Sample records for internal medicine tip

  1. Injector tip for an internal combustion engine

    DOEpatents

    Shyu, Tsu Pin; Ye, Wen

    2003-05-20

    This invention relates to a the tip structure of a fuel injector as used in a internal combustion engine. Internal combustion engines using Homogeneous Charge Compression Ignition (HCCI) technology require a tip structure that directs fuel spray in a downward direction. This requirement necessitates a tip design that is capable of withstanding mechanical stresses associated with the design.

  2. Tips for a Healthy Long-Life Learned from Space Medicine

    NASA Astrophysics Data System (ADS)

    Ohshima, Hiroshi; Yamada, Shin; Matsuo, Tomoaki; Yamamoto, Masafumi; Mukai, Chiaki

    2013-02-01

    The field of space medicine is responsible for maintaining astronauts’ health and optimizing their performance. A prolonged stay in space with little gravity results in weakening of the bones and muscles that otherwise support body weight, which is precisely the problem faced by elderly people on Earth. Space medicine provides the means of alleviating such problems. Bone loss, muscle atrophy, and disturbed circadian rhythms are common issues for both astronauts and the elderly alike and can be prevented, if the risks are addressed correctly. To have a healthy long-life, it is important to practice effective health improvement techniques and take preventive measures. The space medicine technologies a for astronauts will provide helpful information to people living in a super aging society. and Japanese medical societies for health promotion. With the aids of the Japanese Society of Physical Fitness and Sports Medicine, the Japanese Orthopaedic Association, and the Japanese Association of Rehabilitation Medicine, JAXA has made a leaflet titled for general citizen to show the tips for a healthy long-life learned from space medicine from the viewpoints of their respective expertise.

  3. Strategic business planning for internal medicine.

    PubMed

    Ervin, F R

    1996-07-01

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

  4. Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  5. Talking about Complementary and Alternative Medicine with Health Care Provider: A Workbook and Tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  6. Postgraduate education in internal medicine in Europe.

    PubMed

    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.

  7. Talking about Complementary and Alternative Medicine with your Health Care Provider: A workbook and tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  8. Talking about complementary and alternative medicine with your health care provider: A workbook and Tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  9. Philanthropic endowments in general internal medicine.

    PubMed

    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.

  10. Philanthropic Endowments in General Internal Medicine

    PubMed Central

    Murden, Robert A; Lamb, James F

    1999-01-01

    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. PMID:10203639

  11. Index of international publications in aerospace medicine.

    DOT National Transportation Integrated Search

    1993-02-01

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

  12. Index of international publications in aerospace medicine

    DOT National Transportation Integrated Search

    2001-08-01

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

  13. Index of international publications in aerospace medicine.

    DOT National Transportation Integrated Search

    2014-05-01

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

  14. Index of International Publications in Aerospace Medicine

    DOT National Transportation Integrated Search

    2007-01-01

    The 3rd edition of theIndex of International Publications in Aerospace Medicine is a comprehensive listing of : international publications in clinical aerospace medicine, operational aerospace medicine, aerospace : physiology, environmental medicine/...

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

    PubMed

    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.

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

    PubMed

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

    PubMed

    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.

  18. The Future of General Internal Medicine

    PubMed Central

    Larson, Eric B; Fihn, Stephan D; Kirk, Lynne M; Levin, Wendy; Loge, Ronald V; Reynolds, Eileen; Sandy, Lewis; Schroeder, Steven; Wenger, Neil; Williams, Mark

    2004-01-01

    The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep—ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine. PMID:14748863

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

    PubMed

    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

  20. American Internal Medicine in the 21st Century

    PubMed Central

    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

  1. Hospitalist career decisions among internal medicine residents.

    PubMed

    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.

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

    PubMed

    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 < .001). Conversely, 10 008 categorical (65.3%) and 745 primary care program (52.5%) residents reported a subspecialty career plan (AOR, 1.90; 99% CI, 1.62-2.23; P < .001). GIM career plans were reported more frequently by women than men (26.7% vs 17.3%, respectively; AOR, 1.69; 99% CI, 1.53-1.87; P < .001). US medical graduates were slightly more likely to report GIM career plans than international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P < .001). Within primary care programs, US medical graduates were much more

  3. [Masters of Chilean Internal Medicine].

    PubMed

    Rosselot, Eduardo

    2003-08-01

    Master of internal Medicine is the highest award granted by the Chilean Society of Internal Medicine (Sociedad Médica de Santiago) to its members. This article outlines the sense and transcendence of this award and provides an abridged, certainly incomplete, data of the recipients since 1981 when this award was first given. Those who have received it are not the only ones that have the attributes to deserve such distinction. There are many members with similar or even better merits, and therefore the Directory of the Society is usually exposed to a very hard decision when facing each new nomination. When a member is awarded, he becomes a model to be emulated or surpassed by the future generations; thus assumes the great responsibility of maintaining the spirit, the prestige and the projection of Internal Medicine into the future.

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

    PubMed

    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.

  5. Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability

    PubMed Central

    McGinn, Thomas; Jervis, Ramiro; Wisnivesky, Juan; Keitz, Sheri

    2008-01-01

    Background Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. Educational Objectives In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. Pilot Testing We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. Conclusion Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice. PMID:18491194

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

    PubMed

    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.

  7. Teaching Prevention in Internal Medicine Clerkships.

    ERIC Educational Resources Information Center

    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)

  8. Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience.

    PubMed

    Wesley, Tiffany; Hamer, Diana; Karam, George

    2018-04-18

    Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum.

  9. Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience

    PubMed Central

    Wesley, Tiffany; Hamer, Diana; Karam, George

    2018-01-01

    Introduction Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum’s impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Methods Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. Results In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Discussion Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum. PMID:29702059

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed

    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

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

    ERIC Educational Resources Information Center

    Eisenberg, John M.

    1980-01-01

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

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

    PubMed

    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.

  16. Internal medicine residency redesign: proposal of the Internal Medicine Working Group.

    PubMed

    Horwitz, Ralph I; Kassirer, Jerome P; Holmboe, Eric S; Humphrey, Holly J; Verghese, Abraham; Croft, Carol; Kwok, Minjung; Loscalzo, Joseph

    2011-09-01

    Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Reforming the core clerkship in internal medicine: the SGIM/CDIM Project. Society of General Internal Medicine/Clerkship Directors in Internal Medicine.

    PubMed

    Goroll, A H; Morrison, G; Bass, E B; Jablonover, R; Blackman, D; Platt, R; Whelan, A; Hekelman, F P

    2001-01-02

    Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation. Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.

  18. Comparison of research trends in korean and international family medicine in journals of family medicine.

    PubMed

    Jeon, Jin-Kyung; Lee, Jungun; Lee, Dong Ryul

    2014-11-01

    Research is important for the development of family medicine as a professional field in primary care. The aim of this study was to suggest directions for the development of family medicine research by analyzing research trends in original papers published in the Korean Journal of Family Medicine (KJFM) and international journals. We investigated original research papers published in KJFM and 4 international journals from August 2009 to July 2010. Analysis was conducted according to research topics, authors, methods, participants, and data sources. 'Clinical research' was the most common research topic in both the KJFM (88.3%) and international journals (57.3%); however, international journals had more studies in other domains ('education and research,' 'health service,' and 'family medicine'). More authors other than family physicians participated in international journals than in the KJFM (58% and 3.3%, respectively). Most studies were 'cross-sectional' in KJFM (77.0%) and international journals (51.5%): however, the latter had more 'qualitative' studies, 'cohort' studies, and 'systematic reviews' than the former. The largest study population was 'visitors of health promotion center' in the KJFM and 'outpatients' in international journals. Most of the study sources were 'survey' and 'medical records' in both. There were limitations of diversity in the papers of the KJFM. Future investigation on papers of other than family medicine journals should be planned to assess research trends of family physicians.

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

    PubMed

    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.

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

    PubMed

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

    2013-11-01

    Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine. © 2013 Society of Hospital Medicine.

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

    PubMed

    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.

  2. Importance of international networking in academic family medicine.

    PubMed

    Klemenc-Ketiš, Zalika; Kersnik, Janko

    2014-01-01

    European family medicine/general practice (FM/GP) has travelled the long and successful journey of profiling the discipline and has produced valuable position papers on education and research. Nowadays, academic medicine is one of the pillars in the future development of FM/GP in Europe. A common European curriculum on undergraduate and postgraduate family medicine is needed. Also, a sound international platform of teaching institutions and/or teachers of family medicine would foster the further development of family medicine as an academic discipline. This would stimulate students and teachers to engage in international exchange to gain new knowledge and experiences, present their work and ideas abroad and prepare the conditions for further exchange of students and teachers. Established departments of FM/GP, led by a teacher who is a family physician/general practitioner, at each Medical School in Europe should provide students with knowledge and skills related to the core attributes of FM/GP. International exchanges of teachers and students should foster the development of a common curriculum on FM in Europe and foster improvement in the quality of FM education. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.

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

    PubMed

    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.

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

    PubMed

    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)

  5. Market influences on internal medicine residents' decisions to subspecialize.

    PubMed

    Valente, E; Wyatt, S M; Moy, E; Levin, R J; Griner, P F

    1998-06-01

    Managed care reduces the demand for internal medicine subspecialists, but little empirical information is available on how increasing managed care may be affecting residents' training choices. To determine whether increased managed care penetration into an area where residents train was associated with a decreased likelihood that residents who completed general internal medicine training pursued subspecialty training. Secondary logistic regression analysis of data from the 1993 cohort of general internal medicine residents. U.S. residency training sites. 2263 U.S. medical school graduates who completed general internal medicine residency training in 1993. The outcome variable (enrollment in subspecialty training) was derived from the Graduate Medical Education Tracking Census of the Association of American Medical Colleges (AAMC). Health maintenance organization (HMO) penetration (possible range, 0.0 to 1.0; higher values indicate greater penetration) was taken from the Interstudy Competitive Edge Database. Individual and medical school covariates were taken from the AAMC's Student and Applicant Information Management System database and the National Institutes of Health Information for Management Planning, Analysis, and Coordination system. The U.S. Census division was included as a control covariate. 980 participants (43%) enrolled in subspecialty training. Logistic regression analyses indicated a nonlinear association between managed care penetration into a training area and the odds of subspecialization. Increasing managed care penetration was associated with decreasing odds of subspecialization when penetration exceeded 0.15. The choice of subspecialty training increased as HMO penetration increased from 0 to 0.15. Local market forces locally influenced the career decisions of internal medicine residents, but the influence was small compared with the effects of age and sex. These results suggest that market forces help to achieve more desirable generalist

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

    PubMed Central

    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

  7. Factors influencing career decisions in internal medicine.

    PubMed

    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.

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

    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.…

  10. The teaching of liberal arts in internal medicine residency training.

    PubMed

    Povar, G J; Keith, K J

    1984-09-01

    Forty-four members of the Association of Program Directors in Internal Medicine and 58 members of the Society for Research and Education in Primary Care Internal Medicine completed questionnaires on the teaching of liberal arts in internal medicine residency programs and the importance of liberal arts to the practice of medicine. They rated economics of medical care and bioethics as essential to residency training. Law and organization of the health care system as well as economics and bioethics were rated as essential to medical practice. Although there was great variability in the curricula represented, over 40 percent of the respondents reported having formal lecture and/or seminar exposure to these topics in their programs. Problems encountered in implementing liberal arts programs included lack of curriculum time, limited-faculty members, and a lack of interest on the part of residents. There is a need both to arrive at a consensus among residency directors and to explore means of developing interdisciplinary faculties if the liberal arts are to form an established part of internal medicine residency training.

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

    NASA Technical Reports Server (NTRS)

    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.

  12. Predictors of yoga use among internal medicine patients.

    PubMed

    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 < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated with yoga use. Yoga was

  13. The Impact of the Internal Medicine Sub-internship on Medical Student Career Choice

    PubMed Central

    Shea, Judy A.; O’Grady, Elizabeth; Bellini, Lisa M.; Ciminiello, Frank

    2010-01-01

    Background Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown. Objective Determine the immediate and longer-term effect of the medicine sub-internship on students’ decision to pursue internal medicine residency. Design Mixed method, single institution, prospective cohort study. PARTICIPANTS Ninety-two students completing an internal medicine sub-internship in 2006. Measurements Survey administered prior to and immediately after the sub-internship and prior to the match. Questions included likelihood of applying in internal medicine and perceived impact of the sub-internship on career choice. Main Results Seventy-seven percent of students (N = 63) completed the first two surveys; 63% (N = 58) completed the second and third. Immediately post sub-internship, 21% (N = 13) were less likely to apply in internal medicine and 11% (N = 7) were more likely to apply (net change in plans was not significant, p = 0.38). There was a significant relationship between the perceived impact of the sub-internship and likelihood of applying in medicine (ANOVA comparison across means, p <  0.001). Compared to the second survey, on the third survey more students (41%, N = 24) believed the sub-internship positively impacted their decision to apply in medicine, though overall shifting was not significant (p = 0.39). Key themes describing sub-internship impact included the intense workload, value of experiencing internship, rewards of assuming the physician role, and education received (30%, 25%, 20% and 16% of comments, respectively). Conclusions Overall, there was not a significant effect of the sub-internship on students’ decision to apply in internal medicine. Additional research about the relative impact of the sub-internship in relationship to other career choice predictors is needed to better address factors that may encourage or dissuade

  14. The impact of the internal medicine sub-internship on medical student career choice.

    PubMed

    Kogan, Jennifer R; Shea, Judy A; O'Grady, Elizabeth; Bellini, Lisa M; Ciminiello, Frank

    2010-05-01

    Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown. Determine the immediate and longer-term effect of the medicine sub-internship on students' decision to pursue internal medicine residency. Mixed method, single institution, prospective cohort study. Ninety-two students completing an internal medicine sub-internship in 2006. Survey administered prior to and immediately after the sub-internship and prior to the match. Questions included likelihood of applying in internal medicine and perceived impact of the sub-internship on career choice. Seventy-seven percent of students (N = 63) completed the first two surveys; 63% (N = 58) completed the second and third. Immediately post sub-internship, 21% (N = 13) were less likely to apply in internal medicine and 11% (N = 7) were more likely to apply (net change in plans was not significant, p = 0.38). There was a significant relationship between the perceived impact of the sub-internship and likelihood of applying in medicine (ANOVA comparison across means, p < 0.001). Compared to the second survey, on the third survey more students (41%, N = 24) believed the sub-internship positively impacted their decision to apply in medicine, though overall shifting was not significant (p = 0.39). Key themes describing sub-internship impact included the intense workload, value of experiencing internship, rewards of assuming the physician role, and education received (30%, 25%, 20% and 16% of comments, respectively). Overall, there was not a significant effect of the sub-internship on students' decision to apply in internal medicine. Additional research about the relative impact of the sub-internship in relationship to other career choice predictors is needed to better address factors that may encourage or dissuade students from pursuing internal medicine.

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

    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…

  17. Performance of International Medical Students In psychosocial medicine.

    PubMed

    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 < .001; η 2  = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η 2  = .053). No differences emerged within the multiple-choice examination (p = .127). 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

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

    PubMed

    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.

  19. Effect of tip flange on tip leakage flow of small axial flow fans

    NASA Astrophysics Data System (ADS)

    Zhang, Li; Jin, Yingzi; Jin, Yuzhen

    2014-02-01

    Aerodynamic performance of an axial flow fan is closely related to its tip clearance leakage flow. In this paper, the hot-wire anemometer is used to measure the three dimensional mean velocity near the blade tips. Moreover, the filtered N-S equations with finite volume method and RNG k-ɛ turbulence model are adopted to carry out the steady simulation calculation of several fans that differ only in tip flange shape and number. The large eddy simulation and the FW-H noise models are adopted to carry out the unsteady numerical calculation and aerodynamic noise prediction. The results of simulation calculation agree roughly with that of tests, which proves the numerical calculation method is feasible.The effects of tip flange shapes and numbers on the blade tip vortex structure and the characteristics are analyzed. The results show that tip flange of the fan has a certain influence on the characteristics of the fan. The maximum efficiencies for the fans with tip flanges are shifted towards partial flow with respect to the design point of the datum fan. Furthermore, the noise characteristics for the fans with tip flanges have become more deteriorated than that for the datum fan. Tip flange contributes to forming tip vortex shedding and the effect of the half-cylinder tip flange on tip vortex shedding is obvious. There is a distinct relationship between the characteristics of the fan and tip vortex shedding. The research results provide the profitable reference for the internal flow mechanism of the performance optimization of small axial flow fans.

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

    PubMed

    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

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

    PubMed

    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.

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

    PubMed Central

    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

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

    PubMed

    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 < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

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

    PubMed Central

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

    2015-01-01

    Background A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. Objective 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). Methods 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. Results 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 < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Conclusions Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE. PMID:26217421

  5. Medicine safety and children

    MedlinePlus

    ... it is candy. What to Do If Your Child Takes Medicine If you think your child has taken medicine, call the poison control center ... blood pressure monitored. Preventing Medicine Mistakes When giving medicine to your young child, follow these safety tips: Use medicine made only ...

  6. The management of pneumonia in internal medicine.

    PubMed

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

    2013-01-01

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

  7. The international translational regenerative medicine center.

    PubMed

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

    2012-11-01

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

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

    PubMed

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

    2013-02-01

    To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Incidence of refeeding syndrome in internal medicine patients.

    PubMed

    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 < 0.05). Measurement of muscle strength over time was not associated with the occurrence of 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.

  10. 26 CFR 31.3401(a)(16)-1 - Tips.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT TAXES AND COLLECTION OF INCOME TAX AT SOURCE EMPLOYMENT TAXES AND COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3401(a)(16)-1 Tips. Tips paid to an employee are excepted from wages and hence...

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

    PubMed

    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.

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

    PubMed Central

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

    2016-01-01

    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. PMID:27077874

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

    PubMed

    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.

  14. Residents' Perceptions of Primary Care versus Traditional Internal Medicine Programs.

    ERIC Educational Resources Information Center

    Wilson, Howard K.; And Others

    1983-01-01

    Two internal medicine residency programs at Baylor College of Medicine are discussed. The traditional program emphasizes experience in the care of acute problems within a hospital inpatient environment. The primary care residency program emphasizes training in the outpatient environment and in noninternal medicine disciplines. (MLW)

  15. Using High-Content Imaging to Analyze Toxicological Tipping ...

    EPA Pesticide Factsheets

    Presentation at International Conference on Toxicological Alternatives & Translational Toxicology (ICTATT) held in China and Discussing the possibility of using High Content Imaging to Analyze Toxicological Tipping Points Slide Presentation at International Conference on Toxicological Alternatives & Translational Toxicology (ICTATT) held in China and Discussing the possibility of using High Content Imaging to Analyze Toxicological Tipping Points

  16. Challenges facing general internal medicine in the 99th Congress.

    PubMed

    Prout, D M

    1986-01-01

    Since 1976, federal support for training in general internal medicine has been provided through the primary care residency programs under Title VII of the Public Health Service Act. Continuation of these programs is now in jeopardy because of severe fiscal pressures and the response of Congress to the resulting budgetary stringency. General internal medicine faces immediate problems in the budgetary, authorization, and appropriations arenas. However, Congressional proposals for changing the method by which Medicare pays for all graduate medical education may provide an important opportunity. Under a revised method of financing graduate medical education, general internal medicine could eliminate its historical dependence on increasingly unstable federal grant funds and could contribute to the development of new federal incentives for training in the primary care specialties.

  17. Early warning of climate tipping points

    NASA Astrophysics Data System (ADS)

    Lenton, Timothy M.

    2011-07-01

    A climate 'tipping point' occurs when a small change in forcing triggers a strongly nonlinear response in the internal dynamics of part of the climate system, qualitatively changing its future state. Human-induced climate change could push several large-scale 'tipping elements' past a tipping point. Candidates include irreversible melt of the Greenland ice sheet, dieback of the Amazon rainforest and shift of the West African monsoon. Recent assessments give an increased probability of future tipping events, and the corresponding impacts are estimated to be large, making them significant risks. Recent work shows that early warning of an approaching climate tipping point is possible in principle, and could have considerable value in reducing the risk that they pose.

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed

    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

    2012-05-01

    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.

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

    PubMed

    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.

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

    PubMed

    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

  3. Military graduate medical education in internal medicine: an outcomes study.

    PubMed

    Cation, L J; Lenihan, D J; Gutierrez-Nunez, J J

    2001-04-01

    Military graduate medical education has come under increasing scrutiny in recent years as the size of the military medical force declines. To document the outcomes of military graduate medical education in internal medicine, a cohort of Air Force internal medicine residency graduates from Wright-Patterson Medical Center were studied and their residency performance, staff performance, and active duty retention recorded. The study cohort had an outstanding residency performance, as measured by research experience and board certification rate. They also performed well as military staff physicians, receiving numerous individual military medals while holding important administrative and supervisory positions in the military. Finally, the study cohort had a higher than expected active duty retention rate. These findings support the notion that military graduate medical education in internal medicine produces outstanding military internists.

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    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.

  6. International Perspectives on General Internal Medicine and the Case for “Globalization” of a Discipline

    PubMed Central

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

    2006-01-01

    General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the “globalization” of GIM. PMID:16336623

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

    PubMed

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

    2012-06-01

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

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

    PubMed

    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.

  9. [Promising Future in General Internal Medicine for the Next Generation of Physicians].

    PubMed

    Allenbach, Victoria Perpinias; Rozsnyai, Zsofia; Streit, Sven

    2018-06-01

    Promising Future in General Internal Medicine for the Next Generation of Physicians Abstract. We are facing a lack of specialists in general internal medicine in general practitioners' practices as well as in hospitals, while at the same time the population ages and usually displays several chronic diseases (multimorbidity). Thanks to more university places, an improved job description for general internal medicine and new further education offers (curricula), interest in general internal medicine increased again, as surveys of students indicate. The young generation of family doctors and generalists in hospitals wishes flexible working conditions in order to reconcile work, family and spare time in the best possible way. Working atmosphere and colleagues have a high priority. These wishes must now be incorporated into attractive further training with flexible curricula and mentoring offers so that young talents can successfully be promoted.

  10. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Special rule for tips. 31.3402(k)-1 Section 31.3402(k)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT... Collection of Income Tax at Source § 31.3402(k)-1 Special rule for tips. (a) Withholding of income tax in...

  11. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 15 2011-04-01 2011-04-01 false Special rule for tips. 31.3402(k)-1 Section 31.3402(k)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT... Collection of Income Tax at Source § 31.3402(k)-1 Special rule for tips. (a) Withholding of income tax in...

  12. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Special rule for tips. 31.3402(k)-1 Section 31.3402(k)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT... Collection of Income Tax at Source § 31.3402(k)-1 Special rule for tips. (a) Withholding of income tax in...

  13. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Special rule for tips. 31.3402(k)-1 Section 31.3402(k)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT... Collection of Income Tax at Source § 31.3402(k)-1 Special rule for tips. (a) Withholding of income tax in...

  14. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Special rule for tips. 31.3402(k)-1 Section 31.3402(k)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) EMPLOYMENT... Collection of Income Tax at Source § 31.3402(k)-1 Special rule for tips. (a) Withholding of income tax in...

  15. Medicines for ADHD

    MedlinePlus

    ... stomach. DO NOT reduce your dose to save money. If you are having problems paying for medicine, talk with your provider. There may be programs that provide medicines for free or at a lower cost. SAFETY TIPS FOR ...

  16. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI).

    PubMed

    Arienti, Vincenzo; Di Giulio, Rosella; Cogliati, Chiara; Accogli, Esterita; Aluigi, Leonardo; Corazza, Gino Roberto

    2014-10-01

    In recent years, thanks to the development of miniaturized ultrasound devices, comparable to personal computers, tablets and even to smart phones, we have seen an increasing use of bedside ultrasound in internal medicine departments as a novel kind of ultrasound stethoscope. The clinical ultrasound-assisted approach has proved to be particularly useful in assessing patients with nodules of the neck, dyspnoea, abdominal pain, and with limb edema. In several cases, it has allowed a simple, rapid and precise diagnosis. Since 2005, the Italian Society of Internal Medicine and its Ultrasound Study Group has been holding a Summer School and training courses in ultrasound for residents in internal medicine. A national network of schools in bedside ultrasound was then organized for internal medicine specialists who want to learn this technique. Because bedside ultrasound is a user-dependent diagnostic method, it is important to define the limits and advantages of different new ultrasound devices, to classify them (i.e. Echoscopy and Point of Care Ultrasound), to establish appropriate different levels of competence and to ensure their specific training. In this review, we describe the point of view of the Italian Internal Medicine Society on these topics.

  17. Tipping elements in the Earth's climate system.

    PubMed

    Lenton, Timothy M; Held, Hermann; Kriegler, Elmar; Hall, Jim W; Lucht, Wolfgang; Rahmstorf, Stefan; Schellnhuber, Hans Joachim

    2008-02-12

    The term "tipping point" commonly refers to a critical threshold at which a tiny perturbation can qualitatively alter the state or development of a system. Here we introduce the term "tipping element" to describe large-scale components of the Earth system that may pass a tipping point. We critically evaluate potential policy-relevant tipping elements in the climate system under anthropogenic forcing, drawing on the pertinent literature and a recent international workshop to compile a short list, and we assess where their tipping points lie. An expert elicitation is used to help rank their sensitivity to global warming and the uncertainty about the underlying physical mechanisms. Then we explain how, in principle, early warning systems could be established to detect the proximity of some tipping points.

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed

    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.

  1. Medicines and Children

    MedlinePlus

    ... child. Here are some other tips for giving medicine safely to your child: Read and follow the label directions every time. ... new symptoms or unexpected side effects in your child The medicine doesn't appear to be working when you ...

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

    PubMed

    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.

  3. Tipping elements in the Earth's climate system

    PubMed Central

    Lenton, Timothy M.; Held, Hermann; Kriegler, Elmar; Hall, Jim W.; Lucht, Wolfgang; Rahmstorf, Stefan; Schellnhuber, Hans Joachim

    2008-01-01

    The term “tipping point” commonly refers to a critical threshold at which a tiny perturbation can qualitatively alter the state or development of a system. Here we introduce the term “tipping element” to describe large-scale components of the Earth system that may pass a tipping point. We critically evaluate potential policy-relevant tipping elements in the climate system under anthropogenic forcing, drawing on the pertinent literature and a recent international workshop to compile a short list, and we assess where their tipping points lie. An expert elicitation is used to help rank their sensitivity to global warming and the uncertainty about the underlying physical mechanisms. Then we explain how, in principle, early warning systems could be established to detect the proximity of some tipping points. PMID:18258748

  4. 26 CFR 31.3121(q)-1 - Tips included for employee taxes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Tips included for employee taxes. 31.3121(q)-1 Section 31.3121(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... § 31.3121(q)-1 Tips included for employee taxes. (a) In general. Except as otherwise provided in...

  5. 26 CFR 31.3121(q)-1 - Tips included for employee taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 15 2011-04-01 2011-04-01 false Tips included for employee taxes. 31.3121(q)-1 Section 31.3121(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... § 31.3121(q)-1 Tips included for employee taxes. (a) In general. Except as otherwise provided in...

  6. 26 CFR 31.3121(q)-1 - Tips included for employee taxes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Tips included for employee taxes. 31.3121(q)-1 Section 31.3121(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... § 31.3121(q)-1 Tips included for employee taxes. (a) In general. Except as otherwise provided in...

  7. 26 CFR 31.3121(q)-1 - Tips included for employee taxes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Tips included for employee taxes. 31.3121(q)-1 Section 31.3121(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... § 31.3121(q)-1 Tips included for employee taxes. (a) In general. Except as otherwise provided in...

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

    PubMed

    Ofoma, Uchenna R; Lehman, Erik E; Haidet, Paul; Yacht, Andrew C

    2011-01-31

    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). 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. 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 < 0.02) across three content areas. 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.

  9. [Referral to internal medicine for alcoholism: influence on follow-up care].

    PubMed

    Avila, P; Marcos, M; Avila, J J; Laso, F J

    2008-11-01

    The problem of high rates of patient drop-out in alcohol treatment programs is frequently reported in the literature. Our aim was to investigate if internal medicine referral could improve abstinence and retention rates in a cohort of alcoholic patients. A retrospective observational study was conducted comparing 200 alcoholic patients attending a psychiatric unit (group 1) with 100 patients attending both this unit and an internal medicine unit (group 2). We collected sociodemographic and clinical variables and analysed differences regarding abstinence and retention rates by means of univariate and multivariate analysis. At 3 and 12 months follow-up, group 2 patients had higher retention and abstinence rates than group 1 patients. Multivariate analysis including potential confounding variables showed that independent predictors of one-year retention were internal medicine referral and being married. Independent predictors of one-year abstinence were being married, age > 44 years and receipt of drug treatment. The higher retention rate found among patients referred to Internal Medicine specialists, a result that has not been previously reported to the best of our knowledge, emphasizes the importance of a multidisciplinary team approach in the treatment of alcoholism.

  10. Grade inflation in the internal medicine clerkship: a national survey.

    PubMed

    Fazio, Sara B; Papp, Klara K; Torre, Dario M; Defer, Thomas M

    2013-01-01

    Grade inflation is a growing concern, but the degree to which it continues to exist in 3rd-year internal medicine (IM) clerkships is unknown. The authors sought to determine the degree to which grade inflation is perceived to exist in IM clerkships in North American medical schools. A national survey of all Clerkship Directors in Internal Medicine members was administered in 2009. The authors assessed key aspects of grading. Response rate was 64%. Fifty-five percent of respondents agreed that grade inflation exists in the Internal Medicine clerkship at their school. Seventy-eight percent reported it as a serious/somewhat serious problem, and 38% noted students have passed the IM clerkship at their school who should have failed. A majority of clerkship directors report that grade inflation still exists. In addition, many note students who passed despite the clerkship director believing they should have failed. Interventions should be developed to address both of these problems.

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

    PubMed

    Smith, Dustin T; Kohlwes, R Jeffrey

    2011-01-01

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

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

    PubMed

    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.

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

    PubMed

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

    2015-01-01

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

  14. Burnout, Coping, and Spirituality Among Internal Medicine Resident Physicians

    PubMed Central

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

    2013-01-01

    Background 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. Objective We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. Methods 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). Results 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. Conclusions Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit. PMID:24404269

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

    PubMed

    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.

  16. [Shaare Zedek Medical Center's model of an integrated division of internal medicine].

    PubMed

    Yinnon, Amos M; Munter, Gabriel; Friedmann, Reuven; Katz, David; Nesher, Gideon; Tichler, Thomas; Zevin, Shoshana

    2014-01-01

    The specialty and practice of internal medicine have been subject to serious challenges in the last two decades. We describe the integrative model of internal medicine as developed in our hospital, providing solutions to some major challenges. Major components include: (1) Senior physicians and residents are employed by the Division rather than individual Departments of Medicine, allowing for balanced distribution of professional capabilities. (2) Two medical departments specialize in geriatric medicine, while the other departments take care of younger, more intellectually challenging patients. Senior and junior staff members rotate through these departments, allowing for exposure to different patient populations and professional expertise. (3) The backbone of senior physicians is rewarded by a set of incentives, including dedicated time for research. (4) Senior staff from the subspecialties contributes annually 1-2 months as senior physicians in the departments and receive academic and other compensation for their efforts. (5) In cases where medical departments elsewhere are flooded with corridor admissions (a source of frustration and burnout), a short admission unit in the emergency department relieves internal medicine pressures and shortens evaluation and therapy for many patients. Our integrative model of internal medicine allows for improved patient and staff distribution, greater satisfaction among patients and family members, greater professional satisfaction among physicians, while resident vacancies are filled with competent residents.

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

    PubMed

    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.

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

    PubMed Central

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

    2017-01-01

    Importance Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. Objective To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Design, Setting, and Participants 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. Main Outcomes and Measures Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Results 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

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

    PubMed

    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

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

    PubMed

    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.

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

    PubMed

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p < 0.01), 3.2 (SD, 2.1) for naturopathic medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to

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

    PubMed Central

    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 < 0.02) across three content areas. 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. PMID:21281500

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

    PubMed

    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.

  4. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

    PubMed Central

    Verma, Amol A.; Guo, Yishan; Kwan, Janice L.; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A.; Hwang, Stephen W.; Laupacis, Andreas; Mamdani, Muhammad M.; Shadowitz, Steven; Upshur, Ross; Reid, Robert J.; Razak, Fahad

    2017-01-01

    Background: The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. Methods: This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. Results: There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Interpretation: Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high

  5. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.

    PubMed

    Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad

    2017-12-11

    The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017

  6. [Perspectives and challenges to guarantee training and renewal in general internal medicine].

    PubMed

    Waeber, G; Cornuz, J; Gaspoz, J-M; Pécoud, A; Perrier, A

    2009-01-28

    Training new doctors in general internal medicine represents a challenge. This requires to define future needs, which result from interest that are not necessarily convergent between patients, doctors, insurers and politicians. Problems related to medical demography in Switzerland, with the ageing of the population, the increase in health care costs and the place of Switzerland within the European Community require the implementation of specific objectives to train new physicians in general internal medicine. The success of these opportunities depends on social factors, political choices and choices from physician's association. In this article we will approach these challenges by formulating some proposals--nonexhaustive--in order to guarantee sufficient renewal in general internal medicine.

  7. Global payment contract attitudes and comprehension among internal medicine physicians.

    PubMed

    Allen-Dicker, Joshua; Herzig, Shoshana J; Kerbel, Russell

    2015-08-01

    Global payment contracts (GPCs) are increasingly common agreements between insurance payers and healthcare providers that incorporate aspects of risk adjustment, capitation, and pay-for-performance. Physicians are often viewed as potential barriers to implementation of organizational change, but little is known about internist opinion on GPC involvement or specific internist attributes that might predict GPC support. We aimed to investigate internist and internal medicine subspecialist support of GPC involvement, and to identify associations among physician attributes, GPC knowledge, and GPC support. Cross-sectional. General medicine and internal medicine subspecialist physicians within the Beth Israel Deaconess Department of Medicine in Boston, Massachusetts, were surveyed 4 years after care organization entry into a GPC. Measurements collected included reported support for GPC involvement, reason for support, and demonstrated comprehension of key GPC details. Of the 281 respondents (49% response rate), 85% reported supporting involvement in a GPC. In a multivariate ordinal logistic regression model, exposure to prior information about GPCs, demonstrated comprehension of key GPC details, longer time since completion of residency, and lower clinical time commitment were all independently associated with higher levels of GPC involvement support. Four years since first engaging in a global payment contract, a majority of internal medicine physician respondents support this decision. Understanding predictors of physician support for GPC involvement within our care organization may help other health systems to approach organizational change. Health system leaders debating GPC involvement should consider engaging physicians via educational interventions geared toward improving GPC support.

  8. The Teaching of Liberal Arts in Internal Medicine Residency Training.

    ERIC Educational Resources Information Center

    Povar, Gail J.; Keith, Karla J.

    1984-01-01

    A survey on the teaching of liberal arts in internal medicine residency programs and the importance of liberal arts to the practice of medicine is discussed. Law and organization of the health care system as well as economics and bioethics were rated as essential to medical practice. (Author/MLW)

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

    PubMed

    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.

  10. The State of Evaluation in Internal Medicine Residency

    PubMed Central

    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. Cooling circuit for a gas turbine bucket and tip shroud

    DOEpatents

    Willett, Fred Thomas; Itzel, Gary Michael; Stathopoulos, Dimitrios; Plemmons, Larry Wayne; Plemmons, Helen M.; Lewis, Doyle C.

    2002-01-01

    An open cooling circuit for a gas turbine bucket wherein the bucket has an airfoil portion, and a tip shroud, the cooling circuit including a plurality of radial cooling holes extending through the airfoil portion and communicating with an enlarged internal area within the tip shroud before exiting the tip shroud such that a cooling medium used to cool the airfoil portion is subsequently used to cool the tip shroud.

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

    PubMed

    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, p<0.001). The area underneath the receiver operative characteristic curve was 0.69 (95% Confidence Interval [0.63-0.75]), suggesting programs with less than 12 examinees/year are less likely to meet the minimum Accreditation Council for Graduate Medical Education pass-rate standard (sensitivity 63.8%, specificity 60.4%, positive predictive value 82.2%, p<0.001). Although a majority of Internal 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.

