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1.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 518-524, 2020 May 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879100

RESUMO

According to the fact that many coronavirus disease 2019 (COVID-19) patients are seeking for medical help due to some other possible clinical symptoms, besides respiratory symptoms, all the internal medicine departments (including emergency department) could be involved. Moreover, an increasing number of physician are going to work in fever clinic, isolation wards and supporting the medical work in Hubei Province in the future. For a better medical work implementation of physician against COVID-19 and the interpretation of this viral transmission, the work guide was drawn up by Hunan Medical Association, Internal Medicine Specialized Committee.


Assuntos
Infecções por Coronavirus/epidemiologia , Médicos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Betacoronavirus , China , Humanos , Medicina Interna/organização & administração , Pandemias
3.
Rev Med Suisse ; 16(705): 1618-1623, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914593

RESUMO

Transthoracic echocardiography (TTE) performed by a cardiologist is the first choice for exploring cardiac function and anatomy. Its performance and availability increase the demand for this examination, but this is not always justified. According to criteria published in 2011, the practice of a TTE is classified as appropriate, inappropriate or of uncertain value, depending on the clinical indication. This article explores the frequent indications for which TTE by the cardiologist is considered useful and/or appropriate for patients hospitalized in an internal medicine department.


Assuntos
Ecocardiografia/métodos , Medicina Interna/métodos , Hospitalização , Humanos , Guias de Prática Clínica como Assunto
5.
J Med Life ; 13(2): 183-186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742511

RESUMO

Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning. In order to evaluate the usefulness of an early rotation at internal medicine departments, we compared, via script concordance tests, the evolution of residents' clinical reasoning after an initial internal medicine rotation compared to rotations through other medical specialties. Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.


Assuntos
Medicina Interna/educação , Internato e Residência , Aprendizagem , Competência Clínica , Avaliação Educacional , Humanos
6.
Internist (Berl) ; 61(9): 912-921, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32809034

RESUMO

Since the early 2000s, legislators have allowed the establishment of medical care centers to supplement and increase the flexibility of medical cooperation models. Several legal changes in subsequent years were unable to prevent that, contrary to the original intention, almost 90% of the newly founded facilities were established in urban cores and medium-sized centers; that concentration processes and monopolization were encouraged; and that the freedom of choice for patients was restricted. In order to counter the risk of undermining the free exercise of the medical profession and the dictates of economics over patient-oriented medicine in the outpatient sector, corporations, scientific societies, and professional associations are demanding more transparency and narrower limits for non-physician capital investors. There are currently more than 3000 medical care centers in Germany employing around 20,000 physicians, many of whom are internal medicine specialists. Regionally networked medical care center structures combine the advantages of optimized patient care with the growing desire of the younger generation of physicians for flexible working conditions within employment. With increasing acceptance on the part of the medical profession, networked medical care centers are able to create local structures for the expansion of modern intersectoral care and, at the same time, can be available for outpatient specialist training in internal medicine.


Assuntos
Medicina Interna/tendências , Pacientes Ambulatoriais , Assistência ao Paciente/tendências , Médicos , Assistência à Saúde , Alemanha , Hospitais , Humanos
9.
Rev Med Chil ; 148(1): 46-53, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-32730435

RESUMO

BACKGROUND: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess. AIM: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service. MATERIAL AND METHODS: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates. RESULTS: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009). CONCLUSIONS: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.


Assuntos
Deficiência de Vitamina B 12 , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Hospitais , Humanos , Medicina Interna , Masculino , Inquéritos e Questionários , Vitamina B 12
10.
Z Gastroenterol ; 58(7): 642-644, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32659826

RESUMO

"Klug entscheiden" addresses the problem of over- and undersupply in medicine. Following the American model "Choosing wisely" an interdisciplinary team of all internal medicine societies develops evidence-based recommendations to improve the quality of indications. In contrast to guidelines, the initiative does not provide comprehensive medical recommendations, but focuses on problems that are particularly relevant to health care. In addition, it is intended to promote communication between doctors and patients, but also the national debate on the responsible and sensible use of medical resources.


Assuntos
Assistência à Saúde/normas , Medicina Interna/organização & administração , Relações Profissional-Paciente , Sociedades Médicas/normas , Comunicação , Humanos
11.
In Vivo ; 34(3 Suppl): 1603-1611, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-528419

RESUMO

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.


Assuntos
Infecções por Coronavirus , Educação Médica/organização & administração , Cirurgia Geral/educação , Medicina Interna/educação , Pandemias , Pneumonia Viral , Estudantes de Medicina/psicologia , Infecções por Coronavirus/prevenção & controle , Educação a Distância , Avaliação Educacional , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Internato e Residência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Equipamentos de Proteção/provisão & distribução , Treinamento por Simulação , Mídias Sociais , Telemedicina , Realidade Virtual , Carga de Trabalho
12.
In Vivo ; 34(3 Suppl): 1603-1611, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503818

RESUMO

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.


