Discipline Of Internal Medicine Research Articles

Oral health of patients suffering from end-stage solid organ insufficiency prior to solid organ re-transplantation: a retrospective case series study

BackgroundThe oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal).MethodsFrom January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created.ResultsThe clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression.ConclusionsSolid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.

Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition).

In recent years, as living standards have continued to improve, the number of diabetes patients in China, along with the incidence of complications associated with the disease, has been increasing. Among these complications, diabetic foot disease is one of the main causes of disability and death in diabetic patients. Due to the differences in economy, culture, religion and level of medical care available across different regions, preventive and treatment methods and curative results for diabetic foot vary greatly. In multidisciplinary models built around diabetic foot, the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology. In 2019, under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society, the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) was established with the participation of scholars from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology. Drawing lessons from diabetic foot guidelines from other countries, this guide analyses clinical practices for diabetic foot, queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China. This paper begins with assessments and diagnoses of diabetic foot, then describes treatments for diabetic foot in detail, and ends with protections for high-risk feet and the prevention of ulcers. This manuscript covers the disciplines of internal medicine, surgical, nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.Registry number: IPGRP-2020cn124

Implementing a logbook on entrustable professional activities in the final year of undergraduate medical education in Germany - a multicentric pilot study.

Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals.Methods: n=37 medical students and n=17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis.Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: Implementation process of the EPA curriculum and required resources, Entrustment process, Feedback sessions with supervisors, Students’ and supervisors’ role perceptionOverall impact of EPAs on training conditions in the practical year.Conclusion: The study presents a practical implementation of the EPA curriculum in Germany’s undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.

Gender Imbalance in Authorship ofVeterinary Literature: 1995 versus2015.

Despite increasing representation of women in veterinary medicine, gender differences persist in pay and attainment of senior and leadership positions. In academia, scholarly publication is a measure of productivity and is emphasized in the promotion process. This study aimed to analyze gender differences in the authorship of veterinary research articles to understand factors that could influence women's advancement and standing in academic medicine. We hypothesized that the proportion of women authors would increase between 1995 and 2015 and be similar to employment rates of women in academia, and that gender differences would exist in authorship by species, veterinary specialty area, and role (junior versus senior author). We examined 2,086 articles published in eight prominent veterinary journals in 1995 and 2015, determined the gender of first authors, corresponding authors, and senior authors, and collected article information including study design, species, and veterinary specialty area. The proportion of women as first and corresponding author increased significantly between 1995 and 2015, and in both years studied, women authored a larger percentage of articles than the reported percentage of women working in academia. In 2015, women were first authors of 60.0% (95% CI 56.9-63.0) of articles but accounted for only 38.3% of senior authors (95% CI 33.4-43.3). Female first authors were concentrated in articles pertaining to small animal, equine, and internal medicine disciplines and under-represented among articles pertaining to livestock or surgical specialties. The gender gap in the authorship of veterinary clinical research articles has improved dramatically over the past 20 years, although gender disparities persist.

Molecular-based diagnosis of multiple sclerosis and its progressive stage.

Biomarkers aid diagnosis, allow inexpensive screening of therapies, and guide selection of patient-specific therapeutic regimens in most internal medicine disciplines. In contrast, neurology lacks validated measurements of the physiological status, or dysfunction(s) of cells of the central nervous system (CNS). Accordingly, patients with chronic neurological diseases are often treated with a single disease-modifying therapy without understanding patient-specific drivers of disability. Therefore, using multiple sclerosis (MS) as an example of a complex polygenic neurological disease, we sought to determine whether cerebrospinal fluid (CSF) biomarkers are intraindividually stable, cell type-, disease- and/or process-specific, and responsive to therapeutic intervention. We used statistical learning in a modeling cohort (n = 225) to develop diagnostic classifiers from DNA-aptamer-based measurements of 1,128 CSF proteins. An independent validation cohort (n = 85) assessed the reliability of derived classifiers. The biological interpretation resulted from in vitro modeling of primary or stem cell-derived human CNS cells and cell lines. The classifier that differentiates MS from CNS diseases that mimic MS clinically, pathophysiologically, and on imaging achieved a validated area under the receiver operating characteristic curve (AUROC) of 0.98, whereas the classifier that differentiates relapsing-remitting from progressive MS achieved a validated AUROC of 0.91. No classifiers could differentiate primary progressive from secondary progressive MS better than random guessing. Treatment-induced changes in biomarkers greatly exceeded intraindividual and technical variabilities of the assay. CNS biological processes reflected by CSF biomarkers are robust, stable, disease specific, or even disease stage specific. This opens opportunities for broad utilization of CSF biomarkers in drug development and precision medicine for CNS disorders. Ann Neurol 2017;82:795-812.

