice.

    Science.gov (United States)

    Anderson, Zachary L; Scopelliti, Emily M; Trompeter, Jessica M; Havrda, Dawn E

    2015-02-01

    To compare the management of prediabetes between a family practice clinic and internal medicine/endocrinology practice. A randomized, retrospective evaluation of the medical history in 168 eligible patients with a diagnosis of prediabetes or abnormal blood glucose (BG) at a family practice clinic (n = 78) and an internal medicine/endocrinology practice (n = 90). The internal medicine/endocrinology practice provided more counseling regarding lifestyle modifications (91.1% vs 76.9%, P = .039), specific physical activity recommendations (26.7% vs 7.7%, P = .003), and recommended more patients receive 150 minutes/week of moderate exercise (8.9% vs 1.3%, P = .038). The family practice clinic provided more written dietary information (16.9% vs 13.3%, P = .044) and specific weight loss goals (20.5% vs 6.7%, P = .015). The internal medicine/endocrinology practice initiated pharmacological therapy in more patients (51.1% vs 3.8%, P< .001) and had a significant decrease in fasting BG from baseline compared to the family practice clinic (-9.0 vs -5.6 mg/dL, P< .001). Providers are likely to initiate nonpharmacological therapy but may not provide specific education recommended by the American Diabetes Association. The integration of a multidisciplinary team to provide guideline-based nonpharmacologic counseling may be beneficial in improving outcomes in the management of prediabetes. © The Author(s) 2013.

  16. 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

  17. Frequency of bullying perceived in clinical practices of last year interns of a medicine school: cross sectional study

    Directory of Open Access Journals (Sweden)

    Nubia Fernanda Sánchez

    2016-07-01

    Full Text Available Introduction: During the medical internship year, students attend several hospitals and are observed and influenced by postgraduate students, general practitioners and other interns, who provide them with fundamental support regarding professional training. Bullying is defined as an aggressive behavior that occurs between a perpetrator and a victim in different scenarios and authority relationships, such as clinical practices at Medicine programs. Objective: To describe the perceived frequency of bullying among a group of interns of the Faculty of Medicine from Universidad Nacional de Colombia during internship. Materials and methods: A transversal analytical study was performed through a questionnaire applied to 82 medical interns of the School of Medicine from Universidad Nacional de Colombia. Results: The perceived frequency of bullying was 90%. Statistically significant differences were not found in the stratified analysis by sex or place of practice. In most cases, bullying was perpetrated by other interns, while residents and specialists showed a lower frequency. Conclusion: Perceived frequency of bullying was higher than expected according to the existing literature. These results can be used as a basis for new studies.

  18. Internal medicine rounding practices and the Accreditation Council for Graduate Medical Education core competencies.

    Science.gov (United States)

    Shoeb, Marwa; Khanna, Raman; Fang, Margaret; Sharpe, Brad; Finn, Kathleen; Ranji, Sumant; Monash, Brad

    2014-04-01

    The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 core domains (patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice). As attending rounds serve as a primary means for educating trainees at academic medical centers, our study aimed to identify current rounding practices and attending physician perceived capacity of different rounding models to promote teaching within the ACGME core competencies. We disseminated a 24-question survey electronically using educational and hospital medicine leadership mailing lists. We assessed attending physician demographics and the frequency with which they used various rounding models, as defined by the location of the discussion of the patient and care plan: bedside rounds (BR), hallway rounds (HR), and card-flipping rounds (CFR). Using the ACGME framework, we assessed the perceived educational value of each model. We received 153 completed surveys from attending physicians representing 34 institutions. HR was used most frequently for both new and established patients (61% and 43%), followed by CFR for established patients (36%) and BR for new patients (22%). Most attending physicians indicated that BR and HR were superior to CFR in promoting the following ACGME competencies: patient care, systems-based practice, professionalism, and interpersonal skills. HR is the most commonly employed rounding model. BR and HR are perceived to be valuable for teaching patient care, systems-based practice, professionalism, and interpersonal skills. CFR remains prevalent despite its perceived inferiority in promoting teaching across most of the ACGME core competencies. © 2014 Society of Hospital Medicine.

  19. Thieme Textbook Internal Medicine - TIM

    International Nuclear Information System (INIS)

    Flasnoecker, M.

    1999-01-01

    The textbook and reference work covers the entire field of internal medicine arranged in 15 chapters, each covering a particular branch of internal medicine. This subject arrangement corresponds to the subject clusters of the regime of post-graduate education. Every branch, i. e. every chapter, has its own responsible editor. This selection of editors and authors,- all in all 180 experts in general and clinical practice -, guarantees a maximum of competence and compliance with the frontiers of research and clinical experience. (orig./CB) [de

  20. Practical occupational medicine in "practice"

    DEFF Research Database (Denmark)

    Ingemann Larsen, Anders; Schmidt, Jan; Jepsen, Jørgen Riis

    2016-01-01

    with few occupational health resources. This Editorial argues that family physicians are indeed in a position where they can make a major positive difference for their working patients and for the enterprises where they work. Without specialist knowledge in occupational medicine, the family physician......’s empiric knowledge in combination with a narrative approach to the patient permits the contribution from family medicine not only with regard to diagnosis and treatment, but also relating to actions targeted to optimize the patient’s future accommodation at work as well as to protect other similarly......In Denmark, the practice of occupational medicine tends to be carried out by specialists in occupational medicine and less so by family physicians. The provision of health service to workers is therefore limited. This constraint may also apply in other developed countries and even more in countries...

  1. 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.

  2. Postgraduate education in internal medicine in Europe.

    Science.gov (United States)

    Cranston, Mark; Slee-Valentijn, Monique; Davidson, Christopher; Lindgren, Stefan; Semple, Colin; Palsson, Runolfur

    2013-10-01

    Limited information exists on the framework and content of postgraduate education in internal medicine in Europe. This report describes the results of a survey of postgraduate training in internal medicine in the European countries. Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine residents from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on postgraduate training in internal medicine was performed. Twenty-seven countries (90%) completed the questionnaire and approved their datasets. The length of training ranged from four to six years and was commonly five years. The majority of countries offered training in internal medicine and a subspecialty. A common trunk of internal medicine was frequently a component of subspecialty training programmes. Hospital inpatient service was the predominant setting used for training. A final certifying examination was in place in 14 countries. Although some similarities exists, there appear to be significant differences in the organisation, content and governance of postgraduate training in internal medicine between the European countries. Our findings will prove invaluable for harmonisation of training and qualification in internal medicine in Europe. © 2013.

  3. Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery, and General Practice.

    Science.gov (United States)

    Fernando, Antonio T; Consedine, Nathan S

    2017-06-01

    Compassion is an expectation of patients, regulatory bodies, and physicians themselves. Most research has, however, studied compassion fatigue rather than compassion itself and has concentrated on the role of the physician. The Transactional Model of Physician Compassion suggests that physician, patient, external environment, and clinical factors are all relevant. Because these factors vary both across different specialities and among physicians with differing degrees of experience, barriers to compassion are also likely to vary. We describe barriers to physician compassion as a function of specialization (psychiatry, general practice, surgery, internal medicine, and pediatrics) and physician experience. We used a cross-sectional study using demographic data, specialization, practice parameters, and the Barriers to Physician Compassion Questionnaire. Nonrandom convenience sampling was used to recruit 580 doctors, of whom 444 belonged to the targeted speciality groups. The sample was characterized before conducting a factorial Multivariate Analysis of Covariance and further post hoc analyses. A 5 (speciality grouping) × 2 (more vs. less physician experience) Multivariate Analysis of Covariance showed that the barriers varied as a function of both speciality and experience. In general, psychiatrists reported lower barriers, whereas general practitioners and internal medicine specialists generally reported greater barriers. Barriers were generally greater among less experienced doctors. Documenting and investigating barriers to compassion in different speciality groups have the potential to broaden current foci beyond the physician and inform interventions aimed at enhancing medical compassion. In addition, certain aspects of the training or practice of psychiatry that enhance compassion may mitigate barriers to compassion in other specialities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. 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.

  5. [What's new in internal medicine?

    Science.gov (United States)

    Fardet, L

    2017-12-01

    As it is practiced in France, internal medicine meets the Anglo-Saxon definition of the specialty, ie doctors "equipped to handle the broad and comprehensive spectrum of illnesses that affect adults, and are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention - they are not limited to one type of medical problem or organ system". This 2017 "What's new in internal medicine" will consist of 2 parts, a first part on significant publications in the field of systemic and autoimmune diseases and a second part on more diverse publications (HIV, cancer, pregnancy, well-being...) important for medicine in general and its different specialties. © 2017 Elsevier Masson SAS. Tous droits réservés.

  6. Update in Internal Medicine

    Science.gov (United States)

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

    2009-01-01

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

  7. Obstetric medicine: Interlinking obstetrics and internal medicine

    African Journals Online (AJOL)

    1 Mayo Clinic Hospitals, Division of Hospital Internal Medicine, Rochester, Minn, USA ... Obstetric physicians have a specific role in managing pregnant and postpartum women with ... problems may also affect pregnancy outcomes, with increased risk of ... greatly benefited from good control of her diabetes and hypertension.

  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. Mind-Body Medicine Practices in Complementary and Alternative Medicine

    Science.gov (United States)

    ... Visitor Information RePORT NIH Fact Sheets Home > Mind-Body Medicine Practices in Complementary and Alternative Medicine Small Text Medium Text Large Text Mind-Body Medicine Practices in Complementary and Alternative Medicine YESTERDAY ...

  10. 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.

  11. The practice of travel medicine in Europe.

    Science.gov (United States)

    Schlagenhauf, P; Santos-O'Connor, F; Parola, P

    2010-03-01

    Europe, because of its geographical location, strategic position on trade routes, and colonial past, has a long history of caring for travellers' health. Within Europe, there is great diversity in the practice of travel medicine. Some countries have travel medicine societies and provisions for a periodic distribution of recommendations, but many countries have no national pre-travel guidelines and follow international recommendations such as those provided by the WHO. Providers of travel medicine include tropical medicine specialists, general practice nurses and physicians, specialist 'travel clinics', occupational physicians, and pharmacists. One of the core functions of the European Centre for Disease Prevention and Control-funded network of travel and tropical medicine professionals, EuroTravNet, is to document the status quo of travel medicine in Europe. A three-pronged approach is used, with a real-time online questionnaire, a structured interview with experts in each country, and web searching.

  12. Quality of Interhospital Transfer Communication Practices and Association With Adverse Events on an Internal Medicine Hospitalist Service.

    Science.gov (United States)

    Borofsky, Jennifer S; Bartsch, Jason C; Howard, Alan B; Repp, Allen B

    Communication practices around interhospital transfer have not been rigorously assessed in adult medicine patients. Furthermore, the clinical implications of such practices have not been reported. This case-control study was designed to assess the quality of communication between clinicians during interhospital transfer and to determine if posttransfer adverse events (PTAEs) are associated with suboptimal communication. Cases included patients transferred to a Medicine Hospitalist Service from an outside hospital who subsequently experienced a PTAE, defined as unplanned transfer to an intensive care unit or death within 24 hours of transfer. Control patients also underwent interhospital transfer but did not experience a PTAE. A blinded investigator retrospectively reviewed the recorded pretransfer phone conversations between sending and receiving clinicians for adherence to a set of 13 empiric best practice communication elements. The primary outcome was the mean communication score, on a scale of 0-13. Mean scores between PTAE (8.3; 95% confidence interval [CI], 7.6-8.9) and control groups (7.9; 95% CI, 7.1-8.8) did not differ significantly (p = .50), although suboptimal communication on a subset of these elements was associated with increased PTAEs. Communication around interhospital transfer appears suboptimal compared with an empiric set of standard communication elements. Posttransfer adverse events were not associated with aggregate adherence to these standards.

  13. Practical nuclear medicine

    CERN Document Server

    Gemmell, Howard G; Sharp, Peter F

    2006-01-01

    Nuclear medicine plays a crucial role in patient care, and this book is an essential guide for all practitioners to the many techniques that inform clinical management. The first part covers the scientific basis of nuclear medicine, the rest of the book deals with clinical applications. Diagnostic imaging has an increasingly important role in patient management and, despite advances in other modalities (functional MRI and spiral CT), nuclear medicine continues to make its unique contribution by its ability to demonstrate physiological function. This book is also expanded by covering areas of d

  14. Emergency medicine and general practice

    OpenAIRE

    Abela, Gunther

    2005-01-01

    Emergency Medicine and Immediate Medical Care are relatively new specialties. In Malta, there is quite a considerable area of overlap between these specialties and general practice. Indeed, the family physician is confronted with some sort of medical emergency quite regularly. The brief of this article is to go through recent developments in Emergency Medicine as applied to General Practice. The areas considered are Basic Life Support, Head Injury, Asthma, Anaphylaxis, Community Acquired Pneu...

  15. 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.

  16. Practice guidelines. Cookbook medicine.

    Science.gov (United States)

    Harding, J

    1994-08-01

    A large measure of the confusion and doubt currently being sowed in the ongoing debate over the advisability and effectiveness of practice guidelines is a matter of terminology. In deference to the wishes and fears of physicians, the term "requirements" is not used. But requirements they are. Their quality and the degree to which they are useful will depend on their level of detail and the degree to which they are based on positive outcomes. Regardless, attorneys and others will always view and use them as requirements.

  17. [Qualitative and quantitative evaluation of an internal medicine assistance line dedicated to the diagnosis and treatment of diseases for general practice].

    Science.gov (United States)

    Castillo, J-M; Agard, C; Artifoni, M; Brisseau, J-M; Connault, J; Durant, C; Espitia, O; Masseau, A; Neel, A; Perrin, F; Pistorius, M-A; Planchon, B; Ponge, T; Hamidou, M; Pottier, P

    2016-05-01

    Clinical reasoning and treatment challenges within the scope of general practice led to the development of an internal medicine assistance line provided by Nantes University Hospital. The primary outcome of this study was to describe callers' profile, their requests and answers provided. A prospective, cross-sectional, observational, descriptive study was undertaken. For each call were identified the calling physician, her/his specialty and work setting, the call's object and adequacy, the answer provided, the time needed to connect with the assistance line, the time devoted by the internal medicine physician to provide an answer to the request, and whether the assistance line prevented a visit to the emergency room. Each calling physician was then called back to obtain demographic and professional characteristics, and data relating to the call and to the assistance line. Sixty-three days were analyzed and 276 calls identified. The 237 identified calling physicians were mainly females (54%, n=93), with a mean age of 46 years, graduated from Nantes University (65%, n=86), practicing ambulatory general medicine (69%, n=164) in Loire-Atlantique department area (82%, n=176) for a mean duration of 15 years. Calls were mostly associated with diagnostic challenges (61%, n=166) concerning clinical issues (57%, n=155). A sole telephone advice was the main type of answer provided (56%, n=147) and a visit to the emergency room was prevented for 17% of calls. The assistance line activity is adequate with its missions and seems to facilitate patients' healthcare delivery advocating for the development of similar structures in other units. Improvements relating to the information, availability and physicians' training should be considered. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  18. American Internal Medicine in the 21st Century

    Science.gov (United States)

    Huddle, Thomas S; Centor, Robert; Heudebert, Gustavo R

    2003-01-01

    American internal medicine suffers a confusion of identity as we enter the 21st century. The subspecialties prosper, although unevenly, and retain varying degrees of connection to their internal medicine roots. General internal medicine, identified with primary care since the 1970s, retains an affinity for its traditional consultant-generalist ideal even as primary care further displaces that ideal. We discuss the origins and importance of the consultant-generalist ideal of internal medicine as exemplified by Osler, and its continued appeal in spite of the predominant role played by clinical science and accompanying subspecialism in determining the academic leadership of American internal medicine since the 1920s. Organizing departmental clinical work along subspecialty lines diminished the importance of the consultant-generalist ideal in academic departments of medicine after 1950. General internists, when they joined the divisions of general internal medicine that appeared in departments of medicine in the 1970s, could sometimes emulate Osler in practicing a general medicine of complexity, but often found themselves in a more limited role doing primary care. As we enter the 21st century, managed care threatens what remains of the Oslerian ideal, both in departments of medicine and in clinical practice. Twenty-first century American internists will have to adjust their conditions of work should they continue to aspire to practice Oslerian internal medicine. PMID:12950486

  19. 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.

  20. [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.

  1. Nuclear Medicine Practice in Kenya

    International Nuclear Information System (INIS)

    Ndrirangu, T.T.

    2017-01-01

    Nuclear medicine is a medical specialty that relies on the use of nuclear technology in the diagnosis and treatment (therapy) of diseases. Nuclear medicine uses the principle that a certain radiopharmaceutical (tracer) will at a certain point in time have a preferential uptake by a particular body, tissue or cell. Unlike other radiation applications for medical use, nuclear medicine uses open (unsealed) sources of radiation. The tracer is introduced into the body of the patient through several routes (oral, intravenous, percutaneous, intradermally, inhalation, intracapsular etc) and s/he becomes the source of radiation. Early diagnosis of diseases coupled with associated timely therapeutic intervention will lead to better prognosis. In a country with an estimated population of 42 million in 2017, Kenya has only two (2) nuclear medicine facilities (units) that is Kenyatta National Hospital - Public facility and Aga Khan University Hospital which is a Private facility. Being a relatively new medical discipline in Kenya, several measures have been taken by the clinical nuclear medicine team to create awareness at various levels. Kenya does not manufacture radiopharmaceuticals. We therefore have to import them from abroad and this makes them quite expensive, and the process demanding. There is no local training in nuclear medicine and staff have to be sent abroad for training, making this quite expensive and cumbersome and the IAEA has been complimenting in this area. With concerted effort by all stakeholders at the individual, national and international level, it is possible for Kenya to effectively sustain clinical nuclear medicine service not only as a diagnostic tool in many disease entities, but also play an increasingly important role in therapy

  2. 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.

  3. Comparison of Content on the American Board of Internal Medicine Maintenance of Certification Examination With Conditions Seen in Practice by General Internists.

    Science.gov (United States)

    Gray, Bradley; Vandergrift, Jonathan; Lipner, Rebecca S; Green, Marianne M

    2017-06-13

    Success on the internal medicine (IM) examination is a central requirement of the American Board of Internal Medicine's (ABIM's) Maintenance of Certification program (MOC). Therefore, it is important to understand the degree to which this examination reflects conditions seen in practice, one dimension of content validity, which focuses on the match between content in the discipline and the topics on the examination questions. To assess whether the frequency of questions on IM-MOC examinations were concordant with the frequency of conditions seen in practice. The 2010-2013 IM-MOC examinations were used to calculate the percentage of questions for 186 medical condition categories from the examination blueprint, which balances examination content by considering importance and frequency of conditions seen in practice. Nationally representative estimates of conditions seen in practice by general internists were estimated from the primary diagnosis for 13 832 office visits (2010-2013 National Ambulatory Medical Care Surveys) and 108 472 hospital stays (2010 National Hospital Discharge Survey). Prevalence of conditions included on the IM-MOC examination questions. The outcome measure was the concordance between the percentages of IM-MOC examination questions and the percentages of conditions seen in practice during either office visits or hospital stays for each of 186 condition categories (eg, diabetes mellitus, ischemic heart disease, liver disease). The concordance thresholds were 0.5 SD of the weighted mean percentages of the applicable 186 conditions seen in practice (0.74% for office visits; 0.51% for hospital stays). If the absolute differences between the percentages of examination questions and the percentages of office visit conditions or hospital stay conditions seen were less than the applicable concordance threshold, then the condition category was judged to be concordant. During the 2010-2013 IM-MOC examination periods, 3600 questions (180 questions per

  4. Philanthropic endowments in general internal medicine.

    Science.gov (United States)

    Murden, R A; Lamb, J F

    1999-04-01

    We performed two surveys to uncover the status of philanthropic endowments in general internal medicine divisions. The initial survey of U.S. medical school departments of medicine found that only 14.1% of general internal medicine divisions hold endowments versus 21.9% of all other divisions, and that endowment sources for general medicine are atypical. The second survey of successfully endowed divisions found that sympathetic administrators and active pursuit of endowments were associated with endowment success. Aggressive pursuit of endowments, publicizing successes of general medicine, and consideration of endowment sources noted in this study are recommended to improve philanthropic contributions to general internal medicine.

  5. A Practice of Social Medicine

    Directory of Open Access Journals (Sweden)

    Sidney Kark

    2006-08-01

    Full Text Available SOCIAL MEDICINE may be regarded as a practice of medicine concerned with health and disease as a function of group living. It is interested in the health of people in relation to their behaviour in social groups and as such is concerned with care of the individual patient as a member of a family and of other significant groups in his daily life. It is also concerned with the health of these groups as such and with that of the whole community as a community. Concern with the health needs of larger communities and territorial groups such as cities, regions and nations is also an important area of social medicine in which the public health physician is involved. Special interest groups have been the focus of attention of yet other practitioners of social medicine. Children at school, university students and occupational groups are among the more important of these groups for whom special health services, oriented to their specific needs, have been developed. Less formal groupings are now receiving increasing attention by those concerned with community health services, such as the family, in which the relationships between the members have intimate and enduring qualities. Other significant informal groups, in which face-to-face relationships are characteristic, are friendship groups, play groups of children and the neighbourhood community, in rural village or urban neighbourhood.

  6. International Journal of Medicine and Health Development

    African Journals Online (AJOL)

    International Journal of Medicine and Health Development ... This is the official publication of College of Medicine, University of Nigeria under the ... Health related quality of life and sociodemographic characteristics among Iranian students ...

  7. General medicine vs subspecialty career plans among internal medicine residents.

    Science.gov (United States)

    West, Colin P; Dupras, Denise M

    2012-12-05

    Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood. To evaluate the general medicine career plans of internal medicine residents and how career plans evolve during training. A study of US internal medicine residents using an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 US eligible categorical and primary care internal medicine residents, 57,087 (84.9%) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4%) of these residents, of whom 51,390 (76.5%) responded to all survey items and an additional 645 (1.0%) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2%) in this sample. Self-reported ultimate career plans of internal medicine residents. A GIM career plan was reported by 3605 graduating residents (21.5%). A total of 562 primary care program (39.6%) and 3043 categorical (19.9%) residents reported GIM as their ultimate career plan (adjusted odds ratio [AOR], 2.76; 99% CI, 2.35-3.23; P international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P international medical graduates (57.3% vs 27.3%, respectively; AOR, 3.48; 99% CI, 2.58-4.70; P internal medicine residents, including those in primary care training programs, and differed according to resident sex, medical school location, and program type.

  8. PHARMACOKINETIC RESEARCHES AND PRACTICAL MEDICINE

    Directory of Open Access Journals (Sweden)

    V. G. Belolipetskaya

    2015-12-01

    Full Text Available An article gives in a comprehensive manner the main idea of pharmacokinetics, as the science about rules of substances behavior in the internal environment of the organism, as well as of main parameters of pharmacokinetic researches. The article provides vivid and very  persuasive examples of high practical importance of this science both for creating new medical forms of drugs and for choosing the optimal of therapy regime.

  9. PHARMACOKINETIC RESEARCHES AND PRACTICAL MEDICINE

    Directory of Open Access Journals (Sweden)

    V. G. Belolipetskaya

    2005-01-01

    Full Text Available An article gives in a comprehensive manner the main idea of pharmacokinetics, as the science about rules of substances behavior in the internal environment of the organism, as well as of main parameters of pharmacokinetic researches. The article provides vivid and very  persuasive examples of high practical importance of this science both for creating new medical forms of drugs and for choosing the optimal of therapy regime.

  10. Teaching Prevention in Internal Medicine Clerkships.

    Science.gov (United States)

    Kinsinger, Linda

    2000-01-01

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

  11. Hospitalist career decisions among internal medicine residents.

    Science.gov (United States)

    Ratelle, John T; Dupras, Denise M; Alguire, Patrick; Masters, Philip; Weissman, Arlene; West, Colin P

    2014-07-01

    Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

  12. VERTIGO IN INTERNAL MEDICINE PRACTICE

    Directory of Open Access Journals (Sweden)

    O. M. Drapkina

    2015-12-01

    Full Text Available Vertigo is observed in 30% of people above 65 y.o. and in 50% of peoples above 80 y.o. This disorder significantly affects patient quality of life and can be a reason of incidences, trauma and even disability. Vertigo is classified as systemic or non-systemic. It can be consequence of different disturbances. Physician of any clinical specialty can face with this problem. Identification of the vertigo cause is a quite difficult problem, but success of treatment depends on it. First of all treatment strategy should be directed to elimination of the vertigo cause.

  13. Internal radiation dosimetry using nuclear medicine imaging in radionuclide therapy

    International Nuclear Information System (INIS)

    Kim, Kyeong Min; Byun, Byun Hyun; Cheon, Gi Jeong; Lim, Sang Moo

    2007-01-01

    Radionuclide therapy has been an important field in nuclear medicine. In radionuclide therapy, relevant evaluation of internally absorbed dose is essential for the achievement of efficient and sufficient treatment of incurable disease, and can be accomplished by means of accurate measurement of radioactivity in body and its changes with time. Recently, the advances of nuclear medicine imaging and multi modality imaging processing techniques can provide chance of more accurate and easier measurement of the measures commented above, in cooperation of conventional imaging based approaches. In this review, basic concept for internal dosimetry using nuclear medicine imaging is summarized with several check points which should be considered in real practice

  14. Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

    Directory of Open Access Journals (Sweden)

    Giorgio Cioni

    2016-11-01

    Full Text Available Abstract Background Clostridium difficile (CD is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI in Internal Medicine (IM wards in Italy. Methods PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results Among the 10,780 patients observed, 103 (0.96 % showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis. In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001, whereas median length of hospital stay was 16 (IQR = 13 vs 8 (IQR = 8 days (p < 0.001 among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay. The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2–3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.

  15. Nuclear medicine training and practice in the Czech Republic

    International Nuclear Information System (INIS)

    Kaminek, Milan; Koranda, Pavel

    2014-01-01

    Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

  16. Nuclear medicine training and practice in the Czech Republic

    Energy Technology Data Exchange (ETDEWEB)

    Kaminek, Milan; Koranda, Pavel [University Hospital Olomouc, Department of Nuclear Medicine, Olomouc (Czech Republic)

    2014-08-15

    Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

  17. International Journal of Medicine and Biomedical Research

    African Journals Online (AJOL)

    The International Journal of Medicine and Biomedical Research (IJMBR) is a peer-reviewed ... useful to researchers in all aspects of Clinical and Basic Medical Sciences including Anatomical Sciences, Biochemistry, Dentistry, Genetics, ...

  18. Nuclear Medicine Practice in Kenya

    International Nuclear Information System (INIS)

    Ndirangu, T.D.

    2017-01-01

    Nuclear medicine is a medical specialty that relies on the use of nuclear technology in the diagnosis and treatment (therapy) of diseases. Nuclear medicine uses the principle that a certain radiopharmaceutical (tracer) will at a certain point in time have a preferential uptake by a particular body, tissue or cell. This uptake is then imaged by the use of detectors mounted in gamma cameras or PET (positron emission tomography) devices.. Unlike other radiation applications for medical use, nuclear medicine uses open (unsealed) sources of radiation. In a country with an estimated population of 48 million in 2017, Kenya has only two (2) nuclear medicine facilities (units). Being a relatively new medical discipline in Kenya, several measures have been taken by the clinical nuclear medicine team to create awareness at various levels

  19. Predictors of yoga use among internal medicine patients.

    Science.gov (United States)

    Cramer, Holger; Lauche, Romy; Langhorst, Jost; Paul, Anna; Michalsen, Andreas; Dobos, Gustav

    2013-07-13

    Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors. Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P internal integrative medicine patient population and was commonly perceived as beneficial. Yoga use was not associated with the patients' specific diagnosis but with sociodemographic factors, mental health, and health locus of control. To improve adherence to yoga practice, it should be considered that male, younger, and anxious patients and those with low internal health locus of control might be less intrinsically

  20. 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

  1. Internal medicine board certification and career pathways in Japan.

    Science.gov (United States)

    Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kawaguchi, Hideaki; Shimpo, Masahisa; Yasunaga, Hideo

    2017-05-08

    Establishing and managing a board certification system is a common concern for many countries. In Japan, the board certification system is under revision. The purpose of this study was to describe present status of internal medicine specialist board certification, to identify factors associated with maintenance of board certification and to investigate changes in area of practice when physicians move from hospital to clinic practice. We analyzed 2010 and 2012 data from the Survey of Physicians, Dentists and Pharmacists. We conducted logistic regression analysis to identify factors associated with the maintenance of board certification between 2010 and 2012. We also analyzed data on career transition from hospitals to clinics for hospital physicians with board certification. It was common for physicians seeking board certification to do so in their early career. The odds of maintaining board certification were lower in women and those working in locations other than academic hospitals, and higher in physicians with subspecialty practice areas. Among hospital physicians with board certification who moved to clinics between 2010 and 2012, 95.8% remained in internal medicine or its subspecialty areas and 87.7% maintained board certification but changed their practice from a subspecialty area to more general internal medicine. Revisions of the internal medicine board certification system must consider different physician career pathways including mid-career moves while maintaining certification quality. This will help to secure an adequate number and distribution of specialists. To meet the increasing demand for generalist physicians, it is important to design programs to train specialists in general practice.

  2. [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.

  3. 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

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

    Science.gov (United States)

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

    2013-01-01

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

  5. 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.

  6. A practical approach to Events Medicine provision.

    Science.gov (United States)

    Smith, Susan P; Cosgrove, Joseph F; Driscoll, Peter J; Smith, Andrew; Butler, John; Goode, Peter; Waldmann, Carl; Vallis, Christopher J; Topham, Fiona; Mythen, Michael Monty

    2017-08-01

    In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France ( Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest , medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine. 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/.

  7. Commentary: Bad Medicine and Bad Educational Practice

    Science.gov (United States)

    Parslow, Graham R.

    2011-01-01

    This author, a teacher of medical students, has taken a keen interest in the history of the teaching and practice of medicine. The definitive treatment of medical history by Porter left no doubt that it is only for approximately the last century that science has imposed a balance of benefit on Western medical practice. Subsequent reading of Druin…

  8. Radiation Protection Programme in Nuclear Medicine Practice

    International Nuclear Information System (INIS)

    Alarfaj, Abd-I.M.

    2003-01-01

    This paper specifies the main elements of the radiation protection programma (RPP) that should be estabished for each practice, which involves radiation exposure. Practices of nuclear medicine have been considered as an example, since among the 245 installations which are conducting different practices with radiation sources in the Kingdom of Saudi Arabia, there are 78 installations dealing with nuclear medicine practices. Reviewing the RPP in these nuclear medicine installations, it may be easily concluded that the RPPs for the majority of these installations do not respond to the requirements of the regulatory body of the Kingdom, which is King Abdulaziz City for Science and Technology (KACST). This may be attributed to a set of different reasons, such as shortage in understanding the main elements of the RPP as well as in applying methodologies

  9. 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

  10. Internal medicine. An illustrated radiological guide

    International Nuclear Information System (INIS)

    Al-Tubaikh, Jarrah Ali; Sabah Hospital, Kuwait

    2010-01-01

    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.)

  11. 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.)

  12. Mind-Body Practices in Integrative Medicine

    Directory of Open Access Journals (Sweden)

    Niko Kohls

    2012-02-01

    Full Text Available Mind-Body practices have become increasingly popular as components of psychotherapeutic and behavior medicine interventions. They comprise an array of different methods and techniques that use some sort of mental-behavioral training and involve the modulation of states of consciousness in order to influence bodily processes towards greater health, well-being and better functioning. Mind-body practices may thus be interpreted as the salutogenetic mirror image of psychosomatic medicine, where psychophysiological and health consequences of specific psychological states are studied, such as stress arousal, psychological trauma or depression. This contribution examines the empirical evidence of the most common mind-body techniques with regard to their salutogenetic potential. We concisely discuss some aspects of the mind-body problem, before we consider some historical aspects and achievements of psychosomatic medicine. We then turn to some prominent mind-body practices and their application, as well as the empirical database for them.

  13. International surgery: definition, principles and Canadian practice

    Science.gov (United States)

    Lett, Ronald

    2003-01-01

    This article is dedicated to the Canadian international surgeon, Norman Bethune (1890–1939). International surgery is defined as a humanitarian branch of medicine concerned with the treatment of bodily injuries or disorders by incision or manipulations, emphasizing cooperation and understanding among nations and involving education, research, development and advocacy. In this article I review the colonial past, the dark ages following the Declaration of Alma-Ata, the progress made and the present challenges in international surgery. I present a definition of international surgery that recognizes the current era of surgical humanitarianism, validates a global understanding of surgical issues and promotes cooperation among nations. Included are the principles of international surgery: education, research, infrastructure development and advocacy. International surgical projects are classified according to type (clinical, relief, developmental) and integration strategy (vertical or horizontal). Also reviewed are the Canadian practice of international surgery by nongovernmental, professional and academic organizations and the requirements of international and Canadian funding agencies, the development concepts basic to all projects, including results-based management and the cross-cutting themes of gender equity, environmental protection and human safety. I recommend formalizing international surgery into a discipline as a means of promoting surgical care in low-income countries. If international surgery is to be sustained in Canada, infrastructure and support from Canadian surgeons is particularly important. An understanding of the history, definition and classification of international surgery should promote surgical care in low-income countries. PMID:14577711

  14. Nuclear medicine training and practice in Turkey.

    Science.gov (United States)

    Ozcan, Zehra; Bozkurt, M Fani; Erbas, Belkıs; Durak, Hatice

    2017-05-01

    Nuclear medicine applications in Turkey started in the early 1950s, grew as an independent medical discipline and finally were recognized by the Ministry of Health in 1973. Later on, the professional organization of nuclear medicine physicians and other related professionals including radiopharmacists and technologists under the Turkish Society of Nuclear Medicine were established in 1975. Recently after completing more than a half century in Turkey, nuclear medicine has proved to be a strong and evolving medical field with more than 600 physicians serving for the changing needs of clinical practice throughout these years. This article describes past and present facts in this field and attempts to provide insights into the future which hopefully will be brighter than before.

