Science.gov

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. [Fundamentals of internal medicine].

    PubMed

    Stehouwer, C D A

    2006-04-01

    The most important diagnostic tools of the internist are the patient history and physical examination, after which a plan must be made for further diagnostic evaluation and treatment. For this the internist uses clinical reasoning based on his or her knowledge of evidence-based medicine and pathobiology. Pathobiology is primarily concerned with the question of how something works; evidence-based medicine is concerned with whether something works, and if so, how often or how much on average. Diseases do not exist in their own right and diagnostic criteria are based on consensus. A diagnosis of a 'disease' is based on our observation of patients as well as our opinions, whether right or wrong, regarding its cause. It is important to distinguish between 'partial causes' and a 'causative complement'. As a result of this concept, the biological relevance of a partial cause in the development of a disease cannot be derived from the strength of the link between it and the disease. Our opinions regarding the cause of disease appear to be based on induction. However, induction is not a good foundation from which to determine causation. Hypotheses on the cause of disease cannot be proved. They can, however, be disproved. Education, training, research and patient care all depend on effective communication. Communication is enhanced if the thesis is given first and thereafter the arguments. Hence, transfer of patient information such as during a morning report should begin with a working diagnosis (the 'thesis') and thereafter the findings of patient history, et cetera (the 'arguments'). At this time, too little attention is given to these branches of clinical reasoning and communication in education and continuing education in internal medicine. PMID:16649402

  3. 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

  4. [Therapy and internal medicine].

    PubMed

    Bodenmann, P; Pasche, O; Michaelis-Conus, K; Willi, C; Favrat, B; Cornuz, J

    2007-01-31

    This review is based on five articles published in 2006 and dealing with therapies in general internal medicine: in case of acute non complicated rhino-sinusitis, the use of topical corticoids in mono-therapy is indicated; cross-reactivity between penicillins and cephalosporins is less frequent than established so far. In our daily practice we should be more "pro-active" in prescribing probiotics which have proved their efficacy in the prevention of antibiotic-associated diarrhoeas; an antibiotic treatment of three days is recommended in case of non complicated cystitis in women less than 65 years of age. Finally, every patient treated with bisphosphonates must be regularly followed by a dentist. PMID:17319397

  5. [Core competencies in internal medicine].

    PubMed

    Porcel, J M; Casademont, J; Conthe, P; Pinilla, B; Pujol, R; García-Alegría, J

    2011-06-01

    The working group of the Spanish Society of Internal Medicine (SEMI) on "Competencies of the Internist" has defined the basic medical knowledge, skills and attitudes that all internists in Spain should have. This list of competencies represents the Internal Medicine core curriculum within the context of the future educational framework of medical specialties in Health Sciences. PMID:21531405

  6. A Required Internal Medicine Preceptorship.

    ERIC Educational Resources Information Center

    Anderson, M. Brownell; And Others

    1982-01-01

    A preceptorship in an internal medicine clerkship at Southern Illinois University School of Medicine is discussed and evaluated. The results of a telephone survey indicate that the preceptorship had an important impact on the students, who learned time management, office management, and management of chronic clinical problems. (MLW)

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

    MedlinePlus

    ... Medicine Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips U.S. DEPARTMENT OF ... is designed to help you talk with your health care provider(s) about your complementary and alternative medicine (CAM) ...

  8. [Choosing wisely in internal medicine].

    PubMed

    Hasenfuß, G; Märker-Hermann, E; Hallek, M; Fölsch, U R

    2016-06-01

    "Choosing wisely - DGIM" is an initiative of the German Society of Internal Medicine (DGIM) to strengthen the quality of diagnostics and indications for therapy. Aspects of inappropriate patient care are identified based on scientific evidence in collaboration with12 internal medicine and associated societies. Identified aspects are reviewed and endorsed by an interdisciplinary consensus committee. Addressed are those diagnostic and therapeutic measures which are rarely used despite scientific evidence of their usefulness and those which are frequently used although clear evidence exists that the measures are not useful or even harmful. The resulting positive or negative recommendations are intended to support physicians in the assessment of indications. The relevance of the "Choosing wisely - DGIM" initiative is confirmed by a survey involving 4200 members of DGIM. PMID:27251671

  9. Twelve tips for teaching social determinants of health in medicine.

    PubMed

    Martinez, Iveris L; Artze-Vega, Isis; Wells, Alan L; Mora, Jorge Camilo; Gillis, Marin

    2014-11-01

    Abstract Background: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. Aim and method: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. Conclusion: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients. PMID:25373885

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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)

  15. International Society for Magnetic Resonance in Medicine

    MedlinePlus

    ... Upcoming Workshops & Deadlines Past Workshops Endorsed Meetings & Education International Outreach Event Planning Guides Education MR Safety Resources ... Center E-Library Virtual Meetings Connect With Us International Society for Magnetic Resonance in Medicine 2300 Clayton ...

  16. Internal Medicine Training in the Inpatient Setting

    PubMed Central

    Lorenzo, Di Francesco; Pistoria, Michael J; Auerbach, Andrew D; Nardino, Robert J; Holmboe, Eric S

    2005-01-01

    PURPOSE Although the inpatient setting has served as the predominant educational site of internal medicine training programs, many changes and factors are currently affecting education in this setting. As a result, many educational organizations are calling for reforms in inpatient training. This report reviews the available literature on specific internal medicine inpatient educational interventions and proposes recommendations for improving internal medicine training in this setting. METHOD We searched Medline for articles published between 1966 and August 2004 which focused on internal medicine training interventions in the inpatient setting; bibliographies of Medline-identified articles, as well as articles suggested by experts in the field provided additional citations. We then reviewed, classified, and abstracted only articles where an assessment of learner outcomes was included. RESULTS Thirteen studies of inpatient internal medicine educational interventions were found that included an outcome assessment. All were single institution studies. The majority of these studies was of poor methodological quality and focused on specific content areas of internal medicine. None assessed the effectiveness or impact of internal medicine core inpatient experiences or curriculum. CONCLUSION This review identifies significant gaps in our understanding of what constitutes effective inpatient education. The paucity of high quality research in the internal medicine inpatient setting highlights the urgent need to formally define and study what constitutes an effective “core” inpatient curriculum. PMID:16423111

  17. 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

  18. A Behavioral Medicine Course for Postgraduate Trainees in Internal Medicine.

    ERIC Educational Resources Information Center

    Linn, Lawrence S.; And Others

    1980-01-01

    An interdisciplinary faculty of the University of Califiornia at Los Angeles School of Medicine has developed a behavioral science program to teach interns the interpersonal skills necessary for effective physician patient encounters. Curriculum topics include interviewing, problem identification, and situational stress. (JMD)

  19. Recertification in internal medicine - the American experience.

    PubMed

    Dale, David C

    2007-11-01

    The American Board of Internal Medicine (ABIM) sets standards and certifies and recertifies physicians to practise internal medicine and its subspecialties in America. The ABIM was established in 1936 as a non-profit corporation, one of many specialty boards, such as the American Board of Family Medicine, the American Board of Pediatrics, the American Board of Surgery, etc. The umbrella organisation for these groups is the American Board of Medical Specialties. Members of the American College of Physicians take certifying and recertifying examinations produced by ABIM. Beginning in 1990, ABIM certificates were valid for 10 years. To maintain certification, physicians were required to participate in ABIM maintenance of certification (MOC) programme. The goals are to improve quality of care, to set standards for clinical competency, to foster continuing scholarship, and lead to medical quality improvement. The MOC programme involves verification of credentials, completion of self-evaluation, and completion of a secure exam. The self-evaluation component is the most complex and has been the most controversial due to the diversity of internal medicine careers and continued learning patterns. ABIM continually introduces new options for evaluation of practice performance. In addition to recertification in General Internal Medicine, ABIM has subspecialty examinations. MOC has been well received by professional organisations, but there are areas of controversy. It has been accepted as an important way for internists to assure quality of practice and currency of medical information. PMID:18071595

  20. Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories.

    PubMed

    Hughes, Patrick G; Crespo, Maria; Maier, Tina; Whitman, Alia; Ahmed, Rami

    2016-06-01

    Incorporating simulation-based medical education techniques is paramount to ongoing training of emergency physicians. Effective procedure laboratories give learners hands-on experience in life-saving procedures they may otherwise not have clinical exposure to and also prevent skill decay. Using procedural education, adult learning theory, deliberate practice, and mastery learning strategies, the authors offer 10 tips to educators for designing an effective emergency medicine procedure laboratory. PMID:27214775

  1. 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. PMID:23664752

  2. 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. PMID:26530942

  3. 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.

  4. Psychiatry as an Internal Medicine Subspecialty: An Educational Model.

    ERIC Educational Resources Information Center

    Shemo, John P. D.; And Others

    1980-01-01

    To lessen the traditional mind-body dichotomy in medicine, the West Virginia University School of Medicine has integrated psychiatry into the Department of Internal Medicine and the university hospital's psychiatric ward has been transformed into the Conjoint Medicine Service. Patients with a variety of emotional and medical problems are admitted.…

  5. [Sports death--an Internal Medicine problem?].

    PubMed

    Sack, Stefan

    2004-06-01

    Sports means fitness and endurance, regeneration and balance, game and fun. Lack of physical exercise is one of the main risk factors for cardiovascular diseases. Terrifying and not conclusive in the public's mind are events of sudden death, in particular if those are of nontraumatic cause and thus of cardiovascular origin. Organic pathologic examination revealed that a higher proportion of males are affected by sports death. Only 7-9% of those events are related to women, although the percentage of active women among sports people accounts for nearly 50%. The relative risk increases with age and intensity of endurance. For people who are untrained or not used to train, the risk of sudden death is potentially higher. In athletes > 35 years of age, coronary artery disease (CAD) is the most common cause (85%) of sudden death. In the group < 35 years, CAD and acute myocarditis are the predominant causes of sudden death, but also hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), disorders of the conducting system, and Marfan's syndrome. Additional risk factors like acute infections and misuse of doping drugs require the care of a specialist in internal medicine and/or cardiology on top of the care by a specialist in orthopedics and accident/rehabilitation medicine. Physical examination as a precaution and prevention strategy should be available for leisure sports as well as for athlete sports. PMID:15241541

  6. [2012 literature findings in ambulatory internal medicine].

    PubMed

    Vu, F; Ceppi, M; Fasel, E; Dory, E; Amstutz, V; Monney, C; Nanchen, D; Willi, C Clair; Pasche, O; Vauthey, L; Bodenmann, P

    2013-01-23

    In 2012 several articles reported interesting findings for the ambulatory practice in internal general medicine. A negative rapid test for influenza does not rule out that diagnosis. A test assessing the walking speed in the elderly can help determining who would benefit from antihypertensive therapy. Antibiotic treatment has no benefit for acute uncomplicated rhinosinusitis and diverticulitis. Probiotics can reduce the risk of post-antibiotic diarrhea. Daily coffee intake could reduce mortality. Oral supplementation of calcium can be harmful to the cardiovascular system. Subclinical hyperthyroidism should be treated to prevent cardiovascular complications. Aspirin can prevent recurrences in case of a primary thromboembolic event. Local injection of corticosteroids under ultrasonographic guidance for plantar fasciitis can be a safe treatment. Ibuprofen can prevent acute mountain sickness. PMID:23413648

  7. 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)

  8. Field-induced wooden-tip electrospray ionization mass spectrometry for high-throughput analysis of herbal medicines.

    PubMed

    Yang, Yunyun; Deng, Jiewei; Yao, Zhong-Ping

    2015-08-01

    This study demonstrates the first application of field-induced wooden-tip electrospray ionization (ESI) mass spectrometry (MS) for high-throughput analysis of herbal medicines. By application of an opposite and sample-contactless high voltage on the MS inlet rather than wooden tips, a high-throughput analysis device is easily set up, and a relatively fast analysis speed of 6 s per sample was successfully achieved. In addition, fast polarity switching between positive and negative ion detection mode is readily accomplished, which provides more complete chemical information for quality assessment and control of herbal medicines. By using the proposed method, various active ingredients present in different herbal medicines were rapidly detected, and the obtained mass spectra were served as the samples' fingerprints for tracing the origins, establishing the authenticity, and assessing the quality consistency and stability of herbal medicines. Our experimental results demonstrated that field-induced wooden-tip ESI-MS is a desirable method for high-throughput analysis of herbal medicines, with promising prospects for rapidly differentiating the origin, determining the authenticity, and assessing the overall quality of pharmaceuticals. PMID:26320794

  9. Understanding Cultural Differences: Tips for Working with International Staff and Campers.

    ERIC Educational Resources Information Center

    Cameron, Sandy

    2000-01-01

    As camps employ more international staff, effective intercultural communication becomes important. Tips include being aware of cultural differences in the meaning of smiles, eye contact, and hand gestures; speaking slowly and clearly; avoiding slang; explaining common camp phrases; asking people how they would like to be addressed; learning common…

  10. Personal health care of internal medicine residents

    PubMed Central

    Palabindala, Venkataraman; Foster, Paul; Kanduri, Swetha; Doppalapudi, Avanthi; Pamarthy, Amaleswari; Kovvuru, Karthik

    2012-01-01

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

  11. Analysis of Publication Output of Internal Medicine Faculty Members.

    ERIC Educational Resources Information Center

    Manu, Peter; And Others

    1985-01-01

    The number of publications per year produced by a department of internal medicine faculty is analyzed. Publication output was correlated with sectional organization of a department of medicine, the location of faculty assignment, the age of the faculty member, and the change of career goals. (Author/MLW)

  12. 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)

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

    PubMed

    Mok, Emily A

    2010-01-01

    Access to essential medicines is a critical problem that plagues many developing countries. With a daunting number of domestic constraints - technologically, economically, and otherwise - developing countries are faced with a steep uphill battle to meet the human rights obligation of providing essential medicines immediately. To meet these challenges, the international human rights obligations of international assistance and cooperation can play a key role to help developing countries fulfill the need for access to essential medicines. This article seeks to highlight and expand upon the current understanding of international assistance and cooperation for access to essential medicines through a review of obligations identified in international human rights law and a synthesis of official guidance provided on the matter. PMID:20930255

  14. Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part two

    PubMed Central

    Malick, Sadia; Das, Kausik; Khan, Khalid S

    2008-01-01

    Summary Evidence-based medicine (EBM) is the clinical use of current best available evidence from relevant, valid research. Provision of evidence-based healthcare is the most ethical way to practise as it integrates up-to-date patient-oriented research into the clinical decision-making to improve patients' outcomes. This article provides tips for teachers to teach clinical trainees the final two steps of EBM: integrating evidence with clinical judgement and bringing about change. PMID:19029354

  15. Advances in internal medicine. Volume 30

    SciTech Connect

    Stollerman, G.H.

    1984-01-01

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

  16. [New horizons in medicine. Complexity and predictability in internal medicine].

    PubMed

    Guarini, G; Onofri, E

    1993-10-01

    Being a highly sophisticated structure, the human body should be considered on a physical level as a whole of inter-correlated non-linear dynamic systems, which are by definition, complex systems because they are always conditioned in their operativity by numerous variables. We must draw attention to the opportunity that within the field of medical science the concept of complexity referring to diagnostic, therapeutic and prognostical problems, is distinct between structural and functional. The functional complexity of a system, a phenomena, an event, MY be recognized in its dynamics, only if analysed using modern methods recently brought to light, on the relationship which exist between classic determinism and deterministic chaos. Furthermore, also on practical level, the recent discoveries on the general principles, which are at the base of the functional complexity of non-linear dynamic systems, demonstrate exactly how fragile is the probabilistic predictability which guides a doctor in clinical reasoning in all its various stages; in the gathering of anamnestic and objective data; in the programming the researches aimed at confirming the validness of the diagnosis; in the therapy aimed at reaching the best possible results; in the prognosis which summarize the destiny of the binomial patient illness. The scientific enunciate of universal nature, which demonstrate how, from a tiny uncertainty in the initial functional data of a system, of a phenomena, of an event can unleash a condition of absolute unpredictability, find daily confirmation in both clinical and experimental medicine.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8235036

  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. Human genetics: international projects and personalized medicine.

    PubMed

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

    2016-03-01

    In this article, we present the progress driven by the recent technological advances and new revolutionary massive sequencing technologies in the field of human genetics. We discuss this knowledge in relation with drug response prediction, from the germline genetic variation compiled in the 1000 Genomes Project or in the Genotype-Tissue Expression project, to the phenome-genome archives, the international cancer projects, such as The Cancer Genome Atlas or the International Cancer Genome Consortium, and the epigenetic variation and its influence in gene expression, including the regulation of drug metabolism. This review is based on the lectures presented by the speakers of the Symposium "Human Genetics: International Projects & New Technologies" from the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held on the 20th and 21st of April 2015. PMID:26581075

  19. Family medicine training--the international experience.

    PubMed

    Roberts, Richard G; Hunt, Vincent R; Kulie, Teresa I; Schmidt, Wesley; Schirmer, Julie M; Villanueva, Tiago; Wilson, C Ruth

    2011-06-01

    Family medicine is undergoing dramatic transformation around the world. Its organisation, delivery, and funding are changing in profound ways. While the specifics of primary care reform vary, a common emerging strategy involves establishment of primary health care teams that provide improved access, use electronic records, are networked with other teams, and are paid using blended payment schemes. More family doctors are needed in all countries. New approaches beyond the traditional apprenticeships or residency programs will be required to meet global demand. Training of family doctors must change to prepare tomorrow's family physician for a different practice reality. Curricula are more competency-oriented, rather than time-focused. Today's trainees can anticipate a career that includes periodic reassessment of their knowledge base and competency. This article explores these trends and offers some strategies that have proved effective in various parts of the world for training increased numbers of qualified family doctors. PMID:21644860

  20. [Incident-reporting electronic-based system in internal medicine].

    PubMed

    Servet, J; Bart, P-A; Wasserfallen, J-B; Castioni, J

    2015-11-01

    How to recognize, announce and analyze incidents in internal medicine units is a daily challenge that is taught to all hospital staff. It allows suggesting useful improvements for patients, as well as for the medical department and the institution. Here is presented the assessment made in the CHUV internal medicine department one year after the beginning of the institutional procedure which promotes an open process regarding communication and risk management. The department of internal medicine underlines the importance of feedback to the reporters, ensures the staff of regular follow-up concerning the measures being taken and offers to external reporters such as general practioners the possibility of using this reporting system too. PMID:26685652

  1. 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.

  2. 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…

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

    ERIC Educational Resources Information Center

    Oliver, J. E., Jr.

    1979-01-01

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

  4. 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)

  5. Interpersonal Skills Training: Evaluation in an Internal Medicine Residency.

    ERIC Educational Resources Information Center

    Robbins, Alan S.; And Others

    1979-01-01

    To determine the effectiveness of teaching interpersonal skills in a general internal medicine residency, a program was developed utilizing videotape feedback of hospital house-staff/patient interactions. Fifty-one randomly selected house officers were included in a controlled pre- and post-test study design. The results suggest that such a…

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

    PubMed Central

    Kolade, Victor O.; Sethi, Anuradha

    2016-01-01

    Background Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. Purpose To document the reporting of QI training or experience in residency applications. Methods Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Results Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Conclusion Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns. PMID:26908376

  7. 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

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

    MedlinePlus

    ... 2/20 Example: 2/23 CAM Therapies Massage Ginger pills How Much? or How Long? 60 minutes ... are considered a type of dietary supplement. • Examples: ginger, milk thistle, turmeric Over the counter (OTC) medicine: ...

