Internal Medicine Specialists Research Articles

Evaluating ChatGPT's effectiveness and tendencies in Japanese internal medicine.

ChatGPT, a large-scale language model, is a notable example of AI's potential in health care. However, its effectiveness in clinical settings, especially when compared to human physicians, is not fully understood. This study evaluates ChatGPT's capabilities and limitations in answering questions for Japanese internal medicine specialists, aiming to clarify its accuracy and tendencies in both correct and incorrect responses. We utilized ChatGPT's answers on four sets of self-training questions for internal medicine specialists in Japan from 2020 to 2023. We ran three trials for each set to evaluate its overall accuracy and performance on nonimage questions. Subsequently, we categorized the questions into two groups: those ChatGPT consistently answered correctly (Confirmed Correct Answer, CCA) and those it consistently answered incorrectly (Confirmed Incorrect Answer, CIA). For these groups, we calculated the average accuracy rates and 95% confidence intervals based on the actual performance of internal medicine physicians on each question and analyzed the statistical significance between the two groups. This process was then similarly applied to the subset of nonimage CCA and CIA questions. ChatGPT's overall accuracy rate was 59.05%, increasing to 65.76% for nonimage questions. 24.87% of the questions had answers that varied between correct and incorrect in the three trials. Despite surpassing the passing threshold for nonimage questions, ChatGPT's accuracy was lower than that of human specialists. There was a significant variance in accuracy between CCA and CIA groups, with ChatGPT mirroring human physician patterns in responding to different question types. This study underscores ChatGPT's potential utility and limitations in internal medicine. While effective in some aspects, its dependence on question type and context suggests that it should supplement, not replace, professional medical judgment. Further research is needed to integrate Artificial Intelligence tools like ChatGPT more effectively into specialized medical practices.

Panic Disorder Versus Thyroid Medication Overuse: A Case Report

Introduction: Panic disorder is defined as the occurrence of spontaneous panic attacks that are not triggered by any specific stimulus. The symptoms of panic disorder include panic episodes that occur frequently and unexpectedly, as well as anxiety about the possibility of experiencing further panic attacks, the repercussions of panic attacks, or a change in behavior as a result of panic attacks. This study presented the diagnosis and treatment of panic disorder comorbid with thyroid medication overuse. Case presentation: A 36-year-old female patient presented to the emergency room with a primary concern and symptoms consistent with panic disorder, including experiencing a sense of losing control or impending death, chest pain, difficulty breathing, rapid heartbeat, excessive perspiration, trembling, and dizziness. The patient experienced significant periods of anxiety between episodes, preoccupied with the anticipation of the next occurrence. Each episode had a duration of roughly 15 minutes. The patient refutes any history of alcohol or drug misuse, and her sole medical condition is hypothyroidism. Subsequently, we perform a comprehensive analysis of the thyroid profile and make a referral to an internal medicine specialist for collaborative treatment. We treated the patient with a combination of a selective serotonin reuptake inhibitor (SSRI) fluoxetine 20 mg/day and a course of cognitive-behavioral therapy. Conclusion: Repeated episodes of intense panic attacks, accompanied by feelings of anxiety and observable alterations in behavior, distinguish panic disorder as a medical illness. The treatment involves the use of selective serotonin reuptake inhibitors, antidepressants, and cognitive behavioral therapy.

The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis.

