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https://www.readbyqxmd.com/read/28432607/impact-of-the-medical-specialty-on-knowledge-regarding-multidrug-resistant-organisms-and-strategies-toward-antimicrobial-stewardship
#1
Steffen Lebentrau, Christian Gilfrich, Malte W Vetterlein, Harald Schumacher, Philipp J Spachmann, Sabine D Brookman-May, Hans M Fritsche, Martin Schostak, Florian M Wagenlehner, Maximilian Burger, Matthias May
PURPOSE: Evidence is scarce on subject-specific knowledge of multidrug-resistant organisms and rational use of antibiotics. We aimed at evaluating attitude, perception, and knowledge about multidrug-resistant organisms (MDRO) and antibiotic prescribing among urologists versus other medical specialties. METHODS: Within the MR2-study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria), a questionnaire was conducted targeting general surgeons, internists, gynecologists, and urologists in 18 German hospitals...
April 21, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28428644/-how-to-evaluate-the-application-of-clinical-governance-tools-in-the-management-of-hospitalized-hyperglycemic-patients-results-of-a-multicentric-study
#2
Antonio Giulio De Belvis, Maria Lucia Specchia, Anna Maria Ferriero, Silvio Capizzi
Risk management is a key tool in Clinical Governance. Our project aimed to define, share, apply and measure the impact of tools and methodologies for the continuous improvement of quality of care, especially in relation to the multi-disciplinary and integrated management of the hyperglycemic patient in hospital settings. A training project, coordinated by a scientific board of experts in diabetes and health management and an Expert Meeting with representatives of all the participating centers was launched in 2014...
January 2017: Igiene e Sanità Pubblica
https://www.readbyqxmd.com/read/28424823/-coma-in-the-emergency-room
#3
M Braun, C J Ploner, T Lindner, M Möckel, W U Schmidt
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO...
April 19, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28424767/direct-and-indirect-costs-of-asthma-management-in-greece-an-expert-panel-approach
#4
Kyriakos Souliotis, Hara Kousoulakou, Georgios Hillas, Petros Bakakos, Michalis Toumbis, Stelios Loukides, Theodoros Vassilakopoulos
OBJECTIVE: Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. METHODS: A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28419451/do-state-continuing-medical-education-requirements-for-physicians-improve-clinical-knowledge
#5
Jonathan L Vandergrift, Bradley M Gray, Weifeng Weng
OBJECTIVE: To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. DATA SOURCES: Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. STUDY DESIGN: We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge...
April 16, 2017: Health Services Research
https://www.readbyqxmd.com/read/28406489/consensus-recommendation-for-a-diagnostic-guideline-for-acid-sphingomyelinase-deficiency
#6
Margaret M McGovern, Carlo Dionisi-Vici, Roberto Giugliani, Paul Hwu, Olivier Lidove, Zoltan Lukacs, Karl Eugen Mengel, Pramod K Mistry, Edward H Schuchman, Melissa P Wasserstein
Disclaimer:This diagnostic guideline is intended as an educational resource and represents the opinions of the authors, and is not representative of recommendations or policy of the American College of Medical Genetics and Genomics (ACMG). The information should be considered a consensus based on expert opinion, as more comprehensive levels of evidence were not available in the literature in all cases. BACKGROUND: Acid sphingomyelinase deficiency (ASMD) is a rare, progressive, and often fatal lysosomal storage disease...
April 13, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28403004/the-hidden-value-of-narrative-comments-for-assessment-a-quantitative-reliability-analysis-of-qualitative-data
#7
Shiphra Ginsburg, Cees P M van der Vleuten, Kevin W Eva
PURPOSE: In-training evaluation reports (ITERs) are ubiquitous in internal medicine (IM) residency. Written comments can provide a rich data source, yet are often overlooked. This study determined the reliability of using variable amounts of commentary to discriminate between residents. METHOD: ITER comments from two cohorts of PGY-1s in IM at the University of Toronto (graduating 2010 and 2011; n = 46-48) were put into sets containing 15 to 16 residents. Parallel sets were created: one with comments from the full year and one with comments from only the first three assessments...
