Division Of General Internal Medicine Research Articles

Performance of serum soluble interleukin-2 receptor as a diagnostic marker for lymphoma in patients with fever

There have been few reports on the diagnostic performance of soluble interleukin-2 receptor (sIL-2R) for lymphoma. A cross-sectional study was conducted at a university hospital; all patients who were admitted to the Division of General Internal Medicine and underwent serum sIL-2R testing were included. Patients were divided into two groups based on the presence of fever (≥ 38.0 °C). Among 602 patients, 421 had fever and 76 were diagnosed with lymphoma (48 of the 76 were in the febrile group). In all patients, the area under the receiver operating characteristic curve (AUROC) of sIL-2R for the diagnosis of lymphoma was 0.81 [95% confidence interval (CI), 0.75–0.87]. The AUROC was significantly higher in the febrile group (0.88; 95% CI, 0.81–0.94) than in the afebrile group (0.75; 95% CI, 0.65–0.85). In the febrile group, the sensitivity and specificity were 81.2% and 82.3%, respectively, with an optimal cutoff value of 3,250 U/mL. In the afebrile group, they were 89.3% and 54.9%, respectively, with a cutoff value of 868 U/mL. Serum sIL-2R showed high performance as an adjunctive diagnostic marker for lymphoma, particularly among febrile patients. Different cutoff values should be used for patients with and without fever to maximize diagnostic performance.

Against medical advice: A structured approach to narrative medicine as a balm to the madness.

Journal of the American Geriatrics SocietyEarly View ARS LONGA: HUMANITIES AND AGING Against medical advice: A structured approach to narrative medicine as a balm to the madness Michelle Izmaylov MD, Corresponding Author Michelle Izmaylov MD [email protected] Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA Correspondence Michelle Izmaylov, Vanderbilt University Medical Center, Nashville, TN, USA. Email: [email protected]Search for more papers by this authorTom Elasy MD, Tom Elasy MD Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USASearch for more papers by this author Michelle Izmaylov MD, Corresponding Author Michelle Izmaylov MD [email protected] Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA Correspondence Michelle Izmaylov, Vanderbilt University Medical Center, Nashville, TN, USA. Email: [email protected]Search for more papers by this authorTom Elasy MD, Tom Elasy MD Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USASearch for more papers by this author First published: 06 March 2023 https://doi.org/10.1111/jgs.18299Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Birthdays.

Journal of Palliative MedicineVol. 26, No. 3 Personal ReflectionBirthdaysW. David ClarkW. David ClarkAddress correspondence to: W. David Clark, MD, Internal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA E-mail Address: w-david-clark@uiowa.eduInternal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.Search for more papers by this authorPublished Online:1 Mar 2023https://doi.org/10.1089/jpm.2022.0466AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Birthdays." Journal of Palliative Medicine, 26(3), p. 443FiguresReferencesRelatedDetails Volume 26Issue 3Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:W. David Clark.Birthdays.Journal of Palliative Medicine.Mar 2023.443-443.http://doi.org/10.1089/jpm.2022.0466Published in Volume: 26 Issue 3: March 1, 2023PDF download

Be kind. Use systems. Improve care.

Health Services ResearchVolume 58, Issue 2 p. 247-249 COMMENTARY Be kind. Use systems. Improve care Taressa K. Fraze PhD, Corresponding Author Taressa K. Fraze PhD [email protected] orcid.org/0000-0002-8346-6425 Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USA Correspondence Taressa K. Fraze, Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, CA, USA. Email: [email protected]Search for more papers by this authorSunita Mutha MD, Sunita Mutha MD orcid.org/0000-0001-6618-7240 Division of General Internal Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USASearch for more papers by this author Taressa K. Fraze PhD, Corresponding Author Taressa K. Fraze PhD [email protected] orcid.org/0000-0002-8346-6425 Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USA Correspondence Taressa K. Fraze, Family and Community Medicine, Healthforce Center, University of California San Francisco, San Francisco, CA, USA. Email: [email protected]Search for more papers by this authorSunita Mutha MD, Sunita Mutha MD orcid.org/0000-0001-6618-7240 Division of General Internal Medicine, Healthforce Center, University of California San Francisco, San Francisco, California, USASearch for more papers by this author First published: 26 January 2023 https://doi.org/10.1111/1475-6773.14135 Commentary on ‘A systematic review of research on empathy in health care’ by Nembhard et al., https://doi.org/10.1111/1475-6773.14016. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume58, Issue2April 2023Pages 247-249 RelatedInformation

National Academy of Medicine: "National Plan for Health Workforce Wellbeing".

