RESUMEN
Collaborative partnerships between community-based academic residency training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH) tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research - creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes.
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Infecciones por Spirochaetales/sangre , Infecciones por Spirochaetales/diagnóstico por imagen , Sífilis/sangre , Sífilis/diagnóstico por imagen , Treponema pallidum/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Spirochaetales/complicaciones , Sífilis/complicacionesAsunto(s)
Debilidad Muscular/etiología , Temblor/etiología , Anciano , Carcinoma Neuroendocrino/diagnóstico , Femenino , Humanos , Pierna , Síndromes Paraneoplásicos del Sistema Nervioso/diagnóstico , Síndromes Paraneoplásicos del Sistema Nervioso/mortalidad , Síndromes Paraneoplásicos del Sistema Nervioso/patologíaAsunto(s)
Errores Innatos del Metabolismo de los Aminoácidos/inducido químicamente , Errores Innatos del Metabolismo de los Aminoácidos/diagnóstico , Glutatión Sintasa/deficiencia , Acetaminofén/efectos adversos , Errores Innatos del Metabolismo de los Aminoácidos/complicaciones , Disnea/inducido químicamente , Disnea/complicaciones , Disnea/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Studies show postinterview communication from applicants may affect their placement on the program's National Resident Matching Program (NRMP) rank order list. OBJECTIVE: To determine whether postinterview correspondence from applicants to a residency program is associated with the applicant's subsequent position on the program's rank list. METHODS: During 2 recruitment seasons, we collected postinterview correspondence from applicants to 1 residency program. Applicant characteristics and the content and timing of correspondence were compared with the applicant's position on the program's rank list. Data were analyzed using the Pearson χ(2) test. RESULTS: Of 470 applicants interviewed, 290 (61.7%) sent unsolicited correspondence to the program after interviewing. Ten percent (29 of 290) stated they planned to rank the program first, 11.7% (34 of 290) that they planned to rank it highly, and 78.3% (227 of 290) gave no indication of ranking intentions. Applicants who corresponded were no more likely to be ranked in the top 2 quartiles on the rank list than those who did not (P â=â .32) nor were applicants who communicated plans to rank the program "first" or "highly" ranked higher than other corresponding applicants (P â=â .34). Of the 16 applicants who planned to rank the program "first" and who were ranked in the program's match range, 5 did not match with the program, suggesting they may have misled the program. CONCLUSIONS: Postinterview correspondence by applicants was not associated with position on the rank order list. Correspondence does not benefit the applicant and can lead to misleading statements, which may violate the NRMP participation agreement.
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Toxinas Botulínicas Tipo A/aislamiento & purificación , Botulismo/diagnóstico , Clostridium botulinum tipo A , Oftalmoplejía/etiología , Anciano , Botulismo/complicaciones , Trastornos Relacionados con Cocaína/complicaciones , Diagnóstico Diferencial , Disnea/etiología , Humanos , Masculino , Nistagmo Patológico/etiología , Trastornos del Habla/etiología , Verduras/enzimología , Verduras/microbiologíaAsunto(s)
Fatiga/etiología , Nocardiosis/complicaciones , Prednisona/efectos adversos , Trastornos del Sueño-Vigilia/complicaciones , Anciano de 80 o más Años , Comorbilidad , Confusión , Progresión de la Enfermedad , Servicio de Urgencia en Hospital , Fatiga/diagnóstico , Fatiga/fisiopatología , Humanos , Huésped Inmunocomprometido , Pulmón/patología , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Nocardiosis/diagnóstico , Nocardiosis/terapia , Equilibrio Postural , Prednisona/administración & dosificación , Radiografía Torácica , Trastornos de la Sensación , Trastornos del Sueño-Vigilia/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Linfadenitis/diagnóstico , Convulsiones/etiología , Vasculitis del Sistema Nervioso Central/diagnóstico , Adulto , Biopsia , Encéfalo/patología , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Ganglios Linfáticos/patología , Linfadenitis/complicaciones , Linfadenitis/cirugía , Imagen por Resonancia Magnética , Metilprednisolona/uso terapéutico , Cuello , Convulsiones/líquido cefalorraquídeo , Convulsiones/tratamiento farmacológico , Vasculitis del Sistema Nervioso Central/complicaciones , Vasculitis del Sistema Nervioso Central/tratamiento farmacológicoAsunto(s)
Cardiomiopatía Restrictiva/diagnóstico , Cirrosis Hepática/diagnóstico , Pericarditis Constrictiva/diagnóstico , Anciano , Ascitis , Líquido Ascítico/química , Biopsia , Cardiomiopatía Restrictiva/etiología , Diagnóstico Diferencial , Edema , Humanos , Cirrosis Hepática/etiología , Cirrosis Hepática/terapia , Extremidad Inferior , Imagen por Resonancia Magnética , Masculino , Paracentesis , Pericardiectomía , Pericarditis Constrictiva/etiologíaAsunto(s)
Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Síndrome de Peutz-Jeghers/diagnóstico , Dolor Abdominal/etiología , Adulto , Cólico/etiología , Diagnóstico Diferencial , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Pólipos Intestinales/diagnóstico , Intususcepción/diagnóstico , Enfermedades del Yeyuno/diagnóstico , Lentigo , Síndrome de Peutz-Jeghers/complicaciones , Vómitos/etiologíaRESUMEN
HYPOTHESIS: Laparoscopic approaches for weight reduction in the morbidly obese have become common with more than 50,000 bariatric surgical procedures being performed in 2001. The objective of this article is to raise awareness among surgeons of a new complication of rhabdomyolysis from this frequent procedure. DESIGN: Case series extracted from surgical database from January 2, 2001, through December 31, 2002. PATIENTS AND METHODS: We identified 5 cases of postoperative rhabdomyolysis in morbidly obese patients who underwent laparoscopic duodenal switch procedures with parietal gastrectomy. The cause, pathogenesis, and clinical features are reviewed and discussed. RESULTS: Postoperative rhabdomyolysis developed in 5 of 353 morbidly obese patients who underwent consecutive laparoscopic duodenal switch procedures, an incidence of 1.4%. All 5 patients were male, had a mean peak serum creatine kinase level of 19 680 U/L, and reported muscle pain in either the buttock, hip, or shoulder regions during the early postoperative period. CONCLUSIONS: We hypothesized that morbidly obese patients develop critical surface and deep tissue pressures during bariatric surgery, increasing their risk for tissue injury and rhabdomyolysis. Unexplained elevations in the serum creatinine level or reports of buttock, hip, or shoulder pain in the postoperative period should raise the possibility of rhabdomyolysis and prompt clinical investigation. We recommend routine preoperative and postoperative measurements of the serum creatine kinase and serum creatinine levels to aid detection. Surgeons need to keep a low index of suspicion because early diagnosis and treatment are the cornerstones of successful management of rhabdomyolysis.