Internal Medicine Physicians Research Articles

Adult Inpatient Services in Pediatric Hospitals: A National Mixed Methods Study.

Some pediatric institutions have developed adult inpatient services to enable quality care of hospitalized adults. Our objectives were to understand the characteristics of these adult inpatient services in pediatric hospitals, barriers and facilitators to their creation and sustainability, and patient and system needs they addressed. An explanatory mixed methods study was conducted using a distribution of an electronic survey followed by targeted semi-structured interviews of directors (or designates) of adult inpatient services in US pediatric hospitals. The survey identified institutional demographics, service line characteristics, and patient populations. An interview guide was created to explore survey findings and facilitators and barriers in the creation of adult inpatient services. Interviews were conducted after survey completion. A codebook was created using an inductive thematic approach and iteratively refined. Final themes were condensed, and illustrative quotes selected. Ten institutions identified as having an adult inpatient service. Service staffing models varied, but all had dually trained internal medicine and pediatrics physicians. All participants voiced their respective pediatric institutions valued that these services filled a clinical care gap for hospitalized adults adding to whole-person care, patient safety, and health system navigation. Adult inpatient services in pediatric institutions have been present for >15 years. These services address clinical care gaps for adults hospitalized in pediatric institutions and use specialized internal medicine and pediatrics knowledge. Demonstrating return on investment of these services using a traditional fee for service model is a barrier to creation and sustainability.

Depression symptoms and suicide risk of internal medicine residents before and after first year of the COVID-19 pandemic.

Depression is a mental health disorder characterized by the presence of sadness or loss of the ability to feel pleasure, with a high incidence in patients with COVID 19. The investigations have focused on patient care and little on the care of health personnel, these being the ones with the highest mortality rate, so the objective of the study was to investigate the prevalence of depression symptoms and suicide risk and understand the association of depressive disorder and suicide risk with levels of serum cholesterol and low levels of serum cortisol among internal medicine fellows in a specialist medical hospital in Leon, Guanajuato, Mexico, before and after COVID-19. In this longitudinal study, internal medicine residents were initially monitored for 2months before starting to care for patients with COVID-19. Participants were asked to fill out depression symptoms and suicide risk surveys. We measured the serum cholesterol and cortisol of each participant, and again after 11months of treating COVID-19 patients. Depression symptoms and suicide risk were assessed; significant differences were found between the two time periods for depression (p < 0.01), and no difference was found for suicide risk (p = 0.182). We found a significant correlation between serum cholesterol levels and suicide risk (r = 0.366, p < 0.01); we also found differences in serum cortisol levels (p < 0.01) and cholesterol (p < 0.0001) before and after the pandemic. Caring for patients with COVID-19 in the hospital contributed to an increase in levels of depression symptoms and suicidal ideation, as well as differences in levels of cortisol and cholesterol in resident physicians of internal medicine; among the possible reasons for this change could be the conditions of personal protection while treating patients, the uncertainty in the first months of not knowing how the virus was transmitted and not having or knowing when vaccinations would be available, as well as the lack of a strategy of adequate mental health support from the institutions dedicated to their academic training.

Investigating the Small Pixel Effect in Ultra-High Resolution Photon-Counting CT of the Lung.

The aim of this study was to investigate potential benefits of ultra-high resolution (UHR) over standard resolution scan mode in ultra-low dose photon-counting detector CT (PCD-CT) of the lung. Six cadaveric specimens were examined with 5 dose settings using tin prefiltration, each in UHR (120 × 0.2 mm) and standard mode (144 × 0.4 mm), on a first-generation PCD-CT scanner. Image quality was evaluated quantitatively by noise comparisons in the trachea and both main bronchi. In addition, 16 readers (14 radiologists and 2 internal medicine physicians) independently completed a browser-based pairwise forced-choice comparison task for assessment of subjective image quality. The Kendall rank coefficient ( W ) was calculated to assess interrater agreement, and Pearson's correlation coefficient ( r ) was used to analyze the relationship between noise measurements and image quality rankings. Across all dose levels, image noise in UHR mode was lower than in standard mode for scan protocols matched by CTDI vol ( P < 0.001). UHR examinations exhibited noise levels comparable to the next higher dose setting in standard mode ( P ≥ 0.275). Subjective ranking of protocols based on 5760 pairwise tests showed high interrater agreement ( W = 0.99; P ≤ 0.001) with UHR images being preferred by readers in the majority of comparisons. Irrespective of scan mode, a substantial indirect correlation was observed between image noise and subjective image quality ranking ( r = -0.97; P ≤ 0.001). In PCD-CT of the lung, UHR scan mode reduces image noise considerably over standard resolution acquisition. Originating from the smaller detector element size in fan direction, the small pixel effect allows for superior image quality in ultra-low dose examinations with considerable potential for radiation dose reduction.

