Archives of Internal Medicine Research最新文献

{"title":"The role of emergency medicine for postgraduate year one undifferentiated physician: a qualitative analysis of trainees' perspective","authors":"Ching-Yi Shen, Chih C Huang, Weide Tsai, Chen-Hao Liao, N. Lin, Chih-Chun Hsu, K. Kuo","doi":"10.21203/rs.3.rs-60535/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-60535/v1","url":null,"abstract":"\u0000 Background\u0000\u0000PGY1 program was initiated in 2003 for undifferentiated physicians in Taiwan, the program aimed to improve the general competency gap exposed during the SARS epidemic breakout in physicians. Many published studies discussed the effectiveness of the program. We were interested in the learning impacts gained from the physicians' perspectives during EM rotation in the PGY1 program, and little was known regarding this subject.\u0000Methods\u0000\u0000This retrospective study used grounded theory data analysis methods. 201 PGY1 physicians rotated in the emergency department from August 2014 to July 2017 answered three open-ended post-rotation survey questions and resulted in a dataset of 603 comments. A three-member team for code development reviewed all comments and established the code themes with the consensus of the team members. A four-member coding team coded applicable comments accordingly.\u0000Results\u0000\u0000We coded 563 (96%) comments and sorted 32 themes essential to characterize the clinical experiences into two categories. Twenty-six codes were relevant to professional development; 6 were related to the emotional issue. In the professional development category, patient care (33%) was the most frequently coded domains in the sub-level of six core competencies, followed by system-based practice (25%) and interpersonal and communication skills (19%). Senses of growth and improvement were the most frequently coded theme in the emotional issue category, followed by pressure at the workplace and on-the-spot-feedback. The top 3 lessons learned by physicians' perception were decision-making, team and patient communication, and prioritize tasks.\u0000Conclusions\u0000\u0000EM rotation had a productive role in professional development for undifferentiated physicians before receiving specialty discipline training. Gaining experiences on clinical judgment and communication were the strengths of the EM PGY1 program. This model of analysis might be used as a novel way of assessment on the achievement of learning objectives from the trainee's perspective. However, a prospective standardized study protocol is needed for a further affirmative conclusion.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76731851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences by country-level income in COVID-19 cases, deaths, case-fatality rates, and rates per million population in the first five months of the pandemic","authors":"W. Sabawoon","doi":"10.1101/2020.07.13.20153064","DOIUrl":"https://doi.org/10.1101/2020.07.13.20153064","url":null,"abstract":"Abstract Objective: To describe differences by country-level income in COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates per million population. Methods: Publicly available data on COVID-19 cases and deaths from December 31, 2019 to June 3, 2020 were analyzed. Kruskal-Wallis tests were used to examine associations of country-level income with COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates. Results: A total of 380,803 deaths out of 6,348,204 COVID-19 cases were reported from 210 countries and territories globally in the period under study, and the global case-fatality rate was 6.0%. Of the total globally reported cases and deaths, the percentages of cases and deaths were 59.9% and 75.0% for high-income countries, and 30.9% and 20.7% for upper-middle-income countries. Countries in higher-income categories had higher incidence rates and death rates. Between April and May, the incidence rates in higher-income groups of countries decreased, but in other groups, it increased. Conclusions In the first five months of the COVID-19 pandemic, most cases and deaths were reported from high-income and upper-middle-income countries, and those countries had higher incidence rates and death rates per million population than did lower-middle and low-income countries. Keywords: COVID-19, incidence rate, death rate, case fatality rate, income, and country","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89341571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Residents MET their training: Resident’s perception of Medical Emergency Team and its contribution to their Training","authors":"Kangqi Ng, Daryl A Jones, A. Tee","doi":"10.21203/rs.2.22725/v1","DOIUrl":"https://doi.org/10.21203/rs.2.22725/v1","url":null,"abstract":"\u0000 Background Medical Emergency Teams (MET) have been implemented in many hospitals to improve patient safety. Few studies examined how residents perceive the MET as part of training. Objective We aimed to evaluate residents’ perceptions of how MET rotation affected training in the core competencies specified by Accreditation Council for Graduate Medical Education (ACGME). Methods We conducted an online survey of 106 residents. They