Molecular-based diagnosis of Multiple Sclerosis and its progressive stage

Abstract Biomarkers aid diagnosis, allow inexpensive screening of therapies and guide selection of rational patient-specific polypharmacy regimens in most internal medicine disciplines. In contrast, there are no clinically-validated measurements of the physiological status, or dysfunction(s) of cellular components of the central nervous system (CNS). Accordingly, patients with chronic neurological diseases are generally treated with a single disease-modifying therapy without understanding patient-specific drivers of disability. Therefore, using multiple sclerosis (MS) as an example of a complex polygenic neurological disease, we sought to determine if cerebrospinal fluid (CSF) biomarkers are intra-individually stable, cell type-, disease- and/or process-specific and responsive to therapeutic intervention. Using DNA-aptamer-based multiplex assay, in-vitro- and statistical models, we developed in a training cohort (n=225) and validated in an independent-cohort (n=85) two biomarker-based classifiers that differentiate: 1. MS from CNS diseases that mimic MS clinically, pathophysiologically and on imaging, and 2. relapsing-remitting from progressive MS with ~90% accuracy. Treatment-induced changes in biomarkers greatly exceeded intra-individual-and technical variabilities of the assay. The observation that CNS biological processes reflected by combinatorial CSF biomarkers are robust, stable and disease- or even disease-stage specific opens opportunities for broad utilization of CSF biomarkers in drug development and precision medicine for CNS disorders.

Doktorların ve psikiyatri hastalarının psikoterapiye bakışı

Objective: In this study, we aimed to investigate the role of psychotherapy in healing and protection of mental health in integrated psychiatry and general medicine practice. Method: This study is a cross-sectional study that was conducted in Konya Training and Research Hospital between dates May 2013 and July 2013. Data were collected by using 5-item questionnaires prepared separately for patients and doctors from internal medicine and surgical disciplines. Results: The sample is consisting of 173 patients admitted to psychiatric outpatient clinic, 28 doctors from surgical and 89 doctors from internal medicine disciplines. Patients at psychiatric outpatient clinic believed that psychotherapy was an effective method for the treatment of psychiatric disorders, and knew that psychiatrists could apply psychotherapy, but thought that there was no sufficient time at outpatient clinics. No difference was determined between the doctors from internal medicine and surgical disciplines in tendency to ask support from psychiatrists for treatment of their patients (p=0.115). Doctors from internal medine disciplines had a higher proportion of belief that psychotherapy was as effective as medication treatments (p=0.038). No difference was determined between doctors from internal medicine and surgical disciplines in the belief that psychiatrists could provide psychotherapy service. Belief of applicability of psychotherapy at the outpatient clinic settings was higher among doctors from internal medicine than those from the surgical disciplines (p=0.038). Conclusion: This study enabled us to assess the attitudes towards “psychotherapy” among patients and doctors from internal medicine and surgical disciplines.

The "Handling" of power in the physician-patient encounter: perceptions from experienced physicians.

BackgroundModern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.MethodsThirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.ResultsThe analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.ConclusionsAlthough the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.

The empirical analysis of the professional content of secondary clinical treatment subjects and the DRGs range

Objective Taking the respiratory department of internal medicine as an example, to compare the coverage of clinical treatment of the MDC covered by DRGs of Beijing version with the professional services offered as secondary clinical treatment subjects in China. Methods Using the data from medical record home page from hospitals in Beijing above secondary level from 2012 to 2014 and both the DRGs defined in Pareto diagram statistical method and the DRGs proved by experts, for analysis and definition of the DRGs coverage involved by respiratory discipline of internal medicine. Results Respiratory discipline of internal medicine involved DRGs of 42 groups as found by the two methods. Conclusion The DRGs scope of secondary clinical departments in hospitals should be made based on both expert consultation and clinical data statistics method. Key words: DRGs; Clinical disciplines; Coverage of clinical treatment; Performance evaluation; Pareto diagram

Reflections on the First 2 Years of Milestone Implementation.

