Internal Consultations Research Articles

Multi-organ clinical ultrasound as a complement to the diagnostic process in an internal medicine consultation.

Evaluating outpatient cases in internal medicine consultations presents a significant diagnostic challenge. Ultrasound can be a highly useful tool in assessment and decision-making. A prospective observational study was conducted on a cohort of patients attending an internal medicine rapid assessment clinic. Eighty patients were prospectively recruited. A medical consultation was conducted as per usual clinical practice, followed by a POCUS evaluation; collecting pulmonary, cardiac, and abdominal data. All findings were analyzed and recorded, particularly those that were significant or altered the initial diagnosis, subsequent tests, or treatment. Significant ultrasound findings were found in 37.5% of the patients. Of all ultrasound scans, the most clinically relevant were in the heart region (31.9%), followed by the abdomen (26%). These findings led to a change in overall management in 27.5% of patients. Using logistic regression, a model was developed to estimate the presence of clinically relevant findings with an area under the curve (AUC) of 0.78 (95% CI 0.66-0.89; p < 0.001) with 80% Sensitivity and 66% Specificity. The systematic and standardized incorporation of clinical ultrasound in internal medicine consultations contributes to decision-making, can provide significant findings that allow for modifications in clinical suspicion and therapeutic management.

ARTERIAL HYPERTENSION IN DIABETICS: FREQUENCY AND ASSOCIATED FACTORS

Objective: Diabetic patients have an increased risk of developing hypertension. Its pathogenesis in diabetes is complex. It generally takes place in a context of metabolism and insulin resistance. The association of these 2 pathologies worsens the prognosis of these patients. The objective of this work was to evaluate the frequency of hypertension in diabetics, as well as the factors associated with its occurrence. Design and method: A retrospective study was conducted on 70 diabetic patients followed in the department and internal medicine consultations. All the patients benefited from an interrogation and a complete clinical examination. Results: A female predominance was noted (74.6%). The mean age was 55.8 ± 14 years. Our patients were mainly type 2 diabetics (88%), insulin-treated (78%), with an average seniority of 11.7 ± 7 years. More than half of the patients were known to be hypertensive (57.3%). Dyslipidemia was present in 66.7% of cases. The presence of hypertension was associated in a way statistically significant for age, BMI and presence of dyslipidemia, type and duration of diabetes. It was also significantly correlated with diabetic nephropathy, and the degree of renal insufficiency. Discussion: Hypertension is frequently associated with diabetes. It increases cardiovascular morbidity and mortality and accelerates the progression of atherosclerosis. Hypertension is also a contributory factor to diabetic nephropathy and renal failure. Conclusions: The management of hypertension in diabetics and other risk factors is a vital prognostic element in a patient already at high cardiovascular risk.

Abstract P4-03-22: Linking Internal Medicine Care to Metastatic Breast Cancer Patients for Success: LIMBS

