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Sharon E Card, Heather D Clark, Michelle Elizov, Narmin Kassam
General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition...
October 24, 2016: Journal of General Internal Medicine
Aaron S Kesselheim, Wesley Eddings, Tara Raj, Eric G Campbell, Jessica M Franklin, Kathryn M Ross, Lisa A Fulchino, Jerry Avorn, Joshua J Gagne
BACKGROUND: Generic drugs are cost-effective versions of brand-name drugs approved by the Food and Drug Administration (FDA) following proof of pharmaceutical equivalence and bioequivalence. Generic drugs are widely prescribed by physicians, although there is disagreement over the clinical comparability of generic drugs to brand-name drugs within the physician community. The objective of this survey was to assess physicians' perceptions of generic drugs and the generic drug approval process...
2016: PloS One
Ulrike Stentzel, Jens Piegsa, Daniel Fredrich, Wolfgang Hoffmann, Neeltje van den Berg
BACKGROUND: The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people...
October 19, 2016: BMC Health Services Research
Julie A Birt, YingMeei Tan, Neelufar Mozaffarian
OBJECTIVES: To better understand the real-world characteristics and costs of Sjögren's syndrome (SS). METHODS: Analysing the MarketScan Commercial Claims database from Jan. 1, 2006 to Dec. 31, 2011, we identified 10,414 patients ≥18 years old newly diagnosed with SS. Patient characteristics, drugs (commonly used for SS), resource utilisation, and medical costs were evaluated for 12 months pre- and post-diagnosis. RESULTS: Mean age was 55 years; 90% were female...
October 7, 2016: Clinical and Experimental Rheumatology
A G Spruijt, K R Wilting, G D Mithoe, W J M Niessen
OBJECTIVE: To investigate the effect of an intervention in which medical-microbiological laboratories alert general practitioners (GPs) in writing about patients with a chronic hepatitis B or C infection in their practice, urging them to bring these patients under medical surveillance again now that treatment options have improved and guidelines have been revised. DESIGN: Descriptive, prospective. METHOD: All patients who had been diagnosed with hepatitis B or C between 2003 and 2013 on the request of the GP, and for whom diagnostics by an internist, infectious diseases specialist or gastrointestinal/liver specialist had never been requested, were included...
2016: Nederlands Tijdschrift Voor Geneeskunde
Neeraj Nagpal
Physicians and Internists in India have tended to brush under the carpet legal issues affecting their profession. Of concern to all Physicians is the judgment in a recent case where the NCDRC has stated that if MD Medicine Physicians write Physician & Cardiologist on their letterhead it is Quackery. What is MD Medicine degree holder in India qualified and trained to treat ? These are issues which need debate and that can only be initiated once we recognize that there is a problem. Either an MD Medicine is a cardiologist or he is not...
February 2016: Journal of the Association of Physicians of India
J M Porcel, E Cases-Viedma, S Bielsa
OBJECTIVE: Pleural fluid aspiration is a routine procedure for pulmonologists and internists. Our aim was to evaluate technical and methodological aspects of diagnostic and therapeutic thoracenteses performed by last two-year residents of Pulmonology and Internal Medicine. METHODS: An online 24-item questionnaire was sent to participants, and responses were evaluated according to the medical specialty. RESULTS: The survey was completed by 139 (17...
October 4, 2016: Revista Clínica Española
Heinrich Ebner, Francesco Stillo, Gaetano Lanza, Nicola Mangialardi, Giovanni B Agus, Marco Apperti, Eugenio Bernardini, Marcello Bernardini, Benedetto Bernardo, Giuseppe Bianchini, Roberto Bisacci, Stefano Camparini, Nicola Chiulli, Domenico Corda, Aldo Crespi, Antonio De Fiores, Roberto Di Mitri, Walter Dorigo, Juliane A Ebner, Guglielmo Emanuelli, Francesco Ferrara, Giuseppe Genovese, Elena Giacomelli, Benedetta Giannasio, Bruno Gossetti, Mirko Guerra, Vincenzo Mattaliano, Antonello Musiani, Olindo Pieroni, Riccardo Piccioli, Massimo Pisacreta, Carlo Pratesi, Sonia Ronchey, Gennaro Quarto, Antonio Sellitti, Giovanni M Spinelli, Enzo Strati, Antonio Tori, Marco Viani, Pierluigi Zolesio
Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines...
August 2016: Minerva Cardioangiologica
Victor M Montori, Marleen Kunneman, Ian Hargraves, Juan Pablo Brito
In this narrative review, we locate within the tradition of great diagnosticians in internal medicine, a fundamental development in patient-centered care: shared decision making (SDM). In this way, we present SDM as a core component of the clinical method, one in which diagnosis of the situation and of the actions that resolve it is essential toward the practice of evidence-based medicine.
