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Clinical medicine and critical care and gastroenterology

Giovanni Improta, Mario Cesarelli, Paolo Montuori, Liberatina Carmela Santillo, Maria Triassi
RATIONALE, AIMS, AND OBJECTIVES: Lean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare-associated infections (HAIs), a critical quality parameter in the healthcare sector. METHODS: Lean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016...
November 3, 2017: Journal of Evaluation in Clinical Practice
Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Christoph F Dietrich, Adrian Goudie, Liliana Chiorean, Xin Wu Cui, Odd Helge Gilja, Yi Dong, Jacques S Abramowicz, Sudhir Vinayak, Susan Campbell Westerway, Christian Pállson Nolsøe, Yi-Hong Chou, Michael Blaivas
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice...
January 2017: Ultrasound in Medicine & Biology
Takero Naito, Haruhisa Ohtani, Kazuo Kobayashi, Masanobu Miyazaki, Kouji Yamada, Masahiro Sugawara, Yoshikazu Naka, Takao Saruta
OBJECTIVE: The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan. METHODS: We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology...
2013: Nihon Jinzo Gakkai Shi
Lei Cui, Xi-Bin Shen, Li Fang, Xian-Wei Pan, Xiu-Mei Zhong, Xue Gong, Ying Yang
OBJECTIVE: To outline the research fronts of ten major sub-specialties in internal medicine. METHODS: Based on their impact factor scores and the proportion of the journals of 10 subspecialties (endocrinology & metabolism, cardiac & cardiovascular systems, hematology, infectious diseases, nephrology, gastroenterology & hepatology, respiratory system, rheumatology, critical care medicine, clinical neurology) in Journal Citation Report (JCR), and careful consulation of expert clinicians, we identified 50 journals...
February 2013: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Amanda C Wieland, Matthew Quallick, Aimee Truesdale, Pamela Mettler, Kiran M Bambha
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. Primary care providers (PCPs), in contrast to gastroenterology/hepatology (GI/Hep) providers, are the first medical contact for the majority of patients with, or at risk for, NAFLD. PCP awareness of and facility with NAFLD is critical for management of these patients. AIM: The purpose of this study was to assess understanding and practice patterns of PCPs and non-GI/Hep subspecialty providers with respect to the diagnosis and management of NAFLD...
October 2013: Digestive Diseases and Sciences
N Hahn, C Bobrowski, E Weber, P Simon, M Kraft, A Aghdassi, M Raetzell, M Wilke, M M Lerch, J Mayerle
The introduction of the G-DRG reimbursement system has greatly increased the pressure to provide cost effective treatment in German hospitals. Reimbursement based on diagnosis-related groups, which requires stratification of costs incurred is still not sufficiently discriminating the disease severity and severity in relation to the intensive costs in gastroenterology. In a combined retrospective and prospective study at a tertial referral centre we investigated whether this also applies for decompensated liver cirrhosis...
March 2013: Zeitschrift Für Gastroenterologie
Jaykaran Charan, Preeti Yadav, Deepak Saxena, N D Kantharia
CONTEXT: It is observed in studies done for western medical journals that insufficient information related to drug is usually provided in the drug advertisements published in them. AIMS: As data for advertisements published in Indian Medical Journals were lacking, this study was designed with the aim of evaluating drug advertisements published in Indian Medical Journals for adequacy of information on drug and references given to support the claim made in the advertisements...
July 2011: Journal of Pharmacy & Bioallied Sciences
Jonathan Buscaglia, Satish Nagula, Jay Yuan, Juan Carlos Bucobo, Atul Kumar, Chris E Forsmark, Peter V Draganov
INTRODUCTION: Evidence-based medicine (EBM) has become increasingly important in the practice of gastroenterology and endoscopy, and the training of future gastroenterology physicians. The objectives were to assess the attitudes/opinions of gastroenterology specialists towards EBM, and evaluate possible gaps in education for certain EBM-related concepts. METHODS: An internet-based survey was emailed to 4073 gastroenterology specialists. The main outcome measurements were physicians' endorsement of EBM, impact of EBM on clinical practice, utilization of EBM-specific resources, self-assessed understanding of EBM concepts (EBM familiarity score), and actual knowledge of EBM concepts (EBM competency score)...
September 2011: Therapeutic Advances in Gastroenterology
Gary L Freed, Kelly M Dunham, Carol Loveland-Cherry, Kristy K Martyn, Marc J Moote
OBJECTIVE: Historically, most pediatric subspecialists have conducted their clinical work in academic health centers. However, increases in the absolute numbers of pediatric subspecialists in past decades, combined with greater concentrations of children in urban and suburban settings, might result in more opportunities for pediatric subspecialists to enter private practice. Our goal was to assess the proportions of subspecialists in private practice. METHODS: We surveyed a stratified, random, national sample of 1696 subspecialists from 5 subspecialties and assessed the ownership of their current clinical practice settings...
October 2011: Pediatrics
Ching-Hsing Lee, Chia-Pang Shih, Yu-Che Chang, Chung-Hsien Chaou
OBJECTIVES: Emergency medicine (EM) is a young but rapidly growing field. An evaluation of academic performance and the growing impact of EM journals would help to elucidate the increase in the number of EM scientific studies. The authors used the Journal Citation Reports (JCR) database to investigate the scientific achievements of EM journals in the past 10 years. METHODS: This was a literature review study. All data were collected from the JCR database. Journals listed in the EM category from 2000 to 2009 were included...