Background: The care of psoriatic patients requires a multidisciplinary approach that addresses not only skin involvement but also cardiovascular risk factors. Coordination between dermatology and internal medicine departments, with a specific focus on treatment and long-term follow-up, can substantially improve the course of a disease and its associated complications. Objective: to evaluate the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists. Methods: We conducted an observational, prospective, single-center case-control study between October 2016 and December 2019 in San Jorge University Hospital (Huesca, Spain). Cases included patients undergoing follow-up in the combined dermatology and internal medicine clinic. The control group consisted of an equivalent number of randomly selected, age- and sex-matched patients with moderate-to-severe psoriasis who were seen in the general dermatology department of the same hospital during the same time period. Main outcomes and measures: The primary outcome was the control of psoriatic disease and cardiovascular risk factors such as weight, blood pressure, waist circumference, body mass index (BMI), SCORE index (Systematic Coronary Risk Evaluation), and blood test parameters, as well as diet, physical exercise, and habits such as tobacco and alcohol consumption. To compare data collected over time, data were grouped into three time periods: baseline (t1), intermediate (t2), and final (t3). Results: The case group consisted of 27 patients, and the control group consisted of 25 patients. Multivariate analysis was used to evaluate the relationship between the 10-year risk of experiencing a cardiovascular event (SCORE) and the clinical characteristics and analytical variables of patients with psoriasis and controls (n = 52). The variables that were significantly associated with a higher 10-year risk of experiencing a cardiovascular event were age (OR, 1.33; CI95% 1.21-1.50; p < 0.001); smoking (OR, 5.05, CI95% 1.07-27.37; p = 0.047); PASI (OR, 7.98, CI95% 2.32-35.86; p = 0.003); BSA (OR, 1.22, CI95% 1.01-1.49; p = 0.044); and being a control patient (OR, 3.26; CI95% 0.84-13.56; p = 0.029). Conclusions: Pharmacological and behavioral interventions carried out as part of the procedure of the multidisciplinary clinic resulted in improvements in the following variables relative to the control group: PASI, BSA, DLQI, PSOLIFE, lipid profile, insulin and HOMA-IR GGT levels, vitamin D levels, and SCORE. These findings indicate the beneficial effect of the multidisciplinary clinic, which reduced the risk of cardiovascular events in psoriatic patients with metabolic comorbidities.

Oncology: What You May Have Missed in 2023.

Advances in oncology treatment methods have improved outcomes and quality of life for patients with cancer. However, care of these patients can be complex, and the contribution of physicians from different specialties is crucial. This article highlights important publications from 2023 on topics across a wide spectrum relating to the management of oncology patients. The literature was screened for significant new evidence that is relevant to internal medicine specialists and subspecialists whose focus is not oncology. Two articles address the importance of social interventions targeting end-of-life care for low-income and minority patients and the well-being of caregivers. Two additional articles address screening considerations in patients at risk for colorectal and lung cancer. Two more articles address safe use of hormone-related therapies to treat symptoms of menopause and prevent disease recurrence or progression in patients diagnosed with noninvasive breast neoplasia. Finally, several articles were included on topics related to COVID-19 vaccination in patients with cancer, use of cannabinoids for cancer pain control, chronic autoimmune adverse effects related to use of immune checkpoint inhibitors, and the incidence of second primary neoplasms.

Rheumatology: What You May Have Missed in 2023.

Many patients with rheumatologic conditions receive care from physicians other than rheumatologists. Here we note key findings from 6 studies in rheumatology published in 2023 that offer valuable insights for internal medicine specialists and subspecialists outside of rheumatology. The first study investigated the effect of low-dose glucocorticoids on patients with rheumatoid arthritis (RA) over 2 years and challenged existing perceptions about the risks of glucocorticoids in this setting. The second study focused on the updated guideline for preventing and treating glucocorticoid-induced osteoporosis. With the chronic and widespread use of glucocorticoids, the American College of Rheumatology emphasized the importance of assessing fracture risk and initiating pharmacologic therapy when appropriate. The third study explored the potential use of methotrexate in treating inflammatory hand osteoarthritis, suggesting a novel approach to managing this challenging and common condition. The results of the fourth article we highlight suggest that sarilumab has promise as an adjunct treatment of polymyalgia rheumatica relapse during glucocorticoid dosage tapering. The fifth study evaluated sublingual cyclobenzaprine for fibromyalgia treatment, noting both potential benefits and risks. Finally, the sixth article is a systematic review and meta-analysis that assessed the therapeutic equivalence of biosimilars and reference biologics in the treatment of patients with RA. Knowledge of this recent literature will be useful to clinicians regardless of specialty who care for patients with these commonly encountered conditions.