  13. Cooling circuit for a gas turbine bucket and tip shroud

    DOEpatents

    Willett, Fred Thomas

    2004-07-13

    An open cooling circuit for a gas turbine airfoil and associated tip shroud includes a first group of cooling holes internal to the airfoil and extending in a radially outward direction generally along a leading edge of the airfoil; a second group of cooling holes internal to the airfoil and extending in a radially outward direction generally along a trailing edge of the airfoil. A common plenum is formed in the tip shroud in direct communication with the first and second group of cooling holes, but a second plenum may be provided for the second group of radial holes. A plurality of exhaust holes extends from the plenum(s), through the tip shroud and opening along a peripheral edge of the tip shroud.

  14. Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation

    PubMed Central

    Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

    2006-01-01

    BACKGROUND Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. OBJECTIVE To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. DESIGN Cross-sectional mail survey. PARTICIPANTS Chief residents at all accredited U.S. internal medicine residency programs outside New York. MEASUREMENTS AND MAIN RESULTS The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. CONCLUSIONS In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time. PMID:16918742

  15. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cane, crutch, and walker tips and pads. 890.3790 Section 890.3790 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3790 Cane...

  16. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cane, crutch, and walker tips and pads. 890.3790 Section 890.3790 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3790 Cane...

  17. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cane, crutch, and walker tips and pads. 890.3790 Section 890.3790 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3790 Cane...

  18. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cane, crutch, and walker tips and pads. 890.3790 Section 890.3790 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3790 Cane...

  19. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cane, crutch, and walker tips and pads. 890.3790 Section 890.3790 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3790 Cane...

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

    PubMed

    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.

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

    PubMed Central

    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 < 0.05). PGY3 IM-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

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

    PubMed

    Sabath, Bruce F; Singh, Gurkeerat

    2016-01-01

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

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

    PubMed Central

    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

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

    PubMed

    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.

  5. Sports Information Online: Searching the SPORT Database and Tips for Finding Sports Medicine Information Online.

    ERIC Educational Resources Information Center

    Janke, Richard V.; And Others

    1988-01-01

    The first article describes SPORT, a database providing international coverage of athletics and physical education, and compares it to other online services in terms of coverage, thesauri, possible search strategies, and actual usage. The second article reviews available online information on sports medicine. (CLB)

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

    PubMed

    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 < 0.01); completion of rotations in ob/gyn and psychiatry were unrelated to internal medicine subject examination performance. At the school level, longer internal medicine

  7. [Integration of Internal and Clinical Laboratory Medicine].

    PubMed

    Hirokawa, Makoto

    2015-03-01

    The mission of our department is to contribute to diagnostic improvement in medicine in order to promote better outcomes. We have clinical expertise in internal medicine including primary care medicine, hematology, allergy, rheumatology, and nephrology. We also have expertise in clinical laboratory medicine and hospital infection control. Specific areas of academic interest include immune-mediated hematological diseases, allergic diseases, autoimmune diseases, and chronic kidney disease. Immune recovery following hematopoietic stem cell transplantation and the immunopathophysiology of bone marrow failure syndrome have been our main topics of interest, and we have been applying our knowledge of T-cell receptor diversity to these areas in order to explore the mechanisms of immunodeficiency and autoimmunity in hematological disorders. We have found that the peripheral expansion of mature T cells in grafts plays an important role in immune reconstitution after stem cell transplantation in humans, and have also found altered T-cell repertoires in immune-mediated chronic acquired pure red cell aplasia. Thus, quantitative and qualitative analyses of immune receptors could be a promising method for assessing immunocompetence and exploring the pathophysiology of autoimmune diseases. Research and development of novel approaches in this field should be intensively conducted.

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

    PubMed

    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.

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

    PubMed

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

    2015-01-01

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

  10. The International Society for Sexual Medicine: A Rich History and a Bright Future.

    PubMed

    Lewis, Ronald W

    2013-07-01

    Based upon physical presence at most of the historical moments of the development of the International Society for Sexual Medicine (ISSM), extensive personal records on meetings and correspondence associated with the business and the work of the International Society for Sexual and Impotence Research and the ISSM, and information provided by the business office of the ISSM, a review paper was created to present to the reader an accurate history of the ISSM. The article is divided into the early beginnings of the idea of the field of sexual medicine, followed by the organization of what was to become eventually the International Society for Sexual Medicine, description of the development of biennial meetings and some of the major events that occurred at these meetings, a description of officers and leaders of the society and some of their key contributions, other meetings that the ISSM was actively involved in in the field of sexual medicine, a detailed discussion of publications and communications of the organization, and finally a description of the involvement of the ISSM with the recognition of scientific achievement and research in the field. This history is indeed very rich and unique for the parallelism to the development of the entire field of sexual medicine as a true science. The author has spent a great deal of time in making sure that there is written material that substantiates the history that is outlined in this document. It is provided to the reader as a true historical perspective on the ISSM. Lewis RW. The International Society for Sexual Medicine: A rich history and a bright future. Sex Med Rev 2013; 1:65-75. Copyright © 2013 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  11. Predictors of Final Specialty Choice by Internal Medicine Residents

    PubMed Central

    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%, P<.001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal 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

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

    PubMed Central

    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

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

    PubMed

    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.

  14. Spending on medicines in Israel in an international context.

    PubMed

    Sax, Philip

    2005-05-01

    Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure

  15. Nurses as Evaluators of the Humanistic Behavior of Internal Medicine Residents.

    ERIC Educational Resources Information Center

    Butterfield, Paula S.; And Others

    1987-01-01

    The reliability of a 13-item questionnaire designed to assess the humanistic behaviors of internal medicine residents and the reliability of nurses as raters of those behaviors were examined. Residents were evaluated by nurses on two general medicine services and on cardiology and hematology-oncology services. (Author/MLW)

  16. Arteriography of the left internal mammary artery graft utilizing a balloon-tipped floatation catheter: an alternative approach.

    PubMed

    Sharifi, M; Lauer, J; Pompili, V J; Dillon, J C

    1999-11-01

    In this report, we describe an alternative method to the conventional arteriographic techniques of the left internal mammary artery (LIMA) graft using a balloon-tipped floatation catheter placed within the left subclavian artery. The floatation catheter will serve as both an occluder of the subclavian artery as well as a port for contrast injection. It may be effectively employed in the rare instances where direct cannulation of the LIMA graft is not possible.

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

    ERIC Educational Resources Information Center

    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…

  18. International textbook of family medicine: the application of EURACT teaching agenda.

    PubMed

    Švab, Igor; Katić, Milica

    2014-01-01

    The paper describes experiences in the development of an international textbook of family medicine. The process of its development has started in Slovenia, where the Slovenian authors have written a textbook, adhering strictly to the European definition of family medicine and its core competencies. The format and the approach were also adopted by Croatian authors, who have used most of the material from the Slovenian book, but have modified some of the chapters according to the situation in the country and have added some of their own. This activity has created an opportunity for a truly international collaboration in the area of education of family medicine, with a creation of an international consortium, which would be responsible for the core content of the book and local adaptations of the book according to the specificities and needs of different countries. This innovative approach in the development of teaching material may be interesting for a variety of smaller countries in Europe and worldwide. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.

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

    PubMed

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

    2017-12-01

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

  20. Gender differences in salary of internal medicine residency directors: a national survey.

    PubMed

    Willett, Lisa L; Halvorsen, Andrew J; McDonald, Furman S; Chaudhry, Saima I; Arora, Vineet M

    2015-06-01

    Whether salary disparities exist between men and women in medical education leadership roles is not known. The study objective was to determine whether salary disparities exist between male and female Internal Medicine residency program directors, and if so, to identify factors associated with the disparities and explore historical trends. The annual Association of Program Directors in Internal Medicine (APDIM) survey in August 2012 included items to assess the salary and demographic characteristics of program directors, which were merged with publically available program data. To assess historical trends, we used similarly obtained survey data from 2008 to 2011. The study included program directors of 370 APDIM member programs, representing 95.6% of the 387 accredited Internal Medicine training programs in the United States and Puerto Rico. Of the 370 APDIM member programs, 241 (65.1%) completed the survey, of whom 169 (70.1%) were men and 72 (29.9%) were women. Program directors' total annual salary, measured in $25,000 increments, ranged from $75,000 or less to more than $400,000. Historical trends of mode salary by gender from 2008 to 2012 were assessed. The mode salary was $200,000 to 225,000 for men and $175,000 to $200,000 for women (P = .0005). After controlling for academic rank, career in general internal medicine, and program director age, the distribution of salary remained different by gender (P = .004). Historical trends show that the difference in mode salary has persisted since 2008. Leaders in academic medical centers, residency and fellowship directors, and all faculty in medical education need to be aware that salary disparities cited decades ago persist in this sample of medical educators. Closing the gender gap will require continued advocacy for measuring and reporting salary gaps, and changing the culture of academic medical centers. Copyright © 2015 Alliance for Academic Internal Medicine. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    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 < .001) and anxiety (r = .57; p < .001). Because of its short length and robust psychometric qualities, the use of the IMRSS is recommended to quickly and frequently assess and monitor stress among internal medicine residents.

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

    PubMed

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

    2013-10-02

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

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

    PubMed

    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 < .0001). In the long-term retention study, knowledge of US imaging and confidence in identifying structures did decline. This educational intervention resulted in improvement in US knowledge and image acquisition. However, the knowledge diminished over time, suggesting that further education is needed if US is to become an important component of internal medicine training and practice. © 2014 by the American Institute of Ultrasound in Medicine.

  4. Transforming primary care training--patient-centered medical home entrustable professional activities for internal medicine residents.

    PubMed

    Chang, Anna; Bowen, Judith L; Buranosky, Raquel A; Frankel, Richard M; Ghosh, Nivedita; Rosenblum, Michael J; Thompson, Sara; Green, Michael L

    2013-06-01

    The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice. We address two key questions regarding the training of internal medicine residents for practice in PCMHs. First, what are the educational implications of practice transformations to primary care home models? Second, what must we do differently to prepare internal medicine residents for their futures in PCMHs? The 2011 Society of General Internal Medicine (SGIM) PCMH Education Summit established seven work groups to address the following topics: resident workplace competencies, teamwork, continuity of care, assessment, faculty development, 'medical home builder' tools, and policy. The output from the competency work group was foundational for the work of other groups. The work group considered several educational frameworks, including developmental milestones, competencies, and entrustable professional activities (EPAs). The competency work group defined 25 internal medicine resident PCMH EPAs. The 2011 National Committee for Quality Assurance (NCQA) PCMH standards served as an organizing framework for EPAs. The list of PCMH EPAs has the potential to begin to transform the education of internal medicine residents for practice and leadership in the PCMH. It will guide curriculum development, learner assessment, and clinical practice redesign for academic health centers.

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

    PubMed

    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.

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

    PubMed

    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

  7. Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014.

    PubMed

    Hauer, Karen E; Vandergrift, Jonathan; Hess, Brian; Lipner, Rebecca S; Holmboe, Eric S; Hood, Sarah; Iobst, William; Hamstra, Stanley J; McDonald, Furman S

    2016-12-06

    US internal medicine residency programs are now required to rate residents using milestones. Evidence of validity of milestone ratings is needed. To compare ratings of internal medicine residents using the pre-2015 resident annual evaluation summary (RAES), a nondevelopmental rating scale, with developmental milestone ratings. Cross-sectional study of US internal medicine residency programs in the 2013-2014 academic year, including 21 284 internal medicine residents (7048 postgraduate-year 1 [PGY-1], 7233 PGY-2, and 7003 PGY-3). Program director ratings on the RAES and milestone ratings. Correlations of RAES and milestone ratings by training year; correlations of medical knowledge ratings with American Board of Internal Medicine (ABIM) certification examination scores; rating of unprofessional behavior using the 2 systems. Corresponding RAES ratings and milestone ratings showed progressively higher correlations across training years, ranging among competencies from 0.31 (95% CI, 0.29 to 0.33) to 0.35 (95% CI, 0.33 to 0.37) for PGY-1 residents to 0.43 (95% CI, 0.41 to 0.45) to 0.52 (95% CI, 0.50 to 0.54) for PGY-3 residents (all P values <.05). Linear regression showed ratings differed more between PGY-1 and PGY-3 years using milestone ratings than the RAES (all P values <.001). Of the 6260 residents who attempted the certification examination, the 618 who failed had lower ratings using both systems for medical knowledge than did those who passed (RAES difference, -0.9; 95% CI, -1.0 to -0.8; P < .001; milestone medical knowledge 1 difference, -0.3; 95% CI, -0.3 to -0.3; P < .001; and medical knowledge 2 difference, -0.2; 95% CI, -0.3 to -0.2; P < .001). Of the 26 PGY-3 residents with milestone ratings indicating deficiencies on either of the 2 medical knowledge subcompetencies, 12 failed the certification examination. Correlation of RAES ratings for professionalism with residents' lowest professionalism milestone ratings was 0.44 (95% CI, 0.43 to 0

  8. Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

    PubMed

    Doebbeling, C C; Pitkin, A K; Malis, R; Yates, W R

    2001-12-01

    Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.

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

    PubMed

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

    2017-10-06

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

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

    PubMed

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

    2010-03-25

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

  11. Update of the ERS international Adult Respiratory Medicine syllabus for postgraduate training.

    PubMed

    Tabin, Nathalie; Mitchell, Sharon; O'Connell, Elaine; Stolz, Daiana; Rohde, Gernot

    2018-03-01

    First published in 2006, the first European core syllabus in Adult Respiratory Medicine was developed with the intention of harmonising education and training throughout Europe. Internationally recognised by the European Union of Medical Specialists and identified as the first document of its kind in respiratory medicine, it has provided a comprehensive guide for both local and national institutions in the development of adult respiratory training programmes. Like all fields in education, respiratory medicine is an ever-changing area and as such, respective syllabi, curricula and training programmes must adapt and diversify in line with the evolution of core medical concepts. Given the proven importance of the Adult Respiratory Medicine syllabus from both a national and international standpoint, it is of equal importance that said syllabus remains abreast of emerging trends so as to sustain the synchronisation of respiratory medicine in Europe. In order to develop an updated programme, a comprehensive review process of the current syllabus is a necessary endeavour and a step that the European Respiratory Society (ERS) has undertaken through the process of a needs assessment.

  12. Grading Practices and Distributions Across Internal Medicine Clerkships.

    PubMed

    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.

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

    PubMed

    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.

  14. Divergent fates of the medical humanities in psychiatry and internal medicine: should psychiatry be rehumanized?

    PubMed

    Rutherford, Bret R; Hellerstein, David J

    2008-01-01

    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. The journals searched were the three highest-ranking psychiatry and internal medicine journals on the Institute for Scientific Information's Impact Factor rankings that were published in English and aimed at a clinical audience. Operationalized criteria defining the medical humanities allowed the percentage of text in the selected journals constituting medical humanities to be quantified. Journals were hand searched at 10-year intervals from 1950 to 2000. Mixed effects models were used to describe the change in medical humanities over time. The percentage of text within psychiatry journals meeting the criteria for medical humanities declined from a peak of 17% in 1970 to a low of 2% in 2000, while the percentage of humanities articles in internal medicine journals roughly doubled from 5% to 11% over the same time period. A linear model increasing over time best fit the medical humanities in the internal medicine journals, while a cubic model decreasing over time best fit the psychiatry humanities data. Humanities articles in medical journals had a greater breadth and diversity than those in psychiatry journals. Medical humanities publications dramatically decreased over time in psychiatry journals while they more than doubled in internal medicine journals. These data suggest the need for further empirical research and discussion of the potential roles of the humanities in psychiatry.

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

    PubMed

    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 <31%, respectively) from formal echocardiography interpreted by a cardiologist. Sensitivity and specificity of FoCUS for any degree of LVSF impairment were 0.91 (95% confidence interval [CI] 0.80, 0.97) and 0.88 (95% CI 0.81, 0.93), respectively. The interrater agreement between internal medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p < 0.001), 95% CI (0.67, 0.87). Formal echocardiography was classified as "technically limited due to patient factors" in 20% of patients; however, echogenicity was sufficient in 100% of FoCUS exams to classify LVSF. 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.

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

    PubMed

    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.

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

    PubMed

    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.

  18. Internal Medicine Residents' Preferences regarding Medical Ethics Education.

    ERIC Educational Resources Information Center

    Jacobson, Jay A.; And Others

    1989-01-01

    A survey of residents (N=323) in 6 internal medicine programs investigated the topics students wanted included in the medical ethics curriculum and by which of 17 methods they would prefer to be taught. About three-fourths had previous medical ethics instruction, and most wanted more on specific topics, especially legal and end-of-life issues.…

  19. Dynamics of Isolated Tip Vortex Cavitation

    NASA Astrophysics Data System (ADS)

    Pennings, Pepijn; Bosschers, Johan; van Terwisga, Tom

    2014-11-01

    Performance of ship propellers and comfort levels in the surroundings are limited by various forms of cavitation. Amongst these forms tip vortex cavitation is one of the first appearing forms and is expected to be mainly responsible for the emission of broadband pressure fluctuations typically occurring between the 4th to the 7th blade passing frequency (approx. 40--70 Hz). These radiated pressure pulses are likely to excite parts of the hull structure resulting in a design compromise between efficiency and comfort. Insight is needed in the mechanism of acoustic emission from the oscillations by a tip vortex cavity. In the current experimental study the tip vortex cavity from a blade with an elliptic planform and sections based on NACA 662 - 415 with meanline a = 0 . 8 is observed using high speed shadowgraphy in combination with blade force and acoustic measurements. An analytic model describing three main cavity deformation modes is verified and used to explain the origin of a cavity eigenfrequency or ``vortex singing'' phenomenon observed by Maines and Arndt (1997) on the tip vortex cavity originating from the same blade. As no hydrodynamic sound originating from the tip vortex cavity was observed it is posed that a tip flow instability is essential for ``vortex singing.'' This research was funded by the Lloyd's Register Foundation as part of the International Institute for Cavitation Research.

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed Central

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

    2015-01-01

    Background 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. Objective Design, implement, and evaluate a program to support intern professional development through positive psychology coaching. Methods 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. Results 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. Conclusions There is early evidence that a coaching program of interactions with faculty trained in positive psychology may advance intern development and partially address burnout. PMID:26692977

  3. Venous thromboembolism: the prevailing approach to diagnosis, prevention and treatment among Internal Medicine practitioners.

    PubMed

    Markel, Arie; Gavish, Israel; Kfir, Hila; Rimbrot, Sofia

    2017-02-01

    Venous thromboembolism (VTE) is the third most common cause of death and the leading cause of sudden death in hospitalized medical patients. Despite the existence of guidelines for prevention and treatment of this disorder, their implementation in everyday life is not always accomplished. We performed a survey among directors of Internal Medicine departments in our country in order to evaluate their attitude and approach to this issue. A questionnaire with pertinent questions regarding prevention and treatment of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE) was sent to each one of the directors of Internal Medicine Departments around the country. Sixty-nine out of 97 (71%) of the Internal Medicine departments directors responded the questionnaire. We found that several of the current guidelines were followed in a reasonable way. On the other hand, heterogeneity of responses was also present and the performance of current guidelines was imperfectly followed, and showed to be deficient in several aspects. An effort should be done in order to reemphasize and put in effect current guidelines for the prevention and treatment of VTE among hospitalists and Internal Medicine practitioners.

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

    ERIC Educational Resources Information Center

    Rutherford, Bret R.; Hellerstein, David J.

    2008-01-01

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

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

    PubMed

    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.

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

    PubMed Central

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

    2017-01-01

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

  7. Update in Internal Medicine

    PubMed Central

    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

  8. Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance.

    PubMed

    Perez, Jose A; Greer, Sharon

    2009-12-01

    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 Licensing Examination (USMLE) to make decisions in recruitment of potential applicants. This study was done to determine a correlation of USMLE Steps 1, 2 and 3 results with ITE scores in each level of Internal Medicine training. A retrospective review of all residents graduating from an Internal Medicine program from 1999 to 2006 was done. Subjects included had data for all USMLE Steps and ITE during all years of training. Thirty-one subjects were included in the study. Correlations of USMLE Steps 1, 2 and 3 were done with ITE scores (percent correct) in each year of training. Pearson's correlation coefficient (r) was determined for each pairing and a t test to determine statistical significance of the correlation was done. Statistical significance was defined as P value <0.05. The r values for USMLE Step 1 and ITE percent correct in PGY I, II and III were 0.46, 0.55 and 0.51 respectively. Corresponding r values for USMLE Step 2 and ITE percent correct were 0.79, 0.70 and 0.72; for USMLE Step 3 these values were 0.51, 0.37 and 0.51 respectively for each training year. USMLE scores are correlated with ITE scores. This correlation was strongest for USMLE Step 2.

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

    PubMed

    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 < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased 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.

  10. Prolonged length of stay in hospitalized internal medicine patients.

    PubMed

    Barba, Raquel; Marco, Javier; Canora, Jesús; Plaza, Susana; Juncos, Sara Nistal; Hinojosa, Juan; Bailon, Manuel Mendez; Zapatero, Antonio

    2015-12-01

    Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts. We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days. Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95). Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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

    PubMed

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

    PubMed

    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.

  13. Hospital ambulatory medicine: A leading strategy for Internal Medicine in Europe.

    PubMed

    Corbella, Xavier; Barreto, Vasco; Bassetti, Stefano; Bivol, Monica; Castellino, Pietro; de Kruijf, Evert-Jan; Dentali, Francesco; Durusu-Tanriöver, Mine; Fierbinţeanu-Braticevici, Carmen; Hanslik, Thomas; Hojs, Radovan; Kiňová, Soňa; Lazebnik, Leonid; Livčāne, Evija; Raspe, Matthias; Campos, Luis

    2018-04-13

    Addressing the current collision course between growing healthcare demands, rising costs and limited resources is an extremely complex challenge for most healthcare systems worldwide. Given the consensus that this critical reality is unsustainable from staff, consumer, and financial perspectives, our aim was to describe the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for encouraging internists to lead a thorough reengineering of hospital operational procedures by the implementation of innovative hospital ambulatory care strategies. Among these, we include outpatient and ambulatory care strategies, quick diagnostic units, hospital-at-home, observation units and daycare hospitals. Moving from traditional 'bed-based' inpatient care to hospital ambulatory medicine may optimize patient flow, relieve pressure on hospital bed availability by avoiding hospital admissions and shortening unnecessary hospital stays, reduce hospital-acquired complications, increase the capacity of hospitals with minor structural investments, increase efficiency, and offer patients a broader, more appropriate and more satisfactory spectrum of delivery options. Copyright © 2018. Published by Elsevier B.V.

  14. Nasal tip plasty: the delivery approach revisited.

    PubMed

    Xavier, Rui

    2013-02-01

    The delivery approach, though very appropriate for remodeling the tip of the nose, has been overlooked in recent years and has often been passed over for the open approach. One reason for this is the intercartilaginous incision used for the delivery approach, which may cause scarring at the nasal valve area, leading to postoperative functional obstruction of the nose. The delivery of the alar cartilages is another negative, as this maneuver will disrupt the collagen fibers that attach the upper lateral cartilages to the cephalic margin of the alar cartilages, leading to a weakening of the tip's support. We propose a modification to the traditional delivery approach by using a transcartilaginous instead of an intercartilaginous incision to prevent damage to the valve area. We also suggest taking advantage of the interference to the tip's support caused by the disruption of the collagen fibers of the scroll area. The purpose of this article is to describe this modification of the delivery approach and to emphasize the advantages that this controlled interference to the tip's support may have in selected cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  15. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management.

    PubMed

    Nimeri, Abdelrahman A; Maasher, Ahmed; Al Shaban, Talat; Salim, Elnazeer; Gamaleldin, Maysoon M

    2016-09-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the golden standard for bariatric surgery. However, the potential risk for internal hernia after LRYGB remains a significant concern to both patients and surgeons. In addition, patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of internal hernia. The aim of this study was to describe our technique to prevent internal hernia after LRYGB, intra-operative findings, and our management strategies for patients with internal hernia after LRYGB. In this video, we review different technical tips and tricks to explore patients with suspected internal hernia after RYGB, how to reduce obstructed small bowel, and effectively close mesenteric defects to prevent internal hernia after LRYGB. A high index of suspicion and evaluation of the CT scan of the patient by an experienced bariatric surgeon is essential to avoid missing cases of internal hernia after LRYGB. In addition, patients presenting with incarcerated small bowel due to an internal hernia are best managed by standing on the left side of the patient with the left arm tucked and starting at the ileocecal valve and running the small bowel backwards towards the ligament of Treitz. Furthermore, patients with bowel obstruction due to internal hernia may need to have a gastrostomy placed at the remnant of the stomach. Recurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.

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

    PubMed

    Horn, Leora; Tzanetos, Katina; Thorpe, Kevin; Straus, Sharon E

    2008-06-26

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

  17. A job-satisfaction measure for internal medicine residency program directors.

    PubMed

    Beasley, B W; Kern, D E; Howard, D M; Kolodner, K

    1999-03-01

    To develop a job-satisfaction measure that encompasses the multifaceted job of internal medicine residency program directors. Questions were devised to measure program directors satisfaction with various facets of their jobs. In 1996, the authors surveyed all non-military internal medicine program directors in the United States. Of the program directors surveyed, 301 (78%) responded. More respondents than non-respondents held the title of department chairperson in addition to the title of program director (22% vs 7%). Factor analysis and correlation analysis yielded a multifaceted measure (termed PD-Sat) composed of 20 questions and six facets (work with residents, colleague relationships, resources, patient care, pay, and promotion) that made sense based on literature review and discussions with program directors (face validity). The PD-Sat had good internal reliability (Cronbach's alpha = .88), as had each of its six facets (Cronbach's alphas = .60-.90). The six facets correlated modestly with one another (Pearson's r2 = .12-.67), suggesting they were measuring different aspects of a common concept. The PD-Sat correlated significantly with an established four-question global job-satisfaction scale used in previous studies (Pearson's r2 = .33) demonstrating concurrent validity. Scores on the PD-Sat predicted whether program directors were considering, seeking, or making a job change (predictive validity). The PD-Sat performed comparably well in subsets of program directors who were and were not department chairs, suggesting that it might be applicable to different populations of program directors. The authors have developed a new facet-specific job-satisfaction measure that is reliable and valid for assessing the job satisfaction of internal medicine program directors. Because job descriptions for program directors in other specialties are similar, it may also be useful in these populations.

  18. Alternative approaches to ambulatory training: internal medicine residents' and program directors' perspectives.

    PubMed

    Thomas, Kris G; West, Colin P; Popkave, Carol; Bellini, Lisa M; Weinberger, Steven E; Kolars, Joseph C; Kogan, Jennifer R

    2009-08-01

    Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. National cohort study. Internal medicine residents (N = 14,941) and program directors (N = 222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations. Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.

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

    PubMed

    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.

  20. Precision medicine needs pioneering clinical bioinformaticians.

    PubMed

    Gómez-López, Gonzalo; Dopazo, Joaquín; Cigudosa, Juan C; Valencia, Alfonso; Al-Shahrour, Fátima

    2017-10-25

    Success in precision medicine depends on accessing high-quality genetic and molecular data from large, well-annotated patient cohorts that couple biological samples to comprehensive clinical data, which in conjunction can lead to effective therapies. From such a scenario emerges the need for a new professional profile, an expert bioinformatician with training in clinical areas who can make sense of multi-omics data to improve therapeutic interventions in patients, and the design of optimized basket trials. In this review, we first describe the main policies and international initiatives that focus on precision medicine. Secondly, we review the currently ongoing clinical trials in precision medicine, introducing the concept of 'precision bioinformatics', and we describe current pioneering bioinformatics efforts aimed at implementing tools and computational infrastructures for precision medicine in health institutions around the world. Thirdly, we discuss the challenges related to the clinical training of bioinformaticians, and the urgent need for computational specialists capable of assimilating medical terminologies and protocols to address real clinical questions. We also propose some skills required to carry out common tasks in clinical bioinformatics and some tips for emergent groups. Finally, we explore the future perspectives and the challenges faced by precision medicine bioinformatics. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Citation Analysis of The Korean Journal of Internal Medicine from KoMCI, Web of Science, and Scopus

    PubMed Central

    2011-01-01

    The Korean Journal of Internal Medicine (KJIM) is the international journal published in English by the Korean Association of Internal Medicine. To understand the position of the journal in three different databases, the citation indicators were elucidated. From databases such as Korean Medical Citation Index (KoMCI), Web of Science, and Scopus, citation indicators such as the impact factor, SCImago journal rank (SJR), or Hirsch Index were calculated according to the year and the results were drawn. The KJIM 2010 impact factor increased to 0.623 in Web of Science. That of year 2009 in KoMCI was a 0.149. The 2009 SJR in Scopus was 0.073, with a ranking of 27/72 (37.5%) in the category of internal medicine and 414/1,618 (25.6%) in the category of medicine, miscellaneous. The Hirsch Index from KoMCI, Web of Science and Scopus were 5, 14, and 16, respectively. The KJIM is now cited more by international researchers than Korean researchers, indicating that the content of the journal is now valued at the international level. PMID:21437155

  2. Citation analysis of The Korean Journal of Internal Medicine from KoMCI, Web of Science, and Scopus.

    PubMed

    Huh, Sun

    2011-03-01

    The Korean Journal of Internal Medicine (KJIM) is the international journal published in English by the Korean Association of Internal Medicine. To understand the position of the journal in three different databases, the citation indicators were elucidated. From databases such as Korean Medical Citation Index (KoMCI), Web of Science, and Scopus, citation indicators such as the impact factor, SCImago journal rank (SJR), or Hirsch Index were calculated according to the year and the results were drawn. The KJIM 2010 impact factor increased to 0.623 in Web of Science. That of year 2009 in KoMCI was a 0.149. The 2009 SJR in Scopus was 0.073, with a ranking of 27/72 (37.5%) in the category of internal medicine and 414/1,618 (25.6%) in the category of medicine, miscellaneous. The Hirsch Index from KoMCI, Web of Science and Scopus were 5, 14, and 16, respectively. The KJIM is now cited more by international researchers than Korean researchers, indicating that the content of the journal is now valued at the international level.

  3. Remembering tips

    MedlinePlus

    Memory aids; Alzheimer disease - remembering tips; Early memory loss - remembering tips; Dementia - remembering tips ... harder for your brain to create a new memory, even while you can remember actions and events ...

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

    PubMed

    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.

  5. Medicine clerkships and portable computing: a national survey of internal medicine clerkship directors.

    PubMed

    Ferenchick, Gary; Solomon, David; Durning, Steven J

    2010-01-01

    Portable computers are widely used by medical trainees, but there is a lack of data on how these devices are used in clinical education programs. The objective is to define the current use of portable computing in internal medicine clerkships and to determine medicine clerkship directors' perceptions of the current value and future importance of portable computing. A 2006 national survey of institutional members of the Clerkship Directors in Internal Medicine. Eighty-three of 110 (75%) of institutional members responded. An institutional requirement for portable computing was reported by 32 schools (39%), whereas only 13 (16%) provided students with a portable computer. Between 10 and 31 institutions (12-37%) reported student use for patient care activities (i.e. order entry, writing patient notes) and only 2 to 4 institutions (2-5%) required such use. The majority of respondents (59-95%) reported portable computer use for educational activities (i.e., tracking patient problems, knowledge resource), however, only in 5 to 19 (6-23%) were such educational uses required. Fifty-six respondents (68%) reported that portable computer's "added value" for teaching and 61 (73%) reported that portable computers would be important in meeting clerkship objectives in the next 3 years. Of interest, even among the institutions requiring portable computers, only 50% recommended or required specific software. Portable computing is required at 39% of allopathic medical schools in the United States. However required portable computing for specific patient care or educational tasks is uncommon. In addition, guidance on specific software exists in only one half of school requiring portable computers, suggesting informal or unstructured uses of required portable computer's in the remaining half. The educational impact of formal institutional requirements for software versus informal "user-defined" applications is unknown.

  6. Associations of conference attendance with internal medicine in-training examination scores.

    PubMed

    McDonald, Furman S; Zeger, Scott L; Kolars, Joseph C

    2008-04-01

    To examine the association of medical knowledge acquisition with attendance at specific conference types during internal medicine residency. Attendance at residency core curriculum, morbidity and mortality, and medical grand rounds conferences was tracked for 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times while attending the Internal Medicine Residency Program at Mayo Clinic's site in Rochester, MN, between October 1, 1999, and October 1, 2003. Random effects modeling was used to adjust for variables known or hypothesized to be associated with IM-ITE scores and allowed discrimination of effects of individual conferences on IM-ITE scores. Total conference attendance was significantly associated with increased IM-ITE scores, with cohort mean increase of 2.30% (95% confidence interval [CI], 1.24% to 3.36%; P<.001). Core curriculum conferences accounted for much more of this association than either medical grand rounds or morbidity and mortality, with cohort mean increases of 2.05% (95% CI, 0.13% to 3.90%; P=.04), 0.24% (95% CI, -0.56% to 1.03%; P=.61), and 0.03% (95% CI, -1.69% to 1.69%; P=.97), respectively. Conference attendance is associated with improved knowledge acquisition as measured by improved performance on IM-ITE. This finding does not appear to apply to all conferences at our institution but rather is specifically attributable to attendance at the core curriculum series.

  7. A comparative study on cryopreservation of mint (Menth asp.) shoot tips

    USDA-ARS?s Scientific Manuscript database

    Mint is used in natural seasoning, traditional medicine, pharmaceuticals and cosmetics. In some countries it is grown on an industrial scale due to its economic importance; hence, preserving mint genetic resources is of value. We compared three cryopreservation techniques (T) using shoot tips of thr...

  8. How far has The Korean Journal of Internal Medicine advanced in terms of journal metrics?

    PubMed Central

    2013-01-01

    The Korean Journal of Internal Medicine has already been valued as an international journal, according to a citation analysis in 2011. Now, 2 years later, I would like to confirm how much the Journal has advanced from the point of view of journal metrics by looking at the impact factor, cites per document (2 years), SCImago Journal Rank (SJR), and the Hirsch index. These were obtained from a variety of databases, such as the Korean Medical Citation Index, KoreaMed Synapse, Web of Science, JCR Web, and SCImago Journal & Country Rank. The manually calculated 2012 impact factor was 1.252 in the Web of Science, with a ranking of 70/151 (46.4%) in the category of general and internal medicine. Cites per documents (2 years) for 2012 was 1.619, with a ranking of 267/1,588 (16.8%) in the category of medicine (miscellaneous). The 2012 SJR was 0.464, with a ranking of 348/1,588 (21.9%) in the category of medicine (miscellaneous). The Hirsch index from KoreaMed Synapse, Web of Science, and SCImago Journal & Country Rank were 12, 15, and 19, respectively. In comparison with data from 2010, the values of all the journal metrics increased consistently. These results reflect favorably on the increased competency of editors and authors of The Korean Journal of Internal Medicine. PMID:24307835

  9. How far has The Korean Journal of Internal Medicine advanced in terms of journal metrics?

    PubMed

    Huh, Sun

    2013-11-01

    The Korean Journal of Internal Medicine has already been valued as an international journal, according to a citation analysis in 2011. Now, 2 years later, I would like to confirm how much the Journal has advanced from the point of view of journal metrics by looking at the impact factor, cites per document (2 years), SCImago Journal Rank (SJR), and the Hirsch index. These were obtained from a variety of databases, such as the Korean Medical Citation Index, KoreaMed Synapse, Web of Science, JCR Web, and SCImago Journal & Country Rank. The manually calculated 2012 impact factor was 1.252 in the Web of Science, with a ranking of 70/151 (46.4%) in the category of general and internal medicine. Cites per documents (2 years) for 2012 was 1.619, with a ranking of 267/1,588 (16.8%) in the category of medicine (miscellaneous). The 2012 SJR was 0.464, with a ranking of 348/1,588 (21.9%) in the category of medicine (miscellaneous). The Hirsch index from KoreaMed Synapse, Web of Science, and SCImago Journal & Country Rank were 12, 15, and 19, respectively. In comparison with data from 2010, the values of all the journal metrics increased consistently. These results reflect favorably on the increased competency of editors and authors of The Korean Journal of Internal Medicine.

  10. Overspecialized and undertrained? Patient diversity encountered by medical students during their internal medicine clerkship at a university hospital.