The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) collectively constitute the foundation of professional self-regulation in the United States. In February 1999, the 2 organizations approved 6 general competencies broadly relevant for all medical practice, followed by the official launch of the Outcomes Project in 2001. It was expected that the competencies would be an antidote to overspecification of accreditation standards, and that they would empower programs to create training programs grounded in meaningful outcomes in a developmental approach. As many programs can attest, the implementation of outcomes-based (eg, competency-based) medical education has been challenging. One reason has been the difficulty in implementing the competencies in both curriculum and assessment. Program leaders lacked shared mental models within their own training programs, accompanied by a lack of shared understanding nationally within disciplines. It is important to remember that 1 of the thorny problems the milestones were intended to address was the sources of unwanted and unwarranted variability in educational and, by extension, clinical outcomes. In addition, the community cannot improve at scale what cannot be measured, and prior frames and approaches to measurement were insufficient and ineffective. A key goal for milestones thus is to help improve the state and quality of measurement through better assessment in graduate medical education to facilitate the improved outcomes everyone desires. Approximately 10 years ago, conversations began on how to more effectively and meaningfully operationalize the competencies to help improve the design of residency and fellowship programs through the use of a developmental framework. In parallel, the ACGME began to explore mechanisms to move the accreditation system to a focus on outcomes using a continuous quality improvement philosophy. Developmental milestones, using narratives to describe in more descriptive terms the professional trajectories of residents, were seen as a way to move the outcomes project forward. Starting in 2007, the disciplines of internal medicine, pediatrics, and surgery began to create developmental milestones for the 6 competencies. Surgery would subsequently delay the development of their milestones focusing first on the SCORE curriculum. The ACGME began to restructure its accreditation processes in 2009, and soon after, milestone groups were constituted for all specialties. Milestone writing groups were cosponsored by the ACGME and the ABMS member certification boards. Early groups had significant latitude in developing their subcompetencies and milestones; specialties that started the process after 2010 used a standard template. Each milestone set was subjected to review by the educational community in the specialty. BOX 1 provides an overview of the purposes of the milestones across key stakeholders, and FIGURE 1 provides an example of a key driver diagram of milestones as an educational and clinical intervention. As FIGURE 1 highlights, milestones can potentially trigger a number of drivers, or mechanisms, to help enable changes in residency and fellowship education. In 2013, the milestones were officially launched in 7 core specialties (emergency medicine, internal medicine, neurological surgery, orthopaedic surgery, pediatrics, diagnostic radiology, and urology) as a formative, continuous quality improvement component of the new accreditation system. The remaining core disciplines and the majority of subspecialties implemented the milestones starting in July 2014. We have now reached an important ‘‘milestone’’ in the implementation process, and our commentary proDOI: http://dx.doi.org/10.4300/JGME-07-03-43

A Survey of Practitioner’s Knowledge of Psychiatric Medication Costs

Introduction. Escalating medical costs continue to be an issue facing contemporary medicine. One factor contributing to this escalation may be physicians’ knowledge of medication costs. As physicians increasingly face opportunities to treat a variety of symptoms and conditions in a single patient, including co-morbid psychiatric disorders or complications, accurate knowledge of medication costs becomes increasingly important. Methods. Resident and attending physicians (N = 16) across the disciplines of internal medicine, psychiatry, and combined internal medicine/psychiatry from a large, mid-western medical school were surveyed on the costs of several medications that are used to manage physical and psychiatric symptoms. Results. Differences were found in the perceived estimated cost of medications among practitioners particularly with specialty internal medicine training as compared to those with additional psychiatric training/experience. Trends also were noted across practitioners with psychiatric and internal medicine/psychiatry training. Conclusions. The breadth of training and experience can affect accuracy in estimating anticipated costs of medication regimens.