Gastroenterology/Hepatology: What You May Have Missed in 2023.

This article summarizes clinically important gastroenterology developments from 2023 for internal medicine specialists. In colorectal cancer screening, a new RNA fecal screening test is on the horizon, as well as a new analysis on the benefits of using artificial intelligence in screening colonoscopy to detect more polyps. There is new evidence for management of gastrointestinal bleeding, a new drug for treatment of recurrent small-intestinal angiodysplasia, and a new endoscopic treatment method in patients with gastrointestinal tumor bleeding. The authors feature a randomized trial about amitriptyline as treatment for patients with irritable bowel syndrome by primary care providers and bring you news about new biologic agents for inflammatory bowel disease and eosinophilic esophagitis. Finally, they review 2 important articles on new terminology and management of metabolic dysfunction-associated fatty liver disease.

Infectious Diseases: What You May Have Missed in 2023.

In 2023, published research on COVID-19 remains prominent. The aim of this article is to highlight important developments in infectious disease evidence unrelated to COVID-19 that were published in 2023. The literature was screened for sound new evidence relevant to internal medicine specialists and subspecialists whose focus of practice is not infectious diseases. The highlighted publications relate to various organisms and patient populations. One article provides insight into the updated guidelines for the diagnosis and management of infective endocarditis. Several articles address the management of sepsis and bacteremia: comparison of cefepime versus piperacillin-tazobactam, ceftobiprole for the treatment of complicated Staphylococcus aureus bacteremia, and early switch from intravenous to oral antibiotics in patients with gram-negative bacteremia. Another article examines differences in all-cause mortality in patients with Clostridioides difficile infection who receive different treatments. Additional articles provide evidence about the treatment of patients with HIV infection: the utility of preexposure prophylaxis to prevent HIV infection, the efficacy of pitavastatin in reducing cardiovascular disease, and the efficacy of dexamethasone for the treatment of tuberculous meningitis in persons with HIV.

Characteristics affecting the attitude and approach of physicians to breaking bad news: Uncertain medical situations

Breaking bad news is a difficult but unavoidable responsibility of physicians. It constitutes a set of stressfull duties, which become more critical during uncertain medical situations such as the COVID-19 pandemic. The purpose of the current study; To determine the factors that affect physicians’ attitudes and approaches in giving bad news about, life-threatening medical conditions. All staff working in the COVID-19 wards as physicians were invited to complete a standardized questionnaire evaluating the descriptive properties and attitude and approach to breaking bad news in this cross-sectional study. A total of 120 physicians were included in the study. An approximately equal number of physicians working in internal medicine and surgical branches were included in the study (p = 0.540). Internal medicine specialists encountered breaking bad news more commonly than surgeons (p = 0.002). Only 14.2% of them stated that they “always” felt competent. Approximately, 68.3% (n = 82) of the physicians did not receive any kind of training on breaking bad news. More than half of the physicians stated feeling anxious about breaking bad news, particularly when announcing death. Announcement of death due to COVID-19 (5.8%) followed announcing fatal diseases (13.3%) and limb loss with function loss (8.3%). The COVID-19 pandemic revealed the physicians’ need for education on “breaking bad news.” Physicians with a shorter work experience had a higher rate of receiving undergraduate education about breaking bad news than those with more work experience. As the length of service increased, there was a significant increase in the rate of receiving education regarding breaking bad news after graduation (p = 0.037). Additionally, it helped to convey the optimal approach in extraordinary and uncertain medical situations. Our study findings support this statement.The most common reason for breaking bad news is the announcement of death, which should be conveyed to the patient’s relatives in accordance with communication principles, taking into account their current situation. This approach can effectively reduce the anxiety experienced by the physician breaking the news and mitigate reactions from the patient’s relatives such as refusal and incomprehension in the face of the patient’s loss.