  15. Nuclear medicine training and practice in Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Ozcan, Zehra [Ege University School of Medicine, Department of Nuclear Medicine, Izmir (Turkey); Bozkurt, M. Fani; Erbas, Belkis [Hacettepe University School of Medicine, Department of Nuclear Medicine, Ankara (Turkey); Durak, Hatice [Dokuz Eyluel University School of Medicine, Department of Nuclear Medicine, Izmir (Turkey)

    2017-05-15

    Nuclear medicine applications in Turkey started in the early 1950s, grew as an independent medical discipline and finally were recognized by the Ministry of Health in 1973. Later on, the professional organization of nuclear medicine physicians and other related professionals including radiopharmacists and technologists under the Turkish Society of Nuclear Medicine were established in 1975. Recently after completing more than a half century in Turkey, nuclear medicine has proved to be a strong and evolving medical field with more than 600 physicians serving for the changing needs of clinical practice throughout these years. This article describes past and present facts in this field and attempts to provide insights into the future which hopefully will be brighter than before. (orig.)

  16. Nuclear medicine training and practice in Turkey

    International Nuclear Information System (INIS)

    Ozcan, Zehra; Bozkurt, M. Fani; Erbas, Belkis; Durak, Hatice

    2017-01-01

    Nuclear medicine applications in Turkey started in the early 1950s, grew as an independent medical discipline and finally were recognized by the Ministry of Health in 1973. Later on, the professional organization of nuclear medicine physicians and other related professionals including radiopharmacists and technologists under the Turkish Society of Nuclear Medicine were established in 1975. Recently after completing more than a half century in Turkey, nuclear medicine has proved to be a strong and evolving medical field with more than 600 physicians serving for the changing needs of clinical practice throughout these years. This article describes past and present facts in this field and attempts to provide insights into the future which hopefully will be brighter than before. (orig.)

  17. The internal medicine specialist and neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Pizzini

    2013-05-01

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

  18. Factors influencing career decisions in internal medicine.

    Science.gov (United States)

    Macdonald, C; Cawood, T

    2012-08-01

    Numerous factors influence career decisions for internal medicine trainees and Fellows. There is a perception that a greater emphasis is placed on work-family balance by younger physicians. To determine the characteristics of the modern internal medicine workforce and ascertain whether job flexibility is important to career decision-making. We hypothesised that factors which reflect flexibility would be highly influential in decision-making, especially for women and those with young children. A questionnaire was mailed to 250 New Zealand internal medicine trainees and Fellows. It focused on factors, including job flexibility, interest and collegial support, and included demographic details which were primarily aimed at ascertaining family responsibilities. Response rate was 54%. The majority of female physicians are the main person responsible for their children (62%), and the majority of their partners work full-time (80%). This contrasts with male physicians, of whom only 4% are the main person responsible for their children. Flexibility was found to be more influential in women, those with young children, trainees and those working in outpatient-based subspecialties. However, contrary to our original hypothesis, flexibility was not reported to be highly influential in any group, with career choice being most influenced by interest and enjoyment, intellectual challenge and variety within the job. It is hoped that results will inform employers and those involved with training to enable them to better cater for the needs of the workforce and also encourage trainees to consider future family commitments when making career decisions. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

  19. Competency-based education and training in internal medicine.

    Science.gov (United States)

    Weinberger, Steven E; Pereira, Anne G; Iobst, William F; Mechaber, Alex J; Bronze, Michael S

    2010-12-07

    Recent efforts to improve medical education include adopting a new framework based on 6 broad competencies defined by the Accreditation Council for Graduate Medical Education. In this article, the Alliance for Academic Internal Medicine Education Redesign Task Force II examines the advantages and challenges of a competency-based educational framework for medical residents. Efforts to refine specific competencies by developing detailed milestones are described, and examples of training program initiatives using a competency-based approach are presented. Meeting the challenges of a competency-based framework and supporting these educational innovations require a robust faculty development program. Challenges to competency-based education include teaching and evaluating the competencies related to practice-based learning and improvement and systems-based practice, as well as implementing a flexible time frame to achieve competencies. However, the Alliance for Academic Internal Medicine Education Redesign Task Force II does not favor reducing internal medicine training to less than 36 months as part of competency-based education. Rather, the 36-month time frame should allow for remediation to address deficiencies in achieving competencies and for diverse enrichment experiences in such areas as quality of care and practice improvement for residents who have demonstrated skills in all required competencies.

  20. Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.

    Science.gov (United States)

    Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas

    2017-04-01

    Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.

  1. Characterization of internal dosimetry practices

    International Nuclear Information System (INIS)

    Traub, R.J.; Heid, K.R.; Mann, J.C.

    1983-01-01

    Current practices in internal dosimetry at DOE facilities were evaluated with respect to consistency among DOE Contractors. All aspects of an internal dosimetry program were addressed. Items considered include, but are not necessarily limited to, record systems and ease of information retrieval; ease of integrating internal dose and external dose; modeling systems employed, including ability to modify models depending on excretion data, and verification of computer codes utilized; bioassay procedures, including quality control; and ability to relate air concentration data to individual workers and bioassay data. Feasibility of uranium analysis in solution by laser fluorescence excitation at uranium concentrations of one part per billion was demonstrated

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

    Science.gov (United States)

    Eisenberg, John M.

    1980-01-01

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

  3. Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors.

    Science.gov (United States)

    Edwards, Asher; Nam, Samuel

    2018-01-01

    As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education-accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was "very important" (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.

  4. Predictors of Final Specialty Choice by Internal Medicine Residents

    Science.gov (United States)

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

    2006-01-01

    BACKGROUND Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE To identify factors that predict the clinical practice of residents following their training. DESIGN Prospective cohort study. PARTICIPANTS Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, Pinternal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07). CONCLUSION Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process. PMID:16836624

  5. 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

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

    Science.gov (United States)

    Kolade, Victor O; Sethi, Anuradha

    2016-01-01

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

  7. The International Employment Protection Practices

    Directory of Open Access Journals (Sweden)

    Otenko Pavlo V.

    2017-09-01

    Full Text Available The article discusses the need for corporate protection of staff in accordance with both the European and the International labor law. The author defines the essence of the category of «protection of staff», its constituent elements and the importance of function of this mechanism in terms of corporate security. The main methods used in the international practice to achieve a high degree of protection of staff have been systematized and presented. The main stages of development and tendencies concerning the formation of instruments for protection of staff have been analyzed, and the principal indices to assess the degree of protection of staff have been determined.

  8. 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.

  9. Application impact of internal monitoring criteria in radiological protection programs of nuclear medicine services

    International Nuclear Information System (INIS)

    Dantas, Bernardo M.; Dantas, Ana Leticia A.; Juliao, Ligia Q.C.; Lourenco, Maria Cristina; Melo, Dunstana R.

    2005-01-01

    This work presents the simulation of the internal monitoring criteria application for the most used radionuclides by the area of nuclear medicine, taking into consideration the usual conditions of usual source handling and the activity bands authorized by the CNEN. It is concluded that the handling of Iodine 131 for therapeutical purposes is the practice which presents the most risk of internal exposure for the works, requiring the adoption of a program for internal monitoring by the nuclear medicine services

  10. The State of Evaluation in Internal Medicine Residency

    Science.gov (United States)

    Holmboe, Eric; Beasley, Brent W.

    2008-01-01

    Background There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations. Objective To describe evaluation methods used by our nation’s internal medicine residency programs and assess adherence to ACGME methodological recommendations for evaluation. Design Nationwide survey. Participants All internal medicine programs registered with the Association of Program Directors of Internal Medicine (APDIM). Measurements Descriptive statistics of programs and tools used to evaluate competence; compliance with ACGME recommended evaluative methods. Results The response rate was 70%. Programs were using an average of 4.2–6.0 tools to evaluate their trainees with heavy reliance on rating forms. Direct observation and practice and data-based tools were used much less frequently. Most programs were using at least 1 of the Accreditation Council for Graduate Medical Education (ACGME)’s “most desirable” methods of evaluation for all 6 measures of trainee competence. These programs had higher support staff to resident ratios than programs using less desirable evaluative methods. Conclusions Residency programs are using a large number and variety of tools for evaluating the competence of their trainees. Most are complying with ACGME recommended methods of evaluation especially if the support staff to resident ratio is high. PMID:18612734

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

    Science.gov (United States)

    Kunde, A; Harendza, S

    2015-08-01

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

  12. Nuclear medicine in gynecologic oncology: Recent practice

    International Nuclear Information System (INIS)

    Lamki, L.M.

    1987-01-01

    Nuclear medicine tests tell more about the physiological function of an organ that about its anatomy. This is in contrast to several other modalities in current use in the field of diagnostic imaging. Some of these newer modalities, such as computerized tomography (CT), offer a better resolution of the anatomy of the organ being examined. This has caused physicians to drift away from certain nuclear medicine tests, specifically those that focus primarily on the anatomy. When CT scanning is available, for instance, it is no longer advisable to perform a scintigraphic brain scan in search of metastasis;CT scanning is more accurate overall and more likely than a nuclear study to result in a specific diagnosis. In certain cases of diffuse cortical infections like herpes encephalitis, however, a scintiscan is still superior to a CT scan. Today's practice of nuclear medicine in gynecologic oncology may be divided into the three categories - (1) time-tested function-oriented scintiscans, (2) innovations of established nuclear tests, and (3) newer pathophysiological scintistudies. The author discusses here, briefly, each of these categories, giving three examples of each

  13. Code of practice for radiation protection in nuclear medicine

    International Nuclear Information System (INIS)

    Hamed, M. I.

    2010-05-01

    In aim of this study was to develop a draft for a new code practice for radiation protection in nuclear medicine that meets the current relevant international recommendation. The draft includes the following main fields: methods of radiation protection for workers, patients and public. Also, the principles of safe design of nuclear medicine departments, quality assurance program, proper manipulation of radiation sources including radioactive waste and emergency preparedness and response. The practical part of this study includes inspections of three nuclear medicine departments available in Sudan so as to assess the degree of compliance of those departments with what is stated in this code. The inspection missions have been conducted using a checklist that addresses all items that may affect radiation raincoat issues in addition to per formin area radiation monitoring around the installation of the radioactive sources. The results of this revealed that most of the departments do not have effective radiation protection program which in turn could lead to unnecessary exposure to patients, public and workers. Finally, some recommendations are given that - if implemented - could improve the status of radiation protection in nuclear medicine department. (Author)

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

    Science.gov (United States)

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

    2018-04-01

    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 face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  15. [Integrated skills laboratory concept for undergraduate training in internal medicine].

    Science.gov (United States)

    Nikendei, C; Schilling, T; Nawroth, P; Hensel, M; Ho, A D; Schwenger, V; Zeier, M; Herzog, W; Schellberg, D; Katus, H A; Dengler, T; Stremmel, W; Müller, M; Jünger, J

    2005-05-06

    An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine. To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students). The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001). This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.

  16. Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties.

    Science.gov (United States)

    Caskey, Rachel N; Abutahoun, Angelos; Polick, Anne; Barnes, Michelle; Srivastava, Pavan; Boyd, Andrew D

    2018-05-04

    The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists. We used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes. Twenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies. We identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.

  17. 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.

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

    Science.gov (United States)

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

    2017-04-01

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

  19. [What is new in 2016 for the specialist in hospital internal medicine?

    Science.gov (United States)

    Mraihi, Hamza; Chevaux, Fabienne; Castoni, Julien; Aebischer, Oriane; Christou, Foetini; Jaccard, Evrim; Benmachiche, Malik; Tasheva, Plamena; Giroud, Sabine; Kraege, Vanessa; Lamy, Olivier

    2017-01-18

    The year 2016 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice in general internal medicine. From the treatment of NSTEMI in population older than 80, to new sepsis and septic shock criteria to antidotes of new oral anticoagulants, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.

  20. Behavioral Medicine and University Departments of Family Practice

    OpenAIRE

    Grantham, Peter

    1983-01-01

    Behavioral medicine brings knowledge and skills from the social sciences to the practice of medicine. Modifying behavior which causes a health problem, disease prevention and health promotion, improving the relationship between patients and health professionals, understanding cultural and ethical issues, and the effect of illness on behavior are all aspects of behavioral medicine. Such `whole person' medicine fits well into family practice. However, careful consideration of the risks, challen...

  1. Pediatric nuclear medicine: A practical approach

    International Nuclear Information System (INIS)

    Pintelon, H.; Piepsz, A.; Dejonckheere, M.

    1997-01-01

    This paper is devoted to the practical aspects of pediatric nuclear medicine, particularly the controversy about drug sedation. The authors conclude that drug sedation should be exceptionally used. There is an alternative way, consisting in an adequate approach of the patient: good information to the parents and the child; taking care of the child's environment, starting from the first contacts in the waiting room; specific education of technologists: this includes injections and blood sampling, but also proper handling of the child during the procedure and adequate psychological attitudes toward child and parents. Taking these factors into account, it is exceptional that a test has to be postponed because of the lack of collaboration of the patient; good quality images, using the recommended paediatric amounts of radioactivity can be achieved even for procedures of prolonged duration

  2. 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

  3. [The practice guideline 'Problematic alcohol consumption' (second revision) from the Dutch College of General Practitioners; a response from the perspective of internal medicine].

    Science.gov (United States)

    van de Wiel, A

    2006-11-18

    The prevalence of problem drinking in the Dutch population, affecting about 750,000 persons, is much higher than that of abuse or addiction and contributes substantially to healthcare workload and costs. However, recognition, not only in primary care but also in the hospital environment, can be difficult. The symptoms are often non-specific and are not always immediately related to the use of alcohol. Even in cases of overt abuse, like in injuries and trauma, routine drinking histories are recorded poorly and identification and signalling are inadequate. It is estimated that up to 16% of all emergency room patients have consumed alcohol within six hours before their visit. Since a patient will benefit not only from the treatment of his symptoms but also from the uncovering of the underlying problem, more emphasis should be laid on the early identification of problem drinking. Especially in the early phase of problem drinking, interventions, in most cases by primary-care physicians or nurse practitioners, may be successful. Since the revised version of the practice guideline 'Problematic alcohol consumption' from the Dutch College of General Practitioners contains clear and practical advice on the early recognition and management of problem drinking, its use is recommended not only to primary-care physicians but also to hospital-specialist staff.

  4. Internal quality control: best practice.

    Science.gov (United States)

    Kinns, Helen; Pitkin, Sarah; Housley, David; Freedman, Danielle B

    2013-12-01

    There is a wide variation in laboratory practice with regard to implementation and review of internal quality control (IQC). A poor approach can lead to a spectrum of scenarios from validation of incorrect patient results to over investigation of falsely rejected analytical runs. This article will provide a practical approach for the routine clinical biochemistry laboratory to introduce an efficient quality control system that will optimise error detection and reduce the rate of false rejection. Each stage of the IQC system is considered, from selection of IQC material to selection of IQC rules, and finally the appropriate action to follow when a rejection signal has been obtained. The main objective of IQC is to ensure day-to-day consistency of an analytical process and thus help to determine whether patient results are reliable enough to be released. The required quality and assay performance varies between analytes as does the definition of a clinically significant error. Unfortunately many laboratories currently decide what is clinically significant at the troubleshooting stage. Assay-specific IQC systems will reduce the number of inappropriate sample-run rejections compared with the blanket use of one IQC rule. In practice, only three or four different IQC rules are required for the whole of the routine biochemistry repertoire as assays are assigned into groups based on performance. The tools to categorise performance and assign IQC rules based on that performance are presented. Although significant investment of time and education is required prior to implementation, laboratories have shown that such systems achieve considerable reductions in cost and labour.

  5. 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 ...

  6. 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...

  7. Principles to Consider in Defining New Directions in Internal Medicine Training and Certification

    Science.gov (United States)

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

    2006-01-01

    SGIM endoreses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care. PMID:16637826

  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. Substance and materiality? The archaeology of Talensi medicine shrines and medicinal practices.

    Science.gov (United States)

    Insoll, Timothy

    2011-08-01

    Talensi materia medica is varied, encompassing plant, mineral, and animal substances. Healing, medicines, and medicinal practices and knowledge can be shrine-based and linked with ritual practices. This is explored utilising ethnographic data and from an archaeological perspective with reference to future possibilities for research both on Talensi medicine and, by implication, more generally through considering the archaeology of Talensi medicine preparation, use, storage, spread, and disposal. It is suggested that configuring the archaeology of medicine shrines and practices more broadly in terms of health would increase archaeological visibility and research potential.

  10. Good manufacturing practices for medicinal products for human use.

    Science.gov (United States)

    Gouveia, Bruno G; Rijo, Patrícia; Gonçalo, Tânia S; Reis, Catarina P

    2015-01-01

    At international and national levels, there are public and private organizations, institutions and regulatory authorities, who work and cooperate between them and with Pharmaceutical Industry, in order to achieve a consensus of the guidelines and laws of the manufacturing of medicinal products for human use. This article includes an explanation of how operate and cooperate these participants, between them and expose the current regulations, following the line of European Community/European Economic Area, referencing, wherever appropriate, the practiced guidelines, outside of regulatory action of space mentioned. In this way, it is intended to achieve quality, security and effectiveness exceptional levels in the manufacturing of health products. Good Manufacturing Practice aim the promotion of the human health and consequently, to the improvement of quality of life. For achieve the proposed objectives, it is necessary to ensure the applicability of the presented concepts and show the benefits arising from this applicability.

  11. Good manufacturing practices for medicinal products for human use

    Science.gov (United States)

    Gouveia, Bruno G.; Rijo, Patrícia; Gonçalo, Tânia S.; Reis, Catarina P.

    2015-01-01

    At international and national levels, there are public and private organizations, institutions and regulatory authorities, who work and cooperate between them and with Pharmaceutical Industry, in order to achieve a consensus of the guidelines and laws of the manufacturing of medicinal products for human use. This article includes an explanation of how operate and cooperate these participants, between them and expose the current regulations, following the line of European Community/European Economic Area, referencing, wherever appropriate, the practiced guidelines, outside of regulatory action of space mentioned. In this way, it is intended to achieve quality, security and effectiveness exceptional levels in the manufacturing of health products. Good Manufacturing Practice aim the promotion of the human health and consequently, to the improvement of quality of life. For achieve the proposed objectives, it is necessary to ensure the applicability of the presented concepts and show the benefits arising from this applicability. PMID:25883511

  12. International working capital practices of Ghanaian firms

    Directory of Open Access Journals (Sweden)

    J. Abor

    2005-12-01

    Full Text Available International working capital management is important to firms frequently operating in the international market. This article investigates the international working capital practices of top Ghanaian firms involved in international trade. The objective of the study is to ascertain the extent to which Ghanaian firms use international working capital management vehicles. The article focuses on two main areas of international working capital management; international cash management and international sales and accounts receivables management. The results of this study reveal low level of use of international working capital vehicles among Ghanaian firms. Recommendations are made in this regard.

  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. Concussion Management Practice Patterns Among Sports Medicine Physicians.

    Science.gov (United States)

    Stache, Stephen; Howell, David; Meehan, William P

    2016-09-01

    The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

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

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

    2011-02-03

    Feb 3, 2011 ... ... India's efforts to develop medicinal plant gathering, processing, and marketing into a ... while protecting indigenous knowledge, some based on age-old texts. ... To date, his department has helped about a million people in ...

  16. Internal dosimetry in nuclear medicine procedures

    International Nuclear Information System (INIS)

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

    2011-01-01

    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 referred Book of calculation.

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

    African Journals Online (AJOL)

    It also publishes valuable studies in areas of Biological Sciences related to health ... Medicine, Nursing, Physiotherapy, and Medical Ethics and Medical Education. ... The Journal charges US $ 250 (for overseas authors) and N 25,000 (for ...

  18. 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. ... Dr Biruk Germa, Senior Emergency Medicine Resident at Addis Ababa University, also ... The issue Inaccessibility to veterinary services in Ethiopia's livestock sector.

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

    Science.gov (United States)

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

    2011-02-02

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

  20. Family medicine training and practice in Malawi: History, progress ...

    African Journals Online (AJOL)

    Family medicine training and practice in Malawi: History, progress, and the anticipated role of the family physician in the Malawian health system. ... The idea of formal family medicine training and practice in Malawi started as early as 2001 but did not come to fruition until 2011, with the start of the undergraduate clerkship in ...

  1. 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.

  2. Optimizing the Internal Medicine Clinic at Evans Army Community Hospital

    National Research Council Canada - National Science Library

    Bonilla, Jose

    2003-01-01

    ...) 2002, the Internal Medicine (IM) clinic at Evans Army Community Hospital, Fort Carson, Colorado, failed to meet access to care standards for routine appointments, and was only marginally successful in meeting standards for urgent appointments...

  3. Nuclear medicine in thyroid cancer management: A practical approach

    International Nuclear Information System (INIS)

    2009-03-01

    Thyroid cancers are now being diagnosed at an earlier stage and treatments together with follow-up strategies are more effective. However this is not consistent throughout the world. The practice does differ considerably from country to country and region to region. Many International Atomic Energy Agency (IAEA) Members States can benefit from the lessons learned and improve overall patient management of thyroid cancers. The IAEA has significantly enhanced the capabilities of many Member States in the field of nuclear medicine. Functional imaging using nuclear medicine procedures has become an indispensable tool for the diagnosis, treatment planning and management of patients. In terms of treatment, the use of radioiodine ( 131 I) has been central to thyroid cancer and has been successfully used for over six decades. Over the years the IAEA has also assisted many Member States to develop indigenous manufacturing of radioiodine therefore reducing the barriers for the care of patients. This publication is a culmination of efforts by more than twenty international experts in the field to produce a global perspective on the subject. Views expressed are those of individual experts involved and are intended to assist national or regional authorities in decisions regarding the frameworks for effective treatment of thyroid cancer

  4. Handbook of nuclear medicine practice in developing countries

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    This ``Handbook of Nuclear Medicine Practices in the Developing Countries`` is meant primarily for those, who intend to install and practice nuclear medicine in a developing country. By and large, the conventional Textbooks of nuclear medicine do note cater to the special problems and needs of these countries. The Handbook is not trying to replace these textbooks, but supplement them with special information and guidance, necessary for making nuclear medicine cost-effective and useful in a hospital of a developing country. It is written mostly by those, who have made success in their careers in nuclear medicine, in one of these countries. One way to describe this Handbook will be that it represents the ways, in which, nuclear medicine is practised in the developing countries, described by those, who have a long and authentic experience of practising nuclear medicine in a developing country Figs, tabs

  5. Handbook of nuclear medicine practice in developing countries

    International Nuclear Information System (INIS)

    1992-01-01

    This ''Handbook of Nuclear Medicine Practices in the Developing Countries'' is meant primarily for those, who intend to install and practice nuclear medicine in a developing country. By and large, the conventional Textbooks of nuclear medicine do note cater to the special problems and needs of these countries. The Handbook is not trying to replace these textbooks, but supplement them with special information and guidance, necessary for making nuclear medicine cost-effective and useful in a hospital of a developing country. It is written mostly by those, who have made success in their careers in nuclear medicine, in one of these countries. One way to describe this Handbook will be that it represents the ways, in which, nuclear medicine is practised in the developing countries, described by those, who have a long and authentic experience of practising nuclear medicine in a developing country

  6. Thinking and practice of accelerating transformation of traditional Chinese medicine from experience medicine to evidence-based medicine.

    Science.gov (United States)

    Liu, Baoyan; Zhang, Yanhong; Hu, Jingqing; He, Liyun; Zhou, Xuezhong

    2011-06-01

    The gradual development of Chinese medicine is based on constant accumulation and summary of experience in clinical practice, but without the benefit of undergoing the experimental medicine stage. Although Chinese medicine has formed a systematic and unique theory system through thousands of years, with the development of evidence-based medicine, the bondage of the research methods of experience medicine to Chinese medicine is appearing. The rapid transition and transformation from experience medicine to evidence-based medicine have become important content in the development of Chinese medicine. According to the features of Chinese medicine, we propose the research idea of "taking two ways simultaneously," which is the study both in the ideal condition and in the real world. Analyzing and constructing the theoretical basis and methodology of clinical research in the real world, and building the stage for research technique is key to the effective clinical research of Chinese medicine. Only by gradually maturing and completing the clinical research methods of the real world could we realize "taking two ways simultaneously" and complementing each other, continuously produce scientific and reliable evidence of Chinese medicine, as well as transform and develop Chinese medicine from experience medicine to evidence-based medicine.

  7. Using AGREE II to Evaluate the Quality of Traditional Medicine Clinical Practice Guidelines in China.

    Science.gov (United States)

    Deng, Wei; Li, Le; Wang, Zixia; Chang, Xiaonan; Li, Rui; Fang, Ziye; Wei, Dang; Yao, Liang; Wang, Xiaoqin; Wang, Qi; An, Guanghui

    2016-03-15

    To evaluate/assess the quality of the Clinical Practice Guidelines (CPGs) of traditional medicine in China. We systematically searched the literature databases WanFang Data, VIP, CNKI and CBM for studies published between 1978 and 2012 to identify and select CPGs of traditional medicine. We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate these guidelines. A total of 75 guidelines were included, of which 46 guidelines (62%) were on Traditional Chinese Medicine, 19 (25%) on Chinese Integrated Medicine, and 10 (13%) on Uyghur Medicine. Most traditional medicine CPGs published in domestic journals scored medicine. In each domain of AGREE II, traditional Medicine CPGs performed clearly better than international CPGs. The same trend was seen in guidelines of Modern Medicine. An increasing amount of CPGs are being published, but their quality is low. Referring to the key points of international guidelines development, supervision through AGREE II, cooperating with international groups and exploring the strategy of guideline development could improve the quality of CPGs on traditional medicine. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. 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.

  9. 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.)

  10. 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

  11. [Internal Medicine in the curriculum of General Medicine at Universities of Mexico, 2014].

    Science.gov (United States)

    Maldonado, Jesús Adrián; Peinado, José María

    2017-01-01

    The aim of this study was to analyze Internal Medicine as a subject and its requirement in each of the Universities curriculum in Mexico that offers a degree in General Medicine. By the end of the first quarter of 2014, the research was closed and 81 campuses were studied. This research was quantitative, using an analytical technique, written discourse, exploratory and purposive sampling not random and homogeneous type. The Likert questionnaire was used in this study to analyse the following variables: the record of Internal Medicine as a subject, the burden of credit, and the location of the program. The procedure consisted of three phases. First obtaining an official list of all the Universities in the Mexican Association of Colleges and Schools of Medicine. Second, obtaining an analysis of each of the Universities' curriculums, and lastly gathering each variable of the study. The results of the Universities were 63% were public and 37% private. Internal Medicine as a subject in the curriculum was 37.1%, and 20% of the universities include it for six months and 9% offer it the whole year. However, the undergraduate internship in Internal Medicine offers it 100%. In conclusion, Internal Medicine as a subject could disappear from the curriculum in General Medicine before coming to the undergraduate internship, even though the latter is declared required in hospital shifts.

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

    Science.gov (United States)

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

    2014-06-01

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

  13. Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States Internal Medicine Residency Training.

    Science.gov (United States)

    Santhosh, Lekshmi; Babik, Jennifer; Looney, Mark R; Hollander, Harry

    2017-04-01

    Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards. At University of California-San Francisco, this has been accompanied by declining percentages of residency graduates who enter subspecialty training in internal medicine. The decline in subspecialty medicine interest can be attributed to many factors, including differences in compensation, decreased subspecialist exposure, and a changing research funding landscape. Although there has not been systematic documentation of this trend in pulmonary and critical care medicine, we have noted previously pulmonary and critical care-bound trainees switching to hospital medicine instead. With our broad, multiorgan system perspective, pulmonary and critical care faculty should embrace teaching general medicine. Residency programs have instituted creative solutions to encourage more internal medicine residents to pursue careers in subspecialty medicine. Some solutions include creating rotations that promote more contact with subspecialists and physician-scientists, creating clinician-educator tracks within fellowship programs, and appointing subspecialists to internal medicine residency leadership positions. We need more rigorous research to track the trends and implications of the generalist-specialist balance of inpatient ward teams on resident career choices, and learn what interventions affect those choices.

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

    Science.gov (United States)

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    health goals of general internal medicine, family medicine, integrative medicine, and CAM practices.

  15. Index of International Publications in Aerospace Medicine

    Science.gov (United States)

    2014-05-01

    University, 1974. Gerathewohl ST. Principles of Bioastronautics. Englewood Cliffs, NJ, USA: Prentice-Hall, 1963. Gibson DC. Commercial Space Tourism ...College of Sports Medicine, 1996. Jenkins M. Human-Rating Requirements. Houston, TX, USA: Lyndon B. Johnson Space Center, 1998. Johnson B, May GL...USA: U.S. Government Printing Office, 2000. Spencer J, Rugg KL. Space Tourism : Do You Want to Go? Burlington, Canada: Apogee Books, 2004. Stahle J

  16. Quality management audits in nuclear medicine practices

    International Nuclear Information System (INIS)

    2008-12-01

    An effective management system that integrates quality management (QM) is essential in modern nuclear medicine departments in Member States. The IAEA, in its Safety Standards Series, has published a Safety Requirement (GS-R-3) and a Safety Guide (GS-G-3.1) on management systems for all facilities. These publications address the application of an integrated management system approach that is applicable to nuclear medicine organizations as well. Quality management systems are maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, and to satisfy its customers. The IAEA has a long history of providing assistance in the field of nuclear medicine to its Member States. Regular quality audits and assessments are essential for modern nuclear medicine departments. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical and medical physics procedures. Aspects of radiation safety and patient protection should also be integral to the process. Such an approach ensures consistency in providing safe, quality and superior services to patients. Increasingly standardized clinical protocol and evidence based medicine is used in nuclear medicine services, and some of these are recommended in numerous IAEA publications, for example, the Nuclear Medicine Resources Manual. Reference should also be made to other IAEA publications such as the IAEA Safety Standards Series, which include the regulations for the safe transport of nuclear material and on waste management as all of these have an impact on the provision of nuclear medicine services. The main objective of this publication is to introduce a routine of conducting an

  17. Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

    Directory of Open Access Journals (Sweden)

    Alberto Mazza

    2017-11-01

    Full Text Available The aim of this study was to evaluate the management practices of internal medicine clinicians for patients with cardiovascular risk factors, with particular respect to treatment thresholds, medication choices and target goals. A sample of internists - representatives of Internal Medicine Units (IMUs from all the regions in Italy - were identified by the cardiovascular medicine study group of the Italian Internal Medicine FADOI (Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti Society and invited to fill out a questionnaire about hypertension, dyslipidemia and hyperuricemia. From the 101 questionnaires collected, it was found that despite large heterogeneity between IMUs in terms of patient management and adherence to guidelines, internists were experts in the management of patients with multiple cardiovascular risk factors and associated comorbidities. We hope that these data prompt the internal medicine community to consider the value of producing shared, real-world guidelines on the management of cardiovascular disease.

  18. Laboratory Medicine is Faced with the Evolution of Medical Practice

    Directory of Open Access Journals (Sweden)

    Collinson Paul

    2017-09-01

    Full Text Available Laboratory medicine and clinical medicine are co-dependent components of medicine. Laboratory medicine functions most effectively when focused through a clinical lens. Me dical practice as a whole undergoes change. New drugs, treatments and changes in management strategies are introduced. New techniques, new technologies and new tests are developed. These changes may be either clinically or laboratory initiated, and so their introduction requires dialogue and interaction between clinical and laboratory medicine specialists. Treatment monitoring is integral to laboratory medicine, varying from direct drug measurement to monitoring cholesterol levels in response to treatment. The current trend to »personalised medicine« is an extension of this process with the development of companion diagnostics. Technological innovation forms part of modern laboratory practice. Introduction of new technology both facilitates standard laboratory approaches and permits introduction of new tests and testing strategies previously confined to the research laboratory only. The revolution in cardiac biomarker testing has been largely a laboratory led change. Flexibility in service provision in response to changing clinical practice or evolving technology provides a significant laboratory management challenge in the light of increasing expectations, shifts in population demographics and constraint in resource availability. Laboratory medicine practitioners are adept at meeting these challenges. One thing remains constant, that there will be a constant need laboratory medicine to meet the challenges of novel clinical challenges from infectious diseases to medical conditions developing from lifestyle and longevity.

  19. 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

  20. 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.

  1. 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.