    PubMed

    Melderis, Simon; Gutowski, Jan-Philipp; Harendza, Sigrid

    2015-03-31

    During the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care. Little is known about what constitutes their typical learning experiences with respect to patient diversity within the different subspecialties of internal medicine and during on call hours. 25 final year medical students (16 female, 9 male) on their internal medicine clerkship participated in this observational single-center study. To detail the patient diversity encountered by medical students at a university hospital during their 16-week internal medicine clerkship, all participants self-reported their patient contacts in the different subspecialties and during on call hours on patient encounter cards. Patients' chief complaint, suspected main diagnosis, planned diagnostic investigations, and therapy in seven different internal medicine subspecialties and the on call medicine service were documented. 496 PECs were analysed in total. The greatest diversity of chief complaints (CC) and suspected main diagnoses (SMD) was observed in patients encountered on call, with the combined frequencies of the three most common CCs or SMDs accounting for only 23% and 25%, respectively. Combined, the three most commonly encountered CC/SMD accounted for high percentages (82%/63%), i.e. less diversity, in oncology and low percentages (37%/32%), i.e. high diversity, in nephrology. The percentage of all diagnostic investigations and therapies that were classified as "basic" differed between the subspecialties from 82%/94% (on call) to 37%/50% (pulmonology/oncology). The only subspecialty with no significant difference compared with on call was nephrology for diagnostic investigations. With respect to therapy, nephrology and infectious diseases showed no significant differences compared with on call. Internal medicine clerkships at a university hospital provide students with a very limited patient diversity in most internal medicine

  11. Innovative Ideas for Coordinating International Space Activities: International Center for Space Medicine, International Space Authority, and other Global Youth Space Initiatives

    NASA Astrophysics Data System (ADS)

    Marshall, W.

    2002-01-01

    The Space Generation Forum SGF, at UNISPACE-III, as one of its ten formal recommendations to the United Nations in 1999, put forward the suggestion that the an international space authority should be created. Other recommendations were the establishment of an International Center for Space Medicine, creation of a global space exploration and development program, establishment of a global space (Nobel) prize, and a global space library. These projects are being further developed at the Space Generation Summit (SGS), an event at World Space Congress (WSC) which shall unite international students and young professionals to develop a youth vision and strategy for the peaceful uses of space. SGS, endorsed by the United Nations, will take place from October 11- 13th, during which the 200 delegates will discuss ongoing youth space activities, particularly those stemming from the UNISPACE-III/SGF and taken forward by the Space Generation Advisory Council. Delegates will address a variety of topics with the goal of devising new recommendations according to the theme, 'Accelerating Our Pace in Space'. The material presented here and in other technical sessions throughout WSC includes the findings of these discussions. In this paper, we present the International Space Authority idea together with recommendations on how that might be taken forward. The purpose of such an organization would be to allow: 1. Oversight and enforcement for the balanced regulation of multiple interests in space 2. Access for all peoples to the material benefits and knowledge and understanding enabled by the exploration and 3. Pooling of national and industry resources for the creation of space infrastructure, missions and enterprises for Operating principles: 1. The ISA regulatory regime would encourage commercialization and the harnessing of competitive market 2. Consistent with its charter to ensure access to all peoples, all UN member states and appropriate NGOs would 3. Close coordination with

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

    PubMed

    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.

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

    PubMed

    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 was<60 or Pfeiffer questionnaire ≥ 3 errors. 471 polypathological patients, 337 from internal 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%; p<.001) and locomotive ones (39.1% vs 20.4%; p<.001) in geriatrics inpatients. Charlson index was higher for internal 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); p<.001], and lower in Barthel [38.8(32.5) vs 61.2(34.3); p=.001] and Lawton-Brody indexes [0.9(1.6) vs 3.0(2.9); p<.001], and more frequently needed a caregiver (87.8% vs 53.6%; p<.001) and had it. There are differences in disease profile and functional and cognitive situation between polypathological patients of internal medicine and geriatrics departments. © 2013.

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

    PubMed

    Smith, Cynthia D; Levinson, Wendy S

    2015-05-05

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

  15. Lateral Tip Control Effects in CD-AFM Metrology: The Large Tip Limit.

    PubMed

    Dixson, Ronald G; Orji, Ndubuisi G; Goldband, Ryan S

    2016-01-25

    Sidewall sensing in critical dimension atomic force microscopes (CD-AFMs) usually involves continuous lateral dithering of the tip or the use of a control algorithm and fast response piezo actuator to position the tip in a manner that resembles touch-triggering of coordinate measuring machine (CMM) probes. All methods of tip position control, however, induce an effective tip width that may deviate from the actual geometrical tip width. Understanding the influence and dependence of the effective tip width on the dither settings and lateral stiffness of the tip can improve the measurement accuracy and uncertainty estimation for CD-AFM measurements. Since CD-AFM typically uses tips that range from 15 nm to 850 nm in geometrical width, the behavior of effective tip width throughout this range should be understood. The National Institute of Standards and Technology (NIST) has been investigating the dependence of effective tip width on the dither settings and lateral stiffness of the tip, as well as the possibility of material effects due to sample composition. For tip widths of 130 nm and lower, which also have lower lateral stiffness, the response of the effective tip width to lateral dither is greater than for larger tips. However, we have concluded that these effects will not generally result in a residual bias, provided that the tip calibration and sample measurement are performed under the same conditions. To validate that our prior conclusions about the dependence of effective tip width on lateral stiffness are valid for large CD-tips, we recently performed experiments using a very large non-CD tip with an etched plateau of approximately 2 μm width. The effective lateral stiffness of these tips is at least 20 times greater than typical CD-AFM tips, and these results supported our prior conclusions about the expected behavior for larger tips. The bottom-line importance of these latest observations is that we can now reasonably conclude that a dither slope of 3 nm

  16. Lateral Tip Control Effects in CD-AFM Metrology: The Large Tip Limit

    PubMed Central

    Dixson, Ronald G.; Orji, Ndubuisi G.; Goldband, Ryan S.

    2016-01-01

    Sidewall sensing in critical dimension atomic force microscopes (CD-AFMs) usually involves continuous lateral dithering of the tip or the use of a control algorithm and fast response piezo actuator to position the tip in a manner that resembles touch-triggering of coordinate measuring machine (CMM) probes. All methods of tip position control, however, induce an effective tip width that may deviate from the actual geometrical tip width. Understanding the influence and dependence of the effective tip width on the dither settings and lateral stiffness of the tip can improve the measurement accuracy and uncertainty estimation for CD-AFM measurements. Since CD-AFM typically uses tips that range from 15 nm to 850 nm in geometrical width, the behavior of effective tip width throughout this range should be understood. The National Institute of Standards and Technology (NIST) has been investigating the dependence of effective tip width on the dither settings and lateral stiffness of the tip, as well as the possibility of material effects due to sample composition. For tip widths of 130 nm and lower, which also have lower lateral stiffness, the response of the effective tip width to lateral dither is greater than for larger tips. However, we have concluded that these effects will not generally result in a residual bias, provided that the tip calibration and sample measurement are performed under the same conditions. To validate that our prior conclusions about the dependence of effective tip width on lateral stiffness are valid for large CD-tips, we recently performed experiments using a very large non-CD tip with an etched plateau of approximately 2 μm width. The effective lateral stiffness of these tips is at least 20 times greater than typical CD-AFM tips, and these results supported our prior conclusions about the expected behavior for larger tips. The bottom-line importance of these latest observations is that we can now reasonably conclude that a dither slope of 3 nm

  17. Second International Electronic Conference on Medicinal Chemistry (ECMC-2)

    PubMed Central

    Mayence, Annie; Vanden Eynde, Jean Jacques

    2017-01-01

    The second International Electronic Conference on Medicinal Chemistry, organized and sponsored by the publisher MDPI AG and the Journal Pharmaceuticals, took place in November 2016 on the SciForum website (www.sciforum.net/conference/ecmc-12). More than 150 authors from 22 countries participated in the event. Selected works presented during the scientific meeting are disclosed in this report. PMID:28146112

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

    PubMed

    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.

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

    PubMed

    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 < 0.001). This study suggests that most residents fall into

  20. Evaluation of an Online Program To Teach Microbiology to Internal Medicine Residents

    PubMed Central

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

    2014-01-01

    Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation. PMID:25392364

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

    PubMed

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

    2012-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    Bauer, J; Groneberg, D A

    2014-10-01

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

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

    PubMed Central

    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

  6. Twelve tips for the effective use of videos in medical education.

    PubMed

    Dong, Chaoyan; Goh, Poh Sun

    2015-02-01

    Videos can promote learning by either complementing classroom activities, or in self-paced online learning modules. Despite the wide availability of online videos in medicine, it can be a challenge for many educators to decide when videos should be used, how to best use videos, and whether to use existing videos or produce their own. We outline 12 tips based on a review of best practices in curriculum design, current research in multimedia learning and our experience in producing and using educational videos. The 12 tips review the advantages of using videos in medical education, present requirements for teachers and students, discuss how to integrate video into a teaching programme, and describe technical requirements when producing one's own videos. The 12 tips can help medical educators use videos more effectively to promote student engagement and learning.

  7. Screening for Cancer by Residents in an Internal Medicine Program.

    ERIC Educational Resources Information Center

    Lynch, Garrett R.; Prout, Marianne N.

    1986-01-01

    A study of cancer screening by internal medicine residents in an inner-city clinic revealed that screening was more frequent for male patients, and breast examinations and Pap smears were performed on less than a third of female patients, suggesting a need for more intensive early-detection education of residents. (MSE)

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

    PubMed

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

    2016-10-17

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

  9. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization.

    PubMed

    Zaccone, Vincenzo; Tosoni, Alberto; Passaro, Giovanna; Vallone, Carla Vincenza; Impagnatiello, Michele; Li Puma, Domenica Donatella; De Cosmo, Salvatore; Landolfi, Raffaele; Mirijello, Antonio

    2017-11-01

    Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.

  10. [History of the 4th Department of Internal Medicine of the First Faculty of Medicine at Charles University and the General University Hospital in Prague].

    PubMed

    Bartůněk, Petr

    In 2015, the doctors and nurses of the 4th Department of Internal Medicine of the First Faculty of Medicine, Charles University and the General University Hospital in Prague celebrated the 70th anniversary of its founding. The article summarizes the clinics contribution to the field of internal medicine, and particularly to angiology, hepatogastroenterology and lipidology. It comments the clinics current activities and the possibilities of its further development. Attention is also paid to the tradition of high ethical and professional standards of medical care in accordance with the norms established by the clinic's founder, prof. MUDr. Bohumil Prusík.

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

    PubMed

    Kanna, Balavenkatesh; Deng, Changchun; Erickson, Savil N; Valerio, Jose A; Dimitrov, Vihren; Soni, Anita

    2006-10-17

    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. 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". 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. 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.

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

    PubMed Central

    Kanna, Balavenkatesh; Deng, Changchun; Erickson, Savil N; Valerio, Jose A; Dimitrov, Vihren; Soni, Anita

    2006-01-01

    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. PMID:17044924

  13. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department

    PubMed Central

    Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

    2016-01-01

    Abstract Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine. The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department. A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management. The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine. The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to

  14. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.

    PubMed

    Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

    2016-01-01

    Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or

  15. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.

    PubMed

    West, Colin P; Shanafelt, Tait D; Kolars, Joseph C

    2011-09-07

    Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level. To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge. Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates. Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses. Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200,000 relative to no debt). Residents reporting QOL "as bad as it can be" and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL "as good as it can be" and no emotional exhaustion symptoms, respectively. Residents reporting debt greater than $200,000 had

  16. Sex Differences in Rank Attainment among Radiology and Internal Medicine Faculty.

    ERIC Educational Resources Information Center

    Dial, Thomas H.; And Others

    1989-01-01

    The Association of American Medical Colleges Faculty Roster System allows comparison of a cohort of faculty at any selected time following their first faculty appointments. Disparities between men and women in rank attained in radiology and internal medicine were examined. (Author/MLW)

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

    PubMed

    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 < 0.001. Admitting new patients, following their course and responding to emergencies were rated as important overnight tasks for both clerkship and sub-internship students. Overnight experiences offer students additional educational opportunities. Clerkship directors felt that the overnight experience for the sub-intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences

  18. Clinical Holistic Medicine: Chronic Pain in Internal Organs

    PubMed Central

    Ventegodt, Søren; Merrick, Joav

    2005-01-01

    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. PMID:15798880

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

    PubMed

    Kabelka, Ladislav

    2017-10-01

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

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

    PubMed

    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

  1. Influence of blade tip rounding on tip leakage vortex cavitation of axial flow pump

    NASA Astrophysics Data System (ADS)

    Wu, S. Q.; Shi, W. D.; Zhang, D. S.; Yao, J.; Cheng, C.

    2013-12-01

    Tip leakage flow in axial flow pumps is mainly caused by the tip clearance, which is the main cause of tip leakage vortex cavitation and blade tip cavitation erosion. In order to improve tip clearance flow and reduce TLV cavitation, four schemes were adopted to the round blade tip. These are: no tip rounding, one time tip clearance tip rounding, two times tip clearance tip rounding, four times tip clearance tip rounding. Using SST k-ω turbulence model and Zwart cavitation model in CFX software, this simulation obtained four kinds of inner flow field results. The numerical results indicated that with the increase of r*, NPSHc gradually increased and the cavitation performance reduced. However, corner vortex was eliminated so that cavitation in gap was restrained. But TLV vorticity increased and cavitation's range here had a little expansion. Combined with the research of this paper and the different analyses of four schemes, we recommend adopting the two times of the tip clearance rounding.

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

    PubMed

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

    2016-06-01

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

  3. Contraceptive Counseling by General Internal Medicine Faculty and Residents

    PubMed Central

    Shulman, Benjamin; Teal, Stephanie B.; Huebschmann, Amy G.

    2014-01-01

    Abstract Background: Almost half of US pregnancies are unintended, resulting in many abortions and unwanted or mistimed births. Contraceptive counseling is an effective tool to increase patients' use of contraception. Methods: Using an online 20-item questionnaire, we evaluated the frequency of contraceptive counseling provided to reproductive-age women during a prevention-focused visit by University of Colorado internal medicine resident and faculty providers. We also evaluated factors hypothesized to affect contraceptive counseling frequency. Results: Although more than 95% of the 146 medicine faculty and resident respondents agreed that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥80% of the time) to reproductive-age women during a prevention-focused visit. Providing contraceptive counseling routinely was strongly associated with taking an abbreviated sexual history “often”/“routinely” (odds ratio [OR]=11.6 [3.3 to 40.0]) and with high self-efficacy to provide contraceptive counseling (OR=6.5 [1.5 to 29.0]). However, fewer than two-thirds of providers reported taking an abbreviated sexual history “often”/“routinely.” More than 70% of providers reported inadequate knowledge of contraceptive methods as a contraceptive counseling barrier. However, providers' perceived inadequate knowledge was not associated with traditional educational exposures, such as lectures and women's health electives. Conclusions: In prevention-focused visits with reproductive-age women, a minority of internal medicine faculty and residents reported routine contraceptive counseling. Future efforts to increase contraceptive counseling among internists should include interventions that increase provider contraceptive counseling self-efficacy and ensure that providers obtain an abbreviated sexual history. PMID:24766414

  4. Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century

    PubMed Central

    Toohey, Shannon L.; Wray, Alisa; Wiechmann, Warren; Lin, Michelle; Boysen-Osborn, Megan

    2016-01-01

    Introduction Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program’s curriculum to accommodate the modern learner. Discussion These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. Conclusion While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices. PMID:27330668

  5. Ten Tips for Engaging the Millennial Learner and Moving an Emergency Medicine Residency Curriculum into the 21st Century.

    PubMed

    Toohey, Shannon L; Wray, Alisa; Wiechmann, Warren; Lin, Michelle; Boysen-Osborn, Megan

    2016-05-01

    Millennial learners are changing the face of residency education because they place emphasis on technology with new styles and means of learning. While research on the most effective way to teach the millennial learner is lacking, programs should consider incorporating educational theories and multimedia design principles to update the curriculum for these new learners. The purpose of the study is to discuss strategies for updating an emergency medicine (EM) residency program's curriculum to accommodate the modern learner. These 10 tips provide detailed examples and approaches to incorporate technology and learning theories into an EM curriculum to potentially enhance learning and engagement by residents. While it is unclear whether technologies actually promote or enhance learning, millennials use these technologies. Identifying best practice, grounded by theory and active learning principles, may help learners receive quality, high-yield education. Future studies will need to evaluate the efficacy of these techniques to fully delineate best practices.

  6. Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program.

    PubMed

    Kohlwes, R Jeffrey; Cornett, Patricia; Dandu, Madhavi; Julian, Katherine; Vidyarthi, Arpana; Minichiello, Tracy; Shunk, Rebecca; Jain, Sharad; Harleman, Elizabeth; Ranji, Sumant; Sharpe, Brad; O'Sullivan, Patricia; Hollander, Harry

    2011-12-01

    Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.

  7. [Evolution of internal medicine and its specialties in the last decades: an outward view].

    PubMed

    Rosselot, E

    1996-04-01

    The development of the subspecialties of internal medicine in the western world is reviewed from a historical perspective, focusing on the case of the United States of America. During the last decades, changes both in society and in medicine as a whole have prompted a great dispersion of medical practice styles, not always well-defined in their contents and goals, and ranging from primary care to ultra specialization. The definition of the general internist and of the subspecialist together with the attributes of each category according to an American College of Physicians task force group are commented upon. Some of the possible reasons accounting for a decreased interest in general internal medicine during the eighties together with figures supporting a recent reversal of this trend are given. New proposals have originated in government as well as in medical circles to promote the development of general internists, conceived as physicians knowledgeable in the classic subspecialties but also skilled in clinical epidemiology, informatics, behavior medicine, decision-making, clinical economics, ethics, and problem solving. The American College of Physicians, on the other hand, considers that allowing the community-based general internists to disappear, strengthening the generalist's identity as a primary care-oriented physician who provides no subspecially care, becoming hospital-based generalists who act mainly as consultants, or becoming fully trained subspecialists who also provide primary care, are all rejectable options. These arguments illustrate the fact that even in highly developed societies a degree of indefinition remains as to the best balance between general internal medicine and its subspecialties.

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    PubMed Central

    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% (p<0.001). All interns 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

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

    PubMed

    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.

  12. Selection Criteria for Internal Medicine Residency Applicants and Professionalism Ratings During Internship

    PubMed Central

    Cullen, Michael W.; Reed, Darcy A.; Halvorsen, Andrew J.; Wittich, Christopher M.; Kreuziger, Lisa M. Baumann; Keddis, Mira T.; McDonald, Furman S.; Beckman, Thomas J.

    2011-01-01

    OBJECTIVE: To determine whether standardized admissions data in residents' Electronic Residency Application Service (ERAS) submissions were associated with multisource assessments of professionalism during internship. PARTICIPANTS AND METHODS: ERAS applications for all internal medicine interns (N=191) at Mayo Clinic entering training between July 1, 2005, and July 1, 2008, were reviewed by 6 raters. Extracted data included United States Medical Licensing Examination scores, medicine clerkship grades, class rank, Alpha Omega Alpha membership, advanced degrees, awards, volunteer activities, research experiences, first author publications, career choice, and red flags in performance evaluations. Medical school reputation was quantified using U.S. News & World Report rankings. Strength of comparative statements in recommendation letters (0 = no comparative statement, 1 = equal to peers, 2 = top 20%, 3 = top 10% or “best”) were also recorded. Validated multisource professionalism scores (5-point scales) were obtained for each intern. Associations between application variables and professionalism scores were examined using linear regression. RESULTS: The mean ± SD (minimum-maximum) professionalism score was 4.09±0.31 (2.13-4.56). In multivariate analysis, professionalism scores were positively associated with mean strength of comparative statements in recommendation letters (β=0.13; P=.002). No other associations between ERAS application variables and professionalism scores were found. CONCLUSION: Comparative statements in recommendation letters for internal medicine residency applicants were associated with professionalism scores during internship. Other variables traditionally examined when selecting residents were not associated with professionalism. These findings suggest that faculty physicians' direct observations, as reflected in letters of recommendation, are useful indicators of what constitutes a best student. Residency selection committees should

  13. Selection criteria for internal medicine residency applicants and professionalism ratings during internship.

    PubMed

    Cullen, Michael W; Reed, Darcy A; Halvorsen, Andrew J; Wittich, Christopher M; Kreuziger, Lisa M Baumann; Keddis, Mira T; McDonald, Furman S; Beckman, Thomas J

    2011-03-01

    To determine whether standardized admissions data in residents' Electronic Residency Application Service (ERAS) submissions were associated with multisource assessments of professionalism during internship. ERAS applications for all internal medicine interns (N=191) at Mayo Clinic entering training between July 1, 2005, and July 1, 2008, were reviewed by 6 raters. Extracted data included United States Medical Licensing Examination scores, medicine clerkship grades, class rank, Alpha Omega Alpha membership, advanced degrees, awards, volunteer activities, research experiences, first author publications, career choice, and red flags in performance evaluations. Medical school reputation was quantified using U.S. News & World Report rankings. Strength of comparative statements in recommendation letters (0 = no comparative statement, 1 = equal to peers, 2 = top 20%, 3 = top 10% or "best") were also recorded. Validated multisource professionalism scores (5-point scales) were obtained for each intern. Associations between application variables and professionalism scores were examined using linear regression. The mean ± SD (minimum-maximum) professionalism score was 4.09 ± 0.31 (2.13-4.56). In multivariate analysis, professionalism scores were positively associated with mean strength of comparative statements in recommendation letters (β = 0.13; P = .002). No other associations between ERAS application variables and professionalism scores were found. Comparative statements in recommendation letters for internal medicine residency applicants were associated with professionalism scores during internship. Other variables traditionally examined when selecting residents were not associated with professionalism. These findings suggest that faculty physicians' direct observations, as reflected in letters of recommendation, are useful indicators of what constitutes a best student. Residency selection committees should scrutinize applicants' letters for strongly favorable

  14. 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.

    PubMed

    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.

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

    PubMed Central

    Mayence, Annie; Vanden Eynde, Jean Jacques

    2016-01-01

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

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

    PubMed Central

    Mayence, Annie

    2018-01-01

    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. PMID:29425181

  17. Comparison of Various Supersonic Turbine Tip Designs to Minimize Aerodynamic Loss and Tip Heating

    NASA Technical Reports Server (NTRS)

    Shyam, Vikram; Ameri, Ali

    2012-01-01

    The rotor tips of axial turbines experience high heat flux and are the cause of aerodynamic losses due to tip clearance flows, and in the case of supersonic tips, shocks. As stage loadings increase, the flow in the tip gap approaches and exceeds sonic conditions. This introduces effects such as shock-boundary layer interactions and choked flow that are not observed for subsonic tip flows that have been studied extensively in literature. This work simulates the tip clearance flow for a flat tip, a diverging tip gap and several contoured tips to assess the possibility of minimizing tip heat flux while maintaining a constant massflow from the pressure side to the suction side of the rotor, through the tip clearance. The Computational Fluid Dynamics (CFD) code GlennHT was used for the simulations. Due to the strong favorable pressure gradients the simulations assumed laminar conditions in the tip gap. The nominal tip gap width to height ratio for this study is 6.0. The Reynolds number of the flow is 2.4 x 10(exp 5) based on nominal tip width and exit velocity. A wavy wall design was found to reduce heat flux by 5 percent but suffered from an additional 6 percent in aerodynamic loss coefficient. Conventional tip recesses are found to perform far worse than a flat tip due to severe shock heating. Overall, the baseline flat tip was the second best performer. A diverging converging tip gap with a hole was found to be the best choice. Average tip heat flux was reduced by 37 percent and aerodynamic losses were cut by over 6 percent.

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

    PubMed

    Davidson, Chris; Higgens, Clare

    2009-04-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2013-01-01

    As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). The objective is to provide standard operating procedures for FOD. The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition. © 2012 International Society for Sexual Medicine.

  2. Women's Health Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation.

    PubMed

    Davisson, Laura; Nuss, Michelle; Cottrell, Scott

    2010-09-01

    Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program. After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial. The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7-16.6; P  =  .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, -0.7%; 95% CI: -12.1-10.7; P  =  .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues. A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.

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

    PubMed

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

    2016-12-01

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

  4. Probe tip heating assembly

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schmitz, Roger William; Oh, Yunje

    A heating assembly configured for use in mechanical testing at a scale of microns or less. The heating assembly includes a probe tip assembly configured for coupling with a transducer of the mechanical testing system. The probe tip assembly includes a probe tip heater system having a heating element, a probe tip coupled with the probe tip heater system, and a heater socket assembly. The heater socket assembly, in one example, includes a yoke and a heater interface that form a socket within the heater socket assembly. The probe tip heater system, coupled with the probe tip, is slidably receivedmore » and clamped within the socket.« less

  5. Current situation of International Organization for Standardization/Technical Committee 249 international standards of traditional Chinese medicine.

    PubMed

    Liu, Yu-Qi; Wang, Yue-Xi; Shi, Nan-Nan; Han, Xue-Jie; Lu, Ai-Ping

    2017-05-01

    To review the current situation and progress of traditional Chinese medicine (TCM) international standards, standard projects and proposals in International Organization for Standardization (ISO)/ technical committee (TC) 249. ISO/TC 249 standards and standard projects on the ISO website were searched and new standard proposals information were collected from ISO/TC 249 National Mirror Committee in China. Then all the available data were summarized in 5 closely related items, including proposed time, proposed country, assigned working group (WG), current stage and classifification. In ISO/TC 249, there were 2 international standards, 18 standard projects and 24 new standard proposals proposed in 2014. These 44 standard subjects increased year by year since 2011. Twenty-nine of them were proposed by China, 15 were assigned to WG 4, 36 were in preliminary and preparatory stage and 8 were categorized into 4 fifields, 7 groups and sub-groups based on International Classifification Standards. A rapid and steady development of international standardization in TCM can be observed in ISO/TC 249.

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

    PubMed

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

    2013-01-08

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

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

    PubMed Central

    2013-01-01

    Translational science consists of research and development that integrates multiple resources to expedite the successful treatment of disease. The International Park of Translational BioMedicine (IPTBM) is currently being developed within the interface between Zhejiang Province and Shanghai Municipality. IPTBM has been designed to pioneer comprehensive biomedical research that spans the continuum from the education of young scientists to providing the infrastructure necessary for clinical testing and direct observation to better understand human biology while promoting viable commercial results within a vibrant biotechnology community. IPTBM’s goal is to attract global partners organized around five fundamental pillars: 1) Institutional Development, 2) Project Implementation, 3) Development and Production, 4) Investment and 5) Regulatory Clusters to address the needs of an international platform of scientists, institutes, universities, commercial enterprises, investors, politicians, and other stakeholders. The IPTBM differs from existing models including CTSA’s (US, NIH) technology because of its comprehensive approach to merge education, research, innovation, and development to translate clinical and public health needs into target-oriented and cost-efficient projects. PMID:23298286

  8. Internal medicine residents' clinical and didactic experiences after work hour regulation: a survey of chief residents.

    PubMed

    Horwitz, Leora I; Krumholz, Harlan M; Huot, Stephen J; Green, Michael L

    2006-09-01

    Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. Cross-sectional mail survey. Chief residents at all accredited U.S. internal medicine residency programs outside New York. The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long call (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4, P = .12), but 56% of programs reported a decrease in intern attendance at educational activities. In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change; however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time.

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

    PubMed

    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

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  13. Twelve tips for using social media as a medical educator.

    PubMed

    Kind, Terry; Patel, Pradip D; Lie, Désirée; Chretien, Katherine C

    2014-04-01

    We now live, learn, teach and practice medicine in the digital era. Social networking sites are used by at least half of all adults. Engagement with social media can be personal, professional, or both, for health-related and educational purposes. Use is often public. Lapses in professionalism can have devastating consequences, but when used well social media can enhance the lives of and learning by health professionals and trainees, ultimately for public good. Both risks and opportunities abound for individuals who participate, and health professionals need tips to enhance use and avoid pitfalls in their use of social media and to uphold their professional values. This article draws upon current evidence, policies, and the authors' experiences to present best practice tips for health professions educators, trainees, and students to build a framework for navigating the digital world in a way that maintains and promotes professionalism. These practical tips help the newcomer to social media get started by identifying goals, establishing comfort, and connecting. Furthermore, users can ultimately successfully contribute, engage, learn, and teach, and model professional behaviors while navigating social media.

  14. [International family medicine certification exam in Venezuela: the physician's experience].

    PubMed

    Ledesma-Solaeche, Flor Maria; Romero, Nerio Enrique; Atencio, Carlos Miguel; Pineda, Francisco; Fernández, Miguel Angel

    2006-01-01

    To present opinions of physicians participating in a pilot certification exam in the specialty of Family Medicine implemented in Venezuela, in December 2004, by the Mexican Board of Certification of Family Medicine A.C. Descriptive, transversal. Participant physicians (n:37) completed semi-structured questionnaries: one or two weeks before the exam, and immediately after it. 60% of participants were 41-50 years old and 80% women. All of them were practicing physicians; 49% had 5-10 year experience in family medicine. Main motivation to participate in the exam: the need for continuing learning (83%). Results showed their participation motivated continuing education (46%). Books were the most frequently utilized resource when preparing for the exam (54%). 94% were willing to take the exam again in the future, and all would recommend it to their colleagues. 49% said that examination should be taken every 3-4 years and should be voluntary (54%). 86% considered the content of the exam pertinent to their practice while 54% mentioned it was well adapted to their country's reality. Time for the exam was enough according to 71%, and number of questions was considered excessive by 89%. After the exam, 43% estimated to have personal prognosis for excellent or good outcomes. CONCLUSIONS. The international examination was satisfactory, stimulated desires of update, and the participants would repeat and recommend it in the future. The Mexican experience offers an example to put into practice, and the international collaboration would be a valid option to extend the certification processes in Latin America.

  15. Comparison of International Regulations for Written Medicine Information (WMI) on Prescription Medicines.

    PubMed

    Yuan, Hsiu-Chun Tony; Raynor, David K; Aslani, Parisa

    2018-01-01

    This paper presents a review of the literature, including government legislations, policies, guidelines, and recommendations available in the European Union, the United States of America, and Australia pertaining to the availability, development, and distribution of written medicine information (WMI) for prescription medicines. The online databases searched were Embase, International Pharmaceutical Abstracts, Medline, and PubMed, together with Google as the Internet search engine. The design and content of WMI documents have similarities and differences across all the 3 geographical regions. All the 3 regions have legislations in place to evaluate and regulate WMI documents for health care professionals (HCPs) and, to some degree, for patients; however, the degree of regulation varies between the 3 regions. The regulations around the content and information design of WMI impacts how well the WMI performs and consequently influences patients' knowledge and medication-taking behavior. Legislation in certain areas could be seen as more beneficial and can be implemented across the 3 regions. Furthermore, the required legislation on the evaluation of the content of WMIs can be seen in some areas to be more stringent and comprehensive, which when taken onboard across the 3 regions can be valuable when creating WMIs for both patients and HCPs.

  16. A Comprehensive Framework for International Medical Programs: A 2017 consensus statement from the American College of Academic International Medicine

    PubMed Central

    Garg, Manish; Peck, Gregory L.; Arquilla, Bonnie; Miller, Andrew C.; Soghoian, Sari E.; Anderson III, Harry L.; Bloem, Christina; Firstenberg, Michael S.; Galwankar, Sagar C.; Guo, Weidun Alan; Izurieta, Ricardo; Krebs, Elizabeth; Hansoti, Bhakti; Nanda, Sudip; Nwachuku, Chinenye O.; Nwomeh, Benedict; Paladino, Lorenzo; Papadimos, Thomas J.; Sharpe, Richard P.; Swaroop, Mamta; Stawicki, Stanislaw P.

    2017-01-01

    The American College of Academic International Medicine (ACAIM) represents a group of clinicians who seek to promote clinical, educational, and scientific collaboration in the area of Academic International Medicine (AIM) to address health care disparities and improve patient care and outcomes globally. Significant health care delivery and quality gaps persist between high-income countries (HICs) and low-and-middle-income countries (LMICs). International Medical Programs (IMPs) are an important mechanism for addressing these inequalities. IMPs are international partnerships that primarily use education and training-based interventions to build sustainable clinical capacity. Within this overall context, a comprehensive framework for IMPs (CFIMPs) is needed to assist HICs and LMICs navigate the development of IMPs. The aim of this consensus statement is to highlight best practices and engage the global community in ACAIM's mission. Through this work, we highlight key aspects of IMPs including: (1) the structure; (2) core principles for successful and ethical development; (3) information technology; (4) medical education and training; (5) research and scientific investigation; and (6) program durability. The ultimate goal of current initiatives is to create a foundation upon which ACAIM and other organizations can begin to formalize a truly global network of clinical education/training and care delivery sites, with long-term sustainability as the primary pillar of international inter-institutional collaborations. PMID:29291171

  17. [Observational study of patients admitted to an Internal Medicine service].

    PubMed

    Delgado Morales, J L; Alonso del Busto, R; Pascual Calleja, I; Villacorta Martín, M M; Ergueta Martín, P; González Sarmiento, E

    2004-01-01

    To analyse the entered more frequent disease in an Internal Medicine Department, the reasons for hospital admission diagnosis at discharge (according to entrance symptom's guide), the group of affected population and its correlation among them. Over a total of 758 internal medicine admissions of the University Hospital of Valladolid during the year 1999 based on the information of discharge and clinical histories, a descriptive and observational epidemic study was made using the variables of sex, age, reason for admission (guide symptom) and diagnosis at discharge. The obtained results were represented by mean of diagrams of sectors and bars according to the analyzed variables. The data synthesis was made by measures of central tendency and dispersion. SPSS 10.0 version for windows program was used for the statistical study. The non parametric analysis for independent samples was made by the test of median and the U of Mann Whitney, and the parametric by chi-squired test and resistance of Kolmogorov-Smirnov. The median of age is 70 years. Rank 84 years. Interquartile rank 23, fashion in men 75 years and in women 86. The distribution in sex men 51%, women 49%. The more frequent reasons for entrance are dyspnea (35%) and neurological focus (11%). The more frequent diagnosis at discharge are dyspnea and chronic obstructive lung disease worsened by respiratory infection (11%), pneumonia (8%) and acute ischemic stroke (7%). In-patients in this service, are advanced in years (mainly women) (alpha = 0.05). The age does not get a normal distribution (alpha = 0.05). The frequency of the distribution in sex is similar. The most frequent reason for admission is dyspnea (35%). The most frequent diagnoses at discharge are chronic obstructive lung disease (11%), pneumonia (8%) and acute ischemic stroke (7%). The primary and secondary prevention and an improvement of the therapeutic measures of chronic cardiopulmonary disease would reduce significantly the welfare pressure in

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

    PubMed

    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. Internal Medicine House Officers' Performance as Assessed by Experts and Standardized Patients.

    ERIC Educational Resources Information Center

    Calhoun, Judith G.; And Others

    1987-01-01

    Three chronically ill patients were trained to evaluate the performance of 31 second-year internal medicine house officers based upon: a checklist for the medical data elicited during the medical interview; the process of the interview; and the physical examination technique. (Author/MLW)

  20. The 52nd International Conference on Medicinal Chemistry (RICT 2016) of the French Medicinal Chemistry Society (SCT) Held in Caen (Normandy).

    PubMed

    Sapi, Janos; Van Hijfte, Luc; Dallemagne, Patrick

    2017-06-21

    Outstanding Medchem in France: Guest editors Janos Sapi, Luc Van Hjfte, and Patrick Dallemagne look back at the 52 nd International Conference on Medicinal Chemistry (RICT 2016) held in Caen, France. They discuss the history of the French Medicinal Chemistry Society (Société de Chimie Thérapeutique, SCT) and provide highlights of last year's events, including some key presentations now collected in this Special Issue. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

    PubMed Central

    2010-01-01

    Background Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge. Discussion We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula. Summary Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues. PMID:20230607

  2. 78 FR 24313 - Proposed Collection; Comment Request for Tip Reporting Alternative Commitment Agreement (TRAC...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-24

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service Proposed Collection; Comment Request for Tip... Industry and The Cosmetology and Barber Industry AGENCY: Internal Revenue Service (IRS), Treasury. ACTION.... ADDRESSES: Direct all written comments to Yvette Lawrence, Internal Revenue Service, room 6129, 1111...

