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

    2006-04-08

    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.

  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. Core competencies in internal medicine.

    PubMed

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

    2012-06-01

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

  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.

  6. Strategic business planning for internal medicine.

    PubMed

    Ervin, F R

    1996-07-01

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

  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. [Internal medicine and public health].

    PubMed

    2009-08-01

    A special Committee on Internal Medicine and Public Health was established by Sociedad Médica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiológical features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65 years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families.

  9. 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.

  10. 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.

  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 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.

  13. Documentation tips for pulmonary medicine: implications for the inpatient setting.

    PubMed

    Koshy, Sherine

    2012-10-01

    Clinical documentation improvement is an important aspect to achieve top performance. Clinical documentation in a patient's record includes any and all documentation that relates to the care of the patient during the patient's stay or encounter at the hospital. Documentation is key to accurate clinical coding, validating length of stay, resource utilization, physician profiling, case management, severity of illness, risk of mortality, quality management, risk management, clinical outcomes, critical pathways, regulatory compliance, Joint Commission accreditation, managed care, and reimbursement. Good documentation minimizes coding errors, reduces claim denials, and optimizes reimbursement. Implementing quality improvement strategies that make documentation and coding an organizational priority can positively influence operations, services, and revenue. Other external and internal coding audits show that the cause of improper coding is due to lack of proper physician documentation to support reimbursement at the appropriate level. The purpose of this article is to provide tips for documenting pulmonary diagnoses that not only would ensure appropriate reimbursement but also would accurately represent the severity of a patient's condition.

  14. Bloodstream infections in internal medicine.

    PubMed

    Del Bono, Valerio; Giacobbe, Daniele Roberto

    2016-04-02

    Bloodstream infections (BSI) carry a heavy burden of morbidity and mortality in modern internal medicine wards (IMW). These wards are often filled with elderly subjects with several risk factors for BSI, such as multiple comorbidities, polypharmacy, immunosuppression, and indwelling devices. Diagnosing BSI in such a setting might require a high degree of suspicion, since the clinical presentation could be affected by underlying conditions and concomitant medications, which might delay the administration of an appropriate antimicrobial therapy, an event strongly and unfavorably influencing survival. Furthermore, selecting the appropriate antimicrobial therapy to treat these patients is becoming an increasingly complex task in which all possible benefits and costs should be carefully analyzed from patient and public health perspectives. Only a specialized, continuous, and interdisciplinary approach could really improve the management of IMW patients in an era of increasing antimicrobial resistance and complexity of care.

  15. Bloodstream infections in internal medicine

    PubMed Central

    Del Bono, Valerio; Giacobbe, Daniele Roberto

    2016-01-01

    ABSTRACT Bloodstream infections (BSI) carry a heavy burden of morbidity and mortality in modern internal medicine wards (IMW). These wards are often filled with elderly subjects with several risk factors for BSI, such as multiple comorbidities, polypharmacy, immunosuppression, and indwelling devices. Diagnosing BSI in such a setting might require a high degree of suspicion, since the clinical presentation could be affected by underlying conditions and concomitant medications, which might delay the administration of an appropriate antimicrobial therapy, an event strongly and unfavorably influencing survival. Furthermore, selecting the appropriate antimicrobial therapy to treat these patients is becoming an increasingly complex task in which all possible benefits and costs should be carefully analyzed from patient and public health perspectives. Only a specialized, continuous, and interdisciplinary approach could really improve the management of IMW patients in an era of increasing antimicrobial resistance and complexity of care. PMID:26760780

  16. Magnetic field measurements using the transient internal probe (TIP)

    SciTech Connect

    Galambos, J.P.; Bohnet, M.A.; Jarboe, T.R.; Mattick, A.T.

    1995-12-31

    Knowledge of the internal magnetic field profile in hot plasmas is fundamental to understanding the structure and behavior of the current profile. The transient internal probe (TIP) is a novel diagnostic designed to measure internal magnetic fields in hot plasmas. The diagnostic involves shooting a magneto-optic probe through the plasma at high velocities (greater than 2 km/s) using a two stage light gas gun. Local fields are obtained by illuminating the probe with an argon ion laser and measuring the amount of Faraday rotation in the reflected beam. Initial development of the diagnostic is complete. Results of magnetic field measurements conducted at 2 km/s will be presented. Helium muzzle gas introduction to the plasma chamber has been limited to less than 0.4 Torr-{ell}. Magnetic field resolution of 40 Gauss and spatial resolution of 5 mm have been achieved. System frequency response is 10 MHz.

  17. 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)

  18. [Ethical problems in internal medicine].

    PubMed

    von Eiff, A W

    1992-03-28

    In medical and scientific work a physician cannot act without first weighing the issues. This is often purely a weighing of utility and risks; sometimes, however, the issues must be weighted against the background of an image of the human being in which psychological and ethical aspects require consideration. Weighing of the issues is therefore possible only on the basis of expert grounding in the latest discoveries in each particular field, and in such cases also on the foundation of anthropological knowledge and awareness of ethical principles ("nil nocere"). In internal medicine weighing of the issues covers the patient's history, diagnostic and therapeutic measures, and prophylaxis. At a time when cost restraint in health care is necessary to preserve the state's finances and therewith the common good, one issue to be weighed is whether a cost-intensive diagnostic or therapeutic measure is justified in the individual case. In therapy the weighing of issues in the clinic may, however, produce a different result from that in general practice.

  19. International Society for Magnetic Resonance in Medicine

    MedlinePlus

    ... Join the ISMRM Journals History & Mission Central Office Society Award Winners Strategic Plan Policies Corporate Members Contact ... E-Library Virtual Meetings Connect With Us International Society for Magnetic Resonance in Medicine 2300 Clayton Road, ...

  20. Development of transient internal probe (TIP) magnetic field diagnostic

    SciTech Connect

    Galambos, J.P.; Bohnet, M.A.; Jarboe, T.R.; Mattick, A.T.

    1994-12-31

    The Transient Internal Probe (TIP) is designed to permit measurement of internal magnetic fields, in hot, high density plasmas. The concept consists of accelerating a probe to high velocities (2.2 Km/s) in order to minimize probe exposure time to plasma. Faraday rotation within the probe is used to measure the local magnetic field. An Argon laser illuminates the probe consisting of a Faraday-rotator material with a retro-reflector that returns the incident light to the detection system. Performance results of the light gas gun and optical detection system will be shown. To date, the gas gun has been extensively tested consistently achieving velocities between 2 and 3 km/s. The probe and detection scheme have been tested by dropping the probe through a static magnetic field. Magnetic field resolution of 20 gauss and spatial resolution of 5 mm has been achieved. System frequency response is 10Mhz. Work is currently being conducted to integrate the diagnostic system with laboratory plasma experiments. Specifically a gas interfaced system has been developed to prevent helium muzzle gas from entering the plasma chamber with the probe. Additionally the probe must be separated from the sabot which protects the probe during acceleration in the gas gun. Data will be presented showing the results of various separation techniques.

  1. [Organizational structure of internal medicine in Chile].

    PubMed

    Parrochia, E

    1996-04-01

    Internal Medicine, as a comprehensive discipline, has become increasingly dismembered during the last decades due to several reasons, some of which are the growing complexities of its practice, its obstinate confinement to hospital-based practice, its generation of and subsequent disfunction from general internal medicine and the medical subspecialities. In Chile internal medicine is currently organized in three levels of patient care, each of anarchical and distortioned proportions. These levels do not constitute a fluent network of progressive patient care but rather an heterogeneous combination of ironclad compartments in search of their own autonomy. A few of the many problems and challenges that internal medicine faces in Chile are: (a) in primary care medicine, problem-solving abilities must be improved and programmed care must be privileged over free choice. Specialist in general medicine must be assigned to primary care and multiprofessional teams must be strengthened; (b) Secondary care is underdeveloped due to the waning prestige of internal medicine and waxing attractiveness of its subspecialities. Programmed formation of specialist in internal medicine has been so far rigorous and demanding, but excessive in number in relation to available post. This leads trained internist to practice as subspecialist, without having the adequate conditions for such a practice. To avoid this situation, the scope of internal medicine emergency wards, integral medicine clinics, and medical student teaching should be handed over to it; (c) Tertiary care is a task of subspecialist. It is not known how many subspecialist are required, or how many physicians are currently practicing as a subspecialist. Most of the currently practicing subspecialist are self-qualified or have received quick training through short rotations by not always well-qualified centers. Many are only former internal medicine residents. In this setting, it is not possible to devise a prospective plan of

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

    PubMed Central

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

    2008-01-01

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

  3. 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

  4. Index of International Publications in Aerospace Medicine

    DTIC Science & Technology

    2010-10-01

    International Publications in Aerospace Medicine Edmonds C, McKenzie B. Diving Medicine for Scuba Divers. Carnegie, Victoria, Australia: J. L...to Coping with Injury and Illness. San Pedro, CA, USA: Best Publishing Co., 1985. Nessirio BA. Rozhdenie Metoda “Nasyshchennykh Pogruzhenii... Metoda Dlitel’nogo Prebyvaniia Cheloveka pod Povyshennym Davleniem. Sankt-Peterburg, Russia: Kosta, 2004. Parker J. The Sports Diving Medical: A Guide to

  5. [Everyday bioethics in general internal medicine].

    PubMed

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

    2006-11-08

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

  6. ES Cell International & regenerative medicine.

    PubMed

    Colman, Alan; Alliston, Doug

    2006-03-01

    ES Cell International believes that human embryonic stem cells offer a renewable source material for the elaboration of a multitude of different tissues for use in human cell replacement therapy. There are many challenges to the successful implementation of this vision including technical, regulatory, financial and ethical hurdles. However with demographic changes towards an aging population in the richer countries, leading to growing demands of ways to combat degenerative disease, science would be remiss not to explore every potential medical solution.

  7. Internal magnetic field measurements on the Helicity Injected Tokamak (HIT) using the Transient Internal Probe (TIP)

    SciTech Connect

    Galambos, J.P.; Bohnet, M.A.; Jarboe, T.R.; Mattick, A.T.

    1996-12-31

    The Transient Internal Probe (TIP) is a novel diagnostic designed to measure internal magnetic fields in hot plasmas. The diagnostic involves shooting a magneto-optic probe through the plasma at high velocities (greater than 2 km/s) using a two stage light gas gun. Local fields are obtained by illuminating the probe with an argon ion laser and measuring the amount of Faraday rotation in the laser light reflected from the moving probe. Currently, internal magnetic profile measurements are being conducted on the Helicity Injected tokamak (HIT). HIT is a low aspect ratio (A = 1.5) tokamak designed to investigate steady state current drive using coaxial helicity injection. Operating parameters are T{sub e} {approx} 100, n{sub e} {approx} 5 {times} 10{sup 13} cm{sup {minus}3} and I{sub p} = 250 kA. Internal magnetic field profile data will be presented. The TIP diagnostic has a spatial resolution of 1 cm and 20 gauss magnetic field resolution. System frequency response is 10 MHz.

  8. [Hospital based internal medicine in 2012].

    PubMed

    John, G; Darbellay, P; Drepper, M; Spechbach, H; Fosenbauer, M Becerra; Perrier, A; Carballo, S

    2013-01-23

    In an era in which primary and secondary prevention have important implications for public health and health care costs, a series of publications and guidelines give added weight or precision to current medical practice in the fields of hospital based internal medicine. This article presents a selective review of new guidelines and therapeutic options for areas of cardiovascular disease, pulmonary disease, gastroenterology and oncology.

  9. The international translational regenerative medicine center.

    PubMed

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

    2012-11-01

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

  10. 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.

  11. 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.

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

    ERIC Educational Resources Information Center

    Eisenberg, John M.

    1980-01-01

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

  13. [Internal medicine in the last 40 years].

    PubMed

    Mandema, E

    1997-01-04

    Internal medicine in the last 40 years has known many eminent teachers at universities, such as Hijmans van den Bergh, Van Buchem, Borst, Mulder, Lindeboom, De Langen, Hulst, Jordan, Formijne, Major, Snapper, Groen and Querido, and others outside universities such as Stuyt, Van Hees, Eindhoven, Pannekoek, Schalm, Bruins Slot, Heeres, Stolte and Pompen. The main scientific platform on which the bequeathors assembled in the first few decades after World War II was the Algemene Ziektekundige Vereniging ('General Medical Association'), which met in Utrecht. Important medical steps forward in that period were the virtually complete eradication of tuberculosis in the Netherlands, the developing of vaccines against smallpox and polio, but also against the various types of virus hepatitis, and the progress in intensive care, transplantation and molecular biology. The Nederlandsche Internisten Vereeniging ('Dutch Association of Internists') has had its own scientific journal since 1958. Essentials in modern internal medicine are appropriate care and demonstrated usefulness of a treatment (evidence-based medicine); standards, values and ethics are core issues, as are quality control and cost control. Change is also in progress in the doctor-patient relationship, as manifested in the Wet Geneeskundige Behandelingsovereenkomst ('Medical Treatment Accord Act').

  14. 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.…

  15. 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)

  16. American Internal Medicine in the 21st Century

    PubMed Central

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

    2003-01-01

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

  17. [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.

  18. [Strategic orientation of the Spanish Society of Internal Medicine].

    PubMed

    García Alegría, J; Conthe Gutiérrez, P

    2011-01-01

    The council of the Spanish Society of Internal express its position within the general society, origins, objectives, and strategies. The Spanish Foundation of Internal Medicina promotes scientific research and continued education within Internal Medicine, by means of the 17 working groups. Taking into account the actual situation, the authors analyze this situation and formulate the strategy objectives for the upcoming years. These contents are summarized in 10 message decalogue that express the essence and future of Internal Medicine.

  19. Research in Biological and Medical Sciences, Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 1

    DTIC Science & Technology

    Contents: In-house laboratory independent research; Communicable diseases and immunology; Surgery, internal medicine , psychiatry, Biochemistry...surgery, military internal medicine , military psychiatry; Malaria prophylaxis; and Biosensor systems.

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

    PubMed

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

    2015-08-05

    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.

  1. [Oncologic pathology at an internal medicine service].

    PubMed

    de Miranda, M I; da Luz, R; Gonçalves, F M; Monteiro, J S; da Costa, J N

    1990-01-01

    A retrospective survey of the patients with oncological disease admitted to our Department of Internal Medicine in 1987 was conducted to determine its prevalence and to draw a descriptive profile of these patients' admissions. The results show that oncological diseases were the second cause of hospital admissions that year (12%) only exceeded by cardiovascular diseases. About 60% of the patients had neoplasms already diagnosed elsewhere and were admitted for complications or with therapeutic purposes; in 40% of cases the disease was diagnosed in our Department. A wide variety of hematological and non-hematological tumors was found. There were some difficulties in interdisciplinary coordination in the diagnostic and therapeutic approach. More than 50% of the patients had advanced disease, limiting medical intervention to supportive measures. In about 60% of them were oriented to primary care physicians after physicians after discharged from Hospital. These results suggest the dispersion of the available resources for the diagnosis, treatment and follow-up of oncological diseases in our population. A better cancer patients' assistance in Portugal will depend on the promotion of national cancer registers as well as the improvement of cancer prevention and early detection programs, according to the directives of EEC and WHO. We also emphasize the need of investment on undergraduate and postgraduate education programs, specially for primary care physicians.

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

    PubMed

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

    2015-11-04

    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.

  3. Index of International Publications in Aerospace Medicine

    DTIC Science & Technology

    2007-01-01

    C, Lowry C, Pennefather J. Diving and Subaquatic Medicine. California, USA: Best Publishing Co., 1981. Edmonds C, McKenzie B. Diving Medicine for...Practical Guide to Coping with Injury and Illness. San Pedro, CA, USA: Best Publishing Co., 1985. Nessirio BA. Rozhdenie Metoda “Nasyshchennykh...Pogruzhenii” – Metoda Dlitel’nogo Prebyvaniia Cheloveka pod Povyshennym Davleniem. Sankt-Peterburg, Russia: Kosta, 2004. Parker J. The Sports Diving

  4. 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)

  5. Development of a Central Division of General Internal Medicine.

    ERIC Educational Resources Information Center

    Karpf, Michael; And Others

    1989-01-01

    The University of Pittsburgh School of Medicine's Division of General Internal Medicine is described, focusing on personnel and organization, educational programs, clinical and research activities, special programs, finances, and related issues and pressures. The program is proposed as a model for other institutions. (MSE)

  6. International programs of the National Library of Medicine.

    PubMed

    Hsieh, R K

    1988-01-01

    The National Library of Medicine (NLM) has a broad mission in biomedical information service. There are three major reasons for NLM, as a national institution, having an international program: first, the global nature of disease; second, the international scope of medical literature; and third, the universal goal of better communication. This paper reviews NLM's programs in relation to international medical information exchange: International MEDLARS Centers, collaboration with WHO and PAHO, NLM Special Foreign Currency Program, and development of the NLM collection.

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

    PubMed

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

    2014-06-01

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

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

    PubMed Central

    2011-01-01

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

  9. Research in Biological and Medical Sciences Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 2

    DTIC Science & Technology

    preventive medicine; Military medical research program S. E. Asia; Combat surgery; Military internal medicine ; Military psychiatry; Ionizing radiation injury, prevention and treatment; Malaria prophyaxis; Biosensor systems.

  10. Palliative Care Exposure in Internal Medicine Residency Education.

    PubMed

    Edwards, Asher; Nam, Samuel

    2017-01-01

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

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

    PubMed

    Montero Ruiz, E; Monte Secades, R

    2015-04-01

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

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

    PubMed

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

    2013-06-01

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

  13. The International System of Units (SI) and Medicine

    PubMed Central

    Bergeson, Paul S.; Smith, E. Ide

    1981-01-01

    A major international movement is in progress to extend metrication using the International System of Units. Significantly involved is the field of medicine. Extensive changes adopted abroad now appear in foreign medical literature, and physicians in the United States commonly are unprepared to interpret medical information from abroad because the data are reported in unfamiliar terms. The system has broad immediate and future implications to American physicians. PMID:7336719

  14. 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.

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

    PubMed

    Terrett, Nick

    2010-04-01

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

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

    ERIC Educational Resources Information Center

    Jacobson, Jay A.; And Others

    1989-01-01

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

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

    PubMed Central

    Mayence, Annie; Vanden Eynde, Jean Jacques

    2017-01-01

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

  18. 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)

  19. 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…

  20. 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

  1. 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.

  2. Traveling Internal Plane-wave Synthesis (TIPS) for uniform B1 in high field MRI.

    PubMed

    Anderson, Adam W

    2017-02-01

    A new target-field approach to generating uniform radio frequency (RF) fields within the human body for high field MRI is described. The method involves producing a set of external fields which, after interaction with a dielectric object, superimpose to produce a traveling plane wave, exposing all spins to the same RF amplitude (B1) over a cycle of the harmonic field. Conceptually this is similar to conventional RF shimming, but uses a different RF source design, input data, and objective function. The method requires a detailed knowledge of the coupling between exterior field modes, produced by an array of RF sources, and field modes within the body. Given an estimate of the coupling matrix, the linear superposition of external modes that produces a desired internal target field can be determined. The new method is termed Traveling Internal Plane-wave Synthesis (TIPS). A simple design of a coil array is described that can, in principle, generate the required field modes. Simulations demonstrate that radio frequency magnetic fields of nearly uniform (<1% variation) magnitude can be produced within dielectric objects larger than a wavelength in size. If the dielectric medium has non-zero conductivity, traveling waves are attenuated as they traverse the object, but field uniformity within planar slices is preserved. For general 3D imaging, a superposition of plane waves can provide field focusing to balance conductive losses, thereby achieving nearly uniform-magnitude B1+ magnetic fields over a volume of interest.

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

    PubMed

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

    2013-11-01

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

  4. [Improving compliance in internal medicine: the motivational discussion].

    PubMed

    Lugoboni, Fabio; Quaglio, Gianluca; Mezzelani, Paolo; Pajusco, Benedetta; Casari, Rebecca; Lechi, Alessandro

    2004-01-01

    Compliance to treatment is of crucial importance in medicine. High levels of noncompliance to treatment have been reported in the most relevant diseases such as hypertension, coronary artery disease, diabetes and asthma. The aim of this article was to fully evaluate the lack of adherence to treatments in internal medicine. The prevalence of noncompliance and methods to cope with it are presented. The theory of the stages of change is thoroughly examined. Motivational interviewing in low-compliant patients is illustrated dealing both with the theoretical principles and practical applications. Several communication blocks which interfere with the relationship between doctor and patient are finally presented through concrete examples.

  5. Safety Tips: Baseball (For Parents)

    MedlinePlus

    ... by U.S.A. Little League and the American Sports Medicine Institute: 7-8 years old: 50 pitches a ... ON THIS TOPIC Signing Kids Up for Sports Sports Medicine Center Safety Tips: Hockey Safety Tips: Basketball Competitive ...

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

    PubMed

    Semple, Graeme

    2010-04-01

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

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

    PubMed

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

    2015-03-01

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

  9. 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

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

    PubMed

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

    2008-10-01

    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.

  11. 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.

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

    PubMed

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

    2016-04-22

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

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

    PubMed

    Flannery, Michael T

    2014-03-01

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

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

    PubMed

    Norero, C

    1996-04-01

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

  15. Research in Biological and Medical Sciences, Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 2

    DTIC Science & Technology

    Contents: Military preventive medicine; Military medical research program S. E. Asia; Military medical materiel; Combat surgery; Military internal ... medicine ; Military psychiatry; Ionizing radiation injury, prevention, and treatment; Malaria prophylaxis; and Biosensor systems.

  16. 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.

  17. 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.

  18. Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond.

    PubMed

    Jones, Christopher A; Acevedo, Jean; Bull, Janet; Kamal, Arif H

    2016-12-01

    Although recommended for all persons with serious illness, advance care planning (ACP) has historically been a charitable clinical service. Inadequate or unreliable provisions for reimbursement, among other barriers, have spurred a gap between the evidence demonstrating the importance of timely ACP and recognition by payers for its delivery.(1) For the first time, healthcare is experiencing a dramatic shift in billing codes that support increased care management and care coordination. ACP, chronic care management, and transitional care management codes are examples of this newer recognition of the value of these types of services. ACP discussions are an integral component of comprehensive, high-quality palliative care delivery. The advent of reimbursement mechanisms to recognize these services has an enormous potential to impact palliative care program sustainability and growth. In this article, we highlight 10 tips to effectively using the new ACP codes reimbursable under Medicare. The importance of documentation, proper billing, and nuances regarding coding is addressed.

  19. 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…

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

    ERIC Educational Resources Information Center

    Day, Susan C.; And Others

    1984-01-01

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

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

    PubMed Central

    Shappell, Eric; Ahn, James

    2017-01-01

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

  2. International reference preparations for standardization of biological medicinal products.

    PubMed

    Minor, P

    2014-10-01

    International standards are prepared as materials assigned an arbitrary unitage for a biological activity by the Expert Committee on Biological Standardization of the World Health Organization. Working reference materials are calibrated against international standards giving a common unit of measurement between laboratories. The references are assessed by a collaborative study including all relevant assays rather than by a single reference method as in the SI (Le Système international d'unités) system and the unitage assigned is an arbitrary value derived from a consensus of all valid methods. The process has proved valuable in assaying the activity of therapeutic biological medicines and in standardizing certain types of diagnostics. Issues arise with maintaining the unit when the primary reference must be replaced and to some extent in assessing the commutability of the reference with real life analytes.

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

    PubMed

    Engelmann, L; Schneider, D

    1989-01-15

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

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

    PubMed

    Sari, N

    2001-12-01

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

  5. [Electronic calendar as an organization element in Internal Medicine services].

    PubMed

    Alvarez-García, R; Blasco-Fontecilla, H; Legido-Gil, T; López-Castromán, J; Montoya-Ferrer, A; Baca-García, E

    2011-02-01

    The growing volume of information and introduction of new technologies in the Internal Medicine hospital department mare making the traditional updating «methods» of knowledge and organization obsolete. The development of new tools could help the management of information and organization of the medical departments is outdated. Electronic calendar such as the Google calendar facilitate adequate coordination among health care professionals. Our experience suggests that the Google calendar is a simple and useful tool that helps planning and organization of the clinical, educational, and research activities of the different medical departments, limits loss of information and improves efficacy with a close to zero cost of infrastructure.

  6. 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

  7. Clinical holistic medicine: chronic pain in internal organs.

    PubMed

    Ventegodt, Søren; Merrick, Joav

    2005-03-19

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

  8. Moral distress and burnout in internal medicine residents

    PubMed Central

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

    2017-01-01

    Background Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout. Methods The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013–2014 academic year at the University of British Columbia. Results Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/−3; 46% male) reported a median moral distress score (interquartile range) of 77 (50–96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p<0.0001). Women reported higher emotional exhaustion. Moral distress was associated with depersonalization (p=0.01), and both moral distress and burnout were associated with intention to leave the job. Conclusion Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job. PMID:28344714

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

    PubMed

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

    2017-04-01

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

  10. Internal medicine program directors' perceptions of resident work rounds.

    PubMed

    Boutros, A; Della Ratta, R K

    1994-08-01

    Work rounds have received little attention in the medical education literature. At the outset of the second post graduate year, medical residents are expected to function, without much guidance, as both team leaders and teacher. New York State health code regulation 405 restrict house staff work hours and may influence the manner and content of work rounds. The goals of work rounds were identified through a literature review and our own experiences. A 36-item questionnaire utilizing the identified goals was used in this cross-sectional descriptive study. The participants were the Program Directors of New York State Internal Medicine residency programs. Each of the fourteen goals identified reflects one of three resident behaviors: patient care, teaching, and evaluation. The goals that received the highest importance scores were patient management and updating team leader of events. Ninety percent (90%) or more of the participants indicated that patient management, teaching clinical reasoning and problem solving, verifying important chart data, and verifying physical examination should be performed "often" or "almost always." Most programs employed verbal instructions but only few held conference or provided literature on the expectations and conduct of work rounds. New York State Internal Medicine program directors perceive work rounds as primarily a patient care task, and many rely on verbal instructions to convey the objectives to the house staff. While previous research has demonstrated that work rounds are an important setting for house staff education, this study reveals that in most New York State programs this opportunity may be missed.

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

    PubMed

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

    2016-04-12

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

  12. 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.

  13. 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

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

    PubMed

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

    2014-06-01

    A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p < 0.01) and institutionalization (p < 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p < 0.0002), diabetes (p < 0.05, OR 1.936), chronic kidney failure (p < 0.05, OR 2.078) and male gender (p < 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

  15. 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…

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

    PubMed

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

    2017-02-03

    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  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. Real time curriculum map for internal medicine residency

    PubMed Central

    Wong, Roger Y; Roberts, J Mark

    2007-01-01

    Background To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD) in a core internal medicine residency program. Methods We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching), comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis. Results There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years). Only 42 hours (15%) involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year). Most AHD hours (78%) focused on medical expert competencies. Resident satisfaction (90% response) was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4), which improved after 1 year but returned to baseline after 2 years. Conclusion We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics. PMID:17988402

  19. Factors associated with performance in an internal medicine clerkship

    PubMed Central

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

    2017-01-01

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

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

    PubMed

    Chakalaroski, K

    2013-01-01

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

  1. 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…

  2. Tips for Chronic Pain

    MedlinePlus

    Patient Education Sheet Tips for Chronic Pain The SSF thanks Stuart S. Kassan, MD, FACP, Clinical Professor of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, for authoring ...

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

    PubMed

    Almoallim, H

    2011-08-01

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

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

    PubMed

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

    2013-01-08

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

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

    PubMed

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

    2015-10-01

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

  6. Arsov Dimitar, founder of the modern internal medicine in the Republic of Macedonia (1908-2008).

    PubMed

    Polenakovic, Momir

    2008-12-01

    Arsov Dimitar (Kriva Palanka, 28. IX 1908 - Skopje, 2. VII 1974) - specialist of internal medicine, rheumatologist, Professor at the Medical Faculty of the University of Ss. Cyril and Methodius in Skopje, member of the Macedonian Academy of Sciences and Arts. D. Arsov is the founder of the modern internal medicine in the Republic of Macedonia. He has completed medical studies and specialized in internal medicine at Sorbonne, Paris, France. For 22 years he was the Director of the Clinic for Internal Medicine in Skopje and a Head of the Chair for Internal Medicine of the Medical Faculty in Skopje. He has published over 200 scientific and expert papers and five textbooks, in which he introduced series of medical terms, which entered the Macedonian medical terminology. With his researches he has penetrated in all areas of the internal medicine. An original contribution is his study on intravenous application of adrenalin in the treatment of rheumatic fever and rheumatic endocarditis. He was a member and a head of many medical associations. He received a number of awards. He was promoted for Doctor Honoris Causa at the University of Besanson (France) in 1961. As a great clinician, educator and Professor of internal medicine, and scientist he was one of the most distinguished medical persons of the second part of the XX century in the Republic of Macedonia.

  7. [A national qualifying internal medicine examination for Israeli medical students].

    PubMed

    Notzer, N; Shalev, O; Alkan, M; Levinski, U; Rubin, A; Melamed, R

    1995-08-01

    In 1991 the deans of the 4 medical schools in Israel decided to institute a national qualifying examination in internal medicine. This marked the beginning of the process of unifying the qualifying examinations in all major medical fields. We describe the development of the examination, experience with its administration to 720 students in 1992-1994, and the outcome of this initial effort. The examinations were prepared by a committee of senior faculty from the 4 schools, representing all the relevant clinical areas. Professional consultation was provided by the Unit for Medical Education of Tel Aviv University. Each examination consisted of 180 multiple choice items, reflecting an agreed representation of the various medical specialties, and was designed to test both comprehension and problem-solving ability. A syllabus was published by the committee and distributed to students and faculty in preparation for the examination. In composing the examination, the committee took into consideration differences in general policy and varying emphases in the curricula of the 4 schools. Analysis of the results of the 3 annual examinations showed both a high level of reliability and high quality of the majority of the individual test items. There was a trend with time to slightly lower average scores, and fewer passed the exam last year. There was improvement in the results after the first 2 years in the area of problem-solving related to interpretation of imaging, blood smears and clinical photographs, but this trend did not continue into 1994. The introduction of a high level examination based on a common syllabus provided important feedback, improving both student motivation and clinical teaching. For all schools, the outcome of the examination served as an important external indicator of teaching standards. Following this positive experience, uniform examinations in surgical subjects and pediatrics were introduced for the first time in 1993. The committee recommends that

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

    PubMed

    Wardrop, Richard M; Berkowitz, Lee R

    2017-02-01

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

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

    PubMed

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

    2015-01-01

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

  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.

  11. 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…

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

    PubMed

    Davidson, Chris; Higgens, Clare

    2009-04-01

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

  13. 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)

  14. Integration of Women's Health into an Internal Medicine Core Curriculum for Medical Students.

    ERIC Educational Resources Information Center

    Nicolette, JoDean; Jacobs, Michael D.

    2000-01-01

    Describes a collaboration to analyze and integrate elements of women's health into the core curriculum in internal medicine for a medical school's third year clerkship. Illustrates the new curriculum by describing the new module in pulmonary medicine and discusses the use of the process to integrate curricula in other interdisciplinary fields.…

  15. 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.

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

    PubMed

    Chan, Jannet W M; Graham, Colin A

    2011-09-01

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

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

    PubMed

    Gao, Peng-fei; Watanabe, Kenji

    2011-11-01

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

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

    PubMed

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

    2010-10-01

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

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

    PubMed

    Hallas, J

    1996-04-01

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

  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.

  1. Internal medicine interns' and residents' pressure ulcer prevention and assessment attitudes and abilities: results of an exploratory study .