  2. Practical measurement of affordability: An application to medicines

    NARCIS (Netherlands)

    L.M. Niëns (Laurens); E. Van de Poel (Ellen); A. Cameron (ALexandra); M. Ewen (Margaret); R. Laing (Richard); W.B.F. Brouwer (Werner)

    2012-01-01

    markdownabstract__Objective:__ To develop two practical methods for measuring the affordability of medicines in developing countries. __Methods:__ The proposed methods - catastrophic and impoverishment methods - rely on easily accessible aggregated expenditure data and take into account a

  3. Paramedics' experiences of financial medicine practices in the pre ...

    African Journals Online (AJOL)

    Craig Vincent-Lambert

    African Paramedics with regard to the practicing of financial medicine in the local pre- hospital emergency .... These are Basic Life Support (BLS), Intermediate life Support. (ILS) or ... reports by members of the profession have highlighted cir-.

  4. [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

  5. Evidence-Based Laboratory Medicine: Is It Working in Practice?

    OpenAIRE

    Price, Christopher P

    2012-01-01

    The principles of Evidence-Based Medicine have been established for about two decades, with the need for evidence-based clinical practice now being accepted in most health systems around the world. These principles can be employed in laboratory medicine. The key steps in evidence-based practice, namely (i) formulating the question; (ii) searching for evidence; (iii) appraising evidence; (iv) applying evidence; and (v) assessing the experience are all accepted but, as yet, translation into dai...

  6. Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns.

    Science.gov (United States)

    Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur

    2013-08-01

    The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  7. Liberal Internationalism: Theory, History, Practice

    Directory of Open Access Journals (Sweden)

    Oliver Stuenkel

    2014-01-01

    Full Text Available While liberalism keeps adapting to circumstances, its underlying dynamic is the same: Liberalism, Jahn, argues, is a political project that aims to establish individual freedom through private property and to protect and extend this freedom through government by consent - yet, it pursues this goal through the privatization and expropriation of common property and hence requires the production and reproduction of unequal power relations domestically and internationally. Liberalism is thus, in essence, made viable through power politics, with the mere difference that is uses liberal rhetoric as a fig leaf to conceal the ultimate goal: To provide a justification for American hegemony.

  8. Perception of illegal practice of medicine by Brazilian medical students.

    Science.gov (United States)

    Lins, Liliane; Herbas, Suzana; Lisboa, Larissa; Damasceno, Hannah; Menezes, Marta

    2014-06-01

    Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce. To describe the perception of illegal practice of medicine by medical students. A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice of medicine by medical students. Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine (78.8%) and occupational health (55.9%). Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th-9th semester (56.8%) and 10th-11th semester (54.4%) of medical school. Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Quality Management Audits in Nuclear Medicine Practices. 2. Ed

    International Nuclear Information System (INIS)

    2015-01-01

    Quality management systems are essential and should be maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, satisfy its customers and improve professionalism. The quality management (QM) audit methodology in nuclear medicine practice, introduced in this publication, is designed to be applied to a variety of economic circumstances. A key outcome is a culture of reviewing all processes of the clinical service for continuous improvement in nuclear medicine practice. Regular quality audits and assessments are vital for modern nuclear medicine services. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical, medical physics and radiation safety procedures

  10. Criteria for evidence-based practice in Iranian traditional medicine.

    Science.gov (United States)

    Soltani Arabshahi, SeyyedKamran; Mohammadi Kenari, Hoorieh; Kordafshari, Gholamreza; Shams-Ardakani, MohammadReza; Bigdeli, Shoaleh

    2015-07-01

    The major difference between Iranian traditional medicine and allopathic medicine is in the application  of  evidence  and  documents.  In  this  study,  criteria  for  evidence-based  practice  in  Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.

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

    Science.gov (United States)

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

    2013-06-01

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

  12. 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

  13. Personalized medicine. Closing the gap between knowledge and clinical practice.

    Science.gov (United States)

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Duncan Alan K

    2006-05-01

    Full Text Available Abstract Background 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. Methods 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. Results 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 Conclusion 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.

  15. [Diagnosis and treatment in general internal medicine. Curriculum selection].

    Science.gov (United States)

    Casal, E R; Vázquez, E N; Husni, C

    1994-01-01

    In our country general internists are the providers of adult medical care in urban areas. In the past twenty years, with the increasing subspecialization within internal medicine and the development of advances in technology, the role of the general internist seems to be endangered. Recently much attention has been focused on this area and Divisions and Programs of General Internal Medicine have been established in most medical schools in the USA. The University of Buenos Aires instituted a Program of General Internal Medicine in its major teaching hospital in 1987. One of its purposes was to offer an educational experience to residents in the field of internal medicine primary care. This paper summarizes how this program was carried out and the subjects proposed in the area of Diagnosis and Treatment. The Program of General Internal Medicine is performed in the Outpatient Division and it is staffed by 3 faculty members and 4 fellows. Residents in Internal Medicine have a three month, full-time block rotation in the Program. A young, city dwelling, lower middle class population participates in the Program, with almost 10000 visits a year. The Program offers an experience that includes supervised patient care, an average of 100 office visits a month, and seminars and/or workshops covering topics of "Diagnosis and Treatment", "Case Presentations", "Clinical Epidemiology", "Prevention", and "Doctor-Patient Interview". In the area of Diagnosis and Treatment, the criteria used were: 1-frequency of diagnosis as determined by previous investigations, 2-relevant clinical conditions absent from the frequency list as determined by a consensus process by faculty members.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    Science.gov (United States)

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

    2017-06-01

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

  17. A travel clinic in your office: grow your practice and protect international travelers.

    Science.gov (United States)

    Kirsch, Michael

    2009-01-01

    Medical practices today face economic challenges from declining reimbursements and rising overhead costs. Physicians need to develop new income sources to invigorate their practices and remain viable. Travel medicine-advising and immunizing international travelers-is a rapidly growing specialty in the United States that generates substantial cash reimbursements and professional satisfaction. Travel Clinics of America, a physician-operated company, specializes in helping physicians to incorporate travel medicine into their existing practices.

  18. Nuclear medicine training and practice in Poland

    International Nuclear Information System (INIS)

    Teresinska, Anna; Birkenfeld, Bozena; Krolicki, Leszek; Dziuk, Miroslaw

    2014-01-01

    In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes regular

  19. Nuclear medicine training and practice in Poland

    Energy Technology Data Exchange (ETDEWEB)

    Teresinska, Anna [Institute of Cardiology, Department of Nuclear Medicine, Warsaw (Poland); Birkenfeld, Bozena [Pomeranian Medical University, Department of Nuclear Medicine, Szczecin (Poland); Krolicki, Leszek [Warsaw Medical University, Department of Nuclear Medicine, Warsaw (Poland); Dziuk, Miroslaw [Military Institute of Medicine, Department of Nuclear Medicine, Warsaw (Poland)

    2014-10-15

    In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes

  20. A historical overview of traditional medicine practices and policy in ...

    African Journals Online (AJOL)

    Background: Although traditional medicine plays an important role in Ethiopian society, knowledge about the extent and characteristics of traditional healing practices and practitioners is limited and has frequently been ignored in the national health system. Objective: To review history of practices and policies on traditional ...

  1. Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

    Science.gov (United States)

    Drury, David L; Adamo, Philip; Cloeren, Marianne; Hegmann, Kurt T; Martin, Douglas W; Levine, Michael J; Olson, Shawn M; Pransky, Glenn S; Tacci, James A; Thiese, Matthew

    2018-05-01

    : High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.

  2. Practical applications of internal dose calculations

    International Nuclear Information System (INIS)

    Carbaugh, E.H.

    1994-06-01

    Accurate estimates of intake magnitude and internal dose are the goal for any assessment of an actual intake of radioactivity. When only one datum is available on which to base estimates, the choices for internal dose assessment become straight-forward: apply the appropriate retention or excretion function, calculate the intake, and calculate the dose. The difficulty comes when multiple data and different types of data become available. Then practical decisions must be made on how to interpret conflicting data, or how to adjust the assumptions and techniques underlying internal dose assessments to give results consistent with the data. This article describes nine types of adjustments which can be incorporated into calculations of intake and internal dose, and then offers several practical insights to dealing with some real-world internal dose puzzles

  3. 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

  4. Public practice regarding disposal of unused medicines in Ireland.

    Science.gov (United States)

    Vellinga, Akke; Cormican, Sarah; Driscoll, Jacqueline; Furey, Michelle; O'Sullivan, Mai; Cormican, Martin

    2014-04-15

    Over recent years, a global increase in the use of pharmaceutical products has been observed. EU directives state that "Member states shall ensure that appropriate collection systems are in place for medicinal products that are unused or have expired" (Directive 2001/83/EC and Directive 2004/27/EC). There is no published data on how people in Ireland dispose of unused medicines; therefore the purpose of this study is to establish baseline information on storage and disposal of medicines. Data was collected over two 2-week periods a year apart. People in the streets of Galway and Cork were approached randomly and invited to participate by filling out a questionnaire. The questionnaire was completed by 398 individuals (207 in Galway and 191 in Cork). Unused medicines were kept in the home by 88% of the respondents. The most cited reason for keeping unused medicines was "in case they are needed later" (68%). Of the respondents who had disposed of medicine in the past, 72% had done so inappropriately. Environmentally inappropriate disposal methods were through general waste disposal and via the sewage system. Interestingly, of the people who had received advice on disposal practices from a healthcare professional, 75% disposed of their medicine appropriately. There is little awareness among members of the public regarding appropriate ways to dispose of unused medicines. Our findings suggest that effective communication and established protocols will promote appropriate disposal practices. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Evolutionary medicine: update on the relevance to family practice.

    Science.gov (United States)

    Naugler, Christopher T

    2008-09-01

    To review the relevance of evolutionary medicine to family practice and family physician training. Articles were located through a MEDLINE search, using the key words evolution, Darwin, and adaptation. Most references presented level III evidence (expert opinion), while a minority provided level II evidence (epidemiologic studies). Evolutionary medicine deals with the interplay of biology and the environment in the understanding of human disease. Yet medical schools have virtually ignored the need for family physicians to have more than a cursory knowledge of this topic. A review of the main trends in this field most relevant to family practice revealed that a basic knowledge of evolutionary medicine might help in explaining the causation of diseases to patients. Evolutionary medicine has also proven key to explaining the reasons for the development of antibiotic resistance and has the potential to explain cancer pathogenesis. As an organizing principle, this field also has potential in the teaching of family medicine. Evolutionary medicine should be studied further and incorporated into medical training and practice. Its practical utility will be proven through the generation of testable hypotheses and their application in relation to disease causation and possible prevention.

  6. Practice of nuclear medicine in a developing country

    International Nuclear Information System (INIS)

    Hasan, M.M.; Karim, M.A.; Nahar, N.; Haque, M.M.

    2002-01-01

    For more than a half a century nuclear medicine is contributing in the field of medicine. Still nuclear medicine is not widely available in many countries. Especially in developing countries due to many a reasons nuclear medicine could not flourish in that way. Availability of radioisotope, high cost of instrument and sophistication of the branch are the three main reasons behind. Even the countries where nuclear medicine is functioning for quite a long time, the facilities for proper function are still not adequate. Training of manpower, maintenance of instruments, regular supply of isotopes and kit and cost effectiveness are some of the major problems. We have seen some fast developments in nuclear medicine in last few decades. Development of gamma detecting systems with SPECT, positron emission detector (PET), supported computer technology and introduction of some newer radiopharmaceuticals for functional studies are few of the examples. The developing countries also have a problem to go on parallel with these rapid development of nuclear medicine in other part of the world. In last few decades we have also witnessed development of CT, MRI, Ultrasound and other imaging modalities as our competitor. Specially for developing countries these have posed as a major challenge for nuclear medicine. A better understanding between developed and developing nations is the key point of todays ultimate success in any sector. For real development of nuclear medicine and to give the majority of the people the benefit of nuclear medicine a better and more active co-operation is needed between all the countries. The paper presents the difficulties and some practical problems of practicing nuclear medicine in a developing country. And also appeals for global co-operation to solve the problems for better interest of the subject

  7. ACUPUNCTURE APPLICATIONS IN SPORTS MEDICINE PRACTICE

    Directory of Open Access Journals (Sweden)

    Özlem KARASİMAV

    2015-06-01

    Full Text Available Acupuncture is regarded as one of the most popular complementary medical techniques nowadays; and can be used for pain control, injury healing and acceleration of recovery in athletes. If theories explaining the effect mechanisms of acupuncture, its probable risks and potential benefits are clearly presented; sports medicine specialists will be able to make recommendations about this therapy more easily. Acupuncture is evaluated as a quite reliable therapy method in case of being applied by experienced and well-trained hands. Studies on acupuncture have much increased in the western world over the last 30 years. This short review is about some studies presenting the effects of acupuncture, and on the limitations affecting the reliability of these studies.

  8. 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

  9. 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.

  10. Incidence of refeeding syndrome in internal medicine patients.

    Science.gov (United States)

    Kraaijenbrink, B V C; Lambers, W M; Mathus-Vliegen, E M H; Siegert, C E H

    2016-03-01

    Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to a department of internal medicine. All patients acutely admitted to the department of internal medicine of a teaching community hospital in Amsterdam, the Netherlands, between 22 February 2011 and 29 April 2011, were included. We applied the National Institute for Health and Care Excellence (NICE) criteria for determining people at risk of refeeding syndrome and took hypophosphataemia as the main indicator for the presence of this syndrome. Of 178 patients included in the study, 97 (54%) were considered to be at risk of developing refeeding syndrome and 14 patients actually developed the syndrome (14% of patients at risk and 8% of study population). Patients with a malignancy or previous malignancy were at increased risk of developing refeeding syndrome (p refeeding syndrome. The Short Nutritional Assessment Questionnaire score had a positive and negative predictive value of 13% and 95% respectively. The incidence of refeeding syndrome was relatively high in patients acutely admitted to the department of internal medicine. Oncology patients are at increased risk of developing refeeding syndrome. When taking the occurrence of hypophosphataemia as a hallmark, no other single clinical or composite parameter could be identified that accurately predicts the development of refeeding syndrome.

  11. Incidence of refeeding syndrome in internal medicine patients

    NARCIS (Netherlands)

    Kraaijenbrink, B. V. C.; Lambers, W. M.; Mathus-Vliegen, E. M. H.; Siegert, C. E. H.

    2016-01-01

    Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to

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

    Science.gov (United States)

    Flannery, Michael T

    2014-03-01

    This perspective attempts to bring graduate medical offices, residency programs and medical students interested in categorical internal medicine (CIM) a brief update on the American Board of Internal Medicine (ABIM), Accreditation Council for Graduate Medical Education (ACGME) and the National Registry for Medical Programs (NRMP) changes for the past 3-5 years in the United States (US). The US model for certification and recertification may serve as a homogenous example for other countries. This model will be described so that there is an understanding of the importance of such changes in the American system and its effect on resident education. This is critical knowledge for both teachers and learners in internal medicine in preparation for a lifetime career and requirements for certification/credentialing for both programs and their residents/fellows. Data from the review indicate a small increase in the number of applicants but a concordant decrease in ABIM initial certification exams. Programs should well be aware of the new focus on outcomes via the Next Accreditation System (NAS) being put forth by the ACGME. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  13. Optimizing the use of intravenous therapy in internal medicine.

    Science.gov (United States)

    Champion, Karine; Mouly, Stéphane; Lloret-Linares, Celia; Lopes, Amanda; Vicaut, Eric; Bergmann, Jean-François

    2013-10-01

    We aimed to evaluate the impact of physicians' educational programs in the reduction of inappropriate intravenous lines in internal medicine. Fifty-six French internal medicine units were enrolled in a nationwide, prospective, blinded, randomized controlled trial. Forms describing the patients with an intravenous line and internal medicine department characteristics were filled out on 2 separate days in January and April 2007. Following the first visit, all units were randomly assigned to either a specific education program on the appropriate indications of an intravenous line, during February and March 2007, or no training (control group). The Investigators' Committee then blindly evaluated the clinical relevance of the intravenous line according to pre-established criteria. The primary outcome was the percentage of inappropriate intravenous lines. During January 2007, intravenous lines were used in 475 (24.9%) of the 1910 hospitalized patients. Of these, 80 (16.8%) were considered inappropriate. In April 2007, 416 (22.8%) of the 1823 hospitalized patients received an intravenous line, which was considered in 10.2% (21/205) of patients managed by trained physicians, versus 16.6% (35/211) of patients in the control group (relative difference 39%; 95% confidence interval, -0.6-13.3; P = .05). Reduced intravenous administration of fluids, antibiotics, and analgesics accounted for the observed decrease. The use of a simple education program reduced the rate of inappropriate intravenous lines by almost 40% in an internal medicine setting (NCT01633307). Copyright © 2013 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Jones, Roger; Panda, Mukta; Desbiens, Norman

    2008-01-01

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

  15. 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)

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

    Science.gov (United States)

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

    2017-09-01

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

  17. Promoting interventional radiology in clinical practice of emergency medicine

    International Nuclear Information System (INIS)

    Zhou Bing; Yuan Jianhua

    2009-01-01

    Interventional radiology has lot of advantages in dealing with various emergencies. The technique is minimally-invasive, highly-effective and immediately-efficient, moreover, it integrates the diagnosis with the therapy perfectly. Besides, the interventional techniques applied in emergency medicine include not only the vascular interventions,such as embolization, embolectomy, etc, but also the nonvascular interventions, such as tracheal s tent implantation, percutaneous vertebroplasty and so forth. However, importance has not been attached to the clinical use of interventional therapy in emergency medicine so far. It is imperative for us to promote the acceptance of interventional therapy in emergency medicine as well as to popularize the technique in clinical practice. (authors)

  18. International practice experiences in pharmacy education.

    Science.gov (United States)

    Cisneros, Robert M; Jawaid, Sarah Parnapy; Kendall, Debra A; McPherson, Charles E; Mu, Keli; Weston, Grady Scott; Roberts, Kenneth B

    2013-11-12

    To identify reasons for inclusion of international practice experiences in pharmacy curricula and to understand the related structure, benefits, and challenges related to the programs. A convenience sample of 20 colleges and schools of pharmacy in the United States with international pharmacy education programs was used. Telephone interviews were conducted by 2 study investigators. University values and strategic planning were among key driving forces in the development of programs. Global awareness and cultural competency requirements added impetus to program development. Participants' advice for creating an international practice experience program included an emphasis on the value of working with university health professions programs and established travel programs. Despite challenges, colleges and schools of pharmacy value the importance of international pharmacy education for pharmacy students as it increases global awareness of health needs and cultural competencies.

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

    Science.gov (United States)

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

    2017-05-01

    To make an inventory of training of Internal Medicine in France. This study was conducted between May and September 2015 with coordinators (interviews of 45minutes) of local Internal Medicine training and fellows (online questionnaire). All coordinators (n=28) responded to the interviews. Local training of Internal Medicine exists in 86% of regions (3.1±3.1hours/month) and an interregional training in all interregions (34.7±13.9hours/year). When excluding Île-de-France, no correlation between the number of teachers and the amount of lessons was noted (P=0.61). Of the 550 fellows in Internal Medicine in 2014-2015, 223 (41%) responded to the online questionnaire. Mean level was 5.5±2.7 semesters. The rate of satisfaction (1=very dissatisfied and 5=very satisfied) was 3.0±1.0 and 3.8±0.8 for regional and interregional teaching, respectively (P<0.0001). Regional teaching satisfaction was correlated with the perceived expanse of diseases covered into the program (P<0.0001). In addition, 89% of fellows wish to evaluate themselves online, 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.

  20. Economic impact of traditional medicine practice worldwide

    Directory of Open Access Journals (Sweden)

    Ana V. Pejcic

    2017-04-01

    Full Text Available The aim of this literature review was to summarize available findings from publications that reported expenditure on traditional/complementary and alternative medicine (TM/CAM within a representative general population sample of a nation or a defined geographical area. A total of 24 publications met the inclusion criteria and were included in the review. The expenditure on TM/CAM varies worldwide, but direct comparison of the findings of publications included in this review is limited due to the differences in the definitions of TM/CAM, inclusion of various forms of TM/CAM, use of different names and categorization, as well as differences in reported currencies and time periods in which data were collected. Data about the expenditure on TM/CAM in most countries throughout the world are scarce. Further national studies should be conducted in order to provide up-to-date assessment of the TM/CAM related expenditure patterns and use. Uniform nomenclature, definition of TM/CAM and standardized instruments would provide basis for comparability of data of studies conducted in various regions and time periods.

  1. 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.

  2. [Ethical Dilemmas in Practice of Medicine Child].

    Science.gov (United States)

    Ruiz López, Justo; Navarro Zaragoza, Javier; Carrillo Navarro, Francisco; Luna Maldonado, Aurelio

    2017-01-01

    After reviewing the existing bibliography in the last 20 years, we concluded that there is a lack of information regarding the ethical conflicts that affect to pediatrics in their daily practice. It produces certain degree of uncertainty in these professionals at the time of solving these problems. We made a systematic search in the main data bases, finding more than 150 articles related, of which 80 were considered outstanding. After studying them, we have found 40 ethical dilemmas, related to some principle of solution and that we described in this article. Through them we can find such important dilemmas as those related to physical disability, palliative care or consent from children.

  3. Internal Contamination by 131I in nuclear medicine department

    International Nuclear Information System (INIS)

    Chahed, N.; Mtimet, S.; Hammami, H.; Mhiri, A.

    1998-01-01

    Therapeutic applications in nuclear medicine use high activities of 131 I in sodium iodine liquid from which is volatile at ambient temperature. Besides external exposure there is, for the nuclear medicine personnel, an internal exposure risk induced by 131 iodine inhalation. So we tried to assess this risk among the personnel in a nuclear medicine department. We used direct method for measuring 131 radioactivity in vivo by external counting. Gamma ray detector with a Nal ( TI ) probe positioned near the thyroid gland allows investigation of 131 radioactivity. We realised 34 measurements among the personnel, two times at an interval of one month. The results indicate that an 131 iodine internal contamination is found. Estimated thyroid activities were ranging from 35 to 132 Bq. The highest activities has been found in the thyroid of the technicians involved in the administration of 131 iodine therapy. Therefore this values are lower than norms. This study must lead to the implementation control of the 131 iodine internal contamination in order to optimise the personnel protection in nuclear medicine departments (author)

  4. [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.

  5. Exploring CLT Practices in Saudi International Schools

    Science.gov (United States)

    Abdel-Salam, Ahmed Saad

    2014-01-01

    This is a research study conducted on 17 teachers who teach English in Saudi international schools. It mainly aims at exploring teaching practices in these schools in terms of the principles of communicative language teaching (CLT). It also investigates the appropriateness of CLT in this context from the point of view of teachers. Two research…

  6. International Military Practice Amidst Ethical Heterogeneity

    Science.gov (United States)

    2013-12-13

    importance of the multicultural environment cannot be understated, and the ethical make-up, moral philosophy, and cultural relativism (Robertson and...determinism, moral relativism . Rather, the development of students’ ethical and moral strength is achieved by engaging in learning opportunites...INTERNATIONAL MILITARY PRACTICE AMIDST ETHICAL HETEROGENEITY A thesis presented to the Faculty of the U.S. Army Command and

  7. Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study.

    Science.gov (United States)

    Daniels, Vijay J; Kassam, Narmin

    2013-12-21

    There has been a decline in interest in general internal medicine that has resulted in a discrepancy between internal medicine residents' choice in the R4 subspecialty match and societal need. Few studies have focused on the relative importance of personal goals and their impact on residents' choice. The purpose of this study was to assess if internal medicine residents can be grouped based on their personal goals and how each group prioritizes these goals compared to each other. A secondary objective was to explore whether we could predict a resident's desired subspecialty choice based on their constellation of personal goals. We used Q methodology to examine how postgraduate year 1-3 internal medicine residents could be grouped based on their rankings of 36 statements (derived from our previous qualitative study). Using each groups' defining and distinguishing statements, we predicted their subspecialties of interest. We also collected the residents' first choice in the subspecialty match and used a kappa test to compare our predicted subspecialty group to the residents' self-reported first choice. Fifty-nine internal medicine residents at the University of Alberta participated between 2009 and 2010 with 46 Q sorts suitable for analysis. The residents loaded onto four factors (groups) based on how they ranked statements. Our prediction of each groups' desired subspecialties with their defining and/or distinguishing statements are as follows: group 1 - general internal medicine (variety in practice); group 2 - gastroenterology, nephrology, and respirology (higher income); group 3 - cardiology and critical care (procedural, willing to entertain longer training); group 4 - rest of subspecialties (non-procedural, focused practice, and valuing more time for personal life). There was moderate agreement (kappa = 0.57) between our predicted desired subspecialty group and residents' self-reported first choice (p internal medicine subspecialty. The key goals that define

  8. The ANÌMO Decalogue for a Slow Medicine care: the general recommendations of the nurses of internal medicine for a sober, respectful and equitable care

    Directory of Open Access Journals (Sweden)

    Gabriella Bordin

    2015-09-01

    Full Text Available Following the lead of Slow Medicine, the Association of Nurses of Internal Medicine (ANÌMO saw the opportunity to build, through an analysis of the professional practice, an alliance between health professionals and citizens in order to support and facilitate informed choices. From this revision emerged The Decalogue, a document which summarizes the fundamental pillars of the slow nursing to guarantee a sober respectful and equitable care during the hospitalization.

  9. Burnout and Physical Activity in Minnesota Internal Medicine Resident Physicians

    Science.gov (United States)

    Olson, Shawn M.; Odo, Nnaemeka U.; Duran, Alisa M.; Pereira, Anne G.; Mandel, Jeffrey H.

    2014-01-01

    Background Regular physical activity plays an important role in the amelioration of several mental health disorders; however, its relationship with burnout has not yet been clarified. Objective To determine the association between achievement of national physical activity guidelines and burnout in internal medicine resident physicians. Methods A Web-based survey of internal medicine resident physicians at the University of Minnesota and Hennepin County Medical Center was conducted from September to October 2012. Survey measures included the Maslach Burnout Inventory-Human Services Survey and the International Physical Activity Questionnaire. Results Of 149 eligible residents, 76 (51.0%) completed surveys, which were used in the analysis. Burnout prevalence, determined by the Maslach Burnout Inventory, was 53.9% (41 of 76). Prevalence of failure to achieve US Department of Health and Human Services physical activity guidelines was 40.8% (31 of 76), and 78.9% (60 of 76) of residents reported that their level of physical activity has decreased since they began medical training. Residents who were able to meet physical activity guidelines were less likely to be burned out than their fellow residents (OR, 0.38, 95% CI 0.147–0.99). Conclusions Among internal medicine resident physicians, achievement of national physical activity guidelines appears to be inversely associated with burnout. Given the high national prevalence of burnout and inactivity, additional investigation of this relationship appears warranted. PMID:26140116

  10. Associations between quality indicators of internal medicine residency training programs

    Science.gov (United States)

    2011-01-01

    Background Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality. Methods Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression. Results Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation. Conclusions Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification. PMID:21651768

  11. [Assessing research productivity in Department of Internal Medicine, University of Zagreb, School of Medicine and University Hospital Centre Zagreb].

    Science.gov (United States)

    Petrak, Jelka; Sember, Marijan; Granić, Davorka

    2012-01-01

    Bibliometric analysis may give an objective information about publishing activity, citation rate and collaboration patterns of individuals, groups and institutions. The publication productivity of the present medical staff (79 with specialist degree and 22 residents) in Department of Internal Medicine, University of Zagreb School of Medicine in University Hospital Centre Zagreb was measured by the number of papers indexed by Medline, their impact was measured by the number of times these papers had subsequently been cited in the medical literature, while the collaboration pattern was estimated by the authors' addresses listed in the papers. PubMed database was a source for verifying the bibliographic data, and the citation data were searched via Thomson Web of Scence (WoS) platform. There were a total of 1182 papers, published from 1974 to date. The number of papers per author ranged from 0 to 252. Sixty of papers were published in English, and 39% in Croatian language. The roughly equal share was published in local and foreign journals. The RCT studies and practice guidelines were among the most cited papers and were at the same time published by the highly ranked journals. The collaboration analysis confirmed the extensive involment in the international multicentric clinical trials as well as in the development of international/local practice guidelines.

  12. Computed tomographic practice and dosimetry: implications for nuclear medicine: editorial

    International Nuclear Information System (INIS)

    Mountford, P.J.; Harding, L.K.

    1992-01-01

    This editorial briefly discusses the results of an NRPB survey of x-ray computed tomography practice and dosimetry in the UK. A wide variation in practice and patient doses was revealed. The implications for nuclear medicine are considered. The NRPB is to issue formal guidance on protection of the patient undergoing a CT investigation with the aim of achieving a more systematic approach to the justification and optimization of such exposures. (UK)

  13. 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.

  14. 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.

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

    LENUS (Irish Health Repository)

    Ayu, Astri Parawita

    2017-07-18

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

  16. Ethical conflict in the practice of occupational medicine.

    Science.gov (United States)

    Brandt-Rauf, P W

    1989-01-01

    The practice of occupational medicine has been portrayed as being fraught with ethical conflict and yet this problem has received little systematic study. A question and case study survey of a randomly selected cohort of members of the American Occupational Medical Association has been performed to examine the extent and nature of this problem in occupational medicine practice in the United States. The results indicate a strong reliance on traditional medical role models in responding to ethical conflict but with significant underlying tension between more deontological physician-patient approaches and more teleological public health approaches. These results have significant implications for the synthesis of bioethical theories based on a perceived complementarity of ethical reality, as well as suggesting important improvements in future occupational medicine training.

  17. The Practice of Medicine at a District Hospital Emergency Room ...

    African Journals Online (AJOL)

    To remain in touch with the changing environment of medicine, one has to keep on learning and sometimes attend refresher courses far away from the place of work. The rewarding part of the practice is that many junior doctors benefit from the experience of the senior colleagues, who teach them basic skills. A practitioner ...

  18. 29 CFR 541.304 - Practice of law or medicine.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Practice of law or medicine. 541.304 Section 541.304 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS DEFINING AND DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES Professional Employees §...

  19. Infliximab (Revellex(R)): a promise fulfilled?: medicine in practice ...

    African Journals Online (AJOL)

    Infliximab (Revellex(R)): a promise fulfilled?: medicine in practice. JP Wright. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners ...

  20. Problematic communications during 2016 fellowship recruitment in internal medicine.

    Science.gov (United States)

    Cornett, Patricia A; Williams, Chris; Alweis, Richard L; McConville, John; Frank, Michael; Dalal, Bhavin; Kopelman, Richard I; Luther, Vera P; O'connor, Alec B; Muchmore, Elaine A

    2017-01-01

    Some internal medicine residency program directors have expressed concerns that their third-year residents may have been subjected to inappropriate communication during the 2016 fellowship recruitment season. The authors sought to study applicants' interpersonal communication experiences with fellowship programs. Many respondents indicated that they had been asked questions that would constitute violations of the National Residency Matching Program (NRMP) Communications Code of Conduct agreement, including how they plan to rank specific programs. Moreover, female respondents were more likely to have been asked questions during interview experiences about other programs to which they applied, and about their family plans. Post-interview communication policies were not made clear to most applicants. These results suggest ongoing challenges for the internal medicine community to improve communication with applicants and uniform compliance with the NRMP communications code of conduct during the fellowship recruitment process.

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

    Science.gov (United States)

    Al-Aama, Tareef

    2016-06-01

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

  2. 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.

  3. Problematic communications during 2016 fellowship recruitment in internal medicine.

    OpenAIRE

    Cornett, PA; Williams, C; Alweis, RL; McConville, J; Frank, M; Dalal, B; Kopelman, RI; Luther, VP; O'connor, AB; Muchmore, EA

    2017-01-01

    ABSTRACT Some internal medicine residency program directors have expressed concerns that their third-year residents may have been subjected to inappropriate communication during the 2016 fellowship recruitment season. The authors sought to study applicants’ interpersonal communication experiences with fellowship programs. Many respondents indicated that they had been asked questions that would constitute violations of the National Residency Matching Program (NRMP) Communications Code of Condu...

  4. Third International Electronic Conference on Medicinal Chemistry (ECMC-3

    Directory of Open Access Journals (Sweden)

    Annie Mayence

    2018-02-01

    Full Text Available The third International Electronic Conference on Medicinal Chemistry, organized and sponsored by MDPI AG, publisher, and the journal Pharmaceuticals, took place in November 2017 on the SciForum website (www.sciforum.net/conference/ecmc-3. Around 300 authors from 34 different countries participated at the event, which hosted more than 70 presentations, keynotes, videos, and posters. A short description of some works presented during that scientific meeting is disclosed in this report.

  5. Burnout, coping, and spirituality among internal medicine resident physicians.

    Science.gov (United States)

    Doolittle, Benjamin R; Windish, Donna M; Seelig, Charles B

    2013-06-01

    Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r  =  +.28, P  =  .003), as well as the internal/fluid domain (r  =  +.32, P  =  .001), existential axes (r  =  +.32, P  =  .001), and humility/personal application domain (r  =  +.23, P  =  .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r  =  -.20, P  =  .04) and depersonalization (r  =  -.25, P  =  .009). No activity or demographic factor affected any burnout domain. Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.

  6. Internal Medicine Residents Reject ?Longer and Gentler? Training

    OpenAIRE

    Gopal, R. K.; Carreira, F.; Baker, W. A.; Glasheen, J. J.; Crane, L. A.; Miyoshi, T. J.; Prochazka, A. V.

    2007-01-01

    Background Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3?years would be accepted by trainees. Objective We aimed to determine if further work-hour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. Design A postal surv...

