Symptomatic myopathy due to red yeast rice.
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Biological Products↗
Biomedical subjects
Paul S Mueller
Publications and source records attributed to Paul S Mueller.
The association between impact factors and language of general internal medicine journals.
BACKGROUND: We sought to determine the associations between journal country of origin and language and journal impact factor of general medicine journals. METHODS: For each "Medicine, General and Internal" journal listed in the Institute for Scientific Information (ISI) Journal Citation Reports (JCR), the 2003 impact factor, language (ie, English, multiple languages [including English], or non-English), and country of origin (ie, US or non-US) were determined. The mean log impact factors of the journals by language, country of origin, and a combination of country of origin and language were compared. RESULTS: Of the 102 "Medicine, General and Internal" journals listed in the ISI JCR, 41 (40%) were published in the US and 83 (81%) were published in English. English-language journals had a significantly greater 2003 mean log impact factor than non-English journals and journals originating in the US had a significantly greater impact factor than journals originating elsewhere. However, the mean log impact factor of English-language journals originating in the US did not differ significantly from that of English-language journals originating elsewhere. CONCLUSION: Journal impact factor is more associated with journal language (ie, English versus non-English), rather than journal country of origin.
Bibliometrics↗
Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.
BACKGROUND: We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. METHODS: Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. RESULTS: Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average +/- SD, 9.4 +/- 1.0 vs 7.7 +/- 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. CONCLUSION: Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.
Academic Medical Centers↗
Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.
BACKGROUND: Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. METHODS: Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication within 30 days of CABG. Secondary outcomes were any major event and mortality. RESULTS: In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% (315/604) of patients who received intercessory prayer versus 51% (304/597) of those who did not (relative risk 1.02, 95% CI 0.92-1.15). Complications occurred in 59% (352/601) of patients certain of receiving intercessory prayer compared with the 52% (315/604) of those uncertain of receiving intercessory prayer (relative risk 1.14, 95% CI 1.02-1.28). Major events and 30-day mortality were similar across the 3 groups. CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
Aged↗
Blood glucose before and after ECT treatments in Type 2 diabetic patients.
Electroconvulsive therapy (ECT) is often performed for patients with psychiatric disorders who also have diabetes mellitus. Some research has suggested that the course of ECT treatments does not have a consistent effect on blood glucose, but little data exist to inform the clinician about the effects of individual ECT treatments on blood glucose. In this study, 18 patients with type 2 diabetes mellitus were treated with ECT for severe depressive illness. For each patient, a fingerstick blood glucose was routinely obtained before and approximately 20 minutes after each ECT treatment. We found a mean rise of blood glucose after each treatment of approximately 9%, similar to the mean rise of blood glucose among nondiabetic patients undergoing ECT found in a previous study. There were no cases of clinically significant rise or fall in blood glucose. We provide recommendations for management of diabetics during ECT.
Adult↗
Rectus sheath hematoma: review of 126 cases at a single institution.
Rectus sheath hematoma (RSH) is an uncommon condition characterized by abdominal pain and an abdominal wall mass. We reviewed the clinical features, treatment, and outcomes of 126 patients treated for RSH at Mayo Clinic from January 1, 1992, to December 31, 2002. Most patients (64%) were women and the mean +/- SD age was 67.9 +/- 16.5 years. Most patients (69%) were on some form of anticoagulation therapy. The mean international normalized ratio was 2.6 +/- 2.4, and mean activated partial thromboplastin time was 64.2 +/- 42.7 seconds. No patients were pregnant or had a peritoneal dialysis catheter at the time of diagnosis. Approximately half of the patients (48%) had nonsurgical abdominal trauma around the time of diagnosis, with 37 patients (29%) having a cough. The most common presenting signs and symptoms were abdominal pain (84%) and an abdominal wall mass (63%). CT of the abdomen and pelvis was the most commonly used method to establish the diagnosis (83%). Most patients (86%) were successfully treated with symptom management and blood transfusion. Ten patients (7.9%) underwent surgery or endovascular embolization of bleeding vessels, and 2 patients (1.6%) died as a result of RSH bleeding. Although RSH is rarely fatal, the clinician should be aware of important risk factors that lead to RSH including female sex, older age, anticoagulation therapy, and cough or other abdominal trauma. Rapid diagnosis with directed history, physical examination, and CT of the abdomen and pelvis may help decrease unnecessary laparotomy and lead to better triage of patients who present with RSH.
Abdominal Pain↗
Current status of medical grand rounds in departments of medicine at US medical schools.