Abstract Background: The Advanced Breast Cancer (ABC) program at The University of Texas MD Anderson Cancer Center was created by metastatic breast cancer (MBC) patients for MBC patients. The ABC Program seeks to improve quantity and quality of life for patients living with MBC. MD Anderson actively treats 2,076 patients living with MBC. ABC program patient advocates voiced the need to increase MBC patients’ access to internal medicine services coordinated with oncology care. Significance: Previous literature suggests patients living with MBC have difficulty receiving oncology coordinated internal medicine services due to their terminal diagnosis and indefinite prescription of anti-cancer treatment. Comorbidities in this setting are known to be associated with inferior outcomes. ABC Program patient advocates reported various challenges seeking care from community based medical professionals including, timely awareness of their local provider on the status of their cancer. Other challenges included the lack of familiarity of some providers with novel MBC cancer treatment, side effects, and interactions of their cancer treatment with non-cancer conditions and treatment. Therefore, with the increasing life expectancy of MBC patients, there is a growing realization of the importance of managing the medical comorbidities in coordination with the MBC patient’s cancer treatment. Purpose: To increase access and coordinate internal medicine services for MBC patients with medical comorbidities. Interventions: In partnership with ABC Program patient advocates, the Linking Internal Medicine and Metastatic Breast cancer for Success (LIMBS) clinic was created in February 2021. The LIMBS clinic aimed to bridge the gap in lack of oncology coordinated internal medicine service for MBC patients. Evaluation: Breast Medical Oncology providers requested LIMBS clinic consults for 108 patients for comorbidity management since the clinic inception. This is a 44% increase in internal medicine consultations prior to LIMBS clinic creation (60 vs 108). The LIMBS clinic consults resulted in 474 follow up visits. Compared to MBC patients at MD Anderson, LIMBS patients were more likely to be African American (20% vs 13%) and were more likely to be older (59 years vs 57 years). Gender, marital status, and clinical trial enrollment did not differ between LIMBS patients and MBC patients. LIMBS patients had significantly higher rates of hypertension (46% vs 19%), Type II DM (19% vs 6%), hyperlipidemia (13% vs 10%), and hypothyroidism (13% vs 6%) compared to MBC patients in general. LIMBS patients had lower rates of anxiety (8% vs 11%) and depression (2% vs 7%) when compared to the MBC patients in general. The top 10 comorbidities for all MBC patients versus LIMBS patients are listed in Table 1. Discussion: It is feasible to build and integrate internal medicine with breast medical oncology services for patients with metastatic breast cancer. Future research should focus on exploring, describing, and meeting the internal medicine needs of MBC patients. Future initiatives are needed to bridge the gap in care for oncology coordinated internal medicine services between community and tertiary care centers. Table 1. Top 10 Comorbidities of all MBC patients versus LIMBS clinic patients Note. This table demonstrates the top 10 comorbidities for MBC population and the LIMBS population. Citation Format: Abbey Kaler, Akshara Singareeka Raghavendra, Ginny T. Kirklin, Dawn Cunningham, Ellen Manzullo, Debu Tripathy, Zayd Razouki. Linking Internal Medicine Care to Metastatic Breast Cancer Patients for Success: LIMBS [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-22.

Positive impact of the pandemic: the effect of post-COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center.

The coronavirus disease 2019 (COVID-19) pandemic has significantly changed clinical practice across US healthcare. Increased adoption of telemedicine has emerged as an alternative to in-person contact for patient-physician interactions. The aim of this study was to analyze the impact of telemedicine on workflow and care delivery from January 2019 to December 2021 in a neurosurgical department at a quaternary care center. Prospectively captured data on clinic appointment utilization, duration, and outcomes were queried. Visits were divided into in-person visits and telemedicine appointments, categorized as follow-up visits of previously surgically treated patients, internal consultations, new patient visits, and early postoperative returns after surgery. Appointment volume was compared pre- and postpandemic using March 2020 as the pandemic onset. Clinical efficiency was measured by time to appointment, rate of on-time appointments, proportion of appointments resulting in surgical intervention (surgical yield), and patient-reported satisfaction, the latter measured as the proportion of patients indicating "high likelihood to recommend practice." A total of 54,562 visits occurred, most commonly for follow-up for previously operated patients (51.8%), internal new patient referrals (24.5%), and external new patient referrals (19.8%). Total visit volume was stable pre- to postpandemic (1521.3 vs 1512, p = 0.917). However, in-person visits significantly decreased (1517/month vs 1220/month, p < 0.001), with a nadir in April 2020, while telemedicine appointment utilization increased significantly (0.3% vs 19.1% of all visits). Telemedicine utilization remained stable throughout the 1st calendar year following the pandemic. Telemedicine appointments were associated with shorter time to appointment than in-person visits both before and after the pandemic onset (0-5 days from appointment request: 60% vs 33% vs 29.8%, p < 0.001). Patients had on-time appointments in 87% of telemedicine encounters. Notably, telemedicine appointments resulted in surgery in 31.8% of internal consultations or new patient visits, a significantly lower rate than that for in-person visits (51.8%). After the widespread integration of telemedicine, patient satisfaction for all visits was higher than before the pandemic onset (85.9% vs 88.5%, p = 0.027). Telemedicine use significantly increased following the pandemic onset, compensating for observed decreases in face-to-face visits. Utilization rates have remained stable, suggesting effective integration, and delays between referrals and appointments were lower than for in-person visits. Importantly, telemedicine integration was not associated with a decrease in overall patient satisfaction, although telemedicine appointments had a lower surgical yield. These data suggest that telemedicine smoothened the impact of the pandemic on clinical workflow and helped to maintain continuity and quality of outpatient care.