  7. Medicinal plant diversity and traditional healing practices in eastern Nepal.

    Science.gov (United States)

    Shrestha, Nawal; Shrestha, Saugat; Koju, Laxmi; Shrestha, Krishna Kumar; Wang, Zhiheng

    2016-11-04

    The rich floral and ethnic composition of eastern Nepal and the widespread utilization of locally available medicinal plants offer remarkable opportunity for ethnomedicinal research. The present paper aims to explore medicinal plant diversity and use in the remote villages of eastern Nepal. It also aims to evaluate ethnopharmacological significance of the documented use reports and identify species of high indigenous priority. The study was undertaken in four villages located in the Sankhuwasabha district in eastern Nepal. Ethnomedicinal information was collected through structured interviews. The homogeneity of informant's knowledge and the relative importance of documented medicinal plants were validated by informant consensus factor and use value, respectively. Species preference for treatment of particular diseases was evaluated through fidelity level. We reported medicinal properties of 48 species belonging to 33 families and 40 genera, for the treatment of 37 human ailments. The uses of 10 medicinal plants were previously undocumented. The informant consensus factor (F IC ) ranged between 0.38 and 1 with about 50% of values greater than 0.80 and over 75% of values greater than 0.70, indicating moderate to high consensus among the informants on the use of medicinal plants in the region. Swertia chirayita was the most preferred species with significantly high use values, followed by Paris polyphylla and Neopicrorhiza scrophulariiflora. The remote villages in eastern Nepal possess rich floral and cultural diversity with strong consensus among informants on utilization of plants for local healthcare. The direct pharmacological evidence for medicinal properties of most species indicates high reliability of documented information. Careful and systematic screening of compounds isolated from these plants could possibly provide good opportunity for the discovery of novel medicines to treat life-threatening human diseases. We recommend prioritization of medicinal

  8. Medical doctors and complementary and alternative medicine: the context of holistic practice.

    Science.gov (United States)

    Winnick, Terri A

    2006-04-01

    Consumers, health care financing, external and internal competition are factors identified in the medical literature as prompting change within medicine. I test these factors to determine if they also prompt regular doctors to define themselves as 'holistic MDs' and align themselves with complementary and alternative medicine (CAM). State-level regression analyses on the number of MDs advertising in referral directories for CAM therapies find holistic practice a function of practice locale. The proportion of holistic MDs increases in states with an older population, where more patients survive despite serious disabilities, and where non-physician providers pose a competitive threat. Consumer demand, specialization and licensing do not significantly influence adoption of CAM treatments in these analyses. Health care financing has disparate effects. Indemnity insurance constrains holistic practice while HMO penetration enhances it. These results suggest that holistic practice may be an integral part of the regular profession's ongoing professionalization project.

  9. [Monitoring medication errors in an internal medicine service].

    Science.gov (United States)

    Smith, Ann-Loren M; Ruiz, Inés A; Jirón, Marcela A

    2014-01-01

    Patients admitted to internal medicine services receive multiple drugs and thus are at risk of medication errors. To determine the frequency of medication errors (ME) among patients admitted to an internal medicine service of a high complexity hospital. A prospective observational study conducted in 225 patients admitted to an internal medicine service. Each stage of drug utilization system (prescription, transcription, dispensing, preparation and administration) was directly observed by trained pharmacists not related to hospital staff during three months. ME were described and categorized according to the National Coordinating Council for Medication Error Reporting and Prevention. In each stage of medication use, the frequency of ME and their characteristics were determined. A total of 454 drugs were prescribed to the studied patients. In 138 (30,4%) indications, at least one ME occurred, involving 67 (29,8%) patients. Twenty four percent of detected ME occurred during administration, mainly due to wrong time schedules. Anticoagulants were the therapeutic group with the highest occurrence of ME. At least one ME occurred in approximately one third of patients studied, especially during the administration stage. These errors could affect the medication safety and avoid achieving therapeutic goals. Strategies to improve the quality and safe use of medications can be implemented using this information.

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

    Science.gov (United States)

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

    2014-06-01

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

  11. Postherpetic Neuralgia: Practical Experiences Return to Traditional Chinese Medicine

    Directory of Open Access Journals (Sweden)

    Majid Avijgan

    2017-06-01

    In traditional medicine (TM, PHN is mostly due to incomplete heat and damp clearing in liver and spleen meridians, qi and toxic pathogens stagnation, accumulation of yin (blood stagnation in microcapillary, internal fire, and heat and obstruction of meridians. Acupuncture works based on the eradication of wind, clearing of heat, and destroying of damp by regulating qi and blood movement. In clinics, several methods of TM are used to relief PHN, such as simultaneous needling, surrounding needling, acupuncture, electro acupuncture, moxibustion, wet cupping or hijamat, and herbal medicine. In this review, we discussed all these methods and their role in reducing PHN and pain.

  12. Code of practice for radiation protection in veterinary medicine

    International Nuclear Information System (INIS)

    Duffy, J.; Fenton, D.; McGarry, A.; McAllister, H.; Skelly, C

    2002-11-01

    This Code of Practice updates the Code of Practice on Radiation Protection in Veterinary Radiology prepared by the Nuclear Energy Board in June 1989. The Code is designed to give guidance to veterinary surgeons to ensure that they, their employees and members of the public are adequately protected from the hazards of ionising radiation arising from the use of X-ray equipment and radioactive substances in the practice of veterinary medicine. It reflects the regulations as specified in the Radiological Protection Act, 1991, (Ionising Radiation) Order, 2000 (S.I. No. 125 of 2000)

  13. Clinical practice in community medicine: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar

    2017-01-01

    Full Text Available Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative in a health center.

  14. [Comments on "A practical dictionary of Chinese medicine" by Wiseman].

    Science.gov (United States)

    Lan, Feng-li

    2006-02-01

    At least 24 Chinese-English dictionaries of Chinese Medicine have been published in China during the recent 24 years (1984-2003). This thesis comments on "A Practical Dictionary of Chinese Medicine" by Wiseman, agreeing on its establishing principles, sources and formation methods of the English system of Chinese medical terminology, and pointing out the defect. The author holds that study on the origin and development of TCM terms, standardization of Chinese medical terms in different layers, i.e. Chinese medical in classic, in commonly used modern TCM terms, and integrative medical texts, are prerequisites to the standardization of English translation of Chinese medical terms.

  15. Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

    Science.gov (United States)

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J

    2015-01-01

    setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice. © 2015 International Society of Travel Medicine.

  16. 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

    2018-05-15

    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.

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

    Science.gov (United States)

    2011-01-01

    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 internal medicine residents. PMID:21281500

  18. Territorial disputes in international arbitration practice

    Directory of Open Access Journals (Sweden)

    Tubić Bojan

    2014-01-01

    Full Text Available This paper deals with the issue of territorial disputes settlement in international arbitrations. The arbitration represents an efficient way of determining state borders, together with diplomatic means of dispute resolution and procedure before the International Court of Justice. Parties in a dispute choose arbiters, rules of procedure and commit themselves to accept and implement arbitration award, which is based on international law. States can create an ad hoc tribunal or they can decide to resolve the dispute before the Permanent Court of Arbitration in The Hague. In arbitration practice there were cases of successful arbitrations, especially in situations when a dispute was primarily factual and when major economic and political interests were not involved.

  19. Educational practices in the international university

    DEFF Research Database (Denmark)

    Day, Dennis; Kjærbeck, Susanne

    2011-01-01

    forthcoming; and Biber 1996 concerning ‘university registers’). International group work has, on the other hand, received quite some attention in organizational studies. The vast majority of these studies, however, do not concern themselves with the practice of such work, much less interaction. Typically......The point of departure for the investigation reported here is how students involved in a tertiary international program co-establish a 'project group meeting' as one method to fulfill a requirement in their curriculum for 'project work'. In 'project work', students are expected, in groups...... their concern has been to 'explain' measured results of efficiency in terms of pre-existing 'national cultures' (see for example Cox et al., 1991; Earley, 1993). Of special interest for us in this investigation will be how a possible description of the meeting as being within an international program involving...

  20. Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment.

    Science.gov (United States)

    Barsoumian, Alice E; Hartzell, Joshua D; Bonura, Erin M; Ressner, Roseanne A; Whitman, Timothy J; Yun, Heather C

    2018-02-06

    Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a

  1. Practice Variation in Public Sector Internal Auditing

    DEFF Research Database (Denmark)

    Arena, Marika; Jeppesen, Kim Klarskov

    2016-01-01

    This article aims to analyze the rise of practice variations in public sector internal auditing (IA), giving special attention to the role of agents’ embeddedness in multiple institutional arrangements. IA's trends of development and the characteristics of the public sector context, in fact, make...... types of IA developed in three case settings, shaped by the agents’ embeddedness in different institutional fields. This article provides a more comprehensive approach to the study of IA adoption and development in public sector organizations than previous literature, and it highlights the relevance...... of the interplay between actors’ contemporary embeddedness in professional systems and the focal social system as a relevant source of practice variation. In this respect, the case of IA can contribute to previous studies of practice variation in the field of management accounting, shedding some light on the types...

  2. International Workshop on Industry Practices for Forecasting

    CERN Document Server

    Poggi, Jean-Michel; Brossat, Xavier

    2015-01-01

    The chapters in this volume stress the need for advances in theoretical understanding to go hand-in-hand with the widespread practical application of forecasting in industry. Forecasting and time series prediction have enjoyed considerable attention over the last few decades, fostered by impressive advances in observational capabilities and measurement procedures. On June 5-7, 2013, an international Workshop on Industry Practices for FORecasting was held in Paris, France, organized and supported by the OSIRIS Department of Electricité de France Research and Development Division. In keeping with tradition, both theoretical statistical results and practical contributions on this active field of statistical research and on forecasting issues in a rapidly evolving industrial environment are presented. The volume reflects the broad spectrum of the conference, including 16 articles contributed by specialists in various areas. The material compiled is broad in scope and ranges from new findings on forecasting in in...

  3. 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…

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

    Science.gov (United States)

    Day, Susan C.; And Others

    1984-01-01

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

  5. Interdisciplinary promises versus practices in medicine: the decoupled experiences of social sciences and humanities scholars.

    Science.gov (United States)

    Albert, Mathieu; Paradis, Elise; Kuper, Ayelet

    2015-02-01

    This paper explores social scientists' and humanities (SSH) scholars' integration within the academic medical research environment. Three questions guided our investigation: Do SSH scholars adapt to the medical research environment? How do they navigate their career within a culture that may be inconsistent with their own? What strategies do they use to gain legitimacy? The study builds on three concepts: decoupling, doxa, and epistemic habitus. Twenty-nine semi-structured interviews were conducted with SSH scholars working in 11 faculties of medicine across Canada. Participants were selected through purposeful and snowball sampling. The data were analyzed by thematic content analysis. For most of our participants, moving into medicine has been a challenging experience, as their research practices and views of academic excellence collided with those of medicine. In order to achieve some level of legitimacy more than half of our participants altered their research practices. This resulted in a dissonance between their internalized appreciation of academic excellence and their new, altered, research practices. Only six participants experienced no form of challenge or dissonance after moving into medicine, while three decided to break with their social science and humanities past and make the medical research community their new home. We conclude that the work environment for SSH scholars in faculties of medicine does not deliver on the promise of inclusiveness made by calls for interdisciplinarity in Canadian health research. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society.

    Science.gov (United States)

    Larson, E B

    2001-05-15

    During the past quarter century, general internal medicine has emerged as a vital discipline. In the realm of patient care, it is the integrating discipline par excellence. Ironically, as general internists face the challenge of integrating advances of dizzying speed and complexity, and as their clinical practice becomes increasingly effective, it has become much more difficult for them to earn a living. General internists find themselves at the crossroads of prosperity and despair. Although general medicine research leads the research agenda in many departments of medicine, it is particularly vulnerable. The necessary multidisciplinary "programmatic" infrastructure is expensive, and results often take many years to obtain, particularly in the study of chronic disease. The educational environment in many institutions is particularly difficult for general medicine, both because the current emphasis on technical skills obscures patients' and learners' real needs and because complex patients on general medicine services are now so ill and their turnover so rapid. General internal medicine and geriatrics are synergistic, especially in today's marketplace. A focus on geriatric medicine could help general medicine continue to flourish. General internists are ideally suited to the integrated care of elderly patients with multiple problems, research opportunities are enormous in the geriatric population, and the teaching of geriatrics requires a high level of generalist skills. Problems that plague current generalist practice have unique significance to older patients. Organizations that represent general internists would do well to join forces with many other advocacy groups, especially those representing the interests of elderly patients and geriatric medicine.

  7. [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.

  8. 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

  9. Training family medicine residents to practice collaboratively with psychology trainees.

    Science.gov (United States)

    Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina

    2013-01-01

    This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.

  10. Is evidence-based medicine about democratizing medical practice?

    DEFF Research Database (Denmark)

    Thorgård, Keld

    2014-01-01

    The authoritarian standpoint in medicine has been under challenge by various groups and researchers since the 1980s. The challenges have been ethical, political and medical, with patient movements at the forefront. Over the past decade, however, a deep challenge has been posed by evidence......-based medicine (EBM), which has challenged the entire strategy of medical treatment from the point of view of a self-critical, anti-authoritarian and hereby also (it has been claimed) a more democratic medical practice. Previously, the challenges arose out of the patient rights perspective. EBM, by contrast......, was taken to challenge the way doctors consider their medical practice as a whole. The present paper puts this claim of democratization into a historical context. Two dimensions of the democratization hypothesis are discussed and it is argued that they are insufficient to capture the substantial changes...

  11. Practical clinical applications of the computer in nuclear medicine

    International Nuclear Information System (INIS)

    Price, R.R.; Erickson, J.J.; Patton, J.A.; Jones, J.P.; Lagan, J.E.; Rollo, F.D.

    1978-01-01

    The impact of the computer on the practice of nuclear medicine has been felt primarily in the area of rapid dynamic studies. At this time it is difficult to find a clinic which routinely performs computer processing of static images. The general purpose digital computer is a sophisticated and flexible instrument. The number of applications for which one can use the computer to augment data acquisition, analysis, or display is essentially unlimited. In this light, the purpose of this exhibit is not to describe all possible applications of the computer in nuclear medicine but rather to illustrate those applications which have generally been accepted as practical in the routine clinical environment. Specifically, we have chosen examples of computer augmented cardiac, and renal function studies as well as examples of relative organ blood flow studies. In addition, a short description of basic computer components and terminology along with a few examples of non-imaging applications are presented

  12. Compensation and Production in Family Medicine by Practice Ownership

    Directory of Open Access Journals (Sweden)

    Alison C. Essary

    2016-02-01

    Full Text Available The increasing focus on high performance, patient-centered, team-based care calls for a strategy to evaluate cost-effective primary care. The trend toward physician practice consolidation further challenges the primary care health care system. Productivity measures establish provider value and help inform decision making regarding resource allocation in this evolving health care system. In this national survey of family medicine practices, physician assistant (PA productivity, as defined by mean annual patient encounters, exceeds that of both nurse practitioners (NPs and physicians in physician-owned practices and of NPs in hospital or integrated delivery system-owned practices. Total compensation, defined as salary, bonus, incentives, and honoraria for physicians, is significantly more compared to both PAs and NPs, regardless of practice ownership or productivity. Physician assistants and NPs earn equivalent compensation, regardless of practice ownership or productivity. Not only do these data support the value and role of PAs and NPs on the primary care team but also highlight differences in patient encounters between practice settings. Rural and underserved community practices, where physician-owned practices persist, also merit further consideration. Further research is needed to inform both organizational and policy decisions for the provision of high-quality, cost-effective, and accessible primary health care.

  13. 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 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

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

    Science.gov (United States)

    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.

  15. [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.

  16. Postgraduate Course 'Physics Aspects of Nuclear Medicine'. Theoretical and practical intensive version. Preliminary results

    International Nuclear Information System (INIS)

    Lopez Diaz, A.; Gonzalez, G.J.; Torres, A.L.; Fraxedas, M.R.

    2007-01-01

    Full text: Using national and international recommendations about human resource in Nuclear Medicine, a group of experts organized a National Course for the education and training of physicist who work in Cuban hospitals, adapted to national condition and practice of Nuclear Medicine. The program was approved for National Authorities in Nuclear Security and University Schools in Medicine. The program contains two intensive theoretic and practical courses, to be completed over a period of 15 days of full time engagement, complemented with 4 month full attachment to a Nuclear Medicine Service monitored by accredited expert. The theoretical/practical intensive courses have final evaluation: combining practical exercise and a final test. When all docent activities finish the students should clear a final theoretical/practical evaluation by an examination board comprising of at least three accredited experts. The theoretical/practical courses were attended by 19 physicists working in hospitals in Cuba. The contents of the first course included, Introduction to Nuclear Medicine, Principle of NM equipment, Quality assurance and quality control of NM equipment, Radiation Protection and Licence Topics of NM Services. The second course had the following topics: Acquisition and Processing methods in Nuclear Medicine, Nuclear Medicine Techniques and Clinical Dosimetry for radiopharmaceutical therapy. With 100 point of maximum score and 60 point minimum to pass, the final test of this first course comprised of 2 types of questions: 1 Multiple choice questions and 2. long essay type questions. The average scores obtained by the participants was 87.02 points/ students (range 65- 100 points). The students pass the test with very good degree of comprehension: 10-Excellent (90-100 points), 5- Very good (80-89 points), 2-Good (70-79 point) and 2- satisfactory standard (60-69 point). The students evaluated 'satisfactory' the quality of the course (in anonymous poll), reporting like

  17. Contradictions and dilemmas within the practice of immigration medicine.

    Science.gov (United States)

    Bisaillon, Laura

    2013-01-08

    To identify, explore and critique features of how practices associated with immigration medicine are socially organized. Specifically, how the work of designated medical practitioners (DMP) - physicians who conduct immigration medical examinations of prospective immigrants to Canada as contractors to the Canadian government department of Citizenship and Immigration Canada - is organized to occur in interactions with applicants who are diagnosed with the human immunodeficiency virus during the immigration medical examination. Findings from a theoretically informed empirical study using institutional and political activist ethnography inform this article. Data collection and analytic activities spanning 18 months included observational work in institutional settings, textual review, 61 interviews, and 2 focus groups in three Canadian cities. The medical examination of prospective immigrants to Canada is not organized as a therapeutic relation of care and has little to do with medicine per se. The rationale structuring the work of DMPs is actually administrative responsibilities. The work achieved by the DMP positions her/him as a key figure and important decision-maker within the Canadian immigration system. The work of doctors who practice immigration medicine gives rise to contradictions and ethical problems. These are largely unresolvable because of the way in which the labour process in which the DMP is implicated is coordinated. The social organization of immigration doctoring practices has serious consequences for prospective immigrants to Canada, for doctors themselves, and for the Canadian immigration system more broadly.

  18. Short Sleep Times Predict Obesity in Internal Medicine Clinic Patients

    Science.gov (United States)

    Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth

    2007-01-01

    Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI ≥ 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06–8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems. Citation: Buscemi D; Kumar A; Nugent R; Nugent K. Short sleep times predict obesity in internal medicine clinic patients. J Clin Sleep Med 2007;3(7):681–688. PMID:18198800

  19. [Evidence based medicine. A new paradigm for medical practice].

    Science.gov (United States)

    Carneiro, A V

    1998-01-01

    Modern medical practice is an ever-changing process, and the doctor's need for information has been partially met by continuous medical education (CME) activities. It has been shown that CME activities have not prevented clinical knowledge, as well as medical practice, from deteriorating with time. When faced with the need to get the most recent and relevant information possible, the busy clinician has two major problems: most of the published medical literature is either irrelevant or not useful; and there is little time to read it. Evidence-based medicine constitutes a new paradigm for medical practice in the sense that it tries to transform clinical problems into well formulated clinical questions, selecting and critically appraising scientific evidence with predefined and rigorous rules. It combines the expertise of the individual clinician with the best external evidence from clinical research for rational, ethical and efficacious practice. Evidence-based medicine can be taught and practiced by physicians with different degrees of autonomy, with several subspecialties, working in the hospital or in outpatient clinics, alone or in groups.

  20. Closing the gap between theory and practice in Nuclear Medicine

    International Nuclear Information System (INIS)

    Adams, E.J.; Poulos, A.

    2002-01-01

    Aim: The ultimate goal for any clinical teaching program is to have students who demonstrate clinical competence. The Nuclear Medicine Technologist like any health professional should graduate from their course: attaining a defined standard of core knowledge; demonstrating appropriate behaviour for the workplace; and, achieving a predetermined level of clinical skill. In the University of Sydney Nuclear Medicine course, revisions were made to the Clinical Education assessment tools to create a more incremental approach and define competencies that required a higher level of achievement. Nuclear Medicine theory delivery was changed to create a more contextual environment where the student was better prepared for the workplace. The aim of this study is firstly to analyse the relationship between assessment of contextual theory and assessment of clinical practice. A secondary aim is to investigate any relationship between individual clinical assessment tools. Clinical assessment tools include: clinical competencies; observed clinical skills examinations (OSCE); clinical and university supervisor assessments; and assignments. Nuclear Medicine theory assessment tools include: problem oriented teamwork presentations; assignment; and written examination. Method: Correlation of the students' overall marks in the subjects' Nuclear Medicine theory and Clinical Education in the years 2000 and 2001 was undertaken using SPSS. Correlation of the students' scores in the individual clinical assessment tools: Clinical Supervisor to University supervisor; Clinical Supervisor to OSCE; and University Supervisor to OSCE, was completed for the years 2000 and 2001. Results: A statistically significant correlation was found for the students' marks in Nuclear Medicine theory and Clinical Education for the same year. The University and Clinical Supervisors' results significantly correlated for all years. Correlation between the individual assessment tools used in Clinical Education was not

  1. 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.

  2. Factors influencing successful physician recruitment in pediatrics and internal medicine.

    Science.gov (United States)

    King, Kelvin; Camfield, Peter; Breau, Lynn

    2005-01-01

    The objective of the study was to survey recently hired physicians to Canadian Academic Departments of Pediatric and Internal Medicine to understand the factors that underlay successful recruitment. Recruits and Chairs agreed on the 10 most important values. Chairs overvalued the 10 least important Recruit values. Statistical analysis revealed five core themes - in order of importance they are: family lifestyle and opportunities, compensation methodology, children/community (housing, schools, recreational), professional working conditions (technology, staffing, facilities), and academic opportunities. Core themes varied by demographics and academic profile.

  3. Proceedings of the German Society of Internal Medicine

    International Nuclear Information System (INIS)

    Miehlke, K.

    1988-01-01

    The proceedings of the German Society of Internal Medicine from its 94th congress held at Wiesbaden (April 10-14, 1988) provide coverage of the following issues: Gastrointestinal tumours - diagnosis and therapy at an early stage; diagnostic methods used in the pancreas; endoscopy during surgery; medical imaging in gastroenterology; therapy of chronic inflammatory changes of the intestine; proctology on an out-patient basis and geriatric patients showing cerebrovasucular insufficiency. Three papers have been separately for the database. (GDG) With 290 figs., 248 tabs [de

  4. Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept.

    Science.gov (United States)

    Pizzo, Giuseppe; Guiglia, Rosario; Lo Russo, Lucio; Campisi, Giuseppina

    2010-12-01

    During past decades the relationship between dentistry and internal medicine and especially the concept of the so-called focal infection theory have long been a matter of debate. The pathogenesis of focal diseases has been classically attributed to dental pulp pathologies and periapical infections. Nonetheless, in recent years, their role is being dismissed while increasing interest is being devoted to the possible associations between periodontal infection and systemic diseases. In fact, periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases. On the basis of this mechanism, chronic periodontitis has been suggested as a risk factor for cardiovascular diseases associated with atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer's disease. Various hypotheses, including common susceptibility, systemic inflammation, direct bacterial infection and cross-reactivity, or molecular mimicry, between bacterial antigens and self-antigens, have been postulated to explain these relationships. In this scenario, the association of periodontal disease with systemic diseases has set the stage for introducing the concept of periodontal medicine. This narrative review summarizes the evolution of focal infection theory up to the current pathophysiology of periodontal disease, and presents an update on the relationships between chronic periodontitis and systemic diseases. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  5. A study on the indigenous medicinal plants and healing practices in ...

    African Journals Online (AJOL)

    A study on the indigenous medicinal plants and healing practices in Chittagong Hill tracts (Bangladesh) ... and folk cultural practices as community-based extension and dissemination media to highlight the importance of medicinal plants and ...

  6. Violence in forensic medicine practice: a survey of legal medicine practitioners' views.

    Science.gov (United States)

    Sheikhazadi, Ardeshir; Mehrzad, Kiani; Fakhredin, Taghaddosinejad

    2009-09-01

    : To survey the extent of abuse and violence directed toward legal medicine practitioners during the course of their professional duties and to categorize the characteristics of such aggression. : Retrospective survey of the views of a large sample of Tehran's legal medicine practitioners by using a piloted anonymous questionnaire. : In all, 105 (86.1%) of the responders had experienced verbal abuse during the previous 12 months, 79 (64.7%) had experienced some sort of verbal abuse at least once a month, 39 (32%) had experienced verbal abuse every week, and 13 (10.7%) had experienced verbal abuse every day. Of the 122 legal medicine physicians, 39 (32%) were exposed to specific threats, 8 (6.6%) were exposed to physical action without injury, and 7 (5.7%) had experience serious incidents including threats with a weapon or attacks leading to physical injury over the previous year. Even assuming that all the nonresponders did not experience any violence, the aggression by patients affected 75% of legal medicine practitioners in the Tehran province. : Violence toward Tehran's legal medicine practitioners is very common and may be increasing. Some of the participating factors of aggression are potentially avoidable and practices should make strenuous attempts to identify such factors and remedy them. Staff training in interpersonal skills and recognizing anxious patients are essential. Doctors should avoid delays for patients by rearranging the booking policies, visit times, and duration. Victims of aggression must be followed up.

  7. 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.

  8. 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.

  9. Family medicine residents' practice intentions: Theory of planned behaviour evaluation.

    Science.gov (United States)

    Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W

    2015-11-01

    To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.

  10. Recruitment of minority physicians into careers in internal medicine.

    Science.gov (United States)

    Potts, J T

    1992-06-15

    Despite some initial success in the early 1970s, the important goal of increasing the numbers of underrepresented minorities in medical school and on medical faculties has stalled short of proportionate representation. To further the current efforts of the Association of Professors in Medicine (APM) and other national medical groups that are devoted to improving the numbers of minorities in medicine, ideas and program information must be shared among institutions. In this spirit, we review our experience at Massachusetts General Hospital. We found that the first step toward this goal must be an institutional commitment based on increased awareness and on special effort focused on housestaff recruitment. Once the numbers of minorities increase, the department chairperson, training program directors, and other involved faculty can work with younger minority physicians; the cooperative relationship thus created can guide the development of a strong minority recruitment program without requiring an undue time commitment from minority trainees and faculty. The APM has a combined goal: to achieve early practical results in individual departments, to play a catalytic role with the community and other national medical organizations, and to increase the number of minorities entering medical school and careers in medicine generally.

  11. 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.

  12. 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

  13. ANT International chemistry update and best practices

    International Nuclear Information System (INIS)

    Nordmann, F.; Odar, S.; Venz, H.; Kysela, J.; Ruehle, W.; Riess, R.

    2010-01-01

    There is an increasing number of Nuclear Power Plants (NPP) in various countries. Their chemistry practices are different due to the variety of designs and experiences while in the past the view was more monolithic. This is allowing a very rich experience that is extremely difficult to fully be aware of. ANT International is now collecting and evaluating these data as well as related R and D Information. This allows interested parties to have an easier access to the various sources of information. The chemistry experts associated to ANT International have been gathering a comprehensive detailed view of: The numerous laboratory data gained all over the world during the past decades; The extensive plant operating experiences with various types of chemistry strategies, crosschecked for various types of reactors designs and materials; An experienced international knowledge able to give the comprehensive overview that young engineers now in charge of many other activities are unable to fully cover. This paper gives the core conclusions of the detailed ANT International reports and results that have recently been gathered in the area of chemistry. It particularly covers: The primary water chemistry and its relation with radionuclides, dose rates and fuel behaviour; The secondary water chemistry focusing on its rationale selection depending on materials, design and other constraints; The start up and shutdown chemistry with it large variety of practices hardly understandable even for some experts; and, The maintenance remedies such as decontamination, steam generator cleaning and its alternate options. Various types of Reactor designs (PWR, VVER, BWR, CANDU®) are considered. The different materials, for example the impact of steam generator tubing and its evolution on the secondary water chemistry rationale or on the radioactivity built-up in the primary coolant, are described. The ways to improve the plant operation with a long term reliability as well as the most

  14. The radiological protection in the nuclear medicine practice

    International Nuclear Information System (INIS)

    Maldonado M, H.

    2010-09-01

    The nuclear medicine practice dates of the 1950 years, in this work the achievements reached as regards radiological protection are shown, although even lack a lot to make, the doses for the occupationally exposed personnel have decreased with lapsing of the years, thanks to the perception of the nuclear physicians to improve the administration techniques of the radioactive material, the decrease of administered activity and the unit doses use among the most remarkable advances. The changes in the equipment s technology to quantify the activity to administer, detection systems and image formation have demanded the development of the new professionals of the nuclear medicine that allows give protection to the patient. This improvement needs to consolidate with the appropriate normative development, the involved personnel qualification and the methods and procedures actualization to improve the protection of the occupationally exposed personnel, the public, the environment and the patient. (Author)

  15. Emotional labor and professional practice in sports medicine and science.

    Science.gov (United States)

    Hings, R F; Wagstaff, C R D; Thelwell, R C; Gilmore, S; Anderson, V

    2018-02-01

    The aim of this study was to explore how sport medicine and science practitioners manage their emotions through emotional labor when engaging in professional practice in elite sport. To address the research aim a semistructured interview design was adopted. Specifically, eighteen professional sport medicine and science staff provided interviews. The sample comprised sport and exercise psychologists (n=6), strength and conditioning coaches (n=5), physiotherapists (n=5), one sports doctor and one generic sport scientist. Following a process of thematic analysis, the results were organized into the following overarching themes: (a) factors influencing emotional labor enactment, (b) emotional labor enactment, and (c) professional and personal outcomes. The findings provide a novel contribution to understanding the professional demands faced by practitioners and are discussed in relation to the development of professional competencies and the welfare and performance of sport medics and scientists. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Clinical uses of the medicinal leech: A practical review

    Directory of Open Access Journals (Sweden)

    B S Porshinsky

    2011-01-01

    Full Text Available The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons and other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of the leech, and therapy-related complications.

  17. Greek Medicine Practice at Ancient Rome: The Physician Molecularist Asclepiades

    Directory of Open Access Journals (Sweden)

    Luigi Santacroce

    2017-12-01

    Full Text Available Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of “κόσμος” (world knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a “divine God” until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology, Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity. Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus’ theories, refusing extensively

  18. Greek Medicine Practice at Ancient Rome: The Physician Molecularist Asclepiades

    Science.gov (United States)

    Santacroce, Luigi; Bottalico, Lucrezia; Charitos, Ioannis Alexandros

    2017-01-01

    Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking) and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of “κόσμος” (world) knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a “divine God” until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology), Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity). Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus’ theories, refusing extensively the Hippocratic

  19. Greek Medicine Practice at Ancient Rome: The Physician Molecularist Asclepiades.

    Science.gov (United States)

    Santacroce, Luigi; Bottalico, Lucrezia; Charitos, Ioannis Alexandros

    2017-12-12

    Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking) and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of "κόσμος" (world) knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a "divine God" until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology), Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity). Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus' theories, refusing extensively the Hippocratic ideas that

  20. Characteristics of acupuncture users among internal medicine patients in Germany.

    Science.gov (United States)

    Cramer, Holger; Chung, Vincent C H; Lauche, Romy; Zhang, Yan; Zhang, Anthony; Langhorst, Jost; Dobos, Gustav

    2015-06-01

    To identify socio-demographic and health-related factors associated with (a) acupuncture use and (b) the rated helpfulness of acupuncture among internal medicine patients. Data from a larger cross-sectional trial were reanalyzed. Patients who had used acupuncture for managing their primary medical complaint were compared to patients who had not. Predictors for (a) acupuncture use and (b) rated helpfulness were determined using logistic regression analyses. Of 2486 included patients, 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Family medicine and practice in the Mexican Social Security Institute

    Directory of Open Access Journals (Sweden)

    Donovan Casas Patiño

    2014-06-01

    Full Text Available The central ideas of this research paper are related to the practice of family medicine as a specialty. It focuses in its origins, problems, unique characteristics, limitations, scope, management, and processes within the context of primary care of the Mexican Social Security System. This approach was based on a qualitative, hermeneutical study closely related to the Structural Functionalism Theory. Within this framework, medical practice is seen as an equation: Meaning = action + function/structure. This offers an approach to the understanding of reality through surveys and observations in five categories: identity, activity, purpose, values/norms, and power/relationship. The practice of family medicine is defined as a medical act in the Mexican Social Security Institute. This act is limited to a brief encounter and a prescription, which makes it a short, fleeting, medicalized interaction. The result is a negative social imaginary of the physician, the patient and the whole of society. Thus, individuals and society host a negative social imaginary bestowed on doctors and users of the health system.