Clinical aspects and treatment of tricuspid valve regurgitation

Tricuspid regurgitation (TR) leading to right heart failure is prevalent and associated with increased mortality. The significant under-recognition of the disease resulted from insufficient medical therapies and the high associated risk of surgical therapy. Over the last decade there has been a rapid development of interventional treatment options so that the disease has increasingly become the focus of attention of specialists in internal medicine and interventional cardiologists. The etiology of TR is differentiated into primary TR, secondary atrial TR, secondary ventricular TR and TR associated with cardiac implantable electronic devices (CIED). The TR was identified as an independent predictor of mortality, independent of associated diseases such as atrial fibrillation, left-sided heart failure or pulmonary hypertension. Even patients with low to moderate TR have asignificantly increased risk of mortality. Early diagnostics and estimation of the severity by echocardiography as well as timely referral to atertiary heart valve center are decisive in order to evaluate possible treatment options before irreversible right ventricular damage and secondary organ dysfunction occur. For transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement there is now first evidence from randomized controlled studies. While the understanding of TR is continuously improving, new tricuspid valve repair and replacement systems are in a state of steady progress. Whether the treatment has an effect on reduction of the mortality and stabilization of right ventricular failure with a reduction in hospitalization, will first be shown in future studies.

IJCM_261A: Reaching the unreachable: An outreach based approach of IGMC Shimla to organise Ayushmann Health Melas/ Camps at Secondary level facilities in 03 districts of Shimla, Solan and Bilaspur in vicinity of the college

Background: Soul of India lives in its villages with &gt;65% population living in rural settings. Saturation of all services especially Health services is at core of “leave no one behind” in line with principle of ‘Antyodaya’ reaching out at all. To build momentum with Pradhan Mantri Jan Arogya Yojana Ayushman Health Camps were organised by IGMC Shimla at secondary level facilities under flagship campaign Ayushman Bhavah Objective: Evaluation of health care services delivered by IGMC Shimla in Ayushmann Health Melas at secondary level facilities of 03 districts of Himachal Pradesh. Methodology: Ayushman Melas organised by IGMC Shimla at secondary level facilities from September 2023 to December 2023 in 03 districts Shimla (25); Solan (12) and Bilaspur (13) for providing clinical services to beneficiaries. Real time portal based reporting and analysis of same alongwith specialitywise footfallbifurcation is core. Results: As per Real time-based portal report analysis a footfall of 10379 registered out of which 9055 (87.24%) availed specialists services and 1324(12.74%) general physician services. A net of 2672 (29.5%) beneficiaries availed internal medicine specialist services, 458 (5.05%) surgical, 1619 (17.87%) orthopaedics, 772 (8.52%) obstetrics and gynaecology, 1460 (16.12%) Opthalmology, 698 (7.7%) Otorhinolaryngology, 152 (1.67%) psychiatry, 493 (5.44%) dermatology and 731 (8.07%) paediatric services respectively. 1012(9.75%) new diagnosed Hypertensives and 945 (9.10%) new diagnosed Diabetics, 1492 14.37%) beneficiaries screened for Oral Cancers, 804 (7.75%) for breast cancers and 468 (4.5%) for cervical Cancers. 299 (2.88%) new diagnosed cataract cases. 10379 beneficiaries were tested for 11102 tests (106.96%). Conclusion: Comprehensive health care service delivery by camps to unreachable for screening, diagnosis, one stop multi-speciality consultancy, referral and digitalisation of health vitals.

The need for the GREAT+ score to predict relapse in Graves' disease: a questionnaire among patients and internal medicine specialists.