  9. An Efficient In Vitro Plantlet Regeneration from Shoot Tip Cultures of Curculigo latifolia, a Medicinal Plant

    PubMed Central

    Babaei, Nahid; Psyquay Abdullah, Nur Ashikin; Saleh, Ghizan; Lee Abdullah, Thohirah

    2014-01-01

    A procedure was developed for in vitro propagation of Curculigo latifolia through shoot tip culture. Direct regeneration and indirect scalp induction of Curculigo latifolia were obtained from shoot tip grown on MS medium supplemented with different concentrations and combinations of thidiazuron and indole-3-butyric acid. Maximum response for direct regeneration in terms of percentage of explants producing shoot, shoot number, and shoot length was obtained on MS medium supplemented with combination of thidiazuron (0.5 mg L−1) and indole-3-butyric acid (0.25 mg L−1) after both 10 and 14 weeks of cultures. Indole-3-butyric acid in combination with thidiazuron exhibited a synergistic effect on shoot regeneration. The shoot tips were able to induce maximum scalp from basal end of explants on the medium with 2 mg L−1 thidiazuron. Cultures showed that shoot number, shoot length, and scalp size increased significantly after 14 weeks of culture. Transferring of the shoots onto the MS medium devoid of growth regulators resulted in the highest percentage of root induction and longer roots, while medium supplemented with 0.25 mg L−1 IBA produced more numbers of roots. PMID:24723799

  10. An efficient in vitro plantlet regeneration from shoot tip cultures of Curculigo latifolia, a medicinal plant.

    PubMed

    Babaei, Nahid; Abdullah, Nur Ashikin Psyquay; Saleh, Ghizan; Abdullah, Thohirah Lee

    2014-01-01

    A procedure was developed for in vitro propagation of Curculigo latifolia through shoot tip culture. Direct regeneration and indirect scalp induction of Curculigo latifolia were obtained from shoot tip grown on MS medium supplemented with different concentrations and combinations of thidiazuron and indole-3-butyric acid. Maximum response for direct regeneration in terms of percentage of explants producing shoot, shoot number, and shoot length was obtained on MS medium supplemented with combination of thidiazuron (0.5 mg L(-1)) and indole-3-butyric acid (0.25 mg L(-1)) after both 10 and 14 weeks of cultures. Indole-3-butyric acid in combination with thidiazuron exhibited a synergistic effect on shoot regeneration. The shoot tips were able to induce maximum scalp from basal end of explants on the medium with 2 mg L(-1) thidiazuron. Cultures showed that shoot number, shoot length, and scalp size increased significantly after 14 weeks of culture. Transferring of the shoots onto the MS medium devoid of growth regulators resulted in the highest percentage of root induction and longer roots, while medium supplemented with 0.25 mg L(-1) IBA produced more numbers of roots. PMID:24723799

  11. Value of subspecialty experience in internal medicine undergraduate training.

    PubMed

    Al Kadri, Hanan M F; Al-Moamary, Mohamed S; Tamim, Hani M; Al-Kadi, Mohammed T

    2012-05-01

    We aimed from our study to assess how students and clinical supervisors perceive students' achievement in the internal medicine subspecialty clinical attachments in comparison with the general attachments. We conducted a cross-sectional study comparing students' self-assessment ratings during the Medicine Block general and subspecialties clinical attachments at our college of medicine during the period between February 2007 and June 2009. We assessed the level of agreement between students' self-assessment in the different subspecialties with their self-assessment in the general attachments. We repeated the same calculation for the supervisors' assessment. Eighty-three students were included; these students attended eight different clinical attachments. A total of 517 self-assessment forms were completed (120 general internal medicine clinical attachments and 397 forms in different specialty attachments). The clinical supervisors completed parallel assessment forms. The undergraduate medical students' perceived their achievement in the subspecialty attachments well. This was similar to their perception of their achievement in the general clinical attachments. The clinical supervisors perceived students achievement in the subspecialties to be similar to their achievement in the general clinical attachments. In conclusion, we do encourage the implementation of specialty and subspecialty undergraduate clinical attachments for all students as part of their curriculum requirements. Furthermore, we encourage the strategic utilization of specialties/subspecialties attachment distribution aiming to enhance students' future interest to achieve balance in the different health specialties/subspecialties manpower. Further research to support this recommendation is needed. PMID:22569442

  12. [General practice and internal medicine. The fighting with shared issues].

    PubMed

    Beylot, J

    2009-04-01

    The training of the primary care physicians has been neglected for long by the French medical faculties that, since 1958, favoured the hyper-specialization of their students. The initiative of a few primary care physicians supported by some academic internal medicine physicians allowed changing this situation gradually. Commitment of a training period in primary care practice and then the involvement of teaching general medicine physicians in the course of the theoretical training were essential to this shift. Following three decades of reforms that lead to recognize general medicine as a sub-specialty, an acknowledged academic course of general medicine is eagerly expected for 2009 with the first appointments of professors of general medicine with tenure. The general internists who share the same objective of global patient care are determined to support this academic course that they will welcome within the French National Council of Universities. This academic course will have to comply with the same teaching and research requirements than the other medical subspecialties. PMID:19195744

  13. Clinicians, Educators, and Investigators in General Internal Medicine

    PubMed Central

    Mukamal, Kenneth J; Smetana, Gerald W; Delbanco, Tom

    2002-01-01

    Financial and time pressures, disparate promotional pathways, geographic separation, and difficulty acknowledging personal fallibility can contribute to polarization of clinician-educators and investigators in general internal medicine (GIM). As a consequence, clinician-educators and investigators may fail to use their joint expertise, may encounter friction in their relationships, and may present a troubled image to trainees considering careers in GIM. We suggest specific strategies that clinician-educators, investigators, administrative leaders, and medical schools might use to foster collaboration. PMID:12133148

  14. National Library of Medicine: international cooperation for biomedical communications.

    PubMed Central

    Corning, M E

    1975-01-01

    The international programs of the National Library of Medicine may vary in mechanism, but all share the common objective of improved medical research, education, and practice. They are a natural extension of domestic responsibilities and represent a sharing of time, talent, and resources. The programs may be service-oriented, cooperative efforts based on the computerized information storage and retrieval system (MEDLARS), or establishment of regional medical library programs. Policy and operational aspects are presented. PMID:1109613

  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. 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

  17. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis.

    PubMed

    Ballard, David H; Samra, Navdeep S; Gifford, Karen Mathiesen; Roller, Robert; Wolfe, Bruce M; Owings, John T

    2016-06-01

    Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p < 0.001) and venous thrombosis (p < 0.001). Patients with femoral catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p < 0.01). In conclusion, to reduce catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible. PMID:27112774

  18. 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

  19. Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one

    PubMed Central

    Das, Kausik; Malick, Sadia; Khan, Khalid S

    2008-01-01

    Summary Evidence-based medicine (EBM) is an indispensable tool in clinical practice. Teaching and training of EBM to trainee clinicians is patchy and fragmented at its best. Clinically integrated teaching of EBM is more likely to bring about changes in skills, attitudes and behaviour. Provision of evidence-based health care is the most ethical way to practice, as it integrates up-to-date, patient-oriented research into the clinical decision making process, thus improving patients' outcomes. In this article, we aim to dispel the myth that EBM is an academic and statistical exercise removed from practice by providing practical tips for teaching the minimum skills required to ask questions and critically identify and appraise the evidence and presenting an approach to teaching EBM within the existing clinical and educational training infrastructure. PMID:18840865

  20. 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…

  1. Predictors of yoga use among internal medicine patients

    PubMed Central

    2013-01-01

    Background 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. Methods 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. Results 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

  2. Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns

    PubMed Central

    Miloslavsky, Eli M.; Hayden, Emily M.; Currier, Paul F.; Mathai, Susan K.; Contreras-Valdes, Fernando; Gordon, James A.

    2012-01-01

    Background The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored. Objective To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills. Methods Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators. Results A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills. Conclusions Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective. PMID:24294427

  3. Space medicine policy development for the International Space Station

    NASA Astrophysics Data System (ADS)

    Grigoriev, Anatoly I.; Williams, Richard S.; Comtois, Jean-Marc; Damann, Volker; Tachibana, Shoichi; Nicogossian, Arnauld E.; Bogomolov, Valery V.; Pool, Sam L.; Sargsyan, Ashot E.; Knowingkov, Oleg L.; Doarn, Charles R.

    2009-09-01

    Providing medical care capability in a multinational setting in space is a daunting challenge. As the International Space Station (ISS) has taken shape over the last decade the space medicine community of the ISS partners has established a foundation with which to govern medical policy, medial processes, and medical care during the ISS Program. This foundation was predicated on a rich history of bilateral and multilateral cooperation among space faring nations. Three key organizations were established, they include the agency or senior level Multilateral Medical Policy Board (MMPB), the Multilateral Space Medicine Board (MSMB), and the Multilateral Medical Operations Panel (MMOP). All three are staffed by senior medical personnel within each of the partner organizations of the ISS and each has specific roles and responsibilities. These three entities strive to protect the human element of spaceflight through highly effective interaction in a multilingual, multicultural program. This paper reviews the creation of this tripartite approach to the development of medical policy for ISS.

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

    SciTech Connect

    Arpin, Bettina Karin Schimanski; Jones, Brian S.; Bemesderfer, Joy; Ralph, Mark E.; Miller, Jennifer L

    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 vocabulary 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.

  5. Psychiatric side effects of medications prescribed in internal medicine

    PubMed Central

    Casagrande Tango, Rodrigo

    2003-01-01

    Several pharmacological treatments used in internal medicine can induce psychiatric side effects (PSEs) that mimic diagnoses seen in psychiatry. PSEs may occur upon withdrawal or intoxication, and also at usual therapeutic doses. Drugs that may lead to depressive, anxious, or psychotic syndromes include corticosteroids, isotretinoin, levo-dopar mefloquine, interferon-a, and anabolic steroids, as well as some over-the-counter medications. PSEs are often difficult to diagnose and can be very harmful to patients. PSEs are discussed in this review, as well as diagnostic clues to facilitate their identification. PMID:22034468

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

    PubMed Central

    2012-01-01

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

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

    PubMed

    Beltramello, Giampietro; Manicardi, Valeria; Trevisan, Roberto

    2013-06-01

    Hyperglycaemic patients admitted to hospital have worse clinical outcomes with higher operational costs than normoglycaemic patients. Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalisation; adequate 'continuity of care' must be assured after discharge. This requires a multidisciplinary clinical collaboration between the internist and the diabetes team, which plays a central role in the treatment course and should be involved soon after patient admission to the hospital. This document aims to establish guidelines and recommendations for good clinical practice in managing hyperglycaemic internal medicine patients, with or without previous diagnosis of diabetes. The Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) and Società Italiana di Diabetologia (SID) have decided to publish a document useful for internists in the management of hospitalised patients with hyperglycaemia. The Trialogue project, coordinated by a Board of Scientific Experts from the three scientific societies, was initiated for this purpose. A questionnaire consisting of 16 multiple choice questions on the management of hyperglycaemia in hospital was answered by 660 physicians from over 250 Internal Medicine units distributed throughout Italy. Analysis of responses has yielded an overview of routine clinical practice and provided a wealth of ideas to better identify critical points in the treatment of hospitalised patients with hyperglycaemia. These recommendations were developed with the aim of providing mutually agreed practical guidance (instructions for use) that can be readily applied by healthcare professionals in routine clinical practice. PMID:23575748

  8. Teaching skills improvement programmes in US internal medicine residencies.

    PubMed

    Bing-You, R G; Tooker, J

    1993-05-01

    The prevalence and nature of resident teaching skills improvement programmes (TSIP) are unknown. Although residents perceive themselves as important teachers of students, there is little information on how programme directors (PDs) view residents as teachers. A comprehensive questionnaire was sent to all 428 US internal medicine PDs in December 1990, of which 60% (n = 259) responded. Of the 259 responding programmes, only 20% (n = 51) had TSIPs. Characteristics of TSIPs were not uniform. Mean instructional time was 9 hours (range, 1-24 hours). The teacher most frequently utilized to develop and facilitate the TSIP was the PD. PDs from residencies with a TSIP indicated more strongly than PDs without a TSIP that residents contributed to students' learning. Fifty-one per cent of TSIPs required residents to attend. Evaluation/feedback as a teaching method was the most common topic covered in TSIPs. Long-term assessment of teaching skills after programme participation was done in 15% of TSIPs. Although PDs value the resident's role as teacher, current TSIPs in internal medicine residencies are few in number and lack standardization. PDs' attitudes probably influence whether residents are taught teaching skills and whether teaching skills are evaluated. Further investigation of appropriate curriculum for TSIPs and assessment of long-term effectiveness of TSIPs are needed. PMID:8336577

  9. The Use of Smartphones on General Internal Medicine Wards

    PubMed Central

    Morra, D.; Lo, V.; Quan, S.; Wu, R.

    2014-01-01

    Summary Objective To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use. Methods A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys. Results Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity. Conclusion Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians. PMID:25298819

  10. Perception of Thromboembolism Risk: Differences between the Departments of Internal Medicine and Emergency Medicine.

    PubMed

    Vincentelli, Giovanni Maria; Monti, Manuel; Pirro, Maria Rosaria; Bertazzoni, Giuliano; Pugliese, Francesco Rocco; Ciammaichella, Maurizio; Ruggieri, Maria Pia; Landolfi, Raffaele

    2016-01-01

    The latest developments in emergency medicine (EM) have introduced new typologies of patients that have not been taken into account in previous studies of venous thromboembolism (VTE) risk. The aim of the current study was to evaluate by comparing the main international risk scores whether different perceptions of VTE risk exist in internal medicine (IM) departments and in EM departments. This cross-sectional observational study involved 23 IM and 10 EM departments of 21 different hospitals. The patient data were collected by physicians who were blinded to the purpose of the study. The data were analyzed using the main international risk scores. We analyzed 742 patients, 222 (30%) hospitalized in EM departments and the remaining 520 (70%) in IM departments. We found that fewer patients at risk for VTE were treated with low-molecular-weight heparin (LMWH) in EM departments than in IM departments. Moreover, there was significant statistical difference in the use of LMWH between IM and EM departments when the Padua score and immobilization criteria were used to assess the risk. The infrequent use of LMWH in EM patients may have several causes. For example, in EM departments, treatment of acute illness often takes higher priority than VTE risk evaluation. Moreover, immobilization criteria cannot be evaluated for all EM patients because of the intrinsic time requirements. For the aforementioned reasons, we believe that a different VTE risk score is required that takes into account the peculiarities of EM, and establishing such a score should be the object of future study. PMID:27349662

  11. Study on Internal Flow and External Performance of a Semi-open Impeller Centrifugal Pump with Different Tip Clearances

    NASA Astrophysics Data System (ADS)

    Jia, Xiao-Qi; Cui, Bao-Ling; Zhang, Yu-Liang; Zhu, Zu-Chao

    2015-04-01

    To study the influence of tip clearance on internal flow characteristics and external performance of a prototype centrifugal pump with a semi-open impeller, the unsteady numerical simulation and performance experiments are carried out in this paper. The evolution process of leakage vortex with time t, the flow characteristics and the magnitude of leakage rate in tip clearance are obtained in details. The results indicate that the H-Q curve hump of centrifugal pump shows a weakened trend with the increasing of tip clearance Δc. Meanwhile, the leakage rate ΔQ and the ratio of leakage rate to discharge flow rate (ψ) gradually increase. At the same tip clearance, the leakage rate ΔQ increases, while the ratio of leakage rate to discharge flow rate (ψ) decreases with the increasing of discharge flow rate Q. It is found that higher volumetric loss account for a higher percentage of the total loss at small flow rate condition. There easily exist strong leakage vortexes in the impeller inlet, impeller passage and impeller outlet. The pressure difference between suction side and pressure side makes the fluid pass through the tip clearance layer to form a lower pressure region and leakage vortex.

  12. Development of crystallographic-orientation-dependent internal strains around a fatigue-crack tip during overloading and underloading

    SciTech Connect

    Lee, S.Y.; Huang, E.-W.; Wu, W.; Liaw, P.K.; Paradowska, A.M.

    2013-05-15

    In-situ neutron diffraction was employed to directly measure the crystallographic-orientation-dependent (i.e. hkl) internal strains as a function of distance from the crack tip on the pre-cracked Hastelloy C-2000 compact-tension specimen. Both in-plane (IP) and through-thickness (TT) strain evolutions for various grain orientations were examined during tensile overloading and compressive underloading cycles. After overloading, underloading and their combination loadings were applied and unloaded, the significantly different (hkl) residual strain profiles were obtained in the vicinity of the crack tip. The load responses of the (200) grain orientation in both the IP and TT directions were more significant than those of any other orientations. It is suggested that the different orientation-dependent strain distributions around the crack tip are caused by the combined effects of elastic and plastic anisotropy of each (hkl) reflection upon loading and the subsequent development of residual stresses generated near the crack tip during unloading as a result of the plastic deformation. - Highlights: ► (hkl) strains are examined in situ using neutron diffraction. ► Distinct strain responses are developed around the crack tip under loading. ► The strain response of the (200) grain orientation is more significant. ► Possible mechanisms for the orientation-dependent strain responses are provided.

  13. The internal morality of medicine: explication and application to managed care.

    PubMed

    Brody, H; Miller, F G

    1998-06-01

    Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. PMID:9831284

  14. 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

    2016-01-01

    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

  15. 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

  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. Effective Research Strategies for Trainees in Internal Medicine Residency Programs

    PubMed Central

    Wiederman, Michael W.; Sawyer, Robert J.

    2015-01-01

    For most training programs, the development of research endeavors among trainees is an ongoing challenge. In this article, we review various considerations when attempting to undertake research activities within an internal medicine residency training program, including availability of institutional resources (eg, dedicated research time for trainees and faculty, available faculty mentors, accessible adjunctive personnel), engagement of residents into research, classic project quagmires in training programs, the institutional review board, publication options (eg, letters to the editor, case reports, literature reviews, original research reports), and journal submission strategies. Given that research entails multiple components and distinct skills, the overall program goal should be to make research an educationally understandable process for trainees. Research can be a rewarding activity when nurtured in a facilitating educational environment. PMID:26137359

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

    PubMed Central

    2015-01-01

    Purpose: Smartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1%) than year 1–2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5%) than for year 1–2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones. PMID:26582632

  19. 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

  20. 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. PMID:21111933

  1. 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

  2. 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

    2013-01-01

    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

  3. 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…

  4. Feedback from Chief Residents about Proposed Revisions of the Special Requirements for Internal Medicine Residencies.

    ERIC Educational Resources Information Center

    Reynolds, P. Preston; And Others

    1995-01-01

    A survey of 272 medical school chief residents concerning proposed revisions of internal medicine residency requirements found the most strongly supported changes were: enhanced training in interviewing, interpersonal, and physical examination skills; increased emphasis on residency as an educational experience and on general internal medicine in…

  5. Training Student and Adult Assistants, Interns, and Volunteers: Tips for New Librarians Servicing Small Libraries.

    ERIC Educational Resources Information Center

    Smallwood, Carol

    1999-01-01

    Provides tips for designing effective training programs for library assistants. Discusses general points to consider; acquainting new assistants with the library; and assigning jobs that reflect assistants' interests. Suggests special projects for assistants including: arranging displays; cataloging; covering paperback and hardback books;…

  6. Variation in patient management based on ECG interpretation by emergency medicine and internal medicine residents.

    PubMed

    Trzeciak, Stephen; Erickson, Timothy; Bunney, E Bradshaw; Sloan, Edward P

    2002-05-01

    This study was performed to determine the impact of electrocardiogram (ECG) interpretation on urgent patient care decisions by internal medicine (IM) and emergency medicine (EM) resident physicians. Six clinical scenarios and ECGs were given to 31 IM residents and 31 EM residents at a university medical center. Based on the ECG interpretation, the residents were asked to select the best patient management from a list of choices. IM and EM residents were equally likely to choose the correct management for complete heart block (90% IM v 97% EM, P = NS), and pulseless ventricular tachycardia (VT) (94% IM v 97% EM, P = NS). IM residents were less likely to choose the correct management for acute posterior wall myocardial infarction (MI) (26% IM v 74% EM, P <.0001) and unstable supraventricular tachycardia (SVT) (87% IM v 100% EM, P <.05). Residents in both programs were equally likely to misinterpret left ventricular hypertrophy (LVH) (23% IM and 16% EM, P = NS) and benign early repolarization (BER) (48% IM and 52% EM, P = NS) as acute myocardial ischemia when presented with a clinical history not suggestive of cardiac ischemia. IM and EM residents were equally likely to choose the correct management for complete heart block and pulseless VT. Compared with EM residents, IM residents were less likely to choose the correct management of posterior wall MI and unstable SVT. Both IM and EM residents were prone to misinterpreting LVH and BER as acute myocardial ischemia. Resident education in both specialties should focus on ECG interpretation skills to improve patient management decisions. PMID:11992338

  7. International differences in sport medicine access and clinical management

    PubMed Central

    Heron, Neil; Malliaropoulos, Nikolaos G.