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

    Science.gov (United States)

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

    2016-04-12

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

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2014-09-01

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

  5. Student's perception about innovative teaching learning practices in Forensic Medicine.

    Science.gov (United States)

    Gupta, Sanjay; Parekh, Utsav N; Ganjiwale, Jaishree D

    2017-11-01

    Since decades, Forensic Medicine is mainly taught by didactic methods but in last couple of years some other teachinglearning and assessment methods are also introduced at some places which also lacks uniformity. Feedback from learners is most fundamental aspect to assess effectiveness of applied methods, but is not implemented in practice at most medical schools in India. Unfortunately, medical students are deprived of this practical empowerment and thus may not be efficient enough to contribute potentially to the justice system during their professional life. In order to improve their efficiency in the field, we introduced few innovative teaching-learning methods and documented their perceptions. This pilot study was carried out with students who had completed their second professional year (5th semester) of medical curriculum. Students were exposed to few innovative teaching-learning and assessment approaches in addition to conventional methods during their Forensic Medicine term. These approaches were interactivity in large group lecturing, small group activities, student led objective tutorial, court visit in real scenario, practical records book, surprise tests, structured theory question papers, model answers, objective structured practical examinations and structured oral viva. Their perceptions were documented later through structured questionnaire. Students reported all methods as 'interesting' except 'surprise tests'. Court visits were rated highest for generating interest (98%). Clarity of concept was experienced through all methods (range of 71-95%). Interactive large group lectures reported highest (by 95%students) for clarifying concepts, although this is not a typical characteristic of large group teaching. Enhanced learning experience was reported in 75-92.5% for different methods. Student Led Objective Tutorials seemed to facilitate enhance learning most (92.5%). Innovations in teaching-learning are need of hour especially in subject like Forensic

  6. Pricing medicines: theory and practice, challenges and opportunities.

    Science.gov (United States)

    Gregson, Nigel; Sparrowhawk, Keiron; Mauskopf, Josephine; Paul, John

    2005-02-01

    The pricing of medicines has become one of the most hotly debated topics of recent times, with the pharmaceutical industry seemingly being attacked from all quarters. From a company perspective, determining the price for each new product is more crucial than ever, given the present dearth of new drug introductions. But how are pricing strategies developed in practice? What is value-based pricing and how are financial models of return on investment constructed? What are the challenges faced in setting the price for a particular product, and how will scientific and environmental trends provide future pricing challenges or opportunities?

  7. 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

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

    Directory of Open Access Journals (Sweden)

    R. Nardi

    2013-05-01

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

  9. The International Classification for Nursing Practice (ICNP)

    DEFF Research Database (Denmark)

    Mortensen, Randi A.; Nielsen, Gunnar Haase

    2001-01-01

    This publication deals with the general field of health informatics and some issues particular to nursing. It starts with an introduction to health care, discussing the ‘classification and management in nursing information technology’ and the ‘nursing minimum data set’, health concepts......, an introduction to nursing science and the International Classification for Nursing Practice (ICNP). The textbook continues with an information technology aspects’ section. in this section important aspects of health informatics and hospital information systems are discussed, like data protection...... and confidentiality, telecare service for nurses, data analysis methods and classification methods. The last section of this book deals with the organizational impact of health informatics. Major topics are: impacts of communications, information and technology on organizations, impact in nursing environment, quality...

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

    Science.gov (United States)

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

    2017-09-01

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

  11. Evidence - based medicine/practice in sports physical therapy.

    Science.gov (United States)

    Manske, Robert C; Lehecka, B J

    2012-10-01

    A push for the use of evidence-based medicine and evidence-based practice patterns has permeated most health care disciplines. The use of evidence-based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision-making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well-being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence-based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.

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

    Science.gov (United States)

    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 physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. Methods One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. Results Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p internal medicine clerkship. Possible causes and suggestions for improvement are discussed. PMID:24712683

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

    Science.gov (United States)

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

    2017-01-01

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

  14. Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards.

    Science.gov (United States)

    Papadakis, Maxine A; Arnold, Gerald K; Blank, Linda L; Holmboe, Eric S; Lipner, Rebecca S

    2008-06-03

    Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support

  15. Nudging best practice: the HITECH act and behavioral medicine.

    Science.gov (United States)

    Hesse, B W; Ahern, D K; Woods, S S

    2011-03-01

    In February 2009, the US Congress passed the Health Information Technology for Economic and Consumer Health (HITECH) Act in order to stimulate the "meaningful use" of health information technology within medical practice. Economists have noted that other sectors in the economy have demonstrated substantive productivity improvements from investments in information technology but that the health sector lags behind. The "meaningful use" stipulation of the HITECH Act focuses systems redesign within the health sector on user's behavior, a provision that opens a window of contribution from specialists in behavioral medicine. There are several ways for behavioral medicine to become involved in the redesign. One is to help craft a health services environment that optimizes communication between providers and patients, between primary care and specialist care providers, and between patients and their caregivers. Another is to help practitioners and policy-makers create new "decisional architectures" for "nudging" behavior in positive ways through better incentives, understandable instructions, healthy defaults, instructive feedback, back-ups for error, and structured decision-making. New funding opportunities in research, implementation, and training may facilitate the involvement of behavioral medicine-an involvement that is crucial for ensuring the success of reform efforts in the long run.

  16. 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

  17. 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.

  18. The project of model practices in family medicine in Slovenia

    Directory of Open Access Journals (Sweden)

    Tonka Poplas Susič

    2013-11-01

    Full Text Available Background: Primary health care has undergone great changes as a consequence of demographic changes, growing patients’ awareness and organizational changes in the healthcare system. Declining interest in family medicine specialization further worsens the situation. In the period of lack of GPs and their overloading, it is necessary to include a diploma graduate nurse in the team of GPs and to define competencies and activities in such a way that encourage more active approach to the patients, meeting the indicators of quality.The purpose of the article is to describe the project of model practice in Slovenia and to present some results.Methods: A model practice introduces a new concept in the areas of human resource standards (to existing team, a diploma graduate nurse is included on a part-time basis; work competences (use of protocols for the treatment of chronic patients, extended and well-defined preventive screenings, establishing registers of chronic patients and assessing quality by means of quality indicators and work management (redistribution of workload .Results: Due to great interest of general practitioners, a total of 271 model practices were introduced in 2011 and 2012. MPs have been distributed evenly through different regions inSlovenia. Registers of patients with chronic diseases (COPD, asthma and diabetes have been established and during the preventive screening, on average 2 patients with a chronic disease and 15 patients with risk factors have been detected. Patients are treated actively according to their needs rather than their preferences.Conclusions: The project of MPs enables a high quality and cost effectiveness of patients’ treatment in family medicine. With a gradual introducing of new MPs, a well planed and monitored patients’ care will be implemented in the practice. In a long run, disburdening of a secondary care level and more rational consumption of drugs are expected

  19. 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…

  20. Deliberate Practice in Medicine: The Motivation to Engage in Work-Related Learning and Its Contribution to Expertise

    Science.gov (United States)

    van de Wiel, Margje W. J.; Van den Bossche, Piet

    2013-01-01

    This study examined physicians' motivation to engage in work-related learning and its contribution to expertise development beyond work experience. Based on deliberate practice theory, semi-structured interviews were conducted with 17 residents and 28 experienced physicians in internal medicine, focusing on the activities they engaged in during…

  1. 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.

  2. 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

  3. Mister Voxel: 3D internal dosimetry software for nuclear medicine

    International Nuclear Information System (INIS)

    McKay, E.

    1998-01-01

    Full text: Calculation of individual internal dosimetry in nuclear medicine is a complex, multi-stage process. Most often, calculations are biased on the MIRD methodology, which assumes uniform distribution of cumulated activity inside a set of mathematically described internal organs. The MIRD 'reference man' geometry is highly simplified and the dosimetry estimates generated by this method were originally only intended to predict the average dose expected in an exposed population. We have developed a software package for the Macintosh computer ('Mister Voxel') that uses a fast Fourier transform to calculate the 3D distribution of absorbed dose by convolving a 3D dose kernel with a 3D distribution of cumulated activity. This makes it possible to generate dose volume histograms and isodose contours for organs or tumours treated with radiopharmaceuticals, a task not possible using the MIRD technique. In addition to providing 3D convolution, Mister Voxel performs basic image processing functions (image math, filters, cut and paste) and provides a collection of painting tools and simple morphological operators to facilitate the delineation of regions of interest (ROIs) along anatomical boundaries. The package also includes an image registration module with tools for automated or manual registration of 3D data sets. The structure of the package allows ROIs drawn on CT or MRI data to be easily transferred to registered SPECT data. Dose kernels are implemented by plug-in code modules, allowing the user to extend the system's capabilities if required. File import and export capabilities are also extensible

  4. Core addiction medicine competencies for doctors: An international consultation on training.

    Science.gov (United States)

    Ayu, Astri Parawita; El-Guebaly, Nady; Schellekens, Arnt; De Jong, Cor; Welle-Strand, Gabrielle; Small, William; Wood, Evan; Cullen, Walter; Klimas, Jan

    2017-01-01

    Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.

  5. 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.

  6. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

    Science.gov (United States)

    Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.

    2015-01-01

    Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (pinterns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962

  7. The Quality of Written Feedback by Attendings of Internal Medicine Residents.

    Science.gov (United States)

    Jackson, Jeffrey L; Kay, Cynthia; Jackson, Wilkins C; Frank, Michael

    2015-07-01

    Attending evaluations are commonly used to evaluate residents. Evaluate the quality of written feedback of internal medicine residents. Retrospective. Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. From monthly evaluations of residents by attendings, a randomly selected sample of 500 written comments by attendings were qualitatively coded and rated as high-, moderate-, or low-quality feedback by two independent coders with good inter-rater reliability (kappa: 0.94). Small group exercises with residents and attendings also coded the utterances as high, moderate, or low quality and developed criteria for this categorization. In-service examination scores were correlated with written feedback. There were 228 internal medicine residents who had 6,603 evaluations by 334 attendings. Among 500 randomly selected written comments, there were 2,056 unique utterances: 29% were coded as nonspecific statements, 20% were comments about resident personality, 16% about patient care, 14% interpersonal communication, 7% medical knowledge, 6% professionalism, and 4% each on practice-based learning and systems-based practice. Based on criteria developed by group exercises, the majority of written comments were rated as moderate quality (65%); 22% were rated as high quality and 13% as low quality. Attendings who provided high-quality feedback rated residents significantly lower in all six of the Accreditation Council for Graduate Medical Education (ACGME) competencies (p service examination scores. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments on medical knowledge correlated with lower in-service training scores.

  8. 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.

  9. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Hoffman, Barry R; Chan, Daniel W

    2008-01-01

    BACKGROUND: This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS: One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor...... questions to ensure selection of the appropriate test, adherence to good clinical and laboratory practices (e.g., minimization of the risk of incorrect patient and/or specimen identification, tube type, or timing), use of internationally standardized and well-characterized methods, careful adherence...... records. Also mandatory is extensive validation encompassing all stages of analysis before introduction of new technologies such as microarrays and mass spectrometry. Provision of high-quality tumor marker services is facilitated by dialogue involving researchers, diagnostic companies, clinical...

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

    Directory of Open Access Journals (Sweden)

    Michael N Daniels

    Full Text Available 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

  11. Examining Quality Management Audits in Nuclear Medicine Practice as a lifelong learning process: opportunities and challenges to the nuclear medicine professional and beyond.

    Science.gov (United States)

    Pascual, Thomas N B

    2016-08-01

    This essay will explore the critical issues and challenges surrounding lifelong learning for professionals, initially exploring within the profession and organizational context of nuclear medicine practice. It will critically examine how the peer-review process called Quality Management Audits in Nuclear Medicine Practice (QUANUM) of the International Atomic Energy Agency (IAEA) can be considered a lifelong learning opportunity to instill a culture of quality to improve patient care and elevate the status of the nuclear medicine profession and practice within the demands of social changes, policy, and globalization. This will be explored initially by providing contextual background to the identity of the IAEA as an organization responsible for nuclear medicine professionals, followed by the benefits that QUANUM can offer. Further key debates surrounding lifelong learning, such as compulsification of lifelong learning and impact on professional change, will then be weaved through the discussion using theoretical grounding through a qualitative review of the literature. Keeping in mind that there is very limited literature focusing on the implications of QUANUM as a lifelong learning process for nuclear medicine professionals, this essay uses select narratives and observations of QUANUM as a lifelong learning process from an auditor's perspective and will further provide a comparative perspective of QUANUM on the basis of other lifelong learning opportunities such as continuing professional development activities and observe parallelisms on its benefits and challenges that it will offer to other professionals in other medical speciality fields and in the teaching profession.

  12. The practice and earnings of preventive medicine physicians.

    Science.gov (United States)

    Salive, M E

    1992-01-01

    A shortage of preventive medicine (PM) physicians exists in the United States. Researchers know little about these physicians' earnings and practice characteristics. The American College of Preventive Medicine (ACPM) mailed a survey to all self-identified PM physicians on the American Medical Association (AMA) Physician Masterfile. A total of 3,771 (54%) responded; respondents' sex and region of residence were typical for PM physicians in general, with a slight excess of older physicians and those reporting board certification. A total of 2,664 (71%) were working full time, with median earnings of $85,000 (mean $90,000). Among full-time physicians, relatively higher earnings were associated with the following characteristics: male sex; age 45 to 64 years; major source of income from clinical, business, or industrial sources, rather than governmental or academic; and PM board certification. Full-time PM physicians earned much less than office-based private practitioners in several primary care specialties in 1989. The gap in earnings between PM specialists in government positions and those in the private sector is also substantial. Both disparities may require creative solutions.

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

    Science.gov (United States)

    Helble, Matthias; Aizawa, Toshiaki

    2017-02-01

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

  14. The concept of advanced radiographic practice: An international perspective

    International Nuclear Information System (INIS)

    Hardy, Maryann; Legg, Jeffrey; Smith, Tony; Ween, Borgny; Williams, Imelda; Motto, Jenny

    2008-01-01

    Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity

  15. [The safety of herbal medicines in the psychiatric practice].

    Science.gov (United States)

    Boniel, T; Dannon, P

    2001-08-01

    The use of alternative medicines is increasing world-wide and in Israel. These drugs, considered by the Ministry of Health as food supplements, are to be obtained at pharmacies and health stores and are being sold freely, without any professional advice. Many of the herbs are used by patients to treat psychiatric disorders. These herbs have a pharmacological activity, adverse effects and interactions with conventional drugs, which can produce changes in mood, cognition, and behavior. We present the most commonly used herbal drugs, and discuss their safety and efficacy in psychiatric practice. Hypericum--used as an antidepressant and as an antiviral medicine, was reported in 23 randomized clinical trials reviewed from the MEDLINE. It was found to be significantly more effective than placebo and had a similar level of effectiveness as standard antidepressants. Recent studies almost clearly prove that this herb, like most of the conventional antidepressants, can induce mania. Valerian--is used as an anti-anxiety drug, and reported to have sedative as well as antidepressant properties. In contrast to the significant improvement in sleep that was found with the use of valerian, compared to placebo, there are several reports on the valerian root toxicity. This includes nephrotoxicity, headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet. Ginseng--another plant that is widely used as an aphrodisiac and a stimulant. It has been associated with the occurrence of vaginal bleeding, mastalgia, mental status changes and Stevens-Johnson syndrome after it's chronic administration. It has interactions with digoxin, phenelzine and warfarin. Ginkgo--in clinical trials the ginkgo extract has shown a significant improvement in symptoms such as memory loss, difficulties in concentration, fatigue, anxiety, and depressed mood. Long-term use has been associated with increased bleeding time and spontaneous hemorrhage. Ginkgo should be used cautiously in

  16. 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.

  17. [Clinical application evaluation of Guidelines for Diagnosis and Treatment of Internal Diseases in Traditional Chinese Medicine].

    Science.gov (United States)

    Han, Xue-Jie; Liu, Meng-Yu; Lian, Zhi-Hua; Wang, Li-Ying; Shi, Nan-Nan; Zhao, Jun

    2017-09-01

    was best, economy of the guideline was better, and clincal effect was good. The comprehensive application evaluation showed that 75%~80% doctors were satisfied with the guideline. The Guidelines for Diagnosis and Treatment of Internal Diseases in Traditional Chinese Medicine has been widely used in clinical practice, which is of high quality, high degree of clinical application,good safety and economy. But there were some disadvantages of the guideline such as lack of evidence-based medicine and innovation, which is need to be improved constantly in the guideline revision. Copyright© by the Chinese Pharmaceutical Association.

  18. The research rotation: competency-based structured and novel approach to research training of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Dimitrov Vihren

    2006-10-01

    Full Text Available Abstract Background In the United States, the Accreditation Council of graduate medical education (ACGME requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

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

    Science.gov (United States)

    Chakalaroski, K

    2013-01-01

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

  20. 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…

  1. International Mindedness in Practice: The Evidence from International Baccalaureate Schools

    Science.gov (United States)

    Hacking, Elisabeth Barratt; Blackmore, Chloe; Bullock, Kate; Bunnell, Tristan; Donnelly, Michael; Martin, Susan

    2018-01-01

    International Mindedness is an overarching construct related to multilingualism, intercultural understanding and global engagement (Hill, 2012). The concept is central to the International Baccalaureate (IB) and sits at the heart of its education policies and programmes. The aim of this research study was to examine systematically how schools…

  2. How to share inspection practices internationally?

    International Nuclear Information System (INIS)

    Zerger, B.

    2009-01-01

    ASN strives to share practices with its foreign counterparts in order to develop and adopt best practice worldwide. With regard to inspection practices, the exchanges are made with AEN, in particular within the context of the Working Group on Inspection Practices (WGIP). As well as being very rewarding, the exchanges sometimes come up against marked differences in terms of inspection organisation and even in the meaning given to the inspections. The WGIP endeavors, however, to make inspection practice recommendations that are as functional and feasible as possible. (author)

  3. Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey.

    Science.gov (United States)

    Goren, Eric N; Leizman, Debra S; La Rochelle, Jeffrey; Kogan, Jennifer R

    2015-09-01

    Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not been described. We aimed to determine the current status of medical students' overnight experiences in Internal Medicine clerkships and sub-internships, and to assess internal medicine educators' perceptions of the importance of overnight work during internal medicine rotations. In May 2014, the Clerkship Directors in Internal Medicine (CDIM) conducted its annual survey. Twenty-eight questions about student participation in overnight work and perceptions of the importance of overnight work (rated on 1-5 Likert scale, 1 = very unimportant and 5 =  ery important) were included. Descriptive statistics were used to summarize responses. Free text results were analyzed qualitatively. The response rate was 78 %. A minority of respondents reported students having any overnight experience during the clerkship (38.7 %) or the sub-internship (40.7 %). Only 5 % of respondents reported having students assigned to night-float rotations outside of clerkships or sub-internships. Respondents agreed that overnight experiences were more important during the sub-internship than the clerkship, 4.0 ± 1.1 vs. 3.2 ± 1.2, p intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences for medical students.

  4. Determining and prioritizing competencies in the undergraduate internal medicine curriculum in Saudi Arabia.

    Science.gov (United States)

    Almoallim, H

    2011-08-01

    To determine knowledge and skills competencies in internal medicine for the undergraduate curriculum in Saudi Arabia, competencies were identified based on group work utilizing common textbooks. The Delphi Technique was used as a consensus method to determine and prioritize competencies in internal medicine. A group of 20 clinicians rated the identified competencies from 0-3 (0: no need to know, 1: interesting to know, 2: should know and 3: must know). After formulating the results, a second Delphi round was conducted with 5 experts in internal medicine. A total of 1513 knowledge competencies and 189 skills competencies were determined and prioritized. The competencies corresponded to the 12 systems in internal medicine. All competencies rated 2.2-3.0 were produced separately and considered core competencies for the undergraduate internal medicine curriculum. Determining and prioritizing competencies should influence the curriculum reform process.

  5. Use of individualized learning plans among fourth-year sub-interns in pediatrics and internal medicine.

    Science.gov (United States)

    Shepard, Michelle E; Sastre, Elizabeth A; Davidson, Mario A; Fleming, Amy E

    2012-01-01

    Individualized Learning Plans (ILPs) are an effective tool for promoting self-directed learning among residents. However, no literature details ILP use among medical students. Fifty fourth-year sub-interns in pediatrics and internal medicine created ILPs, including a self-assessment of strengths and weaknesses based on ACGME core competencies and the setting of learning objectives. During weekly follow-up meetings with faculty mentors and peers, students discussed challenges and revised goals. Upon completion of the rotation, students completed a survey of Likert-scale questions addressing satisfaction with and perceived utility of ILP components. Students most often self-identified strengths in the areas of Professionalism and Interpersonal and Communication Skills and weaknesses in Patient Care and Systems-Based Practice. Eighty-two percent set at least one learning objective in an identified area of weakness. Students expressed high confidence in their abilities to create achievable learning objectives and to generate strategies to meet those objectives. Students agreed that discussions during group meetings were meaningful, and they identified the setting learning objectives and weekly meetings as the most important elements of the exercise. Fourth-year sub-interns reported that ILPs helped them to accomplish rotation goals, with the setting of learning objectives and weekly discussions being the most useful elements.

  6. World Workshop on Oral Medicine VI: an international validation study of clinical competencies for advanced training in oral medicine.

    Science.gov (United States)

    Steele, John C; Clark, Hadleigh J; Hong, Catherine H L; Jurge, Sabine; Muthukrishnan, Arvind; Kerr, A Ross; Wray, David; Prescott-Clements, Linda; Felix, David H; Sollecito, Thomas P

    2015-08-01

    To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine. An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format. Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested. This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. What’s the Theory in International Practice Theory?

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca

    2015-01-01

    . This distinction is crucial to determining where we look for practices in international relations and how we study them. I will also argue that symbolic interactionism should be included in the practice theory landscape, as it can help us understand the making and unmaking of international orders....

  8. Traditional medicines and alternative practice in the management of ...

    African Journals Online (AJOL)

    main business district of Accra, were visited and traditional medicines for the management of prostate diseases ac- ... This was the constituent in four products (Uro 500®, UR-Quick mixture®, Prostacure® ... Herbal medicine, botanical medicine or phytomedicine ... along with quality clinical research supporting the value.

  9. Social Media in Professional Medicine: New Resident Perceptions and Practices.

    Science.gov (United States)

    Lefebvre, Cedric; Mesner, Jason; Stopyra, Jason; O'Neill, James; Husain, Iltifat; Geer, Carol; Gerancher, Karen; Atkinson, Hal; Harper, Erin; Huang, William; Cline, David M

    2016-06-09

    For younger generations, unconstrained online social activity is the norm. Little data are available about perceptions among young medical practitioners who enter the professional clinical arena, while the impact of existing social media policy on these perceptions is unclear. The objective of this study was to investigate the existing perceptions about social media and professionalism among new physicians entering in professional clinical practice; and to determine the effects of formal social media instruction and policy on young professionals' ability to navigate case-based scenarios about online behavior in the context of professional medicine. This was a prospective observational study involving the new resident physicians at a large academic medical center. Medical residents from 9 specialties were invited to participate and answer an anonymous questionnaire about social media in clinical medicine. Data were analyzed using SAS 9.4 (Cary, NC), chi-square or Fisher's exact test was used as appropriate, and the correct responses were compared between different groups using the Kruskal-Wallis analysis of variance. Familiarity with current institutional policy was associated with an average of 2.2 more correct responses (P=.01). Instruction on social media use during medical school was related to correct responses for 2 additional questions (P=.03). On dividing the groups into no policy exposure, single policy exposure, or both exposures, the mean differences were found to be statistically significant (3.5, 7.5, and 9.4, respectively) (P=.03). In this study, a number of young physicians demonstrated a casual approach to social media activity in the context of professional medical practice. Several areas of potential educational opportunity and focus were identified: (1) online privacy, (2) maintaining digital professionalism, (3) safeguarding the protected health information of patients, and (4) the impact of existing social media policies. Prior social media

  10. Social Media in Professional Medicine: New Resident Perceptions and Practices

    Science.gov (United States)

    2016-01-01

    Background For younger generations, unconstrained online social activity is the norm. Little data are available about perceptions among young medical practitioners who enter the professional clinical arena, while the impact of existing social media policy on these perceptions is unclear. Objective The objective of this study was to investigate the existing perceptions about social media and professionalism among new physicians entering in professional clinical practice; and to determine the effects of formal social media instruction and policy on young professionals’ ability to navigate case-based scenarios about online behavior in the context of professional medicine. Methods This was a prospective observational study involving the new resident physicians at a large academic medical center. Medical residents from 9 specialties were invited to participate and answer an anonymous questionnaire about social media in clinical medicine. Data were analyzed using SAS 9.4 (Cary, NC), chi-square or Fisher’s exact test was used as appropriate, and the correct responses were compared between different groups using the Kruskal–Wallis analysis of variance. Results Familiarity with current institutional policy was associated with an average of 2.2 more correct responses (P=.01). Instruction on social media use during medical school was related to correct responses for 2 additional questions (P=.03). On dividing the groups into no policy exposure, single policy exposure, or both exposures, the mean differences were found to be statistically significant (3.5, 7.5, and 9.4, respectively) (P=.03). Conclusions In this study, a number of young physicians demonstrated a casual approach to social media activity in the context of professional medical practice. Several areas of potential educational opportunity and focus were identified: (1) online privacy, (2) maintaining digital professionalism, (3) safeguarding the protected health information of patients, and (4) the impact of

  11. [Organizational forms of emergency medicine in international comparison].

    Science.gov (United States)

    Lipp, M

    1993-09-01

    The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. A core physical examination in internal medicine: what should students do and how about their supervisors?

    Science.gov (United States)

    Haring, Catharina M; van der Meer, Jos W M; Postma, Cornelis T

    2013-09-01

    Performance of a focused physical examination will induce a high cognitive load for medical students in the early phase of the clinical clerkships. To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily clinical practice of internal medicine. A questionnaire held among physicians that supervise students during the clerkship of internal medicine in one Dutch training region. Of the complete list of physical examination 55 items were considered to be an integral part of the standard general physical examination for medical students. Most emphasized were elements of the physical examination aimed at general parameters, thorax and abdomen, vascular status, lymph nodes, spinal column, skin and some parts of the neurological examination. The standard physical examinations performed by supervisors themselves contain fewer items than they expected from the students. The expectations a supervisor has towards the student correlates with the frequency with which they apply the various components in their own physical examination. This study provides us with a 'core' physical examination for medical students that can be applied in the early phase of the clinical clerkships.

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

    Science.gov (United States)

    Narang, Akhil; Arora, Vineet M

    2015-01-01

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

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Ma Irene

    2009-02-01

    Full Text Available Abstract Background To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Results Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

  16. Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

    Science.gov (United States)

    Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

    2018-03-01

    Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

  17. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  18. [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

  19. Burnout and distress among internal medicine program directors: results of a national survey.

    Science.gov (United States)

    West, Colin P; Halvorsen, Andrew J; Swenson, Sara L; McDonald, Furman S

    2013-08-01

    Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs. The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics

  20. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients.

    Science.gov (United States)

    Blanc, A-L; Spasojevic, S; Leszek, A; Théodoloz, M; Bonnabry, P; Fumeaux, T; Schaad, N

    2018-04-01

    Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly

  1. The 2015 Class of Hospice and Palliative Medicine Fellows-From Training to Practice: Implications for HPM Workforce Supply.

    Science.gov (United States)

    Lupu, Dale; Salsberg, Ed; Quigley, Leo; Wu, Xiaoli

    2017-05-01

    A relatively new specialty, hospice and palliative medicine (HPM), is unusual in that physicians can enter from 10 different specialties. This study sought to understand where HPM physicians were coming from, where they were going to practice, and the job market for HPM physicians. Describe characteristics of the incoming supply of HPM physicians, their practice plans, and experience finding initial jobs. In October 2015, we conducted an online survey of physicians who completed accredited HPM fellowships the previous June. We had electronic mail addresses for 195 of the 243 graduating fellows. About 112 HPM fellows responded (58% of those invited). The most common prior training was internal medicine (45%), followed by family medicine (23%), pediatrics (12%), and emergency medicine (10%). More than 40% had practiced medicine before their HPM training. After graduation, 97% were providing 20 or more hours per week of patient care, with most hours in palliative care. About 72% devoted more than 20 hours per week to palliative care, whereas only 13% worked that much in hospice care. About 81% reported no difficulty finding a satisfactory practice position. About 98% said that they would recommend HPM to others, and 63% took the time to provide written comments that were highly positive about the specialty. New HPM physicians are finding satisfying jobs. They are enthusiastic in recommending the specialty to others. Most are going into palliative medicine, leaving questions about how the need for hospice physicians will be filled. Although jobs appear to be numerous, there are practice areas with more limited opportunities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines.

    Science.gov (United States)

    Ijaz, Nadine; Boon, Heather

    2018-04-01

    The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations.

  3. Impact of the application of criteria of internal monitoring in radiological protection programmes in nuclear medicine services

    International Nuclear Information System (INIS)

    Dantas, B.M.; Dantas, A.L.A.; Juliao, L.Q.C.; Lourenco, M.C.; Melo, D.R.

    2005-01-01

    The manipulation of open sources in Nuclear Medicine services involves risks of external exposure and internal contamination. The radiological protection plan of facilities licensed by CNEN - Brazilian Nuclear Energy Commission - must include the evaluation of such risks and propose a programme of individual monitoring to control exposure and ensure the maintenance of conditions of radiation safety. The IAEA - International Atomic Energy Agency - recommendations presented in the Safety Guide RS-G-1.2 suggest that an internal worker monitoring program be implemented where there is a possibility of internal contamination lead to effective dose committed annual values equal to or greater than 1 mSv. This paper presents the application of such criteria to the radionuclides most frequently used in the field of Nuclear Medicine, taking into account the normal conditions of handling and the ranges of activity authorized by CNEN. It is concluded that iodine 131 manipulation for therapeutic purposes is the practice that presented the greatest risk of internal exposure of workers, requiring the adoption of a programme of internal monitoring of Nuclear Medicine services

  4. Relationship between internal medicine program board examination pass rates, accreditation standards, and program size.

    Science.gov (United States)

    Falcone, John L; Gonzalo, Jed D

    2014-01-19

    To determine Internal Medicine residency program compliance with the Accreditation Council for Graduate Medical Education 80% pass-rate standard and the correlation between residency program size and performance on the American Board of Internal Medicine Certifying Examination. Using a cross-sectional study design from 2010-2012 American Board of Internal Medicine Certifying Examination data of all Internal Medicine residency pro-grams, comparisons were made between program pass rates to the Accreditation Council for Graduate Medical Education pass-rate standard. To assess the correlation between program size and performance, a Spearman's rho was calculated. To evaluate program size and its relationship to the pass-rate standard, receiver operative characteristic curves were calculated. Of 372 Internal Medicine residency programs, 276 programs (74%) achieved a pass rate of =80%, surpassing the Accreditation Council for Graduate Medical Education minimum standard. A weak correlation was found between residency program size and pass rate for the three-year period (p=0.19, pInternal Medicine residency programs complied with Accreditation Council for Graduate Medical Education pass-rate standards, a quarter of the programs failed to meet this requirement. Program size is positively but weakly associated with American Board of Internal Medicine Certifying Examination performance, suggesting other unidentified variables significantly contribute to program performance.

  5. Practical solutions in African agriculture | IDRC - International ...

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

    2016-11-25

    Nov 25, 2016 ... These include technologies, models, and management practices, among them: ... by three meals a week once the products are available in the market. ... been trained on business plan development and entrepreneurship.

  6. Innovating Chinese Herbal Medicine: From Traditional Health Practice to Scientific Drug Discovery

    OpenAIRE

    Gu, Shuo; Pei, Jianfeng

    2017-01-01

    As one of the major contemporary alternative medicines, traditional Chinese medicine (TCM) continues its influence in Chinese communities and has begun to attract the academic attention in the world of western medicine. This paper aims to examine Chinese herbal medicine (CHM), the essential branch of TCM, from both narrative and scientific perspectives. CHM is a traditional health practice originated from Chinese philosophy and religion, holding the belief of holism and balance in the body. W...

  7. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  8. Regulatory and administrative requirements for practice of nuclear medicine in India

    International Nuclear Information System (INIS)

    Tandon, Pankaj

    1998-01-01

    In order to ensure safety of the patients, staff and public in the practice of nuclear medicine, including in-vivo diagnostic investigations, radionuclide therapy and in research using unsealed radioactive substances a number of administrative and regulatory procedures are adopted. The salient features of regulatory and administrative requirements for practice of nuclear medicine in India are discussed

  9. [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

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

    Science.gov (United States)

    Wardrop, Richard M; Berkowitz, Lee R

    2017-02-01

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

  11. Factors influencing selection of internal medicine residency--a prospective study.

    Science.gov (United States)

    Pereg, David; Gronich, Naomi; Lishner, Michael

    2006-08-01

    Recently, the popularity of internal medicine residency has been decreasing. We studied the effect of an improved working environment and a decrease in residents' workload on the selection of internal medicine residency. An organizational diagnosis team joined our department and identified several causes for residents' heavy workload. These findings were subsequently discussed in a workshop and led to a modification of the daily routine and a parallel decrease in workload and rise in residents' satisfaction. Following these changes, the demand for residency in our department rose. We conclude that an improvement in the working environment and workload during residency increases the residents' satisfaction and the demand for residency in internal medicine.

  12. 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.