    PubMed

    Suen, Winnie; Parker, Victoria A; Harney, Lauren; Nevin, Siobhan; Jansen, Jane; Alexander, Linda; Berlowitz, Dan

    2012-04-01

     To evaluate and determine differences between attitudes of internal medicine interns and residents toward pressure ulcer (PU) prevention and to evaluate the interns' abilities to accurately identify wounds and stage PUs, an exploratory, quantitative study was conducted in a 639-bed, safety net academic center. Participants (21 internal medicine interns and 21 internal medicine residents) attending an educational session on PU prevention and care were eligible to participate. The 1-hour conference session was prepared and provided by a physician and wound care nurses. Before the lecture, participants were asked to complete an 11-question paper-and-pencil PU attitude survey. Following the lecture, they were asked to identify 11 wounds and stage PUs using the inpatient admission history and physical template used in the hospital's electronic medical record. An audience response system was used to record correct and incorrect responses. Nineteen (19) interns and 20 residents completed the survey. Twenty-one (21) interns successfully completed the wound assessment quiz. Descriptive statistics were used to examine the survey data and residents' and interns' average attitude scores were compared using independent group t-test. The results suggest that interns and residents have a positive attitude toward and are concerned about PU prevention. The significantly higher overall score among interns compared to residents (average 43.8 versus 38.8 respectively, P = 0.002) suggests interns have a more positive attitude than residents. Statistically significant differences between item scores showed that, compared to residents, interns perceived PU prevention to be more time-consuming (P = 0.01), less of a concern in practice (P = 0.02), and a lower priority than other areas of care (P = 0.003). Compared to residents, interns also were more likely to agree to with statement, "In my opinion, patients tend to not get as many pressure

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

    PubMed Central

    Falcone, John L.; Gonzalo, Jed D.

    2014-01-01

    Objectives: To determine Internal Medicine residency program compliance with the Accreditation Council for Graduate Medical Education 80% pass-rate standard and the correlation between residency program size and performance on the American Board of Internal Medicine Certifying Examination. Methods Using a cross-sectional study design from 2010-2012 American Board of Internal Medicine Certifying Examination data of all Internal Medicine residency programs, comparisons were made between program pass rates to the Accreditation Council for Graduate Medical Education pass-rate standard. To assess the correlation between program size and performance, a Spearman’s rho was calculated. To evaluate program size and its relationship to the pass-rate standard, receiver operative characteristic curves were calculated. Results Of 372 Internal Medicine residency programs, 276 programs (74%) achieved a pass rate of ≥80%, surpassing the Accreditation Council for Graduate Medical Education minimum standard. A weak correlation was found between residency program size and pass rate for the three-year period (ρ=0.19, p<0.001). The area underneath the receiver operative characteristic curve was 0.69 (95% Confidence Interval [0.63-0.75]), suggesting programs with less than 12 examinees/year are less likely to meet the minimum Accreditation Council for Graduate Medical Education pass-rate standard (sensitivity 63.8%, specificity 60.4%, positive predictive value 82.2%, p<0.001). Conclusions Although a majority of Internal Medicine residency programs complied with Accreditation Council for Graduate Medical Education pass-rate standards, a quarter of the programs failed to meet this requirement. Program size is positively but weakly associated with American Board of Internal Medicine Certifying Examination performance, suggesting other unidentified variables significantly contribute to program performance. PMID:25341205

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

    DTIC Science & Technology

    2009-05-28

    for pharmaceutical companies to invest in R&D. • Type III diseases, such as dengue fever and African sleeping sickness, are those that have...customs authorities temporarily halted shipments of generic medicines manufactured in India and in transit to Colombia and Peru via the Netherlands... Peru , Panama, and Colombia. The Obama Administration is reviewing U.S. trade policy, including IPRs and pharmaceuticals

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

    PubMed

    Elfaki, Omer Abdelgadir; Al-Humayed, Suliman

    2016-02-01

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

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

    PubMed

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

    2008-01-30

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

    Baker, David G; Kearney, Michael T

    2012-01-01

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

  9. 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

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

    PubMed

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

    2014-04-01

    Hospitalized older adults are susceptible to complications termed "hazards of hospitalization" (HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This study investigated the effect of an educational intervention to increase internal medicine interns' knowledge and self-efficacy of HOH and to improve their care of hospitalized older adults as measured by their documentation of HOH. Targeted learners were internal medicine interns on their geriatrics rotation at a large academic hospital in 2011 to 2012. The intervention covered 10 specific HOH: delirium, pressure ulcers, urinary incontinence and retention, functional decline, falls, suboptimal prescribing, dehydration and malnutrition, infection, depression, and inappropriate interventions. Knowledge and self-efficacy were measured before and after training. HOH documentation rates of interns who did and did not complete the training were compared over a preset 8-week period. Forty-two of 43 eligible interns completed the curriculum. After training, knowledge was significantly greater (approximately 1 more correct question out of 3, P < .001). Self-reported confidence in managing each hazard also significantly increased (13 questions on two 5-point Likert scales, P < .001). Trained interns had significantly more-frequent documentation of patients' activities of daily living, gait, and plan for functional decline prevention than interns who were not trained (P < .05). Conversely, documentation of instrumental activities of daily living was more frequent among interns who were not trained (P < .01). Implementation of an educational intervention was successful in improving educational and behavior change outcomes regarding HOH.

  11. [International exchanges in the early stage of the Academy of Traditional Chinese Medicine].

    PubMed

    Zhou, Yang

    2015-11-01

    The Academy of Traditional Chinese Medicine under the Ministry of Health was established in 1955. It exerted worldwide influence, and attracted extensive attention internationally. During its early days, lots of letters from abroad asking for TCM consultation were accepted consistently. TCM experts were invited to treat a great number of foreign patients in China or overseas. It also received visits of many foreign government delegations and academic groups. Moreover, physicians were dispatched to visit abroad, international academic conferences were held and training classes were sponsored for returned students and medical interns. Frequent international academic exchanges promoted the friendly intercourse with foreign countries, and the spread of TCM overseas, which displayed the function and value of traditional Chinese medicine, reflecting its unique significance and charm, and its great contributions to the improvement of people's health the world over.

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

    PubMed

    Helble, Matthias; Aizawa, Toshiaki

    2017-02-01

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

  13. 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

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

    PubMed Central

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

    2015-01-01

    Background Residency is an intense period. Challenges, including burnout, arise as new physicians develop their professional identities. Residency programs provide remediation, but emotional support for interns is often limited. Professional development coaching of interns, regardless of their performance, has not been reported. Objective Design, implement, and evaluate a program to support intern professional development through positive psychology coaching. Methods We implemented a professional development coaching program in a large residency program. The program included curriculum development, coach-intern interactions, and evaluative metrics. A total of 72 internal medicine interns and 26 internal medicine faculty participated in the first year. Interns and coaches were expected to meet quarterly; expected time commitments per year were 9 hours (per individual coached) for coaches, 5 1/2 hours for each individual coachee, and 70 hours for the director of the coaching program. Coaches and interns were asked to complete 2 surveys in the first year and to participate in qualitative interviews. Results Eighty-two percent of interns met with their coaches 3 or more times. Coaches and their interns assessed the program in multiple dimensions (participation, program and professional activities, burnout, coping, and coach-intern communication). Most of the interns (94%) rated the coaching program as good or excellent, and 96% would recommend this program to other residency programs. The experience of burnout was lower in this cohort compared with a prior cohort. Conclusions There is early evidence that a coaching program of interactions with faculty trained in positive psychology may advance intern development and partially address burnout. PMID:26692977

  15. 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.

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

    PubMed

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

    2016-10-17

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

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

    PubMed

    Mezzich, Juan E

    2011-04-01

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

  18. 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)

  19. The Development of a Medical Ethics Curriculum in a General Internal Medicine Residency Program.

    ERIC Educational Resources Information Center

    Wartman, Steven A.; Brock, Dan W.

    1989-01-01

    A three-year curriculum in medical ethics operates at Rhode Island Hospital and Brown University as part of the general internal medicine residency program. The six major topics covered are co-taught as seminars by one or more members of the multidisciplinary ethics faculty (philosopher, internist, and communications specialist) and experienced…

  20. The Impact of Managed Care on Internal Medicine Graduate Medical Education at Brooke Army Medical Center

    DTIC Science & Technology

    2000-06-01

    Endoscopic Gastrostomy (PEG): Inserting a tube directly through the abdomen into the stomach to provide long-term nutritional support in patients unable to...of 100 supervised colonoscopies and 20 supervised polypectomies) • Percutaneous liver biopsy (20) • Percutaneous endoscopic gastrostomy (10) • Non...Biopsy Percutaneous Endoscopic Gastrostomy Internal Medicine GME 33 only one procedure, percutaneous liver biopsy, consistently fell below the

  1. 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…

  2. 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)

  3. 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)

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  5. 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…

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  7. Physician Provider Profiling in Brooke Army Medical Center’s Internal Medicine Clinic: A Multiple Regression and Process Control Model

    DTIC Science & Technology

    1999-12-01

    in Brooke Army Medical Center’s Internal Medicine Clinic during the 3rd & 4th quarter of FY 1998. Data regarding 26,502 individual patient-provider...accomplished by selecting internists and internal medicine residents and a single primary diagnosis. Second level case mix adjustment accounted for other

  8. 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…

  9. How confident are internal medicine residents in rheumatology versus other common internal medicine clinical skills: an issue of training time or exposure?

    PubMed

    Katz, Steven J; Oswald, Anna E

    2011-08-01

    The objective of this study was to determine self-confidence of internal medicine (IM) residents regarding rheumatology clinical skills and factors that may affect their confidence. Permission was sought to e-mail a web-based survey to IM residents at all 13 English language Canadian internal medicine programs. Residents were asked to rank self-confidence in rheumatology, cardiology, respirology, and gastroenterology skills. Further questions included site and year of training, career interests, rheumatology experiences, learning opportunities, and assessment frequency. These factors were analyzed by univariate and multivariate analyses. Two hundred sixteen residents (21.8%) from all 13 sites responded to the survey. Resident self-confidence in rheumatology diagnoses was 5.24/10, lower than all three comparator subspecialties. Increasing teaching exposure had a more significant impact on confidence in rheumatology than on comparator subspecialties. Increasing year of training had no association with higher self-confidence for rheumatology, in contrast to the increase in confidence seen with increased year of training for each comparator subspecialty. Further analysis demonstrated that the completion of a rheumatology rotation, increasing learning opportunities, annual assessment, and career interest were associated with greater resident self-confidence. Resident self-confidence for rheumatology skills is cautious at best and is lower than other common subspecialties. Self confidence improves with targeted rheumatology clinical experience and teaching, but does not improve solely with higher year of IM training. Furthermore, the impact of rheumatology teaching is greater than that of other common IM subspecialties. This information is critical to the planning and implementation of effective rheumatology curricula within internal medicine residency programs.

  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.

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

    PubMed

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

    2016-04-01

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

  12. A qualitative study of work-life choices in academic internal medicine.

    PubMed

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

    2014-03-01

    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.

  13. Developing Educators, Investigators, and Leaders During Internal Medicine Residency: The Area of Distinction Program

    PubMed Central

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

    2011-01-01

    Background Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. Context and Purpose To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. Methods and Program Evaluation We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. Results AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. Conclusions The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training. PMID:23205204

  14. BRIEF REPORT: Multiprogram Evaluation of Reading Habits of Primary Care Internal Medicine Residents on Ambulatory Rotations

    PubMed Central

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

    2006-01-01

    OBJECTIVE To assess the reading habits and educational resources of primary care internal medicine residents for their ambulatory medicine education. DESIGN Cross-sectional, multiprogram survey of primary care internal medicine residents. PARTICIPANTS/SETTING Second- and third-year residents on ambulatory care rotations at 9 primary care medicine programs (124 eligible residents; 71% response rate). MEASUREMENTS AND MAIN RESULTS Participants were asked open-ended and 5-point Likert-scaled questions about reading habits: time spent reading, preferred resources, and motivating and inhibiting factors. Participants reported reading medical topics for a mean of 4.3 ± 3.0 SD hours weekly. Online-only sources were the most frequently utilized medical resource (mean Likert response 4.16 ± 0.87). Respondents most commonly cited specific patients' cases (4.38 ± 0.65) and preparation for talks (4.08 ± 0.89) as motivating factors, and family responsibilities (3.99 ± 0.65) and lack of motivation (3.93 ± 0.81) as inhibiting factors. CONCLUSIONS To stimulate residents' reading, residency programs should encourage patient- and case-based learning; require teaching assignments; and provide easy access to online curricula. PMID:16704393

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

    PubMed

    Smith, Cynthia D; Levinson, Wendy S

    2015-05-05

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

  16. 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.

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

    PubMed

    Weigel, Charlene; Suen, Winnie; Gupte, Gouri

    2013-01-01

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

  18. [2015 highlights in hospital-based internal medicine by chief residents].

    PubMed

    Baratali, Laïla; Gachoud, David; Aebischer, Oriane; Bastardot, François; Benmachiche, Malik; Fournier, Judith; Garnier, Antoine; Jaccard, Evrim; Pascual, Marie Mean; Metrailler, Pierre; Pagin, Monica; Voruz, Sophie; Sartori, Claudio

    2016-01-20

    The year 2015 gave us many scientific publications, among whom some will have an impact on our daily practice and some will influence our way of considering some well known diseases. Chief residents in the Service of internal medicine of the Lausanne University hospital, gathered like every year, to share their readings together in order to presentyou a small part of the many publications of 2015, which have been considered to have an impact on our future daily practice.

  19. 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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Background Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Methods Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Results Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. Conclusions We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum. PMID:26692979

  2. Creating a reliable and valid blueprint for the internal medicine clerkship evaluation.

    PubMed

    McLaughlin, Kevin; Lemaire, Jane; Coderre, Sylvain

    2005-09-01

    The objective of this study was to design an examination blueprint for the Internal Medicine clerkship rotation that is congruent with both the learning objectives and delivered learning experiences and reflects the perceived importance of clinical presentations from both the students' and clinicians' perspectives. In this cross-sectional study 11 specialists in General Internal Medicine (GIM) and 11 clinical clerks at the University of Calgary were asked to score each of the 47 clinical presentations in the Internal Medicine clerkship rotation for 'impact' and 'frequency'. These attributes were used to provide an estimate of the relative importance of each clinical presentation. Statistical tests used were the Pearson's correlation coefficient and the Kappa statistic. Multi-attribute utility theory was applied to assess the best way of combining the variables of 'impact' and 'frequency'. The correlation between clerks and GIM specialists was 0.85 for the impact score and 0.86 for the frequency score (p < 0.001 for both). Corresponding Kappa values were 0.71 and 0.82, respectively (p < 0.001 for both). Combining impact and frequency as a multiplicative function produced a distribution that was positively skewed towards common, high impact presentations such as chest pain. We have created an examination blueprint that provides a realistic and objective measure of the relative importance of clinical presentations. Such a blueprint provides both face validity and content validity to the evaluation process.

  3. Understanding Resident Learning Preferences Within an Internal Medicine Noon Conference Lecture Series: A Qualitative Study

    PubMed Central

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

    2014-01-01

    Background The lecture remains the most common approach for didactic offerings in residency programs despite conflicting evidence about the effectiveness of this format. Objective The purpose of this study was to explore the perspectives of internal medicine residents toward conferences held in the lecture format. Methods The investigators invited internal medicine residents (N  =  144) to participate in focus groups discussing their perspectives about noon conference lectures. The investigators used a semistructured guide to ask about motivations for attendance and effectiveness of noon conferences, transcribed the recordings, coded the discussions, and analyzed the results. Results Seven focus groups with a total of 41 residents were held. This identified 4 major domains: (1) motivations for attendance; (2) appropriate content; (3) effective teaching methods; and (4) perspectives on active participation. Residents' motivations were categorized into external factors, including desire for a break and balance to their workload, and intrinsic attributes, including the learning opportunity, topic, and speaker. Appropriate content was described as clinically relevant, practical, and presenting a balance of evidence. Identified effective teaching methods included shorter teaching sessions focused on high-yield learning points structured around cases and questions. While active participation increases residents' perceived level of stress, the benefits of this format include increased attention and learning. Conclusions This study furthers our knowledge of the learning preferences of internal medicine residents within the changing environment of residency education and can be used in conjunction with principles of adult learning to reform how we deliver core medical knowledge. PMID:24701307

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

    PubMed

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

    2016-08-23

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

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

    PubMed

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

    2008-01-01

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

  6. A Program to Help Interns Cope with Stresses in an Internal Medicine Residency.

    ERIC Educational Resources Information Center

    Matthews, Dale A.; And Others

    1988-01-01

    A program in personal and professional development for interns was developed at the University of Connecticut Affiliated Hospitals to reduce maladaptive responses to the stresses of medical training. The goals of the program are to provide a supportive atmosphere, build trust, and promote deeper self-understanding and sensitivity. (Author/MLW)

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

    PubMed Central

    Sabath, Bruce F.; Singh, Gurkeerat

    2016-01-01

    Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution – a community hospital – in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available. PMID:27802866

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

    PubMed

    2007-03-01

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

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

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

    2016-01-01

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

  11. 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

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

    PubMed

    Levey, G S

    1992-09-01

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

  13. Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review

    PubMed Central

    Aronica, Michael; Williams, Ronald; Dennar, Princess E.; Hopkins, Robert H.

    2015-01-01

    Background Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. Objective We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. Methods From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Results Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P < .05), and an increase in the average full-time equivalent support (0.32 before accreditation versus 0.42 in 2013, P < .05). There was also an increase in programs with associate program directors (35% versus 78%), programs with chief residents (71% versus 91%), and an increase in program budgets controlled by program directors (52% versus 69%). The 2013 NRMP match rates increased compared to those of 2005 (99% versus 49%). Performance on the American Board of Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Conclusions Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation. PMID:26692969

  14. Publication of population data of linearly inherited DNA markers in the International Journal of Legal Medicine.

    PubMed

    Parson, Walther; Roewer, Lutz

    2010-09-01

    This manuscript extends on earlier recommendations of the editor of the International Journal of Legal Medicine on short tandem repeat population data and provides details on specific criteria relevant for the analysis and publication of population studies on haploid DNA markers, i.e. Y-chromosomal polymorphisms and mitochondrial DNA. The proposed concept is based on review experience with the two forensic haploid markers databases YHRD and EMPOP, which are both endorsed by the International Society for Forensic Genetics. The intention is to provide guidance with the preparation of population studies and their results to improve the reviewing process and the quality of published data. We also suggest a minimal set of required information to be presented in the publication to increase understanding and use of the data. The outlined procedure has in part been elaborated with the editors of the journal Forensic Science International Genetics.

  15. LATIN AS A LANGUAGE OF INTERNATIONAL COMMUNICATIVE STATUS: MEDICINE OF THE 16TH-17TH CENTURIES.

    PubMed

    Bieliaieva, O; Lysanets, Yu; Melaschenko, M

    2017-01-01

    The research paper is of interdisciplinary nature, written at the crossroads of the history of medicine, functional stylistics and terminology science. The choice of the 16th century as a starting point of the study is due to the fact that quality changes in book and manuscript writing that took place during this period led to unprecedented development and dissemination of scientific knowledge, including biomedical. The 16th century embraces the life and work of such prominent figures in the history of medicine, as Andreas Vesalius, Gabriele Fallopian, Bartolomeo Eustachi, and Girolamo Fracastoro. The 17th century, which is called the century of "scientific revolution", left not less honourable names in the history of medicine - William Harvey, Marcello Malpighi, Thomas Willis, Jean Pecquet, Francis Glisson, Thomas Sydenham. In the context of this study, these prominent figures are interesting due to the fact that their works were written in Latin and constitute the prototypes of modern scientific style, in particular of such genres as thesis, monograph, scientific article, scientific report, polemic presentation, textbook. On the basis of extensive factual material, it has been demonstrated that during 16th-17th centuries, Latin acted as a fully developed language with a clearly oriented international status. As one of basic tools in scientific knowledge, Latin not only performed the epistemological function which was the priority for the development of medicine, but also served as a means of accumulation, reception, transmission and popularization of achievements in various areas of medical science.

  16. 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.

  17. 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.

  18. 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

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

    PubMed Central

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

    2014-01-01

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

  20. Introduction to the 1st International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015).

    PubMed

    Zheng, Yafeng; Jassbi, Amir Reza; Xiao, Jianbo

    2016-03-30

    The 1st International Symposium on Phytochemicals in Medicine and Food (ISPMF 2015) was held in Shanghai, China, from June 26th to 29th, 2015. The 1st ISPMF was organized by the Phytochemical Society of Europe (PSE) and the Phytochemical Society of Asia (PSA). More than 270 scientists from 48 countries attended this meeting. The program of ISPMF 2015 consisted of 12 plenary lectures, 20 invited talks, and 55 short oral presentations in 16 sessions, including phytochemistry, phytomedicine, pharmacology, and application of phytochemicals in medicine and food. The 1st ISPMF has obtained support from Critical Reviews in Food Science and Nutrition, Food Chemistry, Phytochemistry Reviews, and Nutrients. As supported by Prof. Thomas F. Hofmann, a special issue on Journal of Agricultural and Food Chemistry (ACS) for the 1st ISPMF was initiated in January 2015.

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

    PubMed

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

    2009-07-01

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

  2. The International Federation for Emergency Medicine framework for quality and safety in the emergency department.

    PubMed

    Lecky, Fiona; Benger, Jonathan; Mason, Suzanne; Cameron, Peter; Walsh, Chris

    2014-11-01

    All emergency departments (EDs) have an obligation to deliver care that is demonstrably safe and of the highest possible quality. Emergency medicine is a unique and rapidly developing specialty, which forms the hub of the emergency care system and strives to provide a consistent and effective service 24 h a day, 7 days a week. The International Federation of Emergency Medicine, representing more than 70 countries, has prepared a document to define a framework for quality and safety in the ED. Following a consensus conference and with subsequent development, a series of quality indicators have been proposed. These are tabulated in the form of measures designed to answer nine quality questions presented according to the domains of structure, process and outcome. There is an urgent need to improve the evidence base to determine which quality indicators have the potential to successfully improve clinical outcomes, staff and patient experience in a cost-efficient manner--with lessons for implementation.

  3. 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

  4. 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

  5. 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

  6. 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

    2016-08-26

    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.

  7. 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.

  8. Developing a Cultural Consensus Analysis Based on the Internal Medicine Milestones (M-CCA).

    PubMed

    Smith, C Scott; Hill, William; Francovich, Chris; Morris, Magdalena; Langlois-Winkle, Francine; Caverzagie, Kelly; Iobst, William

    2011-06-01

    A national task force identified domains and developmental milestones from the national competencies for resident training. Cultural Consensus Analysis (CCA) is a standard anthropological technique that can identify value conflicts. We created a CCA based on the internal medicine milestones (M-CCA) in 3 steps: converted the 38 domains into active statements; reduced the total number to 12 by summarizing and combining; and simplified the wording. This M-CCA needs further validation, after which it may be useful for assessing the 6-competency model.

  9. 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.

  10. 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.

  11. Technology Tips

    ERIC Educational Resources Information Center

    Stohl, Hollylynne; Harper, Suzanne R.

    2004-01-01

    Some of the graphing capabilities of The Geometer's Sketchpad (GSP) in the "Technology Tips" are introduced. The new graphing features of GSP allow teachers to implement the software not only in geometry classrooms but also into their algebra, precalculus and calculus classes.

  12. 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.

  13. Exporting the American (information) revolution: the international impact of the National Library of Medicine.

    PubMed

    Smith, E V; Janson, F S

    1986-10-01

    The National Library of Medicine has had an enormous impact on health information services all over the world. Although NLM is primarily a national institution, it has become an important international resource by responding to requests from the international community. NLM has been influential in three major ways. First, NLM has provided a model for other national and regional health information services. Second, it has been a catalyst, in that MEDLARS and other services it provides formed the nucleus of many regional networks. NLM helped such networks get started by giving advice on how to set up services and build collections and by "training the trainers" on the MEDLARS system. Third, NLM has supported national and regional operations by providing the additional training and materials needed for day-to-day service.

  14. 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 ...

  15. 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

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

    PubMed

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

    2014-10-01

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

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

    PubMed Central

    Narang, Akhil; Arora, Vineet M

    2015-01-01

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

  18. 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

  19. 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.

  20. 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.

  1. [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

  2. Promoting Quality Care for Recently Resettled Populations: Curriculum Development for Internal Medicine Residents

    PubMed Central

    MacNamara, Marina; Wilhelm, April; Dy, Geolani; Andiman, Sarah; Landau, Carol; Poshkus, Michael; Feller, Edward

    2014-01-01

    Background Residents report they lack preparation for caring for an increasingly diverse US population. In response, a variety of curricula have been developed to integrate cultural competency into medical training programs. To date, none of these curricula has specifically addressed members of recently resettled populations. Methods A preliminary assessment was conducted among internal medicine (IM) residents at 1 program (N  =  147). Based on 2 conceptual frameworks and the survey results, a pilot curriculum was developed and integrated into the interns' ambulatory block education within the general IM track (n  =  9). It included (1) online information made available to all hospital staff; (2) 4 interactive didactic sessions; and (3) increased exposure to newly arrived patients. The curriculum was qualitatively evaluated through 2 focus groups. Results The preliminary assessment was completed by 101 of 147 residents (69%), with 61% of respondents indicating they felt that they received less than adequate education in this area. Eight of the 9 interns exposed to the new curriculum participated in the focus groups. Overall, respondents reported they thought patient care had improved for recently resettled populations and across their patient panels after exposure to the curriculum. Conclusions This study demonstrated that an intervention that included didactics and enhanced exposure to a diverse population improved IM interns' perceptions of care for all patients, including recently settled individuals. PMID:24949138

  3. Racing Against the Clock: Internal Medicine Residents' Time Spent On Electronic Health Records

    PubMed Central

    Chen, Lu; Guo, Uta; Illipparambil, Lijo C.; Netherton, Matt D.; Sheshadri, Bhairavi; Karu, Eric; Peterson, Stephen J.; Mehta, Parag H.

    2016-01-01

    Background Since the late 1980s, resident physicians have spent increasing amounts of time on electronic health record (EHR) data entry and retrieval. Objective longitudinal data measuring time spent on the EHR are lacking. Objective We sought to quantify the time actually spent using the EHR by all first-year internal medicine residents in a single program (N = 41). Methods Active EHR usage data were collected from the audit logs for May, July, and October 2014 and January 2015. Per recommendations from our EHR vendor (Cerner Corporation), active EHR usage time was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 “mouse miles” per minute. Active EHR usage time was tallied for each patient chart viewed each day and termed an electronic patient record encounter (EPRE). Results In 4 months, 41 interns accumulated 18 322 hours of active EHR usage in more than 33 733 EPREs. Each intern spent on average 112 hours per month on 206 EPREs. Interns spent more time in July compared to January (41 minutes versus 30 minutes per EPRE, P < .001). Time spent on the EHR in January echoed that of the previous May (30 minutes versus 29 minutes, P = .40). Conclusions First-year residents spent a significant amount of time actively using the EHR, achieving maximal proficiency on or before January of the academic year. Decreased time spent on the EHR may reflect greater familiarity with the EHR, growing EHR efficiencies, or other factors. PMID:26913101

  4. 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.

  5. Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria

    PubMed Central

    Umeizudike, Kehinde A.; Iwuala, Sandra O.; Ozoh, Obianuju B.; Ayanbadejo, Patricia O.; Fasanmade, Olufemi A.

    2015-01-01

    Objective To assess internal medicine residents’ knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health. Methods A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents’ demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05). Results Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents’ information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for

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

    PubMed

    Huh, Sun

    2011-03-01

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

  7. [Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006].

    PubMed

    Arnau I Figueras, J; Torán Monserrat, P; Martínez-Carretero, J M; Forteza-Rey, J; Pinilla Llorente, B; Brailovsky, C A

    2008-10-01

    Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

  8. 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

  9. 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.

  10. 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

  11. [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.

  12. Board certification in internal medicine and cardiology: Historical success and future challenges.

    PubMed

    Baron, Richard J; Krumholz, Harlan M; Jessup, Mariell; Brosseau, Jennifer L

    2015-05-01

    Board certification is at a critical juncture. As physicians face increased regulation and pressures from both inside and outside the profession, board certification and Maintenance of Certification (MOC) are coming under increased scrutiny from the public and the medical community. At this challenging time, it is important to remind ourselves what board certification is (and what it is not) and revisit the origins of this tangible expression of professional self-regulation, even as we contemplate how it needs to improve. Board certification has evolved over time and must continue to evolve; it is our collective responsibility as physicians that peer-developed standards meet the needs of both the profession and the public. In this article, we will reflect on the history of the American Board of Internal Medicine (ABIM), especially which related to Cardiology, and describe some of ABIM׳s challenges and new directions.

  13. 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.

  14. [The medicines intended for internal use in the Formulary of Mons of 1755].

    PubMed

    Plouvier, L

    1999-01-01

    The Formulary of Mons of 1755 was in use but for 14 years. As a matter of fact, it was adopted in flagrant violation of the centralising measures promulgated by the Empress Maria Theresa who had endeavoured to impose on the entire territory of the southern Low Countries the Vienese Dispensarium, a version of which was published in Brussels in 1747. The medicines intended for internal use appearing in the Formulary of Mons are divided into two categories, namely operationes chimicae and compositiones galenicae. The former comprise of formulae alluding, on the one hand, to substances proper to alchemy (such as mercury and antimony), and, on the other, to substances derived form the techniques in current use of alchemy, namely sales, flores, distilled waters, tinctura and spiriti. Among the latter, several categories of mediciens appear prominently: the category of electuaria, loochs and conservae, that of mellitae, syrops, robs and extracts and that of tablets, trochisci, pills and powders. All these are treated therein.

  15. A blueprint for implementation of a structured portfolio in an internal medicine residency.

    PubMed

    Donato, Anthony A; George, David L

    2012-02-01

    The Accreditation Council for Graduate Medical Education recommends the structured portfolio as a preferred assessment tool for assessing all six of its core physician competencies. However, compared with other evaluation measures, it may be one of the most resource-intensive for learners and evaluators. Given the time and effort needed to properly develop mentors, train evaluators, and persuade learners, facilitation of the learning environment supporting a portfolio may be the most important variable determining its success or failure. The authors review the components necessary to successfully build and maintain a robust portfolio learning environment in a graduate medical education setting. These include gaining staff acceptance, staging implementation, enhancing learner participation, training mentors, choosing paper versus electronic formats, and selecting assessment methods. Their blueprint for implementing a portfolio is informed by their five-year experience with a portfolio rollout in one internal medicine residency, from 2006 to 2011.

  16. Integrating complementary and alternative medicine into medical intern teaching: preliminary findings from an Australian Hospital.

    PubMed

    Pierantozzi, A M; Steel, A; Seleem, M

    2013-11-01

    Globally, the use of complementary and alternative medicine (CAM) as a component of healthcare is well documented [1]. In Australia, despite escalating use of CAM [2], inclusion within medical curriculum is poorly developed. This study reports findings from a pilot-study of medical interns which examined whether the delivery of a CAM education session had impacted on their attitude, perceived knowledge and subsequent clinical practice. The results indicate that the participants' attitudes towards CAM education were positive, with 92% of participants considering it important for inclusion in junior doctor education. Post-session, participants also reported an acquisition of knowledge in relation to common interactions between CAM and conventional medical treatments and indicated a positive impact on subsequent clinical practice, specifically noting increased awareness of CAM enquiry in clinical practice. Results of this pilot study indicate that CAM and junior doctor education may have a positive impact on improving patient safety and management.

  17. 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.

  18. 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.

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

    PubMed Central

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

    2013-01-01

    Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI), brain activity was assessed in internal medicine residents (n = 10) and board-certified internists (faculty, n = 17) from the Uniformed Services University (USUHS) while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD) signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory. PMID:24133462

  20. Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents

    PubMed Central

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

    2013-01-01

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

  1. 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 ...

  2. Communication skills curriculum for foreign medical graduates in an internal medicine residency program.

    PubMed

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

    2014-11-01

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

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

    PubMed

    Hogan, D B

    1999-10-05

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

  4. 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...

