Textbook Of Internal Medicine Research Articles

Medical students' understanding of geriatric medicine

With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. At Ehime University School of Medicine, the Department of Geriatric Medicine was established on April 1,1997. To assess the status of geriatric medicine in undergraduate education, we surveyed the opinions of medical students on geriatric medicine. A questionnaire was sent to both fourth-year medical students before their classes on internal medicine and geriatric medicine had ended and to sixth-year medical students after their classes had already ended. Medical students of Ehime University School of Medicine had significantly more interest in geriatric medicine than students at other medical schools. From a clinical viewpoint of problems in old age, they considered that cerebrovascular disease, cardiovascular disorders, neurocognitive disorders and pulmonary disease were important. A total of 60% agreed that all medical schools should have classes in geriatric medicine, which is a higher rate than that of previous reports. To study the opinions of medical students on textbooks on geriatrics, we also conducted a questionnaire among medical students. Although 90% of students had their own textbooks of internal medicine and almost half (42%) had textbooks on physical examination, none had their own textbook of geriatric medicine. The most frequent reason was "hard to choose the best textbook". The present study indicates that to develop education in geriatric medicine, it is important to make a recommendable text book for medical students, which is easily understood with high quality and originality.

Kelly's Textbook of Internal Medicine

<i>Kelly's Textbook of Internal Medicine</i>

Even with Internet Ailing and Sites Folding, New Resources Pop Up

Even with Internet Ailing and Sites Folding, New Resources Pop Up

Underrepresentation of women among peer reviewers and textbook authors in medicine in Germany

A characteristic feature of German science is the "disappearance" of women during the different ranks from high-school to professorship. The goal of the present study was to determine the proportion of women among peer reviewers of the German research council and among editors and authors of textbooks in internal medicine. The candidate list for the election of the peer reviewers of the German research council in November 1999 was checked for the participation of women. Numbers and proportion of women among the reviewer boards for practical medicine, theoretical medicine, biological chemistry/biophysics and biology were determined. Textbooks of internal medicine in German language were checked for female editors and authors. 1.8% of the present reviewers and 4.3% of the candidate reviewers for the election of the reviewer board for practical medicine were female. The corresponding numbers for the reviewer board for theoretical medicine were 3.2% and 8.2%, respectively. The reviewer board for biological chemistry and biophysics had no woman among the present reviewers and 2.1% among the candidate reviewers. Corresponding proportions for the reviewer board for biology are 18.5% and 13.5%, respectively. The average percentage of women among all 4 reviewer boards which are involved in biomedical research is 5.4% among the present reviewers and 6.5% among the proposed reviewers. A similar situation of underrepresentation of women is present among authors of medical textbooks. Among 65 editors and co-editors of 19 textbooks of internal medicine was no woman at all. Among a total of 1092 authors 47 women corresponding to 4.3% were found. These numbers demonstrate that the subject of gender discrimination in higher ranks in medicine and science in Germany is far from being solved.

End-of-life care content in 50 textbooks from multiple specialties.

Prior reviews of small numbers of medical textbooks suggest that end-of-life care is not well covered in textbooks. No broad study of end-of-life care content analysis has been performed on textbooks across a wide range of medical, pediatric, psychiatric, and surgical specialties. To determine the quantity and rate the adequacy of information on end-of-life care in textbooks from multiple medical disciplines. DESIGN AND SOURCES: A 1998 review of 50 top-selling textbooks from multiple specialties (cardiology, emergency medicine, family and primary care medicine, geriatrics, infectious disease and acquired immunodeficiency syndrome [AIDS], internal medicine, neurology, oncology and hematology, pediatrics, psychiatry, pulmonary medicine, and surgery) for the presence and adequacy of content in 13 end-of-life care domains. Chapters on diseases commonly causing death and those devoted to end-of-life care were identified, read, rated, and compared by textbook specialty, chapter, and domain for the presence of helpful information in the 13 domains. Content for each domain was rated as absent, minimally present, or helpful. Textbook indexes were analyzed for the number of pages relevant to end-of-life care. Overall, helpful information was provided in 24.1% (range, 8.7%-44.2%) of the expected end-of-life content domains; in 19.1% (range, 6.2%-38.5%), expected content received minimal attention; and in 56.9% (range, 23.1 %-77.9%), expected content was absent. As a group, the textbooks with the highest percentages of absent content were in surgery (71.8%), infectious diseases and AIDS (70%), and oncology and hematology (61.9%). Textbooks with the highest percentage of helpful end-of-life care content were in family medicine (34.4%), geriatrics (34.4%), and psychiatry (29.6%). In internal medicine textbooks, the content domains with the greatest amount of helpful information were epidemiology and natural history. Content domains covered least well were social, spiritual, ethical, and family issues, as well as physician after-death responsibilities. On average, textbook indexes cited 2% of their total pages as pertinent to end-of-life care. Top-selling textbooks generally offered little helpful information on caring for patients at the end of life. Most disease-oriented chapters had no or minimal end-of-life care content. Specialty textbooks with information about particular diseases often did not contain helpful information on caring for patients dying from those diseases.