On the demand for telemedicine: Evidence from the COVID-19 pandemic.

Telemedicine can expand access to health care at relatively low cost. Historically, however, demand for telemedicine has remained low. Using administrative records and a difference‐in‐differences methodology, we estimate the change in demand for telemedicine experienced after the onset of the COVID‐19 epidemic and the imposition of mobility restrictions. We find that the number of telemedicine calls made during the pandemic increased by 230 percent compared to the pre‐pandemic period. The effects were mostly driven by older individuals with preexisting conditions who used the service for internal medicine consultations. The demand for telemedicine remained relatively high even after mobility restrictions were relaxed, which is consistent with telemedicine being an “experience good.” These results are a proof of concept for policy makers to use such relatively low‐cost medical consultations, made possible by new technologies, to provide needed expansion of access to health care.

The problems related to internal medicine consultations in the emergency department

Objectives: Overcrowding in the Emergency Department (ED) is a serious and growing problem during recent years and one of the main causes of it is dysfunctional consultation system. We aimed to determine the problems related to patients who were admitted to the ED and requested consultations from internal medicine (IM) physicians and to contribute to the gap in the literature regarding this isssue. Methods: In a period of one year, 3601 patients, who were admitted to the ED of a university hospital and were consulted by IM physicians were included in this prospective cross-sectional study. The epidemiological characteristics of patients, length of ED stay and consultation-related problems were investigated. Results: The most common problems related to consultations were delayed completion of the consultation procedures for 88 (2.4%) patients, and unnecessary consultation requests for 66 (1.8%) patients, and patient referrals with inappropriate indications from IM outpatient clinics to the ED for 53 (1.5%) patients. There were differences of opinion among IM physicians and emergency medicine specialists regarding the need for consultation for 36 (1%) patients. The most important difference was in the various infections seen in patients with histories of hematologic or solid organ malignancies (n = 9). Conclusions: According to these findings, good collaboration must be established among ED physicians and consultant physicians. Furthermore, physicians must avoid inappropriate referral patients from outpatient clinics to the ED. Additionally, unnecessary consultation requests from the ED must be avoided, and consultation requests must be addressed quickly.

Operationalizing Programmatic Assessment: The CBME Programmatic Assessment Practice Guidelines.

Assessing the development and achievement of competence requires multiple formative and summative assessment strategies and the coordinated efforts of trainees and faculty (who often serve in multiple roles, such as academic advisors, program directors, and competency committee members). Operationalizing programmatic assessment (PA) in competency-based medical education (CBME) requires comprehensive practice guidelines, written in accessible language with descriptions of stakeholder activities, to move assessment theory into practice and to help guide the trainees and faculty who enact PA. Informed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, the authors used a multiphase, multimethod approach to develop the CBME Programmatic Assessment Practice Guidelines (PA Guidelines). The 9 guidelines are organized by phases of assessment and include descriptions of stakeholder activities. A user guide provides a glossary of key terms and summarizes how the guidelines can be used by different stakeholder groups across postgraduate medical education (PGME) contexts. The 4 phases of guideline development, including internal stakeholder consultations and external expert review, occurred between August 2016 and March 2020. Local stakeholders and external experts agreed that the PA Guidelines hold potential for guiding initial operationalization and ongoing refinement of PA in CBME by individual stakeholders, residency programs, and PGME institutions. Since July 2020, the PA Guidelines have been used at Queen's University to inform faculty and resident development initiatives, including online CBME modules for faculty, workshops for academic advisors/competence committee members, and a guide that supports incoming residents' transition to CBME. Research exploring the use of the PA Guidelines and user guide in multiple programs and institutions will gather further evidence of their acceptability and utility for guiding operationalization of PA in different contexts.