    2012-01-01

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

  8. Human parvovirus B19: relevance in internal medicine.

    PubMed

    van Elsacker-Niele, A M; Kroes, A C

    1999-06-01

    Infection by the human parvovirus B19 can lead to several clinical manifestations which are relevant in internal medicine. These include aplastic crisis in chronic haemolytic anaemias, exanthemathous disease and arthropathy, mainly in women, and chronic anaemia in the immunocompromised host. After initial replication, probably in the respiratory tract, the virus enters its target cells in the bone marrow, erythroid precursor cells, through its receptor, the blood group P antigen. Viral replication in these cells leads to an arrest in erythropoiesis, normally lasting approximately 1 week. In this stage, an aplastic crisis can be produced in all patients under 'erythropoietic stress'. The viraemia disappears as specific antibodies to the virus become detectable in serum, which may give rise to a rash or arthralgia, symptoms that are probably immune-mediated. In immunologically normal individuals the infection is cleared by the humoral immune system within several weeks, whereafter detectable specific IgG confers lifelong immunity to reinfection. In patients with absent or dysfunctional humoral immunity to this virus, however, persistent infection can occur, which results in chronic suppression of erythropoiesis with chronic anaemia. Passive immunization, by means of normal immunoglobulin preparations has been reported to be effective in treating this condition. Diagnosis of parvovirus infection is usually possible by the detection of specific antibodies of IgM class in cases of recent infection. In patients with aplastic crisis and patients with chronic anaemia diagnosis rests upon the detection of parvovirus B19 DNA in serum by polymerase chain reaction. Parvovirus B19 is a ubiquitous virus. By the age of 15, about 50% of individuals have serologic evidence of a past infection, which may present as the common childhood disease erythema infectiosum. At the age of 70, seroprevalence reaches 80 to 100%. A vaccine against this virus is currently being developed. PMID

  9. [The history of internal medicine in Poznań from the year 1919].

    PubMed

    Hasik, H; Kasprzak, W; Zimmermann-Górska, I

    2000-01-01

    After the 1st World War (1914-1918) the greatest influences in the development of internal medicine were the foundation of Poznán University and its first Dean Prof. H. Swiecicki - a physician. Due to cooperation with Prof. A. Wrzosek the School of Medicine was created. In addition to those mentioned above were the first creators of internal medicine Professors: W. Jezierski, J. Lubieniecki and I. Hoffmann. During World War II Poznań medicine suffered badly. After the War there was a renewal of Poznań and in internal medicine appeared excellent leaders: prof. J. Roguski, prof. S. Kwaśniewski and prof. F. Labendziński. Thanks to them 1st 2nd and 3rd Departments of Internal Medicine transformed in narrow specialized departments integrated in the Institute of Internal Disease and led by prof. K. Jasiński and his vice head prof. J. Hasik and prof. M. Gembicki. In the 1985 there appeared from Internal Institute the Institute of Cardiology with the head prof. A. Cieśliński. There was also overworked the status of out-clinic internal medicine (prof. I. Zimmerman-Górska, dr W. P. Kasprzak). PMID:11765754

  10. 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. PMID:26525948

  11. Air Travel Health Tips

    MedlinePlus

    MENU Return to Web version Air Travel Health Tips Air Travel Health Tips How can I improve plane travel? Most people don't have any problems when ... and dosages of all of your medicines. The air in airplanes is dry, so drink nonalcoholic, decaffeinated ...

  12. The Teaching of Interviewing and Counseling Skills to Internal Medicine Residents.

    ERIC Educational Resources Information Center

    Levin, Ellen M.; And Others

    1979-01-01

    The primary objective of a training program based within an internal medicine department at the University of Texas Medical Branch was to increase the interviewing skills of medicine residents, especially regarding the psychosocial aspects of patients. The program, evaluation methods, and results are described. (JMD)

  13. 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…

  14. 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)

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

    PubMed Central

    Lin, Yi-Hsuan; Tseng, Yen-Han; Chang, Hsiao-Ting; Lin, Ming-Hwai; Tseng, Yen-Chiang; 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. PMID:26500827

  16. European School of Internal Medicine (ESIM) in Brighton: experiences and reflections.

    PubMed

    Hewitt, Stephen; Weidanz, Frauke; Westgeest, Hans; Ruza, Ieva; Ciferska, Hana; Pasquet, Florian; Salomäki, Soile; Olsen, Erik

    2011-06-01

    The European School of Internal Medicine (ESIM) is a meeting aimed at young physicians training in internal medicine throughout Europe. Since 1998 the school has been held annually, and in this report we reflect on our experiences during the recent school in Brighton in July 2010. The school combined a broad mix of lectures, workshops and case presentations covering a variety of rare diseases, and both faculty and residents participated with noticeable enthusiasm, making this a special experience for all of us. The school also provided an opportunity to compare and discuss topical professional issues in internal medicine in Europe and was a memorable social gathering for physicians who share a strong interest in internal medicine. PMID:21570640

  17. The department of internal medicine: hub of the academic health center response to the aging imperative.

    PubMed

    Hazzard, W R

    2000-08-15

    In the 21st century, geriatrics will increasingly dominate U.S. health care as the median age of the population progressively increases. Academic departments of geriatrics have been created in nations that have already experienced this shift. As an alternative strategy that builds on traditional strengths of academic medicine in the United States, departments of internal medicine should lead a multidepartmental, pan-institutional response to the aging imperative. Recognition of gerontology and geriatric medicine as central to the missions of internal medicine in clinical care, education, and research must be increased. In the process, academic departments of internal medicine will develop a high level of geriatric expertise and will launch many programs that address this challenge. Successful development of geriatric programs will serve as a catalyst to strengthen the integration among and between generalists and subspecialists. This will entail developing optimal sites and systems of geriatric care--at different levels of care and over time--that can enhance the geriatric education of medical students, residents, fellows, and practicing physicians. The study of aging and geriatric health care will also become an integral part of departmental research, in its subspecialty divisions as well as its divisions of general internal medicine and geriatrics. This strategy is urgently recommended as both a challenge and an opportunity for all departments of internal medicine. PMID:10929171

  18. Combat internist: the internal medicine experience in a combat hospital in Afghanistan.

    PubMed

    Lee, Rachel U; Parrish, Scott C; Saeed, Omar; Fiedler, Joyce P

    2015-01-01

    Military internists and internal medicine subspecialists are physicians who generally work in traditional internal medicine settings. However, when deployed to combat settings, they must prepare and adapt their skills for a wide spectrum of complex, polytrauma, and multinational patients. There are limitations in personnel, equipment, and technical resources that make the circumstances complex and demanding. This article highlights some of the unique roles, challenges, and experiences of four military internists at the NATO Role 3, a deployed combat hospital in Afghanistan. PMID:25562851

  19. 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. PMID:24465065

  20. 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. PMID:27046243

  1. The changing face of internal medicine: patient centred care.

    PubMed

    Kramer, M H H; Bauer, W; Dicker, D; Durusu-Tanriover, M; Ferreira, F; Rigby, S P; Roux, X; Schumm-Draeger, P M; Weidanz, F; van Hulsteijn, J H

    2014-02-01

    Patient centred care is now considered the gold standard and there should be 'no decision about me, without me'. Internists who treat patients with complex multi-morbidities should consider patients' preferred outcomes, following a 'goal-oriented' principle. Perhaps the most important barrier to goal-oriented care is that medicine is deeply rooted in a disease-outcome-based paradigm. Rather than asking what patients want, the culture of modern medicine has prioritised optimal disease management according to guidelines and population goals. Doing what is right for the patient should be based on trust. Patients and internists must therefore meet as equals: 'I' and 'you' should be replaced by 'we'. PMID:24472695

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

    ERIC Educational Resources Information Center

    el-Guebaly, Nady; Violato, Claudio

    2011-01-01

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

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

    PubMed Central

    Lin, Yansong

    2015-01-01

    Abstract With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era. In this paper, recent developments regarding internal radiation therapy, including developments in radioiodine-131 (131I) and thyroid, radioimmunotherapy (RIT) for non-Hodgkin lymphoma (NHL), and radiopharmaceuticals for bone metastases. Relevant differences and status of their applications in China were mentioned as well. These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine. PMID:26445567

  4. Linking Childhood Maltreatment with Girls’ Internalizing Symptoms: Early Puberty as a Tipping Point

    PubMed Central

    Mendle, Jane; Leve, Leslie D.; Van Ryzin, Mark; Natsuaki, Misaki N.

    2013-01-01

    Early pubertal timing in girls is one of the most frequently replicated antecedents of adolescent emotional distress. Yet understanding the impact of pubertal timing in psychosocial development has presented something of a conundrum for developmentalists, as earlier physical maturation may often be preceded by a range of early adversities and life stressors. The present paper disentangles these associations by investigating childhood maltreatment, adolescent internalizing symptoms, and perceived pubertal timing in girls who were residing in foster care at study entry (N = 100, M = 11.54 years old at Time 1). Girls were assessed at two time points two years apart. There were no significant direct effects of maltreatment on internalizing symptoms; rather, childhood sexual abuse predicted earlier perceived pubertal development at study onset which, in turn, was associated with higher levels of internalizing symptomatology. These higher levels of internalizing symptoms persisted over the two years of the study. This distinctive role for early pubertal timing – even within a sample subject to stressors and risks which far exceed the developmental norm – confirms the unique salience of pubertal timing in emotional adjustment, and suggests that the heightened sexual circumstances of puberty may be especially disturbing for girls whose lives have already been traumatically disrupted by inappropriate and unwanted sexual experiences. PMID:25419091

  5. UK postgraduate medicine examinations: opportunities for international candidates.

    PubMed

    McAlpine, Lawrence; Selamaj, Elona; Shannon, Colleen; Chis, Liliana; Dacre, Jane; Elder, Andrew

    2014-10-01

    The medical profession is global, and ambitious trainee physicians around the world are eager to attain internationally recognised postgraduate medical qualifications. The MRCP(UK) and specialty certificate examinations of the Federation of Royal Colleges of Physicians of the United Kingdom provide such qualifications, and between 2002 and 2013, the number of international candidates attempting these examinations grew substantially. Delivering these proven and reliable UK-based examinations in other countries has many local benefits: it enhances careers, strengthens medical training and improves standards of patient care. In collaboration with international colleagues, the Federation is committed to continued growth that extends these benefits to all physicians, wherever they work and live. PMID:25301910

  6. A method in search of a purpose: the internal morality of medicine.

    PubMed

    Arras, J D

    2001-12-01

    I begin this commentary with an expanded typology of theories that endorse an internal morality of medicine. I then subject these theories to a philosophical critique. I argue that the more robust claims for an internal morality fail to establish a stand-alone method for bioethics because they ignore crucial non-medical values, violate norms of justice and fail to establish the normativity of medical values. I then argue that weaker versions of internalism avoid such problems, but at the cost of failing to provide a clear sense in which their moral norms are internal or can ground a comprehensive approach to moral problems. Finally, I explore various functions that an internal morality might serve, concluding with the observation that, while there may be a core of good sense to the notion of an internal morality of medicine, our expectations for it must be drastically lowered. PMID:11735054

  7. Thermal performance demonstration of a prototype internally cooled nose tip/forebody/window assembly

    NASA Astrophysics Data System (ADS)

    Wojciechowski, Carl J.; Brooks, Lori C.; Teal, Gene; Karu, Zain; Kalin, David A.; Jones, Gregory W.; Romero, Harold

    1996-11-01

    Internally liquid cooled apertures (windows) installed in a full size forebody have been characterized under high heat flux conditions representative of endoatmospheric flight. Analysis and test data obtained in the laboratory and at arc heater test facilities at Arnold Engineering Development Center and NASA Ames are presented in this paper. Data for several types of laboratory bench tests are presented: transmission interferometry and imaging, coolant pressurization effects on optical quality, and coolant flow rate calibrations for both the window and other internally cooled components. Initially, using heat transfer calibration models identical in shape to the flight test articles, arc heater facility thermal test environments were obtained at several conditions representative of full flight thermal environments. Subsequent runs tested the full-up flight article including nosetip, forebody and aperture for full flight duplication of surface heating rates and exposure ties. Pretest analyses compared will to test measurements. These data demonstrate a very efficient internal liquid cooling design which can be applied to other applications such as cooled mirrors for high heat flux applications.

  8. [The new financing system in the Italian National Health Service. Implications for internal medicine].

    PubMed

    Anessi Pessina, E

    1998-01-01

    Since 1995, the Italian National Health Service has begun to fund its hospitals on a DRG basis. This paper presents the main features of the DRG system as well as its likely implications for general internal medicine. The first part describes the introduction of DRGs in the US. The first paragraphs summarize the features of the US health-care system and particularly its private nature with two major exceptions: Medicare and Medicaid. The development of the DRG system and its adoption by Medicare are then described. Finally, the main effects of Medicare's DRG system are underlined: shorter hospital stays, fewer hospital admissions, several diagnostic and surgical procedures shifted from the inpatient to the outpatient setting, and apparently no negative quality implications. The second part focuses on Italy, in general and with specific reference to general internal medicine. For general internal medicine, the new funding system has two major implications. First, it may lead to the creation of larger medical departments including both the current general internal medicine divisions and the various specialties. Second, even under the current organisational structure, divisions will be increasingly required to produce positive financial margins. In this respect, general internal medicine divisions seem to be in a favourable position, especially in terms of costs (both per-diem and per-admission). PMID:9561023

  9. [The informatics: a remarkable tool for teaching general internal medicine].

    PubMed

    Ombelli, Julien; Pasche, Olivier; Sohrmann, Marc; Monti, Matteo

    2015-05-13

    INTERMED training implies a three week course, integrated in the "primary care module" for medical students in the first master year at the school of medicine in Lausanne. INTERMED uses an innovative teaching method based on repetitive sequences of e-learning-based individual learning followed by collaborative learning activities in teams, named Team-based learning (TBL). The e-learning takes place in a web-based virtual learning environment using a series of interactive multimedia virtual patients. By using INTERMED students go through a complete medical encounter applying clinical reasoning and choosing the diagnostic and therapeutic approach. INTERMED offers an authentic experience in an engaging and safe environment where errors are allowed and without consequences. PMID:26118231

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

    PubMed Central

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

    2006-01-01

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

  11. The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part I.

    PubMed

    Espinosa, J A; Espinosa, R D; Wolfe, K A; Joseph, A J

    1995-01-01

    Expertise in quality and process improvement is becoming widely recognized as a valuable resource. The more objective viewpoint and experience of consulting firms or outside professionals in quality and change management often is critical to the success of organization-wide quality or change implementation. Outside consultants, however, are not inexpensive. It is predictable that there will be an increasing tendency for healthcare systems to look internally for organizational and quality expertise. Part one of this article discusses the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility is discussed. Ethical dilemmas are a core challenge, and a number of real-life scenarios and associated strategies are presented. PMID:10140958

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

    PubMed Central

    Jovic, Emily; Wallace, Jean E; Lemaire, Jane

    2006-01-01

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

  13. Oxygen is an essential medicine: a call for international action

    PubMed Central

    Duke, T.; Graham, S. M.; Cherian, M. N.; Ginsburg, A. S.; English, M.; Howie, S.; Peel, D.; Enarson, P. M.; Wilson, I. H.; Were, W.

    2010-01-01

    SUMMARY Hypoxaemia is commonly associated with mortality in developing countries, yet feasible and cost-effective ways to address hypoxaemia receive little or no attention in current global health strategies. Oxygen treatment has been used in medicine for almost 100 years, but in developing countries most seriously ill newborns, children and adults do not have access to oxygen or the simple test that can detect hypoxaemia. Improving access to oxygen and pulse oximetry has demonstrated a reduction in mortality from childhood pneumonia by up to 35% in high-burden child pneumonia settings. The cost-effectiveness of an oxygen systems strategy compares favourably with other higher profile child survival interventions, such as new vaccines. In addition to its use in treating acute respiratory illness, oxygen treatment is required for the optimal management of many other conditions in adults and children, and is essential for safe surgery, anaesthesia and obstetric care. Oxygen concentrators provide the most consistent and least expensive source of oxygen in health facilities where power supplies are reliable. Oxygen concentrators are sustainable in developing country settings if a systematic approach involving nurses, doctors, technicians and administrators is adopted. Improving oxygen systems is an entry point for improving the quality of care. For these broad reasons, and for its vital importance in reducing deaths due to lung disease in 2010: Year of the Lung, oxygen deserves a higher priority on the global health agenda. PMID:20937173

  14. [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. PMID:22768679

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

    PubMed

    Lipp, M

    1993-09-01

    The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8214535

  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. PMID:27033085

  17. 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)

  18. The Clinical Education of Medical Students: A Perspective from Internal Medicine.

    ERIC Educational Resources Information Center

    Tierney, Lawrence M., Jr.

    1986-01-01

    A summary of what is generally thought to be taught well in internal medicine and what is taught less effectively is presented. The roles of medical students are considered in that context. Teaching contributions, evaluation of teaching, problems on clerkships, and opportunities for change are discussed. (MLW)

  19. 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…

  20. 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…

  1. 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)

  2. Comparing Research Activities of Women and Men Faculty in Departments of Internal Medicine.

    ERIC Educational Resources Information Center

    Levey, Barbara A.; And Others

    1990-01-01

    The study compared research activities of men and women from data obtained in a 1982-83 survey of 7,947 medical school faculty in departments of internal medicine. Among findings were that women researchers had significantly fewer National Institutes of Health grants as well as reduced laboratory space. (Author/DB)

  3. Defining a Universe of Expected Competencies: A Methodological Example for Internal Medicine.

    ERIC Educational Resources Information Center

    Bashook, Philip G.; And Others

    This paper describes a method for defining the universe of competencies expected of a general internist. This was accomplished by defining the nature of the medical practice, describing the internal medicine content in terms of subspecialty divisions and general areas of competence, and defining a format for describing competencies. The format for…

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

    ERIC Educational Resources Information Center

    Corning, Mary E.

    1972-01-01

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

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

    PubMed Central

    2013-01-01

    Background 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. Methods 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. Results 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

  6. Complementary and alternative medicine (CAM) use in an Italian cohort of pediatric headache patients: the tip of the iceberg.

    PubMed

    Dalla Libera, D; Colombo, B; Pavan, G; Comi, G

    2014-05-01

    The use of complementary alternative medicine (CAM) in paediatric populations is considerably increased, especially for pain and chronic conditions, as demonstrated by epidemiological surveys both in Europe and in the USA. In our study, CAM was used in 76 % patients of a cohort of 124 children affected by headache (age 4-16 years; 67 % female; 70 % migraine without aura, 12 % migraine with aura, 18 % tensive headache according to IHS criteria) consecutively recruited at a Pediatric Headache University Center. CAM was used as preventive treatment in 80 % cases. The main reasons for seeking CAM were: the wish of avoiding chronic use of drugs with their related side effects, the desire of an integrated approach, the reported inefficacy of conventional medicine, and a more suitable children disposition to CAM than to pharmacological compound. Female gender, younger age, migraine without aura, parents' higher educational status, maternal use of CAM and other associated chronic conditions, correlated with CAM use (p < 0.05). 73 % patients chose CAM also to treat other diseases (i.e. allergies, colitis, asthma, insomnia, muscle-scheletric disorders and dysmenorrhoea). The most assumed CAM were: herbal remedies (64 %) such as Valeriana, Ginkgo biloba, Boswellia serrata, Vitex agnus-castus, passion flower, Linden tree; vitamins/minerals supplements (40 %) with magnesium, 5-Hydroxytryptophan, vitamin B6 or B12, Multivitamin compounds; Homeopathy (47 %) with Silicea, Ignatia Amara, Pulsatilla, Aconitum, Nux Vomica, Calcarea phosphorica; physical treatment (45 %) such as Ayurvedic massage, shiatsu, osteopathy; yoga (33 %); acupuncture (11 %). CAM-often integrated with conventional care-was auto-prescribed in 30 % of the cases, suggested by non-physician in 22 %, by the General Practitioner in 24 % and by paediatrician in 24 %. Both general practitioners and neurologists were mostly unaware of their patients' CAM use. In conclusion, neurologists should inquire for CAM use and

  7. 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…

  8. [80 years' of internal medicine education at the medical school of the university in Belgrade (1922-2002)].