Implications of chills

Chills (perception of cold and involuntary muscle tremor) may accompany almost any infection. Although textbooks of internal medicine and infectious diseases claim that chills indicate bacteraemia,1–3 few studies have addressed this issue.4 We investigated how often chills are associated with bacteraemia, endotoxaemia, and cytokinaemia in a prospective study of 464 consecutive patients (median age 61; 272 men, 192 women) who came to hospital with fever. 90 (19%) had bacteraemia (42 gram-positive, 44 gram-negative, and four both).

The ellipsis of prognosis in modern medical thought

Contemporary textbooks of internal medicine give scant attention to the prognosis of diseases. Has this always been the case? If not, when and why did prognosis come to be de-emphasized? Using a highly regarded, standard medical textbook initially authored by William Osler, The Principles and Practice of Medicine, I performed qualitative and quantitative content analysis of entries regarding lobar pneumonia in selected editions published between 1892 and 1988, with special attention to the period between 1892 and 1947. I chose lobar pneumonia because it was a leading cause of death throughout this period and because it is recognizable across time, thus making it possible to follow the evolution in clinical thinking about prognosis while holding constant the diagnosis. I argue that two powerful forces converged to lead to the ellipsis of prognosis: (1) the emergence of effective therapy, and (2) a fundamental change in the cognitive basis of medicine. With respect to the former, I show that there is a complementary, inverse relationship between the clinical acts of prognostication and therapy; as one increases in salience in the management of a disease, the other decreases. With respect to the latter, I argue that the particular clinical facts deemed to be important about a patient's case have shifted over time, and I explore changes in the clinical and cognitive foundations of physicians' estimation of patients' prognoses—in particular, “symptoms” and “complications.” I conclude that, concurrent with a shift in clinical thought from an individual-based to a diagnosis-based conceptualization of disease, prognosis came to be seen as intrinsic to diagnosis and therapy, and explicit attention to prognosis consequently diminished.

Cecil Textbook of Medicine

It took eight years, but the new edition of the granddaddy of general internal medicine texts has finally been published. At a time when many authoritative reference texts are updated and published every three years, it is surprising that it took this long to get the new Cecil . I suspect that the many physicians who used Cecil as their guide to internal medicine will be quite pleased that the wait is over. On the surface, the novice might wonder if there is a difference among the major internal medicine textbooks. All of them are thick, heavy books with prestigious editors (interestingly, among the editors of Cecil, Harrison , Stein's, and Kelley's texts, none are women). The difference is in their organization, which in some cases is substantial. According to the preface to the previous edition of Cecil , the concept was not to fragment discussions of disease processes but, rather, to combine

BOOK REVIEWS

Book reviewed in this article: Concise edition of internal medicine textbook: Pocket Companion to the Fourth Edition of the Textbook of Veterinary Internal Medicine. Edited by S. J. Ettinger. Introduction to laboratory tests: Small Animal Clinical Diagnosis by Laboratory Methods (2nd edn). By M. D. Willard, H. Tvedten and G. H. Turnwald. Reptile and amphibian questions: Self‐Assessment Colour Review of Reptiles and Amphibians. By Frederic L. Frye and David L. Williams. Diets for laboratory species: Nutritional Requirements of Laboratory Animals (4th edn). By the Subcommittee on Laboratory Animal Nutrition, Board of Agriculture. State of the art in thoracic surgery: Small Animal Thoracic Surgery. By E. C. Orton and T. O. McCracken.

Ｈａｒｒｉｓｏｎ内科書の引用分析

In this paper, one of the famous textbooks of internal medicine, the first edition (1952) of Harrison's Principles of Internal Medicine, was examined on the basis of citation studies. The following results were obtained: 1. There were 1, 750 citations in Harrison. The proportion of journal citations to total citations was 76.4%. 2. Harrison had 5 editors and 48 contributors. Most of them were affiliated with newly established medical schools in southern or western states. 3. The 15 most frequently cited journals are listed. The most important journal was JAMA. 4. The 5 most frequently cited books are listed. This list indicates that most of them were in the field of mycology. 5. The age of the citations indicates that the peak age was 2 years. The median citation age in journals was 5 years, and in books it was 6 years. 6. Harrison's textbook tended to cite English language journals in the references. The proportion of the citations written in English to total citations was 98%. The results were also discussed from the historical background in American medical education.