  5. The learners' perspective on internal medicine ward rounds: a cross-sectional study

    PubMed Central

    2010-01-01

    Background Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees. PMID:20618929

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed

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

    2009-06-01

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

  8. GeoSentinel: the global emerging infections sentinel network of the International Society of Travel Medicine.

    PubMed

    Freedman, D O; Kozarsky, P E; Weld, L H; Cetron, M S

    1999-06-01

    GeoSentinel is a network of 22 member travel/tropical medicine clinics (14 in the United States and 8 in other countries) initiated in 1995 by the International Society of Travel Medicine (ISTM). GeoSentinel is based on the concept that these clinics are ideally situated to effectively detect geographic and temporal trends in morbidity among travelers. The core surveillance tool is a single-page faxable form submitted to a central data site for each post-travel patient, including immigrants, refugees, and foreign visitors. Diagnoses are entered either as specific etiologies or as syndromes and are then linked to geographic locations, reference dates, and clinical presentations. In addition, electronic communication with the larger body of worldwide ISTM member clinics is periodically done to obtain broader data collection in response to specific inquiries. The scope of GeoSentinel has broadened from the initial vision of a provider-based sentinel network tracking emerging infections at their point of entry into developed countries. Its present goals are (1) to monitor global trends in disease occurrence among travelers; (2) to ascertain risk factors and morbidity in groups of travelers categorized by travel purpose and type of traveler; (3) to respond to urgent public health queries; (4) to develop educational priorities for travelers' health; and (5) to effect a rapid response by electronically disseminating alerts to surveillance sites, to all ISTM members in 55 countries, and to public health authorities. In addition, a major byproduct of the network, and now one of its strongest assets, has been the growth of partnerships between ISTM, Centers for Disease Control and Prevention and health-care providers around the world, as well as other medical societies, government, and private organizations. The demographic data, travel patterns, and clinical presentations for the first 2813 patient records analyzed from the GeoSentinel sites are summarized in this paper.

  9. Integrating Systematic Chronic Care for Diabetes into an Academic General Internal Medicine Resident-Faculty Practice

    PubMed Central

    Dorr, David A.; Kelso, Christine; Bowen, Judith L.

    2008-01-01

    Background The quality of care for diabetes continues to fall short of recommended guidelines and results. Models for improving the care of chronic illnesses advocate a multidisciplinary team approach. Yet little is known about the effectiveness of such models in an academic setting with a diverse patient population and resident physicians participating in clinical care. Objective To implement a chronic illness management (CIM) practice within an academic setting with part-time providers, and evaluate its impact on the completion of diabetes-specific care processes and on the achievement of recommended outcomes for patients with diabetes mellitus. Design Retrospective cohort study Subjects Patients with the diagnosis of diabetes mellitus who receive their primary care in an academic general internal medicine resident-faculty practice. Measurements Process and outcomes measures in patients exposed to the CIM practice were compared with non-exposed patients receiving usual care. Main Results Five hundred and sixty-five patients met inclusion criteria. Patients in the CIM practice experienced a significant increase in completion of care processes compared to control patients for measurement of annual low-density lipoprotein (LDL) cholesterol (OR 3.1, 95% CI 1.7–5.7), urine microalbumin (OR 3.3, 95% CI 2.1–5.5), blood pressure (OR 1.8, 95% CI 1.1–2.8), retinal examination (OR 1.9, 95% CI 1.3–2.7), foot monofilament examination (OR 4.2, 95% CI 3.0–6.1) and administration of pneumococcal vaccination (OR 5.2, 95% CI 3.0–9.3). CIM-exposed patients were also more likely to achieve improvements in clinical outcomes of glycemic and blood pressure control reflected by hemoglobin A1c less than 7.0% (OR 1.7, 95% CI 1.02–3) and blood pressure less than 130/80 (OR 2.8, 95% CI 2.1–4.5) compared to controls. Conclusions A systematic chronic care model can be successfully integrated into an academic general internal medicine practice and may result in improved

  10. Analysis of Radiological Case Presentations and their Impact on Therapy and Treatment Concepts in Internal Medicine.

    PubMed

    Dendl, Lena-Marie; Teufel, Andreas; Schleder, Stephan; Rennert, Janine; Stroszczynski, Christian; Mueller-Schilling, Martina; Schreyer, Andreas G

    2017-03-01

    Purpose Evaluation of clinical impact regarding diagnostic and therapeutic changes influenced by interdisciplinary radiological case presentations. Materials and Methods Prospective evaluation of radiological-gastrointestinal clinical case conferences over a 1-year period at a tertiary care center. We documented the preparation (phase 1) and clinical case conference (phase 2) regarding their impact on the radiology report and further diagnostic work-up and therapy. Results 1067 examinations were evaluated in 69 clinical case conferences including 487 cases. We calculated a mean time of 35.8 minutes per conference with 5.1 minutes per case for preparation. During phase 1, major changes compared to the previous report were found in 1.2 % of cases, and no change was found in 91.4 % of cases. In phase 2 an additional relevant finding was found in 0.6 % of cases, while there was no major change to the reports in 99 % of cases. We recommended further radiological diagnostic workup in 9 % of cases and interventional radiological examination in 2.7 % of cases, while no change was documented in 83.2 %. Further radiological or surgical therapy was recommended in 7 % and 6.8 % of cases, respectively. There was no change in therapy in 78.5 % of cases. Conclusion The analysis of an interdisciplinary radiological case presentation in internal medicine shows that the case discussion with the radiologist results in a change in patient management in 37.3 % of cases (16.8 % diagnosis, 21.5 % therapy). Overall, interdisciplinary radiological clinical case conferences help to improve the management and quality of patient care. Our data support the broad implementation of radiological clinical case conferences. Key Points · The second opinion obtained during the preparation of a radiological case presentation does not change the written report in most cases.. · "Talking radiology" in radiological case presentations results in a significant change in

  11. Humanitarian assistance medicine: perceptions of preparedness: a survey-based needs assessment of recent U.S. Army internal medicine residency graduates.

    PubMed

    DeZee, Kent J; Berbano, Elizabeth P; Wilson, Ramey L; Rinaldo, Jean E

    2006-09-01

    The U.S. military provides humanitarian assistance in many areas around the globe. With recent changes in the force structure of the U.S. Army, internal medicine physicians are now at the forefront of providing this care, but the extent of their involvement is not known. This study measured the frequency with which recently trained Army internists provided humanitarian assistance, and it assessed their perceived preparedness for such missions. All graduates from Army internal medicine programs for 4 consecutive years were invited by e-mail to participate in an Internet-based survey. Eighty-nine personnel (49% of those contacted) completed the survey. Of those in a deployable position for >6 months, 72% provided medical humanitarian assistance. Most thought that additional training was needed, especially in tropical disease management, sanitation, and the practices of civilian humanitarian workers. This study demonstrates that military-trained internists are frequently involved in humanitarian assistance medicine, and it suggests that they might benefit from additional training.

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

    PubMed

    Przyłuska, Jolanta

    2006-01-01

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

  13. [Internal medicine and cardiovascular evaluation of preoperative and perioperative patients undergoing ophthalmic surgery].

    PubMed

    Soldini, M

    2013-01-01

    Ophthalmic surgery would a surgical practice with fewer complications compared to other types of surgery. This is only true in part, because of the elderly population of reference. So, in cataract surgery we are faced with a patient with heart disease which carries the signs of aging and degenerative consequences linked to it. The interventions performed in patients with heart disease are still potentially have a greater risk, although site preparation and monitoring during and after surgery in recent years have allowed greater safety for patients and an overall reduction in morbidity and mortality. It is stressed so the importance of a correct clinical diagnosis of the general patient for a better stratification of cardiovascular risk for ophthalmic surgery. It must therefore avoid the most frequent sequelae, such as the ICC, arrhythmias and hypertensive crises. One purpose of a Service of Internal Medicine, like ours, totally dedicated to the functional requirements of the assistance of ophthalmologic patients, both during hospitalization, and in prehospitalization, and especially in Day Hospital and in Day Service, for the cardiac risk stratification in ophthalmic surgery, is to ensure firstly to the patient and then to colleagues ophthalmologist and surgeons and anesthetists the greater security on the plane predictive for reducing perioperative and postoperative morbidity and mortality.

  14. Self-Reported Alcohol and Drug Problems Among Internal Medicine Outpatients: Relationships With Criminal Behavior

    PubMed Central

    Lam, Charlene; Wiederman, Michael W.

    2011-01-01

    Objective: Previous research indicates relationships between alcohol/substance misuse and criminal behavior, but past studies have restricted investigations to atypical samples and/or utilized limited assessments of illegal behavior. In the present study, we explored relationships between alcohol/drug problems and charges for 27 criminal behaviors in a primary care sample. Method: Participants were a cross-sectional sample of 376 consecutive men and women, aged 18 years or older, being seen for nonemergent medical care at an outpatient internal medicine clinic staffed predominantly by residents and located in a midsized, midwestern city in October 2010. Using a self-report survey methodology, we examined relationships between alcohol and drug problems (“Have you ever had a problem with alcohol?” and “Have you ever had a problem with drugs?”) and 27 illegal behaviors as delineated by the categories used by the US Federal Bureau of Investigation. Results: Men with alcohol or drug problems statistically exhibited the greatest number of charges for different forms of illegal behavior (P < .001). These charges were directly related to alcohol/drug misuse (eg, driving under the influence of alcohol or drugs) and otherwise (eg, aggravated assault, simple assault, gambling, larceny-theft). Conclusions: In primary care settings, men with alcohol/drug problems may also have a history of illegal behaviors—a finding that is relevant in terms of social and legal implications. PMID:22454803

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

    PubMed

    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.

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

    PubMed

    Sidorov, J

    1990-10-01

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

  17. The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices.

    PubMed

    McCauley, J; Kern, D E; Kolodner, K; Dill, L; Schroeder, A F; DeChant, H K; Ryden, J; Bass, E B; Derogatis, L R

    1995-11-15

    This cross-sectional study determined the prevalence of domestic violence among female patients presenting to four community-based primary care internal medicine practices in Baltimore, Maryland, between February and July, 1993. Furthermore, it identified clinical characteristics associated with domestic violence. A total of 1952 female patients of diverse socioeconomic backgrounds participated in a self-administered, anonymous survey that solicited data on physical and sexual abuse, alcohol abuse, emotional status, demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history. Of the 1952 respondents, 108 (5.5%) had experienced domestic violence in the previous year, 418 (21.4%) had experienced violence sometime in their adult lives, 429 (22%) before age 18 years, and 639 (32.7%) as either an adult or a child. Current violence status is associated with single or separated status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms. In a logistic regression model, the likelihood of current abuse increased with the number of risk factors. The magnitude of these associations supports the idea that domestic violence is a significant medical public health problem. Detection of domestic violence by physicians or other health care professionals might alter both the diagnostic and treatment plans for these women.

  18. Identification and management of invasive mycoses in internal medicine: a road-map for physicians.

    PubMed

    Falcone, Marco; Concia, Ercole; Iori, Ido; Lo Cascio, Giuliana; Mazzone, Antonino; Pea, Federico; Violi, Francesco; Venditti, Mario

    2014-08-01

    Invasive mycoses are a rising problem, not only in traditional categories of patients like hematologic or neutropenic ones, but also in elderly non-neutropenic patients admitted to internal medicine wards. Patients being admitted to medical wards are usually older, have multiple comorbidities, e.g., liver cirrhosis or chronic obstructive respiratory disease, may be malnourished or receive peripheral or total parenteral nutrition, and frequently are undergoing chronic corticosteroid therapy, chemotherapy for cancer or monoclonal antibodies for autoimmune diseases. Such risk factors may be contemporarily present in a single patient increasing the risk for the development of invasive mycoses. Diagnosis of candidemia and invasive aspergillosis is particularly difficult in patients hospitalized on medical wards, since symptoms and signs have low specificity, and most diagnostic tests have been only validated in neutropenic hematologic patients, but not in those without neutropenia. Both candidemia and invasive aspergillosis carry significant morbidity and mortality. The aim of this paper is to provide a simple guide to physicians for a prompt identification and treatment of patients with possible or suspected invasive mycoses.

  19. Do Internal Medicine Residents Know Enough About Skilled Nursing Facilities To Orchestrate a Good Care Transition?

    PubMed Central

    Ward, Katherine T.; Eslami, Michelle S.; Garcia, Maristela B.; McCreath, Heather E.

    2015-01-01

    BACKGROUND Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether Internal Medicine (IM) residents have sufficient knowledge of the care that can be provided at this site. METHODS We developed a 10-item multiple choice pre-test that assessed knowledge of the definition of a SNF, SNF staffing requirements, and SNF services provided on-site. The test was administered to trainees on the first day of a mandatory SNF rotation that occurred during their first, second or third year of training. RESULTS 67 IM residents (41 PGY-1, 11 PGY-2, and 15 PGY-3) were assessed with the test. The mean number of questions answered correctly was 4.9, with a standard deviation of 1.6. Regardless of their level of training, residents had a poor baseline knowledge of SNF care (mean scores 4.2 for PGY-1, 5.3 for PGY-2, and 6.3 for PGY-3 (p<0.0001). Performance on some questions improved with increased level of training but others did not. CONCLUSIONS Medical residents have insufficient knowledge about the type of care that can be provided at a SNF and efforts to improve this knowledge are needed to assure proper triage of patients and safe transitions to the SNF. PMID:25282630

  20. Identification of dendrobium species used for herbal medicines based on ribosomal DNA internal transcribed spacer sequence.

    PubMed

    Takamiya, Tomoko; Wongsawad, Pheravut; Tajima, Natsuko; Shioda, Nao; Lu, Jun Feng; Wen, Chi Luan; Wu, Jin Bin; Handa, Takashi; Iijima, Hiroshi; Kitanaka, Susumu; Yukawa, Tomohisa

    2011-01-01

    Stems of genus Dendrobium (Orchidaceae) have been traditionally used as an herbal medicine (Dendrobii Herba) in Eastern Asia. Although demand for Dendrobium is increasing rapidly, wild resources are decreasing due to over-collection. This study aimed to identify plant sources of Dendrobii Herba on the market based on sequences of the internal transcribed spacer (ITS) regions of nuclear ribosomal DNA. We constructed an ITS1-5.8S-ITS2 sequence database of 196 Dendrobium species, and the database was employed to identify 21 herbal samples. We found that 13 Dendrobium species (D. catenatum, D. cucullatum, D. denudans, D. devonianum, D. eriiflorum, D. hancockii, D. linawianum, D. lituiflorum, D. loddigesii, D. polyanthum, D. primulinum, D. regium, and D. transparens) were possibly used as plant sources of Dendrobii Herba, and unidentified species allied to D. denudans, D. eriiflorum, D. gregulus, or D. hemimelanoglossum were also used as sources. Furthermore, it is clear that D. catenatum is one of the most important sources of Dendrobii Herba (5 out of 21 samples).

  1. Examination outcomes for international medical graduates pursuing or completing family medicine residency training in Quebec

    PubMed Central

    MacLellan, Anne-Marie; Brailovsky, Carlos; Rainsberry, Paul; Bowmer, Ian; Desrochers, Micheline

    2010-01-01

    ABSTRACT OBJECTIVE To review the success of international medical graduates (IMGs) who are pursuing or have completed a Quebec residency training program and examinations. DESIGN We retrospectively reviewed IMGs’ success rates on the pre-residency Collège des médecins du Québec medical clinical sciences written examination and objective structured clinical examination, as well as on the post-residency Certification Examination in Family Medicine. SETTING Quebec. PARTICIPANTS All IMGs taking their examinations between 2001 and 2008, inclusive, and Canadian and American graduates taking their examinations during this same period. MAIN OUTCOME MEASURES Success rates for IMGs on the pre-residency and post-residency examinations, compared with success rates for Canadian and American graduates. RESULTS Success rates on the pre-residency clinical examinations remained below 50% from 2001 to 2008 for IMGs. Similarly, during the same period, the average success rate on the Certification examination was 56.0% for IMGs, compared with 93.5% for Canadian and American medical graduates. CONCLUSION Despite pre-residency competency screening and in-program orientation and supports, a substantial number of IMGs in Quebec are not passing their Certification examinations. Another study is under way to analyze reasons for some IMGs’ lack of success and to find ways to help IMGs complete residency training successfully and pass the Certification examination. PMID:20841596

  2. The gut microbiota in internal medicine: implications for health and disease.

    PubMed

    Lankelma, J M; Nieuwdorp, M; de Vos, W M; Wiersinga, W J

    2015-02-01

    The human gut microbiota may be viewed as an organ, executing numerous functions in metabolism, development of the immune system and host defence against pathogens. It may therefore be involved in the development of a range of diseases such as gastrointestinal infections, inflammatory bowel disease, allergy and diabetes mellitus. Reversely, certain therapies that are often used, such as antibiotics and chemotherapy, may negatively affect the composition and function of the gut microbiota and thereby the wellbeing of patients. As the microbiota research field is currently moving from association studies to intervention studies and even clinical trials, implementation of this new knowledge into clinical practice is coming near. Several therapeutic interventions that target the gut microbiota are being evaluated, ranging from supplementation of food components to transplantation of faecal microbiota. In this review we provide an overview of current literature on the gut microbiota in both a healthy state and a range of diseases that are relevant for internal medicine. In anticipation of gut microbiota-targeted therapies, it is important to realise the key function of the gut microbiota in physiological processes and the collateral damage that may be caused when disrupting this ecosystem within us.

  3. 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.

  4. Tips for Daily Living

    MedlinePlus

    ... Tips and Gadgets for Daily Activities Dressing Tips Shopping Tips Modifying the Bathroom Driving After Stroke Medication ... and resources. Find a group in your area . Online Support If there is not a support group ...

  5. First Aid Tips

    MedlinePlus

    ... NEI for Kids > First Aid Tips All About Vision About the Eye Ask a Scientist Video Series ... Eye Health and Safety First Aid Tips Healthy Vision Tips Protective Eyewear Sports and Your Eyes Fun ...

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

    PubMed

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

    2009-10-01

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

  7. 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

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

    PubMed

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

    2013-01-01

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

  9. Can CAP guideline adherence improve patient outcome in internal medicine departments?

    PubMed

    Blasi, F; Iori, I; Bulfoni, A; Corrao, S; Costantino, S; Legnani, D

    2008-10-01

    The impact of compliance with Italian guidelines on the outcome of hospitalised community-acquired pneumonia (CAP) in internal medicine departments was evaluated. All Fine class IV or V CAP patients were included in this multicentre, interventional, before-and-after study, composed of three phases: 1) a retrospective phase (RP; 1,443 patients); 2) a guideline implementation phase; and 3) a prospective phase (PP; 1,404 patients). Antibiotic prescription according to the guidelines increased significantly in the PP. The risk of failure at the end of the firstline therapy was significantly lower in the PP versus the RP (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.69-1.00), particularly in Fine class V patients (OR 0.71, 95% CI 0.51-0.98). Analysis of outcome in the overall population (2,847 patients) showed a statistically significant advantage for compliant versus noncompliant therapies in terms of failure rate (OR 0.74, 95% CI 0.60-0.90) and an advantage in terms of mortality (OR 0.77, 95% CI 0.58-1.04). Antipneumococcal cephalosporin monotherapy was associated with a low success rate (68.6%) and the highest mortality (16.2%); levofloxacin alone and the combination of cephalosporin and macrolide resulted in higher success rates (79.1 and 76.7%, respectively) and significantly lower mortalities (9.1 and 5.7%, respectively). Overall, a low compliance with guidelines in the prospective phase (44%) was obtained, indicating the need for future more aggressive and proactive approaches.

  10. A procedural skills OSCE: assessing technical and non-technical skills of internal medicine residents.

    PubMed

    Pugh, Debra; Hamstra, Stanley J; Wood, Timothy J; Humphrey-Murto, Susan; Touchie, Claire; Yudkowsky, Rachel; Bordage, Georges

    2015-03-01

    Internists are required to perform a number of procedures that require mastery of technical and non-technical skills, however, formal assessment of these skills is often lacking. The purpose of this study was to develop, implement, and gather validity evidence for a procedural skills objective structured clinical examination (PS-OSCE) for internal medicine (IM) residents to assess their technical and non-technical skills when performing procedures. Thirty-five first to third-year IM residents participated in a 5-station PS-OSCE, which combined partial task models, standardized patients, and allied health professionals. Formal blueprinting was performed and content experts were used to develop the cases and rating instruments. Examiners underwent a frame-of-reference training session to prepare them for their rater role. Scores were compared by levels of training, experience, and to evaluation data from a non-procedural OSCE (IM-OSCE). Reliability was calculated using Generalizability analyses. Reliabilities for the technical and non-technical scores were 0.68 and 0.76, respectively. Third-year residents scored significantly higher than first-year residents on the technical (73.5 vs. 62.2%) and non-technical (83.2 vs. 75.1%) components of the PS-OSCE (p < 0.05). Residents who had performed the procedures more frequently scored higher on three of the five stations (p < 0.05). There was a moderate disattenuated correlation (r = 0.77) between the IM-OSCE and the technical component of the PS-OSCE scores. The PS-OSCE is a feasible method for assessing multiple competencies related to performing procedures and this study provides validity evidence to support its use as an in-training examination.

  11. 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.

  12. From hagfish to humans: teaching comparative physiology to internal medicine residents.

    PubMed

    Herzig, Shoshana J; Aird, William C; Shah, Brijen J; McKernan, Michael; Zeidel, Mark L

    2012-03-01

    With more clinical information for trainees to master in the face of increasing time pressures, discussions about underlying physiology and the mechanisms of disease seem to have been de-emphasized during residency training. This reduced focus on pathophysiology and basic science may weaken trainees' clinical effectiveness and reduce their interest in pursuing research careers.In response, the authors helped to develop in 2006 a one-week immersive comparative physiology course for second- and third-year internal medicine residents at Beth Israel Deaconess Medical Center. The course, held at the Mount Desert Island Biological Laboratory, includes four modules (hematology, vascular physiology, secretory physiology, and salt and water homeostasis), each composed of basic science experiments using aquatic species and accompanied by clinical correlation discussions and group presentations.From 2007 to 2010, 72 residents rotated through the course. Most reported that it enhanced their understanding of the mechanisms of disease in their patients. After the course, residents reported that physiology played a more prominent role in their teaching and clinical decision making during both ward and intensive care unit rotations. They also reported being more likely than before the course to read about the pathophysiology of disease when faced with a clinical problem.Although cost-intensive and geographically unique, this model for teaching the mechanisms of disease could be applied elsewhere with the help of physician-scientists and clinician-educators. In this article, the authors describe the development of the course, share preliminary data evaluating progress toward its goals, and discuss future directions and lessons learned.

  13. 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.

  14. Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center

    PubMed Central

    Manzano, Joanna-Grace M.; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

    2015-01-01

    Purpose: Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. Methods: We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. Results: We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01). Conclusion: We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals. PMID:26152375

  15. [Principles of cooperation between the specialties of internal medicine, pathology and clinical biochemistry].

    PubMed

    Hölzel, W; Baumgarten, R; Fiedler, H; Zimmermann, S

    1985-12-01

    The optimal utilization of the knowledge and possibilities of pathological and clinical biochemistry presumes a close cooperation between it and the clinical specialties. The common working team of the GDR Society of Internal Medicine and the GDR Society for Clinical Chemistry and Laboratory Diagnostics makes theses of the central points of the cooperation in care, education, further education and postgraduate study and in research a subject for discussion. As essential tasks in the process of medical care are regarded the balance of the examination programme standing at the disposal, the establishment of diagnostic programmes, the establishment of organisational measures, the ascertainment of a use according to indication, the guarantee of the representance of examination material, the control of plausibility and the interpretation of test results. Since the realization of the tasks to a large extent depends on the cooperation of the specialities in education, further education and postgraduate study during the further education the clinician should become acquainted with the possibilities, the limits and the prerequisites for the performance of laboratory diagnostic investigations, the clinical biochemist with the problems of medical care and the value of the laboratory diagnosis in the total process of the treatment. In the field of research the result is a necessary cooperation in the clarification of patho-biochemical mechanisms, in the search for suitable laboratory diagnostic parameters for diagnostics and control of the course as well as in the statement of the validity of laboratory diagnostic parameters and parameter combinations taking into consideration the factors expenses, benefit and risk as well as further diagnostic possibilities.

  16. Factors that contribute to social media influence within an Internal Medicine Twitter learning community.

    PubMed

    Desai, Tejas; Patwardhan, Manish; Coore, Hunter

    2014-01-01

    Medical societies, faculty, and trainees use Twitter to learn from and educate other social media users. These social media communities bring together individuals with various levels of experience. It is not known if experienced individuals are also the most influential members. We hypothesize that participants with the greatest experience would be the most influential members of a Twitter community. We analyzed the 2013 Association of Program Directors in Internal Medicine Twitter community. We measured the number of tweets authored by each participant and the number of amplified tweets (re-tweets). We developed a multivariate linear regression model to identify any relationship to social media influence, measured by the PageRank. Faculty (from academic institutions) comprised 19% of the 132 participants in the learning community (p < 0.0001). Faculty authored 49% of all 867 tweets (p < 0.0001). Their tweets were the most likely to be amplified (52%, p < 0.01). Faculty had the greatest influence amongst all participants (mean 1.99, p < 0.0001). Being a faculty member had no predictive effect on influence (β = 0.068, p = 0.6). The only factors that predicted influence (higher PageRank) were the number of tweets authored (p < 0.0001) and number of tweets amplified (p < 0.0001) The status of "faculty member" did not confer a greater influence. Any participant who was able to author the greatest number of tweets or have more of his/her tweets amplified could wield a greater influence on the participants, regardless of his/her authority.

  17. 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

  18. The Internal Medicine Subinternship--Now More Important than Ever: A Joint CDIM-APDIM Position Paper.

    PubMed

    Vu, T Robert; Angus, S V; Aronowitz, P B; Harrell, H E; Levine, M A; Carbo, A; Whelton, S; Ferris, A; Appelbaum, J S; McNeill, D B; Ismail, N J; Elnicki, D M

    2015-09-01

    For decades, the internal medicine (IM) subinternship has served as a critical interface between undergraduate and graduate medical education. As such, the vast majority of U.S. medical schools offer this rotation to help students prepare for post-graduate training. Historically an experiential rotation, a formal curriculum with specific learning objectives was eventually developed for this course in 2002. Since then, graduate medical education (GME) has changed significantly with the regulation of duty hours, adoption of competency-based education, and development of training milestones and entrustable professional activities. In response to these and many other changes to residency training and medical practice, in 2010, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members-with input from the Clerkship Directors in Internal Medicine (CDIM) Subinternship Task Force-to determine which core skills program directors expected from new medical school graduates. The results of that survey helped to inform a joint CDIM-APDIM committee's decision to re-evaluate the goals of the IM subinternship in an effort to enhance the transition from medical school to residency. This joint committee defined the minimum expectations of what constitutes an IM subinternship rotation, proposed recommended skills for IM subinterns, and discussed challenges and future directions for this crucial course.

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

    PubMed

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

    2015-12-01

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

  20. Tips for Transition

    ERIC Educational Resources Information Center

    Kellems, Ryan, Comp.; Morningstar, Mary E., Comp.

    2009-01-01

    The Tips for Transition contains 134 Transition Tips submitted from all over the country by practitioners. The purpose of the Tips was to identify grassroots transition practices being used by practitioners. Tips are categorized into the following domains: (1) Transition Planning; (2) Student Involvement; (3) Family Involvement; (4) Curriculum and…

  1. Probe tip heating assembly

    SciTech Connect

    Schmitz, Roger William; Oh, Yunje

    2016-10-25

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

  2. Access to medicines among internally displaced and non-displaced people in urban areas in Colombia.

    PubMed

    Ruiz-Rodríguez, Myriam; Wirtz, Veronika J; Idrovo, Alvaro J; Angulo, Mary Lupe

    2012-12-01

    This study analyzes access to medicines among displaced and non-displaced populations in urban areas in Bucaramanga, Colombia. A household survey was carried out to study access to medicines for self-reported and medically diagnosed health conditions. Multiple Poisson regression with robust variance was used to determine factors associated with access to medicines. Two thousand and sixty individuals from 514 families participated. Only 29.1% (95%CI: 22.04-37.08) of the individuals in the sample with prescriptions and 44.3% (95%CI: 40.42-48.25) with self-reported needs for pharmacotherapy were taking medicines. Greater access was associated with the perceived severity of the illness, higher income, having a health center nearby and not perceiving barriers in accessing services. Social security affiliation and being displaced were not related. Social security coverage alone does not have an effect on access to medicines because it does not include essential medicines that correspond to the health needs of this population. Resolving administrative and geographical barriers is likely to improve access to medicines.

  3. 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.

  4. Identification of microRNAs and target genes in the fruit and shoot tip of Lycium chinense: a traditional Chinese medicinal plant.

    PubMed

    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.

  5. 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

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

    PubMed Central

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

    2017-01-01

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

  7. Intervention categories for physiotherapists treating patients with internal medicine conditions on the basis of the International Classification of Functioning Disability and Health.

    PubMed

    Bürge, Elisabeth; Cieza, Alarcos; Allet, Lara; Finger, Monika Elisabeth; Stucki, Gerold; Huber, Erika Omega

    2008-03-01

    The International Classification of Functioning, Disability and Health (ICF) is considered to be a useful tool to overcome differences among different health professionals and to facilitate a common understanding of the patient and of what constitutes care. Three lists of ICF intervention categories for internal medicine have been developed. The next step of the development process is to address their content validity. The data for this study were derived from 300 clinical records. The study was conducted as a retrospective cross-sectional multicentre study in Switzerland. It was performed using convenience samples of records of patients with internal medicine conditions. The validation process enabled the identification of 36 ICF intervention categories in the acute, 41 in the rehabilitation and 38 in the long-term contexts. The developed lists might help define the core competencies of the profession of physiotherapy. These intervention categories are available for intervention documentation in a standardized common language, the ICF, and they offer the possibility of responding to the health-political demand for transparency regarding services offered by health care providers.

  8. 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.

  9. [Re-organization of internal medicine wing in hospitals: a last-ditch effort or the beginning of reform?].

    PubMed

    Sharabi, Yehonatan

    2014-01-01

    Over the last decade numerous publications have dealt with ongoing changes in the traditional practice of internal medicine. In general, in-hospital medicine has evolved into ambulatory or specialized care. In this volume of Harefuah, Yinon et al. discuss trends at Shaare-Zedek Medical Center, focusing on the challenge of attracting residents to general internal medicine. Their model addresses local problems, but they have laid the groundwork for a more radical change. They present an evolutionary process that would transform hospital practice to become both more patient-centered and integrative, with an interdisciplinary team that translates the strengths of in-hospital (in- and out-patient care) vs. ambulatory or over-specialized care. Such reform should also include changes in clinical medical education, coupled with research and academic activities that can only take place in hospitals. The health care system is waiting for the next academic medical center that will take the lead in accepting this challenge and spearhead much needed reform.

  10. 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

  11. [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.

  12. 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

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

    PubMed

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

    2014-02-01

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

  14. 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.

  15. Slender tip laser scalpel

    DOEpatents

    Veligdan, James T.

    2004-01-06

    A laser scalpel includes a ribbon optical waveguide extending therethrough and terminating at a slender optical cutting tip. A laser beam is emitted along the height of the cutting tip for cutting tissue therealong.

  16. Healthy Vision Tips

    MedlinePlus

    ... NEI for Kids > Healthy Vision Tips All About Vision About the Eye Ask a Scientist Video Series ... Links to More Information Optical Illusions Printables Healthy Vision Tips Healthy vision starts with you! Use these ...

  17. A multicenter study of internal medicine residents' perceptions of training, competence, and performance in outpatient HIV care.

    PubMed

    Phillips, Karran A; Cofrancesco, Joseph; Sisson, Stephen; Wu, Albert W; Bass, Eric B; Berkenblit, Gail

    2010-03-01

    Routine HIV screening is recommended by the Centers for Disease Control and Prevention (CDC), but it is unknown how well internal medicine residents are trained in HIV risk assessment, testing, counseling, and initial management of HIV patients. We sought to determine internal medicine residents' attitudes about HIV training and the factors that influence their HIV care performance utilizing a cross-sectional survey of 321 second- and third-year internal medicine residents from four programs in Baltimore, Boston, Detroit, and New York City between March and June 2006. Measurements included HIV care experience; attitudes, competency, and adequacy of HIV training; and basic HIV care performance and factors impacting performance. Two hundred twenty-three residents (69%) completed the survey. While 50% of residents reported over 30 HIV inpatient encounters in the past year, the majority of residents had limited outpatient exposure providing care for only 1-5 HIV outpatients. Managing HIV patients was rated an excellent educational opportunity by 89% of residents and 77% planned to care for HIV patients in the future. However, 39% stated that they did not feel competent to provide HIV outpatient care. Higher rates of residents reported deficiency in outpatient HIV training compared to outpatient non-HIV training (p < 0.05) or inpatient HIV training (p < 0.05). Residents reported substandard HIV risk assessment, testing, counseling, and initial management performance. Self-reported proficiency correlated with the number of HIV outpatients cared for and perceived training adequacy. Current residency training in HIV care remains largely inpatient-based and residents frequently rate HIV outpatient training as inadequate.