OBJECTIVE: To assess the status of medical grand rounds (MGR) as an educational endeavor. METHODS: A survey of 133 departments of medicine at US medical schools was performed from September 2003 to March 2004; the results were compared with those of a previous (1988) survey. RESULTS: Ninety-nine departments (74%) responded to the survey; all 99 conducted MGR. Providing updates in diagnosis, treatment, and medical research, educating house staff and faculty, and promoting collegiality were the most important objectives of MGR. Regarding objectives, responses to the current survey differed significantly from the responses to the 1988 survey for providing updates in medical research (P=.047), providing continuing medical education credit (P<.001), educating house staff (P=.048), and educating faculty (P<.001); the differences were primarily due to higher proportions of current survey respondents rating these objectives as "quite" or "very" important. The most common format was the didactic lecture. Case presentations were uncommonly used, and patients were rarely present. Only 44% of departments used educational needs assessments, and only 13% assessed knowledge gained by attendees. Feedback was irregularly provided to presenters. Most departments (64%) relied on industry to pay for MGR. Lack of presenter-attendee interaction and conflicting meetings were cited as Important challenges. Nevertheless, most (62%) of the current survey respondents thought the quality of MGR had increased. CONCLUSIONS: Departments of medicine regard MGR as an important educational and social endeavor. However, most departments use suboptimal teaching, planning, and evaluation methods, and many rely on industry to pay for MGR. Addressing these concerns and other challenges may enhance the value of MGR.
Clinical Medicine↗
Obstructive intramural coronary amyloidosis and myocardial ischemia are common in primary amyloidosis.
PURPOSE: The purpose of this study was to determine the prevalence of clinical syndromes and pathologic changes of myocardial ischemia due to obstructive intramural coronary amyloidosis among patients with primary amyloidosis and cardiac involvement. SUBJECTS AND METHODS: Medical records and pathologic specimens were reviewed from 96 patients with primary amyloidosis and cardiac involvement at autopsy or after cardiac transplantation during a 20-year period. Medical records were reviewed for patient demographic and clinical characteristics, including evidence for syndromes of myocardial ischemia. Pathologic specimens were examined for obstructive intramural coronary amyloidosis and microscopic changes of myocardial ischemia. RESULTS: Obstructive intramural coronary amyloidosis was present in 63 of 96 patients (66%). Microscopic changes of myocardial ischemia were more common in patients with obstructive intramural coronary amyloidosis (86%) than in those without (52%) (P <.001). In the 76 patients without coexistent severe epicardial coronary atherosclerosis, changes of myocardial ischemia were more common in those with obstructive intramural coronary amyloidosis (83%) than in those without (45%) (P <.001). In patients who had tissue available for review, none had obstruction of epicardial coronary arteries from amyloid. Syndromes of myocardial ischemia affected 16 patients (25%) with obstructive intramural coronary amyloidosis but only 2 patients (6%) without (P=.027). For 11% of the patients with obstructive intramural coronary amyloidosis, a syndrome of myocardial ischemia consisting of acute myocardial infarction or angina pectoris was the first manifestation of primary amyloidosis. CONCLUSION: Most patients with primary systemic amyloidosis and cardiac involvement have obstructive intramural coronary amyloidosis and associated microscopic changes of myocardial ischemia. Syndromes of myocardial ischemia may occur in these patients.
Adult↗
Bronchoesophageal fistula due to broncholithiasis: a case series.
OBJECTIVE: To describe the clinical presentation, diagnostic evaluation, and treatment of bronchoesophageal (BE) fistula due to broncholithiasis, a rare cause of chronic cough with specific therapeutic implications. METHODS: Retrospective chart review of 9 patients diagnosed with BE fistulae at our tertiary-care institution between 1964 and 2002. RESULTS: The median age of patients (3 men, 6 women) was 56 years (range, 34-72 years). Six patients had never smoked. Eight presented with intractable cough typically worse after drinking that was relieved by lying on either side; 1 patient presented with dysphagia. Six patients reported lithoptysis, and most had a history of recurrent pneumonia. Chest findings were nonspecific. Diagnosis was established by radiocontrast studies of the esophagus (5 patients), surgical procedures (3), or bronchoscopy (1). Fistulae were right-sided in 7 patients and left-sided in 2. All patients had surgical repair of the fistulae; 6 patients experienced symptom resolution. CONCLUSION: BE fistula caused by broncholithiasis most commonly affects the right bronchial tree and should be considered in patients with chronic cough associated with drinking, lithoptysis, or recurrent pneumonia. The diagnosis is usually established by radiocontrast studies of the esophagus or incidentally during operations. Surgical repair is required.
Adult↗
Use of electroconvulsive therapy in a patient 10 days after myocardial infarction.
Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depression, even in patients with cardiac risk factors. Although rare, cardiovascular events during ECT remain a principal cause of morbidity and mortality. In particular, a history of recent myocardial infarction (MI) increases the risk of ventricular arrhythmias and cardiac rupture. A widely accepted recommendation is to administer ECT at least 3 months after MI, but sometimes a delay is not possible. Limited literature exists on the use of ECT in severely depressed patients with recent MI. Our literature review revealed 1 previously published case, with less than favorable results. In this case report, we describe a severely depressed, catatonic elderly man who was safely and successfully treated with ECT 10 days after an acute MI. It is essential that appropriate cardiac management be provided before, during, and after ECT by a multidisciplinary team of psychiatrists, internists, cardiologists, and anesthesiologists. Our case report suggests that, with proper management and close monitoring, ECT can be administered safely, even in patients with recent MI.
Aged↗
The Terri Schiavo saga: the making of a tragedy and lessons learned.