Graves' disease (GD) is an auto-immune cause of hyperthyroidism. First-line treatment often consists of a 12-18month course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. The 'Graves recurrent event after therapy+ ' (GREAT+) score may predict individual relapse chances after ATD discontinuation more accurately based on clinical and laboratory parameters at diagnosis. We investigated the need for the GREAT+ score through an online questionnaire among GD patients and physicians treating GD. An anonymous online questionnaire was distributed to patients and physicians between June 2022 and August 2023. The questionnaire was completed by 532 patients and 44 physicians. Results showed that 94% of patients were interested in knowing their GREAT+ score at the start of treatment. 55% would consider definite treatment (radioiodine/thyroidectomy) as first-line treatment in case of a high relapse chance. 98% of the physicians indicated the GREAT + score would support patient counseling. 84% may change their advice for first-line treatment if a patient has a high relapse chance based on the score. Patients and physicians considered the GREAT+ score as a valuable addition to the current available information which could change treatment decisions. Therefore, external validation of the GREAT+ score is justified to implement this score in clinical practice.

Atypical Mycobacterial Infections of the Spine: Evaluation and Management.

Atypical mycobacterial infections of the spine can be difficult to treat and represent a subset of the vertebral osteomyelitis and diskitis spectrum often requiring early and aggressive surgical intervention. The purpose of this review is to improve the understanding of and approach to disease management from the perspective of the spine surgeon. Debridement or excision of the affected levels may be necessary to decrease mycobacterial loads and restore biomechanics. A close relationship with the patient's internal medicine and infectious disease specialists should be maintained to ensure disease eradication or remission. Long-term suppressive antibiotic therapy may be required for infection control. Atypical mycobacterial spine infections are rare, complex, and difficult to eradicate. Our institution proposes a collaborative effort among the spine surgeon, infectious disease specialists, and internal medicine specialists to best approach the work-up, diagnosis, and treatment of these infections. [Orthopedics. 2024;47(2):e61-e66.].

Diagnostic Utility of Thoracic Radiography and Abdominal Ultrasonography in Canine Immune-Mediated Polyarthritis: 77 Cases.

Thoracic radiography and abdominal ultrasonography are part of standard diagnostic investigations in cases of canine immune-mediated polyarthritis (IMPA). However, the clinical importance of thoracic and abdominal imaging towards the management of canine IMPA currently remains unknown. The primary aim of this study was to describe the findings documented on thoracic radiography and abdominal ultrasonography in dogs diagnosed with IMPA, and to evaluate the diagnostic utility of thoracic radiography and abdominal ultrasonography in the initial approach and management of these cases. Seventy-seven dogs diagnosed with IMPA who underwent thoracic radiography and abdominal ultrasonography at a single referral hospital between 2008 and 2022 were included. The diagnostic imaging studies of these 77 dogs were reviewed by one blinded board-certified diagnostic imaging specialist for quality assurance. The medical records, including the diagnostic imaging reports of these dogs, were then reviewed by three blinded board-certified internal medicine specialists. Using a modified version of a previous question and scoring system, the three internal medicine specialists then generated an answer for the overall diagnostic utility and a diagnostic utility score for thoracic radiography and abdominal ultrasonography for each case. The abnormal findings identified in radiography and ultrasonography were described. In the cases where the findings were considered significant enough to immediately affect the case management, the results of the further investigations that were subsequently performed were also described. No abnormalities were detected in thoracic radiography for 30 cases, and none were detected in abdominal ultrasound for 6. The majority of the internists considered thoracic radiography to be not useful in the overall case management at the time of IMPA diagnosis in 70 cases, and considered abdominal ultrasonography to be not useful in the overall case management in 57 cases. The majority of the internists agreed on the utility of thoracic radiography in 95% of the cases, and in 61% of the cases for abdominal ultrasonography. The most common finding in the thoracic radiography was a mild bronchial pulmonary pattern, and the most common in the abdominal ultrasonography was mild lymphadenomegaly. Therefore, although thoracic radiography and abdominal ultrasonography identified numerous abnormal findings in this population of dogs, in the majority of the cases, the findings were deemed not useful towards the overall case management at the time of the initial diagnosis of IMPA. Thus, the use of thoracic radiography and abdominal ultrasonography should be taken into careful consideration when considering initial diagnostic investigations for canine IMPA.