  18. 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.

  19. Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients: A Nationwide Cross-Sectional Study.

    PubMed

    Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

    2016-02-01

    Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan.A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays.Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16-1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15-1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05-2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03-1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09-1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01-1.06; P = 0.008) than weekday-admitted patients.General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment.

  20. Short training in focused cardiac ultrasound in an Internal Medicine department: what realistic skill targets could be achieved?

    PubMed

    Mozzini, Chiara; Garbin, Ulisse; Fratta Pasini, Anna Maria; Cominacini, Luciano

    2015-02-01

    The importance of focused cardiac ultrasound (FCU) in Internal Medicine care has been recognized by the American Society of Echocardiography. The aim of this study was to test what realistic skill targets could be achieved in FCU, with a relatively short training (theoretical and practical) of 9 h offered to Internal Medicine certification board attending students, and if the addition of further 9 h of training could significantly improve the level of competence. Kappa statistic was used to calculate the inter-observer agreement (trainees/tutor). The agreement between the trainees (who completed the entire training) and the tutor was, respectively, "substantial" (k = 0.71) for the identification of pericardial effusion, "moderate" (k = 0.56-0.54) for the identification of marked right ventricular and left ventricular enlargement, "substantial" (k = 0.77) for the assessment of global cardiac systolic function by visual inspection and "fair" (k = 0.35) for the assessment of size and respiratory change in the diameter of the inferior cave vein (IVC). 18 h training in FCU provided proficiency in obtaining adequate images from the parasternal window without providing the ability to correctly master the apical and subcostal windows. As concerns the interpretative skills, only pericardial effusion and visual estimation of global systolic function could be correctly identified, while ventricular enlargement and IVC prove to be more difficult to evaluate. This study supports incorporating FCU into Internal Medicine fellowship training programs, and should facilitate the design of other similar training courses.

  1. 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

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

    DOEpatents

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

    2002-01-01

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

  3. 75 FR 11226 - Proposed Collection; Comment Request for Tip Reporting Alternative Tip Agreement Used in the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-10

    ... Used in the Cosmetology and Barber Industry AGENCY: Internal Revenue Service (IRS), Treasury. ACTION..., the IRS is soliciting comments concerning Tip Reporting Alternative Commitment used in the Cosmetology...: Tip Reporting Alternative Commitment Agreement used in the Cosmetology and Barber Industry. OMB...

  4. 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.

  5. 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

  6. Child Transportation Safety Tips.

    ERIC Educational Resources Information Center

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

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

  7. Risk assessment of student performance in the International Foundations of Medicine Clinical Science Examination by the use of statistical modeling

    PubMed Central

    David, Michael C; Eley, Diann S; Schafer, Jennifer; Davies, Leo

    2016-01-01

    Purpose The primary aim of this study was to assess the predictive validity of cumulative grade point average (GPA) for performance in the International Foundations of Medicine (IFOM) Clinical Science Examination (CSE). A secondary aim was to develop a strategy for identifying students at risk of performing poorly in the IFOM CSE as determined by the National Board of Medical Examiners’ International Standard of Competence. Methods Final year medical students from an Australian university medical school took the IFOM CSE as a formative assessment. Measures included overall IFOM CSE score as the dependent variable, cumulative GPA as the predictor, and the factors age, gender, year of enrollment, international or domestic status of student, and language spoken at home as covariates. Multivariable linear regression was used to measure predictor and covariate effects. Optimal thresholds of risk assessment were based on receiver-operating characteristic (ROC) curves. Results Cumulative GPA (nonstandardized regression coefficient [B]: 81.83; 95% confidence interval [CI]: 68.13 to 95.53) and international status (B: −37.40; 95% CI: −57.85 to −16.96) from 427 students were found to be statistically associated with increased IFOM CSE performance. Cumulative GPAs of 5.30 (area under ROC [AROC]: 0.77; 95% CI: 0.72 to 0.82) and 4.90 (AROC: 0.72; 95% CI: 0.66 to 0.78) were identified as being thresholds of significant risk for domestic and international students, respectively. Conclusion Using cumulative GPA as a predictor of IFOM CSE performance and accommodating for differences in international status, it is possible to identify students who are at risk of failing to satisfy the National Board of Medical Examiners’ International Standard of Competence. PMID:27980449

  8. 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

  9. Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada

    PubMed Central

    Ailon, Jonathan; Mourad, Ophyr; Nadjafi, Maral; Cavalcanti, Rodrigo

    2016-01-01

    Background Point-of-care ultrasound (POCUS) is increasingly used on General Internal Medicine (GIM) inpatient services, creating a need for defined competencies and formalized training. We evaluated the extent of training in POCUS and the clinical use of POCUS among Canadian GIM residency programs. Method Internal Medicine trainees and GIM Faculty at the University of Toronto were surveyed on their clinical use of POCUS and the extent of their training. We separately surveyed Canadian IM Program Directors and Division Directors on the extent of POCUS training in their programs, barriers in the implementation of POCUS curricula, and recommendations for POCUS competencies in IM. Results A majority of IM trainees (90/118, 76%) and GIM Faculty (15/29, 52%) used POCUS clinically. However, the vast majority of resident (111/117, 95%) and GIM Faculty (18/28, 64%) had received limited training. Of the Program Leaders surveyed, half (9/17, 53%) reported POCUS clinical use by their trainees; however only one quarter (4/16, 25%) reported offering formal curricula. Most respondents agreed that POCUS training should be incorporated into IM residency curricula, specifically for procedural guidance. Conclusions A considerable discrepancy exists between the clinical use of POCUS and the extent of formal training among Canadian IM residents and GIM Faculty. We propose that formalized POCUS training should be incorporated into IM residency programs, GIM fellowships, and Faculty development sessions, and identify POCUS skills that could be incorporated into future IM curricula. PMID:28344693

  10. 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.

  11. Intention of residents in internal medicine to care for patients infected with HIV at a university hospital in Taiwan.

    PubMed

    Hsiung, P C; Tsai, Y F; Hung, C C; Chen, M Y

    2001-09-01

    The purpose of this study was to investigate internal medicine residents' HIV-related knowledge and their attitudes towards caring for HIV-infected patients, and determine the extent to which these variables influence their care-providing intention. A cross-sectional survey was conducted in 56 internal medicine residents at a university hospital in Taiwan. Results showed residents' lack of sufficient knowledge was reflected by their inaccurate assessment of HIV-associated risk and their tendency to overuse protective gear in unnecessary situations. In general, residents expressed slightly positive attitudes with a neutral intention to care for HIV-infected patients. Knowledge and attitudes were significantly correlated with intention. The use of stepwise regression analysis revealed attitudes accounted for 59% of the variance in intention. Future efforts should focus on designing, implementing, and evaluating educational programmes that address residents' needs to ensure a solid HIV-related knowledge base, support their positive attitudes, address their ambivalent feelings toward providing HIV care, and enhance their intention to care for HIV-infected patients.

  12. 1st college of physicians lecture: the role of internal medicine as a specialty in the era of subspecialisation.

    PubMed

    Chee, Y C

    2004-11-01

    This paper is divided into 4 parts. The first deals with the definition of specialties and traces its roots from the early 20th century in the United States of America with the formation and growth of Specialty Boards. The second is a reflection on the scene in Singapore from the 1960s to the present, describing the change from public healthcare institutions run by the civil service to the autonomous restructured public service hospitals towards the end of the 20th century. The third section deals with what the 4ps have expressed about changes necessary to the Singapore system in the 21st century. The 4ps are the politicians, the payers, the patients and the public. It is about value for money, better coordination and better communication. Finally, just what is Internal Medicine - its competencies and its practice. A review of the systems in Australia, New Zealand, and the USA is presented. The idea of the "hospitalist" is discussed. Concluding remarks deal with the viability of Internal Medicine because of low reimbursement, administrative burdens and brief patient visits.

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

    PubMed

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

    2016-04-29

    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.

  14. Arctic climate tipping points.

    PubMed

    Lenton, Timothy M

    2012-02-01

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

  15. Mastery Learning of Advanced Cardiac Life Support Skills by Internal Medicine Residents Using Simulation Technology and Deliberate Practice

    PubMed Central

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

    2006-01-01

    BACKGROUND Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education. PMID:16637824

  16. 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

  17. Helicopter blade tips

    NASA Technical Reports Server (NTRS)

    Lyothier, R.

    1983-01-01

    Methods of improving helicopter performance and vibration level by proper shaping of helicopter blade tips are considered. The principle involved consists of reducing the extent of the supersonic zone above the advancing tip and of the turbulent interaction. For stationary and advancing flight, the influence of the rotor and the problems posed by blade tips are reviewed. The theoretical methods of dealing with the two types of flight are briefly stated, and the experimental apparatus is described, including model triple and quadruple rotors. Different blade tip shapes are shown and briefly discussed. The theoretical results include an advancing speed of 309 km/H and a blade tip rotational speed of 215 m/s. The experimental values are advancing speed of 302 km/h and blade tip Mach number 0.86 for both types of rotors.

  18. [Sport medicine].

    PubMed

    Epstein, Yoram

    2012-02-01

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

  19. Institutional profile. The International Society for Cellular Therapy: evolving to meet the demands of the regenerative medicine industry.

    PubMed

    Maziarz, Richard T; Arthurs, Jane; Horwitz, Edwin

    2011-03-01

    The International Society for Cellular Therapy is a global association driving the translation of scientific research to deliver innovative cellular therapies to patients. Established in 1992, its membership and leadership comprises world-class scientists, clinicians, technologists, biotech/pharma and regulatory professionals from 40 countries focused on preclinical and translational aspects of developing cell therapy products. The International Society for Cellular Therapy has evolved in alignment with the maturation of the field of cell therapy and regenerative medicine to create forums for discussion of shared concerns for commercialization of cell therapies and of development of consensus standards, recognizing that true commercialization depends upon the translational scientific community, the regional regulatory and policy institutions, and the technology support and capital investment from industry. It exists to facilitate the international work of many, to spawn new initiatives, and to synergize with other stakeholders to create the best outcome for the many patients across the world depending on the answers and improved health that cellular therapeutics will provide them.

  20. Ankle injuries. Tips from sports medicine physicians.

    PubMed

    Swain, R A; Holt, W S

    1993-02-15

    In dealing with an ankle sprain, worrisome features are few but important to recognize. A "pop" heard or felt at the time of injury, a prolonged course, or a history of several previous injuries are all of concern. Medial tenderness on palpation, positive results on a squeeze test, or markedly positive results on stress testing are also indicators of severe injuries, which may require referral for treatment. Stress testing by an experienced clinician is appropriate for chronic or severe cases. Otherwise, treatment of the acute, uncomplicated ankle injury is straightforward, focusing on early mobilization, rehabilitation, and protection.

  1. Text categorization models for retrieval of high quality articles in internal medicine.

    PubMed

    Aphinyanaphongs, Y; Aliferis, C F

    2003-01-01

    The discipline of Evidence Based Medicine (EBM) studies formal and quasi-formal methods for identifying high quality medical information and abstracting it in useful forms so that patients receive the best customized care possible [1]. Current computer-based methods for finding high quality information in PubMed and similar bibliographic resources utilize search tools that employ preconstructed Boolean queries. These clinical queries are derived from a combined application of (a) user interviews, (b) ad-hoc manual document quality review, and (c) search over a constrained space of disjunctive Boolean queries. The present research explores the use of powerful text categorization (machine learning) methods to identify content-specific and high-quality PubMed articles. Our results show that models built with the proposed approach outperform the Boolean based PubMed clinical query filters in discriminatory power.

  2. 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.

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

    PubMed

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

    2014-05-01

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

  4. Translations of the "Evidence-Based Medicine" concept in different languages: is it time for international standardisation?

    PubMed

    Watine, Joseph

    2010-09-01

    Although the concept of Evidence-Based Medicine (EBM) is quite popular among English speaking physicians, it still needs to be adopted by an overwhelming majority of health care professionals in countries where English is not familiar. Thus, this concept can be translated in many different, and potentially misleading, ways. This is regrettable because the concept is, at least potentially, a very useful one. As an illustration, I have compiled some of the French translations of EBM that are currently in use in French speaking countries, and indicated briefly how most of these translations (except for one) are bound to be misleading. Many of these misleading translations currently in use strongly suggest that it is time for an international standardisation of the translations of EBM in different languages.

  5. Responses to the Medical Review of Systems: Borderline Versus Nonborderline Patients in an Internal Medicine Outpatient Clinic

    PubMed Central

    Lam, Charlene; Wiederman, Michael W.

    2011-01-01

    Objective: In both clinical and empirical reports, individuals with borderline personality disorder have been characterized by tendencies toward somatization. In this study, we examined the relationship between somatic symptoms, in the context of a traditional medical review of systems, and borderline personality disorder, using 2 self-report measures for this Axis II dysfunction. Method: In a cross-sectional consecutive sample of 381 internal medicine outpatients being seen predominantly by resident providers in a midsized, midwestern city in October 2010, we assessed 35 physical symptoms, which constitute 1 version of a medical review of systems, and borderline personality disorder using the Borderline Personality Disorder Scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Results: The total number of symptoms endorsed on the medical review of systems was positively correlated with scores on the PDQ-4 (r = 0.42, P < .001, n = 369) and scores on the SHI (r = 0.36, P < .001, n = 366). In addition, the percentages of participants with borderline personality disorder increased as the number of endorsed symptoms increased. No individual symptom, or symptom pattern, was particularly related to participants with borderline personality disorder features. Conclusions: In an internal medicine outpatient sample from a resident provider clinic, patients with borderline personality disorder characteristics endorsed significantly more physical symptoms on a medical review of systems than those without such characteristics, suggesting a somatic overlay in individuals with this Axis II disorder. No specific physical symptom pattern or cluster was evident among those with these Axis II features. PMID:21977380

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

    PubMed Central

    Urfer, Milena; Elzi, Luigia; Dell-Kuster, Salome; Bassetti, Stefano

    2016-01-01

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

  7. Present Concepts in Internal Medicine. Volume 13, Number 1. Endocrinology Research Symposium,

    DTIC Science & Technology

    1980-01-01

    hypercalcemia of sarcoidosis is associated with a hypersensitivity to vitamin D. The biochemical basis for this is not clear. Glucocorticoid therapy...mechanism is not defined. Although this antagonism is useful in the treatment of sarcoidosis , it is an undesirable side effect accompanying most other...abnormal sensitivity to vitamin D in a patient with sarcoidosis during episode of nephritis. Ann Intern Med 61:702-710, 1964. 60. Anderson J, Harper C

  8. Globalization of P4 medicine: predictive, personalized, preemptive, and participatory--summary of the proceedings of the Eighth International Symposium of the International Society for Strategic Studies in Radiology, August 27-29, 2009.

    PubMed

    Bradley, William G; Golding, Stephen G; Herold, Christian J; Hricak, Hedvig; Krestin, Gabriel P; Lewin, Jonathan S; Miller, Janet C; Ringertz, Hans G; Thrall, James H

    2011-02-01

    In August 2009, the International Society for Strategic Studies in Radiology held its eighth biennial meeting. The program focused on the globalization of predictive medicine--or P4 medicine--as it relates to the practice of radiology and radiology research. P4 medicine refers to predictive, personalized, preemptive, and participatory medicine and was the inspiration of Elias Zerhouni, MD, former director of the National Institutes of Health. This article is a summary of some of the key concepts presented at the meeting by an international group of radiologists, imaging scientists, and leaders of industry. In predictive medicine, imaging and imaging-related technologies will likely play an increasing role in the early detection of disease and, thus, the preemption of the development of advanced, hard-to-treat disease. Research into systems biology and molecular imaging promises to personalize medicine, facilitating the provision of the right care to the right patient at the right time. In participatory medicine, increasing interactions with referring physicians and patients will be helpful in raising awareness and recognition of the role of radiologists and will have a positive effect on professionalism. There is also a need to increase awareness of the vital role of radiologists as imaging and radiation safety experts who evaluate the necessity and appropriateness of examinations, monitor performance quality, and are available for postexamination consultations.

  9. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

    PubMed Central

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D; Serefoglu, Ege Can; Shindel, Alan W; Adaikan, P Ganesan; Becher, Edgardo; Dean, John; Giuliano, Francois; Hellstrom, Wayne JG; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

    2014-01-01

    Introduction In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method A comprehensive literature review was performed. Results This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG

  10. Hot Weather Tips

    MedlinePlus

    ... FCA - A A + A You are here Home HOT Weather Tips Printer-friendly version We all suffer in hot weather. However, for elderly and disabled people and ... stress and following these tips for dealing with hot weather. Wear cool clothing: See that the person ...

  11. Total Telephone Tips.

    ERIC Educational Resources Information Center

    Corder, Lloyd E.; And Others

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

  12. [Certification of internal medicine specialists in Chile by the autonomous corporation for certification of medical specialties].

    PubMed

    López M, José M

    2013-05-01

    Since 1984, 12.294 different medical specialists have been certified in Chile by the Autonomous Corporation for Certification of Medical Specialties (whose Spanish acronym is CONACEM). Infernal Medicine certification started in 1985, approving 1364 candidates thus far. Certification can be obtained in three ways. Sixty one percent of applicants were approved by a reputable university specialization program. Thirty five percent of applicants fulfilled the requirements of a five years practical training program and less than 5% were approved in a training program from another country which was validated in Chile. There are 13 university training programs for medical specialties, lasting three years each. These programs can receive a total of 110 students per year. Half of these programs are not carried out in Santiago. Applicants, who have not completed a certified university training program, must go through a five days practical examination. Since 2002 a written test was added, whose approval is a requisite to gain access to the practical examination. Sixty one percent of applicants have approved the theoretical test. Certifications last 10 years initially and seven years, there after. When certifications expire, a recertification mechanism is required, whose requirements are informed. According to the current legislation, certifications must be done by recognized accrediting agencies. CONACEM has been accepted by the authority and its definitive legal recognition should be a reality soon.

  13. Reshaping the carcinogenic risk assessment of medicines: international harmonisation for drug safety, industry/regulator efficiency or both?

    PubMed

    Abraham, John; Reed, Tim

    2003-07-01

    The most significant institutional entity involved in the harmonisation of drug testing standards worldwide is the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), which comprises the three pharmaceutical industry associations and regulatory agencies of the EU, US and Japan. It is often claimed that such harmonisation will both accelerate the development and approval of new drugs and preserve safety standards, if not strengthen safety regimes. Drawing on extensive documentary research and interviews, this paper systematically examines whether the efforts by the ICH to improve industrial and regulatory efficiency by harmonising drug testing requirements is likely to raise, maintain or compromise safety standards in carcinogenic risk assessment of pharmaceuticals. The evidence suggests that, in the field of carcinogenicity testing, the ICH management of international harmonisation of medicines regulation is not achieving simultaneous improvements in safety standards and acceleration of drug development. Rather, the latter is being achieved at the expense of the former. Indeed, the ICH may be converting permissive regulatory practices of the past into new scientific standards for the future. These findings are significant as many expert scientific advisers to drug regulatory agencies seem to have accepted uncritically the conclusions reached by the ICH, which may affect a potential patient population of half a billion and tens of thousands of clinical trials.

  14. [The relation of the faculty of veterinary medicine with the tropics: from developig assistance-projects to international cooporation 1987-2007].

    PubMed

    Paling, Robert W

    2008-01-01

    In the introduction three stages are distinguished in the relation between the Faculty of Veterinary Medicine and the tropics: (1) Development of a veterinary infrastructure (research and education) in the former colonies, Netherlands-Indies, Surinam and The Netherlands Antilles (1850 - ca. 1949); (2) Developing Aid Assistance (1965-2000) and (3) Cooperation on the basis of bilateral treaties that express the mutual interests of the two countries involved (1993-today). The Faculty in Utrecht entered into such alliances with sister faculties in Thailand, South-Africa and Malaysia. As a result of internal and external factors the study of tropical veterinary medicine was no longer core business of the Faculty of Veterinary Medicine in Utrecht. Tropical veterinary medicine was incorporated in the Department of Parasitology and Tropical Veterinary Medicine. The Office for International Cooperation of the Faculty of Veterinary Medicine, founded in 1987, partly took over the role of the former institute. Its activities are education and information, research support of the ongoing projects and networking. The accent moved from aid to cooperation for mutual interest.

  15. In Vitro Screening for the Tumoricidal Properties of International Medicinal Herbs

    PubMed Central

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

    2009-01-01

    There is growing use of anticancer complementary and alternative medicines (CAMs) worldwide. The purpose of the current study is to assess a sizeable variety of natural and plant sources of diverse origin, to ascertain prospective research directives for cancer treatment and potential new chemotherapy drug sources. In this study, 374 natural extracts (10 μg/mL-5 mg/mL) were evaluated for dose-dependent tumoricidal effects using immortal neuroblastoma of spontaneous malignant origin. The findings indicate no pattern of tumoricidal effects by diverse plants with similar families/genus under the classes Pinopsida, Equisetopsida, Lycopodiosida, Filicosida, Liliopsida Monocotyledons or Magnoliopsida Dicotyledons. The results indicate that many of the most commonly used CAMs exhibited relatively weak tumoricidal effects including cats claw, astragalus, ginseng, echinacea, mistletoe, milk thistle, slippery elm, cayenne, chamomile, don quai, meadowsweet, motherwort and shepherd's purse. The data demonstrate that the most potent plant extracts were randomly dispersed within the plantae kingdom (LC50 = 31-490 μg/mL) in order of the lowest LC50 Dioscorea villosa (Dioscoreaceae) > Sanguinaria canadensis (Papaveraceae) > Dipsacus asper (Dipsacaceae) > Populus balsamifera (Salicaceae) > Boswellia carteri (Burseraceae) > Cyamopsis psoralioides (Fabaceae) > Rhamnus cathartica (Rhamnaceae) > Larrea tridentate (Zygophyllaceae) > Dichroa febrifuga (Hydrangeaceae) > Batschia canescens (Boraginaceae) > Kochia scoparia (Chenopodiaceae) > Solanum xanthocarpum (Solanaceae) > Opoponax chironium (Umbelliferae) > Caulophyllum thalictroides (Berberidaceae) > Dryopteris crassirhizoma (Dryopteridaceae) > Garcinia cambogia (Clusiaceae) > Vitex agnus-castus (Verbenaceae) > Calamus draco (Arecaceae). These findings show tumoricidal effect by extracts of wild yam root, bloodroot, teasel root, bakuchi seed, dichroa root, kanta kari, garcinia fruit, mace, dragons blood and the biblically referenced

  16. In vitro screening for the tumoricidal properties of international medicinal herbs.

    PubMed

    Mazzio, Elizabeth A; Soliman, Karam F A

    2009-03-01

    There is growing use of anticancer complementary and alternative medicines (CAMs) worldwide. The purpose of the current study is to assess a sizeable variety of natural and plant sources of diverse origin, to ascertain prospective research directives for cancer treatment and potential new chemotherapy drug sources. In this study, 374 natural extracts (10 microg/mL-5 mg/mL) were evaluated for dose-dependent tumoricidal effects using immortal neuroblastoma of spontaneous malignant origin. The findings indicate no pattern of tumoricidal effects by diverse plants with similar families/genus under the classes Pinopsida, Equisetopsida, Lycopodiosida, Filicosida, Liliopsida Monocotyledons or Magnoliopsida Dicotyledons. The results indicate that many of the most commonly used CAMs exhibited relatively weak tumoricidal effects including cats claw, astragalus, ginseng, echinacea, mistletoe, milk thistle, slippery elm, cayenne, chamomile, don quai, meadowsweet, motherwort and shepherd's purse. The data demonstrate that the most potent plant extracts were randomly dispersed within the plantae kingdom (LC(50) = 31-490 microg/mL) in order of the lowest LC(50) Dioscorea villosa (Dioscoreaceae) > Sanguinaria canadensis (Papaveraceae) > Dipsacus asper (Dipsacaceae) > Populus balsamifera (Salicaceae) > Boswellia carteri (Burseraceae) > Cyamopsis psoralioides (Fabaceae) > Rhamnus cathartica (Rhamnaceae) > Larrea tridentate (Zygophyllaceae) > Dichroa febrifuga (Hydrangeaceae) > Batschia canescens (Boraginaceae) > Kochia scoparia (Chenopodiaceae) > Solanum xanthocarpum (Solanaceae) > Opoponax chironium (Umbelliferae) > Caulophyllum thalictroides (Berberidaceae) > Dryopteris crassirhizoma (Dryopteridaceae) > Garcinia cambogia (Clusiaceae) > Vitex agnus-castus (Verbenaceae) > Calamus draco (Arecaceae). These findings show tumoricidal effect by extracts of wild yam root, bloodroot, teasel root, bakuchi seed, dichroa root, kanta kari, garcinia fruit, mace, dragons blood and the biblically

  17. Recruiting Ethnically Diverse General Internal Medicine Patients for a Telephone Survey on Physician-Patient Communication

    PubMed Central

    Nápoles-Springer, Anna M; Santoyo, Jasmine; Stewart, Anita L

    2005-01-01

    BACKGROUND Limited evidence exists on the effectiveness of recruitment methods among diverse populations. OBKECTIVE Describe response rates by recruitment stage, ethnic-language group, and type of initial contact letter (for African-American and Latino patients). DESIGN Tracking of response status by recruitment stage and ethnic-language group and a randomized trial of ethnically tailored initial letters nested within a cross-sectional telephone survey on physician-patient communication. PARTICIPANTS Adult general medicine patients with ≥1 visit during the preceding year, stratified by 4 categories: African-American (N= 1,400), English-speaking Latino (N= 894), Spanish-speaking Latino (N= 965), and non-Latino white (N= 1,400). MEASUREMENTS AND RESULTS Ethnically tailored initial letters referred to shortages of African-American (or Latino) physicians and the need to learn about the experiences of African-American (or Latino) patients communicating with physicians. Of 2,482 patients contacted, eligible, and able to participate (identified eligibles), 69.9% completed the survey. Thirty-nine percent of the sampling frame was unable to be contacted, with losses higher among non-Latino whites (46.5%) and African Americans (44.2%) than among English-speaking (32.3%) and Spanish-speaking Latinos (25.1%). For identified eligibles, response rates were highest among Spanish-speaking Latinos (75.2%), lowest for non-Latino whites (66.4%), and intermediate for African Americans (69.7%) and English-speaking Latinos (68.1%). There were no differences in overall response rates between patients receiving ethnically tailored letters (72.2%) and those receiving general letters (70.0%). CONCLUSIONS Household contact and individual response rates differed by ethnic-language group, highlighting the importance of tracking losses by stage and subpopulation. Careful attention to recruitment yielded acceptable response rates among all groups. PMID:15963168

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

    PubMed

    Polenaković, M

    2013-01-01

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

  19. Performances of U.S. Osteopathic and Canadian Medical School Graduates on the American Board of Internal Medicine Certifying Examinations, 1984-1988.

    ERIC Educational Resources Information Center

    Shea, Judy A.; And Others

    1990-01-01

    A study compared the 1984-88 test performances of United States osteopathic medical school graduates and Canadian medical school graduates with those of U.S. and foreign medical school graduates during the same period. Findings, limitations, and implications for recruitment and training of internal medicine specialists are discussed. (Author/MSE)

  20. Applying the milestones in an internal medicine residency program curriculum: a foundation for outcomes-based learner assessment under the next accreditation system.

    PubMed

    Lowry, Becky N; Vansaghi, Lisa M; Rigler, Sally K; Stites, Steven W

    2013-11-01

    In 2010, University of Kansas Medical Center internal medicine residency program leaders concluded that their competency-based curriculum and evaluation system was not sufficient to promote accurate assessment of learners' performance and needed revision to meet the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS). Evaluations of learners seldom referenced existing curricular goals and objectives and reflected an "everyone is exceptional, no one is satisfactory" view.The authors identified the American Board of Internal Medicine and ACGME's Developmental Milestones for Internal Medicine Residency Training as a published standard for resident development. They incorporated the milestones into templates, a format that could be modified for individual rotations. A milestones-based curriculum for each postgraduate year of training and every rotation was then created, with input from educational leaders within each division in the Department of Internal Medicine and with the support of the graduate medical education office.In this article, the authors share their implementation process, which took approximately one year, and discuss their current work to create a documentation system for direct observation of entrustable professional activities, with the aim of providing guidance to other programs challenged with developing an outcomes-based curriculum and assessment system within the time frame of the NAS.

  1. International Evidence-Based Medicine Survey of the Veterinary Profession: Information Sources Used by Veterinarians.

    PubMed

    Huntley, Selene J; Dean, Rachel S; Massey, Andrew; Brennan, Marnie L

    2016-01-01

    Veterinarians are encouraged to use evidence to inform their practice, but it is unknown what resources (e.g. journals, electronic sources) are accessed by them globally. Understanding the key places veterinarians seek information can inform where new clinically relevant evidence should most effectively be placed. An international survey was conducted to gain understanding of how veterinary information is accessed by veterinarians worldwide. There were 2137 useable responses to the questionnaire from veterinarians in 78 countries. The majority of respondents (n = 1835/2137, 85.9%) undertook clinical work and worked in a high income country (n = 1576/1762, 89.4%). Respondents heard about the survey via national veterinary organisations or regulatory bodies (31.5%), online veterinary forums and websites (22.7%), regional, discipline-based or international veterinary organisations (22.7%) or by direct invitation from the researchers or via friends, colleagues or social media (7.6%). Clinicians and non-clinicians reportedly used journals most commonly (65.8%, n = 1207/1835; 75.6%, n = 216/286) followed by electronic resources (58.7%, n = 1077/1835; 55.9%, n = 160/286), respectively. Respondents listed a total of 518 journals and 567 electronic sources that they read. Differences in veterinarian preference for resources in developed, and developing countries, were found. The nominated journals most read were the Journal of the American Veterinary Medical Association (12.7% of nominations) for clinicians and the Veterinary Record (5.7%) for non-clinicians. The most accessed electronic resource reported was the Veterinary Information Network (25.6%) for clinicians and PubMed (7.4%) for non-clinicians. In conclusion, a wide array of journals and electronic resources appear to be accessed by veterinarians worldwide. Veterinary organisations appear to play an important role in global communication and outreach to veterinarians and consideration should be given to how these

  2. International Evidence-Based Medicine Survey of the Veterinary Profession: Information Sources Used by Veterinarians

    PubMed Central

    Huntley, Selene J.; Dean, Rachel S.; Massey, Andrew

    2016-01-01

    Veterinarians are encouraged to use evidence to inform their practice, but it is unknown what resources (e.g. journals, electronic sources) are accessed by them globally. Understanding the key places veterinarians seek information can inform where new clinically relevant evidence should most effectively be placed. An international survey was conducted to gain understanding of how veterinary information is accessed by veterinarians worldwide. There were 2137 useable responses to the questionnaire from veterinarians in 78 countries. The majority of respondents (n = 1835/2137, 85.9%) undertook clinical work and worked in a high income country (n = 1576/1762, 89.4%). Respondents heard about the survey via national veterinary organisations or regulatory bodies (31.5%), online veterinary forums and websites (22.7%), regional, discipline-based or international veterinary organisations (22.7%) or by direct invitation from the researchers or via friends, colleagues or social media (7.6%). Clinicians and non-clinicians reportedly used journals most commonly (65.8%, n = 1207/1835; 75.6%, n = 216/286) followed by electronic resources (58.7%, n = 1077/1835; 55.9%, n = 160/286), respectively. Respondents listed a total of 518 journals and 567 electronic sources that they read. Differences in veterinarian preference for resources in developed, and developing countries, were found. The nominated journals most read were the Journal of the American Veterinary Medical Association (12.7% of nominations) for clinicians and the Veterinary Record (5.7%) for non-clinicians. The most accessed electronic resource reported was the Veterinary Information Network (25.6%) for clinicians and PubMed (7.4%) for non-clinicians. In conclusion, a wide array of journals and electronic resources appear to be accessed by veterinarians worldwide. Veterinary organisations appear to play an important role in global communication and outreach to veterinarians and consideration should be given to how these

  3. Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

    PubMed Central

    2011-01-01

    Background Infectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward. Methods Overall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality. Results Of these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality. Conclusion Bacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal

  4. Bed Bug Tips

    EPA Pesticide Factsheets

    How to deal with bed bugs in one printable page. Ten tips include ensuring correct insect identification, reducing clutter, understand integrated pest management, using mattress and box spring encasements, and heat treatment.