The recent case of Terri Schiavo has been an important medical, legal, and ethical controversy. However, much of the public discussion of the tragedy has been based on inaccurate information regarding the facts of the case and the actual legal and ethical issues involved. This article reviews the pertinent aspects of the case and the ethical and legal questions raised and highlights the lessons we should learn from this unique story.
Adult↗
Medical and ethical aspects of long-term enteral tube feeding.
Clinicians frequently care for patients in whom long-term enteral tube feeding is being considered. The substantial increase in the use of endoscopically placed tubes for long-term feeding reflects the aging population, advances in medicine and technology, and inadequate advance care planning. Physicians should address advance care planning with all patients at the earliest opportunity. Prospective randomized trials measuring clinical outcomes for patients receiving long-term tube feeding are understandably limited. In addition, confusion regarding medical and ethical guidelines for long-term tube feeding often exists among clinicians, patients, and surrogate decision makers. Therefore, we discuss the physiology and clinical tolerance of limited oral nutritional intake, the prevalence of and Indications for long-term tube feeding, the endoscopic procedures and their complications, the reported medical and quality-of-life outcomes, and the critical importance of advance care planning. We present our multidisciplinary approach that combines medical, nutritional, and ethical principles for the care of these patients.
Advance Directives↗
68-year-old man with chronic diarrhea, nausea, and vomiting.
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Aged↗
Safety of electroconvulsive therapy in patients receiving long-term warfarin therapy.
OBJECTIVE: To investigate the safety of electroconvulsive therapy (ECT) in patients receiving long-term warfarin therapy. PATIENTS AND METHODS: Retrospective data were reviewed for 35 consecutively hospitalized patients who received long-term warfarin therapy and ECT at the Mayo Clinic in Rochester, Minn, between January 1, 1994, and December 31, 2001. RESULTS: A total of 300 ECT treatments were administered to the 35 patients. Of 284 ECT treatments for which data were available, no ECT-related complications due to anticoagulation occurred despite increases in blood pressure and pulse rate. One patient experienced ventricular tachycardia, resulting in transfer to a cardiology service for temporary monitoring. No other serious ECT-related adverse effects were noted. The rate of intertreatment delirium was similar to that reported in other studies. CONCLUSIONS: Electroconvulsive therapy in patients receiving long-term warfarin therapy appears to be safe. Although no major adverse effects were identified in our case series, additional prospective evaluation is warranted.
Adult↗
Ethical issues in geriatrics: a guide for clinicians.
Because of demographic trends, it is reasonable to expect that clinicians will care for an increasing number of elderly persons with challenging medical and psychosocial problems. These problems and issues, in turn, may lead to daunting ethical dilemmas. Therefore, clinicians should be familiar with ethical dilemmas commonly encountered when caring for elderly patients. We review some of these dilemmas, including ensuring informed consent and confidentiality, determining decision-making capacity, promoting advance care planning and the use of advance directives, surrogate decision making, withdrawing and withholding interventions, using cardiopulmonary resuscitation and do-not-resuscitate orders, responding to requests for interventions, allocating health care resources, and recommending nursing home care. Ethical dilemmas may arise because of poor patient-clinician communication; therefore, we provide practical tips for effective communication. Nevertheless, even in the best circumstances, ethical dilemmas occur. We describe a case-based approach to ethical dilemmas used by the Mayo Clinic Ethics Consultation Service, which begins with a review of the medical indications, patient preferences, quality of life, and contextual features of a given case. This approach enables clinicians to identify and analyze the relevant facts of a case, define the ethical problem, and suggest a solution.
Advance Directives↗
'Social Medicine', a novel 1-week required clerkship on the biopsychosocial model.
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Curriculum↗
Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients.
The liver is a common site of amyloid deposition in primary systemic amyloidosis. We reviewed the clinical features and natural history of patients with primary systemic amyloidosis and biopsy-proven hepatic involvement who were evaluated at Mayo Clinic from January 1, 1975, to December 31, 1997. The median age of the study group (68 men; 30 women) was 58.5 years. Seventy-one patients (72%) had involuntary weight loss. Hepatomegaly was found in 79 patients (81%). Eighty-two patients (89%) had proteinuria, and 81 patients (86%) had elevated serum alkaline phosphatase levels. Seventy-six patients (83%) had either a serum or urine monoclonal protein. Before liver biopsy, clinicians considered amyloidosis in the differential diagnosis for only 14 patients (26%). None of our patients experienced hepatic rupture or death due to liver biopsy, and only 4 (4%) bled after liver biopsy. The median survival of the 98 patients was 8.5 months. Predictors of a poor prognosis were congestive heart failure, elevated concentrations of bilirubin, and a platelet count greater than 500 x 109/L. In conclusion, clinicians should consider the diagnosis of primary hepatic amyloidosis in patients who present with involuntary weight loss or hepatomegaly. Other clues to the diagnosis include an unexplained elevated serum alkaline phosphatase level, proteinuria, and evidence for hyposplenism (for example, Howell-Jolly bodies on peripheral blood smear). Liver biopsy was safe. Some patients benefit from systemic chemotherapy.
Amyloidosis↗
39-year-old man with human immunodeficiency virus infection and abdominal pain.
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Abdominal Pain↗