The impact of structured education on knowledge and self-efficacy in type 2 diabetes mellitus patients

Patients diagnosed with Type 2 Diabetes Mellitus (T2DM) need to acquire knowledge and self-confidence to effectively engage in self-care activities. A structured education program has the potential to influence knowledge, self-efficacy, and self-care behavior. This study aimed to investigate the impact of education on the knowledge, self-efficacy, and self-care of individuals with T2DM. The research employed a quasi-experimental non-equivalent control group design with purposive sampling. The total sample size consisted of 60 participants, with 30 in each group. The intervention group attended a four-session T2DM structured education program conducted by internal medicine specialists, nurses, nutritionists, and pharmacists, while the control group continued with their usual monthly check-ups. The results of the independent t-test revealed differences in knowledge, self-efficacy, and self-care between the intervention and control groups in the post-test assessment. Education for T2DM patients was found to be effective in enhancing knowledge (p-value=0.000), self-efficacy (p-value=0.000), and self-care (p-value=0.000), making it a recommended component of self-management education to prevent complications. The implications of this study may assist hospitals in developing Standard Operating Procedures (SOPs) for implementing structured education programs for individuals with Type 2 Diabetes Mellitus as a means of enhancing patients’ management skills for T2DM.

Machine learning for risk stratification in the emergency department (MARS-ED) study protocol for a randomized controlled pilot trial on the implementation of a prediction model based on machine learning technology predicting 31-day mortality in the emergency department

BackgroundMany prediction models have been developed to help identify emergency department (ED) patients at high risk of poor outcome. However, these models often underperform in clinical practice and their actual clinical impact has hardly ever been evaluated. We aim to perform a clinical trial to investigate the clinical impact of a prediction model based on machine learning (ML) technology.MethodsThe study is a prospective, randomized, open-label, non-inferiority pilot clinical trial. We will investigate the clinical impact of a prediction model based on ML technology, the RISKINDEX, which has been developed to predict the risk of 31-day mortality based on the results of laboratory tests and demographic characteristics. In previous studies, the RISKINDEX was shown to outperform internal medicine specialists and to have high discriminatory performance. Adults patients (18 years or older) will be recruited in the ED. All participants will be randomly assigned to the control group or the intervention group in a 1:1 ratio. Participants in the control group will receive care as usual in which the study team asks the attending physicians questions about their clinical intuition. Participants in the intervention group will also receive care as usual, but in addition to asking the clinical impression questions, the study team presents the RISKINDEX to the attending physician in order to assess the extent to which clinical treatment is influenced by the results.DiscussionThis pilot clinical trial investigates the clinical impact and implementation of an ML based prediction model in the ED. By assessing the clinical impact and prognostic accuracy of the RISKINDEX, this study aims to contribute valuable insights to optimize patient care and inform future research in the field of ML based clinical prediction models.Trial registrationClinicalTrials.gov NCT05497830. Machine Learning for Risk Stratification in the Emergency Department (MARS-ED). Registered on August 11, 2022. URL: https://clinicaltrials.gov/study/NCT05497830.

Longitudinal follow-up of mixed connective tissue disease and overlapping autoimmune diseases of childhood onset in the Afro-descendant population of the French West Indies