April 11, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28396846/towards-automated-calculation-of-evidence-based-clinical-scores
#8
Christopher A Aakre, Mikhail A Dziadzko, Vitaly Herasevich
AIM: To determine clinical scores important for automated calculation in the inpatient setting. METHODS: A modified Delphi methodology was used to create consensus of important clinical scores for inpatient practice. A list of 176 externally validated clinical scores were identified from freely available internet-based services frequently used by clinicians. Scores were categorized based on pertinent specialty and a customized survey was created for each clinician specialty group...
March 26, 2017: World Journal of Methodology
https://www.readbyqxmd.com/read/28395986/a-decade-of-progress-on-the-genetic-basis-of-coronary-artery-disease-practical-insights-for-the-internist
#9
REVIEW
Domenico Girelli, Chiara Piubelli, Nicola Martinelli, Roberto Corrocher, Oliviero Olivieri
Clinicians are well aware of the importance of a positive family history for coronary artery disease (CAD). Nonetheless, elucidation of the genetic basis of CAD has long proven difficult. The scenario changed in the last decade through the application of modern genomic technologies, like genome-wide association studies (GWAS) and next generation sequencing (NGS). GWAS have discovered over 60 common variants highly associated with CAD. For predictive purposes, such variants have been used to build up Genetic Risk Scores (GRSs), but their incorporation into classical prediction models does not appear substantially outperform the simple addition of family history...
April 7, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28395013/association-of-primary-care-practice-location-and-ownership-with-the-provision-of-low-value-care-in-the-united-states
#10
John N Mafi, Christina C Wee, Roger B Davis, Bruce E Landon
Importance: Hospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care. Objective: To assess the association of hospital location and hospital ownership with the provision of low-value health services. Design, Setting, and Participants: This study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013...
April 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28394065/patients-of-doctors-further-from-medical-school-graduation-have-poorer-outcomes
#11
John J Norcini, John R Boulet, Amy Opalek, W Dale Dauphinee
CONTEXT: There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume. OBJECTIVES: This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes...
May 2017: Medical Education
https://www.readbyqxmd.com/read/28388385/maternal-asthma-management-strategies
#12
REVIEW
Sucharita Kher, Prerna Mota
Asthma in pregnancy is common, and its prevalence is rising. Internists need to be aware of the effects of maternal asthma control on the health of the expectant mother and the baby. With the ever-present worry about medication use and teratogenicity in pregnant women, these patients are often undertreated for their asthma. This review focuses on effects of uncontrolled maternal asthma as well as appropriate management of maternal asthma in the outpatient setting and during exacerbations.
April 2017: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/28381243/internists-career-choice-towards-primary-care-a-cross-sectional-survey
#13
Nathalie Scherz, Stefan Markun, Vera Aemissegger, Thomas Rosemann, Ryan Tandjung
BACKGROUND: Swiss primary care (PC) is facing workforce shortage. Up to 2011 this workforce was supplied by two board certifications: general medicine and internal medicine. To strengthen them against subspecialties, they were unified into one: general internal medicine. However, since unification general practitioners' career options are no longer restrained by early commitment to PC. This may lead to a decrease of future primary care physicians (PCPs). METHODS: To gain insights in timing and factors influencing career choice of internists, we addressed a cross sectional survey to all board certified internists in the years 2000-2010 (n = 1462)...
April 5, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28379818/building-a-sustainable-primary-care-workforce-where-do-we-go-from-here
#14
Mark Linzer, Sara Poplau
The article by Puffer et al in this month's JABFM confirms a high burnout rate (25%) among family physicians renewing their credentials, with a higher rate among young and female doctors. Recent reports confirm high burnout rates among general internists. Thus, mechanisms to monitor and improve worklife in primary care are urgently needed. We describe the Mini Z (for "zero burnout program") measure, designed for these purposes, and suggest interventions that might improve satisfaction and sustainability in primary care, including longer visits, clinician control of work schedules, scribe support for electronic medical record work, team-based care, and an explicit emphasis on work-home balance...