October 3, 2016: European Journal of Internal Medicine
Ofer Havakuk, Michal Laufer Perl, Ofir Praisler, Michael Barkagan, Ben Sadeh, Gilad Margolis, Maayan Konigstein, Lilly Veltman Fuks, Gad Keren, Ehud Chorin, Yaron Arbel
BACKGROUND: Metabolic syndrome (MetS) was shown to be related to a variety of diseases. High level of vigilance for the diagnosis of MetS is expected among health providers. We evaluated the level of awareness to MetS among physician and nurses working in a central hospital. METHODS AND RESULTS: A specially designed anonymous questionnaire was used, including both open and multiple choice questions set to evaluate the participant's awareness to MetS. The study included 126 participants, 71% physicians and 29% nurses...
September 21, 2016: Diabetes & Metabolic Syndrome
Lee A Lindquist, Rachel K Miller, Wayne S Saltsman, Jennifer Carnahan, Theresa A Rowe, Alicia I Arbaje, Nicole Werner, Kenneth Boockvar, Karl Steinberg, Shahla Baharlou
We assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This work was sponsored through a grant from the Association of Subspecialty Physicians (ASP). Members of the team mapped the process of discharging patients from a skilled nursing facility into the community and subsequent care of their outpatient PCP...
October 4, 2016: Journal of General Internal Medicine
Miwako Kobayashi, Daniel J Shapiro, Adam L Hersh, Guillermo V Sanchez, Lauri A Hicks
Background.  Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods.  We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011...
September 2016: Open Forum Infectious Diseases
Clarissa Schulze Zur Wiesch, Anne Lautenbach, Jens Aberle
Indication for bariatric or metabolic surgery depends primarily on body mass index. Recent study results however suggest, that other markers are more reliable predictors of metabolic success. A revision of indication criteria is therefore necessary especially for surgical therapy of type 2 diabetes mellitus. Postoperative management should include screening for postbariatric hypoglycemia and bone density. Furthermore psychologic surveillance is recommended.
September 2016: Deutsche Medizinische Wochenschrift
R Agca, S C Heslinga, S Rollefstad, M Heslinga, I B McInnes, M J L Peters, T K Kvien, M Dougados, H Radner, F Atzeni, J Primdahl, A Södergren, S Wallberg Jonsson, J van Rompay, C Zabalan, T R Pedersen, L Jacobsson, K de Vlam, M A Gonzalez-Gay, A G Semb, G D Kitas, Y M Smulders, Z Szekanecz, N Sattar, D P M Symmons, M T Nurmohamed
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base...
October 3, 2016: Annals of the Rheumatic Diseases
William Virgil Brown, Pamela B Morris, Robert A Wild
The roundtable discussion in this issue will focus on the problems faced by young women with lipid disorders. This is often the source of confusion for the patient and physician because the myth continues that young women do not have complications of atherosclerosis as a result of elevated blood cholesterol. The essential role of women in bearing children during the early years of adulthood also produces difficult decisions because the mother and fetus are usually experiencing similar exposure to therapeutic regimens...
September 2016: Journal of Clinical Lipidology
Sebastián Fernández-Bussy, Gonzalo Labarca, Mario Lanza, Erik Folch, Adnan Majid
The use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases...
July 2016: Revista Médica de Chile
Elizabeth A Phelan, Sally Aerts, David Dowler, Elizabeth Eckstrom, Colleen M Casey
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions...
2016: Frontiers in Public Health
H A Heij, M J van Lieburg
Non-surgical treatment of acute phlegmonous appendicitis has been receiving increasing attention in recent years, representing a reversal of policy. The appendectomy came into vogue at the beginning of the 20th century. It is true that prompt surgical intervention in all patients with appendicitis or an indication thereof almost guarantees success, but it gradually came to be forgotten that this intervention was not always necessary. In this article we will document the historical development of this disease and its treatment, and return to the original reports made by pathologist Reginald Fitz and the internist William Osler to show that their opinion was not black and white...
2016: Nederlands Tijdschrift Voor Geneeskunde
Rajeev Gupta, Sailesh Lodha, Krishna K Sharma, Surendra K Sharma, Sunil Gupta, Arthur J Asirvatham, Bhupendra N Mahanta, Anuj Maheshwari, Dinesh C Sharma, Anand S Meenawat, Raghubir S Khedar
BACKGROUND: Contemporary treatment guidelines advise statin use in all patients with diabetes for reducing coronary risk. Use of statins in patients with type 2 diabetes has not been reported from India. METHODS: We performed a multisite (n=9) registry-based study among internists (n=3), diabetologists (n=3), and endocrinologists (n=3) across India to determine prescriptions of statins in patients with type 2 diabetes. Demographic and clinical details were obtained and prescriptions were audited for various medications with a focus on statins...
2016: BMJ Open Diabetes Research & Care
Ivan Vrcek, Eileen Choudhury, Vikram Durairaj
Herpes zoster ophthalmicus occurs due to reactivation of the varicella zoster virus in the ophthalmic branch of the fifth cranial nerve. This disease primarily affects the elderly as well as the immunocompromised and can result in a wide range of ophthalmic morbidity. Systemic antiviral therapy is the mainstay of treatment; however, consultation with an ophthalmologist is typically indicated. Herein we present a review of this common entity including epidemiology, pathophysiology, evaluation, treatment, follow up and an update on the current body of literature...
September 16, 2016: American Journal of Medicine
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