Vanderbilt Occupational Health Clinic, Vanderbilt Health & Wellness, Vanderbilt Medical Center, Nashville, TN Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN Correspondence: Lori A. Rolando, MD, MPH, Vanderbilt Health & Wellness 1211 21st Avenue South Suite 640 Medical Arts Building Nashville, TN 27212 Funding Sources: NA Conflicts of Interest: None Declared Address for reprints: same as above Sources of Support: NA Ethical Considerations (e.g., IRB #): NA

Web Exclusive. Annals for Hospitalists Inpatient Notes - Improving Medication Reconciliation in Hospitals.

Web ExclusivesAugust 2022Annals for Hospitalists Inpatient Notes - Improving Medication Reconciliation in HospitalsJeffrey L. Schnipper, MD, MPHJeffrey L. Schnipper, MD, MPHHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.L.S.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-1954 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Transitions of care into and out of the hospital are vulnerable times for patients, especially when it comes to medication safety. One type of medication error that occurs during care transitions is medication discrepancies, defined as unexplained differences among documented regimens across different sites of care. Discrepancies are the result of 2 different breakdowns in our care processes: history errors and reconciliation errors. History errors occur when ordered medications are incorrect because the preadmission medication history is incorrect (for example, failure to realize a patient was prescribed aspirin before admission). Reconciliation errors occur when ordered medications are incorrect despite an ...

Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial.

Planning complex operations such as robotic-assisted radical prostatectomy requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) cross-sectional images to understand 3-dimensional (3D), patient-specific anatomy. We sought to determine surgical outcomes for robotic-assisted radical prostatectomy when surgeons reviewed 3D, virtual reality (VR) models for operative planning. A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted laparoscopic radical prostatectomy were prospectively enrolled and randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and MRI only or to an intervention group where MRI and biopsy results were supplemented with a 3D VR model. The primary outcome measure was margin status, and secondary outcomes were oncologic control, sexual function and urinary function. Ninety-two patients were analyzed, with trends toward lower positive margin rates (33% vs 25%) in the intervention group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05). Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036). In 32% of intervention cases, the surgeons modified their operative plan based on the model. When this subset was compared to the control group, there was a strong trend toward increased bilateral nerve sparing (78% vs 92%), and a significantly lower rate of postoperative detectable prostate specific antigen in the intervention subset (31% vs 0%, p=0.038). This randomized clinical trial demonstrated patients whose surgical planning involved 3D VR models have better oncologic outcomes while maintaining functional outcomes.

The Importance of Vitamin D in Long-Term Care Residents

The Importance of Vitamin D in Long-Term Care Residents

Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic.

Cognitive biases are systematic cognitive distortions, which can affect clinical reasoning. The aim of this study was to unravel the most common cognitive biases encountered in in the peculiar context of the COVID-19 pandemic. Case study research design. Primary care. Single centre (Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland). A short survey was sent to all primary care providers (N = 169) taking care of hospitalised adult patients with COVID-19. Participants were asked to describe cases in which they felt that their clinical reasoning was “disrupted” because of the pandemic context. Seven case were sufficiently complete to be analysed. A qualitative analysis of the clinical cases was performed and a bias grid encompassing 17 well-known biases created. The clinical cases were analyzed to assess for the likelihood (highly likely, plausible, not likely) of the different biases for each case. The most common biases were: “anchoring bias”, “confirmation bias”, “availability bias”, and “cognitive dissonance”. The pandemic context is a breeding ground for the emergence of cognitive biases, which can influence clinical reasoning and lead to errors. Awareness of these cognitive mechanisms could potentially reduce biases and improve clinical reasoning. Moreover, the analysis of cognitive biases can offer an insight on the functioning of the clinical reasoning process in the midst of the pandemic crisis.

Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs.