  3. Impact of a competency based curriculum on quality improvement among internal medicine residents.

    PubMed

    Fok, Mark C; Wong, Roger Y

    2014-11-28

    Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency

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

    PubMed

    Haring, Catharina M; Cools, Bernadette M; van der Meer, Jos Wm; Postma, Cornelis T

    2014-04-08

    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. 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. 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 <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001). In conclusion, performance of the general physical examination was already below expectation at the end of the internal

  5. Internal Medicine Residents' Perceived Responsibility for Patients at Hospital Discharge: A National Survey.

    PubMed

    Young, Eric; Stickrath, Chad; McNulty, Monica C; Calderon, Aaron J; Chapman, Elizabeth; Gonzalo, Jed D; Kuperman, Ethan F; Lopez, Max; Smith, Christopher J; Sweigart, Joseph R; Theobald, Cecelia N; Burke, Robert E

    2016-12-01

    Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was

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

    PubMed Central

    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 <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001). Conclusions In conclusion, performance of the general physical examination was already below

  7. What do students actually do on an internal medicine clerkship? A log diary study.

    PubMed

    Murray, E; Alderman, P; Coppola, W; Grol, R; Bouhuijs, P; van der Vleuten, C

    2001-12-01

    There are limited data on the amount of time students spend on teaching and learning while on internal medicine clerkships, and existing data suggest a wide international variation. Community-based teaching of internal medicine is now widespread; but its strengths and weaknesses compared to traditional hospital based teaching are still unclear. To determine the proportion of time students spend on different activities on an internal medicine clerkship, and to determine whether this differs in general practice and in hospital. In addition we aimed to determine students' views on the educational value and enjoyment of various activities. Prospective completion of log diaries recording student activities. Each student was asked to complete the diary for two separate weeks of their internal medicine clerkship: one week of general practice-based teaching and one week of hospital-based teaching. The response rate was 68% (88/130). Students spent approximately 5.5 h per day on teaching and learning activities in both environments, with more time (50 min vs. 30 min, P = 0.007) on unsupervised interaction with patients in hospital than in general practice, and more time (53 min vs. 21 min, P < 0.001) undergoingassessment in general practice than in hospital. Standard deviations were wide, demonstrating the heterogeneous nature of the data. Students perceived supervised interaction with patients and teaching by doctors as the most educational activities in both environments, but found it even more educationally valuable and enjoyable in general practice than in hospital (mean score for educational value: 4.27 in general practice, 3.88 in hospital, P = 0.048; mean score for enjoyment 4.13 in general practice, 3.66 in hospital, P = 0.03). Students greatly value interactions with patients, perceiving these as both educational and enjoyable. Curriculum planners must continue to place patient-based learning at the centre of undergraduate medical education. The heterogeneity of

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

    PubMed

    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 <0.0005 for all), and had a greater range of scores. Negative comments on medical knowledge were associated with lower in-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

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

    PubMed

    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. Twelve tips for integrating leadership development into undergraduate medical education.

    PubMed

    Till, Alex; McKimm, Judy; Swanwick, Tim

    2017-10-26

    Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

  11. Tipping news in information accumulation system

    NASA Astrophysics Data System (ADS)

    Shin, J. K.

    2010-05-01

    As a continuous opinion dynamics model, the information accumulation system (IAS) includes three basic mechanisms of the news, the inheritance and the diffusion as contributing to the information accumulation process of a system. A system is composed of agents who diffuse information through internal interaction, while each of them has incomplete memory or inheritance rate. The news comes from external sources of information, such as mass media. Previously the model IAS was studied only for the small news problems. In this study, a tipping news problem is considered. A key question of the problem is: what is the minimum strength of advertisement that can tip the minority opinion to a majority one? Dynamics of the IAS is briefly revisited with a special interest on nonlinear behavior of the model. In particular, it is shown that a discrete map of the IAS for a single color problem can be transformed into a logistic map, from which the dynamics of the IAS can be better understood. To show the applicability of the IAS model, the result is applied to explain the concept of the critical population size, which claims that there is a minimum population size for a social knowledge system to be continuously inherited without being lost. And critical size of the tipping news is found analytically in terms of IAS parameters. Some of the key results from the present study are compared in detail with the results from the Brownian particle model, which is believed to be the most similar model to the IAS. The concept of tipping news is used to show that a traditional society can tip at an exceptionally low inter-community exposure. Finally, the result was applied to the language competition problem.

  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.

    PubMed

    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. Low Velocity Impacts of Variable Tip Radius on Carbon/Epoxy Plates

    NASA Astrophysics Data System (ADS)

    Delaney, Mac P.

    With a growing use of composite materials in aircraft structures, there is a greater need to understand the response of these materials to low velocity impacts. Low velocity impacts from tool drops or ground equipment collisions can be of varying bluntness and can leave little or no visible evidence of damage. Therefore, a need exists to investigate the initiation of internal damage and the relationship between this internal damage and the external visible damage with respect to the bluntness of the impactor. A pendulum impactor was used to impact 76.2 x 127 mm carbon/epoxy panels that were 8, 16, and 24 plies thick. The panels were impacted by hardened steel tips with radii of 12.7 to 76.2 mm. The experimental results show that the failure threshold energies for each panel thickness and tip radius combination occur at a distinct and consistent energy. This threshold increases with impactor bluntness, and this effect is greater for the 8 ply panel than it is for the 16 or 24 ply panels. To describe the visibility of impact damage, the area of delamination was compared to the depth of the dents resulting from the impacts. For the sharper impact tips, there is a clear relationship between the delamination area and the depth of the dents. However, these relationships are dependent on the radius of the impact tip, and for the blunter impact tips no strong correlation could be determined between the delamination area and the depth of the dents.

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

    PubMed

    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.

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

    PubMed Central

    Shappell, Eric; Ahn, James

    2017-01-01

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

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

    PubMed

    Shappell, Eric; Ahn, James

    2017-01-01

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

  17. Dissemination, analysis, and implementation of the World Report on Disability: the roadmap of the International Society for Physical and Rehabilitation Medicine.

    PubMed

    Gutenbrunner, Christoph; Bethge, Matthias; Stucki, Gerold; Li, Jianan; Lains, Jorge; Olver, John; Frontera, Walter; von Groote, Per; Giustini, Alessandro; Imamura, Marta

    2014-01-01

    The International Society for Physical and Rehabilitation Medicine has recognized the World Report on Disability as a guide for its future activities and endorsed its responsibility to disseminate, to analyze, and to implement the report's recommendations. The activities of the International Society for Physical and Rehabilitation Medicine on the global stage are embedded in a strategy that includes national and regional associations. This article reports on recent and forthcoming activities of the International Society for Physical and Rehabilitation Medicine regarding the World Report on Disability and identifies five major challenges that will impact future International Society for Physical and Rehabilitation Medicine activities. These challenges relate to (1) education and training, (2) the support of strong role models, (3) disaster management, (4) the development of innovative rehabilitation services, and (5) rehabilitation research.

  18. Canada's Patented Medicine Notice of Compliance regulations: balancing the scales or tipping them?

    PubMed Central

    2011-01-01

    Background In order to comply with the provisions of the North American Free Trade Agreement, in 1993 the Canadian federal government introduced the Patented Medicine Notice of Compliance Linkage Regulations. These regulations were meant to achieve a balance between the timely entry of generic medicines and the rights of patent holders. The regulations tied the regulatory approval of generic medicines to the patent status of the original brand-name product. Discussion Since their introduction the regulations have been a source of contention between the generic and the brand-name industry. While the regulations have generated a considerable amount of work for the Federal Court of Canada both sides dispute the interpretation of the "win rate" in the court cases. Similarly, there is no agreement on whether multiple patents on single drugs represent a legitimate activity by the brand-name industry or an "evergreening" tactic. The generic industry's position is that the regulations are being abused leading to the delay in the introduction of lower cost generic products by as much as 8 years. The brand-name companies counter that the regulations are necessary because injunctions against the introduction of generic products are frequently unavailable to them. The regulations were amended in 2006 and again in 2008 but both sides continue to claim that the regulations favour the other party. The battle around the regulations also has an international dimension with interventions by PhRMA, the trade association representing the United States based multinational companies, arguing that the regulations are not stringent enough and that Canada needs to be placed on the U.S. Priority Watch List of countries. Finally, there are multiple costs to Canadian society as a result of the NOC regulations. Summary Despite the rhetoric there has been almost no empiric academic research done into the effect of the regulations. In order to develop rational policy in this area a number of key

  19. A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions.

    PubMed

    Fabbian, Fabio; De Giorgi, Alfredo; Maietti, Elisa; Gallerani, Massimo; Pala, Marco; Cappadona, Rosaria; Manfredini, Roberto; Fedeli, Ugo

    2017-05-01

    In-hospital mortality (IHM) is an indicator of the quality of care provided. The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson Comorbidity indexes. Our aim was to obtain new measures based on internal medicine ICD codes for the original EI, to detect risk for IHM. This single-center retrospective study included hospital admissions for any cause in the department of internal medicine between January 1, 2000, and December 31, 2013, recorded in the hospital database. The EI was calculated for evaluation of comorbidity, then we added age, gender and diagnosis of ischemic heart disease. IHM was our outcome. Only predictors positively associated with IHM were taken into consideration and the Sullivan's method was applied in order to modify the parameter estimates of the regression model into an index. We analyzed 75,586 admissions (53.4% females) and mean age was 72.7±16.3years. IHM was 7.9% and mean score was 12.1±7.6. The points assigned to each condition ranged from 0 to 16, and the possible range of the score varied between 0 and 89. In our population the score ranged from 0 to 54, and it was higher in the deceased group. Receiver operating characteristic curve of the new score was 0.721 (95% CI 0.714-0.727, p<0.001). In order to make prognostic assessment, the use of a score could be of help in targeting interventions in older adults, identifying subjects at high risk for IHM. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  20. Resource Manual for Alcohol and Other Drug Abuse Education in Internal Medicine.

    ERIC Educational Resources Information Center

    Bigby, JudyAnn, Ed.; England, Susan, Ed.

    The resource manual provides guidelines and resources for individuals interested in integrating a substance abuse curriculum into existing programs for medical students and residents in internal medicine. Materials and resources appropriate for practicing physicians are also included. Three sections are: (1) a statement of minimum knowledge and…

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

    PubMed

    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.

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

    PubMed

    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.

  3. Arctic climate tipping points.

    PubMed

    Lenton, Timothy M

    2012-02-01

    There is widespread concern that anthropogenic global warming will trigger Arctic climate tipping points. The Arctic has a long history of natural, abrupt climate changes, which together with current observations and model projections, can help us to identify which parts of the Arctic climate system might pass future tipping points. Here the climate tipping points are defined, noting that not all of them involve bifurcations leading to irreversible change. Past abrupt climate changes in the Arctic are briefly reviewed. Then, the current behaviour of a range of Arctic systems is summarised. Looking ahead, a range of potential tipping phenomena are described. This leads to a revised and expanded list of potential Arctic climate tipping elements, whose likelihood is assessed, in terms of how much warming will be required to tip them. Finally, the available responses are considered, especially the prospects for avoiding Arctic climate tipping points.

  4. [Over projected tip].

    PubMed

    Duron, J-B; Nguyen, P S; Levet, Y; Bardot, J; Aiach, G

    2014-12-01

    Overprojected tip is a pretty usual request not easy to manage. Preop analysis is crucial in order to evaluate tip support and skin thickness and ability to retract. For example, if the skin is very thick and has poor chance to retract, the surgeon should be very careful in the tip projection decreasing to avoid a skin pollybeak deformity. In such cases, he has to analyze the facial proportions, especially other areas projection (radix, dorsum and chin) and think about augmenting them to balance the profile rather than decreasing tip projection. Correction should always be conducted incrementally, starting with weakening the tip support mechanisms and, only if necessary, continue with alar cartilage interruption. This can be performed on many areas (lateral cruras, domes, medial cruras) and with several techniques (resection or interruption+overlapping). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Crack tip fracture toughness of base glasses for dental restoration glass-ceramics using crack opening displacements.

    PubMed

    Deubener, J; Höland, M; Höland, W; Janakiraman, N; Rheinberger, V M

    2011-10-01

    The critical stress intensity factor, also known as the crack tip toughness K(tip), was determined for three base glasses, which are used in the manufacture of glass-ceramics. The glasses included the base glass for a lithium disilicate glass-ceramic, the base glass for a fluoroapatite glass-ceramic and the base glass for a leucite glass-ceramic. These glass-ceramic are extensively used in the form of biomaterials in restorative dental medicine. The crack tip toughness was established by using crack opening displacement profiles under experimental conditions. The crack was produced by Vickers indentation. The crack tip toughness parameters determined for the three glass-ceramics differed quite significantly. The crack tip parameters of the lithium disilicate base glass and the leucite base glass were higher than that of the fluoroapatite base glass. This last material showed glass-in-glass phase separation. The discussion of the results clearly shows that the droplet glass phase is softer than the glass matrix. Therefore, the authors conclude that a direct relationship exists between the chemical nature of the glasses and the crack tip parameter. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Influence of tip end-plate on noise of small axial fan

    NASA Astrophysics Data System (ADS)

    Mao, Hongya; Wang, Yanping; Lin, Peifeng; Jin, Yingzi; Setoguchi, Toshiaki; Kim, Heuy Dong

    2017-02-01

    In this work, tip end-plate is used to improve the noise performance of small axial fans. Both numerical simulations and experimental methods were adopted to study the fluid flow and noise level of axial fans. Four modified models and the prototype are simulated. Influences of tip end-plate on static characteristics, internal flow field and noise of small axial fans are analyzed. The results show that on basis of the prototype, the model with the tip end-plate of 2 mm width and changed length achieved best noise performance. The overall sound pressure level of the model with the tip end-plate of 2 mm width and changed length is 2.4 dB less than that of the prototype at the monitoring point in specified far field. It is found that the mechanism of noise reduction is due to the decrease of vorticity variation on the surface of blades caused by the tip end-plate. Compared with the prototype, the static pressure of the model with the tip end-plate of 2 mm width and changed length at design flow rate decreases by 2 Pa and the efficiency decreases by 0.8%. It is concluded that the method of adding tip end-plate to impeller blades has a positive influence on reducing noise, but it may diminish the static characteristics of small axial fan to some extent.

  7. Inpatient glycemic management in internal medicine: an observational multicenter study in Nanjing, China.

    PubMed

    Hao, Shujie; Zhang, Ning; Fish, Anne Folta; Yuan, Xiaodan; Liu, Lin; Li, Fan; Fang, Zhaohui; Lou, Qingqing

    2017-08-01

    To evaluate the prevalence of hyperglycemia among inpatients in internal medicine, and specifically, to assess the glycemic management of inpatients in non-endocrinology departments in three large urban hospitals in China. A multicenter observational study was conducted using electronic health records, and a survey of 1939 patients who were admitted to internal medicine units and followed until discharge. Those with previously diagnosed diabetes, newly diagnosed diabetes, or impaired fasting glucose were included. Aspects of glycemic management examined were (a) hyperglycemia, (b) endocrinology consultation for hyperglycemia and (c) hypoglycemia. The prevalence of hyperglycemia in internal medicine was 45.7% (886 out of 1939). A total of 741 (83.6%) patients were treated by non-endocrinology departments; of those, 230 (31.1%) were in poor glycemic control and needed an endocrinology consultation. Yet only 57 (24.8%) received one. In 4 cases, the physician did not follow the consultants' advice. Among the remaining 53 consulted patients, 35 (66.1%) were still in poor glycemic control, yet only about half received a second consultation. Finally, among patients treated in non-endocrinology departments, 58 (7.8%) had hypoglycemia; less than half retested their blood glucose after treatment. The majority of patients with hyperglycemia were in non-endocrinology departments. Their glycemic management was poor; the endocrinology consultation rate was low and the result was suboptimal. Also, the management of hypoglycemia was not ideal. Therefore, improving glycemic management is urgently needed in Chinese hospitals.

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed Central

    Lugtenberg, Marjolein; Heiligers, Phil JM; de Jong, Judith D; Hingstman, Lammert

    2006-01-01

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

  10. The tipping point: A mathematical model for the profit-driven abandonment of restaurant tipping.

    PubMed

    Clifton, Sara M; Herbers, Eileen; Chen, Jack; Abrams, Daniel M

    2018-02-01

    The custom of voluntarily tipping for services rendered has gone in and out of fashion in America since its introduction in the 19th century. Restaurant owners that ban tipping in their establishments often claim that social justice drives their decisions, but we show that rational profit-maximization may also justify the decisions. Here, we propose a conceptual model of restaurant competition for staff and customers, and we show that there exists a critical conventional tip rate at which restaurant owners should eliminate tipping to maximize profits. Because the conventional tip rate has been increasing steadily for the last several decades, our model suggests that restaurant owners may abandon tipping en masse when that critical tip rate is reached.

  11. The tipping point: A mathematical model for the profit-driven abandonment of restaurant tipping

    NASA Astrophysics Data System (ADS)

    Clifton, Sara M.; Herbers, Eileen; Chen, Jack; Abrams, Daniel M.

    2018-02-01

    The custom of voluntarily tipping for services rendered has gone in and out of fashion in America since its introduction in the 19th century. Restaurant owners that ban tipping in their establishments often claim that social justice drives their decisions, but we show that rational profit-maximization may also justify the decisions. Here, we propose a conceptual model of restaurant competition for staff and customers, and we show that there exists a critical conventional tip rate at which restaurant owners should eliminate tipping to maximize profits. Because the conventional tip rate has been increasing steadily for the last several decades, our model suggests that restaurant owners may abandon tipping en masse when that critical tip rate is reached.

  12. One hundred years since the birth of academician Dimitar Arsov, founder and nestor of the modern internal medicine in the Republic of Macedonia.

    PubMed

    Polenaković, M

    2013-01-01

    Dimitar Arsov was born in Kriva Palanka on September 28, 1908 and died on July 2, 1974 in Skopje; he had finished elementary education in Kriva Palanka, high school (1922-1926) in Kumanovo, Macedonia and Col-lege of Medicine (1926-1932), Ph. D. University of Paris, Sorbone, France, 1936. He returned to Macedonia in 1937. In 1947 he was elected and Assistant Professor and in 1950 a Docent at the Faculty of Medicine in Skopje. He was appointed Director of the Clinic of Medicine and Head of the Chair of Internal Medicine, who served at those positions in the period 1952-74. In 1958 he was elected Professor of Internal Medicine. The first habilitation of the Medical Faculty in Skopje was defended by D. Arsov in 1954, titled: "The Effects of the Intravenous Epinephrine on the Hypersplenism of Malaria and Cala-Azar". On August 18, 1967, D. Arsov was elected Full Member and also the first member in the field of medicine of the Macedonian Academy of Sciences and Arts. The excellent experience in the work with the patients, precise observation of the symptoms and syndromes of the diseases in each patient, knowing the most advanced therapy at that time enabled D. Arsov to make conclusion for possibility of new therapy and gave him the material for writing scientific papers. In the first half of the 50s, during his regular work, Arsov discovers a new, internationally recognized therapy for rheumatism. Patients of both Cala-Azar and inflammatory rheumatism were treated with small doses of adrenaline therapy and they felt drastic decrease in rheumatism inflammation within one week. This therapy was used a couple of years in several countries around the world. He participated in the undergraduate and graduate studies. He contributed to the development of 2,240 graduated doctors and under his management over 300 doctors specialized in internal medicine and became specialists internists. Under his management, numerous habilitations and dissertations in internal medicine were

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

    PubMed Central

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

    2006-01-01

    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 < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. 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

  14. [Scientific production in clinical medicine and international collaboration networks in South American countries].

    PubMed

    Huamaní, Charles; González A, Gregorio; Curioso, Walter H; Pacheco-Romero, José

    2012-04-01

    International collaboration is increasingly used in biomedical research. To describe the characteristics of scientific production in Latin America and the main international collaboration networks for the period 2000 to 2009. Search for papers generated in Latin American countries in the Clinical Medicine database of ISI Web of Knowledge v.4.10 - Current Contents Connect. The country of origin of the corresponding author was considered the producing country of the paper. International collaboration was analyzed calculating the number of countries that contributed to the generation of a particular paper. Collaboration networks were graphed to determine the centrality of each network. Twelve Latin American countries participated in the production of 253,362 papers. The corresponding author was South American in 79% of these papers. Sixteen percent of papers were on clinical medicine and 36% of these were carried out in collaboration. Brazil had the highest production (22,442 papers) and the lower percentage of international collaboration (31%). North America accounts for 63% of collaborating countries. Only 8% of collaboration is between South American countries. Brazil has the highest tendency to collaborate with other South American countries. Brazil is the South American country with the highest scientific production and indicators of centrality in South America. The most common collaboration networks are with North American countries.

  15. Virtual international experiences in veterinary medicine: an evaluation of students' attitudes toward computer-based learning.

    PubMed

    French, Brigitte C; Hird, David W; Romano, Patrick S; Hayes, Rick H; Nijhof, Ard M; Jongejan, Frans; Mellor, Dominic J; Singer, Randall S; Fine, Amanda E; Gay, John M; Davis, Radford G; Conrad, Patricia A

    2007-01-01

    While many studies have evaluated whether or not factual information can be effectively communicated using computer-aided tools, none has focused on establishing and changing students' attitudes toward international animal-health issues. The study reported here was designed to assess whether educational modules on an interactive computer CD elicited a change in veterinary students' interest in and attitudes toward international animal-health issues. Volunteer veterinary students at seven universities (first-year students at three universities, second-year at one, third-year at one, and fourth-year at two) were given by random assignment either an International Animal Health (IAH) CD or a control CD, ParasitoLog (PL). Participants completed a pre-CD survey to establish baseline information on interest and attitudes toward both computers and international animal-health issues. Four weeks later, a post-CD questionnaire was distributed. On the initial survey, most students expressed an interest in working in the field of veterinary medicine in another country. Responses to the three pre-CD questions relating to attitudes toward the globalization of veterinary medicine, interest in foreign animal disease, and inclusion of a core course on international health issues in the veterinary curriculum were all positive, with average values above 3 (on a five-point scale where 5 represented strong agreement or interest). Almost all students considered it beneficial to learn about animal-health issues in other countries. After students reviewed the IAH CD, we found a decrease at four universities, an increase at one university, and no change at the remaining two universities in students' interest in working in some area of international veterinary medicine. However, none of the differences was statistically significant.

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

    PubMed

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

    2009-01-01

    Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied. We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data. We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey. There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p < .003) less likely to detect missing sign-out data including missing important diseases, contingency plans, or medications. Standardized sign-out did not significantly alter the frequency of dropped tasks or missed lab and X-ray data as perceived by the night intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention. Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.

  17. Enhanced Dielectrophoretic Enrichment of Nanoparticles Using a Nanostructured Tip for Nanoengineered Medicine and Biology

    NASA Astrophysics Data System (ADS)

    Yeo, Woonhong

    2011-12-01

    Enrichment of low-concentration nanoparticles (NPs) is of great interest in the fields of medicine, biology, and environment. In particular, the enrichment of bioparticles such as virus, quantum dots, DNA, or protein can have broad impacts on disease diagnosis, drug discovery, and environmental monitoring. Currently available NP enrichment methods employ centrifugation, microfiltration, or magnetic field. However, these methods are limited in cumbersome preparation steps, low yield, and low throughput. Electric field-based methods have demonstrated potential for NP enrichment, but two-dimensional planar electrodes are limited in sensitivity, molecular transfer, and imaging capability. In addition, the detection of low abundance, non-amplifiable particles such as proteins and metals is very challenging due to the low efficiency of current methods. In this dissertation, the challenges are addressed by nanotip-based NP enrichment. Fundamentals of NP enrichment are studied with a nanostructured tip. The nanotip-based NP enrichment is investigated by correlating a dielectrophoretic (DEP) force with Brownian motion force. In experiment, the predicted NP enrichment is validated by using gold (Au) NPs. The DEP effective distance for NP enrichment with a nanotip is suggested. Sequence-specific enrichment of oligonucleotides is studied by considering DEP force, Brownian motion, and affinity binding. In experiment, the optimal parameters for ultimate enrichment performance are studied using a hybridization assay. In the assay, a nanotip is functionalized with probe-oligonucleotides for sequence-specific binding. Size-specific NP enrichment is explored by studying DEP, capillary action, and viscosity. The capillary action force with a nanotip is calculated analytically, which is then compared with the DEP force. The viscosity effect is considered for NP capturing on a nanotip. The studied size-specific enrichment mechanism is validated in experiment by using various

  18. Development of Bend Sensor for Catheter Tip

    NASA Astrophysics Data System (ADS)

    Nagano, Yoshitaka; Sano, Akihito; Fujimoto, Hideo

    Recently, a minimally invasive surgery which makes the best use of the catheter has been becoming more popular. In endovascular coil embolization for a cerebral aneurysm, the observation of the catheter's painting phenomenon is very important to execute the appropriate manipulation of the delivery wire and the catheter. In this study, the internal bend sensor which consists of at least two bending enhanced plastic optical fibers was developed in order to measure the curvature of the catheter tip. Consequently, the painting could be more sensitively detected in the neighborhood of the aneurysm. In this paper, the basic characteristics of the developed sensor system are described and its usefulness is confirmed from the comparison of the insertion force of delivery wire and the curvature of catheter tip in the experiment of coil embolization.

  19. Competency-Based Medical Education in the Internal Medicine Clerkship: A Report From the Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force.

    PubMed

    Fazio, Sara B; Ledford, Cynthia H; Aronowitz, Paul B; Chheda, Shobhina G; Choe, John H; Call, Stephanie A; Gitlin, Scott D; Muntz, Marty; Nixon, L James; Pereira, Anne G; Ragsdale, John W; Stewart, Emily A; Hauer, Karen E

    2018-03-01

    As medical educators continue to redefine learning and assessment across the continuum, implementation of competency-based medical education in the undergraduate setting has become a focus of many medical schools. While standards of competency have been defined for the graduating student, there is no uniform approach for defining competency expectations for students during their core clerkship year. The authors describe the process by which an Alliance for Academic Internal Medicine task force developed a paradigm for competency-based assessment of students during their inpatient internal medicine (IM) clerkship. Building on work at the resident and fellowship levels, the task force focused on the development of key learning outcomes as defined by entrustable professional activities (EPAs) that were specific to educational experiences on the IM clerkship, as well as identification of high-priority assessment domains. The work was informed by a national survey of clerkship directors.Six key EPAs emerged: generating a differential diagnosis, obtaining a complete and accurate history and physical exam, obtaining focused histories and clinically relevant physical exams, preparing an oral presentation, interpreting the results of basic diagnostic studies, and providing well-organized clinical documentation. A model for assessment was proposed, with descriptors aligned to the scale of supervision and mapped to Accreditation Council for Graduate Medical Education domains of competence. The proposed paradigm offers a standardized template that may be used across IM clerkships, and which would effectively bridge competency evaluation in the clerkship to fourth-year assessment as well as eventual postgraduate training.

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

    PubMed

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

    2017-12-01

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

  1. Using High-Content Imaging to Analyze Toxicological Tipping Points (ICTATT meeting China)

    EPA Science Inventory

    Presentation at International Conference on Toxicological Alternatives & Translational Toxicology (ICTATT) held in China and Discussing the possibility of using High Content Imaging to Analyze Toxicological Tipping Points

  2. International Health Experiences in Family Medicine Residency Training.

    PubMed

    Porter, Maribeth; Mims, Lisa; Garven, Chad; Gavin, Jennifer; Carek, Peter; Diaz, Vanessa

    2016-02-01

    International health experiences (IHEs) have been associated with improved clinical skills, altruistic attitudes, cross-cultural sensitivity, and exposure to community medicine for residents and medical students. Although an increasing number of family medicine residencies offer IHEs, there are currently no standardized competencies or guidelines for developing IHEs. The aim of this study was to examine the content of IHEs in order to provide an overview of the current landscape of global health training in family medicine residency programs. Residency programs self-identifying as offering IHEs on the American Medical Association's (AMA) FREIDA Online website were emailed an electronic survey with questions regarding IHE characteristics, resident selection criteria, faculty support, motivations for participation, challenges to implementation, and funding. Of the 153 programs that responded, 84% still offered IHEs. Most IHEs are 3--4 weeks (71.1%) and are funded by the resident (74.2%). Faculty from the resident's department or institution generally provide supervision (76.6%) and have undergone some type of specialized training in global health (65.6%). Being in good academic standing was the most important eligibility criteria for residents participating in an IHE (86.7%), and funding was reported as the most challenging aspect (62.5%) of offering IHEs. IHEs are increasing in number and receiving more funding, but the experiences are variable among residency programs. While most program directors believe residents participate in IHEs to gain exposure with underserved populations, only a small percentage (5.5%) include a commitment to community service as part of a requirement for participation in an IHE.

  3. Dietary supplement consumption among cardiac patients admitted to internal medicine and cardiac wards.

    PubMed

    Karny-Rahkovich, Orith; Blatt, Alex; Elbaz-Greener, Gabby Atalya; Ziv-Baran, Tomer; Golik, Ahuva; Berkovitch, Matityahu

    2015-01-01

    Dietary supplements may have adverse effects and potentially interact with conventional medications. They are perceived as "natural" products, free of side effects with no need for medical consultation. Little is known about consumption of dietary supplements by patients with cardiac diseases. The objective of this study was to investigate dietary supplement consumption among cardiac patients admitted to internal and cardiology wards. Potential drug-dietary supplement interactions were also assessed. During a period of 6 months, patients with cardiac disease hospitalized in the Internal Medicine and Cardiology Wards at Assaf Harofeh Medical Center were evaluated regarding their dietary supplement consumption. A literature survey examining possible drug-supplement interaction was performed. Out of 149 cardiac patients, 45% were dietary supplement consumers. Patients ad-mitted to the Internal Medicine Wards consumed more dietary supplements than those admit-ted to the Cardiology Division. Dietary supplement consumption was associated with older age (OR = 1.05, p = 0.022), female gender (OR = 2.94, p = 0.014) and routine physical activity (OR = 3.15, p = 0.007). Diabetes mellitus (OR = 2.68, p = 0.020), hematological diseases (OR = 13.29, p = 0.022), and the use of anti-diabetic medications (OR = 4.28, p = 0.001) were independently associated with dietary supplement intake. Sixteen potential moderate interactions between prescribed medications and dietary supplements were found. Consumption of dietary supplements is common among cardiac patients. It is more common in those admitted to Internal Medicine Departments than in those admitted to the Cardiology Wards. Due to the risk of various drug-supplement interactions consumed by patients with cardiac diseases, there is a need to increase awareness and knowledge among medical staff regarding the intake of dietary supplements.

  4. Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

    PubMed

    Clay, Ryan D; Lee, Elizabeth C; Kurtzman, Marc F; Dversdal, Renee K

    2016-12-01

    A growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach. To implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures. The study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns. This was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention. Thirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099. A single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

  5. Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents.

    PubMed

    Pereira, Anne G; Harrell, Heather E; Weissman, Arlene; Smith, Cynthia D; Dupras, Denise; Kane, Gregory C

    2016-06-01

    To obtain feedback from internal medicine residents, a key stakeholder group, regarding both the skills needed for internship and the fourth-year medical school courses that prepared them for residency. This feedback could inform fourth-year curriculum redesign efforts. All internal medicine residents taking the 2013-2014 Internal Medicine In-Training Examination were asked to rank the importance of learning 10 predefined skills prior to internship and to use a dropdown menu of 11 common fourth-year courses to rank the 3 most helpful in preparing for internship. The predefined skills were chosen based on a review of the literature, a national subinternship curriculum, and expert consensus. Chi-square statistics were used to test for differences in responses between training levels. Of the 24,820 internal medicine residents who completed the exam, 20,484 (83%) completed the survey, had complete identification numbers, and consented to have their responses used for research. The three skills most frequently rated as very important were identifying when to seek additional help and expertise, prioritizing clinical tasks and managing time efficiently, and communicating with other providers around care transitions. The subinternship/acting internship was most often selected as being the most helpful course in preparing for internship. These findings indicate which skills and fourth-year medical school courses internal medicine residents found most helpful in preparing for internship and confirm the findings of prior studies highlighting the perceived value of subinternships. Internal medicine residents and medical educators agree on the skills students should learn prior to internship.

  6. [FUNCTIONAL TRAJECTORIES BEFORE, DURING AND AFTER ACUTE HOSPITALIZATION OF OLDER ADULTS IN INTERNAL MEDICINE WARDS].

    PubMed

    Zisberg, Anna; Tonkikh, Orly; Sinoff, Gary; Admi, Hanna; Shapira, Chen; Gur-Yaish, Nurit; Shadmi, Efrat

    2018-01-01

    Hospital-associated functional decline (HAFD) is recognized as a leading cause of adverse hospitalization outcomes, such as prolonged hospitalization, falls, readmission, and mortality. Since most patients hospitalized in internal medicine wards are older-adults, HAFD presents a major challenge to internal medicine. Describe functional trajectories of older-adults (aged ≥70 years) before, during and after acute hospitalization in internal-medicine units. A prospective cohort study was conducted of 741 older-adults, hospitalized in two tertiary hospitals in Israel during the period 2009-2011. Basic functional status two weeks before admission, on-admission, at-discharge and one-month post-discharge was assessed using the modified Barthel Index (BI). Eight trajectories were identified. Two-thirds of the participants were completely or almost independent at the pre-morbid period. About a half of the older-adults were hospitalized with pre-admission functional decline, a quarter deteriorated or died during hospitalization, and one-third improved during hospitalization. Most of the older-adults who were stable in functioning at the pre-admission period (57.1%) remained stable during and post-hospitalization; however, about a third of them did not return to their pre-morbid functioning levels. Approximately half of those with pre-morbid functional decline experienced additional deterioration of at least 5 points on the BI scale. Pre-morbid instrumental functional status, comorbidity and depressive symptoms have been found to distinguish older adults with similar pre-admission and in-hospital functional trends. Eight functional trajectories describe the hospitalization period of older-adults in internal-medicine units. On-admission personal characteristics may be used to identify older-adults who are at risk of unwarranted hospitalization outcomes and thus allow intervention in the hospital-community interface.

  7. The anticoagulation choices of internal medicine residents for stroke prevention in non-valvular atrial fibrillation.

    PubMed

    Moulson, Nathaniel; McIntyre, William F; Oqab, Zardasht; Yazdan-Ashoori, Payam; Quinn, Kieran L; van Oosten, Erik; Hopman, Wilma M; Baranchuk, Adrian

    2017-06-01

    To explore the oral anticoagulation (OAC) prescribing choices of Canadian internal medicine residents, at different training levels, in comparison with the Canadian Cardiovascular Society (CCS) guidelines for non-valvular atrial fibrillation (NVAF). Cross-sectional, web-based survey, involving clinical scenarios designed to favour the use of non-vitamin K antagonists (NOACs) as per the 2014 CCS NVAF guidelines. Additional questions were also designed to determine resident attitudes towards OAC prescribing. A total of 518 internal medicine responses were analysed, with 196 postgraduate year (PGY)-1s, 169 PGY-2s and 153 PGY-3s. The majority of residents (81%) reported feeling comfortable choosing OAC, with 95% having started OAC in the past 3 months. In the initial clinical scenario involving an uncomplicated patient with a CHADS2 score of 3, warfarin was favoured over any of the NOACs by PGY-1s (81.6% vs 73.9%), but NOACs were favoured by PGY-3s (88.3% vs 83.7%). This was the only scenario where OAC choices varied by PGY year, as each of the subsequent clinical scenarios residents generally favoured warfarin over NOACs irrespective of level of training. The majority of residents stated that they would no longer prescribe warfarin once NOAC reversal agents are available, and residents felt risk of adverse events was the most important factor when choosing OAC. Canadian internal medicine residents favoured warfarin over NOACs for patients with NVAF, which is in discordance with the evidence-based CCS guidelines. This finding persisted throughout the 3 years of core internal medicine training. 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/.

  8. Technology Tips

    ERIC Educational Resources Information Center

    Mathematics Teacher, 2004

    2004-01-01

    Some inexpensive or free ways that enable to capture and use images in work are mentioned. The first tip demonstrates the methods of using some of the built-in capabilities of the Macintosh and Windows-based PC operating systems, and the second tip describes methods to capture and create images using SnagIt.

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

    PubMed

    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.

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

    PubMed

    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.