IntroductionOverlap autoimmune syndromes (OAS) and mixed connective tissue disease (MCTD) are rare in children. We performed a retrospective, longitudinal and descriptive study of Afro-Caribbean patients from the French West Indies followed for MCTD and OAS to describe their characteristics and outcomes during childhood.MethodsRetrospective study from January 2000 to 2023. Listings of patients were obtained from multiple sources: computerized hospital archives and national hospital-based surveillance system, registry of pediatricians and adult specialists in internal medicine and the national registry for rare diseases. MCTD was defined according to Kasukawa’s criteria. OAS was defined as overlapping features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis/autoimmune myositis (DM/AM).ResultsSixteen patients were included over a 23-year period (10 MCTD and 6 OAS). The incidence was 0.23 per 100,000 children-years. The mean age at diagnosis was 11.9 years old (2.4–17) with median follow up of 7.9 years (2.1–19.6). SLE phenotype was present in the highest, followed by SSc and DM/AM. Patients had an average of three flares during childhood (1–7). A quarter (25%) had symptomatic pulmonary arterial hypertension (PAH). Ninety-four percent received steroids during follow-up and 88% required a corticosteroid-sparing therapy. Three patients (19%) developed SLE after more than 10y of follow-up. There were no death and no chronic organ failure.ConclusionThis is the largest pediatric cohort of MCTD and OAS in Afro-descendant patients treated in a country with a high standard of care. The clinical evolution did not differ between MCTD and OAS. The main complication was PAH, more frequent in our cohort.

Exploring A Complex Case of Catatonia treatment using Diazepam in a Middle-Aged Female: A Multidisciplinary Exploration of a Unique Case

Background: This case report delves into the intricate interplay between medical and psychiatric domains through the detailed analysis of a 41-year-old female patient presenting with a myriad of symptoms, including decreased level of consciousness, urinary tract infection (UTI), and subsequent catatonia secondary to depression with psychotic features. Case presentation: The collaborative involvement of Internal Medicine, Neurology, Infectious Disease, and Adult Mental Health specialists underscores the necessity of a multidisciplinary approach. The temporal evolution of the patient&amp;apos;s condition, coupled with the sequential adjustments in treatment strategies, provides insights into the nuanced manifestations of overlapping medical and psychiatric conditions. Conclusion: This report aims to highlight the intricate diagnostic process, treatment challenges, and the collaborative efforts required for the successful management of this rare and multifaceted

Multidisciplinary Panel Consensus for the Management of Patients with Type 2 Diabetes: A Delphi Study

To reach a multidisciplinary consensus on managing patients with type 2 diabetes among specialists in family medicine, cardiology, endocrinology, internal medicine, and nephrology. A two-round Delphi study was conducted using a questionnaire with 68 positive/negative statements distributed in four thematic blocks on diabetes management: early diagnosis and prediabetes, referral criteria, treatment and comorbidities, and clinical management. The expert panel was composed of 105 physicians from different specialties (family medicine, cardiology, endocrinology, internal medicine, and nephrology) with experience in managing patients with diabetes and who were members of a diabetes-related society. Response rates for the first and second rounds were 86.7 and 75.2%, respectively. After both rounds, a consensus was reached on 52 (76.5%) items. The recommendations with the highest degree of consensus (median=10, IQR=0.00) were related to anti-smoking education, cardiovascular risk factor target control, and diabetic kidney disease. There were significant differences between family physicians and other specialties for some items. This study provides a set of recommendations for diabetes management agreed upon by specialists from different healthcare settings.

Non-adherence to chronic treatments: A commitment for Internal Medicine specialists

Non-adherence to chronic treatments: A commitment for Internal Medicine specialists

Memorial lecture to the 100th anniversary of the birth of Professor Yu.I. Lorie

In 2022, the 100th anniversary of the birth of Professor Yu.I. Lorie was celebrated. Yuri Ivanovich Lorie is a talented Russian internal medicine specialist and hematologist, a wonderful teacher, and a person of great personal charm. Yu.I. Lorie is the founder of a new direction of hematology in Russia – oncohematology – and the establisher of a school based on deep knowledge and understanding of the oncological principles of hematological malignancies. Yuri Ivanovich Lorie lived a short (only 54 years) but bright life, utterly devoted to Russian medicine. He left a great legacy – a modern, rapidly developing direction in Russian medicine and a school of students who successfully continued the work he started. Looking back at the scientific and practical activities of Yu.I. Lorie and those emotional scientific debates that his colleagues and students remember, it becomes clear how many modern trends in the understanding of oncogenesis, diagnosis and treatment of hematological malignancies this legendary scientist established.