BackgroundIn 2017, the American College of Physicians (ACP) designated Mindfulness-Based Stress Reduction (MBSR), an eight-week group program, as first-line non-pharmacological treatment for chronic low back pain. However, interprofessional collaboration between mindfulness instructors and Primary Care Providers (PCP) remains largely unknown.ObjectiveWe developed a survey to assess communication between mindfulness instructors and PCPs, identify predictors of referral to MBSR, and determine areas where interventions could increase patient access to MBSR.MethodsThe 25-question survey was sent via email to PCPs at the Division of General Internal Medicine, University of Pittsburgh, PA, the Piedmont Health Services Family Medicine Section, Chapel Hill, NC, the Boston Medical Center General Internal Medicine and Family Medicine Sections, Boston, MA, and the UMass Memorial Medical Center Family Medicine Section, Worcester, MA. We used descriptive statistics and logistic regression to analyze the data.ResultsAmong 118 eligible respondents, 85 (72.0%) were female PCPs, mean age was approximately 41.5±10.1, and the majority (65.2%) had been in medical practice ≤10 years. Of these PCPs, 83 (70.1%) reported familiarity with MBSR (95% CI: 62.1, 78.5), and 49 (59.0%) of them referred patients at least yearly. Of those who referred, 8 (16.3%) reported collaboration with mindfulness instructors. PCPs who were quite a bit or very much familiar with MBSR had 5.10 (1.10, 22.50) times the odds (P=.03), and those who were 50 years or younger had 3.30 times the odds (P=.04) of referring patients to MBSR. Frequency of PCPs’ personal practice of mindfulness was not significantly associated with referrals (P=.30).ConclusionThis is the first study to assess interprofessional collaboration between mindfulness instructors and PCPs. Suggestions for a potential integrative health care model are included; further studies on methods to augment communication and education are warranted to improve the referral process and ultimately increase accessibility and utilization of mindfulness-based programs.

Association Between Antidiarrheal Drug Prescription and Return Visits Among Adult Patients With Acute Diarrhea.

Whether antidiarrheal medications have benefits or demerits when administered to adult patients with diarrhea remains controversial. We aimed to evaluate the association between antidiarrheal drug prescription and clinical outcomes in adult patients with acute diarrhea.This retrospective cohort study was conducted by collecting secondary data of patients' health records at St. Luke’s International Hospital from April 1, 2004, to March 31, 2016. We included all participants aged 20-59 years who visited the division of general internal medicine or the emergency room in the hospital due to acute diarrheal symptoms. We excluded those who had chronic diarrhea or were immunocompromised (e.g., those with cancer or immunosuppressant usage). Our primary outcome was return visits within two weeks; the secondary outcome was admission to the hospital due to acute diarrhea within two weeks from the first visit. We compared the outcomes between patients with and without antidiarrheal drug prescriptions. During the study period, a total of 10,246 patients were included, of which 204 (2.0%) were prescribed antidiarrheal drugs. The mean age of the patients was 35.0 (standard deviation: 10.7) years, and 4,130 (40.3%) were men. Patients who were prescribed antidiarrheal drugs were more likely to be prescribed antibiotics (p<0.01). The adjusted odds ratios for return visits among patients with and without antidiarrheal drug prescription were 1.24-1.59, which were not significant.We demonstrated that antidiarrheal drug prescription was not associated with return visits or hospital admission among adult patients with acute diarrhea. This finding suggests that antidiarrheal medications have more benefits than risks in adult patients with acute diarrhea.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Total Pain #417

Journal of Palliative MedicineVol. 24, No. 7 Fast Facts and ConceptsTotal Pain #417Avani Prabhakar and Thomas J. SmithAvani PrabhakarAddress correspondence to: Avani Prabhakar, MD, Section of Palliative Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 359, Baltimore, MD 21287-0005, USA E-mail Address: apatel26@jhmi.eduSearch for more papers by this author and Thomas J. SmithSearch for more papers by this authorPublished Online:4 Jun 2021https://doi.org/10.1089/jpm.2021.0128AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Total Pain #417." Journal of Palliative Medicine, 24(7), pp. 1100–1101FiguresReferencesRelatedDetails Volume 24Issue 7Jul 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Avani Prabhakar and Thomas J. Smith.Total Pain #417.Journal of Palliative Medicine.Jul 2021.1100-1101.http://doi.org/10.1089/jpm.2021.0128Published in Volume: 24 Issue 7: June 4, 2021PDF download