  11. Brief report: Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations.

    PubMed

    Lai, Cindy J; Aagaard, Eva; Brandenburg, Suzanne; Nadkarni, Mohan; Wei, Henry G; Baron, Robert

    2006-05-01

    To assess the reading habits and educational resources of primary care internal medicine residents for their ambulatory medicine education. Cross-sectional, multiprogram survey of primary care internal medicine residents. Second- and third-year residents on ambulatory care rotations at 9 primary care medicine programs (124 eligible residents; 71% response rate). Participants were asked open-ended and 5-point Likert-scaled questions about reading habits: time spent reading, preferred resources, and motivating and inhibiting factors. Participants reported reading medical topics for a mean of 4.3+/-3.0 SD hours weekly. Online-only sources were the most frequently utilized medical resource (mean Likert response 4.16+/-0.87). Respondents most commonly cited specific patients' cases (4.38+/-0.65) and preparation for talks (4.08+/-0.89) as motivating factors, and family responsibilities (3.99+/-0.65) and lack of motivation (3.93+/-0.81) as inhibiting factors. To stimulate residents' reading, residency programs should encourage patient- and case-based learning; require teaching assignments; and provide easy access to online curricula.

  12. [International experience in the legal regulation of the circulation of medicines through the prism of the law of the world trade organization].

    PubMed

    Pasechnyk, Olena V; Hendel, Nataliia V

    2018-01-01

    Introduction: The development of international legal cooperation in the field of health has largely been driven by the trade interests of states. The aim: The article analyzes the legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. Materials and methods: Using the historical legal method has allowed to analyze the genesis of legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. The dialectical method is widely used, in particular, when it comes to the issue of the ratio of market regulation of medicines circulation and public health protection, the formal logic method, in particular, in formulating the general principles, principles and methods of legal regulation in the field of medicines, as well as the systemic method, in particular, in defining the institutional component of legal regulation in the field of medicines. Review: The activities of the WTO include several areas related to health protection: international control over infectious diseases, international legal regulation of food safety (food security), tobacco control, environmental protection, international legal aspects of access and treatment of medicinal and pharmaceutical products, international legal regulation of medical services provision. Conclusions: It is proved that the right to health is a right to access to medicines. However, for many developing countries, it is problematic to obtain patents for the production of necessary medicines or to pay a license fee, which creates a barrier to the realization of the right to health.

  13. Will there be room for the teaching of internal medicine in a university hospital?

    PubMed

    Junod, Alain F

    2002-01-12

    To answer the question addressed, two working groups, one made of the staff of a University clinic, the other one composed of practising general internists, have discussed the assets and weaknesses of a University service of Internal Medicine for postgraduate training. The groups agreed on a number of points: patients' characteristics (complexity and co-morbidities), quality of teaching, method acquisition for clinical reasoning, as well as absence of exposure to ambulatory patients and of follow-up. The groups differed in their views related to the lack of training in psychiatry and psychosocial problems or to hospital dysfunctions. Opening of internal medicine to primary care appears to be necessary at the same time as individual qualities among the senior staff are to be developed, such as critical analysis and self-questioning.

  14. Social medicine and international expert networks in Latin America, 1930-1945.

    PubMed

    Carter, Eric D

    2018-01-03

    This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context. Recognition of difference between Latin America and the global economic core regions was a key impetus for seeking 'national solutions to national problems' in countries like Argentina and Chile, even as integration into these networks provided progressive doctors, scientists, and other intellectuals important international support for local political reforms.

  15. Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis.

    PubMed

    van Seben, Rosanne; Geerlings, Suzanne E; Verhaegh, Kim J M; Hilders, Carina G J M; Buurman, Bianca M

    2016-09-07

    Accurate and timely patient handovers from hospital to other health care settings are essential in order to provide high quality of care and to ensure patient safety. We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 h after hospital discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days rates. The current study is set to implement the TIP, a structured discharge process for all patients admitted to the hospital, with the purpose to provide a safe, reliable and accurate discharge process. Eight hospitals in the Netherlands will implement the TIP on one internal medicine and one surgical ward. An interrupted time series (ITS) analysis, with pre-defined pre and post intervention periods, will be conducted. Patients over the age of 18 admitted for more than 48 h to the participating wards are eligible for inclusion. At least 1000 patients will be included in both the pre-implementation and post-implementation group. The primary outcome is the number of medical, medication and nursing handovers being sent within 24 h after discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days. With regard to potential confounders, data will be collected on patient's characteristics and information regarding the hospitalization. We will use segmented regression methods for analyzing the data, which allows assessing how much TIP changed the outcomes of interest immediately and over time. This study protocol describes the implementation of TIP, which provides the foundation for a safe, reliable and accurate discharge process. If effective, nationwide implementation of the discharge bundle may result from this study protocol. Dutch Trial Registry: NTR5951.

  16. Optical fiber tips for biological applications: From light confinement, biosensing to bioparticles manipulation.

    PubMed

    Paiva, Joana S; Jorge, Pedro A S; Rosa, Carla C; Cunha, João P S

    2018-05-01

    The tip of an optical fiber has been considered an attractive platform in Biology. The simple cleaved end of an optical fiber can be machined, patterned and/or functionalized, acquiring unique properties enabling the exploitation of novel optical phenomena. Prompted by the constant need to measure and manipulate nanoparticles, the invention of the Scanning Near-field Optical Microscopy (SNOM) triggered the optimization and development of novel fiber tip microfabrication methods. In fact, the fiber tip was soon considered a key element in SNOM by confining light to sufficiently small extensions, challenging the diffraction limit. As result and in consequence of the newly proposed "Lab On Tip" concept, several geometries of fiber tips were applied in three main fields: imaging (in Microscopy/Spectroscopy), biosensors and micromanipulation (Optical Fiber Tweezers, OFTs). These are able to exert forces on microparticles, trap and manipulate them for relevant applications, as biomolecules mechanical study or protein aggregates unfolding. This review presents an overview of the main achievements, most impactful studies and limitations of fiber tip-based configurations within the above three fields, along the past 10 years. OFTs could be in future a valuable tool for studying several cellular phenomena such as neurodegeneration caused by abnormal protein fibrils or manipulating organelles within cells. This could contribute to understand the mechanisms of some diseases or biophenomena, as the axonal growth in neurons. To the best of our knowledge, no other review article has so far provided such a broad view. Despite of the limitations, fiber tips have key roles in Biology/Medicine. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Tip-enhanced Raman scattering microscopy: Recent advance in tip production

    NASA Astrophysics Data System (ADS)

    Fujita, Yasuhiko; Walke, Peter; De Feyter, Steven; Uji-i, Hiroshi

    2016-08-01

    Tip-enhanced Raman scattering (TERS) microscopy is a technique that combines the chemical sensitivity of Raman spectroscopy with the resolving power of scanning probe microscopy. The key component of any TERS setup is a plasmonically-active noble metal tip, which serves to couple far-field incident radiation with the near-field. Thus, the design and implementation of reproducible probes are crucial for the continued development of TERS as a tool for nanoscopic analysis. Here we discuss conventional methods for the fabrication of TERS-ready tips, highlighting the problems therein, as well as detailing more recent developments to improve reducibility. In addition, the idea of remote excitation-TERS is enlightened upon, whereby TERS sensitivity is further improved by using propagating surface plasmons to separate the incident radiation from the tip apex, as well as how this can be incorporated into the fabrication process.

  18. Rapid in vitro propagation system through shoot tip cultures of Vitex trifolia L.-an important multipurpose plant of the Pacific traditional Medicine.

    PubMed

    Ahmed, Rafique; Anis, Mohammad

    2014-07-01

    A rapid and efficient plant propagation system through shoot tip explants was established in Vitex trifolia L., a medicinally important plant belonging to the family Verbenaceae. Multiple shoots were induced directly on Murashige and Skoog (MS) medium consisting of different cytokinins, 6-benzyladenine (BA), kinetin (Kin) and 2-isopentenyl adenine (2-iP), BA at an optimal concentration of 5.0 μM was most effective in inducing multiple shoots where 90 % explants responded with an average shoot number (4.4±0.1) and shoot length (2.0±0.1 cm) after 6 weeks of culture. Inclusion of NAA in the culture medium along with the optimum concentration of BA promoted a higher rate of shoot multiplication and length of the shoot, where 19.2±0.3 well-grown healthy shoots with an average shoot length of 4.4±0.1 cm were obtained on completion of 12 weeks culture period. Ex vitro rooting was achieved best directly in soilrite when basal portion of the shoots were treated with 500 μM indole-3-butyric acid for 15 min which was the most effective in inducing roots, as 95 % of the microshoots produced roots. Plantlets went through a hardening phase in a controlled plant growth chamber, prior to ex-vitro transfer. Micropropagated plants grew well, attained maturity and flowered with 92 % survival rate. The results of this study provide the first report on in vitro plant regeneration of Vitex trifolia L. using shoot tip explants.

  19. Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units

    PubMed Central

    Mazzone, Antonino; Dentali, Francesco; La Regina, Micaela; Foglia, Emanuela; Gambacorta, Maurizia; Garagiola, Elisabetta; Bonardi, Giorgio; Clerici, Pierangelo; Concia, Ercole; Colombo, Fabrizio; Campanini, Mauro

    2016-01-01

    Abstract Only a few studies provided data on the clinical history of sepsis within internal Medicine units. The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units. Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis. A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88). In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting. PMID:26825876

  20. The Effect of Reducing Maximum Shift Lengths to 16 Hours on Internal Medicine Interns’ Educational Opportunities

    PubMed Central

    Theobald, Cecelia N.; Stover, Daniel G.; Choma, Neesha N.; Hathaway, Jacob; Green, Jennifer K.; Peterson, Neeraja B.; Sponsler, Kelly C.; Vasilevskis, Eduard E.; Kripalani, Sunil; Sergent, John; Brown, Nancy J.; Denny, Joshua C.

    2013-01-01

    Purpose To evaluate educational experiences of internal medicine interns before and after maximum shift lengths were decreased from 30 hours to 16 hours. Method The authors compared educational experiences of internal medicine interns at Vanderbilt University Medical Center before (2010, 47 interns) and after (2011, 50 interns) duty hour restrictions were implemented in July 2011. The authors compared number of inpatient encounters, breadth of concepts in notes, exposure to five common presenting problems, procedural experience, and attendance at teaching conferences. Results Following the duty hour restrictions, interns cared for more unique patients (mean 118 versus 140 patients per intern, P = .005) and wrote more history and physicals (mean 73 versus 88, P = .005). Documentation included more total concepts after the 16-hour maximum shift implementation, with a 14% increase for history and physicals (338 versus 387, P < .001) and a 10% increase for progress notes (316 versus 349, P < .001). There was no difference in the median number of selected procedures performed (6 versus 6, P = .94). Attendance was higher at the weekly chief resident conference (60% versus 68% of expected attendees, P < .001) but unchanged at morning report conferences (79% versus 78%, P = .49). Conclusions Intern clinical exposure did not decrease after implementation of the 16-hour shift length restriction. In fact, interns saw more patients, produced more detailed notes, and attended more conferences following duty hour restrictions. PMID:23425987

  1. Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital.

    PubMed

    Kara, İskender; Yıldırım, Fatma; Başak, Dilek Yumuş; Küçük, Hamit; Türkoğlu, Melda; Aygencel, Gülbin; Katı, İsmail; Karabıyık, Lale

    2015-06-01

    The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012-August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure.

  2. Cellular functions of TIP60.

    PubMed

    Sapountzi, Vasileia; Logan, Ian R; Robson, Craig N

    2006-01-01

    TIP60 was originally identified as a cellular acetyltransferase protein that interacts with HIV-1 Tat. As a consequence, the role of TIP60 in transcriptional regulation has been investigated intensively. Recent data suggest that TIP60 has more divergent functions than originally thought and roles for TIP60 in many processes, such as cellular signalling, DNA damage repair, cell cycle and checkpoint control and apoptosis are emerging. TIP60 is a tightly regulated transcriptional coregulator, acting in a large multiprotein complex for a range of transcription factors including androgen receptor, Myc, STAT3, NF-kappaB, E2F1 and p53. This usually involves recruitment of TIP60 acetyltransferase activities to chromatin. Additionally, in response to DNA double strand breaks, TIP60 is recruited to DNA lesions where it participates both in the initial as well as the final stages of repair. Here, we describe how TIP60 is a multifunctional enzyme involved in multiple nuclear transactions.

  3. Direct analysis of herbal powders by pipette-tip electrospray ionization mass spectrometry.

    PubMed

    Wang, Haixing; So, Pui-Kin; Yao, Zhong-Ping

    2014-01-27

    Conventional electrospray ionization mass spectrometry (ESI-MS) is widely used for analysis of solution samples. The development of solid-substrate ESI-MS allows direct ionization analysis of bulky solid samples. In this study, we developed pipette-tip ESI-MS, a technique that combines pipette tips with syringe and syringe pump, for direct analysis of herbal powders, another common form of samples. We demonstrated that various herbal powder samples, including herbal medicines and food samples, could be readily online extracted and analyzed using this technique. Various powder samples, such as Rhizoma coptidis, lotus plumule, great burdock achene, black pepper, Panax ginseng, roasted coffee beans, Fructus Schisandrae Chinensis and Fructus Schisandrae Sphenantherae, were analyzed using pipette-tip ESI-MS and quality mass spectra with stable and durable signals could be obtained. Both positive and negative ion modes were attempted and various compounds including amino acids, oligosaccharides, glycosides, alkaloids, organic acids, ginosensides, flavonoids and lignans could be detected. Principal component analysis (PCA) based on the acquired mass spectra allowed rapid differentiation of closely related herbal species. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. International Perspectives on Quality Assurance and New Techniques in Radiation Medicine: Outcomes of an IAEA Conference

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Shortt, Ken; Davidsson, Lena; Hendry, Jolyon

    2008-05-01

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

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

    PubMed

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

    2008-01-01

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

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

    PubMed

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

    2017-04-01

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

  7. Effect of the depressor septi nasi muscle modification on nasal tip rotation and projection.

    PubMed

    Toutounchi, Javad S; Biroon, Sogol H; Banaem, Samira M; Toutounchi, Neghisa S; Nezami, Nariman; Salari, Behzad

    2015-06-01

    The nasal tip is an important esthetic feature of the face and surgery on it is the most challenging part of a rhinoplasty. In the present study, we evaluated the effects of modification of the depressor septi nasi muscle on nasal tip rotation and projection. Eighty primary rhinoplasty patients who required nasal tip modifications were enrolled in a randomized clinical trial from October 2008 to March 2012. A study group composed of 40 patients underwent rhinoplasty including cutting and repositioning of the depressor septi nasi muscle and another group of 40 patients (control) underwent rhinoplasty without manipulation of the depressor septi nasi muscle. Nasal tip rotation and projection, and patient satisfaction were evaluated before and 6 months after the operation. Following rhinoplasty including cutting of the depressor septi nasi muscle, nasal tip rotation and projection, and patient satisfaction were improved in 70, 57.5, and 85 % of the patients, respectively; and in the control group, they were improved in 82.5, 55, and 67.5 %, respectively (P = 0.089, 0.607, and 0.069). Cutting and repositioning of the depressor septi nasi muscle as an adjunct to rhinoplasty is not associated with any additional advantage in terms of nasal tip rotation and projection, or patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  8. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department.

    PubMed

    Testa, Americo; Francesconi, Andrea; Giannuzzi, Rosangela; Berardi, Silvia; Sbraccia, Paolo

    2015-12-01

    The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets

  9. Confidence in palliative care issues by medical students and internal medicine residents.

    PubMed

    Storarri, Ana Carolina Montouro; de Castro, Giovana Dalmedico; Castiglioni, Lilian; Cury, Patricia Maluf

    2017-12-16

    Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities. © 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. Nano-Wilhelmy investigation of dynamic wetting properties of AFM tips through tip-nanobubble interaction

    PubMed Central

    Wang, Yuliang; Wang, Huimin; Bi, Shusheng; Guo, Bin

    2016-01-01

    The dynamic wetting properties of atomic force microscopy (AFM) tips are of much concern in many AFM-related measurement, fabrication, and manipulation applications. In this study, the wetting properties of silicon and silicon nitride AFM tips are investigated through dynamic contact angle measurement using a nano-Wilhelmy balance based method. This is done by capillary force measurement during extension and retraction motion of AFM tips relative to interfacial nanobubbles. The working principle of the proposed method and mathematic models for dynamic contact angle measurement are presented. Geometric models of AFM tips were constructed using scanning electronic microscopy (SEM) images taken from different view directions. The detailed process of tip-nanobubble interaction was investigated using force-distance curves of AFM on nanobubbles. Several parameters including nanobubble height, adhesion and capillary force between tip and nanobubbles are extracted. The variation of these parameters was studied over nanobubble surfaces. The dynamic contact angles of the AFM tips were calculated from the capillary force measurements. The proposed method provides direct measurement of dynamic contact angles for AFM tips and can also be taken as a general approach for nanoscale dynamic wetting property investigation. PMID:27452115

  11. Nano-Wilhelmy investigation of dynamic wetting properties of AFM tips through tip-nanobubble interaction

    NASA Astrophysics Data System (ADS)

    Wang, Yuliang; Wang, Huimin; Bi, Shusheng; Guo, Bin

    2016-07-01

    The dynamic wetting properties of atomic force microscopy (AFM) tips are of much concern in many AFM-related measurement, fabrication, and manipulation applications. In this study, the wetting properties of silicon and silicon nitride AFM tips are investigated through dynamic contact angle measurement using a nano-Wilhelmy balance based method. This is done by capillary force measurement during extension and retraction motion of AFM tips relative to interfacial nanobubbles. The working principle of the proposed method and mathematic models for dynamic contact angle measurement are presented. Geometric models of AFM tips were constructed using scanning electronic microscopy (SEM) images taken from different view directions. The detailed process of tip-nanobubble interaction was investigated using force-distance curves of AFM on nanobubbles. Several parameters including nanobubble height, adhesion and capillary force between tip and nanobubbles are extracted. The variation of these parameters was studied over nanobubble surfaces. The dynamic contact angles of the AFM tips were calculated from the capillary force measurements. The proposed method provides direct measurement of dynamic contact angles for AFM tips and can also be taken as a general approach for nanoscale dynamic wetting property investigation.

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

    PubMed

    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.

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

    PubMed

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

    2013-01-01

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

  14. Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers.

    PubMed

    Moyer, Jeffrey S

    2018-06-01

    Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    PubMed Central

    Zeger, Scott L.; Kolars, Joseph C.

    2007-01-01

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

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

    PubMed

    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.

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

    PubMed

    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.

  18. Sherbrooke - Montevideo: a socially responsible international collaboration to foster family medicine.

    PubMed

    Morin, Martine; Grand'Maison, Paul; Henderson, Eduardo; Vignolo, Julio

    2014-01-01

    The World Health Organization advocates for faculties of medicine to orient health professional education toward the needs of the populations graduates are to serve and to include a greater emphasis on primary health care. It was in this framework that in 2007, the Faculty of Medicine and Health Sciences at the Université de Sherbrooke (FMHS-UdeS) in Canada and the Facultad de Medicina de la Universidad de la Republica (FMUdelaR) in Montevideo, Uruguay developed a comprehensive collaboration to sustain the development of family medicine in both universities through education, practice and research. ACTIVITIES AND OUTCOMES: In addition to information sharing through email and teleconferencing, this five year collaboration has included 28 bilateral visits by the two institutions' teachers and leaders. During these visits, Uruguayan members participated in workshops and benefited from exchanges during educational and clinical activities. Interactions led to the improvement of their skills as teachers of family medicine with an emphasis on clinical teaching, supervision, feedback to learners in clinical evaluations, use of various educational methods, use of standardized patients for teaching and evaluation, and research. FMHS-UdeS members learned about the community aspects of family medicine in Uruguay and reflected on how these could be implemented to the benefit of Canadians. The international collaboration forged between the FMHS-UdeS and the FMUdelaR represents a socially responsible endeavor that has been highly rewarding for all involved. It represents a significant learning opportunity for each group aiming to better prepare physicians to serve as primary health care providers in their communities.

  19. Positive correlation between the usage of complementary and alternative medicine and internal health locus of control

    PubMed Central

    Sasagawa, Masa; Martzen, Mark R.; Kelleher, William J.; Wenner, Cynthia A.

    2008-01-01

    BACKGROUND Because many people with chronic medical conditions utilize complementary and alternative medicine (CAM), understanding their psychosocial characteristics may be useful to identifying effective interventions. The Health Locus of Control (HLOC) measures the perception of controlling one’s own health outcomes by various attributes. People with a high internal HLOC believe that the outcome of their own health seeking is related to their behavior or personal investment. Earlier evidence has shown that a higher internal HLOC is a predictive factor of positive treatment outcomes. OBJECTIVE This study measured the correlation between the degree of CAM use and the level of HLOC. DESIGN An online cross sectional survey was conducted via public bulletin boards and invitational emails. Data from 123 useable responses were analyzed for bivariate correlation between CAM use and HLOC. Subjective reports of various medical modalities were classified into 6 CAM domains and one conventional biomedicine domain. Subscales of HLOC included internal, chance, and powerful others. Chronic conditions, health status, and demographics were self-reported. RESULTS Internal HLOC significantly correlated with CAM use (Spearman’s rho, p<0.004) but not with conventional medicine use (Spearman’s rho, p>0.130). Further analysis of this correlation for those people with chronic conditions could not identify a particular domain used more by people with a high internal HLOC (p>0.187) but the lesser use of conventional medicine was significant (p< 0.031). CAM is either empowering or empowered patients are utilizing CAM. People who use CAM may have a better prognosis and better management of chronic conditions. PMID:18194790

  20. Nanostar probes for tip-enhanced spectroscopy

    NASA Astrophysics Data System (ADS)

    Kim, Woong; Kim, Nara; Park, Joon Won; Kim, Zee Hwan

    2015-12-01

    To overcome the current limit of tip-enhanced spectroscopy that is based on metallic nano-probes, we developed a new scanning probe with a metallic nanostar, a nanoparticle with sharp spikes. A Au nanoparticle of 5 nm was first attached to the end of a tip through DNA-DNA hybridization and mechanical pick-up. The nanoparticle was converted to a nanostar with a core diameter of ~70 nm and spike lengths between 50 nm and 80 nm through the reduction of Au3+ with ascorbic acid in the presence of Ag+. Fabrication yields of such tips exceeded 60%, and more than 80% of such tips showed a mechanical durability sufficient for use in scanning microscopy. Effectiveness of the new probes for tip-enhanced Raman scattering (TERS) and tip-enhanced fluorescence (TEF) was confirmed. The probes exhibited the necessary enhancement for TEF, and the tip-on and tip-off ratios varied between 5 and 100. This large tip-to-tip variability may arise from the uncontrolled orientation of the apexes of the spike with respect to the sample surface, which calls for further fabrication improvement. The result overall supports a new fabrication approach for the probe that is effective for tip-enhanced spectroscopy.To overcome the current limit of tip-enhanced spectroscopy that is based on metallic nano-probes, we developed a new scanning probe with a metallic nanostar, a nanoparticle with sharp spikes. A Au nanoparticle of 5 nm was first attached to the end of a tip through DNA-DNA hybridization and mechanical pick-up. The nanoparticle was converted to a nanostar with a core diameter of ~70 nm and spike lengths between 50 nm and 80 nm through the reduction of Au3+ with ascorbic acid in the presence of Ag+. Fabrication yields of such tips exceeded 60%, and more than 80% of such tips showed a mechanical durability sufficient for use in scanning microscopy. Effectiveness of the new probes for tip-enhanced Raman scattering (TERS) and tip-enhanced fluorescence (TEF) was confirmed. The probes exhibited

  1. [Sport medicine].

    PubMed

    Epstein, Yoram

    2012-02-01

    It is only since the late 20th century that Sport and Exercise Medicine has emerged as a distinct entity in health care. In Israel, sports medicine is regulated by a State Law and a sport physician is certified after graduating a structured program. In the past, sports medicine was related to the diagnosis and treatment of injuries encountered by top athletes. In recent years, the scope of sport medicine has broadened to reflect the awareness of modern society of the dangers of physical inactivity. In this perspective the American College of Sport Medicine (ACSM) recently launched a program--"Exercise is Medicine", to promote physical activity in order to improve health and well-being and prevention of diseases through physical activity prescriptions. This program is from doctors and healthcare providers, adjusted to the patient or trainee. The sport physician does not replace a medical specialist, but having a thorough understanding about the etiology of a sport-related injury enables him to better focus on treatment and prevention. Therefore, Team Physicians in Elite Sport often play a role regarding not only the medical care of athletes, but also in the physiological monitoring of the athlete and correcting aberrations, to achieve peak physical performance. The broad spectrum of issues in sport and exercise medicine cannot be completely covered in one issue of the Journal. Therefore, the few reports that are presented to enhance interest and understanding in the broad spectrum of issues in sports and exercise medicine are only the tip of the iceberg.

  2. Unhappy with internal corporate search? : learn tips and tricks for building a controlled vocabulary ontology.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Arpin, Bettina Karin Schimanski; Jones, Brian S.; Bemesderfer, Joy

    2010-06-01

    Are your employees unhappy with internal corporate search? Frequent complaints include: too many results to sift through; results are unrelated/outdated; employees aren't sure which terms to search for. One way to improve intranet search is to implement a controlled vocabulary ontology. Employing this takes the guess work out of searching, makes search efficient and precise, educates employees about the lingo used within the corporation, and allows employees to contribute to the corpus of terms. It promotes internal corporate search to rival its superior sibling, internet search. We will cover our experiences, lessons learned, and conclusions from implementing a controlled vocabularymore » ontology at Sandia National Laboratories. The work focuses on construction of this ontology from the content perspective and the technical perspective. We'll discuss the following: (1) The tool we used to build a polyhierarchical taxonomy; (2) Examples of two methods of indexing the content: traditional 'back of the book' and folksonomy word-mapping; (3) Tips on how to build future search capabilities while building the basic controlled vocabulary; (4) How to implement the controlled vocabulary as an ontology that mimics Google's search suggestions; (5) Making the user experience more interactive and intuitive; and (6) Sorting suggestions based on preferred, alternate and related terms using SPARQL queries. In summary, future improvements will be presented, including permitting end-users to add, edit and remove terms, and filtering on different subject domains.« less

  3. A Survey of Knowledge and Practices of Transfusion Medicine Among Post Intern Doctors in Specialized Hospital in Sri Lanka.

    PubMed

    Kumarage, Samantha; Fernando, Rahal; Gunasekara, Lanka

    2017-02-01

    Knowledge of transfusion medicine is the key element of better transfusion practices. This deficit observed at the blood bank end on daily basis exposing the patients for redundant risk. We assessed the knowledge of transfusion medicine among post intern doctors. To assess the knowledge of transfusion medicine among post intern doctors in working in our hospital. Self administrated questionnaire was used. 45 questions of transfusion medicine included in the questioner. A total 57 post internship doctors participated in the survey. Statistical analysis was done using SPSS. In overall survey average score was 41.45%. Lowest score 19.8% was for the area of lab result interpretation. Highest score 56.63% obtained for the administration of blood component. Differences among the medical officers of various specialties were not statistically significant. Transfusion medicine knowledge among post internship doctors in our hospital need to be upgraded. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

    PubMed

    Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

    2017-04-18

    Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

  5. Price discrimination in essential medicines: evidence from International Drug Price Indicator Guide data.

    PubMed

    Hanlon, Michael; Zhang, Raymond

    2013-03-01

    Few data are available on what donors, governments and other implementing organisations pay for the medicines they procure. To partly address this shortcoming, we analyse transactions of pharmaceuticals on the WHO's essential medicines list. Our objective was to identify the determinants of prices paid for these drugs. We used data from the 2008 version of the International Drug Price Indicator Guide. We normalised transactions by representing their value as a 'price per daily dose'. We used a mixed-effects regression model to quantify the impact of observable characteristics on prices paid. We present evidence of first-degree price discrimination in the market for essential medicines. We find that as a country's per capita wealth doubles, prices paid for the same pharmaceutical increase by 33%. These data indicate that purchasing agents from wealthier countries pay more for essential medicines, all factors constant. This behaviour is not a form of development assistance for health but rather is indicative of inefficient markets in which buyers' lack of information enables suppliers to charge higher prices than they could otherwise.

  6. Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer

    PubMed Central

    White, Jeffrey D.; Lin, Hongsheng; Wu, Roy S.; Lam, Stephen; Li, Jie; Dou, Jinhui; Kumar, Nagi; Lin, Lizhu; Lao, Lixing

    2017-01-01

    On November 3, 2014, in Bethesda, MD, the Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute held a meeting to examine the potential utility and feasibility of establishing an international consortium for Chinese medicine and cancer. There is significant interest in the West in using components of Chinese medicine (CM) —such as botanicals and herbal medicines, acupuncture and acupressure, and qigong—in the field of oncology, as potential anticancer agents, for symptom management, and to improve quality of life. The proposal for a consortium on CM came from the Chinese Academy of Chinese Medical Sciences, with the aims of improving scientific communications and collaborations and modernizing the studies of CM for cancer. The US National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine agreed to work with Chinese Academy of Chinese Medical Sciences to explore the feasibility of establishing an international consortium for Chinese medicine and cancer. At the meeting, participants from the United States, China, Canada, Australia, and Korea discussed issues in CM and cancer research, treatment, and management, including potential mechanisms of action, proof of efficacy, adverse effects, regulatory issues, and the need for improving the quality of randomized clinical trials of CM treatments and supportive care interventions. Presented in these proceedings are some of the main issues and opportunities discussed by workshop participants. PMID:29244995

  7. Quality of life: international and domestic students studying medicine in New Zealand.

    PubMed

    Henning, Marcus A; Krägeloh, Christian; Moir, Fiona; Doherty, Iain; Hawken, Susan J

    2012-08-01

    International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.

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

    PubMed

    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

  9. A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

    PubMed

    Hamasaki, Tomoko; Hagihara, Akihito

    2015-10-24

    The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). It is important for physicians working in obstetrics and gynecology

  10. International Journal of Occupational Medicine and Environmental Health in world documentation services: the SCOPUS based analysis of citation.

    PubMed

    Przyłuska, Jolanta

    2006-01-01

    A high classification of scientific journals in the ranking of international transfer of knowledge is reflected by other researchers' citations. The International Journal of Occupational Medicine and Environmental Health (IJOMEH) is an international professional quarterly focused on such areas as occupational medicine, toxicology and environmental health edited in Poland. IJOMEH, published in English, is indexed in numerous world information services (MEDLINE, EMBASE, EBSCO, SCOPUS). This paper presents the contribution of IJOMEH publications to the world circulation of scientific information based on the citation analysis. The analysis, grounded on the SCOPUS database, assessed the frequency of citations in the years 1996-2005. Journals in which they have been cited were retrieved and their list is also included.

  11. Child Transportation Safety Tips.

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This document presents nine tips regarding safe infant and child transportation, each tip explained in one to two pages. The tips are as follows: (1) quick safety seat checkup; (2) where should your child ride? (3) how to protect your new baby in the car; (4) what safety seat to use for a big baby or toddler? (5) how should preschool and school…

  12. Method to improve the blade tip-timing accuracy of fiber bundle sensor under varying tip clearance

    NASA Astrophysics Data System (ADS)

    Duan, Fajie; Zhang, Jilong; Jiang, Jiajia; Guo, Haotian; Ye, Dechao

    2016-01-01

    Blade vibration measurement based on the blade tip-timing method has become an industry-standard procedure. Fiber bundle sensors are widely used for tip-timing measurement. However, the variation of clearance between the sensor and the blade will bring a tip-timing error to fiber bundle sensors due to the change in signal amplitude. This article presents methods based on software and hardware to reduce the error caused by the tip clearance change. The software method utilizes both the rising and falling edges of the tip-timing signal to determine the blade arrival time, and a calibration process suitable for asymmetric tip-timing signals is presented. The hardware method uses an automatic gain control circuit to stabilize the signal amplitude. Experiments are conducted and the results prove that both methods can effectively reduce the impact of tip clearance variation on the blade tip-timing and improve the accuracy of measurements.

  13. SU-E-J-81: Beveled Needle Tip Detection Error in Ultrasound-Guided Prostate Brachytherapy.

    PubMed

    Leu, S; Ruiz, B; Podder, T

    2012-06-01

    To quantify the needle tip detection errors in ultrasound images due to bevel-tip orientation in relation to the location on template grid. Transrectal ultrasound (TRUS) system (BK Medical) with physical template grid and 18-gauge bevel-tip (20-deg beveled angle) brachytherapy needle (Bard Medical, Covington, GA) were used. The TRUS was set at 6.5MHz in water phantom at 40°C and measurements were taken with 50% and 100% TRUS gains. Needles were oriented with bevel-tip facing up (0-degree) and inserted through template grid-holes. Reference needle depths were measured when needle tip image intensity was bright enough for potentially consistent readings. High-resolution digital vernier caliper was used to measure needle depth. Needle bevel-tip orientation was then changed to bevel down (by rotating 180-degree) and needle depth was adjusted by retracting so that the needle-tip image intensity appeared similar to when the needle bevel-tip was at 0-degree orientation. Clinically relevant locations were considered for needle placement on the template grids (1st row to 9th row, and 'a-f' columns). For 50% TRUS gain, bevel tip detection errors/differences were 0.69±0.30mm (1st row) to 3.23±0.22mm (9th row) and 0.78±0.71mm (1st row) to 4.14±0.56mm (9th row) in columns 'a' and 'D', respectively. The corresponding errors for 100% TRUS gain were 0.57±0.25mm to 5.24±0.36mm and 0.84±0.30mm to 4.2±0.20mm in columns 'a' and 'D', respectively. These errors/differences varied linearly for grid-hole locations on the rows and columns in between, smaller to large depending on distance from the TRUS probe. Observed no effect of gains (50% vs. 100%) along 'D' column, which was directly above the TRUS probe. Experiment results revealed that the beveled needle tip orientation could significantly impact the detection accuracy of the needle tips, based on which the seeds might be delivered. These errors may lead to considerable dosimetric deviations in prostate brachytherapy seed

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

    PubMed Central

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

    2015-01-01

    Background 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. Objective We describe the use of 1 such tool—UPDATED—to assess written handoff communication skills in internal medicine interns. Methods 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. Results 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. Conclusions 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. PMID:26221442

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

    PubMed

    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.

  16. Dielectrophoretic positioning of single nanoparticles on atomic force microscope tips for tip-enhanced Raman spectroscopy.

    PubMed

    Leiterer, Christian; Deckert-Gaudig, Tanja; Singh, Prabha; Wirth, Janina; Deckert, Volker; Fritzsche, Wolfgang

    2015-05-01

    Tip-enhanced Raman spectroscopy, a combination of Raman spectroscopy and scanning probe microscopy, is a powerful technique to detect the vibrational fingerprint of molecules at the nanometer scale. A metal nanoparticle at the apex of an atomic force microscope tip leads to a large enhancement of the electromagnetic field when illuminated with an appropriate wavelength, resulting in an increased Raman signal. A controlled positioning of individual nanoparticles at the tip would improve the reproducibility of the probes and is quite demanding due to usually serial and labor-intensive approaches. In contrast to commonly used submicron manipulation techniques, dielectrophoresis allows a parallel and scalable production, and provides a novel approach toward reproducible and at the same time affordable tip-enhanced Raman spectroscopy tips. We demonstrate the successful positioning of an individual plasmonic nanoparticle on a commercial atomic force microscope tip by dielectrophoresis followed by experimental proof of the Raman signal enhancing capabilities of such tips. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

    PubMed Central

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

    2008-01-01

    Background Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability. Methods We developed the Guide-O-Game© in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game© consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process. Results The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable. Conclusion We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes. PMID:19017400

  18. Performance of post-processing algorithms for rainfall intensity using measurements from tipping-bucket rain gauges

    NASA Astrophysics Data System (ADS)

    Stagnaro, Mattia; Colli, Matteo; Lanza, Luca Giovanni; Chan, Pak Wai

    2016-11-01

    Eight rainfall events recorded from May to September 2013 at Hong Kong International Airport (HKIA) have been selected to investigate the performance of post-processing algorithms used to calculate the rainfall intensity (RI) from tipping-bucket rain gauges (TBRGs). We assumed a drop-counter catching-type gauge as a working reference and compared rainfall intensity measurements with two calibrated TBRGs operated at a time resolution of 1 min. The two TBRGs differ in their internal mechanics, one being a traditional single-layer dual-bucket assembly, while the other has two layers of buckets. The drop-counter gauge operates at a time resolution of 10 s, while the time of tipping is recorded for the two TBRGs. The post-processing algorithms employed for the two TBRGs are based on the assumption that the tip volume is uniformly distributed over the inter-tip period. A series of data of an ideal TBRG is reconstructed using the virtual time of tipping derived from the drop-counter data. From the comparison between the ideal gauge and the measurements from the two real TBRGs, the performances of different post-processing and correction algorithms are statistically evaluated over the set of recorded rain events. The improvement obtained by adopting the inter-tip time algorithm in the calculation of the RI is confirmed. However, by comparing the performance of the real and ideal TBRGs, the beneficial effect of the inter-tip algorithm is shown to be relevant for the mid-low range (6-50 mmh-1) of rainfall intensity values (where the sampling errors prevail), while its role vanishes with increasing RI in the range where the mechanical errors prevail.

