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At least 19 recordsLinked to original sources
PubMed1999

T grafts with the right internal thoracic artery to left internal thoracic artery versus the left internal thoracic artery and radial artery: flow dynamics in the internal thoracic artery main stem.

OBJECTIVE: Complete arterial coronary artery bypass grafting with 2 grafts can be achieved even in triple vessel disease by use of a T configuration. There is still uncertainty whether the coronary flow reserve in the main stem of the left internal thoracic artery is sufficient to supply more than 1 anastomosed coronary vessel. METHODS: Between March 1996 and February 1999, 251 patients with multivessel coronary artery disease underwent complete arterial revascularization with T grafts, using either the left internal thoracic artery with the free right internal thoracic artery graft (n = 73, group I) or the left internal thoracic artery and radial artery (n = 178, group II). A mean of 4.0 (group I) versus 4.3 (group II) coronary vessels were anastomosed per patient. One week (n = 92) and 6 months (n = 28) after the operation, flow was measured in the proximal left internal thoracic artery with a Doppler guide wire. Maximum flow was determined after injection of adenosine (30 microg). RESULTS: The in-hospital mortality was 2.7% (group I) versus 2.3% (group II). At angiography (n = 142, 56.6%) the patency rate was 96.3% (group I) versus 98.2% (group II). There was no significant difference between baseline flow, maximum flow, and coronary flow reserve between the 2 groups. Coronary flow reserve increased in both groups within the first 6 postoperative months (group I, 1.85 +/- 0.31 vs 2.77 +/- 0.77, P =.0002; group II, 1.82 +/- 0.4 vs 2.53 +/- 0.73, P =.009). CONCLUSION: Both variants of T grafts allow for complete arterial revascularization with good perioperative results. The flow reserve of the proximal internal thoracic artery is adequate for multiple coronary anastomoses irrespective of the choice of the second arterial graft.

Blood Flow Velocity↗
PubMed1995

International Society on Thrombosis and Haemostasis (ISTH), and International Union of Pure and Applied Chemistry (IUPAC), Clinical Properties and units in the clinical laboratory sciences. V. Properties and units in thrombosis and haemostasis (recommendation 1995). International Society on Thrombosis and Haemostasis (ISTH) and International Union of Pure and Applied Chemistry (IUPAC),and International Federation of Clinical Chemistry (IFCC).

Explore the source record for details and available documents.

Chemistry, Clinical↗
PubMed1991

Medical student interest in internal medicine. Initial report of the Society of General Internal Medicine Interest Group Survey on Factors Influencing Career Choice in Internal Medicine.

OBJECTIVE: To determine the factors that attract students toward and push students away from a career in internal medicine. DESIGN: National survey of senior U.S. medical students using a stratified random cluster sampling of medical schools. PARTICIPANTS: The survey included 1650 U.S. senior students from 16 medical schools, of whom 1244 (76%) responded. MEASUREMENTS AND MAIN RESULTS: A survey instrument was developed and pilot tested at 17 medical schools. Twenty-four percent of the respondents to the final survey chose a career in general internal medicine (9%) or subspecialty internal medicine (15%). A career in internal medicine had been "seriously considered" by 608 respondents (50%) who finally chose a career other than internal medicine (the "switchers"). Compared with other specialties, internal medicine was perceived as being more stressful to residents, more demanding of time and workload as a career and a residency, and as an easier residency to enter. Internal medicine was also seen as providing less satisfaction for residents, having lower income potential, and allowing less leisure time. For the 608 switchers, the most important influences leading to their decision to switch were the type of patient seen in internal medicine (for example, chronically ill, alcohol and drug abusing patients) as well as dissatisfaction and stress among internal medicine residents. Factor analysis showed that three factors, "intellectual challenge of internal medicine," "primary care interests," and "the medicine clerkship" attracted students toward internal medicine, whereas three others, "taking care of chronically ill patients," "level of satisfaction among internists and medical residents," and "workload and stress" pushed students away from internal medicine. Factors pushing students away from internal medicine were significantly more negative with regard to a career in general as opposed to subspecialty internal medicine (P less than 0.001). CONCLUSION: Medical students have serious reservations about internal medicine as a career choice. Perceptions about the medical residency, the patients they expect to see, and the dissatisfaction among residents and internists are foremost in their thinking. Changes to improve the attractiveness of internal medicine should address these adverse perceptions while building on the positive influences identified by the respondents.