  5. Tips for labor coaches

    MedlinePlus

    ... some tips for getting prepared. Before the big day Arrives Labor coaches should go to childbirth classes ... get through her labor and delivery. When the day Arrives You might be at the hospital for ...

  6. Insider conference tips

    NASA Astrophysics Data System (ADS)

    Tennant, Jill

    2012-01-01

    Attending an educator conference and its associated exhibit hall can be a rewarding experience for your brain. But if you keep in mind these insider's tips, your feet, arms, stomach, and wallet will also thank you.

  7. Tips from the Classroom.

    ERIC Educational Resources Information Center

    Epstein, Jim; Ashcraft, Nikki; Clarke, Paul M.; Wolf, Grant S.

    1999-01-01

    Four tips for use in the English-as-a-Second-Language classroom are highlighted: Mr. Bean in the Classroom; Defining Your Future; Coin Questions; Our Futures: Simple, Progressive, and Perfect. (Author/VWL)

  8. Eye Drop Tips

    MedlinePlus

    ... Involved News About Us Donate In This Section Eye Drop Tips en Español email Send this article ... the reach of children. Steps For Putting In Eye Drops: Start by tilting your head backward while ...

  9. Effect of a workshop in rational pharmacotherapy for interns during family medicine clerkship in Samsun- Turkey

    PubMed Central

    Fevzi Dikici, Mustafa; Yaris, Fusun; Artiran Igde, Fusun; Yarar, Fulya; Altuntas, Oznur; Alper Gurz, Aysenur

    2014-01-01

    Objective: We aimed to investigate the effect of rational pharmacotherapy workshop for interns on the rationality, cost and number of drugs prescribed. Methods: The participants were asked to prescribe a medication for acute noninflammatory osteoarthritis (ANOA), acute bacterial rhinosinusitis (ARS), acute otitis media (AOM), acute uncomplicated cystitis (AC), and acute bacterial tonsillopharyngitis (ABT) before and after workshop. Total 3000 prescriptions were scored regarding rationality of the drug choice (0-10), format (0-5), instructions (0-4), legibility (0-1) and total (0-20 points). The mean number of drug(s) and total costs per prescription were calculated. Paired samples t-test was used to compare the pre- and post score means. Results: Total pre- and post-prescribing scores (0-20) were significantly different (p=0.00 for each): ANOA (13.59±0.27, 18.33±0.18), ARS (13.26 ±0.18, 15.15 ±0.17), AOM (12.58 ± 0.26, 14.66±0.27), AC (13.53±0.17, 15.76±0.20), ABT (13.54±0.24, 15.49 ±0.28). Mean number of drugs per prescription for the indications in the pre-test and post-test were: ANOA (1.24 ±0.29, 1.02±0.01, p=0.00), ARS (2.08±0.04, 2.00±0.04, p=0.16), AOM (1.66±0.04 and 1.69±0.03, p=0.54), AC (1.55±0.04, 1.39±0.03, p=0.00) and ABT (2.10±0.05, 1.81±0.05, p=0.00). Mean costs per prescription in Turkish Liras: ANOA (6.31±0.29, 4.60±0.05, p=0.00), ARS (13.80±0.38, 4.63±0.04, p=0.00), AOM (10.18±0.28, 4.41±0.07, p=0.00), AC (11.33±0.21, 10.68±0.18, p=0.01) and ABT (12.03±0.34 and 10.41±0.35, p=0.00). Conclusion: Training produced a significant improvement in rational prescribing. PMID:24772132

  10. Twenty-five years of the international Bled course for teachers of family medicine in Europe: Glancing back and looking forward.

    PubMed

    Klemenc-Ketis, Zalika; Svab, Igor; Petek-Ster, Marija; Bulc, Mateja; Buchanan, Josephine; Finnegan, Henry; Correia de Sousa, Jaime; Yaphe, John

    2016-12-01

    The international Bled course for teacher training has played a central role in faculty development in family medicine for the past 25 years. The course was originally designed to promote faculty development for family medicine teachers in the new academic discipline of family medicine in Slovenia in 1990 and to introduce new topics into the family medicine curriculum. In this background paper, we perform a SCOT analysis (strengths, challenges, opportunities, and threats) of the current course, evaluating participant feedback and reviewing past topics and their impact on local and international teaching programmes. We also review the place of the course in the context of other teacher-training programmes in family medicine in Europe. We found that the structure and learning aims of the Bled course have remained stable over 25 years. It provides a safe, well-structured learning environment for the participants even though the course topic is different every year. The course has had a significant impact on curriculum development and teacher training in Slovenia as well as in many other countries in Europe and beyond. Because of the positive impact of the course and the high degree of satisfaction of the participants and course directors, it seems worthwhile to continue this endeavour. New directions for the course will depend on the learning needs of the participants and the evolving medical curricula in the countries they represent.

  11. Population declines lead to replicate patterns of internal range structure at the tips of the distribution of the California red-legged frog (Rana draytonii)

    USGS Publications Warehouse

    Richmond, Jonathan Q.; Backlin, Adam R.; Tatarian, Patricia J.; Solvesky, Ben G.; Fisher, Robert N.

    2014-01-01

    Demographic declines and increased isolation of peripheral populations of the threatened California red-legged frog (Rana draytonii) have led to the formation of internal range boundaries at opposite ends of the species’ distribution. While the population genetics of the southern internal boundary has been studied in some detail, similar information is lacking for the northern part of the range. In this study, we used microsatellite and mtDNA data to examine the genetic structuring and diversity of some of the last remaining R. draytonii populations in the northern Sierra Nevada, which collectively form the northern external range boundary. We compared these data to coastal populations in the San Francisco Bay Area, where the species is notably more abundant and still exists throughout much of its historic range. We show that ‘external’ Sierra Nevada populations have lower genetic diversity and are more differentiated from one another than their ‘internal’ Bay Area counterparts. This same pattern was mirrored across the distribution in California, where Sierra Nevada and Bay Area populations had lower allelic variability compared to those previously studied in coastal southern California. This genetic signature of northward range expansion was mirrored in the phylogeography of mtDNA haplotypes; northern Sierra Nevada haplotypes showed greater similarity to haplotypes from the south Coast Ranges than to the more geographically proximate populations in the Bay Area. These data cast new light on the geographic origins of Sierra Nevada R. draytonii populations and highlight the importance of distinguishing the genetic effects of contemporary demographic declines from underlying signatures of historic range expansion when addressing the most immediate threats to population persistence. Because there is no evidence of contemporary gene flow between any of the Sierra Nevada R. draytonii populations, we suggest that management activities should focus on

  12. Dynamics of Isolated Tip Vortex Cavitation

    NASA Astrophysics Data System (ADS)

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

    2014-11-01

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

  13. Discriminating Between Legitimate and Predatory Open Access Journals: Report from the International Federation for Emergency Medicine Research Committee

    PubMed Central

    Hansoti, Bhakti; Langdorf, Mark I.; Murphy, Linda S.

    2016-01-01

    Introduction Open access (OA) medical publishing is growing rapidly. While subscription-based publishing does not charge the author, OA does. This opens the door for “predatory” publishers who take authors’ money but provide no substantial peer review or indexing to truly disseminate research findings. Discriminating between predatory and legitimate OA publishers is difficult. Methods We searched a number of library indexing databases that were available to us through the University of California, Irvine Libraries for journals in the field of emergency medicine (EM). Using criteria from Jeffrey Beall, University of Colorado librarian and an expert on predatory publishing, and the Research Committee of the International Federation for EM, we categorized EM journals as legitimate or likely predatory. Results We identified 150 journal titles related to EM from all sources, 55 of which met our criteria for OA (37%, the rest subscription based). Of these 55, 25 (45%) were likely to be predatory. We present lists of clearly legitimate OA journals, and, conversely, likely predatory ones. We present criteria a researcher can use to discriminate between the two. We present the indexing profiles of legitimate EM OA journals, to inform the researcher about degree of dissemination of research findings by journal. Conclusion OA journals are proliferating rapidly. About half in EM are legitimate. The rest take substantial money from unsuspecting, usually junior, researchers and provide no value for true dissemination of findings. Researchers should be educated and aware of scam journals. PMID:27625710

  14. Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine

    PubMed Central

    Hominick, Kathryn; McLeod, Victoria; Rockwood, Kenneth

    2016-01-01

    Background Frail older adults present to the Emergency Department (ED) with complex medical, functional, and social needs. When these needs can be addressed promptly, discharge is possible, and when they cannot, hospital admission is required. We evaluated the care needs of frail older adults in the ED who were consulted to internal medicine and seen by a geriatrician to determine, under current practices, which factors were associated with hospitalization and which allowed discharge. Methods We preformed a chart-based, exploratory study. Data were abstracted from consultation records and ED charts. All cases had a standard Comprehensive Geriatric Assessment (CGA which records a Clinical Frailty Scale (CFA) and allows calculation of a Frailty Index (FI). Results Of 100 consecutive patients, 2 died in the ED, 75 were admitted, and 23 were discharged, including one urgent placement. Compared with discharged patients (0.39 ± SD 0.16), those admitted had a higher mean FI-CGA (0.48 ± 0.13; p < .01). Greater mobility dependence (2% in discharged vs. 32% in admitted; p < .05) was notable. Conclusions Discharge decisions require assessment of medical, functional, and social problems. Ill, frail patients often can be discharged home when social and nursing support can be provided. The degree of frailty, impaired mobility, and likely delirium must be taken into account when planning for their care. PMID:27076860

  15. Physiotherapists' Perceptions of and Experiences with the Discharge Planning Process in Acute-Care General Internal Medicine Units in Ontario

    PubMed Central

    Uyeno, Jennifer; Heck, Carol S.

    2014-01-01

    ABSTRACT Purpose: To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. Methods: A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Results: Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Conclusions: Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning. PMID:25125778

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

    PubMed

    Foo, Jong Yong Abdiel

    2009-05-01

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

  17. The International Space Station: A Low-Earth Orbit (LEO) Test Bed for Advancements in Space and Environmental Medicine

    NASA Technical Reports Server (NTRS)

    Ruttley, Tara M.; Robinson, Julie A.

    2010-01-01

    Ground-based space analog projects such as the NASA Extreme Environment Mission Operations (NEEMO) can be valuable test beds for evaluation of experimental design and hardware feasibility before actually being implemented on orbit. The International Space Station (ISS) is an closed-system laboratory that orbits 240 miles above the Earth, and is the ultimate extreme environment. Its inhabitants spend hours performing research that spans from fluid physics to human physiology, yielding results that have implications for Earth-based improvements in medicine and health, as well as those that will help facilitate the mitigation of risks to the human body associated with exploration-class space missions. ISS health and medical experiments focus on pre-flight and in-flight prevention, in-flight treatment, and postflight recovery of health problems associated with space flight. Such experiments include those on enhanced medical monitoring, bone and muscle loss prevention, cardiovascular health, immunology, radiation and behavior. Lessons learned from ISS experiments may not only be applicable to other extreme environments that face similar capability limitations, but also serve to enhance standards of care for everyday use on Earth.

  18. Connecting resident education to patient outcomes: the evolution of a quality improvement curriculum in an internal medicine residency.

    PubMed

    Zafar, Muhammad A; Diers, Tiffiny; Schauer, Daniel P; Warm, Eric J

    2014-10-01

    As part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, residency programs must connect resident-physician education to improved patient care outcomes. Residency training programs, however, face multiple obstacles in doing so. Results from residency quality improvement (QI) curricula tend to show improvement in simple process-based measures but not in more complex outcomes of care such as diabetes or blood pressure control. In this article, the authors describe the evolution of their QI educational program for internal medicine residents at the University of Cincinnati Medical Center within the structure of a novel training model called the Ambulatory Long Block. They discuss a resident-run project that led to reduced rates of patients with uncontrolled diabetes as an example of improvement in outcome measures. Despite favorable results from that particular resident group, the successful intervention did not spread practice-wide. Using this example, they detail the phases of evolution and lessons learned from their curriculum from 2006 to 2014 within a framework of previously published general principles for successful QI education, including those of exemplary care and learning sites. Successful programs require leadership, faculty expertise and mentorship, data management, learner buy-in, and patient engagement. Their experience will hopefully be of help to others as they attempt to simultaneously improve care and education. Further research and innovation are needed in this area, including optimizing strategies for strengthening resident-driven projects through partnership with nursing, allied health, and longitudinally engaged faculty members.

  19. Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population

    PubMed Central

    Dobing, Selina; Frolova, Natalia; McAlister, Finlay

    2016-01-01

    Background Sleep quality in hospitalized Canadian General Internal Medicine patients is not well characterized. Our goals were to characterize hospital sleep quality in this population and identify potentially modifiable barriers to good sleep. Methods GIM inpatients at a quaternary centre in Edmonton, Canada completed a survey, including the Verran-Snyder Halpern (VSH) questionnaire, to characterize the previous night’s sleep within 48 hours prior to discharge. A chart review was also completed to assess comorbidities, discharge diagnoses, and pharmaceutical sleep aid use. Results Patients reported significantly worse nighttime sleep duration in hospital compared with home (mean 5.5 versus 7.0 hours per night, p < 0.0001). Sleep quality was poor, as measured by the VSH disturbance (mean 371), effectiveness (190), and supplementation (115) subscales. Variables independently associated with poorer sleep duration in multivariable regression include prior diagnosis of sleep disorder and multi-patient occupancy rooms. Age, sex, admitting diagnosis, length of stay, frequency of vital checks, and use of sleep pharmaceuticals during the index hospitalization were not associated with sleep duration. The most frequently reported reasons for poor sleep included noise (59%), nursing interruptions (30%), uncomfortable beds (18%), bright lights (16%), unfamiliar surroundings (14%), and pain (9%). Conclusions Sleep quality for GIM inpatients is significantly worse in hospital than at home. There is a need to test non-pharmacologic interventions to address the most frequently identified factors causing poor sleep hygiene for GIM inpatients. PMID:27280292

  20. SU-E-T-507: Internal Dosimetry in Nuclear Medicine Using GATE and XCAT Phantom: A Simulation Study

    SciTech Connect

    Fallahpoor, M; Abbasi, M; Sen, A; Parach, A; Kalantari, F

    2015-06-15

    Purpose Monte Carlo simulations are routinely used for internal dosimetry studies. These studies are conducted with humanoid phantoms such as the XCAT phantom. In this abstract we present the absorbed doses for various pairs of source and target organs using three common radiotracers in nuclear medicine. Methods The GATE software package is used for the Monte Carlo simulations. A typical female XCAT phantom is used as the input. Three radiotracers 153Sm, 131I and 99mTc are studied. The Specific Absorbed Fraction (SAF) for gamma rays (99mTc, 153Sm and 131I) and Specific Fraction (SF) for beta particles (153Sm and 131I) are calculated for all 100 pairs of source target organs including brain, liver, lung, pancreas, kidney, adrenal, spleen, rib bone, bladder and ovaries. Results The source organs themselves gain the highest absorbed dose as compared to other organs. The dose is found to be inversely proportional to distance from the source organ. In SAF results of 153Sm, when the source organ is lung, the rib bone, gain 0.0730 (Kg-1) that is more than lung itself. Conclusion The absorbed dose for various organs was studied in terms of SAF and SF. Such studies hold importance for future therapeutic procedures and optimization of induced radiotracer.

  1. Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group.

    PubMed

    Fregni, Felipe; Imamura, Marta; Chien, Hsin Fen; Lew, Henry L; Boggio, Paulo; Kaptchuk, Ted J; Riberto, Marcelo; Hsing, Wu Tu; Battistella, Linamara Rizzo; Furlan, Andrea

    2010-02-01

    Compared with other specialties, the field of physical and rehabilitation medicine has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional physical and rehabilitation medicine treatments. The best way to change this disadvantage is through a well conducted clinical research, such as standard placebo- or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in physical and rehabilitation medicine that ultimately translates to better clinical care. To address the challenges for the use of placebo in physical and rehabilitation medicine and randomized clinical trials and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in physical and rehabilitation medicine, (2) challenges for the use of placebo in physical and rehabilitation medicine, (3) bioethics, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.

  2. The development of pain medicine in Italy and the rest of Europe 40 years after the first International Association for the Study of Pain Congress.

    PubMed

    Varrassi, Giustino; Paladini, Antonella

    2017-01-01

    Professor Giustino Varrassi and Antonella Paladini speak to Jade Parker, Commissioning Editor: Professor Giustino Varrassi is Full Professor of Anesthesiology and Pain Medicine in the LUdeS University, Valletta, Malta. He graduated at the Medical School of the University 'La Sapienza' (Rome, Italy) in 1973, and became board certified in Anesthesiology and Intensive Care in 1976 and in Pneumology in 1978, both in the same Medical School. He is currently President of the European League Against Pain and of the Paolo Procacci Foundation, and is a founding member of both of these. He is also a member of the World Institute of Pain, and a member of the Board of the Associazione Italiana per lo Studio del Dolore. He has been an invited speaker at more than 500 congresses (national and international), mainly in obstetric anesthesia and pain medicine. He is also the author of approximately 500 papers, published in international and national scientific journals, and 46 book chapters, mainly on obstetric anesthesia and pain medicine. He is the editor of 31 books and congress proceedings, including a textbook on obstetric anesthesia. He has also been the organizer of around 40 congresses, including European and World congresses on Pain Medicine. Professor Antonella Paladini is an Assistant Professor of Anesthesiology and Pain Medicine at the L'Aquila University, Italy. She has recently been nominated as Associate Professor of Anesthesiology in the LUdeS University, in Valletta, Malta. She graduated in medicine at L'Aquila University in 1989, and has got her Board Certification with laude in Anesthesia in 1992 and served as anesthetist in few teaching hospitals, mainly in cardiac surgery departments. Since 2000, she is in charge of the L'Aquila University, and has addressed her interests toward pain medicine. In 2004, she got the Board Certificate in Pain Medicine, with laude, in the University of Verona. She has a huge scientific production, with over 60 papers published in

  3. Roles of the International Council for Laboratory Animal Science (ICLAS) and International Association of Colleges of Laboratory Animal Medicine (IACLAM) in the Global Organization and Support of 3Rs Advances in Laboratory Animal Science.

    PubMed

    Turner, Patricia V; Pekow, Cynthia; Clark, Judy MacArthur; Vergara, Patri; Bayne, Kathryn; White, William J; Kurosawa, Tsutomu Miki; Seok, Seung-Hyeok; Baneux, Philippe

    2015-03-01

    Practical implementation of the 3Rs at national and regional levels around the world requires long-term commitment, backing, and coordinated efforts by international associations for laboratory animal medicine and science, including the International Association of Colleges of Laboratory Animal Medicine (IACLAM) and the International Council for Laboratory Animal Science (ICLAS). Together these organizations support the efforts of regional organization and communities of laboratory animal science professionals as well as the development of local associations and professional colleges that promote the training and continuing education of research facility personnel and veterinary specialists. The recent formation of a World Organization for Animal Health (OIE) Collaborating Center for Laboratory Animal Science and Welfare emphasizes the need for research into initiatives promoting laboratory animal welfare, particularly in emerging economies and regions with nascent associations of laboratory animal science.

  4. Translation and adaptation of an international questionnaire to measure usage of complementary and alternative medicine (I-CAM-G)

    PubMed Central

    2012-01-01

    Background The growing body of data on prevalence of complementary and alternative medicine (CAM) usage means there is a need to standardize measurement on an international level. An international team has published a questionnaire (I-CAM-Q), but no validation has yet been provided. The aim of the present study was to provide a German measurement instrument for CAM usage (I-CAM-G) which closely resembles the original English version, and to assess it’s performance in two potential samples for measuring CAM usage. Methods The English I-CAM-Q questionnaire was translated into German, and adapted slightly. The resulting I-CAM-G questionnaire was then pre-tested on 16 healthy volunteers, and 12 cognitive interviews were carried out. The questionnaire was employed in a sample of breast cancer patients (N = 92, paper and pencil), and a sample from the general population (N = 210, internet survey). Descriptive analyses of items and missing data, as well as results from the cognitive interviews, are presented in this paper. Results The translated questionnaire had to be adapted to be consistent with the German health care system. All items were comprehensible, whereby some items were unambiguous (e.g. CAM use yes/no, helpfulness), while others gave rise to ambiguous answers (e.g. reasons for CAM use), or high rates of missing data (e.g. number of times the CAM modality had been used during the last 3 months). 78% of the breast cancer patients and up to 85% of a sample of the general population had used some form of CAM. Conclusions Following methodologically sound and comprehensive translation, adaptation and assessment processes using recognized translation procedures, cognitive interviews, and studying the performance of the questionnaire in two samples, we arrived at a German questionnaire for measuring CAM use which is comparable with the international (English) version. The questionnaire appropriately measures CAM use, with some items being more appropriate

  5. Intraoperative fracture of phacoemulsification tip.

    PubMed

    Angmo, Dewang; Khokhar, Sudarshan K; Ganguly, Anasua

    2014-01-01

    Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery.

  6. [Recent progress of international harmonization of crude drugs and medicinal plants--activity of FHH (The Western Pacific Regional Forum for the Harmonization of Herbal Medicines)].

    PubMed

    Kawahara, Nobuo

    2011-03-01

    The Western Pacific Regional Forum for the Harmonization of Herbal Medicines (FHH) was established in 2002. The general proposed objective of the FHH is to promote public health by recognizing and developing standards and technical guidelines that aim to improve the quality, safety and efficacy of herbal medicines. At a sub-committee meeting of FHH nomenclature and standardization held in Tokyo, all the participants recognized the importance of comparing the descriptions of herbal medicines contained in member countries' pharmacopoeias or monograph standards as the first step in the harmonization of nomenclature and standardization. It was agreed to set up five expert working groups (EWG) to carry out the following specific tasks: 1) Nomenclature, 2) Testing Methods in Monographs, 3) List of Chemical Reference Standards (CRS) and Reference of Medicinal Plant Materials (RMPM), 4) List of Analytically Validated Methods, and 5) Information on General Tests. In this review, we report four topics of FHH activities from 2002-2009 as follows: 1) Comparative study on testing methods and specification values for crude drugs used in monographs among four Western Pacific regional countries (Japan, China, Korea and Vietnam), 2) Comparative study on TLC conditions for identification, chemical assay conditions for component quantification used in monographs among the four countries, 3) Comparative study on general testing methods for crude drugs among the four countries, 4) Comparative study on TLC identification for crude drugs used in monographs among the four countries considering harmonization and clean analysis.

  7. Evolving Indications for Tips.

    PubMed

    Smith, Mitchell; Durham, Janette

    2016-03-01

    Transjugular intrahepatic portosystemic shunt creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements including covered stents have led to improved TIPS outcomes that have encouraged an expanded application. Evidence for other less frequent indications continues to accumulate, including the indications of primary prophylaxis in patients with high-risk acute variceal bleeding, gastric and ectopic variceal bleeding, primary treatment of medically refractory ascites, recurrent refractory ascites following liver transplantation, hepatic hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome, and portal vein thrombosis. Treatment of patients with high-risk acute variceal bleeding with early TIPS and using transjugular intrahepatic portosystemic shunts as a primary therapy rather than large volume paracentesis for refractory ascites would likely be the 2 circumstances that permit expansion in the frequency of TIPS procedures. The remaining populations discussed above are relatively rare.

  8. Magnet pole tips

    DOEpatents

    Thorn, Craig E.; Chasman, Chellis; Baltz, Anthony J.

    1984-04-24

    An improved magnet which more easily provides a radially increasing magnetic field, as well as reduced fringe field and requires less power for a given field intensity. The subject invention comprises a pair of spaced, opposed magnetic poles which further comprise a pair of pole roots, each having a pole tip attached to its center. The pole tips define the gap between the magnetic poles and at least a portion of each pole tip is separated from its associated pole root. The separation begins at a predetermined distance from the center of the pole root and increases with increasing radial distance while being constant with azimuth within that portion. Magnets in accordance with the subject invention have been found to be particularly advantageous for use in large isochronous cyclotrons.

  9. Magnet pole tips

    DOEpatents

    Thorn, C.E.; Chasman, C.; Baltz, A.J.

    1981-11-19

    An improved magnet more easily provides a radially increasing magnetic field, as well as reduced fringe field and requires less power for a given field intensity. The subject invention comprises a pair of spaced, opposed magnetic poles which further comprise a pair of pole roots, each having a pole tip attached to its center. The pole tips define the gap between the magnetic poles and at least a portion of each pole tip is separated from its associated pole root. The separation begins at a predetermined distance from the center of the pole root and increases with increasing radial distance while being constant with azimuth within that portion. Magnets in accordance with the subject invention have been found to be particularly advantageous for use in large isochronous cyclotrons.

  10. Imaging in internal medicine

    SciTech Connect

    Siegle, R.L.

    1987-01-01

    This book contains nine chapters. The titles are: Gastrointestinal Disease, Cardiovascular Disease, Respiratory Tract Disease, Genitourinary Disease, Oncology, Bone and Joint Disease, Endocrine and Reproductive Disease, Neurologic Disorders, and Medical Complications of Pregnancy.

  11. International emergency medicine fellowships.

    PubMed

    Anderson, Philip D; Aschkenasy, Miriam; Lis, Julian

    2005-02-01

    The active interchange of intellectual ideas in the quest to improve healthcare globally will likely be best served by active interchange among physicians around the world. Subspecialty fellowship training programs for United States and foreign graduates will provide a focused path to development of a global network of physicians dedicated to the delivery of high-quality emergency health services.

  12. Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project

    PubMed Central

    Padrnos, Leslie J; Barr, Patrick J; Klassen, Christine L; Fields, Heather E; Azadeh, Natalya; Mendoza, Neil; Saadiq, Rayya A; Pauwels, Emanuel M; King, Christopher S; Chung, Andrew A; Sakata, Kenneth K; Blair, Janis E

    2016-01-01

    The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider. We sought to improve adherence to the CDC guidelines on the Internal Medicine Resident Hospital Service. We surveyed residents about the CDC guidelines, sent email reminders, provided education, and engaged them in friendly competition. Credit for guideline adherence was awarded if an offer of HIV screening was documented at admission, if a screening test was performed, or if a notation in the resident sign out sheet indicated why screening was not performed. We examined HIV screening of a postintervention group of patients admitted between August 8, 2012, and June 30, 2013, and compared them to a preintervention group admitted between August 1, 2011, and June 30, 2012. Postintervention offers of HIV screening increased significantly (7.9% [44/559] vs 55.5% [300/541]; P<.001), as did documentation of residents' contemplation of screening (8.9% [50/559] vs 67.5% [365/541]; P<.001). A significantly higher proportion of HIV screening tests was ordered postintervention (7.7% [43/559] vs 44.4% [240/541]; P<.001). Monthly HIV screening documentation ranged from 0% (0/53) to 17% (9/53) preintervention, whereas it ranged from 30.6% (11/36) to 100% (62/62) postintervention. HIV screening adherence can be improved through resident education, friendly competition, and system reminders. Barriers to achieving sustained adherence to the CDC guidelines include a heterogeneous patient population and provider discomfort with the subject. PMID:27239302

  13. Relationship of residency program characteristics with pass rate of the American Board of Internal Medicine certifying exam.

    PubMed

    Atsawarungruangkit, Amporn

    2015-01-01

    Objectives To evaluate the relationship between the pass rate of the American Board of Internal Medicine (ABIM) certifying exam and the characteristics of residency programs. Methods The study used a retrospective, cross-sectional design with publicly available data from the ABIM and the Fellowship and Residency Electronic Interactive Database. All categorical residency programs with reported pass rates were included. Using univariate and multivariate, linear regression analyses, I analyzed how 69 factors (e.g., location, general information, number of faculty and trainees, work schedule, educational environment) are related to the pass rate. Results Of 371 programs, only one region had a significantly different pass rate from the other regions; however, as no other characteristics were reported in this region, I excluded program location from further analysis. In the multivariate analysis, pass rate was significantly associated with four program characteristics: ratio of full-time equivalent paid faculty to positions, percentage of osteopathic doctors, formal mentoring program, and on-site child care (OCC). Numerous factors were not associated at all, including minimum exam scores, salary, vacation days, and average hours per week. Conclusions As shown through the ratio of full-time equivalent paid faculty to positions and whether there was a formal mentoring program, a highly supervised training experience was strongly associated with the pass rate. In contrast, percentage of osteopathic doctors was inversely related to the pass rate. Programs with OCC significantly outperformed programs without OCC. This study suggested that enhancing supervision of training programs and offering parental support may help attract and produce competitive residents.

  14. Genetic Analyses of the Internal Transcribed Spacer Sequences Suggest Introgression and Duplication in the Medicinal Mushroom Agaricus subrufescens.

    PubMed

    Chen, Jie; Moinard, Magalie; Xu, Jianping; Wang, Shouxian; Foulongne-Oriol, Marie; Zhao, Ruilin; Hyde, Kevin D; Callac, Philippe

    2016-01-01

    The internal transcribed spacer (ITS) region of the nuclear ribosomal RNA gene cluster is widely used in fungal taxonomy and phylogeographic studies. The medicinal and edible mushroom Agaricus subrufescens has a worldwide distribution with a high level of polymorphism in the ITS region. A previous analysis suggested notable ITS sequence heterogeneity within the wild French isolate CA487. The objective of this study was to investigate the pattern and potential mechanism of ITS sequence heterogeneity within this strain. Using PCR, cloning, and sequencing, we identified three types of ITS sequences, A, B, and C with a balanced distribution, which differed from each other at 13 polymorphic positions. The phylogenetic comparisons with samples from different continents revealed that the type C sequence was similar to those found in Oceanian and Asian specimens of A. subrufescens while types A and B sequences were close to those found in the Americas or in Europe. We further investigated the inheritance of these three ITS sequence types by analyzing their distribution among single-spore isolates from CA487. In this analysis, three co-dominant markers were used firstly to distinguish the homokaryotic offspring from the heterokaryotic offspring. The homokaryotic offspring were then analyzed for their ITS types. Our genetic analyses revealed that types A and B were two alleles segregating at one locus ITSI, while type C was not allelic with types A and B but was located at another unlinked locus ITSII. Furthermore, type C was present in only one of the two constitutive haploid nuclei (n) of the heterokaryotic (n+n) parent CA487. These data suggest that there was a relatively recent introduction of the type C sequence and a duplication of the ITS locus in this strain. Whether other genes were also transferred and duplicated and their impacts on genome structure and stability remain to be investigated.

  15. Genetic Analyses of the Internal Transcribed Spacer Sequences Suggest Introgression and Duplication in the Medicinal Mushroom Agaricus subrufescens

    PubMed Central

    Chen, Jie; Moinard, Magalie; Xu, Jianping; Wang, Shouxian; Foulongne-Oriol, Marie; Zhao, Ruilin; Hyde, Kevin D.; Callac, Philippe

    2016-01-01

    The internal transcribed spacer (ITS) region of the nuclear ribosomal RNA gene cluster is widely used in fungal taxonomy and phylogeographic studies. The medicinal and edible mushroom Agaricus subrufescens has a worldwide distribution with a high level of polymorphism in the ITS region. A previous analysis suggested notable ITS sequence heterogeneity within the wild French isolate CA487. The objective of this study was to investigate the pattern and potential mechanism of ITS sequence heterogeneity within this strain. Using PCR, cloning, and sequencing, we identified three types of ITS sequences, A, B, and C with a balanced distribution, which differed from each other at 13 polymorphic positions. The phylogenetic comparisons with samples from different continents revealed that the type C sequence was similar to those found in Oceanian and Asian specimens of A. subrufescens while types A and B sequences were close to those found in the Americas or in Europe. We further investigated the inheritance of these three ITS sequence types by analyzing their distribution among single-spore isolates from CA487. In this analysis, three co-dominant markers were used firstly to distinguish the homokaryotic offspring from the heterokaryotic offspring. The homokaryotic offspring were then analyzed for their ITS types. Our genetic analyses revealed that types A and B were two alleles segregating at one locus ITSI, while type C was not allelic with types A and B but was located at another unlinked locus ITSII. Furthermore, type C was present in only one of the two constitutive haploid nuclei (n) of the heterokaryotic (n+n) parent CA487. These data suggest that there was a relatively recent introduction of the type C sequence and a duplication of the ITS locus in this strain. Whether other genes were also transferred and duplicated and their impacts on genome structure and stability remain to be investigated. PMID:27228131

  16. Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units: Results of an Italian Multicenter Prospective Study.