March 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28375881/institutional-substance-use-disorder-intervention-improves-general-internist-preparedness-attitudes-and-clinical-practice
#15
Sarah E Wakeman, Genevieve Pham Kanter, Karen Donelan
OBJECTIVE: To assess the impact of hospital substance use disorder (SUD) initiative, which, beginning in October 2014, implemented an inpatient addiction consult team, a postdischarge addiction clinic, recovery coaches, and SUD treatment within primary care on general internists' attitudes, clinical practice, and preparedness to care for SUD. METHODS: Pre and postintervention survey of general internal medicine physicians at Massachusetts General Hospital, in Boston, Massachusetts, in September 2014 (n = 290) and 2015 (n = 296) was conducted...
April 3, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28371816/evaluation-of-an-integrated-multidisciplinary-program-to-address-unsafe-use-of-opioids-prescribed-for-pain
#16
William C Becker, Sara N Edmond, Dana J Cervone, Ajay Manhapra, John J Sellinger, Brent A Moore, Ellen L Edens
Objectives. : Unsafe use of opioids prescribed for pain is a common challenge in primary care. We aimed to describe a novel clinical program designed to address this issue-the Opioid Reassessment Clinic-and evaluate preliminary efficacy. Methods. : The Opioid Reassessment Clinic is a multidisciplinary care team staffed by an internist, addiction psychiatrist, advanced practice nurse, and health psychologist designed to perform enhanced assessment and longitudinal treatment of patients with unsafe use of opioids prescribed for pain...
March 23, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28364218/-memorandum-of-the-german-society-for-rheumatology-on-the-quality-of-treatment-in-rheumatology-update-2016
#17
A Zink, J Braun, E Gromnica-Ihle, D Krause, H J Lakomek, W Mau, U Müller-Ladner, J Rautenstrauch, C Specker, M Schneider
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases...
April 2017: Zeitschrift Für Rheumatologie
https://www.readbyqxmd.com/read/28353532/acute-illness-protocol-for-fatty-acid-oxidation-and-carnitine-disorders
#18
Saud H Aldubayan, Lance H Rodan, Gerard T Berry, Harvey L Levy
Inborn errors of metabolism (IEMs) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare but collectively have an incidence of 1:1000. Most patients with IEMs are followed by a physician with expertise in biochemical genetics (metabolism) but may present outside this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency medicine physicians, pediatricians, internists, critical care physicians, and biochemical geneticists to be familiar with the initial assessment and management of patients with these disorders...
April 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28353024/teaching-an-old-dog-new-tricks-colchicine-in-cardiovascular-medicine
#19
REVIEW
Kevin Chen, Aldo L Schenone, Nyal Borges, Michael Militello, Venu Menon
Colchicine is one of the oldest known drugs that remains part of the current pharmacopeia. Recent studies have examined the efficacy of colchicine in cardiology with promising results. We conducted a search of electronic databases for studies on colchicine in cardiovascular medicine published through October 2016. As the utilization of colchicine in the management of cardiac conditions grows, it is paramount that internists and cardiologists are familiarized with its benefits and risks. We present a comprehensive review of the role of colchicine in the management of cardiovascular diseases with a strong emphasis on side effects and potential drug interactions...
March 28, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28348901/addison-s-disease-and-possible-cannabis-withdrawal-syndrome-presenting-as-an-eating-disorder-in-a-thirty-year-old-female
#20
Kimberly Lazare
A 30-year-old female with a history of anxiety, cannabis use, and Avoidant/Restrictive Food Intake Disorder presented for residential treatment of a Cannabis Use Disorder. Upon arrival, she had not eaten for two days and was found to be hypotensive with electrolyte disturbances. She was admitted to a nearby hospital, where the Internist diagnosed her with Addison's disease. She was treated with corticosteroid therapy, with rapid normalization of her electrolytes, eating, and anxiety. This is the first published case of undiagnosed Addison's disease presenting as an eating disorder, with cannabis use likely contributing to symptoms...
2017: Case Reports in Endocrinology
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