Megatrends in Healthcare: Review for the Swiss National Science Foundation's National Research Programme 74 (NRP74) "Smarter Health Care".

Objectives: In this paper, we present a review of some relevant megatrends in healthcare conducted as part of the Swiss National Science Foundation’s National Research Programme 74 (NRP74) “Smarter Health Care.” Our aim is to stimulate discussions about long-term tendencies underlying the current and future development of the healthcare system. Methods: Our team—a multidisciplinary panel of researchers involved in the NRP74—went through an iterative process of internal consultations followed by a rapid literature review with the goal of reaching group consensus concerning the most relevant megatrends in healthcare. Results: Five megatrends were identified, namely: 1) Socio-demographic shifts. 2) Broadening meaning of “health.” 3) Empowered patients and service users. 4) Digitalization in healthcare. 5) Emergence of new models of care. The main features of each megatrend are presented, drawing often on the situation in Switzerland as a paradigmatic example and adding reflections on the potential influence of the COVID-19 pandemic on them. Conclusion: Considering the long-term megatrends affecting the evolution of healthcare is important—amongst other things–to understand and contextualise the relevance and implications of innovative health services research results.

Treatment of tibial shaft nonunion with a retained nail in morbidly obese patients.

Morbid obesity is a rising worldwide health problem. Tibial shaft nonunion with retained intramedullary nail (IMN) in the morbidly obese is a challenging orthopaedic problem. Prolonged immobilization carries a significant risk of complications. This study aimed to investigate whether decortication and cancellous bone grafting with the application of a circular external fixator (CEF) over the preexisting IMN can achieve fracture union and avoid serious complications. We retrospectively reviewed 27 consecutive morbidly obese patients treated for tibial diaphysis aseptic nonunion after failed IMN. All cases were treated with osteoperiosteal decortication, cancellous bone grafting, and fixation with CEF over the IMN. Peri-operative multidisciplinary patient evaluation included internal medicine, cardiology, chest, vascular surgery, and anesthesia consultations. The union rate, bone results, functional results, and complications were recorded. The mean age of the patients was 37.9years. The mean BMI was 45.8. Sixteen cases (59.3%) were treated for hypertrophic nonunion, while 11 cases (40.7%) were treated for atrophic nonunion. Seven cases (25.9%) had open initial injury, 14 cases (51.9%) had associated comorbidities, and seven cases (25.9%) were smokers. Twenty-six cases united. The mean time to union was 5.2months. Bone results and functional results were good to excellent in 96.3% of the cases. We recorded 25 complications in 21 patients. However, most of the complications were minor. Decortication and cancellous bone grafting with the application of CEF over the preexisting nail is a safe and reliable treatment method for aseptic tibial shaft nonunion with retained IMN in morbidly obese patients.

Parental satisfaction with health care during child hospitalization at a social security facility in Mexico.

The Service Quality in Hospital (SERVQHOS) assesses quality and satisfaction with hospital care received. This study aimed to determine the quality and satisfaction of parents in a tertiary-level pediatric public facility in Mexico. We conducted a cross-sectional study in which 425 anonymous surveys were distributed during the discharge of children. The questionnaire evaluates the individual (subjective) and organizational (objective) quality of service: reliability, tangibles, assurance, responsiveness, and empathy, as well as satisfaction on a 5-point scale from 1 (much worse) to 5 (much better). A total of 401 questionnaires were returned (94%). The mean quality score was 3.6 ± 0.7. The best-rated aspects were the medical equipment technology (3.6 + 0.8), the confidence that the staff transmits to patients (3.6 ± 0.8), and the friendliness of the staff when attending patients (3.6 ± 0.8). The worst-rated aspects were the condition of the rooms (3.4 ± 0.8), the waiting time to be attended by a physician (3.3 ± 0.8), and the timeliness of internal consultations (3.3 ± 0.8). The overall population rated as satisfied in 97% of cases. A high rate of satisfaction was observed concerning both objective and subjective factors. However, the negative aspects of objective quality, such as reliability, should be addressed organizationally without implying economic investment in their resolution.