    PubMed

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

    2016-01-01

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

  17. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

    PubMed

    Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu

    2015-12-01

    The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

  18. Tip timing measurement chain validation with the Universal Tip Timing Calibrator UTTC, approach and experience

    NASA Astrophysics Data System (ADS)

    Pfeifer, Uwe; Zidorn, Michael

    2012-06-01

    The presentation will outline the motivation, results and experience of the development and application of a Universal Tip Timing Calibrator (UTTC) by the Siemens Tip Timing expert group. Due to the importance of the Tip Timing blade vibration measurement technology for the development of new gas turbine frames it is indispensible to calibrate these systems to international traceable standards. The very complex matter of tip timing signals does not allow to refer to simple physical and easy available laboratory standards in a standard working procedure. Even very sophisticated and expensive arbitrary wave and pattern generators are not able to generate signals to be used as calibration signals for multi-sensor tip timing systems of the last generation. So far, these 3rd and 4th generation Blade Vibration Tip Timing Measurement (BVTTM) systems could not be tested and calibrated completely within their dedicated application range regarding blade vibration amplitude, frequency and dynamic response. Based on this situation, the Siemens Tip Timing expert community decided the development of a universal and wide range application Tip Timing Simulator and Calibrator four years ago. Meanwhile, this device exists and is widely used for BVTTM system development, field system set up, data validation and off-line data evaluation. Inside the paper, the technical features and the software capabilities as well will be described in detail. Finally, two application examples with two different BVTTM systems are presented and the results are being discussed. As a summary it can be expressed, that the UTTC was found as a very helpful instrument for an optimal Tip Timing system setup.

  19. Medicine and nursing in the Spanish Civil War: women who served in the health services of the International Brigades (1936-1939).

    PubMed

    Pérez-Aguado, María del Carmen; Brugues, Eulalia; de Leiva-Perez, Alejandra; de Leiva, Alberto

    2010-12-01

    The outbreak of the Spanish Civil War in 1936 had repercussions throughout the world. Even though Western democracies had signed a Non-Intervention Agreement, thousands of foreign volunteers fought on the Republican side. This paper briefly summarizes the issues that directly led to the war, and focuses on the intervention of the International Brigades, the origins of the International Sanitary Service (ISS) and the role played by women at the ISS. These women implemented and collaborated in important and innovative procedures in military medicine, that we analyze below.

  20. EcoTipping Points

    ERIC Educational Resources Information Center

    Marten, Gerald G.; Matthews, Catherine E.

    2009-01-01

    Contrary to what we often hear and teach, there is good news to be found on the environmental front. Environmental success stories show us not only that sustainability is possible, but also how people have made it happen. We can make these stories and their lessons accessible to students with help from the EcoTipping Points Project, which has…

  1. Tips from the Classroom.

    ERIC Educational Resources Information Center

    Benedetti, Teresa; De Gaetano, Yvonne; Weinstein-McShane, Ruth; Paez, Doris; McCarty, Laurie; Ehlers-Zavala, Fabiola; Bakken, Jeffrey P.

    1997-01-01

    This group of classroom tips discusses the benefits of peer coaching, peer group conversation about teachers' classroom experiences, using visual displays for collegial sharing, using cultural brokers in educational settings, and the role of picture books in developing literacy skills in diverse students with disabilities. (Author/CK)

  2. Tips for Energy Savers.

    ERIC Educational Resources Information Center

    Department of Energy, Washington, DC.

    According to 1986 U.S. Department of Energy data, 48% of our residential energy is used to heat and cool our homes, 16% goes for heating water, 12% is used to refrigerators and freezers, and the remaining 24% goes into lighting, cooking, and running appliances. This booklet contains tips for saving energy, including sections on: (1) draft-proof…

  3. Newsletter Design Tips.

    ERIC Educational Resources Information Center

    Welch, Sally

    This paper presents detailed tips on newsletter design. Following an overview, it discusses effective design, anatomy of a page, type, designing tools (organizational tools, text organizers, emphasizing tools, and graphics, presented with some do's and don'ts), and a list of other items to consider. Three appendixes contain a brief glossary of…

  4. 26 CFR 31.3402(k)-1 - Special rule for tips.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  5. [Medicine on mission: The international health reform of Seventh-Day Adventists and their health care facilities in Sweden].

    PubMed

    Eklöf, Motzi

    2008-01-01

    incorporated into the array of treatment resources. The successful enterprises--as they had been for a considerable time--could not, at the end of the 20th century, continue to be self financing or fulfil the missionary objectives among the upper classes. The institutionalised health care apparatus came to an end around the turn of the century, which also included the sale of health associated food product companies. The Seventh-day Adventist's combination of medicine and religion with Christian missionary aims have indeed, not only steered health care models and institutions worldwide, but also which target groups to mainly turn to, the specific treatment philosophy, desirable working environment and which medical technologies to use. Furthermore, the Adventist's health reform and care of the sick provide an example for how different medical cultures influence each other and develop in relation to one another in a pluralistic medical market. The developments are not merely a reflection of the medical, scientific and technical advancements, but also of the medical market's structure, financing and (inter)national connections, of religion, culture and not least of all, patients' options and their choices.

  6. Tipping off endothelial tubes: nitric oxide drives tip cells.

    PubMed

    Priya, Mani Krishna; Sahu, Giriraj; Soto-Pantoja, David R; Goldy, Naga; Sundaresan, Abaya Meenakshi; Jadhav, Vivek; Barathkumar, T R; Saran, Uttara; Jaffar Ali, B M; Roberts, David D; Bera, Amal Kanti; Chatterjee, Suvro

    2015-04-01

    Angiogenesis, the formation of new blood vessels from pre-existing vessels, is a complex process that warrants cell migration, proliferation, tip cell formation, ring formation, and finally tube formation. Angiogenesis is initiated by a single leader endothelial cell called "tip cell," followed by vessel elongation by "stalk cells." Tip cells are characterized by their long filopodial extensions and expression of vascular endothelial growth factor receptor-2 and endocan. Although nitric oxide (NO) is an important modulator of angiogenesis, its role in angiogenic sprouting and specifically in tip cell formation is poorly understood. The present study tested the role of endothelial nitric oxide synthase (eNOS)/NO/cyclic GMP (cGMP) signaling in tip cell formation. In primary endothelial cell culture, about 40% of the tip cells showed characteristic sub-cellular localization of eNOS toward the anterior progressive end of the tip cells, and eNOS became phosphorylated at serine 1177. Loss of eNOS suppressed tip cell formation. Live cell NO imaging demonstrated approximately 35% more NO in tip cells compared with stalk cells. Tip cells showed increased level of cGMP relative to stalk cells. Further, the dissection of NO downstream signaling using pharmacological inhibitors and inducers indicates that NO uses the sGC/cGMP pathway in tip cells to lead angiogenesis. Taken together, the present study confirms that eNOS/NO/cGMP signaling defines the direction of tip cell migration and thereby initiates new blood vessel formation.

  7. 14. TIP TOP MINE. TAILINGS LOCATED DIRECTLY WEST FROM TIP ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. TIP TOP MINE. TAILINGS LOCATED DIRECTLY WEST FROM TIP TOP HOUSE. ID-31-C-12 WOODEN STRUCTURE IS VISIBLE IN TOP LEFT. CABLES VISIBLE LEFT AND CENTER OF TAILINGS. HOUSE IS JUST OVER APEX OF TAILINGS. CAMERA POINTED EAST. - Florida Mountain Mining Sites, Tip Top Mine, West face Florida Mountain, approximately 150 feet below summit, Silver City, Owyhee County, ID

  8. International Travel: Tips for Staying Healthy

    MedlinePlus

    ... Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and Diet Plans Nutrients and Nutritional ... Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and Diet Plans Nutrients and Nutritional ...

  9. International Health and Tropical Medicine 08: Proceedings of a Residential Meeting of the Royal Society of Tropical Medicine and Hygiene, 17-19 September 2008, Brighton, UK.

    PubMed

    Newport, Melanie J; Lang, Trudie

    2009-11-01

    The Royal Society of Tropical Medicine and Hygiene held a residential meeting from 17-19 September 2008. Over 250 delegates from a diverse range of backgrounds and experience convened in Brighton, UK for three days of talks and discussions on a wide variety of themes. Topics ranged from tropical and neglected infectious diseases through to other disorders that whilst not traditionally associated with low income countries pose an increasing challenge; chronic diseases, mental health disorders and problems arising from conflict and poverty combined. The meeting represented the change in focus at RSTMH from tropical infectious diseases towards global health in its broadest sense.

  10. Data Accuracy of the Bubble Sheet Ambulatory Data System and the KG-Ambulatory Data System in the Internal Medicine Clinic, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana

    DTIC Science & Technology

    2000-06-01

    in the Ambulatory Data System (ADS) for the Internal Medicine Clinic at Bayne-Jones Army Community Hospital, Fort Polk, Louisiana. A secondary purpose...Analysis of the financial data indicated that the hospital was minimally at risk for either fraudulent billing or loss of revenue. However, as the Internal ... Medicine Clinic only accounts for 6.3% of outpatient workload, coding behaviors similar to those observed practiced in other high volume clinics would

  11. Drug-induced blood consumption: the impact of adverse drug reactions on demand for blood components in German departments of internal medicine.

    PubMed

    Rottenkolber, Dominik; Schmiedl, Sven; Rottenkolber, Marietta; Thuermann, Petra A; Hasford, Joerg

    2012-10-01

    Therapy for adverse drug reactions (ADRs) often results in the application of blood components. This study aims to assess the demand for blood components and the resulting economic burden (hospital perspective) in German hospitals induced by ADRs leading to admissions to departments of internal medicine. In this prospective study, ADRs leading to hospitalization were surveyed in four regional pharmacovigilance centres in Germany during the years 2000-2007. ADRs assessed as 'possible', 'likely' or 'very likely' were included. Market prices for blood components and hospitalization data were determined by desktop research. A probabilistic sensitivity analysis was performed. A total of 6099 patients were admitted to internal medicine departments because of an outpatient ADR of whom 1165 patients (19.1%; mean age, 73.0 ± 13.0 years) required treatment with blood components owing to major bleeding events. Overall consumption was 4185 erythrocyte concentrates (EC), 426 fresh frozen plasma (FFP) and 48 thrombocyte (TC) units. On the basis of statistical hospital data, we estimated a nationwide demand of approximately 132,020 EC, 13,440 FFP and 1515 TC units, resulting in total costs of €12.66 million per year for all German hospitals. Some 19.2% of all ADR cases were assessed as preventable. Theoretically, a nationwide decreased demand for blood components and a savings potential of €2.43 million per year could be achieved by preventing ADRs in Germany. Blood components are used in one-fifth (mainly gastrointestinal bleeding) of all ADRs, leading to hospitalizations in internal medicine departments. Both blood demand and hospital procurement costs can be significantly lowered by preventing ADRs.

  12. [Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)].

    PubMed

    Salas-Coronas, J; Ramírez-Olivencia, G; Pérez-Arellano, J L; Belhassen-García, M; Carranza-Rodríguez, C; García-Rodríguez, M; Villar-Garcia, J; Treviño-Maruri, B; Serre-Delcor, N; López-Vélez, R; Norman, F; Gómez-Junyent, J; Soriano-Pérez, M J; Rojo-Marcos, G; Rodríguez de Las Parras, E; Lago-Núñez, M M; Muro, A; Muñoz, J

    2017-02-01

    According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

  13. Travel medicine

    PubMed Central

    Aw, Brian; Boraston, Suni; Botten, David; Cherniwchan, Darin; Fazal, Hyder; Kelton, Timothy; Libman, Michael; Saldanha, Colin; Scappatura, Philip; Stowe, Brian

    2014-01-01

    Abstract Objective To define the practice of travel medicine, provide the basics of a comprehensive pretravel consultation for international travelers, and assist in identifying patients who might require referral to travel medicine professionals. Sources of information Guidelines and recommendations on travel medicine and travel-related illnesses by national and international travel health authorities were reviewed. MEDLINE and EMBASE searches for related literature were also performed. Main message Travel medicine is a highly dynamic specialty that focuses on pretravel preventive care. A comprehensive risk assessment for each individual traveler is essential in order to accurately evaluate traveler-, itinerary-, and destination-specific risks, and to advise on the most appropriate risk management interventions to promote health and prevent adverse health outcomes during travel. Vaccinations might also be required and should be personalized according to the individual traveler’s immunization history, travel itinerary, and the amount of time available before departure. Conclusion A traveler’s health and safety depends on a practitioner’s level of expertise in providing pretravel counseling and vaccinations, if required. Those who advise travelers are encouraged to be aware of the extent of this responsibility and to refer all high-risk travelers to travel medicine professionals whenever possible. PMID:25500599

  14. The use of extrication devices in crevasse accidents: official statement of the International Commission for Mountain Emergency Medicine and the Terrestrial Rescue Commission of the International Commission for Alpine Rescue intended for physicians, paramedics, and mountain rescuers.

    PubMed

    Winterberger, Eveline; Jacomet, Hans; Zafren, Ken; Ruffinen, Grégoire Zen; Jelk, Bruno

    2008-01-01

    Injured patients in crevasses who are suspected of having sustained spinal injuries should ideally be extricated after being immobilized in a horizontal position on a stretcher and having a cervical collar applied. Sometimes, however, horizontal stabilization is not possible, because the crevasse is too narrow, and the patient needs to be stabilized in a vertical position. In such cases an extrication device can be a useful adjunct. The Kendrick Extrication Device stabilizes the position of the body and maintains firm support of the head, neck, and torso. Therefore, the International Commission for Mountain Emergency Medicine supports the use of this device in narrow crevasses, if horizontal evacuation is not possible.

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

    PubMed

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

    2016-08-01

    Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continuity, effectiveness, safety and appropriateness of care are guaranteed by an innovative figure called "flow manager," with skilled clinical experience and managerial attitude, and by elaboration of an early personalized discharge plan anticipating every patient's needs according to lean methodology principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.

  16. Children's Knowledge about Medicines.

    ERIC Educational Resources Information Center

    Almarsdottir, Anna B.; Zimmer, Catherine

    1998-01-01

    Examined knowledge about medicines and perceived benefit among 101 children, ages 7 and 10. Found that medicine knowledge was explained using age, educational environment, and degree of internal locus of control as significant predictors. The negative effect of internal locus of control predicted perceived benefit. Retention of drug advertising…

  17. Tipping news in information accumulation system

    NASA Astrophysics Data System (ADS)

    Shin, J. K.

    2010-05-01

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

  18. Gas only nozzle fuel tip

    DOEpatents

    Bechtel, William Theodore; Fitts, David Orus; DeLeonardo, Guy Wayne

    2002-01-01

    A diffusion flame nozzle gas tip is provided to convert a dual fuel nozzle to a gas only nozzle. The nozzle tip diverts compressor discharge air from the passage feeding the diffusion nozzle air swirl vanes to a region vacated by removal of the dual fuel components, so that the diverted compressor discharge air can flow to and through effusion holes in the end cap plate of the nozzle tip. In a preferred embodiment, the nozzle gas tip defines a cavity for receiving the compressor discharge air from a peripheral passage of the nozzle for flow through the effusion openings defined in the end cap plate.

  19. Development of Bend Sensor for Catheter Tip

    NASA Astrophysics Data System (ADS)

    Nagano, Yoshitaka; Sano, Akihito; Fujimoto, Hideo

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

  20. The Macro - TIPS Course Package.

    ERIC Educational Resources Information Center

    Heriot-Watt Univ., Edinburgh (Scotland). Esmee Fairbairn Economics Research Centre.

    The TIPS (Teaching Information Processing System) Course Package was designed to be used with the Macro-Games Course Package (SO 011 930) in order to train college students to apply the tools of economic analysis to current problems. TIPS is used to provide feedback and individualized assignments to students, as well as information about the…

  1. Tips for Mental Health Interpretation

    ERIC Educational Resources Information Center

    Whitsett, Margaret

    2008-01-01

    This paper offers tips for working with interpreters in mental health settings. These tips include: (1) Using trained interpreters, not bilingual staff or community members; (2) Explaining "interpreting procedures" to the providers and clients; (3) Addressing the stigma associated with mental health that may influence interpreters; (4) Defining…

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

    PubMed

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

    2015-03-25

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

  3. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  4. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  5. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  6. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  7. 21 CFR 890.3790 - Cane, crutch, and walker tips and pads.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  8. A hypothesis on the most prevalent psychological type for chief residents in the field of internal medicine.

    PubMed

    Hearney, Elaine G; Razavi, Hossein

    2003-08-01

    Communication is the key to good doctor-patient relations. Resident learning occurs through the process of observation and role modeling. We hypothesize that the most prevalent personality type for chief residents will be in discordance with the most prevalent type (Sensor) in the general population. We set out to determine the communication styles of a national sampling of recent chief residents in the field of medicine. The survey based on Jung's Psychological types: thinker, feeler, the intuitor and sensor. Overall self report of psychological types revealed the majority, both male and female (45.6%) to be in the 'feeler' category. Feelers are described as persons with a high need for interpersonal harmony. They value compassion and empathy and enjoy meeting other people's needs.

  9. Imaging in the Age of Precision Medicine: Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology.

    PubMed

    Herold, Christian J; Lewin, Jonathan S; Wibmer, Andreas G; Thrall, James H; Krestin, Gabriel P; Dixon, Adrian K; Schoenberg, Stefan O; Geckle, Rena J; Muellner, Ada; Hricak, Hedvig

    2016-04-01

    During the past decade, with its breakthroughs in systems biology, precision medicine (PM) has emerged as a novel health-care paradigm. Challenging reductionism and broad-based approaches in medicine, PM is an approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. It involves integrating information from multiple sources in a holistic manner to achieve a definitive diagnosis, focused treatment, and adequate response assessment. Biomedical imaging and imaging-guided interventions, which provide multiparametric morphologic and functional information and enable focused, minimally invasive treatments, are key elements in the infrastructure needed for PM. The emerging discipline of radiogenomics, which links genotypic information to phenotypic disease manifestations at imaging, should also greatly contribute to patient-tailored care. Because of the growing volume and complexity of imaging data, decision-support algorithms will be required to help physicians apply the most essential patient data for optimal management. These innovations will challenge traditional concepts of health care and business models. Reimbursement policies and quality assurance measures will have to be reconsidered and adapted. In their 10th biannual symposium, which was held in August 2013, the members of the International Society for Strategic Studies in Radiology discussed the opportunities and challenges arising for the imaging community with the transition to PM. This article summarizes the discussions and central messages of the symposium.

  10. Evaluation of Medicinal Categorization of Atractylodes japonica Koidz. by Using Internal Transcribed Spacer Sequencing Analysis and HPLC Fingerprinting Combined with Statistical Tools

    PubMed Central

    Kim, Jung-Hoon; Doh, Eui-Jeong; Lee, Guemsan

    2016-01-01

    Atractylodes rhizomes have been used as the herbal medicine “Changchul” or “Baekchul,” according to their clinical purpose, in Korea, China, and Japan. Among the Atractylodes species, the medicinal use of Atractylodes japonica has been controversial, as it is categorized as both Changchul and Baekchul in those countries, and, moreover, parts of the rhizome have been differently used, depending on age of the plant, in Korea. Chromatographic fingerprinting by using HPLC combined with chemometric analyses and internal transcribed spacer (ITS) sequencing analysis were conducted to classify and identify 34 crude drugs derived from Atractylodes rhizomes. The identification of the samples, authenticated by their morphological features as A. japonica Koidz. (Changchul and Baekchul), A. chinensis Koidz., and A. macrocephala Koidz., was confirmed as A. japonica, A. chinensis, and A. macrocephala by ITS sequencing. The results from chemometric analyses showed that the chemical components of the crude drugs from A. japonica were significantly different from those from A. macrocephala but were similar to those from A. chinensis. The analyses also suggested that the categorization by age of A. japonica as Changchul or Baekchul is not recommended. The results indicate that A. japonica should be categorized as “Changchul” and should not be further categorized by age. PMID:27190530

  11. Higher seroprevalence of hepatitis B virus antigen in patients with cystic hydatid disease than in patients referred to internal medicine clinics in Turkey.

    PubMed

    Gültepe, Bilge; Dülger, Ahmet Cumhur; Gültepe, İlhami; Karadas, Sevdegul; Ebinç, Senar; Esen, Ramazan

    2014-02-01

    Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheep-raising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.

  12. Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

    PubMed

    Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

    2013-07-01

    A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

  13. [International collaboration of the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine: assistance for public health in the Republic of Guinea].

    PubMed

    Konstantinov, O K

    2012-01-01

    Within the framework of international collaboration, the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine (IMPTM), I.M. Sechenov First Moscow State Medical University, assisted the Public Health System of the Republic of Guinea in detecting, diagnosing, studying, and preventing tropical infections of viral, bacterial, and parasitic etiologies, and in training national scientific manpower. The work was under way in the Soviet-Guinea Research Microbiology and Virology Laboratory, USSR Ministry of Health, in the Republic of Guinea (now the Pasteur Institute in Guinea (PIG)) in 1978-1991. The circulation of pathogens of a number of tropical infections, the fauna of vectors and carriers of transmissible infections, and their involvement of the circulation of pathogens of these diseases were found in this period. Consultative-and-methodological and medical assistance was given; national higher- and middle-level brainpower trained. It is expedient to restore scientific ties between the IMPTM and the PIG.

  14. [Diagnosis and treatment of imported malaria in Spain: Recommendations from the Malaria Working Group of the Spanish Society of Tropical Medicine and International Health (SEMTSI)].

    PubMed

    Muñoz, Jose; Rojo-Marcos, Gerardo; Ramírez-Olivencia, Germán; Salas-Coronas, Joaquín; Treviño, Begoña; Perez Arellano, José Luis; Torrús, Diego; Muñoz Vilches, Maria Jose; Ramos, Jose Manuel; Alegría, Iñaki; López-Vélez, Rogelio; Aldasoro, Edelweiss; Perez-Molina, Jose Antonio; Rubio, Jose Miguel; Bassat, Quique

    2015-01-01

    Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.

  15. Consensus Document of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine on the diagnosis and treatment of iron deficiency in heart failure.

    PubMed

    Manito, N; Cerqueiro, J M; Comín-Colet, J; García-Pinilla, J M; González-Franco, A; Grau-Amorós, J; Peraira, J R; Manzano, L

    Iron deficiency in patients with heart failure is a medical problem of recent particular interest. This interest has resulted from the publication of several clinical trials that demonstrated that the administration of intravenous iron to such patients improved their functional capacity and even reduced the number of hospitalisations for heart failure decompensation. However, applying the evidence from these studies in clinical practice is still controversial, both in terms of the diagnostic criteria for iron deficiency (absolute and functional) and the optimal method for iron replenishment. This article is a consensus document that integrates the recommendations of the Spanish Society of Internal Medicine and the Spanish Society of Cardiology. The article reviews the scientific evidence and proposes a diagnostic and therapeutic performance protocol for iron deficiency in heart failure.

  16. Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians.

    PubMed

    Butkus, Renee; Lane, Susan; Steinmann, Alwin F; Caverzagie, Kelly J; Tape, Thomas G; Hingle, Susan T; Moyer, Darilyn V

    2016-07-19

    In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.

  17. Effects of a graduate-level interprofessional education program on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care.

    PubMed

    Hanyok, Laura A; Walton-Moss, Benita; Tanner, Elizabeth; Stewart, Rosalyn W; Becker, Kathleen

    2013-11-01

    This article describes the development, implementation and evaluation of a longitudinal interprofessional education (IPE) experience for adult nurse practitioner students and internal medicine residents. This experience focused on providing care for complex community based patients during clinic and home visits, preceded by didactic learning that emphasized understanding one another's professional roles and education, teamwork and conflict management. Evaluation demonstrated significant improvements in attitudes and beliefs associated with professional role, respect among health professions' disciplines and conflict management. Results with regards to attitudes towards IPE and interprofessional practice, and valuing teamwork training were mixed. In particular, the curricular intervention did not change participants'self-reported skill in communication and did not affect attitudes and beliefs towards effects of interprofessional education on patient outcomes.

  18. Tipping the scales.

    PubMed

    1998-12-01

    In the US, the October 1998 murder of a physician who performed abortions was an outward manifestation of the insidious battle against legal abortion being waged by radical Christian social conservatives seeking to transform the US democracy into a theocracy. This movement has been documented in a publication entitled, "Tipping the Scales: The Christian Right's Legal Crusade Against Choice" produced as a result of a 4-year investigation conducted by The Center for Reproductive Law and Policy. This publication describes how these fundamentalists have used sophisticated legal, lobbying, and communication strategies to further their goals of challenging the separation of church and state, opposing family planning and sexuality education that is not based solely on abstinence, promoting school prayer, and restricting homosexual rights. The movement has resulted in the introduction of more than 300 anti-abortion bills in states, 50 of which have passed in 23 states. Most Christian fundamentalist groups provide free legal representation to abortion clinic terrorists, and some groups solicit women to bring specious malpractice claims against providers. Sophisticated legal tactics are used by these groups to remove the taint of extremism and mask the danger posed to US constitutional principles being posed by "a well-financed and zealous brand of radical lawyers and their supporters."

  19. A qualitative assessment of internal medicine resident perceptions of graduate medical education following implementation of the 2011 ACGME duty hour standards

    PubMed Central

    2014-01-01

    Background In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents. Methods We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, “How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?” Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans. Results Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study. Conclusions Residents noted a decline in teaching and are concerned with the decrease in “hands-on” clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education. PMID:24755276

  20. [Comparative analysis of diagnoses by the referring family physician and the hospital admission committee in ambulatory patients at an internal medicine department].

    PubMed

    Hajnal, F; Nagy, P; Abrahám, G

    1997-05-25

    The objectives of the present study were, as follows: 1. To what rate do the primary care doctors refer their patients to the regional internal medicine emergency department? 2. What sort of problems are the reasons of the referring? 3. To what extent are the opinions of the referring doctors confirmed or reviewed by the specialists? 4. What rate of the referred patients are admitted or discharged after the urgent consultations and-or interventions. 5. What kind of additional tests were used by the institutional caregivers in order to make accurate diagnoses? 6. What was the fate of the unaccepted patients? Data were collected in the patient document archive of the First Dept. of Medicine of the Albert Szent-Györgyi Medical University, Szeged, Hungary. Each patients' referring notes and inpatient charts between September 15th, 1995 and January 15th, 1996 were studied in a retrospective way. Upon the results of the study, it was concluded, as follows: The primary care doctors referred their patients with right orientation diagnosis to the emergency department in 70% of the cases. 45.8% of the referred pts. were admitted to the internal inpatient ward. The agreement of the referring and discharge diagnoses was greater (85.7%) among the admitted patients as compared to the unaccepted ones (56.8%). 14% of the referred pts. were referred to other specialists by the internists. On the basis of the results the actual messages of the study for an under- and postgraduate medical teaching group, and for the health care politicians are discussed in the paper.

  1. Diagnostic performance of a multiple real-time PCR assay in patients with suspected sepsis hospitalized in an internal medicine ward.

    PubMed

    Pasqualini, Leonella; Mencacci, Antonella; Leli, Christian; Montagna, Paolo; Cardaccia, Angela; Cenci, Elio; Montecarlo, Ines; Pirro, Matteo; di Filippo, Francesco; Cistaro, Emma; Schillaci, Giuseppe; Bistoni, Francesco; Mannarino, Elmo

    2012-04-01

    Early identification of causative pathogen in sepsis patients is pivotal to improve clinical outcome. SeptiFast (SF), a commercially available system for molecular diagnosis of sepsis based on PCR, has been mostly used in patients hospitalized in hematology and intensive care units. We evaluated the diagnostic accuracy and clinical usefulness of SF, compared to blood culture (BC), in 391 patients with suspected sepsis, hospitalized in a department of internal medicine. A causative pathogen was identified in 85 patients (22%). Sixty pathogens were detected by SF and 57 by BC. No significant differences were found between the two methods in the rates of pathogen detection (P = 0.74), even after excluding 9 pathogens which were isolated by BC and were not included in the SF master list (P = 0.096). The combination of SF and BC significantly improved the diagnostic yield in comparison to BC alone (P < 0.001). Compared to BC, SF showed a significantly lower contamination rate (0 versus 19 cases; P < 0.001) with a higher specificity for pathogen identification (1.00, 95% confidence interval [CI] of 0.99 to 1.00, versus 0.94, 95% CI of 0.90 to 0.96; P = 0.005) and a higher positive predictive value (1.00, 95% CI of 1.00 to 0.92%, versus 0.75, 95% CI of 0.63 to 0.83; P = 0.005). In the subgroup of patients (n = 191) who had been receiving antibiotic treatment for ≥24 h, SF identified more pathogens (16 versus 6; P = 0.049) compared to BC. These results suggest that, in patients with suspected sepsis, hospitalized in an internal medicine ward, SF could be a highly valuable adjunct to conventional BC, particularly in patients under antibiotic treatment.