BOOK REVIEWS

Book reviewed in this article:Detailed study of fracture radiographs: Radiology of Small Animal Fracture Management. By J. P. Morgan and R. L. Leighton.Updated internal medicine textbook: Textbook of Veterinary Internal Medicine, 4th edn. Edited by S. J. Ettinger and E. C. Feldman.Dealing with emergency cases: Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment, 6th edn. By S. I. Bistner and R. B. Ford.

Treating Advanced Cancer in an Era of Increasing Cost Consciousness

IN THIS ISSUEof theARCHIVES, Schapira and Jarrett 1 critically examine the cost vs the benefit of various diagnostic procedures in the evaluation of patients with carcinoma of unknown primary site. In an era with an increasing focus on the cost-effectiveness of therapy, this article is one of a burgeoning number of analyses aimed at optimizing the use of the American health care dollar. It is likely that diseases considered to be poorly treated, both malignant and nonmalignant, will be frequent targets for such analysis. For most patients with carcinoma of unknown primary site, treatment remains relatively ineffective. It has been well documented that once the diagnosis of metastatic cancer is established, the yield of extensive radiologic and endoscopic procedures in identifying a primary site is low. All current textbooks of internal medicine and medical oncology recommend a limited diagnostic evaluation, including only a routine chemistry profile, hemogram, chest

Best books on infectious diseases: a personal choice

Most large textbooks of general medicine have a chapter on infectious diseases. The Oxford Textbook of Medicine remains one of the most comprehensive reference textbooks of internal medicine. The infection section (640 pages) is by far the largest in the textbook. Reflecting the interest of David Warrell, …

Cecil Textbook of Medicine

Textbook of Internal Medicine, edited by William N. Kelley, 2nd ed, 2441 + pp, with illus, $99 single volume, $125 2-volume set, ISBN 0-397510489, Philadelphia, Pa, JB Lippincott, 1992. Medical textbooks of the 19th century were mostly based on the art of medicine and were truly artistic productions. The art is still there, but currently it lacks prestige. Today's textbooks, while providing the needed information, differ in nearly every respect from their predecessors except for their titles. Some of these changes are due to the differences in the practice of medicine, then and now. A century ago most medical care consisted of very careful observation, interrogation, and physical examination of the patient with relatively little emphasis on the sparse laboratory information that was then available. Treatment was considered important but relatively ineffective. However, the nature of the examination forged a bond of understanding and respect between the physician and the patient.

Current Therapy in Internal Medicine

I urge sophomore medical students, as they begin their clinical training, to develop an approach to diagnosis. Later in their careers, after making a diagnosis, they can usually up the treatment. This book is a major source of where to look it up. As the title implies, this is not a textbook of internal medicine in competition with Harrison's, Cecil , and others. It is one of 27 titles in the Current Therapy series by the same publisher. Many of the chapters on specific diseases were taken verbatim from the subspecialty books ( Current Therapy in Cardiovascular Disease, Current Therapy in Nephrology and Hypertension , and others) to constitute a volume aimed at the general internist. It is comparable in price to some of the separate subspecialty books. Readers familiar with the second edition (1987, under different editorship) will find that this is a very different and mainly improved book. The number

Textbook of Internal Medicine.

This two-volume set emphasizes practicality and now includes features designed to provide authoritative answers to the questions and problems faced by students and practitioners every day. Each section includes a series of Approach to Patients chapters focusing on evaluation and work-up. Also included are complete descriptions of disease-specific entities, with Indications for Referrals and Indications for Hospitalization highlighted for quick reference. There is also a Rapid Access Guide at the front of the book summarizing key facts pertaining to the most important disease entities or clinical problems. A free diskette packaged with the single volume contains 250 questions in an interactive format and keyed to the text.

Textbook of Internal Medicine

Textbook of Internal Medicine

Depression, Depressants, and Antidepressants

Depression is a common, serious, and deadly illness. Recent evidence suggests that it is underrecognized by physicians and, even when diagnosed, treated insufficiently (too little too late). Modern antidepressant drugs are highly effective for most patients with more serious (nonpsychotic) depressions, whereas newer psychosocial approaches can benefit patients on the milder end of the spectrum. Many patients improve with combined pharmacotherapy and psychotherapy. What causes the depressive diathesis and what triggers depressive episodes remain enigmas despite centuries of observations and decades of scientific research. Presumably, genetics and early life experiences contribute to the diathesis. Possible triggers of episodes include changes in internal chemistry, stress and loss, and the coming of the winter solstice. Medical illnesses and the drugs used to treat them may also cause depression, particularly in predisposed individuals. Typical lists of possible organic causes resemble tables of contents from internal medicine textbooks. A multitude of factors upsetting the