Career Choice↗
PubMed1995

The impact of an ambulatory rotation on medical student interest in internal medicine. The Society of General Internal Medicine Task Force on Career Choice in Internal Medicine.

OBJECTIVE: To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers. DESIGN: National survey. SETTING AND PARTICIPANTS: The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representative schools nationwide were selected using a stratified, random-sampling method. MEASUREMENTS: The questionnaire asked about characteristics of the ambulatory rotation, perceptions of internal medicine, and factors influencing students toward or away from an internal medicine career. RESULTS: Ambulatory rotations were taken by 543 students (43%). Of these rotations, 73% were required, 74% were during the fourth year, 77% were in general internal medicine, 73% provided continuity of care, and 19% were during the medicine clerkship. Overall, 24% of the students chose careers in general (9%) or subspecialty internal medicine (15%). Thirty percent of the students who did ambulatory rotations planned internal medicine careers, compared with 19% of the students who had no rotation [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.3 to 2.4, p = 0.0001]. This association was of similar magnitudes for students completing required rotations (OR = 1.6, 95% CI 1.2 to 2.2, p = 0.002) and for students completing rotations before or in proximity to when they chose careers (OR = 1.7, 95% CI 1.1 to 2.4, p = 0.01). Ninety percent of the 543 students who had ambulatory rotations were satisfied with the experience. Thirty-eight percent of the highly satisfied students chose internal medicine careers, compared with 21% of the students who had low or moderate satisfaction (p = 0.0001). CONCLUSIONS: An ambulatory rotation is strongly associated with positive perceptions of, attraction to, and choice of a career in internal medicine. Research is needed to determine specific components of an effective rotation. Further development of ambulatory rotations could help attract more students to internal medicine.

Adult↗
PubMed1999

The relevance of attachment theory to a contemporary Jungian view of the internal world: internal working models, implicit memory and internal objects.

In this paper I examine the various meanings of the term 'internal object' and the differences between various theoretical models for the formation of internal objects. I suggest that the idea in attachment theory of 'internal working models' emphasizes the internal world as one consisting of unconscious internalized patterns of emotional relationships. The term 'internal object' lacks this clarity and the different meanings it carries within differing theoretical frameworks are a source of confusion. I describe the role implicit memory plays in the formation of 'internal working model's and suggest that these offer us an alternative explanation for unconscious fantasy and for object relationships to that of instinctual drives. This model is then brought to bear on contemporary Jungian concepts of the internal world, with a suggestion that, seen in this light, Jung's formulation of the concept of the complex has many features in common with the 'internal working model' of attachment theory.

Drive↗
PubMed2004

International questionnaire postal response rate: an experiment comparing no return postage to provision of International Postage Vouchers--"Coupon-Réponse International".

BACKGROUND: Previous studies of methods to increase response rates on international postal surveys did not include providing return postage. We provided International Postage Vouchers--"Coupon-Réponse International" to cover this. The objective of this study was to see if these International Postage Vouchers had an effect on response rates. METHODS: Between-groups, randomized, after-only. RESULTS: There was no difference in response rates between the group that received International Postage Vouchers and the group that did not. (p = 0.23). CONCLUSION: International Postage Vouchers--"Coupon-Réponse International" have no effect on response rates for international postal surveys.

Communication Barriers↗
PubMed2004

The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine.

The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep-ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.

Career Choice↗
PubMed2006

IDEAS internal contamination database: a compilation of published internal contamination cases. A tool for the internal dosimetry community.

In the scope of the IDEAS project to develop General Guidelines for the Assessment of Internal Dose from Monitoring data, two databases were compiled. The IDEAS Bibliography database contains references dealing with problems related to cases of internal contamination. The IDEAS Internal Contamination Database now contains more than 200 cases of internal contamination. In the near future, the IDEAS Internal Contamination database will be made available to the internal dosimetry community. The database has several potential applications, including: training, testing biokinetic models, testing software for calculating intakes and doses from bioassay data, comparison of data from a new accidental intake with that from previous exposures to similar materials. The database is by no means complete, and this presentation is also an appeal for internal contamination cases to extend and update it.

Biological Assay↗
PubMed1993

The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Society of General Internal Medicine Task Force on Career Choice in Internal Medicine.