August 2011: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
H Raspe, S Conrad, C Muche-Borowski
Crohn's disease and ulcerative colitis are diseases characterized by remission and relapse, an early age of onset and restrictions on activities and participation. IBD patients need a comprehensive, easily accessible and problem-oriented health care. This requires the integration and coordination of different health care sectors, medical and non-medical professionals, social and health care facilities and funding agencies. The pathways to guide patients through integrated health care were based on clinical considerations, interviews with patients and specialists, systematically searched evidence and results of a questionnaire survey...
June 2009: Zeitschrift Für Gastroenterologie
Michaela R Jordan, Joslyn Conley, William A Ghali
BACKGROUND: Consultation in hospital is an essential tool for acquiring subspecialty support when managing patients. There is limited knowledge on the utilization of subspecialty consultation from hospital based general internists. Consultation patterns to medical subspecialists and the patient factors that may influence consultation are reported for general medical services. METHODS AND FINDINGS: Hospital discharge data were obtained for patients from medical services over a 2-year period...
2008: BMC Research Notes
Hugh-J Freeman
Henry Norman Bethune was a physician and surgeon from Canada. He had a highly impressive medical career in Montreal but did his most important work in China where he cared for soldiers on the battlefield. He died in 1939 and was recognized as a hero, but only much later received recognition in Canada. He was a skilled doctor, both as a physician and as a surgeon. However, he was much more and will serve as an inspiration for this series. He was an innovator, an idealist and a perfectionist. It is hoped that this series will gather expert commentaries on a range of issues critical to the subspecialty from fundamental science to clinical care so that future directions can be defined...
January 14, 2008: World Journal of Gastroenterology: WJG
Julie Parkes, Paul Roderick, Bethan Bennett-Lloyd, William Rosenberg
BACKGROUND: Chronic hepatitis C infection (CHC) is a major healthcare problem. Effective anti-viral therapy is available. To maximise population effectiveness, co-ordinated services for detection and management of patients with CHC are required. There is a need to determine patterns of healthcare delivery to plan improvements. A study was conducted to determine workload, configuration and care processes of current UK services available to manage patients with CHC. METHODS: A cross-sectional questionnaire survey of consultant members of British Association for the Study of the Liver (n = 53), Infectious Disease consultants (n = 43), and a 1 in 5 sample of Genito-Urinary Medicine (n = 48) and gastroenterologists (n = 200)...
January 10, 2006: BMC Public Health
Burhan Hameed, David M Smith, Jon J Verrechio, J David Schmidt, Leesa E Gillooley, Mary Carmen Valenzano, Simon A Lewis, James M Mullin
Indocyanine green (ICG) is used as a dye marker of the vascular space in gastroenterology, ophthalmology, neurology, and critical care medicine. It is widely regarded to be inert. We report, however, that ICG demonstrates effects on colonic transepithelial electrical parameters which could form a basis for a growing number of deleterious gastrointestinal and other clinical effects. Short-circuit current (Iscc), transepithelial conductance (gt), and transepithelial paracellular flux of 14C-D-mannitol were monitored across sheets of rat distal colon...
September 2004: Digestive Diseases and Sciences
Walter H Curioso, Víctor M Montori, Walter I Curioso
Evidence-based medicine (EBM) integrates the best available external evidence in the care of individual patients with the individual clinical expertise and the patient preferences. This method has been designed for use in daily clinical practice. We describe the rationale for EBM and its principles and application in this article. EBM enables gastroenterologists to update the knowledge required to provide patients with high quality medical care. EBM requires four steps: a) formulating a clinical question arising from a doubt concerning a patient; b) conducting an efficient literature search to answer this question; c) critically appraising this evidence using explicit methods to selected articles to determine the validity of their design and the clinical relevance of their results; and d) applying these results to the patient (taking into account their values and preferences and personal and social circumstances)...
January 2004: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
Philip Schoenfeld, James Scheiman
This article provides an evidence-based medicine framework to critically assess the validity of study design and clinical significance of study results in the context of gastrointestinal therapies for a common clinical scenario. Without systems for critically appraising and applying clinical research, we may become dependent on outdated information. When used in conjunction with clinical judgment, critical appraisal of clinical research facilitates the provision of the very best care to patients. This article, which examines a trial about the gastrointestinal safety of cyclooxygenase (COX)-II-selective nonsteroidal anti-inflammatory drugs (NSAIDs), follows the format of other evidence-based medicine articles in the Canadian Medical Association Journal, the Journal of the American Medical Association, and Gastroenterology...
January 2003: Clinical Gastroenterology and Hepatology
L O Langdon
In the U.S. the subspecialties of internal medicine are well integrated in the overall discipline of internal medicine and each one is also unique. The American Board of Internal Medicine at present certifies 16 unique subdisciplines, which are, in order from the largest to the smallest: cardiology (14,000 certified cardiologists), gastroenterology (10,000 certified), pulmonary disease (9000 certified), critical care medicine (6500 certified), hematology, oncology, nephrology, infectious diseases, allergy and immunology, endocrinology, rheumatology, geriatrics, sport medicine, adolescent medicine...
December 4, 1999: Schweizerische Medizinische Wochenschrift
D Colin-Jones, A Stevens
Too much clinical practice is based on unproved opinion. Health technology assessment (HTA) encourages critical review of the literature in a particular area, from which an objective assessment can be made so that clinical practice may be more scientifically based. Only a small number of centers undertake this type of work, usually at a national level. We have been able to set up a more local HTA system (the Wessex Development and Evaluation Committee) with links to clinicians and both providers and purchasers of health care within a region of 3 million people...
December 1994: Gastroenterologist
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