Predicting ward transfer mortality with machine learning.

In order to address a long standing challenge for internal medicine physicians we developed artificial intelligence (AI) models to identify patients at risk of increased mortality. After querying 2,425 records of patients transferred from non-intensive care units to intensive care units from the Veteran Affairs Corporate Data Warehouse (CDW), we created two datasets. The former used 22 independent variables that included "Length of Hospital Stay" and "Days to Intensive Care Transfer," and the latter lacked these two variables. Since these two variables are unknown at the time of admission, the second set is more clinically relevant. We trained 16 machine learning models using both datasets. The best-performing models were fine-tuned and evaluated. The LightGBM model achieved the best results for both datasets. The model trained with 22 variables achieved a Receiver Operating Characteristics Curve-Area Under the Curve (ROC-AUC) of 0.89 and an accuracy of 0.72, with a sensitivity of 0.97 and a specificity of 0.68. The model trained with 20 variables achieved a ROC-AUC of 0.86 and an accuracy of 0.71, with a sensitivity of 0.94 and a specificity of 0.67. The top features for the former model included "Total length of Stay," "Admit to ICU Transfer Days," and "Lymphocyte Next Lab Value." For the latter model, the top features included "Lymphocyte First Lab Value," "Hemoglobin First Lab Value," and "Hemoglobin Next Lab Value." Our clinically relevant predictive mortality model can assist providers in optimizing resource utilization when managing large caseloads, particularly during shift changes.

Summer Dreams.

Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches-including an official White House portrait of President Ronald Reagan-to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations. If you would like to see your art published in the Methodist DeBakey Cardiovascular Journal, submit your creation online at journal.houstonmethodist.org as a "Humanities" entry.

Contraception.

Contraception counseling and provision are vital components of comprehensive health care. An unplanned pregnancy can be particularly challenging for patients with chronic illness. Internal medicine physicians are uniquely positioned to assess pregnancy readiness and provide contraception, as they often intersect with pregnancy-capable patients at the moment of a new diagnosis or when providing ongoing care for a chronic medical condition. A shared decision-making counseling approach engages patients, ensures patient-centered care, and supports their choice of a contraceptive method that aligns with their reproductive plans and medical needs.

PREVALENCE OF BURNOUT SYNDROME IN HEALTHCARE WORKERS IN NORTH AND SOUTH AMERICA, AND ASIA FROM 2018 TO 2022

The article explores issues concerning prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022. Thus for this purpose, a great number of scientific sources that are related to the topic of the research were examined.&#x0D; Healthcare professionals face a tremendous strain during the performing of their activities that often may lead to stress and burnout syndrome. In particular, duties of healthcare workers include high responsibility for life and health of a patient, self-discipline, urgent decision-making, empathy, high productivity during extreme conditions, constant psychological and intellectual tension.&#x0D; During the past 30+ years, burnout syndrome was studied by scientists, practitioners, and also by general public all around the world. It should be noted, that nowadays a lot of employees (in particular, healthcare workers) are faced with rapid changes in our modern working life, namely, time pressure, pressure of higher productivity/quality of work, need to learn new skills, increasing demands of adaptation to new types of work, hectic jobs, etc., that in result may cause burnout syndrome.&#x0D; Burnout syndrome of healthcare workers is usually associated with poor quality of medical care and may lead to medical errors, exhaustion, inefficiency, and conflicts. High levels of burnout syndrome among medical professionals of different countries around the world vary from 7,4% to 66%.&#x0D; The issues concerning prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022 have not been sufficiently identified and also require more detailed research.&#x0D; Research of scientists that used the Maslach Burnout Inventory (hereinafter – the MBI), and the Copenhagen Burnout Inventory (hereinafter – the CBI) to research the burnout syndrome in healthcare workers of different specialties (including "Family Medicine") were included in this article.&#x0D; Based on the conducted research, the following conclusions can be reached: the research carried out to identify prevalence of burnout syndrome in healthcare workers in North and South America, and Asia from 2018 to 2022 found out the presence of burnout syndrome in healthcare workers ranging from 1,3% to 82,1%. Moreover, prevalence of burnout syndrome in healthcare workers in North and South America varied from 1,3% to 73,5%, whereas in Asia it varied from 5,2% to 82,1%. Factors that associated with burnout in healthcare workers in North and South America, and Asia were examined. The majority of scientific studies on the identification of the prevalence of burnout syndrome in healthcare workers from 2018 to 2022: a) in North and South America have been conducted in Canada, the United States of America, the Federative Republic of Brazil, and the Argentine Republic, etc., whereas b) in Asia have been conducted in China, Japan, India, Pakistan, Iran, Lebanon, Saudi Arabia, Turkey, Oman, Cyprus, Israel, Jordan, and Kazakhstan, etc. Intensivists, physiatrists, resident physicians, oncologists, general surgeons, internal medicine physicians, and emergency medicine physicians are special categories of healthcare workers who are at a high risk of formation of burnout syndrome that may develop due to the specific of professional activity.