Assuntos
Infecções por Coronavirus , Educação Médica/organização & administração , Cirurgia Geral/educação , Medicina Interna/educação , Pandemias , Pneumonia Viral , Estudantes de Medicina/psicologia , Infecções por Coronavirus/prevenção & controle , Educação a Distância , Avaliação Educacional , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Internato e Residência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Equipamentos de Proteção/provisão & distribução , Treinamento por Simulação , Mídias Sociais , Telemedicina , Realidade Virtual , Carga de Trabalho
13.
Medicine (Baltimore) ; 99(24): e20586, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541490

RESUMO

Like research in general internal medicine, family medicine research can play an important role in improving medical knowledge. We aimed to compare articles published in family medicine journals with articles published in general internal medicine journals. In this bibliometric study, we retrieved 658 randomly selected quantitative articles published in 2016 in 18 high impact factor journals of family medicine and general internal medicine. We extracted the following data: author (gender, number of publications, and place of residence of the first author), paper (number of participants, study design) and journal characteristics (journal discipline, 2015 impact factor). We compared the two groups of articles, using multivariate logistic regressions adjusted for impact factor and intra-cluster correlations. The first author of the articles published in family medicine journals, compared to general internal medicine journals, was more often a woman (OR 2.8 [95%CI 1.8-4.4], P-value < .001), living in the Western world (OR 14.4 [95%CI 6.0-34.4], P-value < .001), and a less experienced researcher (<5 vs >15 publications: OR 2.4 [95%CI 1.5-4.0], P-value .01). In addition, these studies generally included more participants (>1000 vs <100: OR 3.5 [95%CI 1.4-8.6], P-value .02). There was no statistically significant difference in the study design between the two groups of articles (P-value .25). Despite some differences between the two groups of articles, studies published in family medicine journals do not appear to be any less ambitious in terms of study design and sample size than those published in general internal medicine journals.


Assuntos
Bibliometria , Medicina de Família e Comunidade , Medicina Interna , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos
15.
Intern Emerg Med ; 15(5): 791-800, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32445165

RESUMO

Coronavirus disease 2019 (COVID-19) is currently causing a pandemic and will likely persist in endemic form in the foreseeable future. Physicians need to correctly approach this new disease, often representing a challenge in terms of differential diagnosis. Although COVID-19 lacks specific signs and symptoms, we believe internists should develop specific skills to recognize the disease, learning its 'semeiotic'. In this review article, we summarize the key clinical features that may guide in differentiating a COVID-19 case, requiring specific testing, from upper respiratory and/or influenza-like illnesses of other aetiology. We consider two different clinical settings, where availability of the different diagnostic strategies differs widely: outpatient and inpatient. Our reasoning highlights how challenging a balanced approach to a patient with fever and flu-like symptoms can be. At present, clinical workup of COVID-19 remains a hard task to accomplish. However, knowledge of the natural history of the disease may aid the internist in putting common and unspecific symptoms into the correct clinical context.


Assuntos
Infecções por Coronavirus/diagnóstico , Medicina Interna , Pneumonia Viral/diagnóstico , Betacoronavirus , Competência Clínica , Diagnóstico Diferencial , Humanos , Pandemias
16.
PLoS One ; 15(5): e0232511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384090

RESUMO

BACKGROUND: Mentoring's success in enhancing a mentee's professional and personal development, and a host organisations' reputation has been called into question, amidst a lack of effective tools to evaluate mentoring relationships and guide oversight of mentoring programs. A scoping review is proposed to map available literature on mentoring assessment tools in Internal Medicine to guide design of new tools. OBJECTIVE: The review aims to explore how novice mentoring is assessed in Internal Medicine, including the domains assessed, and the strengths and limitations of the assessment methods. METHODS: Guided by Levac et al.'s framework for scoping reviews, 12 reviewers conducted independent literature reviews of assessment tools in novice mentoring in PubMed, Embase, Scopus, ERIC, Cochrane, GreyLit, Web of Science, Open Dissertations and British Education Index databases. A 'split approach' saw research members adopting either Braun and Clarke's approach to thematic analysis or directed content analysis to independently evaluate the data and improve validity and objectivity of the findings. RESULTS: 9662 abstracts were identified, 187 full-text articles reviewed, and 54 full-text articles included. There was consensus on the themes and categories identified through the use of the split approach, which were the domains assessed and methods of assessment. CONCLUSION: Most tools fail to contend with mentoring's evolving nature and provide mere snap shots of the mentoring process largely from the mentee's perspective. The lack of holistic, longitudinal and validated assessments propagate fears that ethical issues in mentoring are poorly recognized and addressed. To this end, we forward a framework for the design of 'fit for purpose' multi-dimensional tools. PRACTICE POINTS: Most tools focus on the mentee's perspective, do not consider mentoring's evolving nature and fail to consider mentoring holistically nor longitudinallyA new tool capable of addressing these gaps must also consider inputs from all stakeholders and take a longitudinal perspective of mentoring.