are either junior residents who are in training in internal medicine, non-trainee registrars or senior residents who are training in respiratory or advanced internal medicine. Results We achieved a response rate of 62.3%. More than 90% of residents agreed or strongly agreed that MET contributed positively to their training, made resuscitation of patients safer and more efficient, and disagreed or strongly disagreed that MET made resuscitation of patients more time-consuming or cumbersome. More than 80% agreed or strongly agreed that the MET improved their clinical judgement in medical emergencies, helped achieve their learning goals and exposed them to a wide variety of cases. At least two-thirds thought that the MET posting improved their procedural skills and communication in end of life care discussions. In contrast, 26.6% of respondents agreed or strongly agreed that the MET decreased autonomy of the primary team. One-third felt they needed formal training for the MET posting. Conclusion Our findings suggest that residents perceive participation in MET was beneficial in training and improved patient care. We also found that formal training and consultant oversight may be needed for junior team leaders of MET.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89658362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Cirrhosis and Increased Risk of Cardiovascular Events in a VA Patient Population, A Retrospective Cohort Study","authors":"L. Hashemi, J. Pisegna, M. Budoff, Ning Li, Minh T Nguyen, R. Ebrahimi, E.Y.-L. Chu, E. Streja, D. Elashoff, T. Ganz","doi":"10.26502/aimr.0045","DOIUrl":"https://doi.org/10.26502/aimr.0045","url":null,"abstract":"Background: There is conflicting evidence regarding prevalence and incidence of atherosclerotic cardiovascular disease (ASCVD) in patients with liver cirrhosis. The risk factors associated with ASCVD within this group of patients have not been investigated previously. Methods and Results: This is a retrospective longitudinal study utilizing the Veterans Affairs (VA) Greater Los Angeles Electronic Medical Record of 623 patients with diagnosis of liver disease. We investigated the incidence of ASCVD events and risk factors associated with ASCVD in these patients. We observed an increase in prevalence of ASCVD events in patients with cirrhosis compared to liver disease patients without cirrhosis (19.12% vs 2.46%). Although the cirrhosis group patients were older but, in our Cox-regression model, after adjusting for traditional ASCVD risk factors especially age, cirrhosis remained a major risk factor for ASCVD events with a hazard ratio (HR) of 5.73 (CI: 2.74-12.72). In the subgroup analysis of cirrhosis group, transferrin saturation greater or equal to 40% had 4.27 times higher risk of ASCVD events than lower transferrin saturation. Conclusion: We propose that the liver damage and subsequent decrease in hepcidin production in patients with cirrhosis would cause a major increase in Non-Transferrin-Bound Iron (NTBI) in circulation. Circula-ting NTBI promotes endothelial dysfunction, produces reactive oxygen species (ROS), and exposes important biomolecules, like low density lipoprotein (LDL), to oxidative stress to facilitate atherosclerosis. Accordingly, these epidemiological results provide evidence for further translational investigations to identify factors to mitigate the development of ASCVD.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82568333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exaggerated Immune Reaction to Trichophyton Fungus Results in an Inflammatory Tinea Pedis.","authors":"Robert R Hoopes, Jeffrey B Travers","doi":"10.26502/aimr.0040","DOIUrl":"https://doi.org/10.26502/aimr.0040","url":null,"abstract":"We report a case of a 58-year-old African American male with a long history of scaly itchy feet. The patient presented to the clinic on February 8th, 2018 with an apparent inflammatory reaction on the plantar surface of both feet (Figures 1 and 2). An initial specimen collection from the patient’s plantar surface revealed hyphae indicative of a fungal infection under KOH preparation. This supported the diagnosis of a tinea pedis infection. The patient was treated with ketoconazole topical cream and 20% Urea creams to be applied daily. Follow-up approximately 6 weeks later revealed resolution of underlying fungal infection with minimal remaining inflammation (Figures 3 and 4). With consideration to the subject’s initial presentation of a possible exaggerated immune reaction caused by Trichophyton, we suspected an underlying allergic response (delayed-type hypersensitivity reaction) to the fungus, instead of a cutaneous fungal infection alone. In order to test this hypothesis, we subjected the patient to intradermal skin testing with intradermal Candida and Trichophyton","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39741552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Stroke in COVID-19 Patients: A Narrative Review","authors":"Alejandra G P Alvizo, Wilson O Vaughan, Azka Ali, Ashina K Rana, Ukasha Habib, Pratiksha P Kapartiwar, Sahibzada M Qasim, S. Gopal, Hamza Yunus, C. Ranabhat, Zainab H