Awareness, perceptions and attitudes toward medication-related osteonecrosis of the jaw among physicians who treat osteoporosis

Osteoporosis is the most common indication for antiresorptive drugs (ARDs). Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of ARDs. Multiple risk factors can increase the risk of MRONJ, one of which is the duration of ARD intake, which is usually prolonged for osteoporosis cases. Prevention of MRONJ relies on collaborative care between treating physicians and dental practitioners. Therefore, knowledge about MRONJ and its prevention strategies is crucial for both teams. AimThis study aimed to assess the knowledge and attitudes of physicians toward MRONJ in osteoporosis patients. Another aim was to develop recommendations for the prevention of MRONJ. Materials and methodsThrough an online survey, basic information such as the practice location, training, knowledge, perceptions, and attitudes of physicians regarding ARDs and MRONJ in osteoporosis patients was collected. Statistical analysis was performed for all variables, and their correlations were explored. ResultsA total of 221 physicians participated in the survey: 34.8% were rheumatologists, 25.3% were endocrinologists, 8.6% were family medicine physicians, 5.9% were orthopedists, and 5.9% were internal medicine physicians. Of them, 58.0% reported more than 6 years of experience. Only 78.7% were aware of MRONJ and recognized that bisphosphonates (BPs) can contribute to MRONJ. In contrast, 56.0% recognized denosumab as a causative factor for MRONJ. Duration of ARD therapy and pre- and post-ARD dental care were known to influence the risk of MRONJ by 62% and 65.6% of the participants, respectively. Only 41.6% and 31.2% of participants informed patients about MRONJ prior to BP and denosumab therapy, respectively. Only 25.3% and 20.8% referred patients to dentists before BP and denosumab therapy, respectively. Overall, 65.6% of the participants had a negative attitude toward MRONJ, and 34.4% had a positive attitude. A positive attitude was mostly observed among rheumatologists (55.8%) compared to other specialists (p <0.001). More years of experience were associated with a higher level of knowledge and positive attitude. ConclusionThe findings of this study identified a notable gap in the awareness, knowledge and attitudes of physicians regarding MRONJ in osteoporosis patients. Continuing education programs about ARDs and MRONJ risk are highly recommended.

Editorial introductions.

Editorial introductions.

Assessment of Formation of the Doctor’s Priority Personality Orientation Towards Professional Accomplishments

Background. Numerous psychological traits may contribute to the success of a doctor's career, with the priority orientation of an individual towards qualitative and effective solving of professional tasks being among the most important factors.&#x0D; Purpose. The purpose of the study was to determine the prevalence and to study the determinants of priority orientation of an individual towards qualitative and effective solving of professional tasks among internal medicine physicians of the Tver region.&#x0D; Materials and methods. This medical and social study was conducted as a selective single-stage study based on a set of methodological procedures and techniques related to sociological, psychodiagnostic and statistical methods. A representative sample (p &lt; 0,05) included 597 internal medicine physicians working in medical organizations in the Tver region.&#x0D; Results. Authors assessed the incidence of the priority orientation towards qualitative and effective solving of professional tasks among internal medicine physicians in general and in certain gender and age groups. We identified 16 significant (p &lt; 0,05) medical, social and psychological factors influencing the formation of this priority orientation of internal medicine physicians’ personality, as well as their significance.&#x0D; Conclusions&#x0D; 1. The prevalence of the priority orientation was observed among 32,9% of internal medicine physicians in the Tver region. Statistical data showed that in men the indicators were significantly higher compared to women of all age.&#x0D; 2. Medical and social factors of professional environment supported by psychological determinants of professional motivational and value plan greatly influence the shaping the priority orientation of an individual towards qualitative and effective solving of professional tasks among internal medicine physicians.