  13. Part-time careers in academic internal medicine: a report from the association of specialty professors part-time careers task force on behalf of the alliance for academic internal medicine.

    Science.gov (United States)

    Linzer, Mark; Warde, Carole; Alexander, R Wayne; Demarco, Deborah M; Haupt, Allison; Hicks, Leroi; Kutner, Jean; Mangione, Carol M; Mechaber, Hilit; Rentz, Meridith; Riley, Joanne; Schuster, Barbara; Solomon, Glen D; Volberding, Paul; Ibrahim, Tod

    2009-10-01

    To establish guidelines for more effectively incorporating part-time faculty into departments of internal medicine, a task force was convened in early 2007 by the Association of Specialty Professors. The task force used informal surveys, current literature, and consensus building among members of the Alliance for Academic Internal Medicine to produce a consensus statement and a series of recommendations. The task force agreed that part-time faculty could enrich a department of medicine, enhance workforce flexibility, and provide high-quality research, patient care, and education in a cost-effective manner. The task force provided a series of detailed steps for operationalizing part-time practice; to do so, key issues were addressed, such as fixed costs, malpractice insurance, space, cross-coverage, mentoring, career development, productivity targets, and flexible scheduling. Recommendations included (1) increasing respect for work-family balance, (2) allowing flexible time as well as part-time employment, (3) directly addressing negative perceptions about part-time faculty, (4) developing policies to allow flexibility in academic advancement, (5) considering part-time faculty as candidates for leadership positions, (6) encouraging granting agencies, including the National Institutes of Health and Veterans Administration, to consider part-time faculty as eligible for research career development awards, and (7) supporting future research in "best practices" for incorporating part-time faculty into academic departments of medicine.

  14. The Current State of Rural Neurosurgical Practice: An International Perspective.

    Science.gov (United States)

    Upadhyayula, Pavan S; Yue, John K; Yang, Jason; Birk, Harjus S; Ciacci, Joseph D

    2018-01-01

    Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. A comprehensive literature search was performed for English language manuscripts with keywords "rural" and "neurosurgery" using the National Library of Medicine PubMed database (01/1971-06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.

  15. The current state of rural neurosurgical practice: An international perspective

    Directory of Open Access Journals (Sweden)

    Pavan S Upadhyayula

    2018-01-01

    Full Text Available Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017. Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and

  16. The Current State of Rural Neurosurgical Practice: An International Perspective

    Science.gov (United States)

    Upadhyayula, Pavan S.; Yue, John K.; Yang, Jason; Birk, Harjus S.; Ciacci, Joseph D.

    2018-01-01

    Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to

  17. Forensic Experts′ Opinion Regarding Clinical Forensic Medicine Practice in Indonesia and Malaysia

    Directory of Open Access Journals (Sweden)

    Hanusha Nair Gopalakrishnan

    2016-01-01

    Full Text Available Clinical forensic medicine is a progressing branch. In Indonesia and Malaysia, there is inadequate information regarding this practice. It is always unclear about the job scopes and practitioners involved in this field. The study outlined in this article is aimed to explore the current clinical forensic medicine practice compared to existing systematic practice globally and hence analyzing for presence of difference in this practice between these two countries. A qualitative study was conducted by forensic experts in Indonesia and Malaysia from September to November 2015. In-depth interview was carried out to obtain data which were then validated using literature and legal documents in Indonesia and Malaysia known as the triangulation validation method. Data were presented in narrative form. In Indonesia, forensic pathology and clinical forensic medicine were approached as one whereas in Malaysia separately. This practice was conducted by a general practitioner in collaboration with other specialists if needed in Indonesia; whereas, in Malaysia, this practice was conducted by forensic pathologists or medical officers in the absence of forensic pathologists. Both Indonesia and Malaysia followed the continental regimen in practicing clinical forensic medicine. There was still a lack of involvement of doctors in this field due to lack of understanding of clinical forensic medicine. The current clinical forensic medicine practice has not developed much and has no much difference in both countries. The gap between the current practice with systematic practice cannot be justified due to the absence of one standardized code of practice.

  18. Traditional medicines and alternative practice in the management of ...

    African Journals Online (AJOL)

    Objective: This study was aimed at identifying Ghanaian traditional medicines used for the management of prostate diseases and their constituents. Reviews of studies conducted on them are also presented. Methodology: This was a prospective study. Traditional Medicine samples from consecutive patients with either ...

  19. Post-graduated course 'Basic aspects of medical physics in nuclear medicine': theoretical/practical intensive version: preliminary results

    International Nuclear Information System (INIS)

    Lopez, Adlin; Gonzalez, Joaquin; Torres, Leonel; Fraxedas, Roberto; Varela, Consuelo; Freixas, Vivian.

    2008-01-01

    Full text: Using national and international recommendation about human resource in nuclear medicine, a group of experts organized a national course for the education and training of physicist who works in Cuban hospital, adapted to national condition and practice of nuclear medicine. The program was approved for National Authorities in Nuclear Security and University School in Medicine and content three intensive theoretic and practical courses (15 days of full time duration each), complemented with 4 months full time in Nuclear Medicine Service monitored by accredited expert and 2 months at distance with practical task. The theoretical/practical intensive courses have final evaluation: combining practical exercise and write final test. When all docent activities finish the students should pass a final evaluation by a testing board composed for (at least) three accredited experts. The first theoretical/practical course included 19 physicists who work in hospital, the second 17 and the third 16 students. With 100 point of maximum score and 60 point minimum to pass, the partial final tests included: true or false choice (with 10 aspects to verify, 1 point/correct answer) and questions to write developed answer. The average result was 83.02 points/ students (range 65-100 points). The students evaluated satisfactory the quality of different courses (in anonymous poll), reporting like very good; the quality of conferences, excellent; the usefulness of different charters, very good; the support bibliography, and recommended the repetition of this kind of education and training in order to warranty the human resource, in the same way and content, and included others item in the future. Conclusion: the theoretical/practice intensive courses of this post-graduated course were successful and satisfied the objective of education and training of medical physicist in nuclear medicine. (author)

  20. 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...

  1. [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.

  2. Errors in laboratory medicine: practical lessons to improve patient safety.

    Science.gov (United States)

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

  3. [Parenting practices and internalizing and externalizing problems in Spanish adolescents].

    Science.gov (United States)

    García Linares, Ma Cruz; Cerezo Rusillo, Ma Teresa; de la Torre Cruz, Manuel Jesús; de la Villa Carpio Fernández, Ma; Casanova Arias, Pedro Félix

    2011-11-01

    The goal of this study was to analyze the relationship between parenting practices and internalizing and externalizing problems presented by a group of adolescents according to their gender. Four hundred and sixty-nine secondary school students (aged between 12 and 18) participated in this study. The adolescents presented differences in perception of the educational practices of both parents as a function of their gender. Negative parenting practices were positively related to adolescents' internalizing and externalizing problems, whereas positive practices were negatively related to externalizing problems. Moreover, differences between boys and girls were found in predictor variables of problems, and the predictive power of the variables was higher for externalizing problems.

  4. 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…

  5. International guidance on the establishment of quality assurance programmes for radioactivity measurement in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Zimmerman, B.E. [Dosimetry and Medical Radiation Physics Section, Division of Human Health, International Atomic Energy Agency, Wagramer Strasse 5, P.O. Box 200, A-1400 Vienna (Austria)]. E-mail: b.zimmerman@iaea.org; Herbst, C. [Department of Medical Physics, University of the Free State, Geneeskundige Fisika G 68, Bloemfontein 9300 (South Africa); Norenberg, J.P. [College of Pharmacy, 2502 Marble, NE MSC09 5360, University of New Mexico, Albuquerque 87131 (United States); Woods, M.J. [Ionizing Radiation Consultants, Ltd., 152 Broom Road, Teddington, Middlesex TW11 9PQ (United Kingdom)

    2006-10-15

    A new guidance document for the implementation of quality assurance (QA) programmes for nuclear medicine radioactivity measurement, produced by the International Atomic Energy Agency, is described. The proposed programme is based on the principles of ISO 17025 and will enable laboratories, particularly in developing countries, to provide consistent, safe and effective radioactivity measurement services to the nuclear medicine community.

  6. International guidance on the establishment of quality assurance programmes for radioactivity measurement in nuclear medicine

    International Nuclear Information System (INIS)

    Zimmerman, B.E.; Herbst, C.; Norenberg, J.P.; Woods, M.J.

    2006-01-01

    A new guidance document for the implementation of quality assurance (QA) programmes for nuclear medicine radioactivity measurement, produced by the International Atomic Energy Agency, is described. The proposed programme is based on the principles of ISO 17025 and will enable laboratories, particularly in developing countries, to provide consistent, safe and effective radioactivity measurement services to the nuclear medicine community

  7. Practices on nuclear security and international cooperation

    International Nuclear Information System (INIS)

    Shen Ning

    2009-01-01

    Full text: Nuclear terrorism has been a great threat against the safety and security of the world. It has been reached the consensus by international community to strengthen the nuclear security regime to protect the nuclear and other radiological materials and related facilities. Protection of the security of nuclear and other radiological materials in use, storage and transport and related facilities is always a important issue faced by each country and it depends on the technologies, funds and human resources can be utilized. As nuclear technology has been widely used in different area, China competent authorities have issued a series of regulations, implementation rules and guidelines on security of nuclear and radioactive materials and related facilities. China supports and has taken an active part in the international efforts to strengthen the international nuclear security regime to combat nuclear terrorism. China has paid great importance on international cooperations on nuclear security with IAEA and other countries. More than 10 various national workshops and training courses on nuclear security and physical protection were delivered per year, which provided a communication platform for Chinese facility operators and managers to know the international technology-development and share the research achievements. In cooperation with the IAEA, China has held a great number of regional and national training courses on physical protection and nuclear security since 1998. Different types of training, such as training on awareness, Design Basis Threat (DBT), physical security system design, equipments operation and vulnerability analysis, benefited the administrators, facility operators, engineers and technical staff in charge of physical security system design, operation and maintenance from China and regional countries. Under the framework of the bilateral agreement on Peaceful Use of Nuclear Technology (PUNT), China and U.S. jointly conducted a Technical Demo

  8. A dozen years of American Academy of Sleep Medicine (AASM) International Mini-Fellowship: program evaluation and future directions.

    Science.gov (United States)

    Ioachimescu, Octavian C; Wickwire, Emerson M; Harrington, John; Kristo, David; Arnedt, J Todd; Ramar, Kannan; Won, Christine; Billings, Martha E; DelRosso, Lourdes; Williams, Scott; Paruthi, Shalini; Morgenthaler, Timothy I

    2014-03-15

    Sleep medicine remains an underrepresented medical specialty worldwide, with significant geographic disparities with regard to training, number of available sleep specialists, sleep laboratory or clinic infrastructures, and evidence-based clinical practices. The American Academy of Sleep Medicine (AASM) is committed to facilitating the education of sleep medicine professionals to ensure high-quality, evidence-based clinical care and improve access to sleep centers around the world, particularly in developing countries. In 2002, the AASM launched an annual 4-week training program called Mini-Fellowship for International Scholars, designed to support the establishment of sleep medicine in developing countries. The participating fellows were generally chosen from areas that lacked a clinical infrastructure in this specialty and provided with training in AASM Accredited sleep centers. This manuscript presents an overview of the program, summarizes the outcomes, successes, and lessons learned during the first 12 years, and describes a set of programmatic changes for the near-future, as assembled and proposed by the AASM Education Committee and recently approved by the AASM Board of Directors. Ioachimescu OC; Wickwire EM; Harrington J; Kristo D; Arnedt JT; Ramar K; Won C; Billings ME; DelRosso L; Williams S; Paruthi S; Morgenthaler TI. A dozen years of American Academy of Sleep Medicine (AASM) international mini-fellowship: program evaluation and future directions.

  9. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  10. Progress in organizing national and international comparisons for nuclear medicine measurements

    International Nuclear Information System (INIS)

    Sahagia, Maria; Waetjen, Anamaria C.; Ivan, Constantin

    2008-01-01

    The paper presents the progress registered by the Radionuclide Metrology Laboratory (RML) from IFIN-HH, in improvement of the quality of radiopharmaceuticals activity measurement, and assurance of the whole traceability chain from international level to the national users. The progress in organization of comparisons for radiopharmaceuticals activity measurement is analyzed. A detailed description of two recent national comparisons, and an international one, regarding 131 I solutions, within the frame of the IAEA's CRP E2.10.05 'Harmonization of quality practices for nuclear medicine radioactivity measurements' is done, with the analysis of the strong and week points in measurements. The most important outcome of the paper is the analysis of the evolution in quality of comparisons since a previously reported one. At the RML level, the improvements are: demonstration of the international equivalence of primary Romanian activity standard, improvement of the secondary standard, relevance of the comparison within the IAEA frame, implementation of a quality system in standardization and in comparisons, and implication of the RML in calibrations and metrological checks. The participants' reported improvements refer to growing of the awareness in quality of measurement and improvement of the measurement equipment. Reasons for future comparisons organization are presented. (author)

  11. Alternative medicine and anesthesia: Implications and considerations in daily practice.

    Science.gov (United States)

    Bajwa, Sukhminder Jit Singh; Panda, Aparajita

    2012-10-01

    Nowadays, herbal medicines are widely used by most of the people, including the pre-surgical population. These medicines may pose numerous challenges during perioperative care. The objective of the current literature review is to dwell upon the impact of the use of herbal medicines during the perioperative period, and to review the strategies for managing their perioperative use. The data was generated from various articles of different journals, text books, web source, including, Entrez Pubmed, Medscape, WebMD, and so on. Selected only those herbal medicines for which information on, safety, usage, and precautions during the perioperative period was available. Thereafter, the information about safety, pharmacokinetics, and pharmacodynamics from selected literature was gathered and analyzed. The whole review focused on the fact that these commonly used alternative medicines could sometimes pose as a concern during the perioperative period, in various ways. These complications could be due to their direct action, pharmacodynamic effect, or pharmacokinetic effect. In view of the serious impacts of herbal medicine usage in perioperative care, the anesthesiologist should take a detailed history, especially stressing on the use of herbal medicine during the preoperative anesthetic assessment. The anesthesiologist should also be aware of the potential perioperative effects of those drugs. Accordingly, steps should to be taken to prevent, recognize, and treat the complications that may arise due to their use or discontinuation.

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

    Directory of Open Access Journals (Sweden)

    Aertgeerts Bert

    2005-09-01

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

  13. The practice of nuclear medicine in the Philippines

    International Nuclear Information System (INIS)

    San Luis, T.O.L.

    1996-01-01

    The advent of nuclear medicine in the early 1940's came with the use of radioiodine in the study of thyroid physiology and eventual treatment of hyperthyroidism. Instrumentation to detect radionuclides introduced into the human body, and the production of various radiopharmaceuticals as tracers or as therapy agents provided the impetus for the rapid development of nuclear medicine as a distinct specialty. In the Philippines, nuclear medicine formally began in 1956 with the establishment of the Radioisotope Laboratory at the Philippine General Hospital. Acquisition of nuclear instrumentation by various institutions, training of medical staff and personnel, sourcing of radiopharmaceuticals proceeded thereafter

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

    DEFF Research Database (Denmark)

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

    2003-01-01

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

  15. International Journal of Medicine and Health Development - Vol 8 ...

    African Journals Online (AJOL)

    DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Joseph I. Ikechebelu, 1-6. Vegetarianism- Food as Medicine and A way of Life · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Chima Oji, 7-11. Urolithiasis in Pregnancy – A Clinical Review · EMAIL FULL TEXT EMAIL FULL ...

  16. International Comparisons: Issues of Methodology and Practice

    Directory of Open Access Journals (Sweden)

    Serova Irina A.

    2017-12-01

    Full Text Available The article discusses the methodology and organization of statistical observation of the level of countries’ economic development. The theoretical basis of international comparisons is singled out and on its basis the comparative evaluation of inconsistency of theoretical positions and the reasons of differences of GDP growth is carried out. Based on the complexity of the formation of homogeneous data sets in order to obtain correct comparison results, a general scheme for the relationship between the theoretical base of international comparisons and PPP constraints is defined. The possibility of obtaining a single measurement of the indicators of national economies based on the existing sampling errors, measurement uncertainties and classification errors is considered. The emphasis is placed on combining the work using the ICP and CPI with the aim of achieving comparability of data in the territorial and temporal cross-section. Using the basic characteristics of sustainable economic growth, long-term prospects for changing the ranking positions of countries with different levels of income are determined. It is shown that the clarity and unambiguity of the theoretical provisions is the defining condition for the further process of data collection and formation of correct analytical conclusions.

  17. Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination.

    Science.gov (United States)

    Sisson, Stephen D; Bertram, Amanda; Yeh, Hsin-Chieh

    2015-03-01

    A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P ITE total and percentile rank scores (P ITE percentile rank. Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

  18. Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography.

    Science.gov (United States)

    Johnson, Benjamin K; Tierney, David M; Rosborough, Terry K; Harris, Kevin M; Newell, Marc C

    2016-02-01

    Although focused cardiac ultrasonographic (FoCUS) examination has been evaluated in emergency departments and intensive care units with good correlation to formal echocardiography, accuracy for the assessment of left ventricular systolic function (LVSF) when performed by internal medicine physicians still needs independent evaluation. This prospective observational study in a 640-bed, academic, quaternary care center, included 178 inpatients examined by 10 internal medicine physicians who had completed our internal medicine bedside ultrasound training program. The ability to estimate LVSF with FoCUS as "normal," "mild to moderately decreased," or "severely decreased" was compared with left ventricular ejection fraction (>50%, 31-49%, and internal medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p Internal medicine physicians using FoCUS identify normal versus decreased LVSF with high sensitivity, specificity, and "good/substantial" interrater agreement when compared with formal echocardiography. These results support the role of cardiac FoCUS by properly trained internal medicine physicians for discriminating normal from reduced LVSF. © 2015 Wiley Periodicals, Inc.

  19. US Medical Student Performance on the NBME Subject Examination in Internal Medicine: Do Clerkship Sequence and Clerkship Length Matter?

    Science.gov (United States)

    Ouyang, Wenli; Cuddy, Monica M; Swanson, David B

    2015-09-01

    Prior to graduation, US medical students are required to complete clinical clerkship rotations, most commonly in the specialty areas of family medicine, internal medicine, obstetrics and gynecology (ob/gyn), pediatrics, psychiatry, and surgery. Within a school, the sequence in which students complete these clerkships varies. In addition, the length of these rotations varies, both within a school for different clerkships and between schools for the same clerkship. The present study investigated the effects of clerkship sequence and length on performance on the National Board of Medical Examiner's subject examination in internal medicine. The study sample included 16,091 students from 67 US Liaison Committee on Medical Education (LCME)-accredited medical schools who graduated in 2012 or 2013. Student-level measures included first-attempt internal medicine subject examination scores, first-attempt USMLE Step 1 scores, and five dichotomous variables capturing whether or not students completed rotations in family medicine, ob/gyn, pediatrics, psychiatry, and surgery prior to taking the internal medicine rotation. School-level measures included clerkship length and average Step 1 score. Multilevel models with students nested in schools were estimated with internal medicine subject examination scores as the dependent measure. Step 1 scores and the five dichotomous variables were treated as student-level predictors. Internal medicine clerkship length and average Step 1 score were used to predict school-to-school variation in average internal medicine subject examination scores. Completion of rotations in surgery, pediatrics and family medicine prior to taking the internal medicine examination significantly improved scores, with the largest benefit observed for surgery (coefficient = 1.58 points; p value internal medicine subject examination performance. At the school level, longer internal medicine clerkships were associated with higher scores on the internal medicine

  20. A historical overview of traditional medicine practices and policy in ...

    African Journals Online (AJOL)

    Administrator

    The health and drug policies of the Ethiopian Ministry of Health recognize the ... It is known that many countries in African, Asia and ... medicine due to the cultural acceptability of healers and .... These perceptions are related to the belief that.

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

    Science.gov (United States)

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

    2014-01-01

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

  2. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

    Science.gov (United States)

    Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

    2009-03-01

    Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

  3. Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice.

    Science.gov (United States)

    Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

    2017-01-01

    During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians' practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine.

  4. Herbal Medicines: Malaysian Women’s Knowledge and Practice

    Directory of Open Access Journals (Sweden)

    Law Kim Sooi

    2013-01-01

    Full Text Available This is a cross-sectional, descriptive study among Malay women admitted in the antenatal and postnatal ward to determine the prevalence and use of herbal medicines during pregnancy and elemental analysis in the most popular herbs. A total of 460 women were surveyed. Herbal medicine use during pregnancy was 34.3%, while 73% utilized herbal medicines during labor, because of a belief that it may shorten and ease labor. The most commonly used herbal medicines in pregnancy were Anastatica hierochuntica L. (60.1% followed by coconut oil (35.4%. The majority of women (89.2% used only one type of herbal medicines and took one capsule/glass (38% per day. Herbal medicines use by pregnant women is largely unsupervised (81%, with most women getting information from their parents (60.7% and buying the products directly from traditional midwives (32.2% and 77% agreed upon its efficacy and safety. From the 460 respondents, 89.8% women were in the low end of the herbs knowledge. There was a significant difference found between knowledge score and income (P<0.05. Microdiffraction analysis revealed significant presence of carbon, oxygen, silica, calcium, magnesium, aluminium, potassium, zinc, and iron that were found in Anastatica hierochuntica L. and proved to have good benefits for pregnancy.

  5. 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.

  6. Celebrating international collaboration: reflections on the first Virtual International Practice Development Conference

    Directory of Open Access Journals (Sweden)

    Moira Stephens

    2016-11-01

    Full Text Available This article reports on the first Virtual International Practice Development Conference, held in May 2015 to celebrate International Nurses Day. The article describes key aspects of its planning, offers a flavour of the event itself and sets out an evaluation, including learning points and recommendations to assist with planning similar events in the future. Central to our learning are: The need for practice developers to grasp skills in technology associated with virtual space The need to embrace virtual space itself as another means by which creative and communicative spaces can be established for active learning and practice development activities The potential advantages that international virtual engagement has over face-to-face national or international engagement The delivery of this virtual event made a significant international contribution to global practice development activity within the International Practice Development Collaborative and to enabling practice developers to connect and celebrate on a more global basis. Implications for practice: Virtual space technology skills can assist with sharing and translating practice development research, innovations and critical commentary Virtual space can provide an adjunct to creative and communicative learning spaces Global networking opportunities can be developed and enhanced through the use of virtual space technology Practice developers need to role model the use of virtual technologies

  7. Exploring the Educational Value of Clinical Vignettes from the Society of General Internal Medicine National Meeting in the Internal Medicine Clerkship

    Science.gov (United States)

    Wofford, James L; Singh, Sonal

    2006-01-01

    INTRODUCTION Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE To explore the relevance and learning value of clinical vignettes from the SGIM national meeting in the Internal Medicine clerkship. SETTING Third year Ambulatory Internal Medicine clerkship at one academic medical center (academic year 2005 to 2006). METHODS Students were introduced to the clinical vignette and oriented to the database of clinical vignettes available through the SGIM annual meeting website. Students then reviewed 5 to 10 clinical vignettes using a worksheet, and rated the learning value of each vignette using a 5-point Likert scale (1 = least, 5 = greatest). A single investigator evaluated congruence of the vignette with the Clerkship Directors of Internal Medicine (CDIM)-SGIM curriculum to assess relevance. MAIN RESULTS A total of 42 students evaluated 371 clinical vignettes from the 2004 and 2005 meetings. The clinical vignettes were curriculum-congruent in 42.6% (n = 175), and clearly incongruent in 40.4% (n = 164). The mean rating for learning value was 3.8 (±1.0) (5 signifying greatest learning value). Curriculum-congruent vignettes had a higher mean learning value compared with curriculum-incongruent vignettes (4.0 vs 3.6, Student's t-test, P =.017). CONCLUSION The clinical vignettes presented at the national SGIM meeting offer clinical content that is relevant and of some educational value for third year clerkship students. Based on this pilot study, the educational value and strategies for their use in the clinical clerkships deserve further study. PMID:17026730

  8. Course on internal dosimetry in nuclear medicine; Curso de dosimetria interna en medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    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.

  9. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients.

    Science.gov (United States)

    Desnoyer, Aude; Blanc, Anne-Laure; Pourcher, Valérie; Besson, Marie; Fonzo-Christe, Caroline; Desmeules, Jules; Perrier, Arnaud; Bonnabry, Pascal; Samer, Caroline; Guignard, Bertrand

    2017-07-31

    Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. 22 University and general hospitals from Canada, Belgium, France and Switzerland. 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (pinternal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    Science.gov (United States)

    2009-05-28

    the level of market-based incentives they offer for R&D. • Type I diseases (“chronic diseases”), such as cancer, diabetes , and cardiovascular... diabetes , and asthma may be subject to patents.44 Critics of the TRIPS Agreement maintain that implementation of the agreement will affect...customs authorities temporarily halted shipments of generic medicines manufactured in India and in transit to Colombia and Peru via the Netherlands

  11. Smartphones and Medical Apps in the Practice of Emergency Medicine in Iran

    Directory of Open Access Journals (Sweden)

    Amirhosein Jahanshir

    2017-01-01

    Full Text Available Introduction: Medical applications help physicians to make more rapid and evidence based decisions that may provide better patient care. This study aimed to determine the extent to which smart phones and medical applications are integrated in the emergency department daily practice.Method: In a cross sectional study, a modified standard questionnaire (Payne et al. consisting of demographic data and information regarding quality and quantity of smartphone and medical app utilization was sent to emergency-medicine residents and interns twice (two weeks apart, in January 2015. The questionnaire was put online using open access "Web-form Module" and the address of the web page was e-mailed along with a cover letter explaining the survey. Finally, responses were analyzed using descriptive statistics and SPSS 22 software.Results: 65 cases participated (response rate 86%. The mean age of interns and residents were 25.03 ± 1.13 and 30.27 ± 4.68 years, respectively (p < 0.001. There was no significant difference between interns and residents in owning a smartphone (p = 0.5. Android was more popular than IOS (67.7% against 25.8% and the most popular medical apps were Medscape and UpToDate, respectively. 38 (61.3% of the respondents were using their apps more than once a day and mostly for drug information. English (83.9%, Persian (12.9%, and other languages (3.2% were preferred languages for designing a medical software among the participants, respectively.Conclusion: The findings of present study showed that smartphones are very popular among Iranian interns and residents in emergency department and a substantial number of them own a smartphone and are using medical apps regularly in their clinical practice

  12. [A history of internal medicine: medical specialization: as old as antiquity].

    Science.gov (United States)

    Echenberg, Donald

    2007-11-28

    This article presents a short review of the history of medical specialization and the evolution of internal medicine within the last two centuries. Medical specialization, far from being a recent phenomenon, existed in the Hellenistic world and in Rome. The development of specialization during the latter part of the 19th century and early 20th century is credited to the rapid expansion of medical knowledge which made it impossible for a single doctor to encompass all the different spheres of the profession. The term innere medizin or internal medicine was adopted from German terminology in the 1880's. The Canadian society of internal medicine was formed in 1983 and its main goal is to promote a broad perspective of medical care and to master the complexity in medicine through a generalist approach.

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

    Directory of Open Access Journals (Sweden)

    Krautter M

    2014-09-01

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

  14. [Nursing Internship Internal Medicine: Evaluation and Influences on the Attitude towards the Specialization].

    Science.gov (United States)

    Wirkner, Janine; Stracke, Sylvia; Lange, Anja; Dabers, Thomas; Merk, Harry; Kasch, Richard

    2017-08-01

    Background  German medical students have to perform a nursery internship of three month duration. While this internship is widely discussed, there is a lack of student evaluation data. Objectives  Here, for the first time, student evaluation of a nursery internship in internal medicine (IM) is investigated. Moreover, the question was raised, whether the early experience during this internship may influence students' attitude towards the specialty. Methods  In a nation-wide online-survey, 767 German medical students (mean age 22.8 years; 58 % female) evaluated a nursery internship on an IM ward concerning integration in medical teams, teachers, structure and quality of teaching, and satisfaction. Multivariate comparisons were conducted following the question, whether students could imagine choosing IM for a clinical elective after this nursery internship. Results  71 % of the students felt well integrated in the medical team, most was learned from the nurses, and most students indicated having acquired nursing skills. Only 19 % evaluated the structure of the internship as good, and 40 % indicated that they reached the learning goals. Students who could imagine performing an IM clinical elective (52 %) gave best evaluations on all items. Conclusions  A successful nursery internship can promote students' interest in the specialty of internal medicine. But, there is a strong need for improvement in structure and content, including the, to date missing, definition of learning targets, regarding this first practical experience in medical studies. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    Steven J Durning

    2013-10-01

    Full Text Available Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI, brain activity was assessed in internal medicine residents (n=10 and board-certified internists (faculty, n=17 from the Uniformed Services University (USU while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory.

  16. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg

    2010-06-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Research

  17. [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.

  18. Development of a high-value care subscore on the internal medicine in-training examination.

    Science.gov (United States)

    Ryskina, Kira L; Korenstein, Deborah; Weissman, Arlene; Masters, Philip; Alguire, Patrick; Smith, Cynthia D

    2014-11-18

    Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. U.S. IM residency programs. 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. None.

  19. 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.

  20. Socializing Identity Through Practice: A Mixed Methods Approach to Family Medicine Resident Perspectives on Uncertainty.

    Science.gov (United States)

    Ledford, Christy J W; Cafferty, Lauren A; Seehusen, Dean A

    2015-01-01

    Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.

  1. Knowledge, Attitude, and Practice of Complementary and Alternative Medicine Among Residents of Wayu Town, Western Ethiopia

    Science.gov (United States)

    Belachew, Negash; Tadesse, Tarekegne

    2017-01-01

    Complementary and alternative medicine covers a wide variety of therapies and practices, which vary from country to country and region to region. The study was conducted to assess the knowledge, attitude, and practice of complementary and alternative medicine among the residents of Wayu town, Western Ethiopia. A descriptive cross-sectional study was carried out on 302 residents. A systematic sampling was used to select households. Data were entered in SPSS (version 20; IBM Corp) and descriptive statistics was carried out. Of 302 participants, 51.65% have a good knowledge, 78.6% were aware of complementary and alternative medicine, and 74.22% used it in the past 2 years. A total of 23.83% believe that complementary and alternative medicine is more effective than modern medicine and 28.8% preferred complementary and alternative medicine to modern medicine. This study revealed that in Wayu town, there is relatively high public interest in complementary and alternative medicine practices and a significant number has a good knowledge but generally the attitude toward complementary and alternative medicine is relatively low. PMID:29250965

  2. Knowledge, Attitude, and Practice of Complementary and Alternative Medicine Among Residents of Wayu Town, Western Ethiopia.

    Science.gov (United States)

    Belachew, Negash; Tadesse, Tarekegne; Gube, Addisu Alemayehu

    2017-10-01

    Complementary and alternative medicine covers a wide variety of therapies and practices, which vary from country to country and region to region. The study was conducted to assess the knowledge, attitude, and practice of complementary and alternative medicine among the residents of Wayu town, Western Ethiopia. A descriptive cross-sectional study was carried out on 302 residents. A systematic sampling was used to select households. Data were entered in SPSS (version 20; IBM Corp) and descriptive statistics was carried out. Of 302 participants, 51.65% have a good knowledge, 78.6% were aware of complementary and alternative medicine, and 74.22% used it in the past 2 years. A total of 23.83% believe that complementary and alternative medicine is more effective than modern medicine and 28.8% preferred complementary and alternative medicine to modern medicine. This study revealed that in Wayu town, there is relatively high public interest in complementary and alternative medicine practices and a significant number has a good knowledge but generally the attitude toward complementary and alternative medicine is relatively low.

  3. Promoting Success: A Professional Development Coaching Program for Interns in Medicine.

    Science.gov (United States)

    Palamara, Kerri; Kauffman, Carol; Stone, Valerie E; Bazari, Hasan; Donelan, Karen

    2015-12-01

    Residency is an intense period. Challenges, including burnout, arise as new physicians develop their professional identities. Residency programs provide remediation, but emotional support for interns is often limited. Professional development coaching of interns, regardless of their performance, has not been reported. Design, implement, and evaluate a program to support intern professional development through positive psychology coaching. We implemented a professional development coaching program in a large residency program. The program included curriculum development, coach-intern interactions, and evaluative metrics. A total of 72 internal medicine interns and 26 internal medicine faculty participated in the first year. Interns and coaches were expected to meet quarterly; expected time commitments per year were 9 hours (per individual coached) for coaches, 5 1/2 hours for each individual coachee, and 70 hours for the director of the coaching program. Coaches and interns were asked to complete 2 surveys in the first year and to participate in qualitative interviews. Eighty-two percent of interns met with their coaches 3 or more times. Coaches and their interns assessed the program in multiple dimensions (participation, program and professional activities, burnout, coping, and coach-intern communication). Most of the interns (94%) rated the coaching program as good or excellent, and 96% would recommend this program to other residency programs. The experience of burnout was lower in this cohort compared with a prior cohort. There is early evidence that a coaching program of interactions with faculty trained in positive psychology may advance intern development and partially address burnout.