    PubMed

    Micić, Jovan; Micić, Dragan

    2003-01-01

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

  9. Efficacy of Proximal Aspiration Thrombectomy for Using Balloon-Tipped Guide Catheter in Acute Intracranial Internal Carotid Artery Occlusion

    PubMed Central

    Kim, Yong-Won; Hwang, Yang-Ha; Park, Jaechan; Kim, Yong-Sun

    2016-01-01

    Objective Mechanical thrombectomy (MT) for acute intracranial internal carotid artery (ICA) occlusion is often complicated by difficult revascularization and non-involved territory embolization possibly related with larger clot-burden. This study aims to evaluate the efficacy of proximal aspiration thrombectomy (PAT) using a balloon-tipped guide catheter for clot-burden reduction in such cases with period-to-period analysis (period 1 : standard MT without PAT; period 2 : PAT first, then standard MT for the remaining occlusion). Methods Eighty-six patients who underwent MT for acute intracranial ICA occlusion were included in this analysis from the prospectively maintained stroke registry (33 patients in period 1 and 53 in period 2). In period 2, 'responder' was defined as a case where some amount of clot was retrieved by PAT and the following angiography showed partial or full recanalization. Results Fifteen of fifty-three patients in period 2 (28.3%) were 'responders' to PAT. There was a significantly higher incidence of atrial fibrillation in the 'responder' subgroup. Period 2 showed a significantly shorter puncture-to-reperfusion time (94.5 minutes vs. 56.0 minutes; p=0.002), a significantly higher Thrombolysis in Cerebral Infarction of 2b-3 reperfusion (45.5% vs. 73.6%; p=0.009), but only a trend for better 3-month favorable outcome (mRS 0–2; 36.4% vs. 54.7%; p=0.097). There was no increase in the incidence of procedure-related complications or intracranial hemorrhage in period 2. Conclusion A strategy of PAT before standard MT may result in shorter puncture-to-reperfusion time and better angiographic outcome than a strategy of standard MT for acute intracranial ICA occlusion. PMID:27446520

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

    PubMed

    Goroll, Allan H

    2016-02-01

    Current U.S. primary care workforce shortages and trainees' declining interest in primary care residency training, especially regarding primary care internal medicine, have many parallels with circumstances in the early 1970s, when modern adult primary care first emerged. Rediscovery of the lessons learned and the solutions developed at that time and applying them to the current situation have the potential to help engage a new generation of young physicians in the primary care mission.The author compares the internal medicine residency primary care track at the University of New Mexico, described by Brislen and colleagues in this issue, with the nation's first three-year primary care internal medicine residency track introduced at Massachusetts General Hospital in 1973. Strategies for addressing the challenges of primary care practice and improving learner attitudes toward the field are discussed. The author suggests that primary care physicians should be likened to "quarterbacks" rather than "gatekeepers" or "providers" to underscore the intensity of training, level of responsibility, degree of professionalism, and amount of compensation required for this profession. The advent of multidisciplinary team practice, modern health information technology, and fundamental payment reform promises to dramatically alter the picture of primary care, restoring its standing as one of the best job descriptions in medicine. PMID:26397701

  11. AIMECS 09--Seventh AFMC International Medicinal Chemistry Congress. 23-27 August 2009, Cairns, Queensland, Australia.

    PubMed

    Chan, Danny

    2009-10-01

    The Seventh Asian Federation for Medicinal Chemistry (AFMC) International Medicinal Chemistry Congress (AIMECS) held in Cairns, Australia was co-hosted by the Royal Australian Chemical Institute Division of Biomolecular Chemistry and included topics covering new therapeutic developments in the fields of cancer, cardiovascular disease, anti-infectives and CNS disorders. This conference report highlights selected presentations on anticancer agents, including ALK5 inhibitors, PAR1 inhibitors, anticoagulants, iron chelators, anxiolytics and GABA receptor antagonists. Investigational drugs discussed include IN-1130 (SK Chemicals Co Ltd/In2Gen Co), SCH-530348 (Schering-Plough Corp), apixaban (Bristol-Myers Squibb Co/Pfizer Inc) and BNC-210 (Bionomics Ltd). PMID:19790007

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

    PubMed

    Vincent, Dale S

    2014-11-01

    Residents in an internal medicine residency program "flipped the classroom" in a series of learner-centered activities which included the creation of a medical student interest group, a continuing medical education symposium, and a journal supplement focused on wilderness medicine topics in Hawai'i and Asia Pacific. The project encompassed both scholarly activities (discovery, integration, application, and teaching) as well as scholarship (writing for publication). The project advanced the professional formation of residents by developing competencies and producing outcomes that are key features of the ACGME Next Accreditation System. PMID:25478292

  13. 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

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

    PubMed

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

    2008-06-01

    The Strategic Plan for the Development of Internal Medicine in Andalusia arose from the need that the internal medicine doctors had to redefine the purpose and values of their specialty to cope with the numerous changes occurring in the health care area. The project was developed in three phases. First, the tendency of the health care system and current position of the specialty were analyzed. After, the internal and external opinions on the present-future of Internal Medicine were checked out. Finally, five strategic lines with their action plans were established. Specific objectives were defined within each line: results to be achieved, methodology according to action plan. After several years of collegial work in this initiative, very positive results have been achieved. We conclude that the Strategic Plan has been useful to better define the position of our specialty and to state which tools such as those mentioned are effective to cope with the new challenges that may occur in other groups. PMID:18620654

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

    PubMed Central

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

    2015-01-01

    The medicinal plant Ferula has been widely used in Asian medicine, especially in Uyghur medicine in Xinjiang, China. Given that various substitutes and closely related species have similar morphological characteristics, Ferula is difficult to distinguish based on morphology alone, thereby causing confusion and threatening the safe use of Ferula. In this study, internal transcribed spacer 2 (ITS2) sequences were analyzed and assessed for the accurate identification of two salable Ferula species (Ferula sinkiangensis and Ferula fukangensis) and eight substitutes or closely related species. Results showed that the sequence length of ITS2 ranged from 451 bp to 45 bp, whereas guanine and cytosine contents (GC) were from 53.6% to 56.2%. A total of 77 variation sites were detected, including 63 base mutations and 14 insertion/deletion mutations. The ITS2 sequence correctly identified 100% of the samples at the species level using the basic local alignment search tool 1 and nearest-distance method. Furthermore, neighbor-joining tree successfully identified the genuine plants F. sinkiangensis and F. fukangensis from their succedaneum and closely related species. These results indicated that ITS2 sequence could be used as a valuable barcode to distinguish Uyghur medicine Ferula from counterfeits and closely related species. This study may broaden DNA barcoding application in the Uyghur medicinal plant field. PMID:26120347

  16. 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. PMID:18287480

  17. Resident Research and Scholarly Activity in Internal Medicine Residency Training Programs

    PubMed Central

    Levine, Rachel B; Hebert, Randy S; Wright, Scott M

    2005-01-01

    OBJECTIVES 1) To describe how internal medicine residency programs fulfill the Accreditation Council for Graduate Medical Education (ACGME) scholarly activity training requirement including the current context of resident scholarly work, and 2) to compare findings between university and nonuniversity programs. DESIGN Cross-sectional mailed survey. SETTING ACGME-accredited internal medicine residency programs. PARTICIPANTS Internal medicine residency program directors. MEASUREMENTS Data were collected on 1) interpretation of the scholarly activity requirement, 2) support for resident scholarship, 3) scholarly activities of residents, 4) attitudes toward resident research, and 5) program characteristics. University and nonuniversity programs were compared. MAIN RESULTS The response rate was 78%. Most residents completed a topic review with presentation (median, 100%) to fulfill the requirement. Residents at nonuniversity programs were more likely to complete case reports (median, 40% vs 25%; P =.04) and present at local or regional meetings (median, 25% vs 20%; P =.01), and were just as likely to conduct hypothesis-driven research (median, 20% vs 20%; P =.75) and present nationally (median, 10% vs 5%; P =.10) as residents at university programs. Nonuniversity programs were more likely to report lack of faculty mentors (61% vs 31%; P <.001) and resident interest (55% vs 40%; P =.01) as major barriers to resident scholarship. Programs support resident scholarship through research curricula (47%), funding (46%), and protected time (32%). CONCLUSIONS Internal medicine residents complete a variety of projects to fulfill the scholarly activity requirement. Nonuniversity programs are doing as much as university programs in meeting the requirement and supporting resident scholarship despite reporting significant barriers. PMID:15836549

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

    PubMed Central

    2013-01-01

    Background In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant. Methods Using the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis. Results In our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients’ experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage. Conclusion Our study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey’s critiques of the procedure are still relevant. PMID:24219177

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

    PubMed

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

    2016-01-15

    In many low-income countries where there are few or no neurologists, patients with neurologic diseases are cared for by primary care physicians who receive no formal training in neurology. Here, we report our experience creating a neurology rotation for internal medicine residents in rural Haiti through a collaboration between a public academic medical center in Haiti and a visiting neurologist. We describe the structure of the rotation and the factors that led to its development. PMID:26723993

  20. 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? PMID:18406944

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

    SciTech Connect

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

    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 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?.

  2. 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

  3. 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

  4. Medicines

    MedlinePlus

    ... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...

  5. Medicines

    MedlinePlus

    ... you get better. In the United States, the Food and Drug Administration is in charge of assuring ... can cause unwanted side effects or interactions with food or other medicines you may be taking. They ...

  6. 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

  7. Perceptions of Internal Medicine Residency Program Candidates on the Use of Simulation in the Selection Process

    PubMed Central

    Cannon, Keith; Hartsell, Zachary; Ivanov, Ilko; Charles, Joseph; Joshi, Harshad; Blair, Janis; Geyer, Holly

    2014-01-01

    Background The recruitment of skilled candidates into internal medicine residency programs has relied on traditional interviewing techniques with varying degrees of success. The development of simulated medical technology has provided a new arena in which to assess candidates' clinical skills, knowledge base, situational awareness, and problem-solving dexterities within a standardized environment for educational and assessment purposes. Objective The purpose of this study was to investigate the interest of program candidates in incorporating simulation medicine into the internal medicine residency interview process. Methods As a prospective, survey-based analysis, potential candidates who completed an interview between October 2012 and January 2013 with an accredited internal medicine residency program were sent a postmatch survey that incorporated 3 additional questions relating to their prior experience with medical simulation and their views on incorporating the technology into the interview format. Results Of the 88 candidates who completed an interview, 92% (n  =  81) were scheduled to graduate medical school in 2013 and were graduates of a US medical school. All survey responders described previous experience with medical simulation. Fifty-eight percent (n  =  51) of responders described being “less likely” to interview with or join a residency program if they were required to participate in a 10-minute medical simulation during the interview process. Conclusions The results of this study suggest that despite the increasing role of technology in medical education, its role in high-stakes evaluations (such as residency interviews) requires further maturation before general acceptance by residency candidates can be expected. PMID:24949144

  8. Florida International University: development and accreditation of Miami's Public College of Medicine.

    PubMed

    Rock, John A; Simpson, Joe Leigh; Dambach, George; O'Leary, J Patrick; Markham, Sanford; Bagby, Larry; Seecharan, Khaleel; Berkman, Ronald M

    2009-10-01

    Anticipating pressing health care needs in the region, Florida International University (FIU) proposed the FIU College of Medicine (COM), which was approved by the Florida Board of Governors in March 2006. The FIU COM provides a program of study enabling graduates to pursue a wide spectrum of professional careers. This includes careers in general and subspecialty private practice, academic medicine, public service, health care, and public policy leadership. Irrespective of career choice, the special emphasis of the FIU COM mission is its focus on community health in a diverse metropolitan region. Clinical facilities are met through a public partner and multiple private hospital affiliations. Educational objectives are organized into five strands reflecting the breadth of medical education and running concurrently through the four-year curriculum: (1) human biology, (2) disease, illness, and injury, (3) clinical medicine, (4) professional development, and (5) medicine and society. Founding teaching faculty with expertise in the core basic sciences will not only introduce core scientific concepts during the initial seven months but reinforce these same concepts during organ system integrated courses and clerkships. The Neighborhood Health Education Learning Program is an FIU COM innovation in which each medical student is a member of a team that throughout the four-year curriculum identifies and addresses health care needs and factors affecting health outcomes. Preliminary approval of FIU COM was conferred in February 2008, with the first cohort of 40 students matriculating in August 2009. PMID:19881442

  9. Report from the Second International Conference of Traditional and Complementary Medicine on Health 2015.

    PubMed

    Isidoro, Ciro; Huang, Chia-Chi; Sheen, Lee-Yan

    2016-01-01

    The Second International Conference of Traditional and Complementary Medicine on Health was held from October 24th through 27th at the GIS National Taiwan University Convention Center in Taipei. Twenty-seven invited speakers, representative of fourteen Countries, delivered their lecture in front of an audience of more than two hundreds of attendees. In addition, a poster exhibition with seventy-two presenters completed the scientific sessions. The leitmotif of the Conference was to promote a common platform in which all medical knowledge is integrated to improve the health care system. Traditional medicine and complementary medicine are characterized by a holistic approach to prevent and cure diseases, making use of natural products and/or physical manipulations. In this context, the Conference emphasized the importance of the Quality Control and of standardized methods for the authentication, preparation and characterization of the herbal products and nutrient supplements, as well as the need for controlled clinical trials and for experimental studies to demonstrate the efficacy and to understand the underlying mechanisms of the preventive and curative treatments. In this report, we highlight the novel findings and the perspectives in Traditional and Complementary Medicine (TCM; chuán tǒng jì hù bǔ yī xué) that emerged during the conference. PMID:26870692

  10. Report from the Second International Conference of Traditional and Complementary Medicine on Health 2015

    PubMed Central

    Isidoro, Ciro; Huang, Chia-Chi; Sheen, Lee-Yan

    2016-01-01

    The Second International Conference of Traditional and Complementary Medicine on Health was held from October 24th through 27th at the GIS National Taiwan University Convention Center in Taipei. Twenty-seven invited speakers, representative of fourteen Countries, delivered their lecture in front of an audience of more than two hundreds of attendees. In addition, a poster exhibition with seventy-two presenters completed the scientific sessions. The leitmotif of the Conference was to promote a common platform in which all medical knowledge is integrated to improve the health care system. Traditional medicine and complementary medicine are characterized by a holistic approach to prevent and cure diseases, making use of natural products and/or physical manipulations. In this context, the Conference emphasized the importance of the Quality Control and of standardized methods for the authentication, preparation and characterization of the herbal products and nutrient supplements, as well as the need for controlled clinical trials and for experimental studies to demonstrate the efficacy and to understand the underlying mechanisms of the preventive and curative treatments. In this report, we highlight the novel findings and the perspectives in Traditional and Complementary Medicine (TCM; 傳統暨互補醫學 chuán tǒng jì hù bǔ yī xué) that emerged during the conference. PMID:26870692

  11. 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

  12. 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.

  13. Factors affecting disability in patients attending the internal medicine departments of general hospitals.

    PubMed

    Sata, M; Yoshitake, K; Utsunomiya, H; Hatada, K; Ohtsuka, T; Sugasaki, H; Nakane, Y

    1999-12-01

    The aim of this study was to investigate the effect of sociodemographic factors, physical factors and mental factors on the physical and social disability of patients attending outpatient clinics of general hospitals. Physical and psychiatric morbidity in 1580 consecutive patients attending the internal medicine department of general hospitals was assessed using a stratified two-stage sampling design method. Of the total, 336 patients completed the second stage interview composed of Primary Care Version of Composite International Diagnostic Interview and Groningen Social Disability Schedule to assess sociodemographic, physical and mental factors. In this study, restricted activity days, disability days and Brief Disability Questionnaire were used for the assessment of physical disability, and Groningen Social Disability Schedule was used for social disability. Sociodemographic, physical and mental factors were all related to disability. Among sociodemographic factors, unemployment was associated with physical disability and social disability mildly. Among physical factors, the severity of physical disease was not associated with disability and medically explained somatic symptoms were associated with disability. Furthermore, the mental factor was more strongly associated with physical and social disability. It could be said that the mental factor is more strongly associated with physical and social disability than sociodemographic or physical factors. In addition, even mild mental symptoms not leading to ICD-10 mental disorders affected disability. From the viewpoint of the patients' burden, it is important to assess the mental symptoms as well as physical status in outpatient clinics of internal medicine or primary care. PMID:10687740

  14. Ambulatory care training during core internal medicine residency training: the Canadian experience.

    PubMed Central

    McLeod, P J; Meagher, T W

    1993-01-01

    OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors. RESULTS: All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails. CONCLUSIONS: Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs. PMID:8324688

  15. A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents

    PubMed Central

    Nabors, Christopher; Peterson, Stephen J; Weems, Roger; Forman, Leanne; Mumtaz, Arif; Goldberg, Randy; Kar, Kausik; Borges, Joseph A; Doctor, Ida; Lubben, Orpha; Pherwani, Nisha; Frishman, William H

    2011-01-01

    Background Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education. Methods As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction. Results Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas. Conclusion Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted. PMID:22379526

  16. Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

    PubMed Central

    2012-01-01

    Background The American Board of Internal Medicine Certification Examination (ABIM-CE) is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME) core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores. Methods ABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152). Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS). Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows. Results Paired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051). Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS. Conclusions This study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta-SPS score. Residents with

  17. Report of the International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015).

    PubMed

    Xiao, Jianbo

    2016-08-01

    The International Symposium on Phytochemicals in Medicine and Food (ISPMF2015) was held June 26-29, 2015, in Shanghai, China. This is the first time that a PSE meeting has been held in Asia and a PSE-PSA joint symposium provided an opportunity for communication between scientists from European and Asian countries. More than 270 scientists from 48 countries attended this meeting. ISPMF2015 assembled an exciting and diverse programme with 16 sessions, consisting of 12 plenary lectures, 20 invited talks, 55 short oral presentations, and in excess of 130 posters, dedicated to creating a podium for exchanging the latest research results on phytochemicals for food and human health. PMID:26988528

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

    PubMed

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

    2016-01-01

    The 2015 International Conference on Intelligent Biology and Medicine (ICIBM 2015) was held on November 13-15, 2015 in Indianapolis, Indiana, USA. ICIBM 2015 included eight scientific sessions, three tutorial sessions, one poster session, and four keynote presentations that covered the frontier research in broad areas related to bioinformatics, systems biology, big data science, biomedical informatics, pharmacogenomics, and intelligent computing. Here, we present a summary of the 10 research articles that were selected from ICIBM 2015 and included in the supplement to BMC Systems Biology. PMID:27587087

  19. 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

  20. The International Atomic Energy Agency's activities in radiation medicine and cancer: promoting global health through diplomacy.

    PubMed

    Deatsch-Kratochvil, Amanda N; Pascual, Thomas Neil; Kesner, Adam; Rosenblatt, Eduardo; Chhem, Rethy K

    2013-02-01

    Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries' national security. Recently, health has experienced a "political revolution" or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the "overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015." These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to "accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world." This article discusses global health diplomacy, reviews the IAEA's program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy. PMID:22560564

  1. Education and training in hyperbaric medicine. The Icelandic experience. An example of international scientific cooperation.