Diagnostics différentiels de l’anaphylaxie

Anaphylaxis definition has been recently updated. Despite a rigorous allergy evaluation, there are still anaphylaxis cases without any identified cause, called “idiopathic” for which it is essential to evoke differential diagnoses. These situations are major challenges for the physician and sometimes require a multidisciplinary approach and the advice of expert allergists or internal medicine physicians. Differential diagnoses will be evoked in various circumstances: atypical clinical manifestations, severe anaphylaxis without modification of tryptasemia values, absence of clearly identified allergen, multiplicity of suspected allergens, repeated occurrence of subjective symptoms or in stereotyped circumstances (at restaurant, for example). The variety of these differential diagnoses must be considered according to age, history, clinical presentation and predominant symptoms, circumstances of occurrence. This article aims to remind the criteria for the positive diagnosis of anaphylaxis and to discuss the main differential diagnoses.

Medical student intentions to practice internal medicine in underserved areas associated with debt, identity and extracurricular participation

BackgroundCurrently, Internal Medicine (IM) physicians do not reflect the ethno-racial diversity of the US population. Moreover, there is a shortage of IM physicians in Medically Underserved Areas (MUAs) in the US. The purpose of this study was to determine factors that influence medical students’ intent to practice IM in MUAs. We hypothesized students with intentions to pursue a career in IM and work in MUAs were more likely than their peers to identify as underrepresented in medicine (URiM), report greater student debt loads, and report medical school experiences in cultural competencies.MethodsWe analyzed de-identified data of 67,050 graduating allopathic medical students who completed the Association of American Medical Colleges’ (AAMC) Medical School annual Graduation Questionnaire (GQ) between 2012–2017 by multivariate logistic regression models, examining intent to practice IM in MUAs based on respondent characteristics.ResultsOf 8,363 students indicating an intent to pursue IM, 1,969 (23.54%) students also expressed an intent to practice in MUAs. Students awarded scholarships, (aOR: 1.23, [1.03–1.46]), with debt greater than $300,000 (aOR: 1.54, [1.21–1.95], and self-identified non-Hispanic Black/African American (aOR: 3.79 [2.95–4.87]) or Hispanic (aOR: 2.53, [2.05–3.11]) students were more likely than non-Hispanic White students to indicate intent to practice in MUAs. This pattern also existed for students who participated in a community-based research project (aOR: 1.55, [1.19–2.01]), had experiences related to health disparities (aOR: 2.13, [1.44–3.15]), or had experiences related to global health (aOR: 1.75, [1.34–2.28]).ConclusionsWe identified experiences and characteristics that associate with intention to practice IM in MUAs, which can aid future curricular redesign by medical schools to expand and deepen comprehension of health disparities, access to community-based research, and global health experiences. Loan forgiveness programs and other initiatives to increase recruitment and retention of future physicians should also be developed.

Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges

Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.Disclosures: None

A cross-sectional survey examining clinician characteristics, practices, and attitudes associated with adoption of the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines.

The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results. To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines. A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent. Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms. The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.

Web Exclusive. Annals Graphic Medicine - Why Bedside Rounds Need Bedside Language.