OBJECTIVE: To understand better the decline in medical student interest in internal medicine. DESIGN: Qualitative analysis of 500 essays from respondents who participated in a national survey of graduating medical students from the class of 1990 in 16 medical schools. Medical students were asked the open-ended question, "What suggestions do you have for improving the attractiveness of internal medicine?" A model of career choice was developed for the analysis that included the following factors: ambulatory care exposure and primary care (including relationships with patients); attending physician-student interactions and learning climate; stress and workload; income and prestige; and intellectual stimulation. PARTICIPANTS: The original survey included 1650 fourth-year medical students; 500 essay respondents were stratified by sex and then randomly chosen for the analysis. RESULTS: Students most frequently suggested that ambulatory care experiences be increased and that better relationships with patients be established during medical training (65% of women and 50% of men, P < 0.01). The second most frequent suggestion was to improve internal medicine attending physicians' interactions with students (51% and 48% of women and men, respectively). Students who had seriously considered a career in medicine but switched to other primary care careers (general pediatrics, family medicine) had few concerns about income and prestige, whereas those who chose internal medicine had reservations about expected workload and income. Women were more likely than men to reject internal medicine for other primary care fields (26% of women compared with 16% of men, P = 0.05). CONCLUSIONS: Students, particularly female students, expressed a strong interest in establishing better relationships with patients. Lack of respect by medical attendings and negative teaching methods were important sources of dissatisfaction among both men and women. Attention to these relationship issues, in addition to housestaff stress and expected future income, may improve the attractiveness of internal medicine.

Adult↗
PubMed1989

The future of general internal medicine. Council on Long Range Planning and Development in Cooperation with the American College of Physicians, the American Society of Internal Medicine, and the Society of General Internal Medicine.

The American Medical Association Council on Long Range Planning and Development has been publishing a series of reports that assess trends in the environment of medicine and their impact on physicians and health care provision. The Council believes that each specialty in medicine has unique characteristics and will respond differently to changes in the health care arena. This report, developed in cooperation with the American College of Physicians, the American Society of Internal Medicine, and the Society of General Internal Medicine, provides an overview and environmental analysis of the specialty of general internal medicine. The Council first reviews socioeconomic data pertinent to general internal medicine. This is followed by a review of key issues pertinent to internists that relate to such topics as graduate medical education, reimbursement, scope of practice, manpower, and competition. In the conclusions, the Council suggests activities for the medical profession to pursue in response to the identified environmental trends.

Adult↗
PubMed2000

History of the International Society of Surgery/Société International de Chirurgie (ISS/SIC). I. Short story of Theodor Kocher's life and relationship to the International Society of Surgery.

With the aim of promoting progress in surgery through the friendly exchange of views and experience, the International Society of Surgery was founded in Brussels in 1902, thereby helping to overcome the narrow boundaries of that time's nationalism. At its first congress, the International Society of Surgery (ISS), otherwise known by its French name, Société Internationale de Chirurgie (SIC), already numbered 638 members, among them the most important surgeons from all over the world. Theodor Kocher (1841-1917) was the president of the first congress, held in Brussels in 1905, and was also responsible for the choice of topics. His presidential address clearly reflected the high aims the Society set for itself. Kocher's personal and professional authority, his surgical skill, which he liked so much to communicate to his colleagues, and his international thinking shaped the young Society. He remained on the international committee of the ISS until his death. Renowned surgeons from all over the globe traveled to Bern to see Kocher at work, among whom were many distinguished leaders of U.S. surgery. Thus Kocher's contribution had a great impact on the developing surgery, in particular in the United States. A short curriculum outlines the personality of this outstanding surgeon.

General Surgery↗
PubMed2001

Reforming the core clerkship in internal medicine: the SGIM/CDIM Project. Society of General Internal Medicine/Clerkship Directors in Internal Medicine.

Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation. Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.

Clinical Clerkship↗
PubMed2000

Workshop Report: Combining the staging system of the International Federation of Gynecology and Obstetrics with the scoring system of the World Heath Organization for Trophoblastic Neoplasia. Report of the Working Committee of the International Society for the Study of Trophoblastic Disease and the International Gynecologic Cancer Society.

During the past 5 years the International Society for the Study of Trophoblastic Disease and the International Gynecological Cancer Society have moved to modify the staging system for trophoblastic disease by combining the staging of the International Federation of Gynecology and Obstetrics (FIGO) with the scoring system of the World Health Organization (WHO). By making significant changes in both, the classification will be more acceptable worldwide leading to uniform use by physicians reporting management results in trophoblastic disease. This is the report of the Rome Workshop, which will be presented for ratification to the FIGO Staging Committee in September 2000.

Journal Article↗
PubMed1994

[International guidelines on the diagnostic applications of magnetic resonance. International Non-Ionizing Radiation Committee of the International Radiation Protection Association].