    PubMed

    Sallusti, R; Ferraù, S; Lozano Valdes, A; Gonzales, C; Jónsson, M; Gullo, A

    2001-10-01

    The authors describe their experience in the practice, education and learning in the field of hyperbaric medicine, following a project of international scientific cooperation, first in history, between Italy and Iceland. As a result of this project, the first hyperbaric facility came into use in Iceland in March 1993, initially entirely run and economically supported by the Italian side. Since 1997 the activity has been entirely financed by Icelandic National Health System with a special budget established each year according to an agreement between Icelandic and Italian Health Authorities, leaving the medical and the economical management of the Service to Italian personnel. Hyperbaric medicine is now a reality in the Icelandic medical practice. Moreover, since 1994 young Italian doctors from the University of Trieste, Italy, enrolled in the School of Specialization in Anesthesia, Intensive Care, have received training at the Service of Hyperbaric Medicine of the University of Reykjavik City Hospital, as part of their training. The educational activity, endorsed by the Italian Ministry of University and Research, consists of a theoretical part and of a practical part of operational assistance. At the end of his or her training, the resident has a full knowledge of the indications for hyperbaric oxygen therapy (HBOT) and of the related diagnostic and therapeutic procedures, is autonomous and is able to safely operate an hyperbaric chamber. An analytical report of the activity in year 2000 is also included. PMID:11740419

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

    PubMed

    Dammacco, Franco

    2012-06-01

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

  3. Improving the National Board of Medical Examiners Internal Medicine Subject Exam for Use in Clerkship Evaluation

    PubMed Central

    Elnicki, D Michael; Lescisin, Dianne A; Case, Susan

    2002-01-01

    OBJECTIVE To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN Two-round Delphi technique. PARTICIPANTS The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS Using 1–5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM–CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician

  4. Selected papers from the 7th International Conference on Microtechnologies in Medicine and Biology (MMB 2013)

    NASA Astrophysics Data System (ADS)

    Meng, Ellis; Takayama, Shuichi

    2014-03-01

    In this special section of Journal of Micromechanics and Microengineering are a collection of the best microengineering papers presented at the 7th International Conference on Microtechnologies in Medicine and Biology (MMB 2013) which took place in the seaside town of Marina del Rey, California, USA on 10-12 April, 2013. During the 3-day conference, participants enjoyed talks from 6 invited keynote speakers and 125 flash oral/poster presentations. The MMB conference is a biennial meeting with the primary purpose of fostering interactions between biologists and medical researchers, clinicians, chemists, physicists and engineers to enhance and strengthen the potential microtechnologies that will revolutionize the fields of medicine and biological sciences. The conference possesses a unique format where all poster presenters provide a brief 60 s oral presentation highlighting their research. This format was devised to provide training and exposure for young researchers, especially PhD students and postdocs, in the field and stimulate interdisciplinary exchanges. Therefore, MMB provides an intimate intellectual venue the facilitate discussions and collaborations to advance new research tools and technologies for medicine and biological sciences. The MMB conference series was co-founded by Professor David Beebe (University of Wisconsin—Madison) and Professor André Dittmar (University of Lyon) and was the first international meeting to provide a forum focusing on emerging applications of microtechnologies to unmet needs in medicine and biology. The series was held for the first time in 2000, in Lyon, France and followed by Madison, USA (2002), Oahu Island in Hawaii, USA (2005), Okinawa, Japan (2006), Québec City, Canada (2009), Lucerne, Switzerland (2011), and Marina del Rey, USA (2013). The next conference will be held in Seoul, Korea in 2015. This collection of articles highlights recent progress in microtechnologies with medical and biological applications. We are

  5. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    PubMed

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies. PMID:22450181

  6. Impact of pharmaceutical company representatives on internal medicine residency programs. A survey of residency program directors.

    PubMed

    Lichstein, P R; Turner, R C; O'Brien, K

    1992-05-01

    To survey internal medicine residency program directors regarding interactions between their residents and pharmaceutical company (PC) representatives (PCRs) a questionnaire was sent to the directors of all Accreditation Council for Graduate Medical Education-approved internal medicine residency programs. The survey included 444 program directors, of whom 272 (61.16%) responded. The majority of program directors, 228 (83.8%), allowed PCRs to meet with residents during working hours and 241 (88.6%) permitted PC sponsorship of conferences. About half of the program directors were "moderately" or "very" concerned about the potential adverse effects of PC marketing on resident attitudes and prescribing practices. Seventy percent "agreed" or "strongly agreed" that the benefits of PC sponsorship outweigh the adverse effects and 41.5% believed that refusal to allow PCRs to meet with residents would jeopardize PC funding of other departmental activities. Most program directors reported that alternate funds for conferences were available if PC support was withdrawn. "Unethical" marketing activities were observed by 14.3% of program directors and 37.5% reported that residents had participated in PC-sponsored trips during the 3 years prior to the survey. At the time of this survey, only 35.3% of programs had developed formal policies regulating PCR activities and 25.7% provided residents with formal instruction on marketing issues. Knowledge of the current extent of PCR interactions with residents may be helpful to program directors in developing policies regulating PC-marketing activities. PMID:1580704

  7. [Technical project for the management and functioning of an Internal Medicine care unit].

    PubMed

    del Castillo Rueda, A; de Portugal Alvarez, J

    2004-01-01

    The Internal Medicine Services have a central role in the medical care in our hospital system both as to the volume of patients attended and their variety, reflecting of the preparation and multi-tasking ability of their professionals. The current norms for coverage of heads-of-service demands the presentation of a management project that must test our knowledge, skills and aptitudes for the clinical and medical management and in order to reflect them in a document of commitment with the management and with our fellows who are a part of the care unit. The person in charge of the service, as boss, agent or leader, is the one who must mark the strategic lines, to indicate the aims, to define the projects, to coordinate the tasks and to evaluate the results with other offers to obtain agreed-upon aims controlling the different points of view. Our professional and social commitment is: sharing clinical management with ethics, quality and welfare safety, to offer our patients (consumer or users) the best results (effectiveness), with useful measurements (efficacy) and with the minors drawbacks and costs (efficiency). The aim of this work is to offer the elements that are necessary for the accomplishment and introduction of a project of clinical management in a service of internal medicine, highlighting its methodology and the most important problems than can arise as well as the possible care alternatives. PMID:15195484

  8. Graduating internal medicine residents' self-assessment and performance of advanced cardiac life support skills.

    PubMed

    Wayne, Diane B; Butter, John; Siddall, Viva J; Fudala, Monica J; Wade, Leonard D; Feinglass, Joe; McGaghie, William C

    2006-06-01

    Internal medicine residents in the US must be competent to perform procedures including Advanced Cardiac Life Support (ACLS) to become board-eligible. Our aim was to determine if residents near graduation could assess their skills in ACLS procedures accurately. Participants were 40 residents in a university-based training program. Self-assessments of confidence in managing six ACLS scenarios were measured on a 0 (very low) to 100 (very high) scale. These were compared to reliable observational ratings of residents' performance on a high-fidelity simulator using published treatment protocols. Residents expressed strong self-confidence about managing the scenarios. Residents' simulator performance varied widely (range from 45% to 94%). Self-confidence assessments correlated poorly with performance (median r = 0.075). Self-assessment of performance by graduating internal medicine residents was not accurate in this study. The use of self-assessment to document resident competence in procedures such as ACLS is not a proxy for objective evaluation. PMID:16807178

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

    PubMed

    Hong, Chuang-Ye; Wang, Fu-Mei

    2014-06-01

    During the 100 years from 1850 to 1949, six English textbooks on internal medicine were translated into Chinese and published. Publication of these books was a response to the increased demand for Chinese textbooks after the opening of several Western-style hospitals and medical schools in China where the instruction was in Chinese. Throughout this period, textbooks translated from English were regarded as symbols of mainstream and authority within medical communities in China. There was a shift of translators from British and American medical missionaries to Chinese medical elites. Publishers also changed from missionary hospitals or missionary organizations to the Chinese Medical Association, which was led by ethnic Chinese. After the 1950s, translation activity continued in Taiwan, but it was halted in China until after the Cultural Revolution. This paper provides bibliographic information about these books. The transition of medical authority in China during this 100-year period is also reviewed through the successive publication of translated textbooks on internal medicine. PMID:24820159

  10. Evaluating and Enhancing a Women's Health Curriculum in an Internal Medicine Residency Program

    PubMed Central

    Wayne, Diane B; DaRosa, Debra A

    2004-01-01

    OBJECTIVE Resident education in women's health is required but is often underemphasized. Our aim was to identify women's health topics with the most relevance to our graduates’ practices and to determine how well they were prepared to address women's health issues. DESIGN Postgraduate survey. SETTING University-affiliated internal medicine residency program. PARTICIPANTS Program graduates in general internal medicine practice. METHODS A survey was drafted listing the 65 topics described in a published residency curriculum in women's health. Respondents indicated the extent to which each item was relevant to their practice and the adequacy of instruction received on a Likert-type scale of 1 (not relevant/inadequate) to 5 (highly relevant/adequate). RESULTS The response rate was 86%. Many of the items were highly relevant to our graduates’ practices. Learning needs were found in all areas as none of the topics were rated as “adequately” taught during residency. Many areas in the curriculum had low relevance scores. Few differences were seen in the perceived relevance of women's health problems or the adequacy of instruction received based on gender, practice type and setting, or amount of ambulatory training during residency. CONCLUSIONS Use of this survey has allowed us to tailor and prioritize learning issues in women's health to meet the needs of our graduates. Increased time in ambulatory rotations alone may not be sufficient to prepare residents to provide comprehensive care in this field. Further study of the effectiveness of a dedicated curriculum in women's heath is needed. PMID:15209589

  11. 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

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

    PubMed

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

    2014-08-01

    With approximately 4 physicians per 100,000 inhabitants, Mozambique faces one of the most severe health care provider shortages in Sub-Saharan Africa. The lack of sufficient well-trained medical school faculty is one of Mozambique's major barrier to producing new physicians annually. A partnership between the Universidade Eduardo Mondlane and the University of California, San Diego, has addressed this challenge with support from the Medical Education Partnership Initiative. After an initial needs assessment involving questionnaires and focus groups of residents, and working with key members from the Ministry of Health, the Medical Council, and Maputo Central Hospital, a set of interventions was designed. The hospital's internal medicine residency program was chosen as the focus for the plan. Interventions included curriculum design, new teaching methodologies, investment in an informatics infrastructure for access to digital references, building capacity to support clinical research, and providing financial incentives to retain junior faculty. The number of candidates entering the internal medicine residency program has increased, and detailed monitoring and evaluation is measuring the impact of these changes on the quality of training. These changes are expected to improve the long-term quality of postgraduate training in general through dissemination to other departments. They also have the potential to facilitate equitable distribution of specialists nationwide by expanding postgraduate training to other hospitals and universities. PMID:25072585

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

    PubMed

    Rosemann, Achim; Chaisinthop, Nattaka

    2016-02-01

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

  14. 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. PMID:25145290

  15. Tipping Point

    MedlinePlus Videos and Cool Tools

    ... Tipping Point by CPSC Blogger September 22 appliance child Childproofing CPSC danger death electrical fall furniture head ... TV falls with about the same force as child falling from the third story of a building. ...

  16. [Relationship between lupus headache and headache due to internal injury in traditional Chinese medicine].

    PubMed

    Shen, Si-yu; Fu, Xiao-dong; Zhang, Yong-wen; Dong, Xiao-lei; Zhao, Ling-jie; Cai, Hui

    2009-05-01

    In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology (ACR), and the cognition of neuropsychiatric damage of systemic lupus erythematosus (SLE) was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society (IHS), and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE. PMID:19435552

  17. Training future leaders of academic medicine: internal programs at three academic health centers.

    PubMed

    Morahan, P S; Kasperbauer, D; McDade, S A; Aschenbrener, C A; Triolo, P K; Monteleone, P L; Counte, M; Meyer, M J

    1998-11-01

    The authors review the need for internal programs for leadership training at academic health centers and then describe in detail three programs of this type that have operated during the 1990s: (1) the Allegheny Leadership Institute, founded by the Allegheny Health, Education and Research Foundation, Pittsburgh, Pennsylvania; (2) the Physician Executive Management Development Program (PEMDP) of Saint Louis University School of Medicine; and (3) the University of Nebraska Medical Center Leadership Institute. Educational elements common to these programs include having a small class size and participants from many areas of academic medicine and health care, focusing on educational strategies that draw on participants' experiences and training, conducting the training away from the participants' institutions, having short sessions, using faculty from both within and outside the participants' institutions, and creating strategies to reinforce learning. Lessons learned reflect the unique context of each institution; the authors list the major lessons learned by each of the three programs they surveyed (e.g., leaders of the Saint Louis University PEMDP program believe that it is important to help participants implement desired changes in their work areas once they return to work, and are investigating how to do this). The authors conclude with an extensive list of recommendations to optimize the effects of leadership development training carried out in AHCs' internal programs (e.g., "Focus on specific skills that can be learned, and link the learning experiences to real work situations in health care and higher education") and explain why they think internal leadership institutes have at least three distinct advantages over external programs. PMID:9834697

  18. Filling the Void: Defining Invasive Bedside Procedural Competency for Internal Medicine Residents

    PubMed Central

    Lenchus, Joshua D.; Carvalho, Cristiane Mocelin; Ferreri, Kaitlyn; Sanko, Jill Steiner; Arheart, Kristopher L.; Fitzpatrick, Maureen; Issenberg, S. Barry

    2013-01-01

    Background Residents perform invasive bedside procedures in most training programs. To date, there is no universal approach for determining competency and ensuring quality and safety of care. Objective We developed and implemented an assessment of central venous catheter insertion competency for internal medicine and internal medicine–pediatrics residents, using measurements for knowledge, skill, and attitude and linking them to procedural outcomes. Methods We conducted a cohort study of a 4-week, resident-run procedure service from July 2007 through June 2011 at a large academic medical center. Knowledge was assessed by using a written test, technical skill by using a checklist, and attitude by self- and supervisor assessments of residents' confidence and capability. Competence was defined as (1) a minimum written test score (70%); (2) a perfect checklist score; (3) a resident's self-assessed confidence and capability scores of 4 or 5 of 5; and (4) faculty rating of the resident's confidence and capability as 5 of 5. A composite success rate was based on procedural outcomes (eg, completed procedures, less than 3 forward needle passes, and complication rate) and was compared to the checklist scores. Results A total of 148 internal medicine and medicine–pediatrics residents inserted 639 catheters, and 53 (36%) achieved competence by the end of 4 weeks. Residents judged to be competent by checklist scores had a higher composite success rate than those deemed not competent. Conclusions Our multi-factorial criteria used to define central venous catheter insertion competency effectively discriminated between residents judged to be competent and those judged not competent, using data from procedural outcomes. PMID:24455009

  19. Medicine safety and children

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000619.htm Medicine safety and children To use the sharing features ... especially careful if you have toddlers around. Keep Medicines out of Reach and Sight Safety tips: DO ...

  20. Access to essential medicines for sexual and reproductive health care: the role of the pharmaceutical industry and international regulation.

    PubMed

    Cottingham, Jane; Berer, Marge

    2011-11-01

    The range of medicines and technologies that are essential for sexual and reproductive health care is well established, but access to them is far from universally assured, particularly in less developed countries. This paper shows how the pharmaceutical industry plays a major role in the lack of access to essential medicines for sexual and reproductive health care, by a) investing in products for profit-making reasons despite their negative health impact (e.g. hormone replacement therapy), b) marketing new essential medicines at prices beyond the reach of countries that most need them (e.g. HPV vaccines), and c) failing to invest in the development of new products (e.g. microbicides and medical abortion pills). Small companies, some of them non-profit-making, struggle to fill some of that demand (e.g. for female condoms). International patent protection contributes to high prices of medicines, and while international agreements such as compulsory licensing under TRIPS and the Medicines Patent Pool allow for mechanisms to enable poorer countries to get access to essential medicines, the obstacles created by "big pharma" are daunting. All these barriers have fostered a market in sub-standard medicines (e.g. fake medical abortion pills sold over the internet). An agenda driven by sexual and reproductive health needs, based on the right to health, must focus on universal access to essential medicines at prices developing countries can afford. We call for greater public investment in essential medicines, expanded production of affordable generic drugs, and the development of broad strategic plans, that include affordable medicines and technologies, for addressing identified public health problems, such as cervical cancer. PMID:22118143

  1. 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

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

    PubMed

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

    2011-06-01

    While conventional wisdom has always affirmed the value of animals in promoting human well-being, only recently has their therapeutic role in medicine become the focus of dedicated research. Therapeutic modalities that use animals as a tool for improving the physical, emotional, cognitive and/or social functioning of humans are called animal-assisted interventions (AAI), and are classified into: animal-assisted activities (AAA); animal-assisted therapy (AAT); and service animal programs (SAP). The aim of this review is to analyze the papers published between 2001 and 2010 in the most influential medical journals dealing with AAI, and discuss their findings in the light of what may be of interest for internal medicine and rehabilitation. A total of 35 articles met the strict inclusion criteria for this review: 18 papers dealing with AAA, 8 with AAT, and 9 with SAP. The therapeutic outcomes associated with AAA are: enhancement of socialization; reduction of stress, anxiety and loneliness; improvement in mood and general well-being; and development of leisure/recreation skills. Regarding AAT, horses are often used as a complementary strategy to facilitate the normalization of muscle tone and improve motor skills in children with cerebral palsy and persons with lower limb spasticity. Finally, most SAP utilize dogs, that assist people with various disabilities in performing everyday activities, thus reducing their dependence on other persons. Further studies are needed to better define the fields and programs for the therapeutic use of animals and to increase their utilization in medicine, as a promising, complementary and natural means to improve both functional autonomy and quality of life. PMID:21659977

  3. [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. PMID:25636978

  4. ["Expert approved international standards of evidence-based medicine": a proposal].