  19. Infant-Feeding Intentions and Practices of Internal Medicine Physicians

    PubMed Central

    Serwint, Janet R.; Shuster, Jonathan J.; Levine, David M.

    2016-01-01

    Abstract Background: Personal breastfeeding behavior of physician mothers is associated with their clinical breastfeeding advocacy, which in turn impacts patients' breastfeeding behavior. Internists can play an important role in breastfeeding advocacy as they usually come in contact with mothers longitudinally. Objective: To explore the personal infant-feeding decisions and behavior of physician mothers in internal medicine (IM). Materials and Methods: Physicians with current or previous IM training were isolated from our “Breastfeeding Among Physicians” database. The data in the database were gathered from cross-sectional surveys of 130 physician volunteers, mainly affiliated with the Johns Hopkins University School of Medicine (Baltimore, MD) and the University of Florida College of Medicine (Gainesville, FL). Results: Seventy-two mothers reported current or previous IM training and had 196 infants. Breastfeeding rates were 96% at birth, 77% at 6 months, and 40% at 12 months. Exclusive breastfeeding rates were 78% at birth, 67% at 3 months, and 30% at 6 months. While maternal goal for breastfeeding duration correlated with duration of both exclusive and any breastfeeding, there was a consistent and appreciable disparity between maternal duration goal and actual breastfeeding duration. The participants reported work-related reasons for early supplementation and breastfeeding cessation. Conclusions: We have described for the first time in the literature the personal infant-feeding intentions and behavior of a cohort of IM physician mothers. Workplace interventions to enable internists to maintain breastfeeding after return to work and to achieve their breastfeeding goals might improve the health of these mothers and their infants and positively impact their clinical breastfeeding advocacy. PMID:26918534

  20. Infant-Feeding Intentions and Practices of Internal Medicine Physicians.

    PubMed

    Sattari, Maryam; Serwint, Janet R; Shuster, Jonathan J; Levine, David M

    2016-05-01

    Personal breastfeeding behavior of physician mothers is associated with their clinical breastfeeding advocacy, which in turn impacts patients' breastfeeding behavior. Internists can play an important role in breastfeeding advocacy as they usually come in contact with mothers longitudinally. To explore the personal infant-feeding decisions and behavior of physician mothers in internal medicine (IM). Physicians with current or previous IM training were isolated from our "Breastfeeding Among Physicians" database. The data in the database were gathered from cross-sectional surveys of 130 physician volunteers, mainly affiliated with the Johns Hopkins University School of Medicine (Baltimore, MD) and the University of Florida College of Medicine (Gainesville, FL). Seventy-two mothers reported current or previous IM training and had 196 infants. Breastfeeding rates were 96% at birth, 77% at 6 months, and 40% at 12 months. Exclusive breastfeeding rates were 78% at birth, 67% at 3 months, and 30% at 6 months. While maternal goal for breastfeeding duration correlated with duration of both exclusive and any breastfeeding, there was a consistent and appreciable disparity between maternal duration goal and actual breastfeeding duration. The participants reported work-related reasons for early supplementation and breastfeeding cessation. We have described for the first time in the literature the personal infant-feeding intentions and behavior of a cohort of IM physician mothers. Workplace interventions to enable internists to maintain breastfeeding after return to work and to achieve their breastfeeding goals might improve the health of these mothers and their infants and positively impact their clinical breastfeeding advocacy.

  1. Funding global emergency medicine research-from seed grants to NIH support.

    PubMed

    Hansoti, Bhakti; Levine, Adam; Ganti, Latha; Oteng, Rockefeller; DesRosiers, Taylor; Modi, Payal; Brown, Jeremy

    2016-12-01

    Funding for global health has grown significantly over the past two decades. Numerous funding opportunities for international development and research work exist; however, they can be difficult to navigate. The 2013 Academic Emergency Medicine consensus conference on global health and emergency care identified the need to strengthen global emergency care research funding, solidify existing funding streams, and expand funding sources. This piece focuses on the various federal funding opportunities available to support emergency physicians conducting international research from seed funding to large institutional grants. In particular, we focus on the application and review processes for the Fulbright and Fogarty programs, National Institutes of Health (NIH) Career development awards, and the Medical Education Partnership Initiative (MEPI), including tips and pathways through each application process. Lastly, the paper provides an index that may be used as a guide in determining whether the amount of funding provided by a grant is worth the effort in applying.

  2. [The "International Society for the History of Medicine" and the "Société Française d'Histoire de la Médecine].

    PubMed

    Tricot, Jean-Pierre

    2003-01-01

    Professor J. P. Tricot as President of the International Society for the History of Medicine displayed the significant relationship between both Societies. He conjured up his grand-father's role, Professor J. J. Tricot-Royer, who founded the International Society of Medicine and he dealt with the creation of the Congresses by the International Society and particularly the first congress in Antwerp.

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

    PubMed

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

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

  4. Technical tips during implantation of selective upper airway stimulation.

    PubMed

    Heiser, Clemens; Thaler, Erica; Soose, Ryan J; Woodson, B Tucker; Boon, Maurits

    2018-03-01

    Selective upper airway stimulation is now well-established in the United States and in several European countries, with more than 1,000 patients implanted since U.S. Food and Drug Administration approval in April 2014. The authors herein, all head and neck surgeons, account for approximately one of every five implants completed to date. Several of the authors also provide comprehensive longitudinal care of their patients as dual-specialty sleep medicine physicians. Multi-center, retrospective clinical analysis. More than 300 implants have been evaluated and reviewed in five different implant centers (Germany, United States). This analysis shares tips and techniques from the collective experiences with more than 300 implants, which can help newer implanters learn vicariously both for standard practices in executing routine implants through activation and, importantly, for working through more challenging encounters with anatomy, special patient phenotypes, system testing, and troubleshooting. These tips should help new implanters handle most of the situations arising during implantation and avoid common pitfalls. Laryngoscope, 128:756-762, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Twelve tips for using applied improvisation in medical education.

    PubMed

    Hoffmann-Longtin, Krista; Rossing, Jonathan P; Weinstein, Elizabeth

    2018-04-01

    Future physicians will practice medicine in a more complex environment than ever, where skills of interpersonal communication, collaboration and adaptability to change are critical. Applied improvisation (or AI) is an instructional strategy which adapts the concepts of improvisational theater to teach these types of complex skills in other contexts. Unique to AI is its very active teaching approach, adapting theater games to help learners meet curricular objectives. In medical education, AI is particularly helpful when attempting to build students' comfort with and skills in complex, interpersonal behaviors such as effective listening, person-centeredness, teamwork and communication. This article draws on current evidence and the authors' experiences to present best practices for incorporating AI into teaching medicine. These practical tips help faculty new to AI get started by establishing goals, choosing appropriate games, understanding effective debriefing, considering evaluation strategies and managing resistance within the context of medical education.

  6. Prom Health and Safety Tips

    MedlinePlus

    ... Halloween Prom Tips Spring Break Valentine Tips Winter Holiday Tips 12 Ways Holiday Song Healthy Living Check-Ups are Important Check- ... Test Wash Hands Stay Warm Have a Healthy Holiday Don’t Drink and Drive Widgets Healthy People ...

  7. PREFACE: International Conference on Image Optimisation in Nuclear Medicine (OptiNM)

    NASA Astrophysics Data System (ADS)

    Christofides, Stelios; Parpottas, Yiannis

    2011-09-01

    Conference logo The International Conference on Image Optimisation in Nuclear Medicine was held at the Atlantica Aeneas Resort in Ayia Napa, Cyprus between 23-26 March 2011. It was organised in the framework of the research project "Optimising Diagnostic Value in SPECT Myocardial Perfusion Imaging" (YΓΕΙΑ/ΔYΓΕΙΑ/0308/11), funded by the Cyprus Research Promotion Foundation and the European Regional Development Fund, to present the highlights of the project, discuss the progress and results, and define future related goals. The aim of this International Conference was to concentrate on image optimization approaches in Nuclear Medicine. Experts in the field of nuclear medicine presented their latest research results, exchanged experiences and set future goals for image optimisation while balancing patient dose and diagnostic value. The conference was jointly organized by the Frederick Research Centre in Cyprus, the Department of Medical and Public Health Services of the Cyprus Ministry of Health, the Biomedical Research Foundation in Cyprus and the AGH University of Science and Technology in Poland. It was supported by the Cyprus Association of Medical Physics and Biomedical Engineering, and the Cyprus Society of Nuclear Medicine. The conference was held under the auspices of the European Federation of Organisations for Medical Physics and the European Association of Nuclear Medicine. The conference scientific programme covered several important topics such as functional imaging; image optimization; quantification for diagnosis; justification; simulations; patient dosimetry, staff exposures and radiation risks; quality assurance and clinical audit; education, training and radiation protection culture; hybrid systems and image registration; and new and competing technologies. The programme consisted of 13 invited and keynote presentations as well as workshops, round table discussions and a number of scientific sessions. A total of 51 speakers presented their

  8. The Effect of a CD-ROM Multimedia Tool on the Cardiac Auscultation Ability of Internal Medicine Residents

    PubMed Central

    Mangrulkar, Rajesh S.; Watt, John M.; Chapman, Chris M.; Judge, Richard D.; Stern, David T.

    2001-01-01

    In order to test the hypothesis that self study with a CD-ROM based cardiac auscultation tool would enhance knowledge and skills, we conducted a controlled trial of internal medicine residents and evaluated their performance on a test before and after exposure to the tool. Both intervention and control groups improved their auscultation knowledge and skills scores. However, subjects in the CD-ROM group had significantly higher improvements in skills, knowledge, and total scores than those not exposed to the intervention (all p<0.001). Therefore, protected time for internal medicine residents to use this multimedia computer program enhanced both facets of cardiac auscultation.

  9. Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned?

    PubMed

    Daneshvar, Farshid; Weinreich, Michael; Daneshvar, Danial; Sperling, Michael; Salmane, Chadi; Yacoub, Harout; Gabriels, James; McGinn, Thomas; Smith, Marianne C

    2017-02-01

    Previous studies have shown a falloff in physicians' physical activity from medical school to residency. Poor fitness may result in stress, increase resident burnout, and contribute to mortality from cardiovascular disease and other causes. Physicians with poor exercise habits are also less likely to counsel patients about exercise. Prior studies have reported resident physical activity but not cardiorespiratory fitness age. The study was conducted in 2 residency programs (3 hospitals) to assess internal medicine residents' exercise habits as well as their cardiorespiratory fitness age. Data regarding physical fitness levels and exercise habits were collected in an anonymous cross-sectional survey. Cardiopulmonary fitness age was determined using fitness calculator based on the Nord-Trøndelag Health Study (HUNT). Of 199 eligible physicians, 125 (63%) responded to the survey. Of respondents, 11 (9%) reported never having exercised prior to residency and 45 (36%) reported not exercising during residency ( P < .001). In addition, 42 (34%) reported exercising every day prior to residency, while only 5 (4%) reported exercising daily during residency ( P < .001), with 99 (79%) participants indicating residency obligations as their main barrier to exercise. We found residents' calculated mean fitness age to be 5.6 years higher than their mean chronological age ( P < .001). Internal medicine residents reported significant decreases in physical activity and fitness. Residents attributed time constraints due to training as a key barrier to physical activity.

  10. Intern evaluation strategies in family medicine residency education: what is-and is not-being done.

    PubMed

    Yates, Jennifer E

    2013-06-01

    Family medicine interns often have deficiencies that are not initially appreciated. By recognizing those growth opportunities early, programs may be able to better meet their interns' training needs. This study provides a needs assessment to ascertain what evaluation tools are being utilized by residency programs to assess their incoming interns. A questionnaire was sent to all US family medicine residency program coordinators (439 programs) via Survey Monkey© inquiring about whether intern evaluation is performed and, if so, what strategies are used. A mixed mode methodology was used: mailing with incentive, email prompts, and telephone calls. Of 439 programs, 220 (50%) responded to the survey. Most respondents (145, 66%) think intern evaluation is needed. However, only 79 (36%) programs are actually doing intern evaluations-only 14 (6.4%) extensively. Most programs are performing simulations (81, 45%) and assessing knowledge/comfort levels (79, 36%); less than one third are considering personality/learning styles, and almost no programs are evaluating skills such as typing (three, 1.4%) and math (one, 0.5%). Many programs use evaluations to guide future planning, help with early identification of challenging learners, and to match training to the residents' needs. Several programs expressed concern about how they would use the information once obtained. The majority of respondents agreed that a baseline intern evaluation is useful; few are actually doing it. This area is not well-described in the literature; residency programs could benefit from information sharing. The next step is to encourage interest in and implementation of such strategies.

  11. Tip off the HAT– Epigenetic control of learning and memory by Drosophila Tip60

    PubMed Central

    Xu, Songjun; Elefant, Felice

    2015-01-01

    Disruption of epigenetic gene control mechanisms involving histone acetylation in the brain causes cognitive impairment, a debilitating hallmark of most neurodegenerative disorders. Histone acetylation regulates cognitive gene expression via chromatin packaging control in neurons. Unfortunately, the histone acetyltransferases (HATs) that generate such neural epigenetic signatures and their mechanisms of action remain unclear. Our recent findings provide insight into this question by demonstrating that Tip60 HAT action is critical for morphology and function of the mushroom body (MB), the learning and memory center in the Drosophila brain. We show that Tip60 is robustly produced in MB Kenyon cells and extending axonal lobes and that targeted MB Tip60 HAT loss results in axonal outgrowth disruption. Functional consequences of loss and gain of Tip60 HAT levels in the MB are evidenced by defects in memory. Tip60 ChIP-Seq analysis reveals enrichment for genes that function in cognitive processes and accordingly, key genes representing these pathways are misregulated in the Tip60 HAT mutant fly brain. Remarkably, increasing levels of Tip60 in the MB rescues learning and memory deficits resulting from Alzheimer's disease associated amyloid precursor protein (APP) induced neurodegeneration. Our studies highlight the potential of HAT activators as a therapeutic option for cognitive disorders. PMID:26327426

  12. The pluralization of the international: Resistance and alter-standardization in regenerative stem cell medicine

    PubMed Central

    Rosemann, Achim; Chaisinthop, Nattaka

    2016-01-01

    The article explores the formation of an international politics of resistance and ‘alter-standardization’ in regenerative stem cell medicine. The absence of internationally harmonized regulatory frameworks in the clinical stem cell field and the presence of lucrative business opportunities have resulted in the formation of transnational networks adopting alternative research standards and practices. These oppose, as a universal global standard, strict evidence-based medicine clinical research protocols as defined by scientists and regulatory agencies in highly developed countries. The emergence of transnational spaces of alter-standardization is closely linked to scientific advances in rapidly developing countries such as China and India, but calls for more flexible regulatory frameworks, and the legitimization of experimental for-profit applications outside of evidence-based medical care, are emerging increasingly also within more stringently regulated countries, such as the United States and countries in the European Union. We can observe, then, a trend toward the pluralization of the standards, practices, and concepts in the stem cell field. PMID:26983174

  13. Advanced turbine blade tip seal system

    NASA Technical Reports Server (NTRS)

    Zelahy, J. W.

    1981-01-01

    An advanced blade/shroud system designed to maintain close clearance between blade tips and turbine shrouds and at the same time, be resistant to environmental effects including high temperature oxidation, hot corrosion, and thermal cycling is described. Increased efficiency and increased blade life are attained by using the advanced blade tip seal system. Features of the system include improved clearance control when blade tips preferentially wear the shrouds and a superior single crystal superalloy tip. The tip design, joint location, characterization of the single crystal tip alloy, the abrasive tip treatment, and the component and engine test are among the factors addressed. Results of wear testing, quality control plans, and the total manufacturing cycle required to fully process the blades are also discussed.

  14. Total Telephone Tips.

    ERIC Educational Resources Information Center

    Corder, Lloyd E.; And Others

    This manual of telephone behavior tips for business and sales professionals offers ways to handle the disgruntled caller and makes suggestions on topics relevant to the telephone. The manual is divided into the following sections and subsections: (1) Common Courtesy (staff tips, answering the telephone, screening calls, transferring calls, taking…

  15. [Drug-food interactions in internal medicine: What physicians should know?].

    PubMed

    Mouly, S; Morgand, M; Lopes, A; Lloret-Linares, C; Bergmann, J-F

    2015-08-01

    Orally administered medications may interact with various fruits, vegetables, herbal medicines, functional foods or dietary supplements. Drug-food interactions, which are mostly unknown from prescribers, including internists, may be responsible for changes in drug plasma concentrations, which may decrease efficacy or led to sometimes life-threatening toxicity. Aging, concomitant medications, transplant recipients, patients with cancer, malnutrition, HIV infection and those receiving enteral or parenteral feeding are at increased risk of drug-food interactions. This review focused on the most clinically relevant drug-food interactions, including those with grapefruit juice, Saint-John's Wort, enteral or parenteral nutrition, their respective consequences in the clinical setting in order to provide thoughtful information for internists in their routine clinical practice. Specific clinical settings are also detailed, such as the Ramadan or multiple medications especially in elderly patients. Drug-food interactions are also presented with respect to the main therapeutic families, including the non-steroidal anti-inflammatory drugs, analgesics, cardiovascular medications, warfarin as well as new oral anticoagulants, anticancer drugs and immunosuppressant medications. Considerable effort has been achieved to a better understanding of food-drug interactions and increase clinicians' ability to anticipate their occurrence and consequences in clinical practice. Describing the frequency of relevant food-drug interactions in internal medicine is paramount in order to optimize patient care and drug dosing on an individual basis as well as to increase patients and doctors information. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  16. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

    PubMed

    Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

    2014-05-01

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should

  17. Stochastic integrated assessment of climate tipping points indicates the need for strict climate policy

    NASA Astrophysics Data System (ADS)

    Lontzek, Thomas S.; Cai, Yongyang; Judd, Kenneth L.; Lenton, Timothy M.

    2015-05-01

    Perhaps the most `dangerous’ aspect of future climate change is the possibility that human activities will push parts of the climate system past tipping points, leading to irreversible impacts. The likelihood of such large-scale singular events is expected to increase with global warming, but is fundamentally uncertain. A key question is how should the uncertainty surrounding tipping events affect climate policy? We address this using a stochastic integrated assessment model, based on the widely used deterministic DICE model. The temperature-dependent likelihood of tipping is calibrated using expert opinions, which we find to be internally consistent. The irreversible impacts of tipping events are assumed to accumulate steadily over time (rather than instantaneously), consistent with scientific understanding. Even with conservative assumptions about the rate and impacts of a stochastic tipping event, today’s optimal carbon tax is increased by ~50%. For a plausibly rapid, high-impact tipping event, today’s optimal carbon tax is increased by >200%. The additional carbon tax to delay climate tipping grows at only about half the rate of the baseline carbon tax. This implies that the effective discount rate for the costs of stochastic climate tipping is much lower than the discount rate for deterministic climate damages. Our results support recent suggestions that the costs of carbon emission used to inform policy are being underestimated, and that uncertain future climate damages should be discounted at a low rate.

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

    PubMed

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

    2010-05-10

    (99m)Tc is the most widely used radionuclide in nuclear medicine. It is obtained by elution of (99)Mo-(99m)Tc generators. Depending on the quality of the generator and its integrity, (99)Mo may be extracted from the column during the elution process, becoming a radionuclidic impurity in the (99m)Tc eluate. This fact would impart an unnecessary dose to the patients submitted to diagnostic procedures. The aim of this work is to evaluate (99)Mo incorporation and internal effective doses in nuclear medicine patients through bioassay techniques, providing information on the metabolism of molybdenum in humans. A methodology based on in vivo and in vitro measurements was developed. In vivo measurements were performed with a NaI detector installed in the IRD WBC. Urine samples were analysed with a HPGe at the IRD bioassay laboratory. Patients showed detectable activities of (99)Mo in whole body and urine. Results were interpreted with AIDE software. Estimated incorporation was compared to predicted values based on ICRP model. Effective doses were in the order of micro sieverts. Results suggest the need to implement a routine quality control program of radionuclidic impurity of (99)Mo in (99m)Tc eluates to be conducted by radiopharmacy laboratories of nuclear medicine centers.

  19. [Re-organization of internal medicine wing in hospitals: a last-ditch effort or the beginning of reform?].

    PubMed

    Sharabi, Yehonatan

    2014-01-01

    Over the last decade numerous publications have dealt with ongoing changes in the traditional practice of internal medicine. In general, in-hospital medicine has evolved into ambulatory or specialized care. In this volume of Harefuah, Yinon et al. discuss trends at Shaare-Zedek Medical Center, focusing on the challenge of attracting residents to general internal medicine. Their model addresses local problems, but they have laid the groundwork for a more radical change. They present an evolutionary process that would transform hospital practice to become both more patient-centered and integrative, with an interdisciplinary team that translates the strengths of in-hospital (in- and out-patient care) vs. ambulatory or over-specialized care. Such reform should also include changes in clinical medical education, coupled with research and academic activities that can only take place in hospitals. The health care system is waiting for the next academic medical center that will take the lead in accepting this challenge and spearhead much needed reform.

  20. Scanning tip microwave near field microscope

    DOEpatents

    Xiang, Xiao-Dong; Schultz, Peter G.; Wei, Tao

    1998-01-01

    A microwave near field microscope has a novel microwave probe structure wherein the probing field of evanescent radiation is emitted from a sharpened metal tip instead of an aperture or gap. This sharpened tip, which is electrically and mechanically connected to a central electrode, extends through and beyond an aperture in an endwall of a microwave resonating device such as a microwave cavity resonator or a microwave stripline resonator. Since the field intensity at the tip increases as the tip sharpens, the total energy which is radiated from the tip and absorbed by the sample increases as the tip sharpens. The result is improved spatial resolution without sacrificing sensitivity.

  1. Impact of medicine-related information on medicine purchase and use by literate consumers.

    PubMed

    Thawani, Vijay R; Gharpure, Kunda J; Sontakke, Smita D

    2014-01-01

    To measure impact of information, education, and communication intervention (IEC) on rational medicine use, purchase, and stocking behavior. This was a pre- and post-design, interventional study. Base data were collected in first visit, using pre tested questionnaire from 500 respondents, who were of either gender, English speaking, at least graduates, permanent residents, and willing to participate. IEC was framed based on problems identified from this data. First intervention was handouts distributed in the second visit, containing information on cost saving in medicine purchase. Second intervention was a lecture session on medicine prices, rational use of medicines, and tips on saving on medicine purchase. Five articles about medicine use and price differences were published in the local newspaper, over 10 days, formed third intervention. After 1 month, post-intervention data was collected using same instrument with some additional questions. Results were analyzed by Chi-square test using Graph Pad prism Version 3.0. Awareness about price variation, self-medication, expiry period, generic and brand quality increased post-intervention. Attitudes toward new, costly, brands, injections, sharing and reusing old prescriptions changed post-intervention. Behavioral changes in stocking habits, adherence to doctors' advice, getting cash memo, comparing prices, reading labels, were seen post-intervention. People carry false notions about medicines which influence their use and habits. This intervention successfully changed behavior and could bring awareness on many aspects of medicine use.

  2. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned.

    PubMed

    Blumenthal, Daniel M; Bernard, Ken; Fraser, Traci N; Bohnen, Jordan; Zeidman, Jessica; Stone, Valerie E

    2014-11-30

    Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system. The course met weekly for two to three hours during July, 2013. Sessions included large group discussions and small group reflection meetings. Topics included leadership styles, emotional intelligence, and leading clinical teams. Course materials were designed internally and featured "business school style" case studies about everyday clinical medicine which explore how leadership skills impact care delivery. Participants evaluated the course's impact and quality using a post-course survey. Questions were structured in five point likert scale and free text format. Likert scale responses were converted to a 1-5 scale (1 = strongly disagree; 3 = neither agree nor disagree; 5 = strongly agree), and means were compared to the value 3 using one-way T-tests. Responses to free text questions were analyzed using the constant comparative method. All sixteen pilot course participants completed the survey. Participants overwhelmingly agreed that the course provided content and skills relevant to their clinical responsibilities and leadership roles. Most participants also acknowledged that taking the course improved their understanding of their strengths and weaknesses as leaders, different leadership styles, and how to manage interpersonal conflict on clinical teams. 88% also reported that the course increased their interest in pursuing additional leadership training. A clinical leadership course for internal medicine residents designed by colleagues, and utilizing case studies about clinical medicine, resulted in significant self-reported improvements in clinical leadership competencies.

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

    PubMed

    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.

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

    PubMed

    Sweileh, Waleed M

    2017-03-20

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

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

    PubMed

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

    PubMed Central

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

    2013-01-01

    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 advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: 1) the love of being a physician (“Raison d’être”), 2) family obligations (“2nd Shift”), and 3) balancing work demands with non-work life (“Negotiating Academic Medicine”). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists’ planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement. PMID:23605099

  7. Turbine blade with contoured chamfered squealer tip

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lee, Ching-Pang

    2014-12-30

    A squealer tip formed from a pressure side tip wall and a suction side tip wall extending radially outward from a tip of the turbine blade is disclosed. The pressure and suction side tip walls may be positioned along the pressure sidewall and the suction sidewall of the turbine blade, respectively. The pressure side tip wall may include a chamfered leading edge with film cooling holes having exhaust outlets positioned therein. An axially extending tip wall may be formed from at least two outer linear surfaces joined together at an intersection forming a concave axially extending tip wall. The axiallymore » extending tip wall may include a convex inner surface forming a radially outer end to an inner cavity forming a cooling system. The cooling system may include one or more film cooling holes in the axially extending tip wall proximate to the suction sidewall, which promotes increased cooling at the pressure and suction sidewalls.« less

  8. Evaluation of a redesign initiative in an internal-medicine residency.

    PubMed

    McMahon, Graham T; Katz, Joel T; Thorndike, Mary E; Levy, Bruce D; Loscalzo, Joseph

    2010-04-08

    Several organizations have advocated for comprehensive redesign of graduate medical training, but the effect that residency redesign will have on measures of patient satisfaction, resident and intern (trainee) satisfaction, and patient care is unknown. We designed an experimental inpatient-medicine service with reduced resident workload comprising two teams, with each team consisting of two attending physicians, two residents, and three interns. Attending physicians, selected for their teaching prowess, supervised the teams throughout the workday and during bedside team-teaching rounds. This experimental model was compared with a control model comprising two teams, with each consisting of one resident and two interns, plus multiple supervising attending physicians who volunteered to participate. Patients were alternately assigned to the experimental teams and the control teams, subject to limits on the number of patients interns are allowed to admit. Over a 12-month period, 1892 patients were assigned to the experimental teams and 2096 to the control teams; the average census per intern was 3.5 and 6.6 patients, respectively. Overall satisfaction was significantly higher among trainees on the experimental teams than among those on the control teams (78% and 55%, respectively; P=0.002). As compared with the control teams, the experimental teams were not associated with a higher average length of patient stay or readmission rate; adherence to standards for quality of inpatient care was similar in both groups of teams. Interns on the experimental teams spent more time in learning and teaching activities than did interns on the control teams (learning: 20% of total time vs. 10%, P=0.01; teaching: 8% of total time vs. 2%, P=0.006). As compared with a traditional inpatient care model, an experimental model characterized by reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for

  9. Slender tip laser scalpel

    DOEpatents

    Veligdan, James T.

    2004-01-06

    A laser scalpel includes a ribbon optical waveguide extending therethrough and terminating at a slender optical cutting tip. A laser beam is emitted along the height of the cutting tip for cutting tissue therealong.

  10. Scanning tip microwave near field microscope

    DOEpatents

    Xiang, X.D.; Schultz, P.G.; Wei, T.

    1998-10-13

    A microwave near field microscope has a novel microwave probe structure wherein the probing field of evanescent radiation is emitted from a sharpened metal tip instead of an aperture or gap. This sharpened tip, which is electrically and mechanically connected to a central electrode, extends through and beyond an aperture in an end wall of a microwave resonating device such as a microwave cavity resonator or a microwave stripline resonator. Since the field intensity at the tip increases as the tip sharpens, the total energy which is radiated from the tip and absorbed by the sample increases as the tip sharpens. The result is improved spatial resolution without sacrificing sensitivity. 17 figs.

  11. Prescription, Dispensation, and Generic Medicine Replacement Ratios: Influence on Japanese Medicine Costs

    PubMed Central

    Yokoi, Masayuki; Tashiro, Takao

    2016-01-01

    This study used publicly available data to examine the effect of the separation of dispensing and prescribing medicines between pharmacists in pharmacies and doctors in medical institutions (the separation system) and the generic medicine replacement ratio on the cost of various medicines in Japanese prefectures. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each administrative district is highly variable. In our multiple regression analysis, the dependent variables were the costs of daily medicines, specifically, total, internal, external, and injection medicines, as well as medical devices, and the independent variables were the expansion rate of the separation system and generic medicine replacement ratio. The expansion rate of the separation system showed a significant negative partial correlation with the daily costs of total, internal, and injection medicines as well as medical devices. Moreover, the rate of replacing brand name medicines with generic medicines showed a significant negative partial correlation with the daily costs of total and internal medicines. However, external and injection medicines and medical devices did not because only a few or no generic products of these types were sold in the Japanese market. Otherwise, expansion of the separation system was effective in reducing medicine costs, except in the case of external medicines. This suggests that the cost efficiency effect of the separation system does not function all the time. PMID:26234979

  12. Progress on the FIReTIP Diagnostic on NSTX-U

    NASA Astrophysics Data System (ADS)

    Scott, Evan; Barchfeld, Robert; Riemenschneider, Paul; Muscatello, Chris; Sohrabi, Mohammad; Domier, Calvin; Ren, Yang; Kaita, Robert; Luhmann, Neville, Jr.; NSTX-U Team

    2016-10-01

    The Far-infrared Tangential Interferometer/Polarimeter (FIReTIP) system on NSTX-U at the PPPL aims to provide robust, line-averaged electron density measurements. The system consists of three optically-pumped 119 µm methanol lasers, one of which can be tuned via Stark broadening, allowing for uniquely high intermediate frequencies and time resolutions. One of the major goals of FIReTIP is to incorporate it into the NSTX-U plasma control system (PCS) for real-time plasma density feedback control. The front-end optics mounted to Bay G, which shape and position the beam going into the plasma, and internal retroreflector located near Bay B, which facilitates double-pass measurements, are hard-mounted to the NSTX-U vacuum vessel. Because interferometric density measurements are sensitive to vibrational effects, FIReTIP has been upgraded to a two-color interferometer system with the inclusion of a 633 nm laser interferometer for the direct measurement of vibrations and a field programmable gate array (FPGA) for the subsequent subtraction of vibrational effects from the density measurement in real-time. This work is supported by the U.S. Department of Energy Grant DE-FG02-99ER54518.

  13. Current Perspective in the International Trade of Medicinal Plants Material: An Update.

    PubMed

    Vasisht, Karan; Sharma, Neetika; Karan, Maninder

    2016-01-01

    The recent years have seen an increased interest in medicinal plants together with the therapeutic use of phytochemicals. Medicinal plants are utilized by the industry for the production of extracts, phytopharmaceuticals, nutraceuticals and cosmeceuticals and their use is expected to grow faster than the conventional drugs. The enormous demand of medicinal plant material has resulted in huge trade both at domestic and international levels. The trade data of medicinal plant material with commodity code HS 1211 (SITC.4, code 292.4) and their derived/related products which are traded under different commodity codes has been acquired from COMTRADE, Trade Map, country reports, technical documents etc for the period 2001 to 2014. The data was analyzed using statistical tools to draw conclusions. The significant features of the global trade; the leading source, consumer, import and export countries; and the striking trends are presented. The trade of the ten key countries and the selected important items is also discussed in detail. The conservative figure of trade of medicinal plants materials and their derived/related products including extracts, essential oils, phytopharmaceuticals, gums, spices used in medicine, tannins for pharmaceutical use, ingredients for cosmetics etc. as calculated from the global export data for the year 2014 is estimated at USD 33 billion. The average global export in medicinal plants under HS 1211 for the fourteen year period was USD 1.92 billion for 601,357 tons per annum and for the year 2014 it stood at 702,813 tons valued at USD 3.60 billion. For the studied period, an annual average growth rate (AAGR) of 2.4% in volumes and 9.2% in values of export was observed. Nearly 30% of the global trade is made up by top two countries of the import and export. China and India from Asia; Egypt and Morocco from Africa; Poland, Bulgaria and Albania from Europe; Chile and Peru from South America are important supply sources. The USA, Japan and Europe

  14. Reference system for scanning probe tip fingerprinting

    NASA Astrophysics Data System (ADS)

    Turansky, Robert; Bamidele, Joseph; Sugawara, Yasuhiro; Kantorovitch, Lev; Stich, Ivan

    2012-02-01

    Knowledge of the chemical structure of the tip asperity in Non-Contact Atomic Force Microscopy (NC-AFM) is crucial as controlled manipulation of atoms and/or molecules on surfaces can only be performed if this information is available. However, a simple and robust protocol for ensuring a specific tip termination has not yet been developed. We propose a procedure for chemical tip finger printing and an example of a reference system, the oxygen-terminated Cu(110) surface, that enables one to ensure a specific tip termination with Si, Cu, or O atoms. To follow this up and unambiguously determine tip types, we performed a theoretical DFT study of the line scans with the tip models in question and found that the tip characterization made based on experimental results (Cu/O-terminated tip imaging Cu/O atoms) is in fact incorrect and the opposite is true (Cu/O-terminated tip imaging O/Cu atoms). This protocol allows the tip asperity's chemical structure to be verified and established both before as well as at any stage of the manipulation experiment when numerous tip changes may take place.

  15. Getting Out of Silos: An Innovative Transitional Care Curriculum for Internal Medicine Residents Through Experiential Interdisciplinary Learning

    PubMed Central

    Schoenborn, Nancy L.; Christmas, Colleen

    2013-01-01

    Background Care transitions are common and highly vulnerable times during illness. Physicians need better training to improve care transitions. Existing transitional care curricula infrequently involve settings outside of the hospital or other health care disciplines. Intervention We created a curriculum to teach internal medicine residents how to provide better transitional care at hospital discharge through experiential, interdisciplinary learning in different care settings outside of the acute hospital, and we engaged other health care disciplines frequently involved in care transitions. Setting/Participants Nineteen postgraduate year-1 internal medicine trainees at an academic medical center in an urban location completed experiences in a postacute care facility, home health care, and outpatient clinics. Program Description The 2-week required curriculum involved teachers from geriatric medicine; physical, occupational, and speech therapy; and home health care, with both didactic and experiential components and self-reflective exercises. Program Evaluation The curriculum was highly rated (6.86 on a 9-point scale) and was associated with a significant increase in the rating of the overall quality of transitional care education (from 4.09 on a 5-point scale in 2011 to 4.53 in 2012) on the annual residency program survey. Learners reported improved knowledge in key curricular areas and that they would change practice as a result of the curriculum. Conclusions Our transitional care curriculum for internal medicine residents provides exposure to care settings and health care disciplines that patients frequently encounter. The curriculum has shown positive, short-term effects on learners' perceived knowledge and behavior. PMID:24455024

  16. Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist.