The perceived impact of the KAM reforms on audit reports, audit quality and auditor work practices: stakeholders’ perspectives

PurposeThe purpose of this study is to understand how the new reforms related to key audit matters (KAM) disclosures in Australia may have impacted audit quality by eliciting the perceptions of key stakeholders in the audit and assurance services market.Design/methodology/approachThe study uses a qualitative approach and New Institutional Sociology (NIS) to explain how auditors have responded to the KAM reforms. Interviews were conducted with 20 individuals representing identified groups of stakeholders in the market for audit and assurance services in Australia.FindingsThe study finds there is little consensus between some stakeholder groups on whether the KAM reforms may have improved audit quality, based on the perceptions shared. The findings conveyed that the auditors and regulators, standard setters acknowledge that KAM disclosures are either costly and/or time-consuming to implement. The Big Four auditors indicate these reforms led to changes mainly around internal consultations and independent reviews, whereas the non-Big Four auditors highlighted increased interactions with audit clients.Originality/valueThis is one of the first studies to examine the perceived post-implementation impacts on audit quality of the KAM reforms (ISA 701) after the initial two years of implementation and how auditors have responded, explored through the lens of institutional logic.

Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry

Background and objectivesOsteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients’ care more effectively and efficiently. Material and methodsThrough an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. ResultsIn total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients’ mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). ConclusionsThese results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Epidemiological and Clinical Aspects of Autoimmune Dysthyroidism in Internal Medicine at Aristide Le Dantec Hospital

Introduction: Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). Materials and Methods: This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded; they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, i.e. in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. Results: Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. Conclusion: Autoimmune thyroiditis is common in our daily practice in Senegal; it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED

Background and objectivesOsteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients’ care more effectively and efficiently. Material and methodsThrough an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. ResultsIn total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients’ mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). ConclusionsThese results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Negotiating Brexit: A clash of approaches?

On 31 January 2020, the UK left the European Union after 47 years of membership. This paper uses the conceptual distinction between integrative and distributive bargaining to compare the EU’s and the UK’s approaches in the negotiations that led to the Withdrawal Agreement, setting out the terms of the UK’s exit, and the Political Declaration on the framework for the future EU–UK relationship. While it would be rational to expect both parties to adopt integrative approaches given the nature of the issues, the long history of cooperation, and the parties’ mutual interest in maintaining a close relationship in the future, the comparison demonstrates that it was mainly the EU that leaned towards the integrative end of the negotiating spectrum, with extensive internal consultations, a willingness to engage in open and interest-based discussions aimed at problem-solving, and high levels of transparency, whereas the UK leaned further to the distributive end, reflecting less engagement and consultation with domestic constituents, a focus on pre-determined positions that need defending, and lower levels of transparency.

Multidisciplinary care and units for uveitis in the internal medicine departments in Spain: Survey of the Systemic Autoimmune Diseases Group

ObjectiveTo identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain. Material and methodsWe conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017. ResultsWe identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year. ConclusionsThis study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialized national reference institutions.

The Evaluation of Consultations Performing by an University Hospital Internal Medicine Clinic