    PubMed

    Raspe, Heiner; Sawicki, Peter

    2010-01-01

    Section 35b of the German Code of Social Law Book V (SGB V) mentions "expert approved international standards of evidence-based medicine" (EbM). An idea which started as a reform movement in and for clinical medicine more than twenty years ago is here, from a socio-legal perspective, being utilised as a normative concept in terms of a standard-creating methodology, which is meant to form the basis for the "methods and criteria" of comparative benefit/risk assessment of medical drugs mentioned in the respective law. The present paper places the standards in a hierarchy between "description and analysis of benefits" at the bottom and, at the top, "fundamental concerns of EbM". Apart from a variety of standards, we propose seven basic principles and four fundamental concerns of EbM (pursuit of empirical truth, patient welfare, pragmatism, procedural justice). Each of the basic principles, standards, methods and criteria can be taken to substantiate the respective superordinate category (basic concerns etc.). The position and role of the standards will be explained using the example "search for and selection of literature". PMID:21129703

  5. 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

  6. 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

  7. Knowledge about cancer screening among medical students and internal medicine residents in Mexico City.

    PubMed

    Villarreal-Garza, Cynthia; García-Aceituno, Luis; Villa, Antonio R; Perfecto-Arroyo, Miguel; Rojas-Flores, Miriam; León-Rodríguez, Eucario

    2010-12-01

    It is extremely important that physicians are aware of cancer screening precise indications. We sought to explore its knowledge among Mexican medical students and internal medicine residents. Students and residents completed a questionnaire-based survey about breast, cervical, colon, and prostate cancer screening. Four hundred fifty-one individuals answered the survey: 64.52% students and 35.48% residents. Mean knowledge score was 63.97 ± 14.97. Residents scored higher than students (p = 0.0001). No difference in the education concerning cervical and colon cancer screening was found. Knowledge of screening guidelines is suboptimal among medical students and residents. Further efforts should be targeted to educational and training programs in this country. PMID:20221811

  8. Basic biomedical sciences and the future of medical education: implications for internal medicine.

    PubMed

    Brass, Eric P

    2009-11-01

    The academic model of medical education in the United States is facing substantial challenges. Apprenticeship experiences with clinical faculty are increasingly important in most medical schools and residency programs. This trend threatens to separate clinical education from the scientific foundations of medical practice. Paradoxically, this devaluation of biomedical science is occurring as the ability to use new discoveries to rationalize clinical decision making is rapidly expanding. Understanding the scientific foundations of medical practice and the ability to apply them in the care of patients separates the physician from other health care professionals. The de-emphasis of biomedical science in medical education poses particular dangers for the future of internal medicine as the satisfaction derived from the application of science to the solving of a clinical problem has been a central attraction of the specialty. Internists should be engaged in the ongoing discussions of medical education reform and provide a strong voice in support of rigorous scientific training for the profession. PMID:19882372

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

    PubMed

    Tulsky, A A; Kouides, R W

    1998-06-01

    We surveyed physicians presenting abstracts at the 1995 Society of General Internal Medicine annual meeting to determine whether the oral or poster format better achieved their presentation goals. Poster presentations better met respondents' objectives for feedback and criticism and for networking and developing collaborative projects, while oral presentations better met their objectives for national visibility and sharing knowledge within one's field. Sixty-nine percent of respondents preferred to present oral abstracts. The majority of these presenters preferred to present their research in an oral format although poster presentations still played an important role for them, particularly as a venue for feedback on their work. As meeting size increases, different presentation formats should be explored that best meet the needs of the academic community. PMID:9669572

  10. Emergence of family medicine in ethiopia: an international collaborative education model.

    PubMed

    Franey, Cara; Evensen, Ann; Bethune, Cheri; Zemenfes, Daniel

    2016-05-01

    Family Medicine (FM) is a new specialty in Ethiopia. The first seven family physicians graduated in February 2016 from the inaugural residency programme at Addis Ababa University. Cooperation amongst Ethiopian and expatriate decision-makers and physicians was needed to begin the programme. Intentional replacement of expatriates with Ethiopian family physicians has begun. Barriers include lack of understanding of FM and the human and financial resources needed for scaling up the programme. Regular programme review with resident physician involvement has allowed the FM training programme to adapt and fit the Ethiopian context. Further successes will result from ongoing support and advocacy from the Federal Ministry of Health and other Ethiopian, African, and international primary care organisations. PMID:27254792

  11. Acute bacterial skin and skin structure infections in internal medicine wards: old and new drugs.

    PubMed

    Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco

    2016-08-01

    Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed. PMID:27084183

  12. Physician experience and outcomes among patients admitted to general internal medicine teaching wards

    PubMed Central

    McAlister, Finlay A.; Youngson, Erik; Bakal, Jeffrey A.; Holroyd-Leduc, Jayna; Kassam, Narmin

    2015-01-01

    Background: Physician scores on examinations decline with time after graduation. However, whether this translates into declining quality of care is unknown. Our objective was to determine how physician experience is associated with negative outcomes for patients admitted to hospital. Methods: We conducted a retrospective cohort study involving all patients admitted to general internal medicine wards over a 2-year period at all 7 teaching hospitals in Alberta, Canada. We used files from the Alberta College of Physicians and Surgeons to determine the number of years since medical school graduation for each patient’s most responsible physician. Our primary outcome was the composite of in-hospital death, or readmission or death within 30 days postdischarge. Results: We identified 10 046 patients who were cared for by 149 physicians. Patient characteristics were similar across physician experience strata, as were primary outcome rates (17.4% for patients whose care was managed by physicians in the highest quartile of experience, compared with 18.8% in those receiving care from the least experienced physicians; adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.72–1.06). Outcomes were similar between experience quartiles when further stratified by physician volume, most responsible diagnosis or complexity of the patient’s condition. Although we found substantial variability in length of stay between individual physicians, there were no significant differences between physician experience quartiles (mean adjusted for patient covariates and accounting for intraphysician clustering: 7.90 [95% CI 7.39–8.42] d for most experienced quartile; 7.63 [95% CI 7.13–8.14] d for least experienced quartile). Interpretation: For patients admitted to general internal medicine teaching wards, we saw no negative association between physician experience and outcomes commonly used as proxies for quality of inpatient care. PMID:26283716

  13. Internal dosimetry of nuclear medicine workers through the analysis of (131)I in aerosols.

    PubMed

    Carneiro, Luana Gomes; de Lucena, Eder Augusto; Sampaio, Camilla da Silva; Dantas, Ana Letícia Almeida; Sousa, Wanderson Oliveira; Santos, Maristela Souza; Dantas, Bernardo Maranhão

    2015-06-01

    (131)I is widely used in nuclear medicine for diagnostic and therapy of thyroid diseases. Depending of workplace safety conditions, routine handling of this radionuclide may result in a significant risk of exposure of the workers subject to chronic intake by inhalation of aerosols. A previous study including in vivo and in vitro measurements performed recently among nuclear medicine personnel in Brazil showed the occurrence of (131)I incorporation by workers involved in the handling of solutions used for radioiodine therapy. The present work describes the development, optimization and application of a methodology to collect and analyze aerosol samples aiming to assess internal doses based on the activity of (131)I present in a radiopharmacy laboratory. Portable samplers were positioned at one meter distant from the place where non-sealed liquid sources of (131)I are handled. Samples were collected over 1h using high-efficiency filters containing activated carbon and analyzed by gamma spectrometry with a high-purity germanium detection system. Results have shown that, although a fume hood is available in the laboratory, (131)I in the form of vapor was detected in the workplace. The average activity concentration was found to be of 7.4Bq/m(3). This value is about three orders of magnitude below the Derived Air Concentration (DAC) of 8.4kBq/m(3). Assuming that the worker is exposed by inhalation of iodine vapor during 1h, (131)I concentration detected corresponds to an intake of 3.6Bq which results in a committed effective dose of 7.13×10(-5)mSv. These results show that the radiopharmacy laboratory evaluated is safe in terms of internal exposure of the workers. However it is recommended that the presence of (131)I should be periodically re-assessed since it may increase individual effective doses. It should also be pointed out that the results obtained so far reflect a survey carried out in a specific workplace. Thus, it is suggested to apply the methodology

  14. Communication Skills Curriculum for Foreign Medical Graduates in an Internal Medicine Residency Program

    PubMed Central

    Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M.; Kelley, Amy S.

    2014-01-01

    Background Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. Methods The workshop consisted of 2 interactive sessions, in a small group with 2 learners and 1-2 facilitators, during the Geriatrics block of the internship year. Twenty-three IM interns were surveyed at the beginning and at the end of the 4-week block and at 3 months after completion of the workshop about their knowledge, confidence and skill in communication, and asked about any challenges to effective communication with older patients. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. Results On a 4-point Likert scale, there was an average improvement of 0.70 in self-reported confidence in communication, which sustained at 3 months after completion of the workshop. Participants reported several patient, physician and system barriers to effective communication. Conclusion Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in sustained increase in overall confidence among IM interns in communication with older adults, and may help overcome certain patient and physician-specific communication barriers. PMID:25354834

  15. Technology Tips

    ERIC Educational Resources Information Center

    Santos-Trigo, Manuel

    2004-01-01

    A dynamic program for geometry called Cabri Geometry II is used to examine properties of figures like triangles and make connections with other mathematical ideas like ellipse. The technology tip includes directions for creating such a problem with technology and suggestions for exploring it.

  16. TIP list

    SciTech Connect

    Ludwig, M E

    2006-06-22

    Subcontractors and vendors providing services, including the installation of purchased goods, are required to complete a TIP List. This list does not include every Environment, Safety, and Health (ES&H) related concern at LLNL. It is intended to highlight major concerns common to most on-site service activities.

  17. Cryopreservation of in vitro-grown shoot tips of Chinese medicinal plant Atractylodes macrocephala Koidz. using a droplet-vitrification method

    Technology Transfer Automated Retrieval System (TEKTRAN)

    BACKGROUND: Atractylodes macrocephala Koidz. is an important medicinal species from China and has been used for thousands of years because of pharmacological antioxidant, hepatoprotective, anti-inflammatory, anti-allergic, antithrombotic, antiviral, and anticarcinogenic activities. OBJECTIVE: The ai...

  18. The Feasibility of Consortia for Internal Medicine Graduate Medical Education: Perspectives from a Survey of Residency Directors.

    ERIC Educational Resources Information Center

    Libby, Donald L.; And Others

    1997-01-01

    A survey of 330 internal medicine residency directors found two-thirds of programs had ongoing academic affiliations. Support for the arrangements was stronger in university programs than in community or other hospitals, where such affiliations were considered less equitable and mutually trusting. Experience with consortia mitigated objections to…

  19. An interactive web-based project to stimulate internal medicine resident reading using board-type questions.

    PubMed

    Tuncel-Kara, Meryem; Islam, Ebtesam Attaya; Wang, Helen; Pelley, John; Nugent, Kenneth

    2015-04-01

    Since restricted resident work hours have reduced resident participation in traditional educational activities, we wanted to evaluate e-mail-based education in an internal medicine residency. One internal medicine faculty member sent four clinical case-based questions per week to all internal medicine residents over a 10-month period (132 questions total). The mean percentage of participation on a set of questions was 69% (range, 43% to 97%). The mean percentage of correct answers on all questions for all residents was 70% (range, 15% to 100%). Seventy-three percent of the question sets resulted in an electronic interaction between the residents and the faculty sponsor. Based on an anonymous survey, 96% of the residents found the program useful. The faculty sponsor spent 60 to 150 minutes per week on this activity. We think that this program increased overall reading since it did not replace any traditional activity; further, it provided practice with board-type questions. This approach can supplement the educational curriculum for internal medicine training. PMID:25829643

  20. Aerodynamic investigation of an air-cooled axial-flow turbine. Part 2: Rotor blade tip-clearance effects on overall turbine performance and internal gas flow conditions: Experimental results and prediction methods

    NASA Technical Reports Server (NTRS)

    Yamamoto, A.; Takahara, K.; Nouse, H.; Mimura, F.; Inoue, S.; Usui, H.

    1977-01-01

    Total turbine blade performance was investigated while changing the blade tip clearance in three ways. The internal flow at the moving blade outlet point was measured. Experimental results were compared with various theoretical methods. Increased blade clearance leads to decreased turbine efficiency.

  1. Female residents experiencing medical errors in general internal medicine: a qualitative study

    PubMed Central

    2014-01-01

    Background Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today’s approach to errors emphasizes systemic factors. Doctors’ individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital. Methods Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Results Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one’s own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience. Conclusions This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our

  2. Assessment of leadership training needs of internal medicine residents at the Massachusetts General Hospital.

    PubMed

    Fraser, Traci N; Blumenthal, Daniel M; Bernard, Kenneth; Iyasere, Christiana

    2015-07-01

    Internal medicine (IM) physicians, including residents, assume both formal and informal leadership roles that significantly impact clinical and organizational outcomes. However, most internists lack formal leadership training. In 2013 and 2014, we surveyed all rising second-year IM residents at a large northeastern academic medical center about their need for, and preferences regarding, leadership training. Fifty-five of 113 residents (49%) completed the survey. Forty-four residents (80% of respondents) reported a need for additional formal leadership training. A self-reported need for leadership training was not associated with respondents' gender or previous leadership training and experience. Commonly cited leadership skill needs included "leading a team" (98% of residents), "confronting problem employees" (93%), "coaching and developing others" (93%), and "resolving interpersonal conflict" (84%). Respondents preferred to learn about leadership using multiple teaching modalities. Fifty residents (91%) preferred to have a physician teach them about leadership, while 19 (35%) wanted instruction from a hospital manager. IM residents may not receive adequate leadership development education during pregraduate and postgraduate training. IM residents may be more likely to benefit from leadership training interventions that are physician-led, multimodal, and occur during the second year of residency. These findings can help inform the design of effective leadership development programs for physician trainees. PMID:26130876

  3. Outbreak of multiresistant OXA-24- and OXA-51-producing Acinetobacter baumannii in an internal medicine ward.

    PubMed

    Tena, Daniel; Martínez, Nora Mariela; Oteo, Jesús; Sáez, David; Vindel, Ana; Azañedo, María Luisa; Sánchez, Lorenzo; Espinosa, Alfredo; Cobos, Juan; Sánchez, Rosario; Otero, Ignacio; Bisquert, Julia

    2013-01-01

    Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious. PMID:23883845

  4. Assessment of leadership training needs of internal medicine residents at the Massachusetts General Hospital

    PubMed Central

    Blumenthal, Daniel M.; Bernard, Kenneth; Iyasere, Christiana

    2015-01-01

    Internal medicine (IM) physicians, including residents, assume both formal and informal leadership roles that significantly impact clinical and organizational outcomes. However, most internists lack formal leadership training. In 2013 and 2014, we surveyed all rising second-year IM residents at a large northeastern academic medical center about their need for, and preferences regarding, leadership training. Fifty-five of 113 residents (49%) completed the survey. Forty-four residents (80% of respondents) reported a need for additional formal leadership training. A self-reported need for leadership training was not associated with respondents' gender or previous leadership training and experience. Commonly cited leadership skill needs included “leading a team” (98% of residents), “confronting problem employees” (93%), “coaching and developing others” (93%), and “resolving interpersonal conflict” (84%). Respondents preferred to learn about leadership using multiple teaching modalities. Fifty residents (91%) preferred to have a physician teach them about leadership, while 19 (35%) wanted instruction from a hospital manager. IM residents may not receive adequate leadership development education during pregraduate and postgraduate training. IM residents may be more likely to benefit from leadership training interventions that are physician-led, multimodal, and occur during the second year of residency. These findings can help inform the design of effective leadership development programs for physician trainees. PMID:26130876

  5. Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application.

    PubMed

    Jacquet, Gabrielle A; Bayram, Jamil D; Ewen, William B; Hansoti, Bhakti; Andescavage, Steven; Price, David; Suter, Robert E; Vu, Alexander

    2013-01-01

    Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows' knowledge of their programs' curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70%) did not know their program's curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process. PMID:23533764

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

    PubMed Central

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

    2013-01-01

    Background Cultural competence training in residency is important to improve learners’ confidence in cross-cultural encounters. Recognition of cultural diversity and avoidance of cultural stereotypes are essential for health care providers. Methods We developed a multimethod approach for cross-cultural training of Internal Medicine residents and evaluated participants’ preparedness for cultural encounters. The multimethod approach included (1) a conference series, (2) a webinar with a national expert, (3) small group sessions, (4) a multicultural social gathering, (5) a Grand Rounds presentation on cross-cultural training, and (6) an interactive, online case-based program. Results The program had 35 participants, 28 of whom responded to the survey. Of those, 16 were white (62%), and residents comprised 71% of respondents (n=25). Following training, 89% of participants were more comfortable obtaining a social history. However, prior to the course only 27% were comfortable caring for patients who distrust the US system and 35% could identify religious beliefs and customs which impact care. Most (71%) believed that the training would help them give better care for patients from different cultures, and 63% felt more comfortable negotiating a treatment plan following the course. Conclusions Multimethod training may improve learners’ confidence and comfort with cross-cultural encounters, as well as lay the foundation for ongoing learning. Follow-up is needed to assess whether residents’ perceived comfort will translate into improved patient outcomes. PMID:23683845

  7. Training international medical graduate clinical fellows: the challenges and opportunities for adolescent medicine programs.

    PubMed

    Goldberg, Eudice

    2016-08-01

    Adolescent medicine achieved accreditation status first in the United States in 1994 and then in Canada in 2008 and even if it is not an accredited subspecialty in most other Western nations, it has still become firmly established as a distinct discipline. This has not necessarily been the case in some developing countries, where even the recognition of adolescence as a unique stage of human development is not always acknowledged. The program at SickKids in Toronto has prided itself in treating its international medical graduates (IMG) clinical fellows the same as their Canadian subspecialty residents by integrating them seamlessly into the training program. Although this approach has been laudable to a great extent, it may have fallen short in formally acknowledging and addressing the challenges that the IMG trainees have had to overcome. Moving forward, faculty must be trained and supports instituted that are geared specifically towards these challenges. This must be done on a formal basis to ensure both the success of the trainees as well as the overall enrichment of the fellowship training programs. PMID:26115499

  8. Abstracts From the Proceedings of the 2015 Annual Meeting of the Clerkship Directors of Internal Medicine (CDIM).

    PubMed

    Nixon, L James; Ryder, Hilary F; Alexandraki, Irene; Lyons, Maureen D; McEwen, Kelsey Angell; DeWaay, Deborah J; Warrier, Sarita; Lang, Valerie J; LaRochelle, Jeffrey

    2016-01-01

    Since its inception in 1989, Clerkship Directors in Internal Medicine (CDIM) has promoted excellence in medical student education. CDIM members move medical education forward by sharing innovations in curriculum and assessment and discoveries related to educating our students and administering our programs. The Alliance for Academic Internal Medicine, of which CDIM is a founding member, broadens the umbrella beyond student education to include five academically focused specialty organizations representing departments of medicine, teaching hospitals, and medical schools working together to advance learning, discovery, and caring. CDIM held its 2015 annual meeting at Academic Internal Medicine Week in Atlanta, Georgia. This year 36 innovation and research submissions were selected for either oral abstract or poster presentation. The quality of the presentations was outstanding this year and included many of the most important issues in medical education. The CDIM research committee selected the following seven abstracts as being of the highest quality, the most generalizable, and relevant to the readership of Teaching and Learning in Medicine. Two abstracts include information from the CDIM annual survey, which remains a rich source for answering questions about student education on a national level. Looking at trends in medical education, three of the seven selected abstracts mention entrustable professional activities. Three of the abstracts address how we assess student skill and provide them with appropriate feedback. These include two schools' approach to bringing milestones into the medical student realm, use of objective structured clinical exam for assessing clinical skill in clerkship, and what students want in terms of feedback. Four articles deal with curricular innovation. These include interprofessional education, high-value care, transitions of care, and internship preparation. We are pleased to share these abstracts, which represent the breadth and

  9. Publishing history does not correlate with clinical performance among internal medicine residents.

    PubMed

    Cavalcanti, Rodrigo B; Detsky, Allan S

    2010-05-01

    OBJECTIVES Selection criteria for applicants to the internal medicine programme at the University of Toronto have included the number and quality of scholarly items published. We sought to determine whether previous publishing record correlated with resident performance as measured by in-training evaluation reports (ITERs) and global impressions of clinical competency by site programme directors and senior educators (global impression). METHODS Data on the total number, quality and type of items published, as well as the timing of publishing with regard to pre-MD training, were abstracted from the curricula vitae of individuals who applied for residency during 2001-2005. These were correlated with overall, Expert and Scholar role ITER scores, and with global impression, using Spearman rank correlation scores. RESULTS We gathered publishing history data on 181 residents, for 162 of whom ITER data were available. Overall, 68.5% of residents had published, but only 14.9% had published during medical school. There was a weak correlation of borderline significance (rho = 0.15, P = 0.055) between overall ITER score and number of items published. No such correlation was found with CanMEDS Medical Expert and Scholar role scores. Global impression classified 33.9% of residents as top-rated. More top-rated residents had published (76.7% versus 65.1%; P = 0.07), but the number of items published during medical school were similar between top-rated and non-top-rated residents (16.1% versus 12.3%; P = 0.46). CONCLUSIONS Our results do not support publishing record as a predictor of residents' clinical performance. Surprisingly, the correlation between publishing record and Scholar role scores was also weak, possibly indicating an inability of the ITER to capture this competency. Further research is needed to identify predictors and measures of performance in scholarly activities. PMID:20345694

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

    PubMed Central

    2012-01-01

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

  11. Quantitative Study of the Characteristics of Effective Internal Medicine Noon Conference Presentations.

    PubMed

    Fraser, Traci; Sargsyan, Zaven; Baggett, Travis P; Baggett, Meridale

    2016-05-01

    Background Increasing demands on residents' time have made it critically important to maximize the effectiveness of didactic activities and motivate independent study. Objective Our aim was to correlate characteristics of noon conferences with internal medicine (IM) residents' ratings of perceived effectiveness and intent to pursue independent reading. Methods We assessed characteristics of each noon conference by direct observation using predetermined metrics. We surveyed IM residents to assess their perception of the conference's effectiveness and their intention to pursue additional reading. A variety of modeling techniques were used to discern meaningful correlations of effectiveness and motivation. Results A total of 649 evaluations of 29 conferences were submitted by 153 of 185 (83%) residents in the program. Median effectiveness score was 6 (on a scale of 1 to 7). Clinicopathological conferences had 0.55-point higher effectiveness scores than traditional conferences (P = .011). In multivariable analyses focusing on traditional conferences, summary statement inclusion was significantly associated with 0.43-point higher effectiveness scores (P = .016), and having resident speakers was associated with 0.50-point higher effectiveness scores than unfamiliar faculty (P = .045). Conferences with higher effectiveness scores had significantly higher proportions of respondents indicating intention to read. Conclusions This is the first study to quantitatively assess correlations of high effectiveness ratings of noon conferences in a residency program. Intention to read improved with increasing effectiveness scores of conferences, suggesting residents are more inclined to pursue self-directed learning when topics are well presented. Considering these attributes in designs of didactic sessions may enhance their educational value. PMID:27168885

  12. Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia.