    PubMed

    Guignard, Bertrand; Bonnabry, Pascal; Perrier, Arnaud; Dayer, Pierre; Desmeules, Jules; Samer, Caroline Flora

    2015-07-01

    Patients admitted to general internal medicine wards might receive a large number of drugs and be at risk for drug-related problems (DRPs) associated with increased morbidity and mortality. This study aimed to detect suboptimal drug use in internal medicine by a pharmacotherapy evaluation, to suggest treatment optimizations and to assess the acceptance and satisfaction of the prescribers. This was a 6-month prospective study conducted in two internal medicine wards. Physician rounds were attended by a pharmacist and a pharmacologist. An assessment grid was used to detect the DRPs in electronic prescriptions 24h in advance. One of the following interventions was selected, depending on the relevance and complexity of the DRPs: no intervention, verbal advice of treatment optimization, or written consultation. The acceptance rate and satisfaction of prescribers were measured. In total, 145 patients were included, and 383 DRPs were identified (mean: 2.6 DRPs per patient). The most frequent DRPs were drug interactions (21%), untreated indications (18%), overdosages (16%) and drugs used without a valid indication (10%). The drugs or drug classes most frequently involved were tramadol, antidepressants, acenocoumarol, calcium-vitamin D, statins, aspirin, proton pump inhibitors and paracetamol. The following interventions were selected: no intervention (51%), verbal advice of treatment optimization (42%), and written consultation (7%). The acceptance rate of prescribers was 84% and their satisfaction was high. Pharmacotherapy expertise during medical rounds was useful and well accepted by prescribers. Because of the modest allocation of pharmacists and pharmacologists in Swiss hospitals, complementary strategies would be required. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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

    PubMed

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

    2011-06-01

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

  18. Understanding Resident Learning Preferences Within an Internal Medicine Noon Conference Lecture Series: A Qualitative Study

    PubMed Central

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

    2014-01-01

    Background The lecture remains the most common approach for didactic offerings in residency programs despite conflicting evidence about the effectiveness of this format. Objective The purpose of this study was to explore the perspectives of internal medicine residents toward conferences held in the lecture format. Methods The investigators invited internal medicine residents (N  =  144) to participate in focus groups discussing their perspectives about noon conference lectures. The investigators used a semistructured guide to ask about motivations for attendance and effectiveness of noon conferences, transcribed the recordings, coded the discussions, and analyzed the results. Results Seven focus groups with a total of 41 residents were held. This identified 4 major domains: (1) motivations for attendance; (2) appropriate content; (3) effective teaching methods; and (4) perspectives on active participation. Residents' motivations were categorized into external factors, including desire for a break and balance to their workload, and intrinsic attributes, including the learning opportunity, topic, and speaker. Appropriate content was described as clinically relevant, practical, and presenting a balance of evidence. Identified effective teaching methods included shorter teaching sessions focused on high-yield learning points structured around cases and questions. While active participation increases residents' perceived level of stress, the benefits of this format include increased attention and learning. Conclusions This study furthers our knowledge of the learning preferences of internal medicine residents within the changing environment of residency education and can be used in conjunction with principles of adult learning to reform how we deliver core medical knowledge. PMID:24701307

  19. [Position paper of the German Society for Medical Intensive Care Medicine and Emergency Medicine (DGIIN) on medical intensive care medicine].

    PubMed

    Riessen, R; Janssens, U; Buerke, M; Kluge, S

    2016-05-01

    In this paper the German Society for Medical Intensive Care Medicine and Emergency Medicine (DGIIN) provides statements regarding the importance and advancement of Medical Intensive Care Medicine within the structures of Internal Medicine in Germany. Of pivotal importance are the training of medical intensivists, the cooperation with intensivists from other disciplines and the collaboration with emergency departments. In order to fulfil the various and challenging tasks in patient care, training, research and medical education competently and on an international level, more intensivists in leading positions especially in academic institutions are essential.

  20. Development and Implementation of a Web-based Evaluation System for an Internal Medicine Residency Program.

    ERIC Educational Resources Information Center

    Rosenberg, Mark E.; Watson, Kathleen; Paul, Jeevan; Miller, Wesley; Harris, Ilene; Valdivia, Tomas D.

    2001-01-01

    Describes the development and implementation of a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Features include automatic entry of evaluations by faculty or students into a database, compliance tracking, reminders, extensive reporting capabilities, automatic…

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

    PubMed

    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.

  2. [Lung abscess and thoracic empyema: retrospective analysis in an internal medicine department].

    PubMed

    Monteiro, Rita; Alfaro, Tiago M; Correia, Lurdes; Simão, Adélia; Carvalho, Armando; Costa, J Nascimento

    2011-12-01

    Lung abscess is a collection of necrotic and suppurated tissue located at the pulmonary parenchyma. Empyema is defined as the presence of pus in the pleural space. To study the clinical and microbiological characteristics, treatment and prognosis of patients with lung abscess and/or empyema admitted to an Internal Medicine ward. A retrospective analysis of medical records was performed, including all patients admitted to an Internal Medicine ward for lung abscess or empyema, between 2000 and 2008. Thirty patients were included (22 males/ eight females), accounting for 0.18% of all patients admitted in this ward in the same period. Three patients had pulmonary abscess, 18 empyema, and nine both diseases. The average age was 68.5 years (31 to 90). The most frequent complaints were dyspnoea (90%), fever (73.3%), cough (66.7%), weight loss (60%) and chest pain (53.3%). The most frequent associated disorders were stroke associated disability (46.7%), heart failure (43.3%) and arterial hypertension (33.3%). Thoracentesis was performed in all patients with empyema. In one patient with lung abscess an anaerobic microorganism was identified. In patients with empyema, cultures were positive in 61.1% of cases, with a slight predominance of methicillin-resistant Staphylococcus aureus (27.3%) and Prevotella intermedia (18.2%). In patients with both abscess and empyema, cultures of the abscess were positive in 44.4% and of the pleural fluid in 33.3%, with no predominant microorganism. Empiric antimicrobial therapy was started in all patients and later adapted to the antibiotic sensitivity test results. Surgery was performed in three patients. Seven patients (23.3%) died during admission. The average age of the patients who died was 81.3 years and of those who survived was 64.5 years. Lung abscess and empyema are infrequent diseases in an Internal Medicine ward, affect mostly males and have unspecific clinical manifestations. The chest X-ray, computed tomography (CT) and

  3. The relationship between communication scores from the USMLE Step 2 Clinical Skills examination and communication ratings for first-year internal medicine residents.

    PubMed

    Winward, Marcia L; Lipner, Rebecca S; Johnston, Mary M; Cuddy, Monica M; Clauser, Brian E

    2013-05-01

    This study extends available evidence about the relationship between scores on the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination and subsequent performance in residency. It focuses on the relationship between Step 2 CS communication and interpersonal skills scores and communication skills ratings that residency directors assign to residents in their first postgraduate year of internal medicine training. It represents the first large-scale evaluation of the extent to which Step 2 CS communication and interpersonal skills scores can be extrapolated to examinee performance in supervised practice. Hierarchical linear modeling techniques were used to examine the relationships among examinee characteristics, residency program characteristics, and residency-director-provided ratings. The sample comprised 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and received ratings during their first year of internal medicine residency training. Although the relationship is modest, Step 2 CS communication and interpersonal skills scores predict communication skills ratings for first-year internal medicine residents after accounting for other factors. The results of this study make a reasonable case that Step 2 CS communication and interpersonal skills scores provide useful information for predicting the level of communication skill that examinees will display in their first year of internal medicine residency training. This finding demonstrates some level of extrapolation from the testing context to behavior in supervised practice, thus providing validity-related evidence for using Step 2 CS communication and interpersonal skills scores in high-stakes decisions.

  4. Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients

    PubMed Central

    Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

    2016-01-01

    Abstract Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan. A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays. Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16–1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15–1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05–2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03–1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09–1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01–1.06; P = 0.008) than weekday-admitted patients. General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment. PMID:26871788

  5. Chemically etched fiber tips for near-field optical microscopy: a process for smoother tips.

    PubMed

    Lambelet, P; Sayah, A; Pfeffer, M; Philipona, C; Marquis-Weible, F

    1998-11-01

    An improved method for producing fiber tips for scanning near-field optical microscopy is presented. The improvement consists of chemically etching quartz optical fibers through their acrylate jacket. This new method is compared with the previous one in which bare fibers were etched. With the new process the meniscus formed by the acid along the fiber does not move during etching, leading to a much smoother surface of the tip cone. Subsequent metallization is thus improved, resulting in better coverage of the tip with an aluminum opaque layer. Our results show that leakage can be avoided along the cone, and light transmission through the tip is spatially limited to an optical aperture of a 100-nm dimension.

  6. ADHD: Tips to Try

    MedlinePlus

    ... Staying Safe Videos for Educators Search English Español ADHD: Tips to Try KidsHealth / For Teens / ADHD: Tips to Try Print en español TDAH: Consejos que puedes probar ADHD , short for attention deficit hyperactivity disorder , is a ...

  7. Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs.

    PubMed

    Choe, John H; Knight, Christopher L; Stiling, Rebekah; Corning, Kelli; Lock, Keli; Steinberg, Kenneth P

    2016-07-01

    The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.

  8. Effects of Double-Leakage Tip Clearance Flow on the Performance of a Compressor Stage with a Large Rotor Tip Gap

    NASA Technical Reports Server (NTRS)

    Hah, Chunill

    2016-01-01

    Effects of a large rotor tip gap on the performance of a one and half stage axial compressor are investigated in detail with a numerical simulation based on LES and available PIV data. The current paper studies the main flow physics, including why and how the loss generation is increased with the large rotor tip gap. The present study reveals that when the tip gap becomes large, tip clearance fluid goes over the tip clearance core vortex and enters into the next blade's tip gap, which is called double-leakage tip clearance flow. As the tip clearance flow enters into the adjacent blade's tip gap, a vortex rope with a lower pressure core is generated. This vortex rope breaks up the tip clearance core vortex of the adjacent blade, resulting in a large additional mixing. This double-leakage tip clearance flow occurs at all operating conditions, from design flow to near stall condition, with the large tip gap for the current compressor stage. The double-leakage tip clearance flow, its interaction with the tip clearance core vortex of the adjacent blade, and the resulting large mixing loss are the main flow mechanism of the large rotor tip gap in the compressor. When the tip clearance is smaller, flow near the end wall follows more closely with the main passage flow and this double-leakage tip clearance flow does not happen near the design flow condition for the current compressor stage. When the compressor with a large tip gap operates at near stall operation, a strong vortex rope is generated near the leading edge due to the double-leakage flow. Part of this vortex separates from the path of the tip clearance core vortex and travels from the suction side of the blade toward the pressure side of the blade. This vortex is generated periodically at near stall operation with a large tip gap. As the vortex travels from the suction side to the pressure side of the blade, a large fluctuation of local pressure forces blade vibration. Nonsynchronous blade vibration occurs due

  9. Magnet pole tips

    DOEpatents

    Thorn, Craig E.; Chasman, Chellis; Baltz, Anthony J.

    1984-04-24

    An improved magnet which more easily provides a radially increasing magnetic field, as well as reduced fringe field and requires less power for a given field intensity. The subject invention comprises a pair of spaced, opposed magnetic poles which further comprise a pair of pole roots, each having a pole tip attached to its center. The pole tips define the gap between the magnetic poles and at least a portion of each pole tip is separated from its associated pole root. The separation begins at a predetermined distance from the center of the pole root and increases with increasing radial distance while being constant with azimuth within that portion. Magnets in accordance with the subject invention have been found to be particularly advantageous for use in large isochronous cyclotrons.

  10. Magnet pole tips

    DOEpatents

    Thorn, C.E.; Chasman, C.; Baltz, A.J.

    1981-11-19

    An improved magnet more easily provides a radially increasing magnetic field, as well as reduced fringe field and requires less power for a given field intensity. The subject invention comprises a pair of spaced, opposed magnetic poles which further comprise a pair of pole roots, each having a pole tip attached to its center. The pole tips define the gap between the magnetic poles and at least a portion of each pole tip is separated from its associated pole root. The separation begins at a predetermined distance from the center of the pole root and increases with increasing radial distance while being constant with azimuth within that portion. Magnets in accordance with the subject invention have been found to be particularly advantageous for use in large isochronous cyclotrons.

  11. Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips.

    PubMed

    Helvacioglu, Firat; Yeter, Celal; Tunc, Zeki; Sencan, Sadik

    2013-08-01

    To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12-degree and 22-degree bent tips using the Infiniti Vision System. Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Comparative case series. Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22-degree bent tip (Group 1) or a 12-degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds ± 27.23 (SD), 11.53 ± 6.99, 0.22 ± 0.26, and 42.86 ± 15.64, respectively, in Group 1 and 84 ± 45.04 seconds, 16.68 ± 10.66, 0.48 ± 0.68, and 46.27 ± 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 ± 28.58 cc in Group 1 and 82.08 ± 26.21 cc in Group 2 (P=.134). Torsional phacoemulsification performed with 22-degree bent tips provided more effective lens removal than 12-degree bent tips, with a lower UST and CDE. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  12. [Representation of Internal Medicine in G-DRG System - Analysis of Reasons for Prolonged Length of Stay].

    PubMed

    Siam, Kristina; Roeder, Norbert; Fölsch, Ulrich R; Spies, Hans-Friedrich

    2017-08-01

    Background  There is an ongoing discussion within the German Society of Internal Medicine (DGIM) and the Professional Association of German Internists (BDI) about the appropriate depiction and remuneration of internal medicine in the G-DRG. Method  Therefore, cases with a significantly prolonged length of stay were analyzed in a multicenter study. 124 cases from 6 hospitals were collected for evaluation. Results  The results show that the observed prolongation of hospitalization was mainly due to medical reasons. Discussion  Thus, patients with unclear symptoms and consequently need for a thorough workup could not be identified to cause longer inpatient stay. Instead, treatment complications and comorbidities led to extended hospitalization. The results also reveal prolonged hospitalization as a consequence of unsettled or delayed postdischarge care e. g. in rehabilitation facilities. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Validity of three clinical performance assessments of internal medicine clerks.

    PubMed

    Hull, A L; Hodder, S; Berger, B; Ginsberg, D; Lindheim, N; Quan, J; Kleinhenz, M E

    1995-06-01

    To analyze the construct validity of three methods to assess the clinical performances of internal medicine clerks. A multitrait-multimethod (MTMM) study was conducted at the Case Western Reserve University School of Medicine to determine the convergent and divergent validity of a clinical evaluation form (CEF) completed by faculty and residents, an objective structured clinical examination (OSCE), and the medicine subject test of the National Board of Medical Examiners. Three traits were involved in the analysis: clinical skills, knowledge, and personal characteristics. A correlation matrix was computed for 410 third-year students who completed the clerkship between August 1988 and July 1991. There was a significant (p < .01) convergence of the four correlations that assessed the same traits by using different methods. However, the four convergent correlations were of moderate magnitude (ranging from .29 to .47). Divergent validity was assessed by comparing the magnitudes of the convergence correlations with the magnitudes of correlations among unrelated assessments (i.e., different traits by different methods). Seven of nine possible coefficients were smaller than the convergent coefficients, suggesting evidence of divergent validity. A significant CEF method effect was identified. There was convergent validity and some evidence of divergent validity with a significant method effect. The findings were similar for correlations corrected for attenuation. Four conclusions were reached: (1) the reliability of the OSCE must be improved, (2) the CEF ratings must be redesigned to further discriminate among the specific traits assessed, (3) additional methods to assess personal characteristics must be instituted, and (4) several assessment methods should be used to evaluate individual student performances.

  14. Gas only nozzle fuel tip

    DOEpatents

    Bechtel, William Theodore; Fitts, David Orus; DeLeonardo, Guy Wayne

    2002-01-01

    A diffusion flame nozzle gas tip is provided to convert a dual fuel nozzle to a gas only nozzle. The nozzle tip diverts compressor discharge air from the passage feeding the diffusion nozzle air swirl vanes to a region vacated by removal of the dual fuel components, so that the diverted compressor discharge air can flow to and through effusion holes in the end cap plate of the nozzle tip. In a preferred embodiment, the nozzle gas tip defines a cavity for receiving the compressor discharge air from a peripheral passage of the nozzle for flow through the effusion openings defined in the end cap plate.

  15. Impact of medicine-related information on medicine purchase and use by literate consumers

    PubMed Central

    Thawani, Vijay R.; Gharpure, Kunda J.; Sontakke, Smita D.

    2014-01-01

    Aims: To measure impact of information, education, and communication intervention (IEC) on rational medicine use, purchase, and stocking behavior. Materials and Methods: This was a pre- and post-design, interventional study. Base data were collected in first visit, using pre tested questionnaire from 500 respondents, who were of either gender, English speaking, at least graduates, permanent residents, and willing to participate. IEC was framed based on problems identified from this data. First intervention was handouts distributed in the second visit, containing information on cost saving in medicine purchase. Second intervention was a lecture session on medicine prices, rational use of medicines, and tips on saving on medicine purchase. Five articles about medicine use and price differences were published in the local newspaper, over 10 days, formed third intervention. After 1 month, post-intervention data was collected using same instrument with some additional questions. Results were analyzed by Chi-square test using Graph Pad prism Version 3.0. Results: Awareness about price variation, self-medication, expiry period, generic and brand quality increased post-intervention. Attitudes toward new, costly, brands, injections, sharing and reusing old prescriptions changed post-intervention. Behavioral changes in stocking habits, adherence to doctors’ advice, getting cash memo, comparing prices, reading labels, were seen post-intervention. Conclusion: People carry false notions about medicines which influence their use and habits. This intervention successfully changed behavior and could bring awareness on many aspects of medicine use. PMID:25097282

  16. Senior internal medicine residents' confidence with essential topics in evidence-based medicine taught during internship.

    PubMed

    Keddis, Mira T; Beckman, Thomas J; Cullen, Michael W; Reed, Darcy A; Halvorsen, Andrew J; Wittich, Christopher M; West, Colin P; McDonald, Furman S

    2011-12-01

    Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, -0.86; P  =  .002), study design for prognosis questions (mean difference, -0.75; P  =  .004), number needed to harm (mean difference, -0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, -0.65, P  =  .009), and retrieval of evidence (mean difference, -0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught

  17. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

    PubMed

    Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu

    2015-12-01

    The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and 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 concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

  18. Families with Special Needs: Caregiving Tips

    MedlinePlus

    ... Halloween Prom Tips Spring Break Valentine Tips Winter Holiday Tips 12 Ways Holiday Song Healthy Living Check-Ups are Important Check- ... Test Wash Hands Stay Warm Have a Healthy Holiday Don’t Drink and Drive Widgets Healthy People ...

  19. Genotoxicity effects of silver nanoparticles on wheat (Triticum aestivum L.) root tip cells.

    PubMed

    Abdelsalam, Nader R; Abdel-Megeed, Ahmed; Ali, Hayssam M; Salem, Mohamed Z M; Al-Hayali, Muwafaq F A; Elshikh, Mohamed S

    2018-07-15

    The distribution and use of nanoparticles have rapidly increased over recent years, but the available knowledge regarding their mode of action, ecological tolerance and biodegradability remains insufficient. Wheat (Triticum aestivum L.) is the most important crop worldwide. In the current study, the effects of silver nanoparticles (AgNPs) obtained from two different sources, namely, green and chemical syntheses, on chromosomal aberrations and cell division were investigated. Wheat root tips were treated with four different AgNP concentrations (10, 20, 40 and 50 ppm) for three different exposure durations (8, 16 and 24 h), and the different concentrations of the nanoparticles were added to the tested grains until the root lengths reached 1.5-2 cm. For each concentration, the mitotic indexes (%) were obtained from an analysis of ~ 2000 cells. The treated root-tip cells exhibited various types of chromosomal aberrations, such as incorrect orientation at metaphase, chromosomal breakage, metaphasic plate distortion, spindle dysfunction, stickiness, aberrant movement at metaphase, fragmentation, scattering, unequal separation, scattering, chromosomal gaps, multipolar anaphase, erosion, and distributed and lagging chromosomes. These results demonstrate that the root tip cells of wheat can readily internalize the AgNPs and that the internalized AgNPs can interfere with the cells' normal function. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Tip cap for a rotor blade

    NASA Technical Reports Server (NTRS)

    Kofel, W. K.; Tuley, E. N.; Gay, C. H., Jr.; Troeger, R. E.; Sterman, A. P. (Inventor)

    1983-01-01

    A replaceable tip cap for attachment to the end of a rotor blade is described. The tip cap includes a plurality of walls defining a compartment which, if desired, can be divided into a plurality of subcompartments. The tip cap can include inlet and outlet holes in walls thereof to permit fluid communication of a cooling fluid there through. Abrasive material can be attached with the radially outer wall of the tip cap.

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

    PubMed

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

    2009-12-01

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

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

    PubMed

    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.

  3. [Integrative medicine development in China: enlightenment from Kampo medicine].

    PubMed

    Gao, Peng-fei

    2011-10-01

    Japanese Kampo medicine has made huge progress in the 300-year development, especially in Kampo education, research and development of Kampo medicinal drugs, and industrialization and internationalization of Kampo medicine in recent 30 years. Based on the study of Japanese Kampo medicine, this article discussed some characteristics of Kampo medicine. For example, the emphasis of Kampo medicine research is the effectiveness and scientificalness; classical prescriptions are the main application in Kampo medicine while it also values correspondence between prescription and syndrome as well as abdomen examination; Kampo medicine emphasized the continuity of education after graduation; international development is accelerating in the research of Kampo medicinal drugs. Such a development strategy of Kampo medicine may benefit the development of integrative medicine in China.

  4. Internal medicine in the United States and Germany: mutual influences from 1870 to today.

    PubMed

    Schulte-Bockolt, Arnd; Soergel, Konrad H; Stein, Juergen

    2016-11-01

    Over the past 140 years, the close academic and clinical interactions in Internal Medicine between German-speaking countries and the United States have been through three distinct stages. From 1870 until the First World War, German medical research, teaching, and university organization served as a model for U.S. medical schools and practice. However, after World War I, medical education reforms were implemented in the U.S., and due also to radical economic and political changes at home, German medicine lost its pioneering role. Furthermore, many scientists and clinicians were forced to emigrate in the face of racial and political persecution in Germany and Austria. Since the Second World War, American medicine has grown further to become the world leader in research, training, and clinical practice. The earlier trend of American physicians studying abroad was thus reversed, with many of today's foremost German physicians completing clinical and research training in the United States.

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

    PubMed

    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.

  6. Assessing the Effects of the 2003 Resident Duty Hours Reform on Internal Medicine Board Scores

    PubMed Central

    Romano, Patrick S.; Itani, Kamal M.F.; Rosen, Amy K.; Small, Dylan; Lipner, Rebecca S.; Bosk, Charles L.; Wang, Yanli; Halenar, Michael J.; Korovaichuk, Sophia; Even-Shoshan, Orit; Volpp, Kevin G.

    2014-01-01

    Purpose To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. Method The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform. Results The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23), −3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores. Conclusions The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations. PMID:24556772

  7. Assessing the effects of the 2003 resident duty hours reform on internal medicine board scores.

    PubMed

    Silber, Jeffrey H; Romano, Patrick S; Itani, Kamal M F; Rosen, Amy K; Small, Dylan; Lipner, Rebecca S; Bosk, Charles L; Wang, Yanli; Halenar, Michael J; Korovaichuk, Sophia; Even-Shoshan, Orit; Volpp, Kevin G

    2014-04-01

    To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform. The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were -5.43 (-7.63, -3.23), -3.44 (-5.65, -1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores. The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations.

  8. Chronic kidney disease care delivered by US family medicine and internal medicine trainees: results from an online survey

    PubMed Central

    Lenz, Oliver; Fornoni, Alessia

    2006-01-01

    Background Complications of chronic kidney disease (CKD) contribute to morbidity and mortality. Consequently, treatment guidelines have been developed to facilitate early detection and treatment. However, given the high prevalence of CKD, many patients with early CKD are seen by non-nephrologists, who need to be aware of CKD complications, screening methods and treatment goals in order to initiate timely therapy and referral. Methods We performed a web-based survey to assess perceptions and practice patterns in CKD care among 376 family medicine and internal medicine trainees in the United States. Questions were focused on the identification of CKD risk factors, screening for CKD and associated co-morbidities, as well as management of anemia and secondary hyperparathyroidism in patients with CKD. Results Our data show that CKD risk factors are not universally recognized, screening for CKD complications is not generally taken into consideration, and that the management of anemia and secondary hyperparathyroidism poses major diagnostic and therapeutic difficulties for trainees. Conclusion Educational efforts are needed to raise awareness of clinical practice guidelines and recommendations for patients with CKD among future practitioners. PMID:17164005

  9. Taxicab tipping and sunlight

    PubMed Central

    2017-01-01

    Does the level of sunlight affect the tipping percentage in taxicab rides in New York City? We examined this question using data on 13.82 million cab rides from January to October in 2009 in New York City combined with data on hourly levels of solar radiation. We found a small but statistically significant positive relationship between sunlight and tipping, with an estimated tipping increase of 0.5 to 0.7 percentage points when transitioning from a dark sky to full sunshine. The findings are robust to two-way clustering of standard errors based on hour-of-the-day and day-of-the-year and controlling for day-of-the-year, month-of-the-year, cab driver fixed effects, weather conditions, and ride characteristics. The NYC cab ride context is suitable for testing the association between sunlight and tipping due to the largely random assignment of riders to drivers, direct exposure to sunlight, and low confounding from variation in service experiences. PMID:28594917

  10. Taxicab tipping and sunlight.

    PubMed

    Devaraj, Srikant; Patel, Pankaj C

    2017-01-01

    Does the level of sunlight affect the tipping percentage in taxicab rides in New York City? We examined this question using data on 13.82 million cab rides from January to October in 2009 in New York City combined with data on hourly levels of solar radiation. We found a small but statistically significant positive relationship between sunlight and tipping, with an estimated tipping increase of 0.5 to 0.7 percentage points when transitioning from a dark sky to full sunshine. The findings are robust to two-way clustering of standard errors based on hour-of-the-day and day-of-the-year and controlling for day-of-the-year, month-of-the-year, cab driver fixed effects, weather conditions, and ride characteristics. The NYC cab ride context is suitable for testing the association between sunlight and tipping due to the largely random assignment of riders to drivers, direct exposure to sunlight, and low confounding from variation in service experiences.

  11. Internal Medicine Residents' Retention of Knowledge and Skills in Bedside Ultrasound.

    PubMed

    Town, James A; Bergl, Paul A; Narang, Akhil; McConville, John F

    2016-10-01

    The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound. Participants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training ( P  < .001). At 12 months, mean knowledge score fell to 73.0%, significantly different from both prior assessments ( P  < .001). Despite knowledge decline, the mean skills assessment score improved from a baseline of 30.5% to 50.4% at 12 months ( P  < .001). Residents reporting more ultrasound use (> 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups. Residents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates.

  12. Internal Medicine Residents' Retention of Knowledge and Skills in Bedside Ultrasound

    PubMed Central

    Town, James A.; Bergl, Paul A.; Narang, Akhil; McConville, John F.

    2016-01-01

    ABSTRACT Background  The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. Objective  We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. Methods  We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound. Results  Participants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training (P < .001). At 12 months, mean knowledge score fell to 73.0%, significantly different from both prior assessments (P < .001). Despite knowledge decline, the mean skills assessment score improved from a baseline of 30.5% to 50.4% at 12 months (P < .001). Residents reporting more ultrasound use (> 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups. Conclusions  Residents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates. PMID:27777666

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

    PubMed

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

    2017-08-01

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

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

    PubMed

    Degtiar, Irina

    2017-12-01

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

  15. [Publication rate of Deutsche Forschungsgemeinschaft (DFG)-supported research projects. An analysis of the "fate" of DFG-support methods in anesthesia, surgery and internal medicine].

    PubMed

    Boldt, J; Maleck, W

    2000-09-22

    Outstanding medical research is not possible without financial support. The success of supported research projects have been evaluated only rarely. The publication rate of research projects supported by the German Research Council (Deutsche Forschungsgemeinschaft [DFG]) was assessed separately for internal medicine, surgery, and anesthesiology. Based on the "Figures and Facts" published by the DFG all supported projects of 1996 for all three specialities were included. In a Medline-based analysis all published papers dealing with the supported project and all papers published by the supported persons from 1996 to may 2000 were documented. A total of 315 grants were analysed (internal medicine: 234; surgery: 63; anesthesiology: 18). Projects with clinical topics were less often supported (n = 80) than experimental projects (n = 235). 162 (69.3%) of the grants in internal medicine, 41 (65.1) in surgery, and 14 (77.8%) of the grants in anesthesiology were published. In anesthesiology all published projects were in English language (internal medicine: 98.2%; surgery: 95%). Independent of the topic of the grant, several supported persons in internal medicine and surgery did not publish any papers between 1996 and may 2000, whereas all supported anesthesiologists published papers in peer reviewed journals in this time period. The publication rate of DFG supported projects is not sufficient. Except for a final internal report after finishing the research project no quality control exists for DFG grants. Unfortunately, not all supported projects were published. A better feedback between the financial support by the DFG and the publication rate of DFG grants is desirable.

  16. Efficiency Analysis of Integrated Public Hospital Networks in Outpatient Internal Medicine.

    PubMed

    Ortíz-Barrios, Miguel Angel; Escorcia-Caballero, Juan P; Sánchez-Sánchez, Fabián; De Felice, Fabio; Petrillo, Antonella

    2017-09-07

    Healthcare systems are evolving towards a complex network of interconnected services due to the increasing costs and the increasing expectations for high service levels. It is evidenced in the literature the importance of implementing management techniques and sophisticated methods to improve the efficiency of healthcare systems, especially in emerging economies. This paper proposes an integrated collaboration model between two public hospitals to reach the reduction of weighted average lead time in outpatient internal medicine department. A strategic framework based on value stream mapping and collaborative practices has been developed in real case study settled in Colombia.

  17. Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

    PubMed

    Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

    2013-01-01

    In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

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

    PubMed Central

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

    2013-01-01

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

  19. Children's Knowledge about Medicines.

    ERIC Educational Resources Information Center

    Almarsdottir, Anna B.; Zimmer, Catherine

    1998-01-01

    Examined knowledge about medicines and perceived benefit among 101 children, ages 7 and 10. Found that medicine knowledge was explained using age, educational environment, and degree of internal locus of control as significant predictors. The negative effect of internal locus of control predicted perceived benefit. Retention of drug advertising…

  20. An investigation of tip planform influence on the aerodynamic load characteristics of semispan, upswept wing and wing-tip

    NASA Technical Reports Server (NTRS)

    Vanaken, Johannes M.

    1986-01-01

    A semi-span wing, equipped with an interchangeable tip, which was varied in planform and size was examined. Total wing aerodynamic loading was obtained from the wind tunnel scale system. The wing tip was mounted on a separate six-component strain gauge balance, which provided the aerodynamic loads on the tip. The tests were accomplished in the NASA Ames 7X10-Foot Wind Tunnel at a Mach number of 0.178. The aerodynamic load characteristics of the wing and of the tip were presented with the tip at several incidence angles relative to the wing inboard section.

  1. An Investigation of the Variety and Complexity of Statistical Methods Used in Current Internal Medicine Literature.

    PubMed

    Narayanan, Roshni; Nugent, Rebecca; Nugent, Kenneth

    2015-10-01

    Accreditation Council for Graduate Medical Education guidelines require internal medicine residents to develop skills in the interpretation of medical literature and to understand the principles of research. A necessary component is the ability to understand the statistical methods used and their results, material that is not an in-depth focus of most medical school curricula and residency programs. Given the breadth and depth of the current medical literature and an increasing emphasis on complex, sophisticated statistical analyses, the statistical foundation and education necessary for residents are uncertain. We reviewed the statistical methods and terms used in 49 articles discussed at the journal club in the Department of Internal Medicine residency program at Texas Tech University between January 1, 2013 and June 30, 2013. We collected information on the study type and on the statistical methods used for summarizing and comparing samples, determining the relations between independent variables and dependent variables, and estimating models. We then identified the typical statistics education level at which each term or method is learned. A total of 14 articles came from the Journal of the American Medical Association Internal Medicine, 11 from the New England Journal of Medicine, 6 from the Annals of Internal Medicine, 5 from the Journal of the American Medical Association, and 13 from other journals. Twenty reported randomized controlled trials. Summary statistics included mean values (39 articles), category counts (38), and medians (28). Group comparisons were based on t tests (14 articles), χ2 tests (21), and nonparametric ranking tests (10). The relations between dependent and independent variables were analyzed with simple regression (6 articles), multivariate regression (11), and logistic regression (8). Nine studies reported odds ratios with 95% confidence intervals, and seven analyzed test performance using sensitivity and specificity calculations

  2. Using functional neuroimaging combined with a think-aloud protocol to explore clinical reasoning expertise in internal medicine.

    PubMed

    Durning, Steven J; Graner, John; Artino, Anthony R; Pangaro, Louis N; Beckman, Thomas; Holmboe, Eric; Oakes, Terrance; Roy, Michael; Riedy, Gerard; Capaldi, Vincent; Walter, Robert; van der Vleuten, Cees; Schuwirth, Lambert

    2012-09-01

    Clinical reasoning is essential to medical practice, but because it entails internal mental processes, it is difficult to assess. Functional magnetic resonance imaging (fMRI) and think-aloud protocols may improve understanding of clinical reasoning as these methods can more directly assess these processes. The objective of our study was to use a combination of fMRI and think-aloud procedures to examine fMRI correlates of a leading theoretical model in clinical reasoning based on experimental findings to date: analytic (i.e., actively comparing and contrasting diagnostic entities) and nonanalytic (i.e., pattern recognition) reasoning. We hypothesized that there would be functional neuroimaging differences between analytic and nonanalytic reasoning theory. 17 board-certified experts in internal medicine answered and reflected on validated U.S. Medical Licensing Exam and American Board of Internal Medicine multiple-choice questions (easy and difficult) during an fMRI scan. This procedure was followed by completion of a formal think-aloud procedure. fMRI findings provide some support for the presence of analytic and nonanalytic reasoning systems. Statistically significant activation of prefrontal cortex distinguished answering incorrectly versus correctly (p < 0.01), whereas activation of precuneus and midtemporal gyrus distinguished not guessing from guessing (p < 0.01). We found limited fMRI evidence to support analytic and nonanalytic reasoning theory, as our results indicate functional differences with correct vs. incorrect answers and guessing vs. not guessing. However, our findings did not suggest one consistent fMRI activation pattern of internal medicine expertise. This model of employing fMRI correlates offers opportunities to enhance our understanding of theory, as well as improve our teaching and assessment of clinical reasoning, a key outcome of medical education.

  3. Turbine blade squealer tip rail with fence members

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Little, David A

    2012-11-20

    A turbine blade includes an airfoil, a blade tip section, a squealer tip rail, and a plurality of chordally spaced fence members. The blade tip section includes a blade tip floor located at an end of the airfoil distal from the root. The blade tip floor includes a pressure side and a suction side joined together at chordally spaced apart leading and trailing edges of the airfoil. The squealer tip rail extends radially outwardly from the blade tip floor adjacent to the suction side and extends from a first location adjacent to the airfoil trailing edge to a second locationmore » adjacent to the airfoil leading edge. The fence members are located between the airfoil leading and trailing edges and extend radially outwardly from the blade tip floor and axially from the squealer tip rail toward the pressure side.« less

  4. 29 CFR 516.28 - Tipped employees.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Tipped employees. 516.28 Section 516.28 Labor Regulations... EMPLOYERS Records Pertaining to Employees Subject to Miscellaneous Exemptions Under the Act; Other Special Requirements § 516.28 Tipped employees. (a) With respect to each tipped employee whose wages are determined...

  5. Trends and Tipping Points of Drought-induced Tree Mortality

    NASA Astrophysics Data System (ADS)

    Huang, K.; Yi, C.; Wu, D.; Zhou, T.; Zhao, X.; Blanford, W. J.; Wei, S.; Wu, H.; Du, L.

