Prevalence and prognosis of intrapulmonary shunts in patients with hepatic cirrhosis.

We investigated the prevalence of intrapulmonary shunts in 82 patients with hepatic cirrhosis referred for echocardiography as part of liver transplantation evaluation. Intrapulmonary shunts were present in 49 of 82 patients (60%). Baseline characteristics were similar in patients with and without intrapulmonary shunts. Mean follow up was 41 +/- 15 months in patients with intrapulmonary shunts and 42 +/- 15 months in patients without intrapulmonary shunts (P not significant). At follow up, 8 of 49 patients (16%) with intrapulmonary shunts and 4 of 33 patients (12%) without intrapulmonary shunts had died (P not significant).

Comparison of outcomes in patients with active infective endocarditis and a paravalvular abscess on a prosthetic valve versus a native valve.

We investigated in-hospital and long-term mortality in 16 patients with infective endocarditis and paravalvular abscess on a prosthetic valve (6 of whom underwent surgery) and in 12 patients with infective endocarditis and paravalvular abscess on a native valve (8 of whom underwent surgery). The only significant risk factor for in-hospital mortality in patients with prosthetic or native value paravalvular abscess was age (P < 0.001). In-hospital mortality was 33% in patients with prosthetic valve paravalvular abscess undergoing surgery and 33% in patients treated medically (P = not significant). In-hospital mortality was 25% in patients with native valve paravalvular abscess undergoing surgery and 25% in patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with prosthetic valve paravalvular abscess was 67% for patients treated surgically versus 40% for patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with native valve paravalvular abscess was 75% for patients treated surgically versus 50% for patients treated medically (P = not significant).

Comparison of outcomes in patients with active infective endocarditis with versus without paravalvular abscess and with and without valve replacement.

In 82 patients with infective endocarditis, including 11 with a perivalvular abscess detected by transesophageal echocardiography, age was a significant predictor of in-hospital mortality (p <0.001). At 3.8-year follow-up, 5 of 7 patients with an abscess who had valve replacement and 2 of 4 patients with an abscess who did not have surgery survived (p = NS); 13 of 22 patients (59%) with no abscess who had valve replacement and 20 of 49 patients (41%) with no abscess who did not have surgery survived (p = NS).

A comparison of humanistic qualities among medical students, residents, and faculty physicians in internal medicine.

Humanistic qualities of integrity, respect and compassion are important components of medical education. Studies, however, suggest that students may not perceive their faculty physicians as humanistic. Knowing how the perception of humanistic qualities varies by training level may offer insight on how we teach humanism. In this study, the authors compared humanistic quality scores of fourth-year medical students, internal medicine residents, and attending physicians on a general medicine ward of a teaching hospital. A validated nursing survey to assess humanistic qualities among physicians was distributed to randomly selected nurses on the medicine wards. The survey measured physician relationships with other medical staff, the patient, and family members. Each item was scored on a 5-point Likert scale. Composite scores for physician to staff relationships and physician to patient/family relationships, as well as an overall evaluation score, were compared across levels of physician training. A t test was done to determine statistical significance across training levels. No statistically significant differences were found between internal medicine residents and attending physicians. Subinterns appear to have better perceived qualities of humanism compared with resident and attending physicians. Because resident and attending physicians play an important role in medical education, efforts should be made to improve the perceived humanistic qualities of both resident and attending physicians.