Re: "Perceptions" of questionable value.
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Biomedical subjects
S M Salerno
Publications and source records attributed to S M Salerno.
The opinion of current and recent internal medicine residents regarding a fourth year of training and the future of general internal medicine. American College of Physicians National Council of Associates.
OBJECTIVE: To determine the opinion of current residents and recent graduates of internal medicine training programs regarding an additional mandatory year of residency training. METHODS: A survey was made of 2,000 associate members of the American College of Physicians from five geographic regions. RESULTS: Of 917 respondents, 70.3% thought a fourth year of training would impact negatively on their choice of a career in internal medicine, and 82.9% believed a mandatory fourth year should not be required of residents choosing a subspecialty career. Furthermore, 58.1% of physicians surveyed thought a mandatory fourth year would discourage individuals from pursuing subspecialty careers. If a mandatory fourth year of training were required, 50.7% respondents indicated that it should consist of ambulatory training in a number of general fields, while 49.6% physicians believed the training should focus on one or two subspecialty fields. CONCLUSIONS: A mandatory fourth year of training is not supported by residents and recent graduates of the programs surveyed.
Attitude of Health Personnel↗
The effect of multiple neuroimaging studies on classification, treatment, and outcome of acute ischemic stroke.
OBJECTIVE: To examine the effect of serial neuroimaging studies on the diagnosis, therapy, and outcome of patients with acute stroke. DESIGN: Retrospective case series. SETTING: Tertiary care teaching hospital. PATIENTS: 206 adult patients (mean age +/- SD, 66.0 +/- 10.8 years) hospitalized with a diagnosis of acute stroke between 1990 and 1993. MEASUREMENTS: Strokes were retrospectively assigned to five categories (large-vessel, small-vessel, cardioembolic, other, or unknown) using standardized criteria based on the history, physical examination, ancillary test results, and first computed tomographic (CT) or magnetic resonance imaging (MRI) study of the head. Strokes were reclassified after the results of further neuroimaging studies, if any, were reviewed. The type and timing of therapy and the patient outcome at hospital discharge were documented. RESULTS: The additional studies changed stroke classification in only 20.0% of the 140 patients who had two or more neuroimaging studies. All classification changes were from the unknown cause category to a category with a specific cause. In most patients receiving treatment (93.2%), therapy began before an additional CT or MRI study was obtained. In patients who had one neuroimaging study, 70.1% went home, 24.0% went to a skilled nursing facility, and 5.9% died; the corresponding percentages in persons who had multiple studies were 73.3%, 24.4%, and 2.2% (P > 0.1). CONCLUSIONS: Serial neuroimaging studies did not alter the classification of strokes for which an initial diagnosis had already been made. However, they were useful in determining the cause of strokes initially classified as having an unknown cause. Therapy was almost always begun immediately after the first CT or MRI study was obtained. Outcome at hospital discharge was not significantly related to the number of neuroimaging studies obtained.
Aged↗
Sulfasalazine pulmonary toxicity in ulcerative colitis mimicking clinical features of Wegener's granulomatosis.
The centrally accentuated antineutrophil cytoplasmic antibody test (c-ANCA) is widely regarded as a sensitive and specific marker for Wegener's granulomatosis (WG). There are increasing reports, however, of false-positive c-ANCAs, usually in the setting of other vasculidities. We report a case of a 27-year-old man with ulcerative colitis who developed pulmonary symptoms, peripheral nodular lung infiltrates, and an elevated c-ANCA suggesting WG. Chest CT and open lung biopsy specimens were consistent with WG. The symptoms and pulmonary infiltrates resolved after discontinuation of sulfasalazine therapy. The c-ANCA remained elevated due to the occurrence of false-positive values in ulcerative colitis. We conclude sulfasalazine toxicity can mimic clinical aspects of WG and that c-ANCA testing should be interpreted with caution in patients with ulcerative colitis.
Adult↗
Eosinophilic pneumonia and respiratory failure associated with a trazodone overdose.
Drug-induced eosinophilic lung disease commonly presents as a simple pulmonary eosinophilia-like syndrome consisting of transient pulmonary infiltrates, peripheral eosinophilia, and mild pulmonary symptoms that disappear promptly upon withdrawal of the offending medication. However, a more fulminant presentation most resembling acute eosinophilic pneumonia has been recently described. We present a patient with BAL-confirmed eosinophilic pneumonia (EP) and respiratory failure after a trazodone overdose. This is the first case of EP associated with trazodone and only the third drug-mediated EP reported to precipitate respiratory failure.
Acute Disease↗
Calcium channel antagonists. What do the second-generation agents have to offer?
Calcium channel antagonists have gained widespread acceptance for treatment of a variety of cardiovascular disorders. Newer drugs of the dihydropyridine class are especially attractive for treating hypertension and angina because of their increased vascular selectivity, favorable side-effect profile, and pharmacokinetics that allow once-daily dosing. In the future, calcium channel antagonists may also play a role in antiatherogenic therapy and in treatment of congestive heart failure and cerebrovascular disease as results of prospective studies become available and new agents are developed.
Arteriosclerosis↗
Dystonia in central pontine myelinolysis without evidence of extrapontine myelinolysis.
A 44-year-old female is described who developed persistent upper extremity and orolingual dystonia several weeks after suspected onset of central pontine myelinolysis (CPM), later confirmed by characteristic pontine lesions on MRI. No foci of the extrapontine myelinolysis were evident. This case confirms that dystonia may be a late and persistent sequela of CPM and may occur in the absence of visible lesions outside the brainstem.
Adult↗
Monitoring EMS protocol deviations: a useful quality assurance tool.
STUDY OBJECTIVE: To determine the incidence, type, and outcome of protocol deviations in an emergency medical services (EMS) system. DESIGN: Retrospective consecutive case series. SETTING: Seven advanced life support ambulance services servicing five area hospital emergency departments. PATIENTS: 1,246 patients requiring advanced life support care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Advanced life support ambulance runs during a two-month period were examined for protocol deviations. Of 1,246 runs examined, 16% had deviations. Approximately 55% of these deviations were minor, 38% were serious, and 7% were very serious in nature. The effects of the errors were evaluated using hospital records. Results showed that 89.5% of patients were unaffected, 5.0% improved, and 5.5% suffered complications from deviations. Emergency medical technicians committed 69% of the deviations without the consent of medical control, medical control committed an additional 18%, and both were responsible in 13% of cases. Incomplete histories were found in 8% of cases. CONCLUSION: Protocol deviations committed in prehospital care do not usually cause direct harm to patients. On review of these deviations, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control. This type of quality assurance study has the ability to identify areas of strength and weakness in an EMS system, allowing planning of ongoing educational efforts in the system.
Clinical Protocols↗
Advances in neurology at Turner's Lane Military Hospital.
The work of physicians at Turner's Lane Military Hospital, Philadelphia, stimulated interest in neurology in the United States, leading to the post-Civil War emergence of neurology as a distinct medical specialty. These physicians advanced their profession and benefitted their patients.
History, 19th Century↗