  4. 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…

  5. The impact of the improvement in internal medicine consultation process on ED length of stay.

    Science.gov (United States)

    Shin, Sangheon; Lee, Soo Hoon; Kim, Dong Hoon; Kim, Seong Chun; Kim, Tae Yun; Kang, Changwoo; Jeong, Jin Hee; Lim, Daesung; Park, Yong Joo; Lee, Sang Bong

    2018-04-01

    Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy. This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine. Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94min to 706.62min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59min to 180.38min and from 481.89min to 362.37min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar. The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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.

  7. 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

  8. Do Pain Medicine Fellowship Programs Provide Education in Practice Management? A Survey of Pain Medicine Fellowship Programs.

    Science.gov (United States)

    Przkora, Rene; Antony, Ajay; McNeil, Andrew; Brenner, Gary J; Mesrobian, James; Rosenquist, Richard; Abouleish, Amr E

    2018-01-01

    We hypothesized that there is a gap between expectations and actual training in practice management for pain medicine fellows. Our impression is that many fellowships rely on residency training to provide exposure to business education. Unfortunately, pain management and anesthesiology business education are very different, as the practice settings are largely office- versus hospital-based, respectively. Because it is unclear whether pain management fellowships are providing practice management education and, if they do, whether the topics covered match the expectations of their fellows, we surveyed pain medicine program directors and fellows regarding their expectations and training in business management. A survey. Academic pain medicine fellowship programs. After an exemption was obtained from the University of Texas Medical Branch Institutional Review Board (#13-030), an email survey was sent to members of the Association of Pain Program Directors to be forwarded to their fellows. Directors were contacted 3 times to maximize the response rate. The anonymous survey for fellows contained 21 questions (questions are shown in the results). Fifty-nine of 84 program directors responded and forwarded the survey to their fellows. Sixty fellows responded, with 56 answering the survey questions. The responder rate is a limitation, although similar rates have been reported in similar studies. The majority of pain medicine fellows receive some practice management training, mainly on billing documentation and preauthorization processes, while most do not receive business education (e.g., human resources, contracts, accounting/financial reports). More than 70% of fellows reported that they receive more business education from industry than from their fellowships, a result that may raise concerns about the independence of our future physicians from the industry. Our findings support the need for enhanced and structured business education during pain fellowship. Business

  9. 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.

  10. Attitudes and Practices of Massage Therapists as Related to Conventional Medicine

    Science.gov (United States)

    Footracer, Katherine G.; Monaghan, Melissa; Wisniewski, Nicole P.; Mandel, Ellen

    2012-01-01

    Introduction Research into opinions about complementary and alternative medicine (CAM) has focused on conventional medical practitioners with little exploration of CAM practitioners’ views. Purpose To survey attitudes and practices of massage therapists toward conventional medicine. Research Design An anonymous online survey consisting of Likert-type scales, fill-in answers, and multiple-choice questions was used. Participants Members of the Associated Bodywork & Massage Professionals (ABMP), the largest massage therapy association in the US with over 77,000 members. Main Outcome Measures Participants were asked about their years of practice and training, choice of health care practitioners, sources for information about CAM and Western/allopathic medicine, client referral patterns, optimal treatment approaches for various medical conditions, and overall impressions of CAM and Western/ allopathic medicine. Results Analysis of n = 3,148 responses indicated that while 66.9% of respondents had a neutral or worse impression of Western/allopathic medicine, 64.3% use a conventional medicine practitioner as their primary health care provider, 61.9% have referred clients to a conventional medicine practitioner in the past six months, and 90.5% seek out information on Western/allopathic medicine. The mode response of the best treatment approach to various medical problems was a mix of Western/allopathic medicine and CAM. Conclusions This study suggests that despite the ambivalence of many massage therapists towards conventional medicine, many use it, encourage clients to do so, and see involvement of both as crucial to health. PMID:22553480

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

    LENUS (Irish Health Repository)

    Mc Kenna, F

    2010-11-05

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

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

    Science.gov (United States)

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

    2017-08-01

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

  13. Evidence based practice in traditional & complementary medicine: An agenda for policy, practice, education and research.

    Science.gov (United States)

    Leach, Matthew J; Canaway, Rachel; Hunter, Jennifer

    2018-05-01

    To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. Four central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Cytogenetics And Its Relevance to the Practice of Modern Medicine ...

    African Journals Online (AJOL)

    This review outlines the importance of cytogenetics in modern medicine, the need to develop the application to the level of a full discipline in Nigeria to prevent and control these disorders and reawaken the interest of scientists and postgraduate students in this all-important discipline. Keywords: Human cytogenetics ...

  15. Paramedics' experiences of financial medicine practices in the pre ...

    African Journals Online (AJOL)

    Craig Vincent-Lambert

    Financial medicine. Ethics abstract. Background: The term “financial medicine” refers to the delivery of health-related services where the generation of financial gain or “profit” takes precedence over .... These are Basic Life Support (BLS), Intermediate life Support ... reports by members of the profession have highlighted cir-.

  16. Precision medicine in airway diseases: moving to clinical practice

    NARCIS (Netherlands)

    Agustí, Alvar; Bafadhel, Mona; Beasley, Richard; Bel, Elisabeth H.; Faner, Rosa; Gibson, Peter G.; Louis, Renaud; McDonald, Vanessa M.; Sterk, Peter J.; Thomas, Mike; Vogelmeier, Claus; Pavord, Ian D.

    2017-01-01

    On February 21, 2017, a European Respiratory Society research seminar held in Barcelona discussed how to best apply precision medicine to chronic airway diseases such as asthma and chronic obstructive pulmonary disease. It is now clear that both are complex and heterogeneous diseases, that often

  17. A historical overview of traditional medicine practices and policy in ...

    African Journals Online (AJOL)

    The health and drug policies of the Ethiopian Ministry of Health recognize the important role traditional health systems play in health care. Unfortunately, little has ... Conclusion: The Ethiopian government firmly supports and encourages traditional medicine through its policies as part of the national heritage. Despite these ...

  18. An anatomy memorial tribute: fostering a humanistic practice of medicine.

    Science.gov (United States)

    Vora, A

    1998-01-01

    Medical students' first "patients" are the individuals who donate their bodies for laboratory dissection, and these first lessons of medicine serve as a model for the doctor-patient relationship. An Anatomy Memorial Tribute was initiated by students at Mount Sinai School of Medicine to honor these donors. Students and faculty shared music, art, and readings of original poetry and prose. The event facilitated dialogue about attitudes and feelings with regards to death and dying. Controversial issues included anonymity versus identification of donors and the appropriateness of professionals showing emotion in public. The feedback from both students and faculty participants in the event was overwhelmingly positive. Students wrote that the tribute provided a sense of closure for their dissection experience and reinvolved them in shaping their education; faculty indicated that it was appropriate. Memorial tributes are a first step toward fostering the personal growth and emotional preparation required for competent and compassionate patient care. To encourage a humanistic approach to medical education, faculty have the opportunity to participate in such tributes, facilitate sensitive use of language in the anatomy laboratory, and expand the broader medical school curriculum in relation to death and dying. Medical students may expand the concept of memorial tributes and enhance their professional growth in this area by sharing information, ideas, and experiences through national organizations such as the Humanistic Medicine Group of the American Medical Students Association. The capacity of physicians to effectively serve patients facing the end of life is particularly relevant in the setting of palliative medicine.

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

    Science.gov (United States)

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

    2014-01-01

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

  20. Social media; resolving tunnel vision in practicing medicine.

    Science.gov (United States)

    Kordmahaleh, Fatemeh Hosseini; Rouhipour, Alaleh; Mirbaha, Sahar; Baratloo, Alireza

    2018-01-01

    With the emergence of social media, physicians who use social media, including emergency medicine physicians, have shared their experiences with their colleagues instead of working alone and keeping their experiences to themselves. This study aimed to evaluate the rate and type of use of electronic online sources and social media, in order to improve learning and education among emergency medicine residents. This was a cross-sectional study carried out from September 2015 until August 2016 on emergency medicine residents of two main medical universities of Tehran, Iran. A questionnaire was prepared by reviewing the existing studies and asking emergency medicine professors inside and outside Iran for opinions. Census sampling method was applied and all emergency medicine residents were included. The gathered data were analyzed using statistical tests of chi square, Independent-samples t-test and Pearson's correlation coefficient via SPSS version 21. Seventy three residents with the mean age of 34.2±5.2 years participated in this study (60.3% female). Smart phone is the most important tool they use for connecting to the Internet. About 30% use the Internet for about 1-2 hours a day. In half of these participants less than 25% of this time is spent on something related to their academic field of study. The correlation of sex (p=0.034) and age (p=0.049) with extent of using social media related to the academic field of study were significant. Other analytical analyses were not statistically significant (p>0.05). In summary, the findings of current study showed that despite sufficient access to proper technology, use of social media and online sources by high majority of the studied EM residents regarding improvement of their learning and educational level is very limited.

  1. Medical Mucilage Used in Traditional Persian Medicine Practice

    Science.gov (United States)

    Heydarirad, Ghazaleh; Choopani, Rasool; Mehdi, Pasalar; Jafari, Jamileh Mahdavi

    2016-01-01

    Background: Mucilage compounds are pharmaceutically important polysaccharides that have an extensive range of applications, including binding agents, thickeners, water retention agents, emulsion stabilizers, suspending agents, disintegrates, film formers, and gelling agents. A historical approach to medical science written by Iranian scholars could help in identifying excellent ideas and provide valuable information in this field for proper application. The aim of the current study was to introduce some mucilage uses derived from traditional Persian medicine (TPM). Methods: In this literature review, we assessed a few main traditional manuscripts of Iranian medicine, including the books Al Havi, Canon of Medicine, Qarabadine-kabir, Zakhireh-ye Khwarazm shahi, Tuhfat ul-Momineen and Makhzan-ul-Adwiah. The word “loab” in the aforementioned books were searched and all data about mucilage compounds were collected. Results: The use of medicinal plants containing mucilage in Iran dates back to ancient times. In traditional Persian manuscripts, mucilage is one of the most cited applications of medicinal plants for therapeutic objectives. There are various mucilage-producing plants in TPM such as Malva silvestris, Linum usitissimum, Althaea officinalis, Plantago psyllium, Descureania sophia and Ziziphus vulgaris. They have been used traditionally via oral or topical routes for respiratory, gastrointestinal, urinary, musculoskeletal, and genital systems as well as skin disorders. Certain applications are unique and promising for today’s chronic ailments. Conclusion: A scientific assessment of these valuable manuscripts would provide a better insight into the thoughts of the past sages and applicable for clinical use of the mucilage compounds. This may lead to research opportunities in the future. PMID:27840507

  2. Practical Biostatistics A Friendly Step-by-Step Approach for Evidence-based Medicine

    CERN Document Server

    Suchmacher, Mendel

    2012-01-01

    Evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It is a practice that uses statistical analysis of scientific methods and outcomes to drive further experimentation and diagnosis. The profusion of evidence-based medicine in medical practice and clinical research has produced a need for life scientists and clinical researchers to assimilate biostatistics into their work to meet efficacy and practical standards. Practical Biostatistics provides researchers, medical professionals, and students with a friendly, practica

  3. Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

    Science.gov (United States)

    1997-01-01

    An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

  4. International Good Practice on Practical Implementation of Characterisation in Decommissioning. Radiological Characterization in Decommissioning of Nuclear Facilities: International Good Practice on Practical Implementation

    International Nuclear Information System (INIS)

    Larsson, A.; Empdage, M.; Weber, I.; )

    2017-01-01

    Within the Nuclear Energy Agency (NEA), the Working Party on Decommissioning and Dismantling (WPDD) operates under the umbrella of the Radioactive Waste Management Committee (RWMC). The WPDD provides a focus for the analysis of decommissioning policy, strategy and regulation, including the related issues of waste management, release of buildings and sites from regulatory control and associated cost estimation and funding. WPDD also convenes task groups comprised of experts from the NEA member countries to review related topics such as characterisation techniques which support decommissioning and associated waste management. The Task Group on Radiological Characterisation and Decommissioning was established in 2011 to identify and present characterisation good practice at different stages of decommissioning and to identify areas that could, or should, be developed further through international cooperation and coordination. By the end of 2016 two phases of work will be complete. The first phase developed strategic guidance for decision makers on the selection and tailoring of strategies for radiological characterisation, which gives an overview of good practice for radiological characterisation at different phases of the life cycle of a nuclear installation. The second phase has focused on strategies for practical implementation of radiological characterisation from a waste and materials end-state perspective. This paper provides a summary of the phase 2 findings, covering: -) a major international survey (questionnaire) to elicit the views of characterisation experts regarding good practice; -) Learning drawn from recent international case studies; -) The collation and analysis of regulations, standards and guidance documents; -) Learning distilled from an international conference on characterisation co-organised by the task group; and -) Overall conclusions regarding characterisation good practice, recommendations and identified areas for further international

  5. 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

  6. Internal Medicine residents use heuristics to estimate disease probability

    Directory of Open Access Journals (Sweden)

    Sen Phang

    2015-12-01

    Conclusions: 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.

  7. MERGING conventional and complementary medicine in a clinic department - a theoretical model and practical recommendations.

    Science.gov (United States)

    Pérard, Marion; Mittring, Nadine; Schweiger, David; Kummer, Christopher; Witt, Claudia M

    2015-06-09

    Today, the increasing demand for complementary medicine encourages health care providers to adapt and create integrative medicine departments or services within clinics. However, because of their differing philosophies, historical development, and settings, merging the partners (conventional and complementary medicine) is often difficult. It is necessary to understand the similarities and differences in both cultures to support a successful and sustainable integration. The aim of this project was to develop a theoretical model and practical steps that are based on theories from mergers in business to facilitate the implementation of an integrative medicine department. Based on a literature search and expert discussions, the cultures were described and model domains were developed. These were applied to two case studies to develop the final model. Furthermore, a checklist with practical steps was devised. Conventional medicine and complementary medicine have developed different corporate cultures. The final model, which should help to foster integration by bridging between these cultures, is based on four overall aspects: culture, strategy, organizational tools and outcomes. Each culture is represented by three dimensions in the model: corporate philosophy (core and identity of the medicine and the clinic), patient (all characteristics of the professional team's contact with the patient), and professional team (the characteristics of the interactions within the professional team). Overall, corporate culture differs between conventional and complementary medicine; when planning the implementation of an integrative medicine department, the developed model and the checklist can support better integration.

  8. Systems medicine: a new approach to clinical practice.

    Science.gov (United States)

    Cardinal-Fernández, Pablo; Nin, Nicolás; Ruíz-Cabello, Jesús; Lorente, José A

    2014-10-01

    Most respiratory diseases are considered complex diseases as their susceptibility and outcomes are determined by the interaction between host-dependent factors (genetic factors, comorbidities, etc.) and environmental factors (exposure to microorganisms or allergens, treatments received, etc.) The reductionist approach in the study of diseases has been of fundamental importance for the understanding of the different components of a system. Systems biology or systems medicine is a complementary approach aimed at analyzing the interactions between the different components within one organizational level (genome, transcriptome, proteome), and then between the different levels. Systems medicine is currently used for the interpretation and understanding of the pathogenesis and pathophysiology of different diseases, biomarker discovery, design of innovative therapeutic targets, and the drawing up of computational models for different biological processes. In this review we discuss the most relevant concepts of the theory underlying systems medicine, as well as its applications in the various biological processes in humans. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  9. Brand Name Statin Prescribing in a Resident Ambulatory Practice: Implications for Teaching Cost-Conscious Medicine.

    Science.gov (United States)

    Ryskina, Kira L; Pesko, Michael F; Gossey, J Travis; Caesar, Erica Phillips; Bishop, Tara F

    2014-09-01

    Several national initiatives aim to teach high-value care to residents. While there is a growing body of literature on cost impact of physicians' therapeutic decisions, few studies have assessed factors that influence residents' prescribing practices. We studied factors associated with intensive health care utilization among internal medicine residents, using brand name statin prescribing as a proxy for higher-cost care. We conducted a retrospective, cross-sectional analysis of statin prescriptions by residents at an urban academic internal medicine program, using electronic health record data between July 1, 2010, and June 30, 2011. For 319 encounters by 90 residents, patients were given a brand name statin in 50% of cases. When categorized into quintiles, the bottom quintile of residents prescribed brand name statins in 2% of encounters, while the top quintile prescribed brand name statins in 98% of encounters. After adjusting for potential confounders, including patient characteristics and supervising attending, being in the primary care track was associated with lower odds (odds ratio [OR], 0.38; P  =  .02; 95% confidence interval [CI], 0.16-0.86), and graduating from a medical school with an above-average hospital care intensity index was associated with higher odds of prescribing brand name statins (OR, 1.70; P  =  .049; 95% CI, 1.003-2.88). We found considerable variation in brand name statin prescribing by residents. Medical school attended and residency program type were associated with resident prescribing behavior. Future interventions should raise awareness of these patterns in an effort to teach high-value, cost-conscious care to all residents.

  10. An Evolution in Research Practice for Investigating International Business Relationships

    OpenAIRE

    Anne HAMPTON; James ROWELL

    2013-01-01

    The purpose of this paper is to discuss the development and rationale of research methodology for a specific topic of research. The topic in question is an investigation into international business relationships, a complex subject and one that is very topical in the growing world of international business. It is intended to examine the logical development of research practice in our study and to show the changing thought processes and justifications we have made over a period of time. It is h...

  11. Medicines

    Science.gov (United States)

    Medicines can treat diseases and improve your health. If you are like most people, you need to take medicine at some point in your life. You may need to take medicine every day, or you may only need to ...

  12. IMPACT OF TRADITIONAL PRACTICES ON MEDICINAL PLANT TRADE IN THE RAINFOREST OF NIGERIA

    Directory of Open Access Journals (Sweden)

    Gbadebo Osemeobo

    2010-01-01

    Full Text Available A cross-sectional survey was used to assess the impact of traditional practices on trade in traditional plants within the rainforest of Nigeria. A questionnaire survey and market-based observations were used to derive data from 110 stakeholders including: plant collectors, sellers, middlemen and traditional healers. Results of data analyses indicate that: (i plants not suitable for cultural practices were not usually used for traditional medicine. (ii Traditional management of the forests based on open access, restricted access and closed access rights could no longer protect habitats of medicinal plants. (iii Breakdown of management practices in the forests was common because of a twin factor: violators of regulations were not being punished; and there were increasing disputes over land boundaries among communities. (iv Medicinal plants on regular trade were in decline. Stakeholder participation in species rehabilitation in the forests and establishment of ex situ gardens may sustain the medicinal plant trade.

  13. Structured patient handoff on an internal medicine ward: A cluster randomized control trial.

    Science.gov (United States)

    Tam, Penny; Nijjar, Aman P; Fok, Mark; Little, Chris; Shingina, Alexandra; Bittman, Jesse; Raghavan, Rashmi; Khan, Nadia A

    2018-01-01

    The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at

  14. 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

  15. Female authorship in emergency medicine parallels women practicing academic emergency medicine.

    Science.gov (United States)

    Tinjum, Banu E; Getto, Leila; Tiedemann, Juliah; Marri, Maaya; Brodowy, Michelle; Bollinger, Melissa; O'Connor, Robert E; Breyer, Michael J

    2011-12-01

    Studies have shown that women in emergency medicine (EM) lag behind their male counterparts in academic productivity. We compared the proportion of female attending physicians from EM academic programs to the proportion of female first or second authors of original scientific manuscripts and case reports from four major EM journals in a single year. We used a retrospective cross-sectional design. Original scientific manuscripts and case reports from four major EM journals published in 2005: Academic Emergency Medicine, Annals of Emergency Medicine, American Journal of Emergency Medicine, and Journal of Emergency Medicine were reviewed to determine genders of first and second authors. The proportion of female first or second authorship was then compared to the proportion of female EM attending physicians from 134 academic EM programs in the United States. Data were analyzed using Pearson's chi-squared and Clopper-Pearson binomial confidence intervals as appropriate. A p-value of ≤ 0.05 was considered significant. The percentage of female faculty; 940/3571 (26.32%, 95% confidence interval [CI] 24.9-27.8%) vs. the percentage of female first or second authorship 289/1123 (25.73%, 95% CI 23.3-28.4%) was not statistically significant (p = 0.562). There was no difference in the proportion of male and female authors with multiple manuscripts (p = 0.889). As measured by first and second authorship, there was no discrepancy between the proportion of female EM faculty and the proportion of female authorship in EM literature from 2005. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

    Science.gov (United States)

    Díez-Manglano, Jesús; de Escalante Yangüela, Begoña; García-Arilla Calvo, Ernesto; Ubis Díez, Elena; Munilla López, Eulalia; Clerencia Sierra, Mercedes; Revillo Pinilla, Paz; Omiste Sanvicente, Teresa

    2013-12-01

    To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. A cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index wasinternal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; pinternal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); pinternal medicine and geriatrics departments. © 2013.

  17. [Community pharmacy and general internal medicine are at the same crossroads: some opportunities should be seized].

    Science.gov (United States)

    Bugnon, O; Buchmann, M

    2012-11-28

    The medicines give some symptoms relief and save lives every day. However, the responsible use of medicines is not definitively attained for the modern health systems. The shortcomings in this area are the cause of major negative clinical outcomes for the patients and the cause of additional cost for the health financing system. The two centenarians, as the International Pharmaceutical Federation (FIP) and the "Policlinique Médicale Universitaire (PMU)" in Lausanne, preview the solutions from now on for reversing this trend, such as the interdisciplinary collaborative approaches, the introduction of adequate financial incentives and the strengthening of education and research in community medicine, pharmacy and health.

  18. 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).

  19. Medicine as a Community of Practice: Implications for Medical Education.

    Science.gov (United States)

    Cruess, Richard L; Cruess, Sylvia R; Steinert, Yvonne

    2018-02-01

    The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community's norms.Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education's complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.

  20. An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

    Science.gov (United States)

    Mi, Misa; Moseley, James L; Green, Michael L

    2012-02-01

    Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

  1. International symposium on standards and codes of practice in medical radiation dosimetry. Book of extended synopses

    International Nuclear Information System (INIS)

    2002-01-01

    The development of radiation measurement standards by National Metrology Institutes (NMIs) and their dissemination to Secondary Standard Dosimetry Laboratories (SSDLs), cancer therapy centres and hospitals represent essential aspects of the radiation dosimetry measurement chain. Although the demands for accuracy in radiotherapy initiated the establishment of such measurement chains, similar traceable dosimetry procedures have been implemented, or are being developed, in other areas of radiation medicine (e.g. diagnostic radiology and nuclear medicine), in radiation protection and in industrial applications of radiation. In the past few years the development of primary standards of absorbed dose to water in 60 Co for radiotherapy dosimetry has made direct calibrations in terms of absorbed dose to water available in many countries for the first time. Some laboratories have extended the development of these standards to high energy photon and electron beams and to low and medium energy x-ray beams. Other countries, however, still base their dosimetry for radiotherapy on air kerma standards. Dosimetry for conventional external beam radiotherapy was probably the field where standardized procedures adopted by medical physicists at hospitals were developed first. Those were related to exposure and air kerma standards. The recent development of Codes of Practice (or protocols) based on the concept of absorbed dose to water has led to changes in calibration procedures at hospitals. The International Code of Practice for Dosimetry Based on Standards of Absorbed Dose to Water (TRS 398) was sponsored by the International Atomic Energy Agency (IAEA), World Health Organization (WHO), Pan-American Health Organization (PAHO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) and is expected to be adopted in many countries worldwide. It provides recommendations for the dosimetry of all types of beams (except neutrons) used in external radiotherapy and satisfies

  2. International symposium on standards and codes of practice in medical radiation dosimetry. Book of extended synopses

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    The development of radiation measurement standards by National Metrology Institutes (NMIs) and their dissemination to Secondary Standard Dosimetry Laboratories (SSDLs), cancer therapy centres and hospitals represent essential aspects of the radiation dosimetry measurement chain. Although the demands for accuracy in radiotherapy initiated the establishment of such measurement chains, similar traceable dosimetry procedures have been implemented, or are being developed, in other areas of radiation medicine (e.g. diagnostic radiology and nuclear medicine), in radiation protection and in industrial applications of radiation. In the past few years the development of primary standards of absorbed dose to water in {sup 60}Co for radiotherapy dosimetry has made direct calibrations in terms of absorbed dose to water available in many countries for the first time. Some laboratories have extended the development of these standards to high energy photon and electron beams and to low and medium energy x-ray beams. Other countries, however, still base their dosimetry for radiotherapy on air kerma standards. Dosimetry for conventional external beam radiotherapy was probably the field where standardized procedures adopted by medical physicists at hospitals were developed first. Those were related to exposure and air kerma standards. The recent development of Codes of Practice (or protocols) based on the concept of absorbed dose to water has led to changes in calibration procedures at hospitals. The International Code of Practice for Dosimetry Based on Standards of Absorbed Dose to Water (TRS 398) was sponsored by the International Atomic Energy Agency (IAEA), World Health Organization (WHO), Pan-American Health Organization (PAHO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) and is expected to be adopted in many countries worldwide. It provides recommendations for the dosimetry of all types of beams (except neutrons) used in external radiotherapy and

  3. [Factor analysis and internal consistency of pedagogical practices questionnaire among health care teachers].

    Science.gov (United States)

    Pérez V, Cristhian; Vaccarezza G, Giulietta; Aguilar A, César; Coloma N, Katherine; Salgado F, Horacio; Baquedano R, Marjorie; Chavarría R, Carla; Bastías V, Nancy

    2016-06-01

    Teaching practice is one of the most complex topics of the training process in medicine and other health care careers. The Teaching Practices Questionnaire (TPQ) evaluates teaching skills. To assess the factor structure and internal consistency of the Spanish version of the TPP among health care teachers. The TPQ was answered by 315 university teachers from 13 of the 15 administrative Chilean regions, who were selected through a non-probabilistic volunteer sampling. The internal consistency of TPP factors was calculated and the correlation between them was analyzed. Six factors were identified: Student-centered teaching, Teaching planning, Assessment process, Dialogue relationship, Teacher-centered teaching and Use of technological resources. They had Cronbach alphas ranging from 0.60 to 0.85. The factorial structure of TPQ differentiates the most important functions of teaching. It also shows a theoretical consistency and a practical relevance to perform a diagnosis and continuous evaluation of teaching practices. Additionally, it has an adequate internal consistency. Thus, TPQ is valid and reliable to evaluate pedagogical practices in health care careers.

  4. Impunity for International Terrorists? Key Legal Questions and Practical Considerations

    Directory of Open Access Journals (Sweden)

    Christophe Paulussen

    2012-04-01

    Full Text Available This Research Paper discusses several of the key questions related to the subject of impunity of international terrorists, taking both a fundamental and a more practical approach within the context of international law. First, it reflects on a number of core definitional and theoretical questions which have been pushed into the background of day‐to‐day reality, by the actual fight against terrorism. For instance: what does the concept of impunity entail exactly and which kinds of standards could be used in measuring impunity? Is it clear what falls under the header of international terrorism and can it in fact be argued that international terrorists enjoy impunity? In practical terms, the paper explores a number of questions related to the actual prosecution of terrorism. What are the obstacles that national prosecutors face every day when prosecuting suspects of international terrorism? To what extent does a rule that prima facie seems ideal to fight terrorism (aut dedere aut judicare: either extradite or prosecute apply to terrorist offences? And what is the role of international criminal law – and the international criminal tribunals – in fighting terrorism? The Paper concludes with a series of recommendations.

  5. International conference on clinical PET and molecular nuclear medicine (IPET 2007). Book of abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    The International Atomic Energy Agency is organizing its first international conference on 'Clinical PET and Molecular Nuclear Medicine'. Medical imaging technologies have undergone explosive growth over the past two decades. Today, imaging is at a crossroad, with molecular targeted imaging agents expected to broadly expand the capabilities of conventional anatomical imaging methods. Observing molecular interactions in the living body by the radiotracer technique has become known as 'molecular nuclear medicine'. Molecular nuclear medicine techniques analyze cellular biochemistry and its relationship to disease processes expressed in tissue and organ dysfunction, for diagnostic and therapeutic purposes. People can often have similar manifestations of disease, but no two patients will be the same. Functional radionuclide imaging and positron emission tomography (PET) provide excellent opportunities to follow the pathology in individual patients and therefore provide a means for tailored clinical management. These also provide the means to assess the response to treatment in a safe and non-invasive manner. Changes at molecular and cellular levels provide vital clues for evaluating the effectiveness of chosen clinical treatment plans. This information is expected to have a major impact on understanding disease, disease detection, individualised treatment, and drug development. Recently, considerable attention has been drawn to nuclear medicine with the visualization of biochemical processes in vivo such as PET studies with 18F-FDG in many different organs and in cancerous tissues. With the arrival of PET/CT systems there is a new era of accurate mapping of disease processes. Today, 18F-FDG is the most useful PET tracer for the detection, staging, treatment planning and management of cancer. There is mounting evidence for its competitive advantage over conventional techniques in major medical areas including oncology, cardiology, and neurology. Nuclear medicine is

  6. International conference on clinical PET and molecular nuclear medicine (IPET 2007). Book of abstracts

    International Nuclear Information System (INIS)

    2007-01-01

    The International Atomic Energy Agency is organizing its first international conference on 'Clinical PET and Molecular Nuclear Medicine'. Medical imaging technologies have undergone explosive growth over the past two decades. Today, imaging is at a crossroad, with molecular targeted imaging agents expected to broadly expand the capabilities of conventional anatomical imaging methods. Observing molecular interactions in the living body by the radiotracer technique has become known as 'molecular nuclear medicine'. Molecular nuclear medicine techniques analyze cellular biochemistry and its relationship to disease processes expressed in tissue and organ dysfunction, for diagnostic and therapeutic purposes. People can often have similar manifestations of disease, but no two patients will be the same. Functional radionuclide imaging and positron emission tomography (PET) provide excellent opportunities to follow the pathology in individual patients and therefore provide a means for tailored clinical management. These also provide the means to assess the response to treatment in a safe and non-invasive manner. Changes at molecular and cellular levels provide vital clues for evaluating the effectiveness of chosen clinical treatment plans. This information is expected to have a major impact on understanding disease, disease detection, individualised treatment, and drug development. Recently, considerable attention has been drawn to nuclear medicine with the visualization of biochemical processes in vivo such as PET studies with 18F-FDG in many different organs and in cancerous tissues. With the arrival of PET/CT systems there is a new era of accurate mapping of disease processes. Today, 18F-FDG is the most useful PET tracer for the detection, staging, treatment planning and management of cancer. There is mounting evidence for its competitive advantage over conventional techniques in major medical areas including oncology, cardiology, and neurology. Nuclear medicine is

  7. Precision medicine in oncology: New practice models and roles for oncology pharmacists.

    Science.gov (United States)

    Walko, Christine; Kiel, Patrick J; Kolesar, Jill

    2016-12-01

    Three different precision medicine practice models developed by oncology pharmacists are described, including strategies for implementation and recommendations for educating the next generation of oncology pharmacy practitioners. Oncology is unique in that somatic mutations can both drive the development of a tumor and serve as a therapeutic target for treating the cancer. Precision medicine practice models are a forum through which interprofessional teams, including pharmacists, discuss tumor somatic mutations to guide patient-specific treatment. The University of Wisconsin, Indiana University, and Moffit Cancer Center have implemented precision medicine practice models developed and led by oncology pharmacists. Different practice models, including a clinic, a clinical consultation service, and a molecular tumor board (MTB), were adopted to enhance integration into health systems and payment structures. Although the practice models vary, commonalities of three models include leadership by the clinical pharmacist, specific therapeutic recommendations, procurement of medications for off-label use, and a research component. These three practice models function as interprofessional training sites for pharmacy and medical students and residents, providing an important training resource at these institutions. Key implementation strategies include interprofessional involvement, institutional support, integration into clinical workflow, and selection of model by payer mix. MTBs are a pathway for clinical implementation of genomic medicine in oncology and are an emerging practice model for oncology pharmacists. Because pharmacists must be prepared to participate fully in contemporary practice, oncology pharmacy residents must be trained in genomic oncology, schools of pharmacy should expand precision medicine and genomics education, and opportunities for continuing education in precision medicine should be made available to practicing pharmacists. Copyright © 2016 by the

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

    Science.gov (United States)

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

    2014-01-01

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

  9. Individual monitoring of internal exposure for nuclear medicine workers in Switzerland

    International Nuclear Information System (INIS)

    Baechler, S.; Stritt, N.; Bochud, F. O.