Magnetic resonance imaging has become an established diagnostic modality. The clinical usefulness of in vivo magnetic resonance spectroscopy was demonstrated in several instances and is being explored further. These techniques involve exposure of the patient to static and time-varying magnetic fields and radiofrequency electromagnetic fields. In particular exposure situations, these fields may pose a health hazard. The purpose of this paper is to provide information on the guidelines issued by the International Non-Ionizing Radiation Committee of the International Radiation Protection Association on levels of exposure and health effects from magnetic and radiofrequency electromagnetic fields associated with magnetic resonance diagnostic devices, and on precautions to be taken to minimize health hazards to patients undergoing magnetic resonance examinations.

Biophysical Phenomena↗
PubMed1999

International reference reagents: antihuman globulin. An ISBT/ICSH joint working party report. International Society of Blood Transfusion. International Committee for Standardization in Haematology.

An international working party has conducted a study designed to select a suitable reference reagent for antihuman globulin, to replace those first made available in 1987. The chosen preparation contains levels of anti-IgG and anti-C3 (anti-C3c and anti-C3d) potency that are considered suitable to serve for reference when evaluating either polyspecific antihuman globulin reagents or those containing their separate monospecific components. The reference material is available in 2-ml freeze-dried aliquots from seven assigned distribution centres.

Coombs Test↗
PubMed1996

Future roles and training of internal medicine subspecialists. American Board of Internal Medicine Task Force on Subspecialty Internal Medicine.

While fellowship training programs are being reduced in size to better conform to societal needs, the training of subspecialist basic scientists and clinical investigators must be protected to ensure continued discovery and the scholarly application of knowledge to patient care. Fewer subspecialist clinicians must be appropriately trained to serve as consultants, as principal care providers, and as scholarly leaders and educators in their subspecialties. This article describes the recommendations of the American Board of Internal Medicine for subspecialty training. To encourage physicians to choose careers as investigators, overlapping but different training paths are delineated for subspecialist clinicians and investigators. More didactic coursework is recommended for both paths. To maximize the contribution of fewer subspecialists, it is essential to provide rigorous training that is appropriately relevant and realistically matched with career opportunities.

Certification↗
PubMed2002

Performance-based assessment of internal medicine interns: evaluation of baseline clinical and communication skills.

OBJECTIVE: To assess baseline clinical and communication skills of entering internal medicine interns in performance of the medical interview and in written documentation of the clinical encounter. DESCRIPTION: Over three years, entering internal medicine interns at the University of New Mexico Health Sciences Center have taken an OSCE during their first week of training. Each year the process was refined based on feedback from both residents and faculty. This year, the intern examination consisted of four standardized cases. Twenty-two interns performed a focused interview and physical examination on each actor patient. For three of the cases, the intern wrote a chart note following the interview. After the fourth case, a trained faculty member who had watched the interview via a television monitor gave immediate feedback to the intern about his or her communication skills. The standardized patients were trained to complete checklists that included history, physical exam, and communication items for each intern. The written notes were graded using templates devised for each case that covered key historical and physical exam findings, problem identification, differential diagnosis, clinical reasoning, and logical diagnostic or treatment plans. The interns filled out an anonymous evaluation of the exercise where they were asked about whether the cases were appropriate for their level of training, and about how prepared they felt for the examination. The results for each set of skills were then reported to the interns and their supervising clinic attendings. For comparison, they were given the performance standards expected of fourth-year medical students at our institution. The videotaped encounters and the written notes are available for the faculty and trainees to review either together or independently. DISCUSSION: This exercise has given the faculty a detailed view of baseline clinical and written documentation skills of our entering interns. Overall, the residents demonstrated at least minimal competency in history taking and communication skills, but not in performing the expected focused physical exam. Their written reports showed adequate documentation of historical items but not of pertinent physical findings. The interns did not consistently make a problem list, provide a differential diagnosis, or show clinical reasoning despite being instructed to do so. There was great variation in performances between interns. Analysis of the interns' evaluations of this exercise showed that they felt it covered appropriate material, and they felt sufficiently prepared. Several interns had never done an OSCE prior to this exam. Written comments were positive about getting structured feedback early in their training. This format has allowed the identification of specific deficiencies in clinical skills for each of our interns, and this information will be used to guide our clinic preceptors in their teaching and in future evaluations. It would be ideal to design a second OSCE based on cases specific to internal medicine for the third-year residents, and compare skills developed over time.

Clinical Competence↗