Web Exclusives23 May 2023Annals Graphic Medicine - Why Bedside Rounds Need Bedside LanguageFREERebekah L. Gardner, MD, Vinald W. Francis, BFA, Daniel Baxter, BFA, and Kate Cahill, MDRebekah L. Gardner, MDAlpert Medical School of Brown University, Providence, Rhode Island (R.L.G., K.C., V.W.F.)Search for more papers by this author, Vinald W. Francis, BFAAlpert Medical School of Brown University, Providence, Rhode Island (R.L.G., K.C., V.W.F.)Search for more papers by this author, Daniel Baxter, BFAGlenshaw, Pennsylvania (D.B.)Search for more papers by this author, and Kate Cahill, MDAlpert Medical School of Brown University, Providence, Rhode Island (R.L.G., K.C., V.W.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G22-0044 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Rebekah L. Gardner, MD; Vinald W. Francis, BFA; Daniel Baxter, BFA; Kate Cahill, MDAffiliations: Alpert Medical School of Brown University, Providence, Rhode Island (R.L.G., K.C., V.W.F.)Glenshaw, Pennsylvania (D.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G22-0044.Author/Illustrator Information: Rebekah L. Gardner, MD, is an academic general internal medicine physician and graphic medicine enthusiast (e-mail, [email protected]edu). Vinald W. Francis, BFA, is a medical illustrator and visual design specialist (e-mail, [email protected]edu). Daniel Baxter, BFA, is an artist and musician (e-mail, [email protected]com). Kate Cahill, MD, is a general internal medicine physician and clinician–educator (e-mail, [email protected]edu).This article was published at Annals.org on 23 May 2023. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Latest ePublished: 23 May 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

ANMCO-SIMEU consensus document: appropriate management of atrial fibrillation in the emergency department.

Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable impact on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, in order to make it homogeneous across the national territory.

Beachscape.

Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches-including an official White House portrait of President Ronald Reagan-to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations. If you would like to see your art published in the Methodist DeBakey Cardiovascular Journal, submit your creation online at journal.houstonmethodist.org as a "Humanities" entry.

Development of a Visit Facilitator Role to Assist Physicians in an Ambulatory Consultative Medical Practice

ObjectiveTo decrease the electronic health record (EHR) clerical burden and improve patient/clinician satisfaction, allied health staff were trained as visit facilitators (VFs) to assist the physician in clinical and administrative tasks. Patients and MethodsFrom December 7, 2020, to October 11, 2021, patients with complex medical conditions were evaluated by an internal medicine physician in an outpatient general internal medicine (GIM) consultative practice at a tertiary care institution. A VF assisted with specific tasks before, during, and after the clinical visit. Presurvey and postsurvey assessments were performed to understand the effect of the VF on clinical tasks as perceived by the physician. ResultsA total of 57 GIM physicians used a VF, and 41 (82%) physicians and 39 (79%) physicians completed the pre-VF and post-VF surveys, respectively. Physicians reported a significant reduction in time reviewing outside materials, updating pertinent information, and creating/modifying EHR orders (P<.05). Clinicians reported improved interactions with patients and on-time completion of clinical documentation. In the pre-VF survey, “too much time spent” was the most common response for reviewing outside material, placing/modifying orders, completing documentation/clinical notes, resolving in-baskets, completing dismissal letters, and completing tasks outside of work hours. In the post-VF survey, “too much time spent” was not the most common answer to any question. Satisfaction improved in all areas (P<.05). ConclusionVFs significantly reduced the EHR clinical burden and improved GIM physician practice satisfaction. This model can potentially be used in a wide range of medical practices.

Infectious Diseases: What You May Have Missed in 2022.

In 2022, COVID-19 remained the infectious disease at the top of most internal medicine physicians' minds. However, it was not the only infectious disease that was the topic of clinically relevant research that year. This article highlights some important infectious disease evidence unrelated to COVID-19 that was published in 2022. The literature was screened for sound new evidence relevant to internal medicine specialists and subspecialists whose focus of practice is not infectious diseases. The publications highlighted relate to various organisms in different patient populations. One article provides insight into the role of Helicobacter pylori eradication in the treatment of functional dyspepsia. The descriptive epidemiology of bacterial (Staphylococcus aureus) and viral (mpox) infections are the focus of 2 other articles. Several articles address the management of resistant and difficult-to-treat infections: multidrug-resistant gram-negative infections, resistant HIV-1, rifampin-resistant tuberculosis, cryptococcal meningitis, and invasive fungal infection in the setting of neutropenia. Another article provides data on effective HIV preexposure prophylaxis in women, an understudied population. Finally, given the urgent need to reduce inappropriate use of antibiotics, an article on antibiotic stewardship for hospitalized patients with presumed sepsis in a non-intensive care unit setting is also included.

Disaster Medicine Education for Israeli Medical Response Teams to the Ukrainian Refugee Crisis.

Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice. An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel's major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health. Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5). The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.