Assuntos
Medicina Interna/educação , Tutoria , Mentores , Avaliação Educacional/métodos , Humanos
17.
South Med J ; 113(5): 201-204, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358612

RESUMO

OBJECTIVES: A large discrepancy exists in resident educational activities between daytime and nighttime medical rotations. The Accreditation Council for Graduate Medical Education duty-hour regulations led to the increased adoption of the dedicated nighttime rotation called night float. Nighttime education has largely been negatively perceived by night float medical residents. Although there have been attempts to improve nighttime education, none of the initiatives included faculty-guided structured night curriculum. Our objective was to improve resident experience with and perception of nighttime education by implementing a structured, faculty-guided, nighttime educational curriculum. METHODS: This was an assessment of an educational initiative at a single academic medical center, Virginia Commonwealth University Health System. The internal medicine residency program implemented a teaching nocturnist program in 2013 and a novel faculty-guided nighttime teaching curriculum in 2016 called midnight report. We then evaluated resident experience with and perception of nighttime education at our institution using anonymous free-response surveys for the academic year July 2016-June 2017. RESULTS: Of the 142 eligible residents, 95 (67%) responded to the survey. The majority of the residents (54%-77%) positively perceived their experience of the nighttime educational environment during their night float rotation after implementation of the teaching nocturnist program and midnight report. CONCLUSIONS: Compared with the published literature reporting negative perceptions of the nighttime educational environment by residents at different academic centers, our results showed that the majority of our residents positively perceived the impact of our new faculty-guided nighttime educational curriculum.


Assuntos
Currículo , Educação de Pós-Graduação em Medicina/métodos , Docentes de Medicina , Medicina Interna/educação , Jornada de Trabalho em Turnos , Educação de Pós-Graduação em Medicina/organização & administração , Humanos
18.
J Pediatr ; 222: 22-27, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32380026

RESUMO

OBJECTIVE: To describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children's hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted. STUDY DESIGN: We describe our approach to surge-in-place at a children's hospital to meet the local demands of the COVID-19 pandemic. Instead of redeploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children's hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult patients with COVID-19. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes. RESULTS: The median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the intensive care unit, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2, 7). CONCLUSIONS: Our pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be redeploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Hospitais Pediátricos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências/estatística & dados numéricos , Adulto , Betacoronavirus , Cuidados Críticos/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Medicina Interna/normas , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Respiração Artificial
20.
Ann Otol Rhinol Laryngol ; 129(10): 988-995, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456500

RESUMO

OBJECTIVE: To examine the use of intramuscular corticosteroid (IMCS) injections for treatment of acute upper respiratory infections (URI) and the influence on healthcare utilization. METHODS: This retrospective cohort study used patient encounter data from a large multicenter regional health care system between 2013 and 2017. Adult patients diagnosed with acute URI (acute pharyngitis, acute sinusitis, acute otitis media, and URI not otherwise specified) during ambulatory encounters were included. Follow-up encounters for a diagnosis of acute URI within 60 days were identified and patient characteristics, encounter details, and procedure codes were retrieved. Frequency data was used to calculate IMCS injection administration prevalence, utilization trends, and associations with covariates. Follow-up data for return encounters within 60 days for the same diagnosis was examined. RESULTS: Of the 153 848 initial encounters, 34 600 (22.5%) patients received IMCS injection for acute URI. Injection rates varied from 0.85% to 49.1% depending on specialty and practitioner type. Internal medicine, family medicine, urgent care, and otorhinolaryngology clinics most commonly administered IMCS. 3788 patients returned for a second encounter of which 751 (19.8%) received an injection. IMCS injection during the first encounter was associated with increased odds of repeat visit within 60 days (OR: 1.74; 95% CI: 1.61-1.88). CONCLUSION: IMCS use in the treatment of acute URI is highly prevalent despite lack of evidence for impact and safety. Prevalence is variable across multiple medical and surgical specialties including otorhinolaryngology. Administration of IMCS injection may contribute to the likelihood of a subsequent healthcare visit for the same indication.


Assuntos
Corticosteroides/uso terapêutico , Assistência Ambulatorial/estatística & dados numéricos , Otite Média/tratamento farmacológico , Faringite/tratamento farmacológico , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Adulto , Idoso , Medicina de Família e Comunidade , Feminino , Humanos , Injeções Intramusculares , Medicina Interna , Masculino , Pessoa de Meia-Idade , Otolaringologia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos
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