BOOK REVIEWS

Book reviews in this article: Dysphagia: Diagnosis and Treatment Edited by David W. Gelfand and Joel E. Richter. New York: Igaku‐Shoin, 1989. Illustrated xiii + 382 pages, includes index. Price: $125.00. Common Problems in Gastrointestinal Radiology. By William M. Thompson. Chicago: Year Book Medical Publishers Inc., 1989. Illustrated, 670 pages Price: $216.00. Acute Treatment of Duodenal Ulcer. Analysis of 293 Randomized Clinical Trials. By T. Poynard and J. P. Pignon. John Libbey, 1989. Price: $30.00 Current Gastroenterology, Volume 9. Edited by Gary Gitnick, MD. Chicago: Year Book Medical Publishers Inc., 1989. Illustrated, xii + 359 pages, includes index. Price: $114.00. Progress in Gastrointestinal Surgery. Edited by John S. Najarian and John P. Delaney. Chicago: Year Book Medical Publishers, 1989. Price $215.00. Textbook of Internal Medicine. Edited by William N. Kelley. Philadelphia: J. B. Lippincott, 1989. Price: $135.00. Data Analysis for Clinical Medicine: The Quantitative Approach to Patient Care in Gastroenterology. Edited by Thomas C. Chalmers.

Catastrophic medical events with exhaustive exercise: “White collar rhabdomyolysis”

Each year, especially in the United States, young and middle aged men die from a variety of causes during or following intense physical exertion. For unknown reasons, death and disability as a consequence of physical effort are virtually unknown in women, despite the fact that they participate heavily in competitive sports. The most important complications of exhaustive exercise are shown in Table 1. Of these, rhabdomyolysis, especially if associated with exertional heat stroke, is one of the most devastating clinical illnesses that exists. The term rhabdomyolysis defines an injury to skeletal muscle cells of such severity that their contents leak into the circulation. The injury may be confirmed biochemically by demonstrating elevated concentrations of enzymes in serum that are specifically located in skeletal muscle cells (CK-MM, aldolase) or myoglobin. Myoglobin released into the circulation is filtered and excreted into the urine, so-called myoglobinuria. The latter invokes the risk of acute renal failure (pigment nephropathy). Exertional rhabdomyolysis is an exceptionally common event. It is probably experienced in mild form by everyone who has undergone some form of exercise training during their youth when it is expressed simply by stiff and tender muscles. If at that time someone happened to measure a serum CK value, it would be slightly to modestly elevated. Some of the most classic examples of frank exertional rhabdomyolysis occur among our most highly trained endurance runners. In the majority of cases, there is no history or other apparent evidence for myopathy before the event. In most who survive major episodes, subsequent muscle testing has shown no results that suggest a hereditary myopathy such as McArdle's Syndrome, carnitine palmityl transferase deficiency, or other myopathy. Because of this, it is assumed that any normal person may develop frank rhabdomyolysis provided the provocation is adequate. Provocative events consist of exhaustive exercise, especially when competitive, and particularly if the athlete musters his supreme effort to win during the last segment of a race. Hot or warm weather and a high relative humidity increase the risk enormously. Victims of this disorder often give a history that they continued to run despite cramping pain and dead legs. Some of them continue to run despite obvious disorientation and confusion. Observers commonly recall that victims appeared pallid or gray as if their skin vessels had become constricted as a result of a massive discharge of norepinephrine or alternatively, their cardiac output and peripheral circulation had failed. It seems that it is this last burst of effort that often provides the coup de grace , so that the patient develops major and widespread soft tissue injury and in some cases, heat stroke as an associated illness. It is unfortunate that the gravity of acute exertional rhabdomyolysis is so often unappreciated by physicians who initially provide care for these patients. Although the victim may collapse and appear to recover quickly, in some of these, potentially fatal metabolic acidosis, hyperkalemia, disseminated intravascular coagulation and the acute respiratory distress syndrome may appear during the following 24 hours. The syndrome of rhabdomyolysis is given little attention in the major textbooks of internal medicine. Perhaps this is one of the reasons why the gravity of the illness is so commonly unappreciated at the onset when appropriate identification and treatment of its complications could be life saving. There is strong evidence that training induces a degree of resistance to development of exertional rhabdomyolysis as well as exertional heat stroke. Some of this evidence will be reviewed, but with emphasis on the fact that even a highly trained athlete can still develop exertional rhabdomyolysis. Following the review of the physiological mechanisms that help forestall injury incident to exertion, several cases will be presented that will highlight some of the devastating complications of exercise.