    PubMed

    Giannella, M; Pinilla, B; Capdevila, J A; Martínez Alarcón, J; Muñoz, P; López Álvarez, J; Bouza, E

    2012-08-01

    Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2 weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5 years; p < 0.001), had poorer functional status (Barthel 100, 30 and 65; p < 0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p < 0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p < 0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p < 0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p < 0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population. PMID:22284436

  13. Effect of didactic lectures on obesity documentation and counseling among internal medicine residents

    PubMed Central

    Ren, Vicky; Ellison, Kathleen; Miller, Jonathan; Busireddy, Kiran; Vickery, Erin; Panda, Mukta; Qayyum, Rehan

    2016-01-01

    Background Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic. Objective We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents. Methods We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables. Results Of the 278 patients with BMI≥30 kg/m2, 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05–1.11; P<0.001). In addition, as compared to postgraduate year (PGY) 1 residents, PGY-3 residents were 56% (OR=0.44; 95% CI=0.21–0.95; P=0.03) less likely to counsel obese patients. Conclusions Obesity is inadequately addressed in primary care settings, and didactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed. PMID:27124168

  14. Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship?

    PubMed Central

    Cohee, Brian M.; Koplin, Stephen A.; Shimeall, William T.; Quast, Timothy M.; Hartzell, Joshua D.

    2015-01-01

    Background Mentorship programs are perceived as valuable, yet little is known about the effect of program design on mentoring effectiveness. Intervention We developed a program focused on mentoring relationship quality and evaluated how subsequent relationships compared to preexisting informal pairings. Methods Faculty members were invited by e-mail to participate in a new mentoring program. Participants were asked to complete a biography, subsequently provided to second- and third-year internal medicine residents. Residents were instructed to contact available mentors, and ultimately designate a formal mentor. All faculty and residents were provided a half-day workshop training, written guidelines, and e-mails. Reminders were e-mailed and announced in conferences approximately monthly. Residents were surveyed at the end of the academic year. Results Thirty-seven faculty members completed the biography, and 70% (26 of 37) of residents responded to the survey. Of the resident respondents, 77% (20 of 26) chose a formal mentor. Of the remainder, most had a previous informal mentor. Overall, 96% (25 of 26) of the residents had identified a mentor of some kind compared to 50% (13 of 26) before the intervention (P < .001), and 70% (14 of 20) who chose formal mentors identified them as actual mentors. Similar numbers of residents described their mentors as invested in the mentorship, and there was no statistical difference in the number of times mentors and mentees met. Conclusions Facilitated selection of formal mentors produced relationships similar to preexisting informal ones. This model may increase the prevalence of mentorship without decreasing quality. PMID:26217434

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

    PubMed Central

    Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph

    2014-01-01

    Background Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. Purpose To provide insights into students’ experiences regarding their on-ward training with and without accompanying PAL tutors. Methods A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. Results The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students’ anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. Conclusion On-ward PAL programs represent a particularly valuable tool for students’ support in training clinical competencies on ward. The tutor–student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians. PMID:25278789

  16. Rheumatologic skills development: what are the needs of internal medicine residents?

    PubMed

    Kroop, Susan F; Chung, Cecilia P; Davidson, Mario A; Horn, Leora; Damp, Julie B; Dewey, Charlene

    2016-08-01

    Given the burden of rheumatic disease in our society and the anticipated future shortage of rheumatologists, all internal medicine (IM) residencies need to train internists who are capable of caring for patients with rheumatic diseases. The objective of this study was to perform a targeted needs assessment of the self-confidence of IM residents in the evaluation and care of patients with rheumatologic diseases. A 16-item, web-based, self-assessed confidence survey tool was administered to participating post graduate year (PGY)1 (N = 83) and PGY3 (N = 37) residents. The categories of questions included self-confidence in performing a rheumatologic history and exam, performing common rheumatologic procedures, ordering and interpreting rheumatologic laboratory tests, and caring for patients with common rheumatologic diseases. Resident demographics, prior rheumatology exposure, and career plans were also queried. PGY3 residents had higher self-assessed confidence than PGY1 residents in all categories. Self-assessed confidence in joint procedures was consistently low in both groups and when compared to other categories. Prior exposure to a rheumatology course or elective was not consistently associated with higher self-assessed confidence ratings across all categories. PGY3 residents showed less interest in rheumatology as a career than PGY1 residents, although the interest in the topic of rheumatology was not statistically different. Our needs assessment shows a low level of self-assessed confidence in rheumatology knowledge and skills among IM residents. Despite improvement with PGY year of training, self-assessed confidence remains low. To improve resident's skills and self-confidence in rheumatology, more curricular innovations are needed. Such innovations should be assessed for overall effectiveness. PMID:26694057

  17. Internal Medicine Residents' Perceived Ability to Direct Patient Care: Impact of Gender and Experience

    PubMed Central

    Bartels, Christie; Goetz, Sarah; Ward, Earlise

    2008-01-01

    Abstract Background Physicians are expected to effect patient care by giving orders to members of a healthcare team. Because women are socialized to be less directive than men, the assertive behavior required of new physicians may be experienced differently by male and female residents. We sought to explore the effects of gender and year of training on residents' experiences and perceived ability to direct patient care. Methods This was a mixed-methods, cross-sectional, descriptive study employing a quantitative written survey and qualitative interviews among internal medicine residents at an academic health center. Measurements included questionnaires and interviews about stress, assertiveness, and personal factors that influence their effectiveness in directing patient care. Analyses examined differences by gender and year of training. Results One hundred residents were invited to participate; 65 returned questionnaires, and 16 of these residents were interviewed. Compared with male residents, female residents selected less assertive behaviors for clinical scenarios (p = 0.047) and were more likely to perceive gender as inhibiting their ability to influence patient care (p < 0.01). Stress associated with being assertive varied more with experience than gender. Interviews corroborated these findings and supported the complexity of gender norms for behavior for female residents in a directive leadership position. Conclusions When compared with male peers, female residents reported more gender issues in residency and chose less assertive behaviors in clinical scenarios. Experience mitigated some gender differences. Our findings suggest that discussion of the existing research on prescriptive gender norms for behavior and leadership may be warranted in resident orientation. PMID:19049356

  18. 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. PMID:23550215

  19. Integration of an Introductory Pharmacy Practice Experience With an Advanced Pharmacy Practice Experience in Adult Internal Medicine

    PubMed Central

    Bird, Matthew L.; Vesta, Kimi S.; Harrison, Donald L.; Dennis, Vincent C.

    2012-01-01

    Objective. To describe the development, implementation, and assessment of an internal medicine introductory pharmacy practice experience (IPPE) that was integrated with an existing advanced pharmacy practice experience (APPE) in internal medicine. Design. A structured IPPE was designed for first-, second-, and third-year pharmacy (P1, P2, and P3) students. Activities for the IPPE were based on the established APPE and the individual learner's educational level. Assessment. Students reported a greater understanding of clinical pharmacists’ roles, increased confidence in their clinical skills, and better preparation for APPEs. Peers viewed the approach as innovative and transferable to other practice settings. Participating faculty members provided a greater number of contact hours compared to traditional one-time site visits. Conclusions. Integrating an IPPE with an existing APPE is an effective and efficient way to provide patient care experiences for students in the P1-P3 years in accordance with accreditation standards. PMID:22544969

  20. Everyday ethics in internal medicine resident clinic: an opportunity to teach

    PubMed Central

    Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Beach, Mary Catherine; Hughes, Mark T

    2011-01-01

    OBJECTIVES Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor–resident interactions. METHODS This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. RESULTS Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor–Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor–System Interaction (financial issues; doctor–system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). CONCLUSIONS In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly

  1. 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. PMID:27028030

  2. Perceptions of Interns and General Medicine Examiners Regarding Cardiovascular Case Presentation in Practical Exams of General Medicine in Final MBBS Summative Examinations

    PubMed Central

    Nimbal, Naren; Rekha, M C; Patil, Giridhar; Padaki, Samata; Dambal, Amrut; Pise, Gajanan; Kalsad, S T

    2015-01-01

    Introduction Assessment of cardiovascular cases in practical exit exam is limited to simple history taking and physical examination. Standards of assessment are not uniform. This makes assessment less valid and reliable. Aim To explore the perceptions of Internees and General Medicine Examiners about current practices in Cardio Vascular system (CVS) case presentation in final MBBS exit exams and the necessity to change some of the practices. Materials and Methods A set questions pertaining to the preparation for exams, validity, reliability, feasibility and educational impact were prepared to guide in obtaining the perceptions of internees and internal medicine examiners. Focus group discussions were conducted. Data Analysis was done by immersion-crystallization process. Results Most of the internees admitted to feeling concerned because of difficulty in diagnosing murmurs by auscultation. Most of the examiners felt concerned about the logistics involved in arranging practical exams. Both admitted to the lack of uniform standards in assessment. Both agreed that the present system thrived as it was relatively feasible. Some internees suggested that the exam may be conducted in two parts by splitting the syllabus instead of once. Some internees suggested incorporating a student-doctor program to improve practical skills just like the on-going student nurse program. Conclusion There is a need for overhauling the assessment of cardiovascular system in final MBBS summative exams towards one aligned to the competencies as required in an Indian Medical Graduate. Blueprinting of practical assessment with due weightage assigned to epidemiologically important topics is the need of the hour. PMID:26816933

  3. An International Comparison of Attitudes Toward Traditional and Modern Medicine in a Chinese and an American Clinic Setting

    PubMed Central

    Burke, Adam; Kuo, Tony; Harvey, Rick; Wang, Jun

    2011-01-01

    Introduction. International comparative research on traditional medicine (TM) offers a useful method for examining differences in patient characteristics and can provide insight into: (i) more universal characteristics which may cross cultures and international borders; (ii) unique characteristics influenced by regional/national factors; and (iii) cultural values of immigrant populations. To explore these issues TM patients from the United States and China were compared. Methods. Data collection took place at two TM college clinics. A convenience sample of 128 patients in China and 127 patients in the United States completed a 28-item questionnaire. Results. There was a marked similarity between the two patient groups in terms of the biological characteristics of age and gender. Musculoskeletal issues were the most common presenting complaints in the United States; while in China TM was used for a more diverse array of conditions. The majority of patients in both countries had initially used allopathic medicine (AM); significantly, more of the United States respondents stopped allopathic treatment after beginning traditional treatment. In comparing the two countries, patients in China were significantly more satisfied with AM and American patients significantly more satisfied with TM. In comparing the two medicines, the patient samples in both countries were significantly more satisfied with TM than AM. Discussion. Although treatment often originated with allopathic providers, many patients sought alternatives presumably to find the best solution to their problems. This tendency toward self-assignment suggests that a pluralistic healthcare system may provide the greatest satisfaction resulting from personal choice and improved outcomes. PMID:18955368

  4. [Evolution of the international intellectual property rights system: patent protection for the pharmaceutical industry and access to medicines].

    PubMed

    Chaves, Gabriela Costa; Oliveira, Maria Auxiliadora; Hasenclever, Lia; de Melo, Luiz Martins

    2007-02-01

    This article discusses the evolution of the international intellectual property rights system in three phases and the implications for public health, especially for the implementation of policies for access to medicines. During the first phase, characterized by the Paris and Berne Convention, signatory countries defined which technological fields should be protected (or not). Under the second phase, with the enforcement of the WTO TRIPS Agreement, countries are obliged to grant patent protection for all technological fields, including for the pharmaceutical industry. Within their national legislations, countries also have the opportunity to implement access to TRIPS flexibilities for medicines. With the third phase, characterized by the negotiation and signing of bilateral and regional free trade agreements, countries will have to implement TRIPS-plus provisions which may have negative implications for the TRIPS flexibilities as well as for policies for access to medicines. The authors conclude that the currently proposed international intellectual property rights system favors patent-holder rights and that a balance is needed between patent holders' and health rights. PMID:17221075

  5. Development of residency program guidelines for interaction with the pharmaceutical industry. Education Council, Residency Training Programme in Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ont.

    PubMed Central

    1993-01-01

    Medical residency programs are likely to face increasing pressure to address their relations with the pharmaceutical industry. Our internal medicine residency program has developed guidelines that were adopted after extensive debate by residents and faculty members. The guidelines are based on the principles that residents and faculty should set the educational agenda and that the residency program should not allow gifts of any sort from industry to residents. Specific policies include obtaining and screening educational materials from the industry before residents are exposed to them, proscribing "drug lunches" and accepting industry sponsorship only when the residency program maintains complete control of the educational event being sponsored. The industry response to the guidelines was split; about half reacted negatively, and half found the guidelines acceptable. Our experience suggests that productive debate about guidelines for the interaction of residency programs with the pharmaceutical industry is possible and desirable and that explicit policies can clarify areas of ambiguity. PMID:8348422

  6. Identification of MicroRNAs and Target Genes in the Fruit and Shoot Tip of Lycium chinense: A Traditional Chinese Medicinal Plant

    PubMed Central

    Khaldun, A. B. M.; Huang, Wenjun; Liao, Sihong; Lv, Haiyan; Wang, Ying

    2015-01-01

    Although Lycium chinense (goji berry) is an important traditional Chinese medicinal plant, little genome information is available for this plant, particularly at the small-RNA level. Recent findings indicate that the evolutionary role of miRNAs is very important for a better understanding of gene regulation in different plant species. To elucidate small RNAs and their potential target genes in fruit and shoot tissues, high-throughput RNA sequencing technology was used followed by qRT-PCR and RLM 5’-RACE experiments. A total of 60 conserved miRNAs belonging to 31 families and 30 putative novel miRNAs were identified. A total of 62 significantly differentially expressed miRNAs were identified, of which 15 (14 known and 1 novel) were shoot-specific, and 12 (7 known and 5 novel) were fruit-specific. Additionally, 28 differentially expressed miRNAs were recorded as up-regulated in fruit tissues. The predicted potential targets were involved in a wide range of metabolic and regulatory pathways. GO (Gene Ontology) enrichment analysis and the KEGG (Kyoto Encyclopedia of Genes and Genomes) database revealed that “metabolic pathways” is the most significant pathway with respect to the rich factor and gene numbers. Moreover, five miRNAs were related to fruit maturation, lycopene biosynthesis and signaling pathways, which might be important for the further study of fruit molecular biology. This study is the first, to detect known and novel miRNAs, and their potential targets, of L. chinense. The data and findings that are presented here might be a good source for the functional genomic study of medicinal plants and for understanding the links among diversified biological pathways. PMID:25587984

  7. Using direct observation, formal evaluation, and an interactive curriculum to improve the sign-out practices of internal medicine interns.

    PubMed

    Gakhar, Bhavna; Spencer, Abby L

    2010-07-01

    The safe transfer (handoff) of responsibility for patient care from one physician to another requires that health care facilities have rigorous sign-out systems and that physicians develop effective communication skills. In 2007 and 2008, to improve the spoken and written sign-out practices of the 25 interns at Allegheny General Hospital (Pittsburgh, Pennsylvania), the authors designed and administered Likert scale surveys about training in and satisfaction with current sign-out practices; directly observed and evaluated interns performing spoken sign-outs; assessed and graded interns' sign-out sheets; and compared sign-out sheets with patient records to evaluate their accuracy. On the basis of their findings, the authors developed a new curriculum with didactic and interactive components to target intern-level and system-level problems. The curriculum emphasized the importance of complete and accurate sign-outs, provided examples of good and poor sign-outs, and assigned interns to work in small groups to practice sign-out skills and receive feedback from peers and program leaders. Reevaluation of interns two months after curriculum implementation revealed not only better performance on each of the seven items evaluated for spoken sign-out but also substantial improvement in the completeness of sign-out sheets and the accuracy of reporting of identification data, code status, and medications data. The curriculum was well received by interns, and it helped them develop skills required by the Accreditation Council for Graduate Medical Education, including competencies in communication, practice-based learning, and systems-based practice. PMID:20375830

  8. International Society for Aerosols in Medicine, 17th congress, 10-14 May 2009, Monterey, California, USA.

    PubMed

    Newman, Steve

    2009-08-01

    The 17th biennial congress of the International Society for Aerosols in Medicine (ISAM) was held in Monterey, California, between 10 and 14 May 2009. The congress was attended by approximately 300 delegates from 18 countries. Podium presentations were focused on advances in pulmonary drug delivery, but clearance of materials from the lungs by a variety of processes and the potential harmful effects of inhaled particles were also covered. There were > 100 proffered posters, and a commercial exhibition in which 20 companies displayed their products. There were excellent networking opportunities, and the inauguration of more formal networking groups will allow dialogue to continue. Abstracts of podium and poster presentations were provided in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, and it is likely that some of the podium presentations will appear as full papers in that journal in due course. The next conference in this series takes place in Rotterdam, The Netherlands, in June 2011. PMID:19637975

  9. Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics.

    PubMed

    Strelnick, A H; Bateman, W B; Jones, C; Shepherd, S D; Massad, R J; Townsend, J M; Grossman, R; Korin, E; Schorow, M

    1988-08-15

    The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification in their specialty, emphasized the psychosocial aspects and social determinants of health and illness, and shared a faculty, curriculum, and commitment to provide medical care for inner-city, underserved populations. We discuss the program's history and curriculum, administrative and academic structure, shared "cross-track" faculty units (psychosocial; social medicine; and research, education, and evaluation), and graduates' practice outcomes. The interdisciplinary character of the Residency Program in Social Medicine helps physicians successfully serve the underserved and exemplifies that interdisciplinary medical education succeeds when interdisciplinary health care teams are organized for optimal patient care. Only the federal government has the perspective and power to foster more interdisciplinary collaboration and strengthen primary care education in a period of shrinking resources. PMID:3395040

  10. Transitioning Toward Competency: A Resident-Faculty Collaborative Approach to Developing a Transitions of Care EPA in an Internal Medicine Residency Program

    PubMed Central

    Chan, Brian; Englander, Honora; Kent, Kyle; Desai, Sima; Obley, Adam; Harmon, David; Kansagara, Devan

    2014-01-01

    Background Residency training and evaluation are moving toward competency-based models. Managing transitions of care is 1 of 16 entrustable professional activities (EPAs) that signal readiness for independent internal medicine practice. Methods for developing EPAs are evolving within the medical education community. Objective We describe a process for developing a transitions-of-care EPA for internal medicine inpatient and ambulatory settings using an iterative, consensus-building, resident-faculty collaborative approach. Methods We used an independent rank-ordering process and successive consensus group meetings to cull an initial list of 142 developmental Milestones to the 15 most relevant to transitions of care for internal medicine patients in an academic medical center and affiliated Veterans Administration hospital. Four senior internal medicine residents and 4 internal medicine faculty members representing inpatient and ambulatory practice settings identified examples of specific tasks and evaluative techniques for each Milestone. Results We demonstrate a feasible resident-faculty collaboration to develop transitions of care as an EPA for an internal medicine training program. Inclusion of residents along with faculty provided broader insights as well as an important learning opportunity for trainees. Conclusions Our process demonstrated the feasibility of designing an EPA, but questions remain about how entrustment-based evaluation can be implemented in clinical settings. Our framework may serve as a foundation for EPA development in other areas of clinical practice. PMID:26140133

  11. Characteristics of Internal Medicine Physicians Disciplined by Professional Colleges in Canada

    PubMed Central

    Liu, Jessica J.; Alam, Asim Q.; Goldberg, Hanna R.; Matelski, John Justin; Bell, Chaim M.