    2011-01-01

    Monitoring of internal exposure for nuclear medicine workers requires frequent measurements due to the short physical half lives of most radionuclides used in this field. The aim of this study was to develop screening measurements performed at the workplace by local staff using standard laboratory instrumentation, to detect whether potential intake has occurred. Such measurements do not enable to determine the committed effective dose, but are adequate to verify that a given threshold is not exceeded. For radioiodine, i.e. 123 I, 124 I, 125 I and 131 I, a calibrated surface contamination monitor is placed in front of the thyroid to detect whether the activity threshold has been exceeded. For radionuclides with very short physical half-lives (≤6 h), such as 99m Tc) and those used in positron emission tomography imaging, i.e. 11 C, 15 O, 18 F and 68 Ga, screening procedures consist in performing daily measurements of the ambient dose rate in front of the abdomen. Other gamma emitters used for imaging, i.e. 67 Ga, 111 In and 201 Tl, are measured with a scintillation detector located in front of the thorax. For pure beta emitters, i.e. 90 Y and 169 Er, as well as beta emitters with low-intensity gamma rays, i.e. 153 Sm, 177 Lu, 186 Re and 188 Re, the procedure consists in measuring hand contamination immediately after use. In Switzerland, screening procedures have been adopted by most nuclear medicine services since such measurements enable an acceptable monitoring while taking into account practical and economic considerations. (authors)

  10. Das Lübecker Repetitorium "Innere Kompakt" [The Luebeck compact revision course in Internal Medicine

    Directory of Open Access Journals (Sweden)

    Kühn, Johanna

    2007-08-01

    Full Text Available [english] Introduction: The initiation of the amended second state examination in human medicine in autumn 2006 made many students feel insecure. Aim of the Luebeck compact revision course in Internal Medicine was to reassure the students by optimal preparation. Project description: In September 2006, for the first time, 75 students in their final practical year of study participated in the revision course. During eight days, the relevant topics for the second state examination in Internal Medicine were discussed – as lectures in the morning and in small working groups with case presentations in the afternoon. Results: Daily evaluation as well as a detailed evaluation at the end of the course point out the positive and negative aspects of the project. A final grade of 1.92 and a level of recommendation of 100% reflect a very positive feedback. Discussion and conclusion: To ensure a successful realisation of such a course, time and effort may not be underrated: it takes i.e. a structured time-table and motivated tutors as well as a detailed planning and administrative tasks to realise such a project. However, the students´ better preparation for their examinations and jobs compensate the additional time and effort. Therefore, we decided to establish comparable revision courses in Internal Medicine annually, and other clinical areas like Surgery will follow. [german] Einleitung: Die Einführung des neuen zweiten Staatsexamens im Herbst letzten Jahres führte bei vielen Medizinstudenten zu Verunsicherung. Diesem so genannten „Hammerexamen“ durch optimale Vorbereitung seinen Schrecken zu nehmen, war Ziel des neu eingeführten Repetitoriums der Inneren Medizin in Lübeck. Projektbeschreibung: Erstmals im September letzten Jahres nahmen 75 Studierende im Praktischen Jahr am Repetitorium „Innere kompakt“ teil. Innerhalb von acht Tagen wurden die wesentlichen prüfungsrelevanten Inhalte der Inneren Medizin behandelt – vormittags als

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

    Science.gov (United States)

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

    2015-04-01

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

  12. Aid conditionalities, international Good Manufacturing Practice standards and local production rights: a case study of local production in Nepal.

    Science.gov (United States)

    Brhlikova, Petra; Harper, Ian; Subedi, Madhusudan; Bhattarai, Samita; Rawal, Nabin; Pollock, Allyson M

    2015-06-14

    Local pharmaceutical production has been endorsed by the WHO as a means of addressing health priorities of developing countries. However, local producers of essential medicines must comply with international pharmaceutical standards in order to be eligible to compete in donor tenders. These standards determine production rights for on-patent and off-patent medicines, and guide international procurement of medicines. We reviewed the literature on the impact of Good Manufacturing Practice (GMP) on local production; a gap analysis from the literature review indicated a need for further research. Over sixty interviews were conducted with people involved in the Nepali pharmaceutical production and distribution chain from 2006 to 2009 on the GMP areas of relevance: regulatory capacity, staffing, funding and training, resourcing of GMP, inspectors' interpretation of the rules and compliance. Although Nepal producers have increased their overall share of the domestic market, only the public manufacturer, Royal Drugs, focuses on medicines for public health programmes; private producers engage mainly in brand competition for private markets, not essential medicines. Nepali regulators and producers state that implementation of GMP standards is hindered by low regulatory capacity, insufficient training of staff in the industry, financial constraints and lack of investment for upgrading capital. The transition period to mandatory compliance with WHO GMP rules is lengthy. Less than half of private producers had WHO GMP in 2013. Producers are not directly affected by international harmonisation of standards as they do not export medicines and the Nepali regulator does not enforce the WHO standards strictly. Without an international GMP certificate they cannot tender for donor dependent health programmes. In Nepal, local private manufacturers focus mainly on brand competition for private consumption not essential medicines, the government preferentially procures essential

  13. [Hyperthyroidism in children. Experience in internal medicine in Mali].

    Science.gov (United States)

    Sidibé, A T; Dembélé, M; Diarra, A S; Bocoum, A I; Mousseni, E; Ag Aboubacrine, S; Traoré, H A; Ag Rhaly, A

    2007-06-01

    Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

  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...... 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...

  15. Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

    Science.gov (United States)

    Dandachi, Dima; Dang, Bich N; Wilson Dib, Rita; Friedman, Harvey; Giordano, Thomas

    2018-05-01

    Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

  16. Singapore International Schools: Best Practice in Culturally Diverse Music Education

    Science.gov (United States)

    Cain, Melissa Anne

    2010-01-01

    This paper explores the preliminary outcomes of research into the place and role of cultural diversity in primary music classes at five International Schools in Singapore. It highlights the ways in which school philosophy, policy, curriculum and in-service training influence teacher practice. The research provides insights into the challenges…

  17. 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.

  18. Prevalence and Significance of Unrecognized Lower Extremity Peripheral Arterial Disease in General Medicine Practice

    Science.gov (United States)

    McGrae McDermott, Mary; Kerwin, Diana R; Liu, Kiang; Martin, Gary J; O'Brien, Erin; Kaplan, Heather; Greenland, Philip

    2001-01-01

    OBJECTIVE To determine the prevalence of unrecognized lower extremity peripheral arterial disease (PAD) among men and women aged 55 years and older in a general internal medicine (GIM) practice and to identify characteristics and functional performance associated with unrecognized PAD. DESIGN Cross-sectional. SETTING Academic medical center. PARTICIPANTS We identified 143 patients with known PAD from the noninvasive vascular laboratory, and 239 men and women aged 55 and older with no prior PAD history from a GIM practice. Group 1 consisted of patients with PAD consecutively identified from the noninvasive vascular laboratory (n = 143). Group 2 included GIM practice patients found to have an ankle brachial index less than 0.90, consistent with PAD (n = 34). Group 3 consisted of GIM practice patients without PAD (n = 205). MEASUREMENTS AND MAIN RESULTS Leg functioning was assessed with the 6-minute walk, 4-meter walking velocity, and Walking Impairment Questionnaire (WIQ). Of GIM practice patients, 14% had unrecognized PAD. Only 44% of patients in Group 2 had exertional leg symptoms. Distances achieved in the 6-minute walk were 1,130, 1,362, and 1,539 feet for Groups 1, 2, and 3, respectively, adjusting for age, gender, and race (P < .001). The degree of difficulty walking due to leg symptoms as reported on the WIQ was comparable between Groups 2 and 3 and significantly greater in Group 1 than Group 2. In multiple logistic regression analysis including Groups 2 and 3, current cigarette smoking was associated independently with unrecognized PAD (odds ratio [OR], 6.82; 95% confidence interval [95% CI], 1.55 to 29.93). Aspirin therapy was nearly independently associated with absence of PAD (OR, 0.37; 95% CI, 0.12 to 1.12). CONCLUSION Unrecognized PAD is common among men and women aged 55 years and older in GIM practice and is associated with impaired lower extremity functioning. Ankle brachial index screening may be necessary to diagnose unrecognized PAD in a GIM

  19. [Social Security Needs Social Medicine: Self-image of Physicians Practicing Social Medicine in Statutory Health Insurances and Social Security Systems].

    Science.gov (United States)

    Nüchtern, E; Bahemann, A; Egdmann, W; van Essen, J; Gostomzyk, J; Hemmrich, K; Manegold, B; Müller, B; Robra, B P; Röder, M; Schmidt, L; Zobel, A; von Mittelstaedt, G

    2015-09-01

    In January, 2014, the division "Social Medicine in Practice and Rehabilitation" of the German Society for Social Medicine and Prevention established a working group on the self-image of the physicians active in the field of social medicine (medical expertise and counseling). The result of this work is the contribution presented here after consensus was achieved by specialists of social medicine from different fields and institutions (social security etc.) and in good cooperation with Prof. Dr. Gostomzyk and Prof. Dr. Robra. Based on the importance of an up to date social medicine for claimants and recipients of benefits on the one hand and the social security system on the other, and also on a description of the subjects, objectives and methods the following aspects are presented: · The perspective of social medicine. · Qualification in social medicine, concerning specialist training and continuing medical education. · The fields of duty of experts in social medicine. · The proceedings in social medicine. The working group identified challenges for the specialists in social medicine by a narrowed perception of social medicine by physicians in hospitals and practice, accompanied by an enlarged importance of expertise in social medicine, by the demand for more "patient orientation" and gain of transparency, and concerning the scientific foundation of social medicine. The working group postulates: · The perspective of social medicine should be spread more widely.. · Confidence in experts of social medicine and their independency should be strengthened.. · The not case-related consulting of the staff and executives should be expanded.. · Social medicine in practice needs support by politics and society, and especially by research and teaching.. · Good cooperation and transfer of experiences of the different branches of social security are essential for the impact of social medicine.. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Training Pathology Residents to Practice 21st Century Medicine

    Directory of Open Access Journals (Sweden)

    W. Stephen Black-Schaffer MA, MD

    2016-09-01

    Full Text Available Scientific advances, open information access, and evolving health-care economics are disrupting extant models of health-care delivery. Physicians increasingly practice as team members, accountable to payers and patients, with improved efficiency, value, and quality. This change along with a greater focus on population health affects how systems of care are structured and delivered. Pathologists are not immune to these disruptors and, in fact, may be one of the most affected medical specialties. In the coming decades, it is likely that the number of practicing pathologists will decline, requiring each pathologist to serve more and often sicker patients. The demand for increasingly sophisticated yet broader diagnostic skills will continue to grow. This will require pathologists to acquire appropriate professional training and interpersonal skills. Today’s pathology training programs are ill designed to prepare such practitioners. The time to practice for most pathology trainees is typically 5 to 6 years. Yet, trainees often lack sufficient experience to practice independently and effectively. Many studies have recognized these challenges suggesting that more effective training for this new century can be implemented. Building on the strengths of existing programs, we propose a redesign of pathology residency training that will meet (and encourage a continuing evolution of American Board of Pathology and Accreditation Council for Graduate Medical Education requirements, reduce the time to readiness for practice, and produce more effective, interactive, and adaptable pathologists. The essence of this new model is clear definition and acquisition of core knowledge and practice skills that span the anatomic and clinical pathology continuum during the first 2 years, assessed by competency-based metrics with emphasis on critical thinking and skill acquisition, followed by individualized modular training with intensively progressive responsibility

  1. Identifying Best Practices for Engaging Faculty in International Agricultural Education

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    Alexa J. Lamm

    2013-10-01

    Full Text Available Universities are being called upon to internationalize curriculum as the need for a globally competent workforce increases. Without globally-competent faculty, international integration within higher education cannot occur. Literature indicates that participation in short-term international agricultural education experiences is important to increasing agricultural faculty members’ cultural awareness. However, the best way to design and implement such experiences for faculty is uncharted. The purpose of the study was to identify best practices for facilitating a short-term international education experience for faculty in the agricultural and life sciences that encouraged learning, discussion, and reflection leading faculty to further integrate international perspectives in their agricultural courses in the U.S. Through a qualitative research design, reflective observations and statements from a planning team conducting short-term international agricultural education experience in Ecuador were used to provide a thick, rich description of the successes/challenges faced while designing and implementing the experience. The results provided a list of best practices future planning team members can use to emphasize learning before, during, and after a short-term international agricultural education experience for faculty.

  2. Nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan.

    Science.gov (United States)

    Smith, Graeme D; Wu, Shu-Chen

    2012-09-01

    To gain an insight into this issue, this study used a qualitative approach and aims to explore and describe nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan. The integration of complementary and alternative medicine with conventional medicine has become more common worldwide in recent years. An increase in patient use and an expansion of nurses using complementary and alternative medicine has spawned further investigation. Most published studies have concentrated on the usage of complementary and alternative medicine in western societies and have focused principally on physicians' attitudes and practice patterns in this regard. Despite the large amount of time and the unique relationship that nurses share with their patients, little research has investigated the nurse's attitudes and practice regarding complementary and alternative medicine. Moreover, there has been no previous research into understanding this issue from the Taiwanese nursing perspective. A qualitative research design. By using an exploratory, descriptive, qualitative approach, data were collected from 11 registered nurses. The methods of the data collection were in-depth, semi-structured interviews, field notes and memos and the data were analysed using the constant comparative method. Three major categories emerged from the data; namely, a 'lack of clear definition', 'limited experience' and 'high interest' towards complementary and alternative medicine. These results suggest that the definition of complementary and alternative medicine is often unclear for nurses in Taiwan. Due to the organisational policies and personal knowledge base, very few nurses integrate complementary and alternative medicine into their daily practice. However, the nurses in Taiwan show a great desire to participate in complementary and alternative medicine continuing education programmes. This study is not only significant in filling the gap in the existing literature

  3. Internal audit practices and trends in Romania and worldwide

    Directory of Open Access Journals (Sweden)

    Ionela-Corina CHERSAN

    2016-09-01

    Full Text Available For a long time, internal audit has been seen mainly as an activity of providing assistance to external auditors, especially by checking up accounting procedures as part of the internal control evaluation process. At present, while this role of the internal auditor has not disappeared, the role of consultant manager has gained primary importance. In this context, it is increasingly obvious that the professional profile of the internal auditor will undergo changes generated not only by the changes in the role that he or she fulfils, but also by the challenges that the business world needs to deal with: risk management, increasingly sophisticated information technology, data mining etc. This study relies on the information provided by The Institute of Internal Auditors Research Foundation – IIARF which includes data extracted from The Global Internal Audit Common Body of Knowledge – CBOK database, and it aims to point out the practices and trends regarding internal audit in Romania and worldwide, and, respectively, the competencies traditionally required from internal auditors, their views on the skills they master and on the scope of their further skill development.

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

    Directory of Open Access Journals (Sweden)

    Snell Linda

    2006-11-01

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

  5. Ionizing radiation and the importance for the environmental medicine practice

    International Nuclear Information System (INIS)

    Arndt, D.

    1992-01-01

    Results of radiation exposed persons from the population are presented and the consequences are valuated. The radioecological burden and the consequences of events for the environmental medicine are debatted (e.g. Hiroshima/Nagasaki 1945, Bikini H-bomb experiment 1954, container explosion in the MAJAK nuclear weapons centre 1957 and inadmissible waste removal in south Ural 1950/51, accident at the Chernobyl power plant and their consequences particulary for Germany 1986 till now, theft of sources used for radiotherapy and the contamination of the environment after the Goiana accident 1987). Further the risk of radon cure, transatlantic flights, vagabondized sources, uranium mining and some cases of probable stochastic radiation effects (e.g. leukemia clusters at Sellafield, Elbmarsch and Sittensen) is discussed. (orig.) [de

  6. Sustainable Practices in Medicinal Chemistry Part 2: Green by Design.

    Science.gov (United States)

    Aliagas, Ignacio; Berger, Raphaëlle; Goldberg, Kristin; Nishimura, Rachel T; Reilly, John; Richardson, Paul; Richter, Daniel; Sherer, Edward C; Sparling, Brian A; Bryan, Marian C

    2017-07-27

    With the development of ever-expanding synthetic methodologies, a medicinal chemist's toolkit continues to swell. However, with finite time and resources as well as a growing understanding of our field's environment impact, it is critical to refine what can be made to what should be made. This review seeks to highlight multiple cheminformatic approaches in drug discovery that can influence and triage design and execution impacting the likelihood of rapidly generating high-value molecules in a more sustainable manner. This strategy gives chemists the tools to design and refine vast libraries, stress "druglikeness", and rapidly identify SAR trends. Project success, i.e., identification of a clinical candidate, is then reached faster with fewer molecules with the farther-reaching ramification of using fewer resources and generating less waste, thereby helping "green" our field.

  7. Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine.

    Science.gov (United States)

    Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele

    2008-01-01

    Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

  8. Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study.

    Science.gov (United States)

    Hägg-Martinell, A; Hult, H; Henriksson, P; Kiessling, A

    2017-02-14

    To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture. Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice. 21 medical students and 30 supervisors participated. Two themes were identified: Nervousness and curiosity- students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved -students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives. This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways. Published

  9. Aligning Career Expectations with the Practice of Medicine: Physician Satisfaction

    Science.gov (United States)

    Gibson, Denise D.; Borges, Nicole J.

    2009-01-01

    This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary…

  10. Paramedics' experiences of financial medicine practices in the pre ...

    African Journals Online (AJOL)

    Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical ...

  11. A survey of Korean medicine doctors' clinical practice patterns for autism spectrum disorder: preliminary research for clinical practice guidelines.

    Science.gov (United States)

    Lee, Jihong; Lee, Sun Haeng; Lee, Boram; Yang, In Jun; Chang, Gyu Tae

    2018-03-13

    The aim of this study was to investigate autism spectrum disorder (ASD) clinical practice patterns of Korean medicine doctors (KMDs) through questionnaire survey. Questionnaires on Korean medicine (KM) treatment for ASD were distributed to 255 KMDs on December 5, 2016. The KMDs were psychiatrists, pediatricians, or general practitioners, who treated patients with ASD. The questionnaire covered items on treatment methods, aims of treatment, KM syndrome differentiation, diagnostic tools, and sociodemographic characteristics. Frequency analysis was conducted to describe the participants and their practices. A total 22.4% KMDs (n = 57/255) completed the questionnaires and 54 KMDs (21.2%) matched the inclusion criteria. The KMDs utilized herbal medicine (27.3%), body acupuncture (17.6%), scalp acupuncture (10.7%), moxibustion (6.4%), and Korean medical psychotherapy (5.9%) to treat ASD. The most commonly prescribed herbal medicine was Yukmijihwang-tang. Forty-eight (88.9%) KMDs responded that they used KM syndrome differentiation. 'Organ system, Qi, Blood, Yin, Yang, Fluid and Humor diagnosis' was most frequently used for syndrome differentiation. ASD was mainly diagnosed based on the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and DSM-5. The present study demonstrated the current status of KMDs' diagnosis and treatment of ASD. In future clinical trials and clinical practice guidelines, these findings will provide meaningful information on the actual practice patterns of KMDs.

  12. Interprofessional Education in the Internal Medicine Clerkship Post-LCME Standard Issuance: Results of a National Survey.

    Science.gov (United States)

    Alexandraki, Irene; Hernandez, Caridad A; Torre, Dario M; Chretien, Katherine C

    2017-08-01

    Several decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard. To examine the status of IPE within internal medicine (IM) clerkships including perspectives, curricular content, barriers, and assessment a year after the LCME standard issuance. Anonymous online survey. IM clerkship directors from each of the Clerkship Directors in Internal Medicine's 121 U.S. and Canadian member medical schools in 2014. In 2014, a section on IPE (18 items) was included in the Clerkship Directors in Internal Medicine annual survey of its 121 U.S. and Canadian member medical schools. Items (18) assessed clerkship director (CD) perspectives, status of IPE curricula in IM clerkships, and barriers to IPE implementation. Data were analyzed using descriptive statistics and qualitative analysis of free-text responses to one of the survey questions. The overall survey response rate was 78% (94/121). The majority (88%) agreed that IPE is important to the practice of IM, and 71% believed IPE should be part of the IM clerkship. Most (76%) CDs agreed there is need for faculty development programs in IPE; 27% had such a program at their institution. Lack of curricular time, scheduling conflicts, and lack of faculty trained in IPE were the most frequently cited barriers. Twenty-nine percent had formal IPE activities within their IM clerkships, and 38% were planning to make changes. Of those with formal IPE activities, over a third (37%) did not involve student assessment. Since LCME standard issuance, only a minority of IM clerkships have included formal IPE activities, with lectures as the predominant method. Opportunities exist for enhancing educational methods as well as IPE faculty development.

  13. Assessment of knowledge, attitudes and practices about public health nutrition among students of the University of Medicine in Tirana, Albania

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    Jolanda Hyska

    2015-12-01

    Full Text Available Aim: the aim of this survey was twofold: (i: to assess medical students’ knowledge, attitudes and practices regarding nutrition in general, in order to identify their level of competences in the field of nutrition which will be useful in their future role of providers/health care professionals, and; (ii to assess the knowledge, attitudes and practices regarding the discipline of public health nutrition in order to identify the needs for improving the curriculum of this subject in all the branches of the University of Medicine in Tirana. Methods: A cross-sectional study was conducted in June-July 2013 including a representative sample of 347 students at the University of Medicine in Tirana, Albania (61% females and 39% males; overall mean age: 23±2 years; response rate: 87%. A nutritional questionnaire, adopted according to the models used in previous international studies, was used to assess the level of knowledge, attitudes and practices among the university students. Results: Overall, about one third of the students was not satisfied with the quality and quantity of nutritional education and demanded a more scientifically rigorous curriculum. In general, students’ knowledge about infant feeding practices was adequate. However, there were gaps in the students’ knowledge regarding the commencement of breastfeeding, or the duration of exclusive breast-feeding. Furthermore, there was evidence of an insufficient level of knowledge among students regarding diet and nutrition in general and their health impact, especially on development and prevention of chronic diseases. Conclusion: This survey identified significant gaps in the current curriculum of public health nutrition at the University of Medicine in Tirana. Our findings suggest the need for intervention programs to improve both the quantitative and the qualitative aspects of nutrition curricula in all the branches of the University of Medicine Tirana, in accordance with the

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

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    Andrei Brateanu

    2012-10-01

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

  15. 40 years of biannual family medicine research meetings--the European General Practice Research Network (EGPRN).

    Science.gov (United States)

    Buono, Nicola; Thulesius, Hans; Petrazzuoli, Ferdinando; Van Merode, Tiny; Koskela, Tuomas; Le Reste, Jean-Yves; Prick, Hanny; Soler, Jean Karl

    2013-12-01

    To document family medicine research in the 25 EGPRN member countries in 2010. Semi-structured survey with open-ended questions. Academic family medicine in 23 European countries, Israel, and Turkey. 25 EGPRN national representatives. Demographics of the general population and family medicine. Assessments, opinions, and suggestions. EGPRN has represented family medicine for almost half a billion people and > 300,000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research. Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.

  16. 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.

  17. Perceptions and practices of pharmaceutical wholesalers surrounding counterfeit medicines in a developing country: a baseline survey

    Directory of Open Access Journals (Sweden)

    Khan Mohiuddin H

    2011-11-01

    Full Text Available Abstract Background Recent investigations by the Ministry of Health of Cambodia suggest that counterfeit medicines have been introduced into the pharmaceutical market in tampered packaging. To further explore this possibility, an interview survey was conducted at the wholesaler level to investigate the medicinal supply chain in Cambodia. Methods Managing executives of 62 (83.8% registered wholesalers of modern medicines in Cambodia were interviewed in 2009 on their knowledge of, perception on, and practices related to counterfeiting issues through a semi-structured questionnaire. Results According to our findings, 12.9% of the wholesalers had encountered counterfeit medicine. However, they demonstrated a variety of perceptions regarding this issue. A majority (59.7% defined counterfeit medicines as medicines without registration, while other definitions included medicines that were fraudulently manufactured, medicines without a batch/lot number, those containing harmful ingredients or a reduced amount of active ingredients, and expired medicines. Additionally, 8.1% responded that they did not know what counterfeit medicines were. During procurement, 66.1% of the wholesalers consider whether the product is registered in Cambodia, while 64.5% consider the credibility and quality of the products and 61.3% consider the reputation of the manufacturers. When receiving a consignment, 80.6% of wholesalers check the intactness of medicines, 72.6% check the specification and amount of medicines, 71% check Cambodian registration, 56.5% check that the packaging is intact, 54.8% check batch and lot numbers, 48.4% check the dates of manufacture and expiration, and 9.7% check analytical certificates. Out of 62 wholesalers, 14.5% had received medicines that arrived without packages or were separated from their packaging and had to be repacked before distribution. Significant statistical association was found between wholesalers who received medicines separately

  18. Perceptions and practices of pharmaceutical wholesalers surrounding counterfeit medicines in a developing country: a baseline survey.

    Science.gov (United States)

    Khan, Mohiuddin H; Akazawa, Manabu; Dararath, Eav; Kiet, Heng B; Sovannarith, Tey; Nivanna, Nam; Yoshida, Naoko; Kimura, Kazuko

    2011-11-11

    Recent investigations by the Ministry of Health of Cambodia suggest that counterfeit medicines have been introduced into the pharmaceutical market in tampered packaging. To further explore this possibility, an interview survey was conducted at the wholesaler level to investigate the medicinal supply chain in Cambodia. Managing executives of 62 (83.8%) registered wholesalers of modern medicines in Cambodia were interviewed in 2009 on their knowledge of, perception on, and practices related to counterfeiting issues through a semi-structured questionnaire. According to our findings, 12.9% of the wholesalers had encountered counterfeit medicine. However, they demonstrated a variety of perceptions regarding this issue. A majority (59.7%) defined counterfeit medicines as medicines without registration, while other definitions included medicines that were fraudulently manufactured, medicines without a batch/lot number, those containing harmful ingredients or a reduced amount of active ingredients, and expired medicines. Additionally, 8.1% responded that they did not know what counterfeit medicines were.During procurement, 66.1% of the wholesalers consider whether the product is registered in Cambodia, while 64.5% consider the credibility and quality of the products and 61.3% consider the reputation of the manufacturers. When receiving a consignment, 80.6% of wholesalers check the intactness of medicines, 72.6% check the specification and amount of medicines, 71% check Cambodian registration, 56.5% check that the packaging is intact, 54.8% check batch and lot numbers, 48.4% check the dates of manufacture and expiration, and 9.7% check analytical certificates.Out of 62 wholesalers, 14.5% had received medicines that arrived without packages or were separated from their packaging and had to be repacked before distribution. Significant statistical association was found between wholesalers who received medicines separately from their packs/containers and who consider their

  19. PP144. Profile of lupus pregnancy in internal medecine practice.

    Science.gov (United States)

    Haddad, T; Hakem, D; Berrah, A

    2012-07-01

    The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome 'APLS' is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. it's a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21-41), SLE evolve with an average of 2.5years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient's. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive

  20. Hippocrates' First Aphorism: Reflections on Ageless Principles for the Practice of Medicine.

    Science.gov (United States)

    Loscalzo, Joseph

    2016-01-01

    Hippocrates' first aphorism presents a structurally simple but conceptually complex series of observations on the art and science of medicine. Its principles are timeless, relevant to physicians in antiquity as well as in the current era. This article analyzes Hippocrates' aphorism in light of Galen's and others' commentaries on it and interprets the principles espoused by Hippocrates in light of the perennial challenges of the practice of medicine.

  1. Teambuilding and leadership training in an internal medicine residency training program.

    Science.gov (United States)

    Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J

    2004-06-01

    The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a "reef survival exercise" and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees' agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members' decisions, highlighting the importance and value of teamwork to attendees. Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further

  2. Teambuilding and Leadership Training in an Internal Medicine Residency Training Program

    Science.gov (United States)

    Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J

    2004-01-01

    OBJECTIVE The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. METHOD A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a “reef survival exercise” and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. RESULTS Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees’ agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members’ decisions, highlighting the importance and value of teamwork to attendees. CONCLUSIONS Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful

  3. Identification and management of chronic kidney disease complications by internal medicine residents: a national survey.

    Science.gov (United States)

    Agrawal, Varun; Agarwal, Mohit; Ghosh, Amit K; Barnes, Michael A; McCullough, Peter A

    2011-05-01

    Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3. Most of the residents correctly recognized anemia (91%) and bone disease (82%) as complications at estimated glomerular filtration rate less than 60 mL/min/1.73 m; however, only half of the residents identified coronary artery disease (54%) as a CKD complication. For a patient with estimated glomerular filtration rate less than 60 mL/min/1.73 m, two thirds of the residents would workup for anemia (62%), whereas half of them would check for mineral and bone disorder (56%). With regard to anemia of CKD, less than half of the residents knew the CKD goal hemoglobin level of 11 to 12 g/dL (44%); most would supplement iron stores (86%), whereas fewer would consider nephrology referral (28%). For mineral and bone disorders, many residents would recommend dietary phosphorus restriction (68%) and check 25-hydroxyvitamin D (62%); fewer residents would start 1,25-dihydroxyvitamin D (40%) or refer to the nephrologist (45%). Residents chose to discontinue angiotensin-converting enzyme inhibitor for medication-related complication of greater than 50% decline in estimated glomerular filtration rate (68%) and potassium greater than 5.5 mEq/L (93%). Mean performance score improved with increasing PGY (PGY1 59.4% ± 17.6%, PGY2 63.6% ± 15.6%, and PGY3 66.2% ± 16.5%; P = 0.002). Our study identified specific gaps in knowledge of CKD complications and management among internal medicine residents. Educational

  4. International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice.

    Science.gov (United States)

    Ubaka, Chukwuemeka; Brechtelsbauer, Erich; Goff, Debra A

    2017-07-01

    Health-system and community pharmacy practice in the United States is experiencing transformational change; however, this transformation is lagging in the international arena. As a result, efforts are being made to provide support and education to the international pharmacy leaders and practitioners. This article describes one effort, the Mandela Washington Fellows Program, and suggests areas where pharmacy leaders can be involved to help advance the practice of pharmacy on an international level. The Mandela Washington Fellows Program for young Africa leaders consists of a US-Africa pharmacy-mentoring program identified ranging from educational opportunities to collaboration for implementation of patient care programs. The specifics of the mentoring program include daily meetings, clinic and ward rounds, round table discussions with mentors, and visits to various hospital care systems. Lessons were learned and strategies for sustaining the program are discussed. These types of programs represent leadership opportunities that may not be apparent to most pharmacy directors, but expanding their view to helping international pharmacists expand their practice only strengthens the professional goal of providing patient-centered pharmacy services.

  5. Essential travel medicine

    CERN Document Server

    Zuckerman, Jane N; Leggat, Peter

    2015-01-01

    This 1st edition of Essential Travel Medicine provides an excellent concise introduction to the specialty of Travel Medicine. This core text will enable health care practitioners particularly those new to the clinical practice of Travel Medicine, to gain a fundamental understanding of the diverse and complex issues which can potentially affect the health of the many millions of people who undertake international travel. Jane N Zuckerman is joined by Gary W Brunette from CDC and Peter A Leggat from Australia as Editors. Leading international specialists in their fields have contributed authoritative chapters reflecting current knowledge to facilitate best clinical practice in the different aspects of travel medicine. The aim of Essential Travel Medicine is to provide a comprehensive guide to Travel Medicine as well as a fundamental knowledge base to support international undergraduate and postgraduate specialty training programmes in the discipline of Travel Medicine. The 1st edition of Essential Travel ...

  6. Evaluation of knowledge change of internal medicine residents following a training program in smoking cessation

    International Nuclear Information System (INIS)

    Labib, N.A.; Radwan, G.N.; Salma, R.A.A.; Horeesh, N.A.

    2012-01-01

    One of the major barriers to smoking cessation practice is that many health professionals do not have the knowledge and skills on how to intervene. Objectives: To assess the effect of a training program on physicians' knowledge about tobacco dependence and cessation interventions. Subjects and Methods: A comprehensive training program was given to internal medicine residents in Cairo University Hospitals, Egypt during 2008-2009. An anonymous, 11- item questionnaire was administered before and after the training program. The training process was evaluated by participants' satisfaction using a 13- item checklist. The objective of the study was adequately explained to participants and their consensus was obtained with assured confidentiality. Results: A total of 163 internists entered the training program. Improvement in overall knowledge was evidenced by higher mean score in the post-test than pre-test (6.2 vs. 4.7; p<0.001). Significant improvement were seen in the participants' knowledge related to assessment of tobacco dependence (61% vs. 27%;p<0.001), interventions for smokers willing to quit (51.6 vs. 28.2%; p<0.001), interventions for smokers unwilling to quit (40.8 vs. 19.6%; p<0.001) and coping skills to handle withdrawal symptoms (52.9 vs. 30.7;p<0.001). Almost all participants reported that the training was very useful (96%) and applicable (85.6%) in their medical practices. Conclusions: Targeted training of health professionals has a potential to translate into improved smoking cessation counseling and to increase their inclination to intervene. Policy message: Continued medical education and regular/targeted training of health providers should be done. (author)

  7. Social Media in Professional Medicine: New Resident Perceptions and Practices

    OpenAIRE

    Lefebvre, Cedric; Mesner, Jason; Stopyra, Jason; O'Neill, James; Husain, Iltifat; Geer, Carol; Gerancher, Karen; Atkinson, Hal; Harper, Erin; Huang, William; Cline, David M

    2016-01-01

    Background For younger generations, unconstrained online social activity is the norm. Little data are available about perceptions among young medical practitioners who enter the professional clinical arena, while the impact of existing social media policy on these perceptions is unclear. Objective The objective of this study was to investigate the existing perceptions about social media and professionalism among new physicians entering in professional clinical practice; and to determine the e...

  8. Nudging best practice: the HITECH act and behavioral medicine

    OpenAIRE

    Hesse, Bradford William; Ahern, David K; Woods, Susan S

    2010-01-01

    In February 2009, the US Congress passed the Health Information Technology for Economic and Consumer Health (HITECH) Act in order to stimulate the “meaningful use” of health information technology within medical practice. Economists have noted that other sectors in the economy have demonstrated substantive productivity improvements from investments in information technology but that the health sector lags behind. The “meaningful use” stipulation of the HITECH Act focuses systems redesign with...

  9. 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