  2. Usage Pattern and Serum Level Measurement of Amikacin in the Internal Medicine Ward of the Largest Referral Hospital in the South of Iran: A Pharmacoepidemiological Study

    PubMed Central

    Namazi, Soha; Sagheb, Mohammad Mahdi; Hashempour, Mohammad Mahdi; Sadatsharifi, Arman

    2016-01-01

    Background: The inappropriate use of aminoglycosides has harmful effects such as the development of resistant pathogens and the incidence of nephrotoxicity and ototoxicity. Therefore, drug utilization evaluation of these drugs may improve their usage remarkably. The aim of this study was to assess the usage pattern of amikacin in an internal medicine ward. Methods: This cross-sectional study was conducted in the Internal Medicine Ward of Nemazee Teaching Hospital, Shiraz, Iran, in 2011. The guideline for amikacin use was approved by the institutional Pharmacy and Therapeutics Committee, and the study criteria were developed to assess several parameters involved in amikacin therapy such as appropriateness of drug use, dosage, duration of therapy, toxicity monitoring, and serum concentration assay. Serum concentration was assayed using a Cobas Mira AutoAnalyzer. Clinical and paraclinical parameters such as glomerular filtration rate, culture, microbial sensitivity, white blood cell count, and fever were collected. Results: Sixty-three patients were evaluated. Fifty-seven percent of the patients needed dose readjustment; however, it was not performed for 89% of them. Culture between 48 and 72 hours after amikacin administration was not controlled for 79% of the patients. In 19% of the patients, optimum therapeutic effect was not achieved. The mean±SD of the trough and peak concentrations was 7.63±5.4 μg/mL and 15.67±7.79 μg/mL, respectively. Forty-five percent of the trough and 38% of the peak levels were within the therapeutic range. The overall adherence of amikacin usage to the guideline was only 48%. Conclusion: To achieve appropriate treatment and prevent toxic effects, we recommend that pharmacokinetic dosing methods, amikacin guideline, and serum monitoring be considered. PMID:27217603

  3. The Elevation of Annals of Rehabilitation Medicine to the Status of an International Journal After Adopting an English-Only Policy

    PubMed Central

    2015-01-01

    Objective To use bibliometric analyses to determine whether Annals of Rehabilitation Medicine (hereafter also referred to as Annals) became an international journal after adopting an English-only policy in 2011. Methods Articles from the third issue of 2011 to the third issue of 2015 were analyzed according to the following parameters: whether the research was supported by funding, country of authorship, impact factor, total citations, the countries of researchers who cited Annals; the journals that cited Annals; and the Hirsch index. Results One hundred twenty-eight (34.2%) of the 374 original articles were supported by research funds. The main authors were from Korea (550/556, 98.9%), the USA (3), Iran (2), Japan (1), Turkey (1), and the United Kingdom (1). The manually calculated impact factors in 2013 and 2014 were 0.582 and 0.667, respectively. The total annual citations from years 2012 to 2015 were 15, 130, 252, and 189, respectively. The countries of residence of the main authors who cited Annals were the USA (146), Korea (89), and China (49). The journals that cited Annals most frequently were the Journal of Physical Therapy (34), Archives of Physical Medicine and Rehabilitation (15), and Frontiers in Human Neuroscience (13). The Hirsch index was 9. Conclusion The above results demonstrate that the change of the language policy of Annals to English-only was successful in elevating the journal to the international level. The journal's aim of sharing up-to-date knowledge dedicated to advancing the care of the disabled and enhancing their everyday abilities and quality of life has been satisfactorily realized. PMID:26605163

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

    PubMed Central

    ESLAMI, JAMSHID; KHADEMI, MOHSEN

    2015-01-01

    Introduction An evaluation of the curriculum elements can be recognized as a necessity in curriculum dynamic and improvement. This study aimed at evaluating five main elements of a physiopathology curriculum in internal medicine (objectives, content, methods, evaluation, and management). Method The present study is of a descriptive-analytical type, and the studypopulation consisted of a total of 48 faculty members of internal medicine physiopathology departmentat Shiraz University of Medical Sciences. Participants wereselected using Cochran’s sample size formula andthrough simple random sampling.Thedatawere collected using a 58-item questionnaire devised by the researcher, usingcurriculum planning experts. Face and content validity of the scale were obtained throughexpert views and modifications provided by 10 professors and experts in medical curriculum evaluation. Also, research reliability was calculated using Alpha Cronbachto be 0.99. Reliability value and coefficient was acceptable.Moreover, One-sample t-test, Independent t-test and one-way ANOVA were used for data analysis. Results Based on the faculty members’ views, of the five curriculum elements, objectives and content were in relatively good conditions (at an average level) while other elements including method, evaluation and management were in poor conditions (lower than average). According to results oftwo-way ANOVA, there wasa significant relationship between faculty members with various work experiencein terms of curriculum evaluation. Conclusion According to research findings, a comparative examination of the curriculum elements and their characteristics in physiopathology course can be conducted, resulting in identification of curriculum weaknesses and their pitfalls. Also, with regard to teaching, evaluation, management methods, weak and strong pointsof the course,efficiency, and effectiveness of the elements were identified. PMID:25927069

  5. Cases in Space Medicine: Right Lower Quadrant Abdominal Pain in a Female Crewmember on the International Space Station

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas R.; Scheuring, Richard; Jones, Jeffery

    2007-01-01

    A case study of a medical emergency aboard the International Space Station is reviewed. The case involves a female crewmember who is experiencing acute abdominal pain. The interplay of the Crew Medical Officer (CMO) and the NASA Flight Surgeon is given. Possible diagnoses, and advised medical actions are reviewed. Along the case study questions are posed to the reader, and at the end answers are given.

  6. Financial modeling in medicine: cash flow, basic metrics, the time value of money, discount rates, and internal rate of return.

    PubMed

    Lexa, Frank James; Berlin, Jonathan W

    2005-03-01

    In this article, the authors cover tools for financial modeling. Commonly used time lines and cash flow diagrams are discussed. Commonly used but limited terms such as payback and breakeven are introduced. The important topics of the time value of money and discount rates are introduced to lay the foundation for their use in modeling and in more advanced metrics such as the internal rate of return. Finally, the authors broach the more sophisticated topic of net present value.

  7. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    PubMed

    2011-09-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

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

    PubMed

    Ranque, B; Nardon, O

    2017-01-24

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

  9. Income Tax Tips

    ERIC Educational Resources Information Center

    Brown, Darryl Lee

    2006-01-01

    Every year at this time millions of Americans scramble to file or extend their income tax returns. This article explores some of the Internal Revenue Code (IRC) sections that might affect (or relate to) the taxation of parents of disabled or special healthcare needs children. Many of these tax provisions also apply to parents with adult children…

  10. Tips to Prevent Tick Bites

    EPA Pesticide Factsheets

    Using the right insect repellent and other preventive actions can discourage ticks, mosquitoes, and other biting insects from landing on you. Tips include avoiding tick habitats and minimizing exposed skin.

  11. Tips to Prevent Mosquito Bites

    EPA Pesticide Factsheets

    Using the right insect repellent and other preventive actions can discourage mosquitoes from landing on you. Tips include removing mosquito habitats such as standing water, minimizing exposed skin, and staying indoors while mosquitoes are most active.

  12. Gardening Health and Safety Tips

    MedlinePlus

    ... Hot Weather Tips for persons with disabilities and physical activity. Talk to your health care provider if you ... for Everyone (Arthritis Foundation) Enjoy the benefits of physical activity. Gardening is an excellent way to get physical ...

  13. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    MedlinePlus

    ... ray or ultrasound equipment, a stent, and a balloon-tipped catheter are used. The equipment typically used ... the stent is in the correct position, the balloon is inflated, expanding the stent into place. The ...

  14. Try These Time Management Tips.

    ERIC Educational Resources Information Center

    Bimrose, Jack J.

    1987-01-01

    Offers 12 time management tips for harried school administrators, including using a personal calendar, calling five-minute meetings with secretaries, mail-sorting, delegating or declining certain tasks, controlling visitors, screening phone calls, streamlining meetings, and other ideas. (MLH)

  15. Tips on Writing News Articles

    ERIC Educational Resources Information Center

    White, Shannon

    1975-01-01

    The author offers journalism tips to vocational agriculture teachers involved in public relations coverage through newspaper articles. Specific suggestions cover headlines, leading paragraphs, localization of the story, organization, and format of a news release. (EA)

  16. Flu Prevention and Treatment Tips

    MedlinePlus

    Flu Prevention and Treatment Tips Expert Information from Healthcare Professionals Who Specialize in the Care of Older Adults Influenza, or the “flu,” is a contagious respiratory illness. It can cause ...

  17. Health Tips for Older Adults

    MedlinePlus

    ... held weights, like soup cans, to improve your strength. The Go4Life campaign, sponsored by the National Institute on Aging (NIA), offers easy-to-use materials on health and aging. Try their tips on ...

  18. Search Tips: MedlinePlus

    MedlinePlus

    ... Tools Español You Are Here: Home → Search Tips URL of this page: https://medlineplus.gov/searchtips.html ... site by adding 'site:' and the domain or URL to your search words. For example, if you ...

  19. Spinal Cord Injury Prevention Tips

    MedlinePlus

    ... knee and elbow pads, wrist braces, and gloves. Swimming/diving prevention tips • Do not dive in water ... all rules and warning signs at water parks, swimming pools, and public beaches. • The first time you ...

  20. Medical standards for mountain rescue operations using helicopters: official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    PubMed

    Tomazin, Iztok; Ellerton, John; Reisten, Oliver; Soteras, Inigo; Avbelj, Miha

    2011-01-01

    The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.

  1. Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog: Part One.

    PubMed

    Avedillo, L; Martín-Alguacil, N; Salazar, I

    2015-08-01

    Traditional veterinary anatomical models describe the branches of the caudal gluteal artery as the iliolumbar, cranial gluteal, lateral caudal, satellite of the ischiatic nerve and dorsal perineal arteries. However, some classical veterinary anatomy textbooks often indicate variations the general organization of the arterial tree, without giving any pattern of origin or illustrations of the different branching. The aim of this study was to investigate the presumptive variability of the caudal gluteal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twelve anatomical variations were found, nine occurring in more than 5% of the dogs, and three in <5%. A 'long-type' internal iliac artery, which means short caudal gluteal and internal pudendal arteries, was identified, while a 'perineal trunk' was observed as an interesting arterial variation. If the caudal segment alone is taken into consideration, identical vascular patterns in both hemi-pelvises are found in 17% of the dogs. Significant statistical correlation was found for four different types of anatomic variations and gender, two types of variations and body size, one type of variation for body side and one type of variation for head shape.

  2. Diving medicine.

    PubMed

    Benton, P J; Glover, M A

    2006-01-01

    Recreational diving developed in the late 1940s when self-contained underwater breathing apparatus (SCUBA) first became available for civilian use. At the same time the development of the commercial airliner, in particular the jet airliner, made possible the concept of international travel for pleasure as opposed to business. Over the past 50 years the number of international tourists has increased by over 2500% from a mere 25 million in 1950 to over 700 million in 2002 (Treadwell TL. Trends in travel. In: Zuckerman JN, editor. Principles and practice of travel medicine, 2001; p. 2-6). The popularity of recreational diving has also increased over the same period from an activity experienced by a small number of individuals in the early 1950s to an activity today enjoyed by many millions. The combination of increased international travel and the means by which to enter and explore the underwater world has led to diving becoming increasingly popular as a tourist activity.

  3. Toxocariasis diagnosed in international travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013.

    PubMed

    Van Den Broucke, Steven; Kanobana, Kirezi; Polman, Katja; Soentjens, Patrick; Vekemans, Marc; Theunissen, Caroline; Vlieghe, Erika; Van Esbroeck, Marjan; Jacobs, Jan; Van Den Enden, Erwin; Van Den Ende, Jef; Van Gompel, Alfons; Clerinx, Jan; Bottieau, Emmanuel

    2015-03-01

    Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion. From 2000 to 2013, 190 travelers showed Toxocara-antibodies, of a total of 3436 for whom the test was requested (5.5%). Toxocariasis was diagnosed in 28 cases (23 symptomatic and 5 asymptomatic) including 21 highly probable and 7 definitive. All but one patients were adults. Africa and Asia were the place of acquisition for 10 and 9 cases, respectively. Twelve patients (43%) were short-term travelers (< 1 month). Symptoms, when present, developed during travel or within 8 weeks maximum after return, and included abdominal complaints (11/23 symptomatic patients, 48%), respiratory symptoms and skin abnormalities (10 each, 43%) and fever (9, 39%), often in combination. Two patients were diagnosed with transverse myelitis. At presentation, the median blood eosinophil count was 1720/μL [range: 510-14160] in the 21 symptomatic cases without neurological complication and 2080/μL [range: 1100-2970] in the 5 asymptomatic individuals. All patients recovered either spontaneously or with an anti-helminthic treatment (mostly a 5-day course of albendazole), except both neurological cases who kept sequelae despite repeated treatments and prolonged corticotherapy. Toxocariasis has to be considered in travelers returning

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Tips included for employee taxes. 31.3121(q)-1 Section 31.3121(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... SOURCE Federal Insurance Contributions Act (Chapter 21, Internal Revenue Code of 1954) General...

  5. 26 CFR 31.6053-4 - Substantiation requirements for tipped employees.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Substantiation requirements for tipped employees. 31.6053-4 Section 31.6053-4 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... Provisions of Subtitle F, Internal Revenue Code of 1954) § 31.6053-4 Substantiation requirements for...

  6. 75 FR 11227 - Proposed Collection; Comment Request for Tip Rate Determination Agreement (TRDA) for Use in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-10

    ... Internal Revenue Service Proposed Collection; Comment Request for Tip Rate Determination Agreement (TRDA... continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Tip Rate...

  7. H2S2014 in Kyoto: the 3rd International Conference on H2S in Biology and Medicine.

    PubMed

    Kimura, Hideo

    2015-04-30

    About 20 years ago, a pungent gas was found to be the physiological mediator of cognitive function and vascular tone. Since then, studies on hydrogen sulfide (H2S) have uncovered its numerous physiological roles such as protecting various tissues/organs from ischemia and regulating inflammation, cell growth, oxygen sensing, and senescence. These effects of H2S were extensively studied, and some of the corresponding mechanisms were also studied in detail. Previous studies on the synergistic interaction between H2S and nitric oxide (NO) have led to the discovery of several potential signaling molecules. Polysulfides are considerably potent and are one of the most active forms of H2S. H2S has a significant therapeutic potential, which is evident from the large number of novel H2S-donating compounds and substances developed for manipulating endogenous levels of H2S. The Third International Conference on H2S was held in Kyoto in June 2014. One hundred and sixty participants from 21 countries convened in Kyoto to report new advances, discuss conflicting findings, and make plans for future research. This article summarizes each oral presentation presented at the conference.

  8. Turbine blade with contoured chamfered squealer tip

    SciTech Connect

    Lee, Ching-Pang

    2014-12-30

    A squealer tip formed from a pressure side tip wall and a suction side tip wall extending radially outward from a tip of the turbine blade is disclosed. The pressure and suction side tip walls may be positioned along the pressure sidewall and the suction sidewall of the turbine blade, respectively. The pressure side tip wall may include a chamfered leading edge with film cooling holes having exhaust outlets positioned therein. An axially extending tip wall may be formed from at least two outer linear surfaces joined together at an intersection forming a concave axially extending tip wall. The axially extending tip wall may include a convex inner surface forming a radially outer end to an inner cavity forming a cooling system. The cooling system may include one or more film cooling holes in the axially extending tip wall proximate to the suction sidewall, which promotes increased cooling at the pressure and suction sidewalls.

  9. Diabetes Medicines

    MedlinePlus

    ... Problems Diabetes & Sexual & Urologic Problems Insulin, Medicines, & Other Diabetes Treatments Taking insulin or other diabetes medicines is ... also available. What medicines might I take for diabetes? The medicine you take will vary by your ...

  10. Reducing outbreaks: using international governmental risk pools to fund research and development of infectious disease medicines and vaccines.

    PubMed

    Erfe, J Mark

    2014-12-01

    The deadliest Ebola outbreak the world has ever seen is currently ravaging West Africa, despite the concerted efforts of the World Health Organization and many national governments. The current picture is troubling, but not altogether unexpected. Ebola was initially identified in 1976, and since that time, few drugs have been developed to combat it. The same is true for myriad other dangerous infectious diseases to which the world is currently susceptible. One proposal that might prevent outbreaks of this scale and magnitude from recurring would be to have the World Health Organization (WHO) and its technical partners assess which of its member states are at high risk for a disease, either directly or indirectly, and facilitate the creation of international governmental risk pools of those member states. Risk pools would offer open-indexed grant contracts to fund vaccine and drug development for a particular disease, and pharmaceutical companies could browse the index to apply for these grants. If the risk-pool states and a particular company sign a contract, a mutually agreed upon amount of the vaccine or drug would be produced at a below-market purchase price for those states. In return, the company would keep any patents or intellectual property rights for the developed vaccines or drugs. Risk-pool countries that did not use their vaccine or drug could resell that supply on secondary markets to other countries outside of the risk pool. This arrangement will increase the supply of tested drug and vaccine candidates available for combatting unexpected outbreaks of any previously discovered major infectious disease in the future.

  11. Reducing Outbreaks: Using International Governmental Risk Pools to Fund Research and Development of Infectious Disease Medicines and Vaccines

    PubMed Central

    Erfe, J. Mark

    2014-01-01

    The deadliest Ebola outbreak the world has ever seen is currently ravaging West Africa, despite the concerted efforts of the World Health Organization and many national governments. The current picture is troubling, but not altogether unexpected. Ebola was initially identified in 1976, and since that time, few drugs have been developed to combat it. The same is true for myriad other dangerous infectious diseases to which the world is currently susceptible. One proposal that might prevent outbreaks of this scale and magnitude from recurring would be to have the World Health Organization (WHO) and its technical partners assess which of its member states are at high risk for a disease, either directly or indirectly, and facilitate the creation of international governmental risk pools of those member states. Risk pools would offer open-indexed grant contracts to fund vaccine and drug development for a particular disease, and pharmaceutical companies could browse the index to apply for these grants. If the risk-pool states and a particular company sign a contract, a mutually agreed upon amount of the vaccine or drug would be produced at a below-market purchase price for those states. In return, the company would keep any patents or intellectual property rights for the developed vaccines or drugs. Risk-pool countries that did not use their vaccine or drug could resell that supply on secondary markets to other countries outside of the risk pool. This arrangement will increase the supply of tested drug and vaccine candidates available for combatting unexpected outbreaks of any previously discovered major infectious disease in the future. PMID:25506281

  12. [Sports medicine in Germany].

    PubMed

    Dickhuth, H-H

    2005-08-01

    Sports medicine covers many different aspects, ranging from clinical specialties, such as internal medicine, orthopedics or pediatrics to physiology and sports sciences. The requirements for sports medicine evolve mainly from exercise physiology (elite, leisure and health oriented physical activity), orthopedics and traumatology as well as from preventive and rehabilitative issues. In the new German curriculum, sports medicine is defined as a subspecialty. Historically, sports medicine in Germany has a federal structure with a governing body (Deutsche Gesellschaft für Sportmedizin und Prävention). Due to these facts, University Departments of Sports Medicine (which vary greatly in size and performance) are either attached to Medical or non-Medical Faculties, such as Sports Sciences. In medical schools, sports medicine can be selected as an elective subject. However, the main part of teaching sports medicine is covered by Sports Science Faculties. In an international context, the strength of German sports medicine is its clinical orientation and close cooperation with the sport itself, especially high-performance sports. In the future, like in the Anglo- American countries, sports medicine in Germany will play a major role in health prevention and rehabilitation.

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

    PubMed

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

    2014-01-01

    Objectif : Étudier la préparation du départ des patients dans les unités de médecine interne générale des hôpitaux de soins actifs de l'Ontario du point de vue des physiothérapeutes. Méthodes : Une étude transversale portant sur l'utilisation d'un questionnaire en ligne a été envoyée aux participants en novembre 2011. Les caractéristiques démographiques des répondants et le classement des facteurs ont été analysés par statistique descriptive et l'on a procédé à des tests-t pour déterminer les différences entre groupes (compte tenu des caractéristiques démographiques). On a codé les réponses aux questions ouvertes de façon à dégager des thèmes. Résultats : La mobilité était considérée comme le principal facteur de la détermination de la préparation au départ. Les autres facteurs ont inclus la disponibilité des moyens de soutien social et des ressources communautaires. La communication entre les professions a été jugée importante, mais les processus étaient souvent informels. Les politiques sur le départ, la disponibilité au moment opportun d'autres options sur le plan du départ et les pressions exercées en faveur du départ hâtif ont une incidence sur la planification du départ. Les répondants ont aussi signalé un manque de formation en planification des départs et des anecdotes portant sur les dilemmes éthiques vécus par les répondants ont appuyé ces thèmes. Conclusions : Les physiothérapeutes tiennent compte de nombreux facteurs en plus de la fonction physique du patient au cours du processus de planification du départ. Il faudrait envisager d'améliorer la communication et la répartition des ressources au sein de l'équipe pour faire face aux réalités de la planification des départs.

  14. A survey of emergency medical services in mountain areas of Europe and North America: official recommendations of the International Commission for Mountain Emergency Medicine (ICAR Medcom).

    PubMed

    Brugger, Hermann; Elsensohn, Fidel; Syme, Dave; Sumann, Günther; Falk, Markus

    2005-01-01

    Survey of on-site treatment of patients in mountain areas of 14 countries in Europe and North America (nonresponder rate 33%) to compare emergency medical services. Around 37,535 ground rescuers and 747 helicopters are ready for evacuation of casualties and patients in mountain areas. And 1316 physicians and 50,967 paramedics take part in ground and air mountain rescue operations. In Europe, 63.2% of helicopters have a physician on board, 17.8% are staffed with a paramedic, and 19% have no medically trained personnel on board. In North America, 31.6% (p < 0.001) of helicopters are staffed with a doctor, 59.3% (p < 0.001) with a paramedic, and 9.1% (p < 0.001) have no medical personnel. The percentage of on-site treatment according to the recommendations of the International Liaison Committee on Resuscitation (ILCOR) or International Commission for Alpine Rescue (ICAR) varies among all countries (p < 0.001) and is positively related to the percentage of physician-staffed helicopters (r = 0.76, p < 0.001). Paramedics in 90.9% countries are obliged to be medically trained, but physicians only need to have a standardized training in emergency medicine in 50% (p < 0.042). On-site treatment according to ILCOR or ICAR recommendations is performed more often in countries where physicians are regularly involved in mountain rescue operations. However, no conclusions can be drawn from the data as to the efficiency of treatment. The data show a lack of medical education in specific, mountain rescue-related problems. Physicians involved should undergo suitable training.

  15. Tipping Points in Texas Rivers

    NASA Astrophysics Data System (ADS)

    Phillips, Jonathan

    2016-04-01

    Anticipating geomorphic tipping points requires that we learn from the past. Major geomorphic changes in coastal plain rivers of Texas resulting in river metamorphosis or regime shifts were identified, and the major driving factors determined. Nine fluvial tipping points were identified from contemporary observations, historical records, and Quaternary reconstructions. Two of the tipping points (between general aggrading and degrading valley states) are associated with reversals in a fundamental system control (sea-level). One (stable or aggrading vs. degrading channels) is associated with an abrupt change in sediment supply due to dam construction, and two others (changes from meandering to anastomosing channel patterns, and different anastomosis styles) are similarly related to changes in sediment supply and/or transport capacity, but with additional elements of historical contingency. Three tipping points are related to avulsions. One, from a regime dominated to reoccupation of former channels to one dominated by progradation into flood basins, is driven by progressive long term filling of incised valleys. Another, nodal avulsions, are driven by disturbances associated with tectonics or listric faults. The third, avulsions and related valley metamorphosis in unfilled incised valleys, is due to fundamental dynamical instabilities within the fluvial system. This synthesis and analysis suggests that geomorphic tipping points are sometimes associated with general extrinsic or intrinsic (to the fluvial system) environmental change, independent of any disturbances or instabilities. Others are associated with natural (e.g., tectonic) or human (dams) disturbances, and still others with intrinsic geomorphic instabilities. This suggests that future tipping points will be equally diverse with respect to their drivers.

  16. Fluid management in traumatic shock: a practical approach for mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    PubMed

    Sumann, Günther; Paal, Peter; Mair, Peter; Ellerton, John; Dahlberg, Tore; Zen-Ruffinen, Gregoire; Zafren, Ken; Brugger, Hermann

    2009-01-01

    Sumann, Günther, Peter Paal, Peter Mair, John Ellerton, Tore Dahlberg, Gregoire Zen-Ruffinen, Ken Zafren, and Hermann Brugger. Fluid management in traumatic shock: a practical approach for mountain rescue. High Alt. Med. Biol. 10:71-75, 2009.-The management of severe injuries leading to traumatic shock in mountains and remote areas is a great challenge for emergency physicians and rescuers. Traumatic brain injury may further aggravate outcome. A mountain rescue mission may face severe limitations from the terrain and required rescue technique. The mission may be characterized by a prolonged prehospital care time, where urban traumatic shock protocols may not apply. Yet optimal treatment is of utmost importance. The aim of this study is to establish scientifically supported recommendations for fluid management that are feasible for the physician or paramedic attending such an emergency. A nonsystematic literature search was performed; the results and recommendations were discussed among the authors and accepted by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Diagnostic and therapeutic strategies are discussed, as well as limitations on therapy in mountain rescue. An algorithm for fluid resuscitation, derived from the recommendations, is presented in Fig. 1. Focused on the key criterion of traumatic brain injury, different levels of blood pressure are presented as a goal of therapy, and the practical means for achieving these are given.

  17. Use of short message service reminders to improve attendance at an internal medicine outpatient clinic in Saudi Arabia: a randomized controlled trial.

    PubMed

    Youssef, A

    2014-06-09

    Non-attendance at outpatient appointments is a major problem. This study aimed to evaluate the efficacy of sending short message service (SMS) reminders to patients' mobile phones in reducing non-attendance at scheduled appointments. A randomized clinical trial was conducted in 2011 in an internal medicine outpatient clinic at a hospital in Eastern Province, Saudi Arabia. Eligible patients (n = 502) were randomly allocated to receive an SMS reminder of their appointment (intervention group) or no reminder (control group). The non-attendance rate was significantly lower in the reminder group (26.3%) than the non-reminder group (39.8%). In multivariate logistic regression, age, sex and nationality did not affect attendance rates but having their first contact with the hospital (OR = 7.40) and not receiving an SMS reminder (OR = 0.56) were significant factors in non-attendance. All patients surveyed about their perceptions of the SMS reminder (n = 76) reported they would like to continue to receive SMS reminders in the future.

  18. [Palliative care consultation in the ICU : Descriptive analysis of internal medicine intensive care using a mixed model over 12 months].

    PubMed

    Lenz, K; Hofmann-Bichler, B; Pihringer, J; Firlinger, F; Pickl, A; Clodi, M

    2017-02-01

    We retrospectively analyzed the data of 56 of 669 critically ill patients admitted to an internal medicine intensive care unit (ICU) with palliative care provided by a palliative care team over the period of 12 months. For delivering palliative care, we used a mixed model-consisting of both integrative and consultative elements. SAPS III severity score in patients with palliative care was 63 ± 15 compared to 50 ± 15 in all critically ill patients. Hospital mortality was 62.5 vs. 16%. After 3 months, 19.6% of patients with palliative care provided by the palliative care team were still alive. In 15 patients curative therapies were discontinued, while there was no further escalation of the therapy in 30 patients. In 47 patients, special help to the relatives was offered. In 13 cases, there was a disagreement between relatives and the ICU team; in 5 cases a family conference was implemented. Two patients wanted extensive intensive care therapy, despite unfavorable prognosis; one patient wished to die. One patient had an advanced directive.

  19. [The oldest German textbook on internal medicine of horses, edited at the Kayserlich-Köngliche Pferd-Cur und Operations Schul in Vienna in 1770].

    PubMed

    Greiner, S

    1996-06-01

    The manuscript has the title: "Erkandtnus deren innerlichen Krankheiten des Pferds überhaupt". Through two take downs of the lectures of Ludwig Scotti, the founder of the first school for veterinarians in the German speaking part of Europe and its first teacher, the manuscript is identified as another take down. The first part of the manuscript, which is about internal medicine, in large passages is a literally translation of Lafosse's "Guide de Maréchal". In most passages the second part, which is about pharmacology, is a copy of the German translation of Claude Bourgelat's "Matière médicale" published in 1766. Nevertheless Scotti brings in his own experiences by inserting in or rewriting of some chapters or by adding other theories, likewise his prescriptions cannot be found in Bourgelat's book. The manuscript is an example for the highest level in veterinary science in the second half of the 18th century. This is emphasized through the comparison with contemporary literature in German language, for example the books of von Sind and Deigendesch.

  20. Immobilization and splinting in mountain rescue. Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations.

    PubMed

    Ellerton, John; Tomazin, Iztok; Brugger, Hermann; Paal, Peter

    2009-01-01

    Immobilization and splinting of fractures are essential to reduce morbidity and mortality in mountain rescue. Therefore, members of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) debated the results of a literature review carried out by the authors. Focusing on common immobilization and splinting techniques relevant to mountain rescue, a consensus document was formulated. Pain relief of appropriate speed of onset and strength should be available on scene. Spinal immobilization is recommended for all casualties that have sustained head or spine injury. The preferred method is a vacuum mattress with an appropriately sized rigid cervical collar. In such casualties, only those in an unsafe environment or with time-critical injuries should be evacuated before spinal immobilization is performed. In some casualties, the cervical spine may be cleared and a cervical collar may be omitted. In the presence of hemodynamic instability and where there is a suspicion of a fractured pelvis, an external compression splint should be applied. Splinting of a femoral shaft fracture is important to limit pain and life-threatening blood loss. If time allows, extremity fractures should be adequately splinted and, if the practitioner is skilled, a displaced fracture or joint dislocation should be reduced on scene with the use of appropriate analgesia.

  1. Pattern of antibiotic prescription and resistance profile of common bacterial isolates in the internal medicine wards of a tertiary referral centre in Nigeria.

    PubMed

    Iliyasu, Garba; Dayyab, Farouq M; Bolaji, Tiamiyu A; Habib, Zaiyad G; Takwashe, Isa M; Habib, Abdulrazaq G

    2015-06-01

    Indiscriminate and excessive use of antibiotics is the major driver to the development of bacterial resistance, which is now a global challenge. Information regarding antibiotic use in Nigerian hospitals is lacking. This study examined the pattern of antibiotic prescription in a tertiary hospital in Nigeria. In a retrospective survey, case records of patients who were admitted into the medical wards over a 6-month period were reviewed. A pre-formed questionnaire was administered that sought information such as sociodemographic data, drug data, basis of prescription and other relevant information on all patients who received antibiotics. Data were analysed using SPSS for Windows v.16. Of 412 patients admitted into the internal medicine ward during the study period, 202 (49.0%) received antibiotics, of whom 125 (61.9%) received more than one antibiotic. Overall there were 334 antibiotic prescriptions. Community-acquired pneumonia (67/202; 33.2%) was the leading cause of antibiotic prescription, and ceftriaxone (132/334; 39.5%) was the most commonly prescribed antibiotic. The parenteral route was the commonest route of administration (270/334; 80.8%) and most of the prescriptions were empirical (323/334; 96.7%). Antimicrobial resistance among common bacterial isolates was noted. Inappropriate antibiotic prescription is common. There was frequent use of third-generation cephalosporins as empirical therapy, with de-escalation in only a handful of cases. This highlights the need for introduction of antibiotic guidelines.

  2. Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

    PubMed

    Ellerton, John A; Zuljan, Igor; Agazzi, Giancelso; Boyd, Jeffrey J

    2009-01-01

    Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

  3. Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program's findings

    PubMed Central

    Friedman, Karen A.; Balwan, Sandy; Cacace, Frank; Katona, Kyle; Sunday, Suzanne; Chaudhry, Saima

    2014-01-01

    Purpose As graduate medical education (GME) moves into the Next Accreditation System (NAS), programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. Method We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010–2011 (pre-Dreyfus model) and 2011–2012 (post-Milestone model) in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME) competencies. Results Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. Conclusions For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class. PMID:25425408

  4. International Youth Justice Systems: Promoting Youth Development and Alternative Approaches: A Position Paper of the Society for Adolescent Health and Medicine.

    PubMed

    2016-10-01

    Youth incarceration is an international public health concern among developed and developing countries. Worldwide, youth are held in incarceration, detention, and other secure settings that are inappropriate for their age and developmental stages, jeopardizing their prosocial development, and reintegration into society. Youth incarceration lacks evidence and cost-effectiveness. The well-being of youth is a key indicator of the welfare of families, communities, and society at large; therefore, the Society for Adolescent Health and Medicine (SAHM) supports a paradigm shift in the role of the justice system as it relates to treatment of youth. SAHM recommends justice systems focus greater attention and resources on identifying and reducing the antecedents of high-risk and criminal behaviors, recognizing the rights and freedom of young persons, and prioritizing the well-being of youth over punitive measures that may harm and disrupt healthy adolescent development. SAHM supports the following positions: (1) incarceration is a last option for selected offenders who have committed the most serious violent crimes and are unable to remain safely in the community; (2) youth justice policies, programs, and practices affecting youth be evidence based and trauma informed; (3) youth justice policies, programs, and practices must incorporate research and ongoing program evaluation; (4) youth justice policies shall protect the privacy and dignity of children younger than 18 years; and (5) health care professionals and media will promote positive portrayals of youth in healthy relationships within their communities and reduce representations and images of youth that are negative, violent, deviant, and threatening.