Perceptions on gender awareness and considerations in career choices of medical students in a medical school in Taiwan

The trend of medical career choice in the younger generation has resulted in deficiency of manpower in the four major disciplines of internal medicine, surgery, obstetrics/gynecology, and pediatrics, which will threaten people's health care in Taiwan. However, perceptions of gender awareness and factors affecting the career choices of medical students have not been investigated systemically in Taiwan. To explore the perceptions on gender awareness and considerations in career choices, we recruited 280 1st- and 7th-year male and female medical students at a Medical University for the study. A modified Nijmegen questionnaire using a 5-point Likert scale containing medical curricula (18 items), gender awareness (13 items), and career inclination (9 items) was adopted as the investigation tool in our study. The response rate was 75% (224/280). With regard to gender, the 1st-year male students had greater confidence in being a physician than the female students (p < 0.05), and female students subjectively suggested an advantage to communicate with patients or colleagues (p < 0.05). Faculty attitude in treating students differently by gender was more prominent in the 7th-year than in the 1st-year students (p < 0.001), and they felt male preceptors typically were more enthusiastic to teach and to rank higher grades to female than to male students; however, this was not observed among female preceptors. Both male and female students showed a low level of agreement that clinical skills and performance of a physician were significantly different by gender and “female physicians are more empathetic and provide more communications than male physicians”. Factors influencing career choices of medical students, including “personal interests/talents” and “academic achievement of the specialty,” were not significantly different by gender. Factors included “training and learning environments of the specialty”, “risk of lawsuit”, and “economic incentive” were more appreciated by the senior than the junior students (p < 0.05). Effect of “family” or “spouse” did not differ significantly regardless of gender or seniority. The 7th-year students had experiences in clinical medicine and had different considerations in career choice in comparison to the 1st-year students, and gender played a role in senior students. In addition, the senior rather than the junior students regarded “training and learning environments”, “risk of lawsuit”, and “economic incentive” as more important factors affecting the career choices, and male students paid more attention to these issues. Other factors such as fixed hours of duty with no emergency, easier lifestyle, and more time to take care his/her families were also important factors affecting career choice in medical students regardless of their gender; however, the junior students disclosed lower concern on the issues. In addition, four major misperceptions of gender and health issues were prevalent in the 7th-year students; therefore, we recognized the importance of integrating gender issues into medical curriculum to diminish gender misunderstanding and prejudice, and to provide gender-specific health care is mandatory in Taiwan.

Highlights in cardiology

Any appraisal of today’s highlights in cardiology must look back on pioneering achievements in the past. The history of this important discipline of internal medicine shows us that the most important steps in its development were temporarily very distant from each other. As early as 1622William Harvey for the first time described the blood circulation; in 1733Steven Hales reported on his experiment of blood pressure measurement, but it was not before 1895 that the pediatricianScipione Riva-Rocci presented his technique for bloodless registration of the systolic and diastolic blood pressure. This method—named after him—was corroborated by the work of the Russian physiologist N. S.Korotkow in 1905. In 1903Willem Einthoven recorded electrical currents in the heart, and 1910 was the year of birth of clinical electrocardiography introduced bySir Thomas Lewis.

Renal Research in 19th Century Germany

In the 19th century, clinical nephrology had not been established as a specific discipline of internal medicine, but major contributions to the understanding of renal physiology and kidney disease had been made by a number of authors from the German-speaking world. This essay describes the introduction of the concept of glomerular filtration by Carl Ludwig, the brilliant analysis of renal histology by Jacob Henle, the histologic description and insight into the evolution of chronic kidney disease by Friedrich Theodor von Frerichs, and the recognition of albuminuria in patients without primary kidney disease by Hermann Senator.

Anger Management And Factors That Influence Anger In Physicians

Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Duzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expression Inventory, and the Beck Anxiety and Depression Inventories were administered to all participants. The physicians (n=158) were evaluated and compared with controls (n=105) in terms of anger control and sociodemographic variables. Results: Anger-control scores were higher in physicians (pl0.01) and in those who willingly chose the medical profession (pl0.05). Age, number of years as a physician, and the specialty were negatively correlated with anger management in physicians working in the surgical disciplines (pl0.01). Only Beck anxiety and depression scores were positively correlated with anger-trait scores and anger-in scores for physicians working in the internal medicine disciplines (pl0.01). Conclusion: Physicians were relatively successful in coping with anger. A willingness to choose the medical profession was a factor influencing anger control. Age was the major factor affecting anger management in physicians.