    2015-01-01

    Abstract Physician misconduct is of serious concern to patient safety and quality of care. Currently, there are limited data on disciplinary proceedings involving internal medicine (IM) physicians. The aim of this study was to investigate the number and nature of disciplinary cases among IM physicians compared with those of other disciplined physicians. Our retrospective study reviewed information from all provincial Colleges of Physicians and Surgeons (CPS) and compiled a database of all disciplined physicians from 2000 to 2013 in Canada. Disciplinary rate differences (RDs) were calculated for IM physicians and compared with other physicians. From 2000 to 2013, overall disciplinary rates were low (9.6 cases per 10,000 physician years). There were 899 disciplinary cases, 49 of which involved 45 different IM physicians. IM physicians comprised 10.8% of all disciplined physicians and were disciplined at a lower rate than non-IM physicians, incurring 5.18 fewer cases per 10,000 physician years than other physicians (95% confidence interval [CI] 3.62–6.73; P < 0.001). They were significantly less likely to be disciplined for: unprofessional conduct (RD 1.16; CI 0.45–1.87; P = 0.001); unlicensed activity (RD 0.78; CI 0.37–1.19; P < 0.001); standard of care issues (RD 1.37; CI 0.49–2.26; P = 0.002); sexual misconduct (RD 1.65; CI 0.90–2.40; P < 0.001); miscellaneous (RD 0.80; CI 0.11–1.50; P = 0.020); mental illness (RD 0.06; CI 0.01–0.12; P = 0.025); inappropriate prescribing (RD 0.74; CI 0.15–1.33; P = 0.010); and criminal conviction (RD 0.33; CI 0.00–0.65; P = 0.048). No significant differences were found with respect to unclear violations, fraudulent behavior/prevarication, or offenses involving drugs/alcohol (all RDs less than 0.32). IM physicians were also less likely to incur the following penalties: voluntary license surrender (RD 0.53; CI 0.37–0.69; P < 0.001); suspension (RD 2.39; CI 1.26–3.51; P

  12. Characteristics of Internal Medicine Physicians Disciplined by Professional Colleges in Canada.

    PubMed

    Liu, Jessica J; Alam, Asim Q; Goldberg, Hanna R; Matelski, John Justin; Bell, Chaim M

    2015-07-01

    Physician misconduct is of serious concern to patient safety and quality of care. Currently, there are limited data on disciplinary proceedings involving internal medicine (IM) physicians.The aim of this study was to investigate the number and nature of disciplinary cases among IM physicians compared with those of other disciplined physicians.Our retrospective study reviewed information from all provincial Colleges of Physicians and Surgeons (CPS) and compiled a database of all disciplined physicians from 2000 to 2013 in Canada. Disciplinary rate differences (RDs) were calculated for IM physicians and compared with other physicians.From 2000 to 2013, overall disciplinary rates were low (9.6 cases per 10,000 physician years). There were 899 disciplinary cases, 49 of which involved 45 different IM physicians. IM physicians comprised 10.8% of all disciplined physicians and were disciplined at a lower rate than non-IM physicians, incurring 5.18 fewer cases per 10,000 physician years than other physicians (95% confidence interval [CI] 3.62-6.73; P < 0.001). They were significantly less likely to be disciplined for: unprofessional conduct (RD 1.16; CI 0.45-1.87; P = 0.001); unlicensed activity (RD 0.78; CI 0.37-1.19; P < 0.001); standard of care issues (RD 1.37; CI 0.49-2.26; P = 0.002); sexual misconduct (RD 1.65; CI 0.90-2.40; P < 0.001); miscellaneous (RD 0.80; CI 0.11-1.50; P = 0.020); mental illness (RD 0.06; CI 0.01-0.12; P = 0.025); inappropriate prescribing (RD 0.74; CI 0.15-1.33; P = 0.010); and criminal conviction (RD 0.33; CI 0.00-0.65; P = 0.048). No significant differences were found with respect to unclear violations, fraudulent behavior/prevarication, or offenses involving drugs/alcohol (all RDs less than 0.32). IM physicians were also less likely to incur the following penalties: voluntary license surrender (RD 0.53; CI 0.37-0.69; P < 0.001); suspension (RD 2.39; CI 1.26-3.51; P < 0.001); retraining/assessment (RD 1.58; CI 0.77-2.39; P < 0

  13. Preparing for Fellowship in Internal Medicine. Steps for Success with a Focus on Pulmonary and/or Critical Care Programs.

    PubMed

    Bosslet, Gabriel T; Burkart, Kristin M; Miles, Matthew C; Lenz, Peter H; Huebert, Candace A; McCallister, Jennifer W

    2015-04-01

    This paper outlines specific tips for those applying to pulmonary and/or critical care medicine fellowship training in the United States using the PAIR-Match steps: preparation, application, interview, ranking, and match. Preparation for fellowship begins long before the application process with an assessment of one's long-term goals (to the extent that these are known). The cornerstone of the application is the curriculum vitae, which should highlight applicants' pulmonary and critical care-related experiences and scholarly work. Applicants should obtain letters of recommendation from faculty members who know them well and can write a letter that speaks to their strengths in clinical, scholarly, or leadership areas. The personal statement is an opportunity to share experiences not otherwise shared in the application and is an opportunity to explain any breaks in training or performance lapses. When selecting programs to which they will apply, applicants should pay close attention to the areas of education and curriculum, clinical experience, scholarly opportunity, and personal factors. Preparing for interviews should include a review of the program at which one is interviewing and development of relevant questions regarding details of the program. The interview day is the applicant's opportunity to see the "personality" of the program by meeting with the program director, faculty, and current fellows and to assess whether the program is a good fit for their goals. Applicants should only rank those programs they are willing to attend, in order of preference; they should be aware that the match process is binding. PMID:25742296

  14. In Vitro Screening of Tumoricidal Properties of International Medicinal Herbs: Part II

    PubMed Central

    Mazzio, Elizabeth A.; Soliman, Karam F. A.

    2010-01-01

    With growing use of anticancer complementary and alternative medicines (CAMs) worldwide, there is a need to assess and screen commercially available natural products for relative tumoricidal properties under standard experimental conditions. In the current study, we screened and ranked 264 traditional Chinese and Egyptian herbal medicines for tumoricidal potency against malignant neuroblastoma in vitro. The data obtained show that tumoricidal potencies of plants were randomly dispersed throughout similar orders, families and genera under the Division: Magnoliophyta, class: Magnoliopsida, subclasses: Asteridae, Caryophyllidae, Dilleniidae, Hamamelididae, Magnoliidae and Rosidae. The most potent plant extracts (LC50 < 0.08 mg/ml) were prepared from gromwell root also known as ‘Hong Tiao Zi Cao’ (Lithospermum Erythrorhizon) Family (Boraginaceae) > beth root (Trillium Pendulum), Family (Liliaceae) and galbanum (Ferula Galbaniflua), Family (Apiaceae). Gromwell root is traditionally used in the preparation of Chinese medicinal tea. In addition, galbanum was highly regarded for its sacred and medicinal value according to ancient texts and the bible. Future research will be required to isolate and identify chemical constituents within these plants which are responsible for tumoricidal effects. PMID:20564497

  15. Non-Linear Dose-Response Relationships in Biology, Toxicology and Medicine - An International Conference

    SciTech Connect

    Calabrese, Edward J.; Kostecki, Paul T.

    2002-05-28

    Conference abstract book contains seven sections: Plenary-4 abstracts; Chemical-9 abstracts; Radiation-7 abstracts; Ultra Low Doses and Medicine-6 abstracts; Biomedical-11 abstracts; Risk Assessment-5 abstracts and Poster Sessions-25 abstracts. Each abstract was provided by the author/presenter participating in the conference.

  16. Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality

    PubMed Central

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

    2014-01-01

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

  17. Limitations of Condensed Teaching Strategies to Develop Hand-Held Cardiac Ultrasonography Skills in Internal Medicine Residents.

    PubMed

    Wilkinson, Jeffrey S; Barake, Walid; Smith, Chris; Thakrar, Amar; Johri, Amer M

    2016-08-01

    Advances in ultrasonographic technology have allowed for hand-held cardiac ultrasonography (HHCU) units that fit into a physician's laboratory coat. Recently, studies to educate internal medicine residents have shown promise. The optimal duration and methodology for teaching HHCU skills has not been established. Over a 1-year period, internal medicine residents were recruited during their cardiology ward rotation into a single-centre nonblinded randomized trial. The 2 condensed teaching strategies were (1) a conventional ward-based program and (2) a technology-driven simulation-based strategy. Outcomes were evaluated by (1) an objective structured clinical examination (OSCE) to evaluate interpretation ability (assessing both type I and type II error rates) and (2) demonstration of HHCU skills graded by 2 level III echocardiographers. Twenty-four internal medicine residents were randomized. After teaching, the conventional teaching group had a significant absolute increase in the ability to make a singular correct diagnosis (20%; P < 0.001). In the technology arm, making a singular correct diagnosis increased 24% from baseline (P = 0.001). Interpretation skill was not significantly different between groups. The false-positive rate increased by an absolute 14% and 17% in the conventional and technology groups, respectively (P = 0.079 and P = 0.008). Our findings suggest that HHCU interpretation skills improve after either a conventional ward-based or a technology-driven approach. However, our study emphasizes the important limitations of both teaching programs, because we detected a trend toward an increase in the false-positive rate after both approaches. This suggests that a short duration of training may not be sufficient for HHCU to be performed in a safe manner. PMID:26860772

  18. Prom Health and Safety Tips

    MedlinePlus

    ... Healthy Occasions Autumn Tips Camping Tips Family Reunions Gardening Tips Halloween Tips Healthy Halloween Prom Tips Spring ... ways to stay active, such as walking, dancing, gardening, swimming, and more. Be active for 60 minutes ...

  19. Medicinal plants used to control internal and external parasites in goats.

    PubMed

    Sanhokwe, Marcia; Mupangwa, Johnfisher; Masika, Patrick J; Maphosa, Viola; Muchenje, Voster

    2016-01-01

    The use of medicinal plants plays a major role in the primary health care of animals in South Africa. A survey was conducted to document medicinal plants used to control parasites in goats in Kwezi and Ntambethemba villages in the Eastern Cape Province, South Africa. Information from 50 farmers and 3 herbalists was obtained through the use of a structured questionnaire, and a snowball sampling technique was used to identify key informants. The obtained data were analysed using PROC FREQ of SAS (2003), and fidelity level values were determined to estimate the healing potential of the mentioned plants. The survey revealed nine plant species belonging to eight families that were used to control parasites in goats. Asphodelaceae (22.22%) was the most frequently used plant family. Leaves were the most used plant parts, constituting 60.38%. They were prepared either as infusions or decoctions of single plants or in mixtures. Aloe ferox, Acokanthera oppositifolia and Elephantorrhiza elephantina were the plants having the highest fidelity level for their use to control parasites, each scoring 100%, followed by Albuca setosa (83.33%). The study revealed low knowledge about ethnoveterinary medicine in the study area. It also revealed that information on ethno-veterinary medicine in this area is mostly confined to older people and there is danger that this knowledge can be lost before being passed on to other generations. Therefore, there is an urgent need to document information on these plant species so that the future generation can benefit. Further investigation should be carried out to validate the efficacy and safety of the above-mentioned plants so as to provide cheap alternative ways of controlling parasites. PMID:27247061

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

    PubMed Central

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

    1995-01-01

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

  1. How we implemented a resident-led medical simulation curriculum in a large internal medicine residency program.

    PubMed

    Mathai, Susan K; Miloslavsky, Eli M; Contreras-Valdes, Fernando M; Milosh-Zinkus, Tanya; Hayden, Emily M; Gordon, James A; Currier, Paul F

    2014-04-01

    Mannequin-based simulation in graduate medical education has gained widespread acceptance. Its use in non-procedural training within internal medicine (IM) remains scant, possibly due to the logistical barriers to implementation of simulation curricula in large residency programs. We report the Massachusetts General Hospital Department of Medicine's scale-up of a voluntary pilot program to a mandatory longitudinal simulation curriculum in a large IM residency program (n = 54). We utilized an eight-case curriculum implemented over the first four months of the academic year. An intensive care unit curriculum was piloted in the spring. In order to administer a comprehensive curriculum in a large residency program where faculty resources are limited, thirty second-year and third-year residents served as session facilitators and two senior residents served as chairpersons of the program. Post-session anonymous survey revealed high learner satisfaction scores for the mandatory program, similar to those of the voluntary pilot program. Most interns believed the sessions should continue to be mandatory. Utilizing residents as volunteer facilitators and program leaders allowed the implementation of a well-received mandatory simulation program in a large IM residency program and facilitated program sustainability. PMID:24495251

  2. Tipping elements in the Earth's climate system

    SciTech Connect

    Lenton, T.M.; Held, H.; Lucht, W.; Rahmstorf, S.; Kriegler, E. |; Hall, J.W.; Schellnhuber, H.J. |

    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 the authors introduce the term 'tipping element' to describe large-scale components of the Earth system that may pass a tipping point. They 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 they 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 the authors explain how, in principle, early warning systems could be established to detect the proximity of some tipping points.

  3. Tips to Protect Workers in Cold Environments

    MedlinePlus

    ... Anti-Retaliation Tips To Protect Workers In Cold Environments Prolonged exposure to freezing or cold temperatures may ... 321-OSHA. Freedom of Information Act | Privacy & Security Statement | Disclaimers | Important Web Site Notices | International | Contact Us ...

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

    PubMed Central

    Leafloor, Cameron W; Lochnan, Heather A; Code, Catherine; Keely, Erin J; Rothwell, Deanna M; Forster, Alan J; Huang, Allen R

    2015-01-01

    Background Since the mid-1980s, medical residents’ long duty hours have been under scrutiny as a factor affecting patient safety and the work environment for the residents. After several mandated changes in duty hours, it is important to understand how residents spend their time before proposing and implementing future changes. Time-motion methodology may provide reliable information on what residents do while on duty. Purpose The purpose of this study is to review all available literature pertaining to time-motion studies of internal medicine residents while on a medicine service and to understand how much of their time is apportioned to various categories of tasks, and also to determine the effects of the Accreditation Council for Graduate Medical Education (ACGME)-mandated duty hour changes on resident workflow in North America. Methods Electronic bibliographic databases were searched for articles in English between 1941 and April 2013 reporting time-motion studies of internal medicine residents rotating through a general medicine service. Results Eight articles were included. Residents spent 41.8% of time in patient care activities, 18.1% communicating, 13.8% in educational activities, 19.7% in personal/other, and 6.6% in transit. North American data showed the following changes after the implementation of the ACGME 2003 duty hours standard: patient care activities from 41.8% to 40.8%, communication activities from 19.0% to 22.3%, educational activities from 17.7% to 11.6%, and personal/other activities from 21.5% to 17.1%. Conclusion There was a paucity of time-motion data. There was great variability in the operational definitions of task categories reported in the studies. Implementation of the ACGME duty hour standards did not have a significant effect on the percentage of time spent in particular tasks. There are conflicting reports on how duty hour changes have affected patient safety. A low proportion of time spent in educational activities deserves

  5. Nasal Tip Deficiency.

    PubMed

    Cerkes, Nazim

    2016-01-01

    Nasal tip deficiency can be congenital or secondary to previous nasal surgeries. Underdeveloped medial crura usually present with underprojected tip and lack of tip definition. Weakness or malposition of lateral crura causes alar rim retraction and lateral nasal wall weakness. Structural grafting of alar cartilages strengthens the tip framework, reinforces the disrupted support mechanisms, and controls the position of the nasal tip. In secondary cases, anatomic reconstruction of the weakened or interrupted alar cartilages and reconstitution of a stable nasal tip tripod must be the goal for a predictable outcome. PMID:26616702

  6. Report on the VIIth International Symposium on Heat Shock Proteins in Biology & Medicine.

    PubMed

    Calderwood, Stuart K; Hightower, Lawrence E

    2015-03-01

    This seventh symposium in a series on heat shock proteins in biology and medicine was held November 1-5, 2014, at the Hilton Hotel in Old Town Alexandria, Virginia. Approximately 70 participants including principal investigators, postdoctoral fellows, and graduate students were in attendance. The major themes were: new properties of heat shock proteins (HSPs) and heat shock factor (HSF) and role in the etiology of cancer, molecular chaperones in aging, extracellular HSPs in inflammation and immunity, role of heat shock and the heat shock response in immunity and cancer, protein aggregation disorders and HSP expression, and Hsp70 in blood cell differentiation. The next meeting is planned for the fall of 2016 in the same venue. PMID:25542250

  7. The 18th Congress of the International Society for Aerosols in Medicine.

    PubMed

    Mitchell, Jolyon P; Nichols, Steven C

    2011-09-01

    The 18th biennial Congress of ISAM was held for 4 days at the De Doelen Congress Centre, Rotterdam, Netherlands, at which approximately 350 delegates, including 60 session chairs and speakers, attended. The abstracts of the 49 podium talks and the 126 posters that were presented have been published in the society's technical journal (journal of Aerosol Medicine and Pulmonary Delivery), and the detailed program can be found on the ISAM website (www.isam.org). Postgraduate courses on the topics: 'Inhalation Therapy at the Intensive Care Unit'; 'Walking the Standards Maze: Standards for Device Development, Device Performance and Regulatory Approval'; and 'Nuts and Bolts of Aerosol Delivery: Theory, Guidelines and Practice', were offered to participants prior to the Congress itself. PMID:22833908

  8. Biomarkers for Heart Failure: An Update for Practitioners of Internal Medicine.

    PubMed

    Wettersten, Nicholas; Maisel, Alan S

    2016-06-01

    Biomarkers have become an integral part of practicing medicine, especially in heart failure. The natriuretic peptides are commonly used in the evaluation of heart failure, but their role extends beyond diagnosis and includes risk stratification and management of heart failure patients. Newer biomarkers have arrived and are becoming part of routine care of heart failure patients. Both ST2 and high-sensitivity troponin have significant prognostic value for mortality, but also may assist in the titration of medical therapy. Procalcitonin can help guide appropriate antibiotic use in patients with heart failure. The ability to appropriately use and interpret these biomarkers is imperative to the care of heart failure patients, especially as these newer biomarkers become widely used. PMID:26844635

  9. Flows with tip leakage

    NASA Astrophysics Data System (ADS)

    Moore, John

    The flow development within the tip gap and the flow tip leakage, applying Navier-Stokes codes, are discussed. The loss production, the turbine inefficiency and the heat transfer to the blade tip, are considered. The measurements and calculations used demonstrate features of the flow, such as separation and reattachment on the blade tip, shock formation in the tip gap, and formation and dissipation of tip gap secondary kinetic energy. A procedure for calculating turbine blade tip temperatures is included. The results for a centrifugal compressor show the interaction of the tip leakage and passage flows. The radial blackflow near the shroud wall at low off-design flow rates is considered. The calculations demonstrate the potential use of a computational fluid dynamics code for predicting a centrifugal compressor map.

  10. Diet and Exercise Tips

    MedlinePlus

    ... Health News & Publications Annual Meeting Calendar Diet and Exercise Tips Diet and Exercise Tips News media interested in covering the latest ... Health Statistics concludes that 35 percent of adults exercise regularly (more than 6 of 10 don’t), ...