Amaç: Bu çalışmanın amacı; hastanemizde istenen iç hastalıkları konsültasyonlarının retrospektif olarak incelenmesi ve konsültas-yon istemlerindeki eksikliklerin saptanmasıdır. Materyal ve Metot: 01.09.2017 – 31.10.2017 tarihleri arasında acil servis ve diğer yatan hasta kliniklerinden istenen iç hastalıkları konsültasyonları kayıtlar üzerinden retrospektif olarak incelendi. Hastaların demografik verileri ve konsültasyon istem metinleri kaydedildi. Dört soru ile konsültasyon metinleri yeterlilik açısından değerlendirildi ve puanlandı.Bulgular: 2 aylık sürede toplam 416 konsültasyon cevaplanmıştı. 172 acil servis, 244 diğer servislerdi. Yaş ortalaması acil servis için 62,7, diğer servisler için ise 61,8 idi. Nefroloji her iki grupta da en sık konsültasyon istenen iç hastalıkları yan dalı idi. Konsültasyonların %68 gibi büyük bir çoğunluğu ilk 1 saat içeris-inde sonuçlandırılmıştı. Hastaların %53,5’i için yatış kararı verild-iği görüldü. Her iki grupta da değerlendirme puanlarına bakıldığın-da konsültasyon istem metinlerinin yetersiz olduğu görüldü.Sonuç: Konsültasyon istem metinleri genel olarak yetersiz olup ilgili hekimleri yeterli olarak bilgilendirmemektedir. Danışılan hasta hakkında yeterli bilgi sahibi olmayan konsültan hekimin hasta hakkında doğru karar vermesi zorlaşmaktadır. Bu sebeple konsültasyon istem metinlerinin düzeltilmesi çok önemlidir.

Electronic Consults for Infectious Diseases in a United States Multisite Academic Health System.

We launched Infectious Disease electronic consultations (eConsults) in 2018. During the first 15.5 months, primary care practitioners submitted 328 eConsults; the most frequent reasons were a positive culture or polymerase chain reaction (PCR) result, syphilis, and latent tuberculosis. Practitioners commonly requested advice on antimicrobial choice, clinical evaluation, and indications for treatment. Internal phone consultations decreased after eConsult implementation.

Unidades y asistencia multidisciplinar de uveítis en los servicios de medicina interna en España: encuesta del Grupo de Enfermedades Autoinmunes Sistémicas

ObjectiveTo identify the multidisciplinary uveitis units in which internal medicine departments participate in collaboration with ophthalmology departments in Spain. Material and methodsWe conducted a multicentre, observational cross-sectional study that collected information using a structured survey sent by email to 1015 partners of the Systemic Autoimmune Diseases Workgroup of the Spanish Society of Internal Medicine (GEAS-SEMI) from the 1st to the 31st of March 2017. ResultsWe identified a total of 21 support units/consultations for the ophthalmology departments. Seventeen (81%) of the units were specific internal medicine-ophthalmology consultations, and 5 (24%) units had been created in the past 5 years. A median of 460 patients were assessed per unit by the end of the year. ConclusionsThis study shows, for the first time in Spain, the important and close collaboration between ophthalmologists and internists, especially in highly specialised national reference institutions.

Addressing food loss and waste in fish value chain using a web-based information, Repository

Food loss and waste (FLW) in fisheries is a major concern and occur in most fish distribution chains throughout the world. FLW across the fish value chain is estimated to be 35 percent. These losses constitute lost income to fishers, processors and traders and other value chain actors and contribute to food and nutrition insecurity. Thus, it is globally recognized as a challenge that needs to be addressed. There has been much work done to address and prevent losses in fisheries value chains. However, a key issue is related to the availability and quality of information. Information needed to guide policy development and management of the resources is of poor quality and often not produced or distributed in a timely manner. The 32nd Session of the Committee on Fisheries (COFI), July 2016 reiterated the topical importance of reducing fish losses and made a plea for the development by Food and Agriculture Organization of the United Nations (FAO) for a guidance for reduction of fish losses. FAO, through the Products, Trade and Marketing Branch (FIAM), supported by the Norwegian government had developed an information repository that can provide solutions for reducing or eliminating food losses for common loss scenarios in fish value chains. It provides access to fish loss and waste related information for informed policy in the fisheries and aquaculture from the post-harvest to consumption stages. It aims to provide guidance to policy-makers, development practitioners, non-governmental organizations (NGOs) and value chain actors ability to facilitate the development of solutions to food loss scenarios on the ground at the targeted points of the supply chain, as well as at policy level. The development of the repository was guided by an internal FAO specialist group covering food loss, policy, fisheries and ICT and an expert group of specialists coming from the public sector, civil society and research institutions with representation of a range of geographical regions. A series of internal and external consultations were done before the webpage was launched on May 2019.