Safety of Breastfeeding by Mothers With COVID-19: New Evidence From Israel

* Abbreviations: COVID-19 — : coronavirus disease 2019 EBF — : exclusive breastfeeding SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 WHO — : World Health Organization Human milk is the ultimate food to promote healthy growth and development of children aged <2 years.1 Optimal breastfeeding practices, as recommended by the World Health Organization (WHO), include initiation of skin-to-skin contact with breastfeeding within 1 hour of birth, exclusive breastfeeding (EBF) for 6 months, then continued breastfeeding with appropriate complementary foods for up to 2 years and beyond.1 The WHO also recommends that mothers with suspected or confirmed coronavirus disease 2019 (COVID-19) should be encouraged to initiate or continue to breastfeed.2 However, concerns have been raised about whether mothers with COVID-19 can transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to their infant or young child through breastfeeding or horizontally. In a case series of 53 women infected with SARS-CoV-2 and their 55 mostly breastfed infants reported in this issue of Pediatrics , Shlomai et al3 report no neonatal SARS-CoV-2 infections, … Address correspondence to Marcel Yotebieng, MD, MPH, PhD, Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY 10467. E-mail: marcel.yotebieng{at}einsteinmed.org

DAMPening Mortality in COVID-19: Therapeutic Insights From Basic Cardiometabolic Studies on S100A8/A9.

DAMPening Mortality in COVID-19: Therapeutic Insights From Basic Cardiometabolic Studies on S100A8/A9.

Women in Medicine: Dr. Louise Pilote

Always driven by a desire to understand, Dr. Louise Pilote (MDCM, MPH, PhD, FRCPC) can accurately be described as a lifelong learner. As the former Director of the Division of General Internal Medicine at McGill University, this clinician scientist is a Professor of Medicine at McGill and holds a James McGill chair. Her research interests include cardiovascular disease, specifically in women, as well as health service outcomes. Pilote’s most recent endeavor focuses on the impact of gender on health outcomes, on a globalized scale. Now a mother of five, Pilote shares her experience with infertility and how to integrate professional and personal life. She also discusses the intersection of medicine and feminism, while providing advice for the next wave of clinician researchers.

A View from the Frontline: Palliative and Ethical Considerations of the COVID-19 Pandemic.

A View from the Frontline: Palliative and Ethical Considerations of the COVID-19 Pandemic.

Three Reasons to Focus on Patient and Family Engagement During the COVID-19 Pandemic.

Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland. Correspondence: Hanan Aboumatar, MD, MPH, Armstrong Institute for Patient Safety and Quality, 750 E Pratt St, 15th Floor, Baltimore, MD 21202 ([email protected]). The author declares no conflicts of interest.

Cannabis medicine: How it should be done

Julia Arnsten, M.D., M.P.H., chief of the Division of General Internal Medicine in the Albert Einstein College of Medicine in New York City, practices at Montefiore in the Bronx. She told a gathering of the New York Society of Addiction Medicine (NYSAM) members Feb. 7 how cannabis (marijuana) treatment should work.

Graceful Self-Promotion: The impact of a short faculty development session.

This article was migrated. The article was marked as recommended. Self-promotion can be challenging for physicians who are looking to advance their careers. While they want to make their successes in the workplace known, they are afraid of coming off as aggressive and turning off the people that they are trying to impress with their accomplishments. This dilemma led to the coining of the term "graceful self-promotion" (GSP), a method of making one's accomplishments and abilities visible with tact and humility. The Division of General Internal Medicine at the University of Florida undertook a faculty development session focusing on GSP skills. The session started with participants interacting with each other using Bingo cards which listed GSP strategies in order to facilitate discussion. This was followed by an interactive discussion on barriers to career advancement and strategies to practice GSP. Changes in physician knowledge regarding self-promotion techniques and attitudes towards its importance were assessed using statistical tests from responses to pre- and post-surveys. We measured a positive change in physician attitudes towards their ability to self-promote following the information session (p-value < 0.005). Perceptions about the importance of self-promotion activities improved as well (p-value < 0.005). Participants comments revealed greater understanding of need for networking, developing a spirit of generativity, and having a prepared Elevator Speech. In this era where pressure to generate clinical revenue allows for limited faculty development time even a short 1-hour session can create awareness about importance of GSP for academic advancement, strategies for participants to use, and awareness of barriers to GSP.