    2014-12-01

    Drought-induced tree mortality worldwide has been recently reported in a review of the literature by Allen et al. (2010). However, a quantitative relationship between widespread loss of forest from mortality and drought is still a key knowledge gap. Specifically, the field lacks quantitative knowledge of tipping point in trees when coping with water stress, which inhibits the assessments of how climate change affects the forest ecosystem. We investigate the statistical relationships for different (seven) conifer species between Ring Width Index (RWI) and Standardized Precipitation Evapotranspiration Index (SPEI), based on 411 chronologies from the International Tree-Ring Data Bank across 11 states of the western United States. We found robust species-specific relationships between RWI and SPEI for all seven conifer species at dry condition. The regression models show that the RWI decreases with SPEI decreasing (drying) and more than 76% variation of tree growth (RWI) can be explained by the drought index (SPEI). However, when soil water is sufficient (i.e., SPEI>SPEIu), soil water is no longer a restrictive factor for tree growth and, therefore, the RWI shows a weak correlation with SPEI. Based on the statistical models, we derived the tipping point of SPEI (SPEItp) where the RWI equals 0, which means the carbon efflux by tree respiration equals carbon influx by tree photosynthesis. When the severity of drought exceeds this tipping point(i.e. SPEItipping points for seven species-specific trees vary between -2.45 and -1.40. The lower value of a tipping point represents the stronger ability to endure drought. The predicted tipping points can be used as reference of tree mortality for assessment of forest mortality risk under climate change.This work was supported by the Fund for

  6. Normal and variant anatomy of the nasal tip.

    PubMed

    Ketcham, Amy S; Dobratz, Eric J

    2012-04-01

    A thorough understanding of nasal tip anatomy is a prerequisite to understanding the nuances of restructuring the nasal tip. The three-dimensional structural anatomy of the nasal tip is complex. Additionally, the interrelationship between these structures determines the ultimate form and function of the nasal tip. As a result, alteration of one structure in the tip will often lead to change in other portions of the nasal tip. This dynamic concept of anatomy in the nasal tip makes proper alteration of the nasal tip one of the most challenging tasks faced by a rhinoplasty surgeon. This article provides a fundamental knowledge of the normal anatomy of the tip structures and how their interaction with each other determines the shape and support of the lower portion of the nose. It also provides a description of some common variants of tip anatomy that cause patients to seek consultation for rhinoplasty. A proper understanding of the concepts presented provides a foundation to build on as the reader continues to explore the "nuances of the nasal tip." Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    PubMed Central

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

    2017-01-01

    Objectives 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. Design and setting 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. Participants 21 medical students and 30 supervisors participated. Results 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. Conclusions 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

  8. Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors.

    PubMed

    Rencic, Joseph; Trowbridge, Robert L; Fagan, Mark; Szauter, Karen; Durning, Steven

    2017-11-01

    Recent reports, including the Institute of Medicine's Improving Diagnosis in Health Care, highlight the pervasiveness and underappreciated harm of diagnostic error, and recommend enhancing health care professional education in diagnostic reasoning. However, little is known about clinical reasoning curricula at US medical schools. To describe clinical reasoning curricula at US medical schools and to determine the attitudes of internal medicine clerkship directors toward teaching of clinical reasoning. Cross-sectional multicenter study. US institutional members of the Clerkship Directors in Internal Medicine (CDIM). Examined responses to a survey that was emailed in May 2015 to CDIM institutional representatives, who reported on their medical school's clinical reasoning curriculum. The response rate was 74% (91/123). Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic. Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers. Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve

  9. Southwestern Pine Tip Moth

    Treesearch

    Daniel T. Jennings; Robert E. Stevens

    1982-01-01

    The southwestern pine tip moth, Rhyacionia neomexicana (Dyar), injures young ponderosa pines (Pinus ponderosa Dougl. ex Laws) in the Southwest, central Rockies, and midwestern plains. Larvae feed on and destroy new, expanding shoots, often seriously reducing terminal growth of both naturally regenerated and planted pines. The tip moth is especially damaging to trees on...

  10. Sasang constitutional medicine as a holistic tailored medicine.

    PubMed

    Kim, Jong Yeol; Pham, Duong Duc

    2009-09-01

    Sasang constitutional medicine (SCM) is a unique traditional Korean therapeutic alternative form of medicine. Based on the Yin and Yang theory and on Confucianism, humans are classified into four constitutions. These differ in terms of (i) sensitivity to certain groups of herbs and medicines, (ii) equilibrium among internal organic functions, (iii) physical features and (iv) psychological characteristics. We propose that two main axes in the physiopathology of SCM (food intake/waste discharge and consuming/storing Qi and body fluids) are equivalent to the process of internal-external exchange and catabolism/anabolism in modern physiology, respectively. We then used this hypothesis to discuss the physiological and pathological principles of SCM. Constitution-based medicine is based on the theory that some medicinal herbs and remedies are only appropriate for certain constitutions and can cause adverse effects in others. The constitutional approach of SCM share the same vision as tailored medicine; an individualized therapy that can minimize the risk of adverse reaction while increasing the efficacy and an individualized self-regulation that can help prevent specific susceptible chronic disease and live healthily. There is still a long way to this goal for both SCM and tailored medicine, but we may benefit from systems approaches such as systems biology. We suggest that constitutional perspective of SCM and our hypothesis of two main processes may provide a novel insight for further studies.

  11. The impact of the night float system on internal medicine residency programs.

    PubMed

    Trontell, M C; Carson, J L; Taragin, M I; Duff, A

    1991-01-01

    To study the design, method of implementation, perceived benefits, and problems associated with a night float system. Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups. The 442 accredited internal medicine residency programs listed in the 1988-89 Directory of Graduate Medical Education Programs. Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication. Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.

  12. An optical fiber bundle sensor for tip clearance and tip timing measurements in a turbine rig.

    PubMed

    García, Iker; Beloki, Josu; Zubia, Joseba; Aldabaldetreku, Gotzon; Illarramendi, María Asunción; Jiménez, Felipe

    2013-06-05

    When it comes to measuring blade-tip clearance or blade-tip timing in turbines, reflective intensity-modulated optical fiber sensors overcome several traditional limitations of capacitive, inductive or discharging probe sensors. This paper presents the signals and results corresponding to the third stage of a multistage turbine rig, obtained from a transonic wind-tunnel test. The probe is based on a trifurcated bundle of optical fibers that is mounted on the turbine casing. To eliminate the influence of light source intensity variations and blade surface reflectivity, the sensing principle is based on the quotient of the voltages obtained from the two receiving bundle legs. A discrepancy lower than 3% with respect to a commercial sensor was observed in tip clearance measurements. Regarding tip timing measurements, the travel wave spectrum was obtained, which provides the average vibration amplitude for all blades at a particular nodal diameter. With this approach, both blade-tip timing and tip clearance measurements can be carried out simultaneously. The results obtained on the test turbine rig demonstrate the suitability and reliability of the type of sensor used, and suggest the possibility of performing these measurements in real turbines under real working conditions.

  13. An Optical Fiber Bundle Sensor for Tip Clearance and Tip Timing Measurements in a Turbine Rig

    PubMed Central

    García, Iker; Beloki, Josu; Zubia, Joseba; Aldabaldetreku, Gotzon; Illarramendi, María Asunción; Jiménez, Felipe

    2013-01-01

    When it comes to measuring blade-tip clearance or blade-tip timing in turbines, reflective intensity-modulated optical fiber sensors overcome several traditional limitations of capacitive, inductive or discharging probe sensors. This paper presents the signals and results corresponding to the third stage of a multistage turbine rig, obtained from a transonic wind-tunnel test. The probe is based on a trifurcated bundle of optical fibers that is mounted on the turbine casing. To eliminate the influence of light source intensity variations and blade surface reflectivity, the sensing principle is based on the quotient of the voltages obtained from the two receiving bundle legs. A discrepancy lower than 3% with respect to a commercial sensor was observed in tip clearance measurements. Regarding tip timing measurements, the travel wave spectrum was obtained, which provides the average vibration amplitude for all blades at a particular nodal diameter. With this approach, both blade-tip timing and tip clearance measurements can be carried out simultaneously. The results obtained on the test turbine rig demonstrate the suitability and reliability of the type of sensor used, and suggest the possibility of performing these measurements in real turbines under real working conditions. PMID:23739163

  14. Shell-Isolated Tip-Enhanced Raman and Fluorescence Spectroscopy.

    PubMed

    Huang, Ya-Ping; Huang, Sheng-Chao; Wang, Xiang-Jie; Bodappa, Nataraju; Li, Chao-Yu; Yin, Hao; Su, Hai-Sheng; Meng, Meng; Zhang, Hua; Ren, Bin; Yang, Zhi-Lin; Zenobi, Renato; Tian, Zhong-Qun; Li, Jian-Feng

    2018-06-18

    Tip-enhanced Raman spectroscopy can provide molecular fingerprint information with ultrahigh spatial resolution, but the tip will be easily contaminated, thus leading to artifacts. It also remains a great challenge to establish tip-enhanced fluorescence because of the quenching resulting from the proximity of the metal tip. Herein, we report shell-isolated tip-enhanced Raman and fluorescence spectroscopies by employing ultrathin shell-isolated tips fabricated by atomic layer deposition. Such shell-isolated tips not only show outstanding electromagnetic field enhancement in TERS but also exclude interference by contaminants, thus greatly promoting applications in solution. Tip-enhanced fluorescence has also been achieved using these shell-isolated tips, with enhancement factors of up to 1.7×10 3 , consistent with theoretical simulations. Furthermore, tip-enhanced Raman and fluorescence signals are acquired simultaneously, and their relative intensities can be manipulated by changing the shell thickness. This work opens a new avenue for ultrahigh resolution surface analysis using plasmon-enhanced spectroscopies. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Associations Between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) Scores

    PubMed Central

    Zeger, Scott L.; Kolars, Joseph C.

    2008-01-01

    Background Little is known about the associations of previous standardized examination scores with scores on subsequent standardized examinations used to assess medical knowledge in internal medicine residencies. Objective To examine associations of previous standardized test scores on subsequent standardized test scores. Design Retrospective cohort study. Participants One hundred ninety-five internal medicine residents. Methods Bivariate associations of United States Medical Licensing Examination (USMLE) Steps and Internal Medicine In-Training Examination (IM-ITE) scores were determined. Random effects analysis adjusting for repeated administrations of the IM-ITE and other variables known or hypothesized to affect IM-ITE score allowed for discrimination of associations of individual USMLE Step scores on IM-ITE scores. Results In bivariate associations, USMLE scores explained 17% to 27% of the variance in IME-ITE scores, and previous IM-ITE scores explained 66% of the variance in subsequent IM-ITE scores. Regression coefficients (95% CI) for adjusted associations of each USMLE Step with IM-ITE scores were USMLE-1 0.19 (0.12, 0.27), USMLE-2 0.23 (0.17, 0.30), and USMLE-3 0.19 (0.09, 0.29). Conclusions No single USMLE Step is more strongly associated with IM-ITE scores than the others. Because previous IM-ITE scores are strongly associated with subsequent IM-ITE scores, appropriate modeling, such as random effects methods, should be used to account for previous IM-ITE administrations in studies for which IM-ITE score is an outcome. PMID:18612735

  16. Associations between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) scores.

    PubMed

    McDonald, Furman S; Zeger, Scott L; Kolars, Joseph C

    2008-07-01

    Little is known about the associations of previous standardized examination scores with scores on subsequent standardized examinations used to assess medical knowledge in internal medicine residencies. To examine associations of previous standardized test scores on subsequent standardized test scores. Retrospective cohort study. One hundred ninety-five internal medicine residents. Bivariate associations of United States Medical Licensing Examination (USMLE) Steps and Internal Medicine In-Training Examination (IM-ITE) scores were determined. Random effects analysis adjusting for repeated administrations of the IM-ITE and other variables known or hypothesized to affect IM-ITE score allowed for discrimination of associations of individual USMLE Step scores on IM-ITE scores. In bivariate associations, USMLE scores explained 17% to 27% of the variance in IME-ITE scores, and previous IM-ITE scores explained 66% of the variance in subsequent IM-ITE scores. Regression coefficients (95% CI) for adjusted associations of each USMLE Step with IM-ITE scores were USMLE-1 0.19 (0.12, 0.27), USMLE-2 0.23 (0.17, 0.30), and USMLE-3 0.19 (0.09, 0.29). No single USMLE Step is more strongly associated with IM-ITE scores than the others. Because previous IM-ITE scores are strongly associated with subsequent IM-ITE scores, appropriate modeling, such as random effects methods, should be used to account for previous IM-ITE administrations in studies for which IM-ITE score is an outcome.

  17. Sirt1 physically interacts with Tip60 and negatively regulates Tip60-mediated acetylation of H2AX

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Yamagata, Kazutsune, E-mail: kyamagat@ncc.go.jp; Kitabayashi, Issay

    2009-12-25

    Sirt1 appear to be NAD(+)-dependent deacetylase that deacetylates histones and several non-histone proteins. In this study, we identified Sirt1 as a physical interaction partner of Tip60, which is a mammalian MYST-type histone acetyl-transferase that specifically acetylates histones H2A and H4. Although Tip60 also acetylates DNA damage-specific histone H2A variant H2AX in response to DNA damage, which is a process required for appropriate DNA damage response, overexpression of Sirt1 represses Tip60-mediated acetylation of H2AX. Furthermore, Sirt1 depletion by RNAi causes excessive acetylation of H2AX, and enhances accumulation of {gamma}-ray irradiation-induced MDC1, BRCA1, and Rad51 foci in nuclei. These findings suggest thatmore » Sirt1 functions as negative regulator of Tip60-mediated acetylation of H2AX. Moreover, Sirt1 deacetylates an acetylated Tip60 in response to DNA damage and stimulates proteasome-dependent Tip60 degradation in vivo, suggesting that Sirt1 negatively regulates the protein level of Tip60 in vivo. Sirt1 may thus repress excessive activation of the DNA damage response and Rad51-homologous recombination repair by suppressing the function of Tip60.« less

  18. Tip-Enhanced Raman Scattering Imaging of Two-Dimensional Tungsten Disulfide with Optimized Tip Fabrication Process.

    PubMed

    Lee, Chanwoo; Kim, Sung Tae; Jeong, Byeong Geun; Yun, Seok Joon; Song, Young Jae; Lee, Young Hee; Park, Doo Jae; Jeong, Mun Seok

    2017-01-13

    We successfully achieve the tip-enhanced nano Raman scattering images of a tungsten disulfide monolayer with optimizing a fabrication method of gold nanotip by controlling the concentration of etchant in an electrochemical etching process. By applying a square-wave voltage supplied from an arbitrary waveform generator to a gold wire, which is immersed in a hydrochloric acid solution diluted with ethanol at various ratios, we find that both the conical angle and radius of curvature of the tip apex can be varied by changing the ratio of hydrochloric acid and ethanol. We also suggest a model to explain the origin of these variations in the tip shape. From the systematic study, we find an optimal condition for achieving the yield of ~60% with the radius of ~34 nm and the cone angle of ~35°. Using representative tips fabricated under the optimal etching condition, we demonstrate the tip-enhanced Raman scattering experiment of tungsten disulfide monolayer grown by a chemical vapor deposition method with a spatial resolution of ~40 nm and a Raman enhancement factor of ~4,760.

  19. The contribution of Enrico C. Vigliani (1907-1992) to the international development of occupational medicine and industrial hygiene.

    PubMed

    Riva, M A; Carnevale, F; D'Orso, M I; Iavicoli, S; Bertazzi, P A; Cesana, G

    2012-01-01

    One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH. The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene. A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed. In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission. Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

  20. Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

    PubMed

    Rottenkolber, Dominik; Schmiedl, Sven; Rottenkolber, Marietta; Farker, Katrin; Saljé, Karen; Mueller, Silke; Hippius, Marion; Thuermann, Petra A; Hasford, Joerg

    2011-06-01

    German hospital reimbursement modalities changed as a result of the introduction of Diagnosis Related Groups (DRG) in 2004. Therefore, no data on the direct costs of adverse drug reactions (ADRs) resulting in admissions to departments of internal medicine are available. The objective was to quantify the ADR-related economic burden (direct costs) of hospitalizations in internal medicine wards in Germany. Record-based study analyzing the patient records of about 57,000 hospitalizations between 2006 and 2007 of the Net of Regional Pharmacovigilance Centers (Germany). All ADRs were evaluated by a team of experts in pharmacovigilance for severity, causality, and preventability. The calculation of accurate person-related costs for ADRs relied on the German DRG system (G-DRG 2009). Descriptive and bootstrap statistical methods were applied for data analysis. The incidence of hospitalization due to at least 'possible' serious outpatient ADRs was estimated to be approximately 3.25%. Mean age of the 1834 patients was 71.0 years (SD 14.7). Most frequent ADRs were gastrointestinal hemorrhage (n = 336) and drug-induced hypoglycemia (n = 270). Average inpatient length-of-stay was 9.3 days (SD 7.1). Average treatment costs of a single ADR were estimated to be approximately €2250. The total costs sum to €434 million per year for Germany. Considering the proportion of preventable cases (20.1%), this equals a saving potential of €87 million per year. Preventing ADRs is advisable in order to realize significant nationwide savings potential. Our cost estimates provide a reliable benchmark as they were calculated based on an intensified ADR surveillance and an accurate person-related cost application. Copyright © 2011 John Wiley & Sons, Ltd.

  1. Oxygen-Free Welding Contact Tips

    NASA Technical Reports Server (NTRS)

    Pike, James F.

    1993-01-01

    Contact tips for gas/metal arc welding (GMAW) fabricated from oxygen-free copper. Prototype tips tested in robotic welding, for which application intended. Reduces electrical erosion, increases electrical conductivity, and reduces mechanical wear. Productivity of robotic welding increases while time during welding interrupted for removal and replacement of contact tips minimal. Improves alignment of joints and filler metal, reducing rate of rejection and repair of unacceptable weldments. Utility extends beyond aerospace industry to mass production of various types of hardware, including heavy off-highway construction equipment.

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

    PubMed

    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.

  3. Historical Roots of International Biomedical and Health Informatics: The Road to IFIP-TC4 and IMIA through Cybernetic Medicine and the Elsinore Meetings.

    PubMed

    Kulikowski, C A

    2017-08-01

    Background: It is 50 years since the International Federation of Information Processing (IFIP) Societies approved the formation of a new Technical Committee (TC) 4 on Medical Information Processing under the leadership of Professor Francois Grémy, which was the direct precursor of the International Medical Informatics Association (IMIA). Objectives: The goals of this paper are to give a very brief overview of early international developments leading to informatics in medicine, with the origins of the applications of computers to medicine in the USA and Europe, and two meetings - of the International Society of Cybernetic Medicine, and the Elsinore Meetings on Hospital Information Systems-that took place in 1966. These set the stage for the formation of IFIP-TC4 the following year, with later sponsorship of the first MEDINFO in 1974, setting the path for the evolution to IMIA. Methods: This paper reviews and analyzes some of the earliest research and publications, together with two critical contrasting meetings in 1966 involving international activities in what evolved into biomedical and health informatics in terms of their probable influence on the formation of IFIP-TC4. Conclusion: The formation of IFIP-TC 4 in 1967 by Francois Grémy arose out of his concerns for merging, at an international level, the diverse strands from the more abstract work on cybernetic medicine and its basis in biophysical and neural modeling, with the more concrete and health-oriented medical information processing that was developing at the time for hospitals and clinical decision-making. Georg Thieme Verlag KG Stuttgart.

  4. Low photon-count tip-tilt sensor

    NASA Astrophysics Data System (ADS)

    Saathof, Rudolf; Schitter, Georg

    2016-07-01

    Due to the low photon-count of dark areas of the universe, signal strength of tip-tilt sensor is low, limiting sky-coverage of reliable tip-tilt measurements. This paper presents the low photon-count tip-tilt (LPC-TT) sensor, which potentially achieves improved signal strength. Its optical design spatially samples and integrates the scene. This increases the probability that several individual sources coincide on a detector segment. Laboratory experiments show feasibility of spatial sampling and integration and the ability to measure tilt angles. By simulation an improvement of the SNR of 10 dB compared to conventional tip-tilt sensors is shown.

  5. RANS computations of tip vortex cavitation

    NASA Astrophysics Data System (ADS)

    Decaix, Jean; Balarac, Guillaume; Dreyer, Matthieu; Farhat, Mohamed; Münch, Cécile

    2015-12-01

    The present study is related to the development of the tip vortex cavitation in Kaplan turbines. The investigation is carried out on a simplified test case consisting of a NACA0009 blade with a gap between the blade tip and the side wall. Computations with and without cavitation are performed using a R ANS modelling and a transport equation for the liquid volume fraction. Compared with experimental data, the R ANS computations turn out to be able to capture accurately the development of the tip vortex. The simulations have also highlighted the influence of cavitation on the tip vortex trajectory.

  6. Mapping International University Partnerships Identified by East African Universities as Strengthening Their Medicine, Nursing, and Public Health Programs.

    PubMed

    Yarmoshuk, Aaron N; Guantai, Anastasia Nkatha; Mwangu, Mughwira; Cole, Donald C; Zarowsky, Christina

    International university partnerships are recommended for increasing the capacity of sub-Saharan African universities. Many publications describe individual partnerships and projects, and tools are available for guiding collaborations, but systematic mappings of the basic, common characteristics of partnerships are scarce. To document and categorize the international interuniversity partnerships deemed significant to building the capacity of medicine, nursing, and public health programs of 4 East African universities. Two universities in Kenya and 2 in Tanzania were purposefully selected. Key informant interviews, conducted with 42 senior representatives of the 4 universities, identified partnerships they considered significant for increasing the capacity of their institutions' medicine, nursing, and public health programs in education, research, or service. Interviews were transcribed and analyzed. Partners were classified by country of origin and corresponding international groupings, duration, programs, and academic health science components. One hundred twenty-nine university-to-university partnerships from 23 countries were identified. Each university reported between 25 and 36 international university partners. Seventy-four percent of partnerships were with universities in high-income countries, 15% in low- and middle-income countries, and 11% with consortia. Seventy percent included medicine, 37% nursing, and 45% public health; 15% included all 3 programs. Ninety-two percent included an education component, 47% research, and 24% service; 12% included all 3 components. This study confirms the rapid growth of interuniversity cross-border health partnerships this century. It also finds, however, that there is a pool of established international partnerships from numerous countries at each university. Most partnerships that seek to strengthen universities in East Africa should likely ensure they have a significant education component. Universities should make

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

    PubMed Central

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

    2018-01-01

    Most emergency medicine (EM) residency programs provide an orientation program for their incoming interns, with the lecture being the most common education activity during this period. Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format. PMID:29383072

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

    PubMed

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

    2018-01-01

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

  9. Smart helicopter rotor with active blade tips

    NASA Astrophysics Data System (ADS)

    Bernhard, Andreas Paul Friedrich

    2000-10-01

    The smart active blade tip (SABT) rotor is an on-blade rotor vibration reduction system, incorporating active blade tips that can be independently pitched with respect to the main blade. The active blade tip rotor development included an experimental test program culminating in a Mach scale hover test, and a parallel development of a coupled, elastic actuator and rotor blade analysis for preliminary design studies and hover performance prediction. The experimental testing focussed on a small scale rotor on a bearingless Bell-412 hub. The fabricated Mach-scale active-tip rotor has a diameter of 1.524 m, a blade chord of 76.2 mm and incorporated a 10% span active tip. The nominal operating speed is 2000 rpm, giving a tip Mach number of 0.47. The blade tips are driven by a novel piezo-induced bending-torsion coupled actuator beam, located spanwise in the hollow mid-cell of the main rotor blade. In hover at 2000 rpm, at 2 deg collective, and for an actuation of 125 Vrms, the measured blade tip deflection at the first four rotor harmonics is between +/-1.7 and +/-2.8 deg, increasing to +/-5.3 deg at 5/rev with resonant amplification. The corresponding oscillatory amplitude of the rotor thrust coefficient is between 0.7 · 10-3 and 1.3 · 10-1 at the first four rotor harmonics, increasing to 2.1 · 10-3 at 5/rev. In general, the experimental blade tip frequency response and corresponding rotor thrust response are well captured by the analysis. The flexbeam root flap bending moment is predicted in trend, but is significantly over-estimated. The blade tips did not deflect as expected at high collective settings, because of the blade tip shaft locking up in the bearing. This is caused by the high flap bending moment on the blade tip shaft. Redesign of the blade tip shaft assembly and bearing support is identified as the primary design improvement for future research. The active blade tip rotor was also used as a testbed for the evaluation of an adaptive neural-network based

  10. Senior Internal Medicine Residents' Confidence with Essential Topics in Evidence-Based Medicine Taught During Internship

    PubMed Central

    Keddis, Mira T.; Beckman, Thomas J.; Cullen, Michael W.; Reed, Darcy A.; Halvorsen, Andrew J.; Wittich, Christopher M.; West, Colin P.; McDonald, Furman S.

    2011-01-01

    Background Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. Objective To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. Methods All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. Results Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P  =  .002), study design for prognosis questions (mean difference, −0.75; P  =  .004), number needed to harm (mean difference, −0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, −0.65, P  =  .009), and retrieval of evidence (mean difference, −0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. Conclusions Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents

  11. Biophysical Characterization of the Type III Secretion Tip Proteins and the Tip Proteins Attached to Bacterium-Like Particles

    PubMed Central

    Choudhari, Shyamal P.; Chen, Xiaotong; Kim, Jae Hyun; van Roosmalen, Maarten L.; Greenwood, Jamie C.; Joshi, Sangeeta B.; Picking, William D.; Leenhouts, Kees; Middaugh, C. Russell; Picking, Wendy L.

    2014-01-01

    Bacterium-like particles (BLPs), derived from Lactococcus lactis, offer a self-adjuvanting delivery vehicle for subunit protein vaccines. Proteins can be specifically loaded onto the BLPs via a peptidoglycan anchoring domain (PA). In this study, the tip proteins IpaD, SipD and LcrV belonging to type three secretion systems of Shigella flexneri, Salmonella enterica and Yersinia enterocolitica, respectively, were fused to the PA and loaded onto the BLPs. Herein, we biophysically characterized these nine samples and condensed the spectroscopic results into three-index empirical phase diagrams (EPDs). The EPDs show distinctions between the IpaD/SipD and LcrV subfamilies of tip proteins, based on their physical stability, even upon addition of the PA. Upon attachment to the BLPs, the BLPs become defining moiety in the spectroscopic measurements, leaving the tip proteins to have a subtle yet modulating effect on the structural integrity of the tip proteins-BLPs binding. In summary, this work provides a comprehensive view of physical stability of the tip proteins and tip protein-BLPs and serves as a baseline for screening of excipients to increase the stability of the tip protein-BLPs for future vaccine formulation. PMID:24916512

  12. The resident scholar program: a research training opportunity for internal medicine house staff.

    PubMed

    Byrnes, Abigail B; McCormack, Francis X; Diers, Tiffiny; Jazieh, Abdul-Rahman

    2007-01-01

    Housestaff research training is a challenging task that is complicated by the lack of a structured process and dedicated time. The Resident Scholar Program (RSP) at the University of Cincinnati, Department of Internal Medicine was created to overcome these challenges. Interested internal medicine house staff are required to submit an application to the residency research director including a project description signed by a faculty mentor. If the project is approved, a 4-month elective rotation is scheduled for the following year. Residents spend the first month on a consult service in the subspecialty area of their research and the remaining 3 months performing their research project. The RSP was launched in July 2003. The percentage of residents participating in research more than tripled. The subspecialty areas represented by RSP research were more diverse than those represented in prior years. Most participants participated in clinical research projects (84%), with 63% of projects being prospective in design. The RSP residents were twice as likely to obtain subspecialty fellowship positions compared to non-RSP residents (89% vs 46%, respectively). The RSP enables house staff to participate in research opportunities in their areas of interest. Development of a more systematic assessment method to study the impact of the program is underway, but the high participation rate reflects resident interest in such a program, particularly for residents with aspirations in pursuing fellowship training.

  13. BRIEF REPORT: Reducing Inappropriate Usage of Stress Ulcer Prophylaxis Among Internal Medicine Residents

    PubMed Central

    Liberman, Joshua D; Whelan, Chad T

    2006-01-01

    BACKGROUND Many inpatients receive stress ulcer prophylaxis (SUP) inappropriately. This indiscriminate usage increases costs and avoidable side-effects. Practice-based learning and improvement (PBLI) methodology may improve compliance with published guidelines. OBJECTIVE To investigate the response of internal medicine residents to an educational intervention regarding SUP. DESIGN A prospective, pre and postintervention cohort study using an educational intervention based on PBLI. PATIENTS Three groups of consecutively admitted patients (1 group preintervention and 2 groups postintervention) on the medicine ward at a University Hospital. MAIN OUTCOME MEASURE Rates of inappropriate SUP prescription and discharge with an inappropriate prescription. RESULTS One month after the intervention, inappropriate prophylaxis was significantly decreased (59% pre, 29% postintervention, P<.002). The rate of discharge with an inappropriate prescription also decreased, but was not significant (25% pre, 14% postintervention, P = .14). In the 6-month postintervention cohort, inappropriate SUP remained lower (59% pre, 33% postintervention, P<.007). The rate of discharge with an inappropriate prescription was also significantly lower (25% pre, 7% postintervention, P<.009). CONCLUSION Practice-based learning and improvement can improve compliance with published guidelines, and change practice patterns. After the intervention, both inappropriate prophylaxis and inappropriate prescriptions upon discharge were reduced. Importantly, the intervention was sustained, transmitted across academic years to a new class of interns who had not directly experienced the intervention. PMID:16704396

  14. Aerodynamic tip desensitization in axial flow turbines

    NASA Astrophysics Data System (ADS)

    Dey, Debashis

    The leakage flow near the tip of unshrouded rotor blades in axial turbines imposes significant thermal loads on the blade. It is also responsible for up to a third of aerodynamic losses in a turbine stage. The leakage flow, mainly induced by the pressure differential across the rotor tip section, usually rolls into a stream-wise vertical structure near the suction side part of the blade tip. The current study uses several concepts to reduce the severity of losses introduced by the leakage vortex. Three tip desensitization techniques, both active and passive, are examined. Coolant flow from a tip trench is used to counter the momentum of the leakage jet. Next, a very short winglet obtained by slightly extending the tip platform in the tangential direction is investigated. Lastly, the widely used concept of squealer tip is studied. The current investigation is performed in the Axial Flow Turbine Research Facility (AFTRF) of the Pennsylvania State University. Rotating frame five hole probe measurements as well as stationary frame phase averaged total pressure measurements downstream of a single stage turbine facility were taken. The study enables one to draw conclusions about the nature of the flowfield in the rotor tip region. It also shows that significant efficiency gains could be obtained by using some of these techniques.

  15. Radiofrequency Wire Recanalization of Chronically Thrombosed TIPS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Majdalany, Bill S., E-mail: bmajdala@med.umich.edu; Elliott, Eric D., E-mail: eric.elliott@osumc.edu; Michaels, Anthony J., E-mail: Anthony.michaels@osumc.edu

    Radiofrequency (RF) guide wires have been applied to cardiac interventions, recanalization of central venous thromboses, and to cross biliary occlusions. Herein, the use of a RF wire technique to revise chronically occluded transjugular intrahepatic portosystemic shunts (TIPS) is described. In both cases, conventional TIPS revision techniques failed to revise the chronically thrombosed TIPS. RF wire recanalization was successfully performed through each of the chronically thrombosed TIPS, demonstrating initial safety and feasibility in this application.

  16. Analytical Modeling of Pressure Wall Hole Size and Maximum Tip-to-Tip Crack Length for Perforating Normal and Oblique Orbital Debris Impacts

    NASA Technical Reports Server (NTRS)

    Schonberg, William P.; Mohamed, Essam

    1997-01-01

    This report presents the results of a study whose objective was to develop first-principles-based models of hole size and maximum tip-to-tip crack length for a spacecraft module pressure wall that has been perforated in an orbital debris particle impact. The hole size and crack length models are developed by sequentially characterizing the phenomena comprising the orbital debris impact event, including the initial impact, the creation and motion of a debris cloud within the dual-wall system, the impact of the debris cloud on the pressure wall, the deformation of the pressure wall due to debris cloud impact loading prior to crack formation, pressure wall crack initiation, propagation, and arrest, and finally pressure wall deformation following crack initiation and growth. The model development has been accomplished through the application of elementary shock physics and thermodynamic theory, as well as the principles of mass, momentum, and energy conservation. The predictions of the model developed herein are compared against the predictions of empirically-based equations for hole diameters and maximum tip-to-tip crack length for three International Space Station wall configurations. The ISS wall systems considered are the baseline U.S. Lab Cylinder, the enhanced U.S. Lab Cylinder, and the U.S. Lab Endcone. The empirical predictor equations were derived from experimentally obtained hole diameters and crack length data. The original model predictions did not compare favorably with the experimental data, especially for cases in which pressure wall petalling did not occur. Several modifications were made to the original model to bring its predictions closer in line with the experimental results. Following the adjustment of several empirical constants, the predictions of the modified analytical model were in much closer agreement with the experimental results.

  17. MEDICINAL CANNABIS LAW REFORM IN AUSTRALIA.

    PubMed

    Freckelton, Ian

    2016-03-01

    Attempts at medicinal cannabis law reform in Australia are not new. However, in historical perspective 2015 and 2016 will be seen as the time when community debate about legalisation of medicinal cannabis reached a tipping point in a number of Australian jurisdictions and when community impetus for change resulted in major reform initiatives. In order to contextualise the changes, the August 2015 Report of the Victorian Law Reform Commission (VLRC) and then the Access to Medicinal Cannabis Bill 2015 (Vic) introduced in December 2015 into the Victorian Parliament by the Labor Government are scrutinised. In addition, this editorial reviews the next phase of developments in the course of 2015 and 2016, including the Commonwealth Narcotic Drugs Amendment Act 2016 and the Queensland Public Health (Medicinal Canna- bis) Bill 2016. It identifies the principal features of the legislative initiatives against the backdrop of the VLRC proposals. It observes that the principles underlying the Report and the legislative developments in the three Australian jurisdictions are closely aligned and that their public health approach, their combination of evidence-based pragmatism, and their carefully orchestrated checks and balances against abuse and excess constitute a constructive template for medicinal cannabis law reform.

  18. Tips for Good Electronic Presentations.

    ERIC Educational Resources Information Center

    Strasser, Dennis

    1996-01-01

    Describes library uses of presentation graphics software and offers tips for creating electronic presentations. Tips include: audience retention; visual aid options; software package options; presentation planning; presentation showing; and use of text, colors, and graphics. Sidebars note common presentation errors and popular presentation…

  19. Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

    PubMed Central

    Farnan, Jeanne M.; Johnson, Julie K.; Meltzer, David O.; Harris, Ilene; Humphrey, Holly J.; Schwartz, Alan; Arora, Vineet M.

    2010-01-01

    Background Supervision is central to resident education and patient safety, yet there is little published evidence to describe a framework for clinical supervision. The aim of this study was to describe supervision strategies for on-call internal medicine residents. Methods Between January and November 2006, internal medicine residents and attending physicians at a single hospital were interviewed within 1 week of their final call on the general medicine rotation. Appreciative inquiry and critical incident technique were used to elicit perspectives on ideal and suboptimal supervision practices. A representative portion of transcripts were analyzed using an inductive approach to develop a coding scheme that was then applied to the entire set of transcripts. All discrepancies were resolved via discussion until consensus was achieved. Results Forty-four of 50 (88%) attending physicians and 46 of 50 (92%) eligible residents completed an interview. Qualitative analysis revealed a bidirectional model of suggested supervisory strategies, the “SUPERB/SAFETY” model; an interrater reliability of 0.70 was achieved. Suggestions for attending physicians providing supervision included setting expectations, recognizing uncertainty, planning communication, having easy availability, reassuring residents, balancing supervision, and having autonomy. Suggested resident strategies for seeking supervision from attending physicians included seeking input early, contacting for active clinical decisions or feeling uncertain, end of life issues, transitions in care, or help with systems issues. Common themes suggested by trainees and attending physicians included easy availability and preservation of resident decision-making autonomy. Discussion Residents and attending physicians have explicit expectations for optimal supervision. The SUPERB/SAFETY model of supervision may be an effective resource to enhance the clinical supervision of residents. PMID:21975883

  20. An experimental investigation of free-tip response to a jet

    NASA Technical Reports Server (NTRS)

    Young, L. A.

    1986-01-01

    The aerodynamic response of passively oscillating tips appended to a model helicopter rotor was investigated during a whirl test. Tip responsiveness was found to meet free-tip rotor requirements. Experimental and analytical estimates of the free-tip aerodynamic spring, mechanical spring, and aerodynamic damping were calculated and compared. The free tips were analytically demonstrated to be operating outside the tip resonant response region at full-scale tip speeds. Further, tip resonance was shown to be independent of tip speed, given the assumption that the tip forcing frequency is linearly dependent upon the rotor rotational speed.