SOMOSAT: Utility of a web-based self-assessment tool in undergraduate medical education

Background: Relatively few studies have rigorously assessed the effectiveness of computer-based self-assessment in medical education.Aim: To assess whether an online self-assessment tool can be an effective adjunct to a traditional curriculum for second-year medical students.Methods: The NYU School of Medicine Online Self-Assessment Tool (SOMOSAT) consists of >450 multiple-choice questions spanning disciplines of internal medicine, administered as separate modules focused on individual organ systems. Questions are coded on multiple dimensions, permitting second-year medical students to receive low-stakes, highly specific feedback regarding their knowledge and performance. Students can also review their answers to guide future study. We employed data collected during SOMOSAT operation to assess its utility and effectiveness.Results: Overall, SOMOSAT accurately predicted student performance on future exams. SOMOSAT participants generally performed better than non-participants on subsequent graded course examinations (p < 0.05). Students using SOMOSAT subsequently experienced greater improvement in areas in which they initially performed poorly, compared with those in which they initially performed well. Students reported that SOMOSAT was most helpful in filling knowledge gaps, and providing opportunities to practice exam-style questions.Conclusion: The ability of SOMOSAT to enhance learning and exam performance suggests that web-based self-assessment tools can be effective adjuncts to traditional educational methods.

Commentary: Training Internists for Practice Focused on Meeting Patient Needs

The author describes the evolution of practice within the broad specialty of internal medicine. This evolution is driven by scientific discovery, emergent patient needs, and market forces. Four ages describe the evolution: the age of the Oslerian diagnostic consultant, the age of the subspecialist, the age of the primary care internist, and the emerging age of focused general internal medicine practice. The author suggests that competence in practice-based learning and improvement linked with evaluation of practice performance throughout a career permits the professions to abandon the notion that valid learning for medical practice occurs only by completing a designated number of months of residency or fellowship training. By applying competency-based standards for specialty certification and maintaining its validity for current practice, boards can provide trainees and practitioners a tool for professional accountability for initial and continuous professional competence. The lifelong learning and evaluation process permits the timely recognition of proficiency acquired in practice. This process engages internists in ongoing guided reflection on measures of performance and provides evidence that they have incorporated new knowledge, technology, skills, and attitudes that align their practice with patient needs. As dialogue with internal medicine stakeholders and customers continues, the author describes how the training standards for certification might adapt to the evolving demands for the specialty practice and how the evaluation of continuous professional development through the maintenance of certification provides an instrument for identifying and recognizing proficiency in providing focused care within the broad discipline of internal medicine.

The Harvard Medical School-Cambridge Integrated Clerkship: An Innovative Model of Clinical Education

The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.

What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

BackgroundWe conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal.MethodsWe performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies.ResultsWe evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional titles supplied 46.8%. For the disciplines of internal medicine, general/family practice, and mental health (but not general practice nursing), the number of clinically important articles was correlated withScience Citation Index (SCI) Impact Factors.ConclusionsAlthough many clinical journals publish high-quality, clinically relevant and important original studies and systematic reviews, the articles for each discipline studied were concentrated in a small subset of journals. This subset varied according to healthcare discipline; however, many of the important articles for all disciplines in this study were published in broad-based healthcare journals rather than subspecialty or discipline-specific journals.

Liaison psychiatry and referral rates among hospitalized patients.

The study was conducted to assess the psychiatric co-morbidity among general hospital patients and their rate of referrals. A hospital based descriptive observational study. The study was conducted in a private teaching hospital for a period of 6 months. All admitted patients in different disciplines were assessed on a structured proforma supplemented by detailed psychiatric interview on positive cases. Morbidity patterns were assessed on the basis of ICD-10 classification. The total referral record was also maintained and compared with the data of morbidity and the number of referred cases. Out of the total 487 patients seen, 180 patients were found to have psychiatric co-morbidity; depression outnumbered all psychiatric disorders followed by mixed anxiety depression and somatoform disorders. Married female formed the majority group and the vulnerable age was between 41 to 60 years. Large segment of patients belonged to the discipline of internal medicine with the lowest (12%) referral rate. Out of 121 patients, referred from department of psychiatry, 44% were seen by the department of medicine followed by the gynecology and other disciplines. There is generally a low referral rate despite significant mental health co-morbidity. Training is needed for non-psychiatrists and there is a need for development of consultation-liaison psychiatry services in hospitals