  5. Research With Scanning Tip Microscopy

    DTIC Science & Technology

    1991-12-31

    08ro P noiwe bae?041Le Research With Scanning Tip Microscopy AFOSR-89-0498 V AUTHOS)i Professor Dror Sarid 7. PFOUImNG 00ANIZATION NAMEIS) AND...forces and (b) surfaces. UNCLASS UNCLASS UNCLASS UL FINAL REPORT TO THE AFOSR ൱-, to J4ti. r Aat io Research in Scanning Tip Microscopy Dror Sarid Dtst...microscopy have been used to investigate (a) forces and (b) surfaces. a. Forces 1. Dror Sarid , Douglas lams, Volker Weissenberger, and L. Stephen Bell

  6. External cervical resorption: diagnostic and treatment tips

    PubMed Central

    Consolaro, Alberto

    2016-01-01

    ABSTRACT External cervical resorption is caused, almost exclusively, by dental trauma - especially those characterized by concussion - and is a dental disease to be diagnosed and treated accurately by endodontists. However, the vast majority of the cases is initially diagnosed by an orthodontist, due to the imaging possibilities in standardized documentations. Among the causes of external cervical resorption, it is common to mistakenly attribute it to orthodontic treatment, traumatic occlusion or even to chronic inflammatory periodontal disease. External cervical resorption is associated to dental trauma in several situations mentioned in this paper. In old cases, and eventually still nowadays, it may have been induced by internal tooth bleaching, which is increasingly less frequent in endodontically treated teeth. There are some tips to be followed and some care that must be taken during the diagnosis and treatment of external cervical resorption clinical cases. The present study lists foundations that will allow the professional to perform safely and accurately in each specific case. Some of these tips and care measures are of orthodontic nature. PMID:27901225

  7. Scanning tip microwave near field microscope

    DOEpatents

    Xiang, Xiao-Dong; Schultz, Peter G.; Wei, Tao

    1998-01-01

    A microwave near field microscope has a novel microwave probe structure wherein the probing field of evanescent radiation is emitted from a sharpened metal tip instead of an aperture or gap. This sharpened tip, which is electrically and mechanically connected to a central electrode, extends through and beyond an aperture in an endwall of a microwave resonating device such as a microwave cavity resonator or a microwave stripline resonator. Since the field intensity at the tip increases as the tip sharpens, the total energy which is radiated from the tip and absorbed by the sample increases as the tip sharpens. The result is improved spatial resolution without sacrificing sensitivity.

  8. Scanning tip microwave near field microscope

    DOEpatents

    Xiang, X.D.; Schultz, P.G.; Wei, T.

    1998-10-13

    A microwave near field microscope has a novel microwave probe structure wherein the probing field of evanescent radiation is emitted from a sharpened metal tip instead of an aperture or gap. This sharpened tip, which is electrically and mechanically connected to a central electrode, extends through and beyond an aperture in an end wall of a microwave resonating device such as a microwave cavity resonator or a microwave stripline resonator. Since the field intensity at the tip increases as the tip sharpens, the total energy which is radiated from the tip and absorbed by the sample increases as the tip sharpens. The result is improved spatial resolution without sacrificing sensitivity. 17 figs.

  9. Teaching Tips: Improving College Instruction.

    ERIC Educational Resources Information Center

    McGlynn, Angela Provitera

    Designed to help teachers improve instruction, this handbook provides tips gathered from focus groups of teachers and students at New Jersey's Mercer County Community College, as well as from other teaching resources. The first part focuses on the contribution of faculty-student interaction to student success, listing 21 suggestions for building…

  10. STRV Cryocooler Tip Motion Suppression

    NASA Technical Reports Server (NTRS)

    Glaser, R.; Ross, R. G., Jr.; Johnson, D. L.

    1994-01-01

    The Space Technology Research Vehicle (STRV-1b) scheduled to fly at the beginning of June 1994, has a cryocooler vibration suppression experiment aboard doing motion suppression of the tip of the coldfinger. STRV-1b is a bread box sized satellite to be launched on the next flight of the Ariane-4.

  11. Library Management Tips that Work

    ERIC Educational Resources Information Center

    Smallwood, Carol, Ed.

    2011-01-01

    There's no shortage of library management books out there--but how many of them actually tackle the little details of day-to-day management, the hard-to-categorize things that slip through the cracks of a larger handbook? "Library Management Tips that Work" does exactly that, addressing dozens of such issues facing library managers, including: (1)…

  12. 99 Tips for Safe Schools.

    ERIC Educational Resources Information Center

    Kaufer, Steve

    This pamphlet highlights 99 tips for maintaining safe schools. Areas of interest include: alarm systems and control of access, vandalism, parent education, transportation, school design, personnel training, and graffiti. The majority of the pointers deal with maintaining and implementing various forms of electronic surveillance and strategies for…

  13. Assigning Effective Homework. Classroom Tips

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2010

    2010-01-01

    Each new school year brings high hopes, great expectations and challenges for both new and seasoned educators. The American Federation of Teachers (AFT) has developed a series called "Classroom Tips" to help educators start the year right and anticipate the year ahead. Over the past 40 years, most research studies on homework have found that…

  14. Turbine blade tip flow discouragers

    DOEpatents

    Bunker, Ronald Scott

    2000-01-01

    A turbine assembly comprises a plurality of rotating blade portions in a spaced relation with a stationery shroud. The rotating blade portions comprise a root section, a tip portion and an airfoil. The tip portion has a pressure side wall and a suction side wall. A number of flow discouragers are disposed on the blade tip portion. In one embodiment, the flow discouragers extend circumferentially from the pressure side wall to the suction side wall so as to be aligned generally parallel to the direction of rotation. In an alternative embodiment, the flow discouragers extend circumferentially from the pressure side wall to the suction side wall so as to be aligned at an angle in the range between about 0.degree. to about 60.degree. with respect to a reference axis aligned generally parallel to the direction of rotation. The flow discouragers increase the flow resistance and thus reduce the flow of hot gas flow leakage for a given pressure differential across the blade tip portion so as to improve overall turbine efficiency.

  15. Blade tip timing (BTT) uncertainties

    NASA Astrophysics Data System (ADS)

    Russhard, Pete

    2016-06-01

    Blade Tip Timing (BTT) is an alternative technique for characterising blade vibration in which non-contact timing probes (e.g. capacitance or optical probes), typically mounted on the engine casing (figure 1), and are used to measure the time at which a blade passes each probe. This time is compared with the time at which the blade would have passed the probe if it had been undergoing no vibration. For a number of years the aerospace industry has been sponsoring research into Blade Tip Timing technologies that have been developed as tools to obtain rotor blade tip deflections. These have been successful in demonstrating the potential of the technology, but rarely produced quantitative data, along with a demonstration of a traceable value for measurement uncertainty. BTT technologies have been developed under a cloak of secrecy by the gas turbine OEM's due to the competitive advantages it offered if it could be shown to work. BTT measurements are sensitive to many variables and there is a need to quantify the measurement uncertainty of the complete technology and to define a set of guidelines as to how BTT should be applied to different vehicles. The data shown in figure 2 was developed from US government sponsored program that bought together four different tip timing system and a gas turbine engine test. Comparisons showed that they were just capable of obtaining measurement within a +/-25% uncertainty band when compared to strain gauges even when using the same input data sets.

  16. [Management of patients with TIPS].

    PubMed

    Dailleau, Édith; Dos Santos, Sophie; Garçon, Adrien; Russeil, Cécile; Brajon, Stéphanie

    2015-01-01

    The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is now performed in almost twenty hospitals in France, including Tours university hospital. The aim is to reduce portal hypertension (PHT) by diverting the portal system to the caval system within the liver. The main cause of PHT is cirrhosis, which may be of alcoholic, viral, dysmetabolic or autoimmune origin.

  17. Predicting casualties implied by TIPs

    NASA Astrophysics Data System (ADS)

    Trendafiloski, G.; Wyss, M.; Wyss, B. M.

    2009-12-01

    When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral

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

    PubMed

    Bahri, Priya; Harrison-Woolrych, Mira

    2012-12-01

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

  19. Travel and Adventure Medicine Resources.

    PubMed

    Sanford, Christopher A; Pottinger, Paul S

    2016-03-01

    Given the ever-changing nature of travel medicine, practitioners who provide pretravel and posttravel care are obligatorily students for the duration of their professional careers. A large variety of resources are available for medical practitioners. Providers should join at least one travel or tropical medicine professional association, attend its annual meeting, and read its journal. The largest general travel medicine association is the International Society of Travel Medicine.

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

    PubMed

    Francès, C

    2008-12-01

    Brief virologic news included the discovery of the virophage, a unique parasite of the giant mimivirus and the association of HHV-8 infection with a peculiar form of African diabetes. Secondly, this news focused on risk factors for arterial or venous thrombosis and therapy for auto-immune disorders. Only oral estrogen therapy increases the risk of venous thromboembolism in postmenopausal women. Despite significant homocysteine lowering, vitamin supplementation with folic acid, vitamins B6 and B12 did not reduce total cardiovascular events among high-risk patients. Patients with venous thromboembolism have a substantially increased long-term risk of subsequent cardiovascular events while obesity, systemic arterial hypertension, and diabetes are common risk factors for arterial and venous thrombosis. The non fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infection in all ethnic groups. Preventive anticoagulation of in-patients with risk of venous thromboembolism was inadequately prescribed in many hospitals of the world. Subcutaneous administration of methotrexate was more effective than the oral administration at the same dosage in patients suffering from active rheumatoid arthritis. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Anti-IL-5 and anti-IL-6 antibodies were effective for the treatment of respectively hypereosinophilic syndrome and rheumatoid arthritis. The efficacy of proteasome inhibitors and mesenchymal stems cells have been demonstrated in respectively two mouse strains with lupus-like disease and steroid-resistant severe acute graft-versus-host disease. These treatments may be useful for auto-immune disorders if their long term toxicity is acceptable. In conclusion, subcutaneous injections of physiological saline, used as placebo in two different trials, enhanced in vitro activation of immunocompetent cells in healthy individuals.

  1. Tips for Reducing Pesticide Impacts on Wildlife

    EPA Pesticide Factsheets

    This Web page provides tips for pesticide users in residential and agricultural settings, as well as tips for certified pesticide applicators for ways to protect wildlife from potentially harmful effects of pesticides.

  2. [Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)].

    PubMed

    Diagne, Nafissatou; Faye, Atoumane; Ndao, Awa Cheikh; Djiba, Boundia; Kane, Baidy Sy; Ndongo, Souhaibou; Pouye, Abdoulaye

    2016-01-01

    Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.

  3. [A retrospective study on the incidence of chronic renal failure in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo (the capital city of Madagascar)].

    PubMed

    Ramilitiana, Benja; Ranivoharisoa, Eliane Mikkelsen; Dodo, Mihary; Razafimandimby, Evanirina; Randriamarotia, Willy Franck

    2016-01-01

    Chronic renal failure is a global public health problem. In developed countries, this disease occurs mainly in the elderly, but in Africa it rather affects active young subjects. This disease need for expensive treatments in a low income country, because of its costs. Our aim is to describe the epidemiology of new cases of chronic renal failure in Madagascar. This is a retrospective, descriptive study of 239 patients with chronic renal failure over a 3 year period, starting from 1 January 2007 to 31 December 2009, in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo. The incidence was 8.51% among patients hospitalized in the Department. The average age of patients was 45.4 years with extremes of 16 and 82 years and a sex ratio 1,46. The main antecedent was arterial hypertension (59.8%). Chronic renal failure was terminal in 75.31% of the cases (n=180). The causes of chronic renal failure were dominated by chronic glomerulonephritis (40.1%), nephroangiosclerosis (35.5%). Hemodialysis was performed in 3 patients (1.26%), no patient was scheduled for a renal transplantation. Mortality rate in the Department was 28.87%. Chronic renal failure is a debilitating disease with a dreadful prognosis which affects young patients in Madagascar. Its treatment remains inaccessible to the majority of patients. The focus must be mainly on prevention, especially on early effective management of infections, arterial hypertension and diabetes to reduce its negative impacts on the community and public health. The project on renal transplantation: living donor, effective and less expensive treatment compared to hemodialysis could also be a good solution for these Malagasy young subjects.

  4. Effectiveness of an educational intervention on the management of type 2 diabetic patients hospitalized in Internal Medicine: results from the FADOI-DIAMOND study.

    PubMed

    Gulli, Giovanni; Frasson, Stefania; Borzì, Vito; Fontanella, Andrea; Grandi, Marco; Marengo, Claudio; Nicolucci, Antonio; Pastorelli, Ruggero; Solerte, Bruno; Gatti, Adriano; Raimondo, Francesco Cristiano; Bonizzoni, Erminio; Gussoni, Gualberto; Mazzone, Antonino; Ceriello, Antonio

    2014-10-01

    Appropriate management of hyperglycemia is crucial for patients with type 2 diabetes. Aim of the FADOI-DIAMOND study was to evaluate real-world management of type 2 diabetic patients hospitalized in Internal Medicine wards (IMW) and the effects of a standardized educational intervention for IMW staff. DIAMOND has been carried out in 53 Italian IMW, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase). In PRE phase, each center reviewed the charts of the last 30 hospitalized patients with known type 2 diabetes. An educational program was conducted in each center by means of the "outreach visit," a face-to-face meeting between IMW staff and a trained external expert. Six months after, each center repeated the data collection (POST phase), specular to the PRE. A total of 3,167 patients were enrolled (1,588 PRE and 1,579 POST). From PRE phase to POST, patients with registered anthropometric data (54.1 vs. 74.9 %, p < 0.001) and in-hospital/recent measurement of glycated hemoglobin (48.2 vs. 61.4 %, p < 0.005) increased significantly. After educational program, more patients received insulin during hospitalization (68.3 vs. 63.6 %, p = 0.005). A more relevant variation in glycemia during hospitalization was observed in POST phase than PRE (-22.2 vs. -15.5 mg/dL, p < 0.001), without differences as for occurrence of hypoglycemia (12.3 vs. 11.9 %). A one-shot educational intervention led to persistent improvement in the management of hospitalized patients with type 2 diabetes and to significant better glycemic control. Further studies might evaluate the effectiveness of a more aggressive educational program, on both management and outcomes.

  5. Tip cap for a rotor blade

    NASA Technical Reports Server (NTRS)

    Kofel, W. K.; Tuley, E. N.; Gay, C. H., Jr.; Troeger, R. E.; Sterman, A. P. (Inventor)

    1983-01-01

    A replaceable tip cap for attachment to the end of a rotor blade is described. The tip cap includes a plurality of walls defining a compartment which, if desired, can be divided into a plurality of subcompartments. The tip cap can include inlet and outlet holes in walls thereof to permit fluid communication of a cooling fluid there through. Abrasive material can be attached with the radially outer wall of the tip cap.

  6. Aerospace Medicine

    NASA Technical Reports Server (NTRS)

    Michaud, Vince

    2015-01-01

    NASA Aerospace Medicine overview - Aerospace Medicine is that specialty area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space.

  7. Nuclear Medicine.

    ERIC Educational Resources Information Center

    Badawi, Ramsey D.

    2001-01-01

    Describes the use of nuclear medicine techniques in diagnosis and therapy. Describes instrumentation in diagnostic nuclear medicine and predicts future trends in nuclear medicine imaging technology. (Author/MM)

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

    PubMed Central

    Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward. PMID:28164113

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

    PubMed

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

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

  10. Extended family medicine training

    PubMed Central

    Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.

    2016-01-01

    Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of

  11. Heart failure - medicines

    MedlinePlus

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  12. Coated fiber tips for optical instrumentation

    NASA Astrophysics Data System (ADS)

    Barton, John B.; Chanda, Sheetal; Locknar, Sarah A.; Carver, Gary E.

    2016-03-01

    Compact optical systems can be fabricated by integrating coatings on fiber tips. Examples include fiber lasers, fiber interferometers, fiber Raman probes, fiber based spectrometers, and anti-reflected endoscopes. These interference filters are applied to exposed tips - either connectorized or cleaved. Coatings can also be immersed within glass by depositing on one tip and connecting to another uncoated tip. This paper addresses a fiber spectrometer for multispectral imaging - useful in several fields including biomedical scanning, flow cytometry, and remote sensing. Our spectrometer integrates serial arrays of reflecting fiber tips, delay lines between these elements, and a single element detector.

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  14. Advanced turbine blade tip seal system

    NASA Technical Reports Server (NTRS)

    Zelahy, J. W.

    1981-01-01

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

  15. Parametric tip effects for conformable rotor applications

    NASA Technical Reports Server (NTRS)

    Mantay, W. R.; Yeager, W. T., Jr.

    1983-01-01

    A research study was initiated to systematically determine the impact of selected blade tip geometric parameters on aeroelasticity conformable rotor performance and loads characteristics. The model articulated rotors included baseline and torsionally soft blades with interchangeable tips. Seven blade tip designs were evaluated on the baseline rotor and three tip designs were tested on the torsionally soft blades. The designs incorporated a systematic variation in three geometric parameters: sweep, taper, and anhedral. The rotors were evaluated in the NASA Langley Transonic Dynamics Tunnel at several advance ratios, lift and propulsive force values, and tip Mach numbers. Based on the test results, tip parameter variations generated significant rotor performance and loads difference for both baseline and torsionally soft blades. Azimuthal variation of elastic twist generated by the tip parameters strongly correlated with rotor performance and loads, but the magnitude of advancing blade elastic twist did not correlate.

  16. Individualized medicine, health medicine, and constitutional theory in Chinese medicine.

    PubMed

    Wang, Qi

    2012-03-01

    The patterns of modern science and changes in the medical model can result in the transformation of the current state of individualized and health medicines into being the primary trend in medical development. Chinese and Western medical systems are dissimilar in terms of value orientations, thinking style, and research directions because of their different historical and cultural backgrounds. Individualized treatment in modern medicine is mainly established based on individual genome information and the differences in mononucleotide polymorphisms. However, such treatment method is expensive, creates an uncertain genetic marker, and leads to different result interpretations, among other problems. The Chinese constitutional theory developed in the 1970s expresses the principle behind Chinese health medicine and individual treatment and provides the corresponding methods. The Chinese constitutional theory divides the constitution of the Chinese population into nine categories based on established classification criteria. It promotes the study of the relationship of each constitution to diseases and Chinese medicine preparation toward adjusting the constitution and preventing diseases. The theory also provides methods and tools for individualized treatment. Constitution identification shows the direction and provides the core technology for the evaluation of the health status. By combining the developments in modern biotechnology, new diagnostic techniques and treatment models of constitution-differentiation, disease-differentiation, and syndrome-differentiation can be established for the development of individualized Chinese medicine treatment and health medicine for the international medical community.

  17. The grapevine tonoplast aquaporin TIP2;1 is a pressure gated water channel.

    PubMed

    Leitão, Luís; Prista, Catarina; Loureiro-Dias, Maria C; Moura, Teresa F; Soveral, Graça

    2014-07-18

    In plants, the vacuole is a multifunctional organelle with an important role in the maintenance of the intracellular space. Tonoplast membranes are highly permeable to water due to their content in aquaporins TIPs (Tonoplast Intrinsic Proteins) that allow the rapid water influx creating an internal turgor pressure responsible for cell expansion, elongation and shape. The aim of the present study was to evaluate if the grapevine Vitis vinifera TIP2;1 would operate as a possible volume regulator gated by membrane surface tension. For that, the wild type VvTIP2;1 and a non-functional mutated form were heterologous expressed in yeast. Using an experimental strategy in which cells are incubated in external media that induce an increase in internal hydrostatic pressure and consequently membrane surface tension, we were able to compare the osmotic permeability (Pf) and the activation energy for water transport (Ea) of yeast strains expressing the functional and a non-functional TIP2;1. We found Pf and Ea dependence on internal turgor pressure only for the strain harboring the functional aquaporin indicating that TIP2;1 activity is regulated by membrane tension changing from an open to a closed state in an internal pressure dependent manner. This turgor dependent gating of TIP2;1 might be a mechanism to regulate vacuolar size and shape in plants withstanding hostile drought conditions such as grapevine.

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

    PubMed

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

    2016-08-01

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

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

    NASA Technical Reports Server (NTRS)

    Shyam, Vikram; Ameri, Ali

    2012-01-01

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

  20. Traceability in nuclear medicine

    NASA Astrophysics Data System (ADS)

    Zimmerman, Brian E.; Judge, Steven

    2007-08-01

    Accurate, reproducible measurement of radioactivity in nuclear medicine applications is vital to ensure the safety and effectiveness of disease diagnosis and treatment using unsealed radioactive sources. The need to maintain a high degree of confidence in those measurements requires that they be carried out so as to be traceable to national and international standards. In addition, measurement traceability for radioactivity in medicine helps ensure international consistency in measurement at all levels of practice (national measurement laboratories, research institutions, isotope producers, radiopharmaceutical manufacturers and clinics). This paper explores the importance of radioactivity measurement in nuclear medicine and demonstrates how traceability can be extended from international standards to the quantity of the drug administered to the patient.

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

    NASA Astrophysics Data System (ADS)

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

    2015-05-01

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

  2. Endoscopic septoplasty: Tips and pearls.

    PubMed

    Pons, Y; Champagne, C; Genestier, L; Ballivet de Régloix, S

    2015-12-01

    This article is designed to provide a step-by-step description of our endoscopic septoplasty technique and discuss its difficulties and technical tips. Endoscopic septoplasty comprises 10 steps: diagnostic endoscopy, subperichondral infiltration, left mucosal incision, dissection of the left subperichondral flap, cartilage incision (0.5 centimetre posterior to the mucosal incision), dissection of the right subperichondral flap, anterior cartilage resection, perpendicular plate dissection, dissection and resection of the maxillary crest, endoscopic revision, mucosal suture and Silastic stents. A satisfactory postoperative result was observed at 3 months in 97% of cases in this series. The main contraindication to endoscopic septoplasty is anterior columellar deviation of the nasal septum requiring a conventional procedure.

  3. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a list of recommendations and additional conclusions: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

    PubMed

    Le Roux, Peter; Menon, David K; Citerio, Giuseppe; Vespa, Paul; Bader, Mary Kay; Brophy, Gretchen; Diringer, Michael N; Stocchetti, Nino; Videtta, Walter; Armonda, Rocco; Badjatia, Neeraj; Bösel, Julian; Chesnut, Randall; Chou, Sherry; Claassen, Jan; Czosnyka, Marek; De Georgia, Michael; Figaji, Anthony; Fugate, Jennifer; Helbok, Raimund; Horowitz, David; Hutchinson, Peter; Kumar, Monisha; McNett, Molly; Miller, Chad; Naidech, Andrew; Oddo, Mauro; Olson, DaiWai; O'Phelan, Kristine; Provencio, J Javier; Puppo, Corinna; Riker, Richard; Roberson, Claudia; Schmidt, Michael; Taccone, Fabio

    2014-12-01

    Careful patient monitoring using a variety of techniques including clinical and laboratory evaluation, bedside physiological monitoring with continuous or non-continuous techniques and imaging is fundamental to the care of patients who require neurocritical care. How best to perform and use bedside monitoring is still being elucidated. To create a basic platform for care and a foundation for further research the Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to develop recommendations about physiologic bedside monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews as a background to the recommendations. In this article, we highlight the recommendations and provide additional conclusions as an aid to the reader and to facilitate bedside care.

  4. Blade Tip Rubbing Stress Prediction

    NASA Technical Reports Server (NTRS)

    Davis, Gary A.; Clough, Ray C.

    1991-01-01

    An analytical model was constructed to predict the magnitude of stresses produced by rubbing a turbine blade against its tip seal. This model used a linearized approach to the problem, after a parametric study, found that the nonlinear effects were of insignificant magnitude. The important input parameters to the model were: the arc through which rubbing occurs, the turbine rotor speed, normal force exerted on the blade, and the rubbing coefficient of friction. Since it is not possible to exactly specify some of these parameters, values were entered into the model which bracket likely values. The form of the forcing function was another variable which was impossible to specify precisely, but the assumption of a half-sine wave with a period equal to the duration of the rub was taken as a realistic assumption. The analytical model predicted resonances between harmonics of the forcing function decomposition and known harmonics of the blade. Thus, it seemed probable that blade tip rubbing could be at least a contributor to the blade-cracking phenomenon. A full-scale, full-speed test conducted on the space shuttle main engine high pressure fuel turbopump Whirligig tester was conducted at speeds between 33,000 and 28,000 RPM to confirm analytical predictions.

  5. The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements.

    PubMed

    Cohen, Jillian Clare; Illingworth, Patricia

    2003-05-01

    In this paper, we provide an overview of how the outcomes of the Uruguay Round affected the application of pharmaceutical intellectual property rights globally. Second, we explain how specific pharmaceutical policy tools can help developing states mitigate the worst effects of the TRIPS Agreement. Third, we put forward solutions that could be implemented by the World Bank to help overcome the divide between creating private incentives for research and development of innovative medicines and ensuring access of the poor to medicine. Fourth, we evaluate these solutions on the basis of utilitarian considerations and urge that equitable pricing is morally preferable to the other solutions.

  6. Turbine blade tip with offset squealer

    DOEpatents

    Bunker, Ronald Scott

    2001-01-01

    An industrial turbine assembly comprises a plurality of rotating blade portions in a spaced relation with a stationary shroud. The rotating blade includes a root section, an airfoil having a pressure sidewall and a suction sidewall defining an outer periphery and a tip portion having a tip cap. An offset squealer is disposed on the tip cap. The offset squealer is positioned inward from the outer periphery of the rotating blade. The offset squealer increases the flow resistance and reduces the flow of hot gas flow leakage for a given pressure differential across the blade tip portion so as to improve overall turbine efficiency.

  7. Advanced optical blade tip clearance measurement system

    NASA Technical Reports Server (NTRS)

    Ford, M. J.; Honeycutt, R. E.; Nordlund, R. E.; Robinson, W. W.

    1978-01-01

    An advanced electro-optical system was developed to measure single blade tip clearances and average blade tip clearances between a rotor and its gas path seal in an operating gas turbine engine. This system is applicable to fan, compressor, and turbine blade tip clearance measurement requirements, and the system probe is particularly suitable for operation in the extreme turbine environment. A study of optical properties of blade tips was conducted to establish measurement system application limitations. A series of laboratory tests was conducted to determine the measurement system's operational performance characteristics and to demonstrate system capability under simulated operating gas turbine environmental conditions. Operational and environmental performance test data are presented.

  8. Tip-modulation scanned gate microscopy.

    PubMed

    Wilson, Neil R; Cobden, David H

    2008-08-01

    We introduce a technique that improves the sensitivity and resolution and eliminates the nonlocal background of scanned gate microscopy (SGM). In conventional SGM, a voltage bias is applied to the atomic force microscope tip and the sample conductance is measured as the tip is scanned. In the new technique, which we call tip-modulation SGM (tmSGM), the biased tip is oscillated and the induced oscillation of the sample conductance is measured. Applied to single-walled carbon nanotube network devices, tmSGM gives sharp, low-noise and background-free images.

  9. [Personalized medicine: equity and access].

    PubMed

    Joly, Yann; Knoppers, Bartha M

    2014-11-01

    Personalized medicine has seen a recent increase in popularity amongst medical researchers and policymakers. Nevertheless, there are persistent legal, ethical, and social questions that need to be explored, particularly related to the criticism that personalized medicine constitutes an elitist model of healthcare. Investigating this critique the current manuscript argues that personalized medicine has the potential to become a positive force for equitable access to better healthcare at a national and international level.

  10. Herbal Medicine

    MedlinePlus

    ... for its scent, flavor, or therapeutic properties. Herbal medicines are one type of dietary supplement. They are ... and fresh or dried plants. People use herbal medicines to try to maintain or improve their health. ...

  11. Diabetes Medicines

    MedlinePlus

    Diabetes means your blood glucose, or blood sugar, levels are too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends ...

  12. Toward an Educated Health Consumer: Mass Communication and Quality in Medical Care. Fogarty International Series on the Teaching of Preventive Medicine. Volume 7.

    ERIC Educational Resources Information Center

    Marshall, Carter L.

    Focus in this preventive medicine monograph for health professionals is on consumer health education and the current and potential effects of mass communication on the quality of medical care. Following an introduction, the content is presented in four chapters. Chapter 1 covers the state of the art in consumer health education and discusses three…

  13. [SPORT MEDICINE].

    PubMed

    Constantini, Naama; Mann, Gideon

    2016-06-01

    Sports Medicine is a relatively new subject in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age. Sports medicine, which started developing in the 19th century, is today a specialty, primary or secondary, in many countries, while in others it is a fellowship or under the jurisdiction of local or sports authorities. In Israel, the field exists since the 1950's and is advanced. The Sports Medicine Society founded a 3-year course of continued education in sport medicine as part of the Tel-Aviv University Faculty of Medicine. Later on, a fellowship in general Sports Medicine and in Orthopedic Sports Medicine were developed within the Israel Medical Association. A year ago, Israel formally became a member of the global "Exercise is Medicine" foundation, and under this title promotes education for health care providers on exercise prescription. The understanding of the importance of physical activity and fitness as part of a healthy lifestyle is increasing in Israel, as well as the number of amateur athletes, and the profession of sports medicine takes a big part in this process.

  14. Prescription sleep medicine for aircrew.

    PubMed

    Nicholson, Anthony N

    2011-05-01

    It is suggested that the Aerospace Medical Association convene an international expert body to determine the relevance of the pharmacological profiles of hypnotics to the practice of aviation medicine.

  15. [Market oriented occupational medicine].

    PubMed

    Rurik, Imre; Cseh, Károly

    2012-09-09

    The history and the recent state of occupational medicine in Hungary, and its relation with governmental labor organizations are analyzed. In the past 20 years, large "socialist" factories were replaced by smaller companies employing fewer workers. They have been forced to establish contract with occupational health providers. Many of them offer primary care services, whereas family physicians having a board examination in occupational medicine are allowed to work in this field as well. The market of occupational medicine is less regulated, and ethical rules are not always considered. Undercutting prices is a common practice. The recent system could be improved by some regulations which should be respected. There is no reason to make rough changes establishing a new market for profit oriented insurance companies, and to allow employees and employers to work without specification neglecting international agreements. Occupational medicine should be supervised again by the health authorities instead of economists who have quite different, short-term priorities.

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

    PubMed

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

    2016-01-25

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

  17. WIYN tip-tilt module performance

    NASA Astrophysics Data System (ADS)

    Claver, Charles F.; Corson, Charles; Gomez, R. Richard, Jr.; Daly, Philip N.; Dryden, David M.; Abareshi, Behzod

    2003-02-01

    The WIYN Tip-Tilt Module (WTTM) is an addition to the existing Instrument Adapter System (IAS) providing a high performance optical-NIR image stabilized port on the WIYN 3.5m telescope. The WTTM optical system uses a 3-mirror off-axis design along with a high bandwidth tilt mirror. The WTTM is a reimaging system with 15% magnification producing a 4x4 arcminute field of view and near diffraction limited imagery from 400-2000nm. The optics are diamond turned in electroless Nickel over an Aluminum substrate. The WTTM opto-mechanical assembly was designed and built using the principals of the "build-to-print" technique, where the entire system is fabricated and assembled to tolerance with no adjustments. A unique high performance error sensor, using an internal mirrorlette array that feeds 4 fiber coupled avalanche photodiode photon counters, provides the tilt signal. The system runs under the Real-Time Linux operating system providing a maximum closed loop rate of 3khz. In this paper we report on the successful lab testing, verification of the "build-to-print" technique and on telescope performance of the WTTM.

  18. British Columbia Transfer TIPS. Second Edition Revised

    ERIC Educational Resources Information Center

    Finlay, Finola, Ed.; Karlinski, Jean, Ed.

    2005-01-01

    BCTransfer TIPS is a user friendly document outlining how transfer between British Columbia (BC) post-secondary institutions works. It includes tips, student quotes, scenarios, a personal plan and checklist. Information in this document can only be reproduced with permission from the British Columbia Council on Admissions and Transfer (BCCAT.)

  19. Economics of tipping the climate dominoes

    NASA Astrophysics Data System (ADS)

    Lemoine, Derek; Traeger, Christian P.

    2016-05-01

    Greenhouse gas emissions can trigger irreversible regime shifts in the climate system, known as tipping points. Multiple tipping points affect each other’s probability of occurrence, potentially causing a `domino effect’. We analyse climate policy in the presence of a potential domino effect. We incorporate three different tipping points occurring at unknown thresholds into an integrated climate-economy model. The optimal emission policy considers all possible thresholds and the resulting interactions between tipping points, economic activity, and policy responses into the indefinite future. We quantify the cost of delaying optimal emission controls in the presence of uncertain tipping points and also the benefit of detecting when individual tipping points have been triggered. We show that the presence of these tipping points nearly doubles today’s optimal carbon tax and reduces peak warming along the optimal path by approximately 1 °C. The presence of these tipping points increases the cost of delaying optimal policy until mid-century by nearly 150%.

  20. News: Tripping over tipping points/elements

    EPA Science Inventory

    The term “tipping point” has been used to identify a critical threshold susceptible to a tiny perturbation that can qualitatively alter the state or development of a system. “Tipping element” has been introduced to describe large-scale components of the Earth system that may pass...