Khan, A. Nasir, A. Shrestha, A. Neupane","doi":"10.26502/aimr.0055","DOIUrl":"https://doi.org/10.26502/aimr.0055","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) is primarily known as a respiratory illness; however, a wide variety of symptoms and complications can also occur. It is associated with a small but clinically significant risk of stroke attributed to a hypercoagulable state. There is a need to summarize clinical characteristics, stroke mechanisms, and recommendations to prevent stroke in Arch Intern Med Res 2021; 4 (2): 048-053 DOI: 10.26502/aimr.0055 Archives of Internal Medicine Research 49 this population. The literature search was performed using PubMed, and after applying the inclusion and exclusion criteria, 6 published papers were found. The overall incidence of stroke in COVID patients can range from 1 to 2%, with high variability. COVID patients who developed stroke were mostly men, with a mean age above 60, and had a severe COVID-19 infection. In most cases, it was a large artery stroke. Acute Ischemic Stroke (AIS) in the setting of COVID-19 is associated with worse outcomes. It is very important to practice social distancing to prevent people from getting the infection. Prophylactic treatment should be given in patients with symptomatic COVID-19 infections, while asymptomatic carriers can prevent their chance of COVID-19 stroke by lifestyle changes and dietary modifications.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82032199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potassium Binders","authors":"M. Tinawi","doi":"10.26502/aimr.0034","DOIUrl":"https://doi.org/10.26502/aimr.0034","url":null,"abstract":"Sodium polystyrene sulfonate was approved by the FDA in 1958. It was the only potassium binder available on the market until 2015. Patiromer and sodium zirconium cyclosilicate are newly approved potassium binders. They are better tolerated and can be used on a chronic basis to mitigate hyperkalemia. They allow patients to continue to use critical medications such as ACE inhibitors even in advanced chronic kidney disease.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84478627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rimegepant in the Treatment of Migraine","authors":"M. A. Haider, M. Hanif, M. Ali, Muhammad Umer Ahmed, Sundas, A. H. Karim","doi":"10.26502/aimr.0030","DOIUrl":"https://doi.org/10.26502/aimr.0030","url":null,"abstract":"Migraine is a common and chronic disorder with significant financial and socioeconomic burden. It is the 2nd most common reason for the years lived with disability after back pain. Current available treatment of migraine is limited to subpopulation due to poor tolerability, efficacy, side effects, contraindication and drug-drug interactions. So there is need to evolve some treatment to overcome these limitations. Calcitonin-gene-related peptide receptor has been identified in the pathophysiology of migraine over 30 years and in recent few years, some CGRP-receptor antagonists have been identified and can reduce the unmet needs in the treatm- ent of migraine. This article is focused on exploring the role of rimegepant (CGRP-receptor antagonist) by reviewing myriads of articles published in Pubmed and Google scholar.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89529116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension in Pregnancy","authors":"M. Tinawi","doi":"10.26502/aimr.0018","DOIUrl":"https://doi.org/10.26502/aimr.0018","url":null,"abstract":"Hypertension is commonly encountered in the course of pregnancy. It can predate or manifest during pregnancy. It requires prompt recognition and treatment. If left untreated, hypertension in pregnancy will lead to significant maternal and fetal morbidity and mortality. This mini-review will discuss the classification of hypertension in pregnancy, identify treatment goals, discuss preeclampsia in some detail and discuss management of these disorders based on recent guidelines. This review is intended as a quick summary and a practical guide. Extensive reviews of the subject are widely available.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88807421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Ultrasound-Guided Percutaneous Catheter Drainage in the Management of Infected Pancreatic Necrosis","authors":"Namhun Jong, S. Rim, Hye-Song Kim, Chung-Sa Ji, Hakchol Ri, Jong-Nam Kang","doi":"10.26502/aimr.0013","DOIUrl":"https://doi.org/10.26502/aimr.0013","url":null,"abstract":"Background: Percutaneous catheter drainage has been widely accepted in infected necrotizing pancreatitis. Aims: We evaluated clinical safety and efficacy of ultrasound-guided percutaneous catheter drainage in patients with infected pancreatic necrosis. Subjects: Our prospective study included 44 patients who developed infection of peri/pancreatic necrosis. Of these patients, 25 cases received ultrasound-guided PCD study group) whereas 21 cases underwent surgery (control group). Intervention: On admission all patients were treated with fluid therapy, nutritional support, antibiotics, gastrointestinal decompression and analgesics. Ultrasound-guided PCD or surgery were performed in patients who suspected infection of necrotic collection. Conversion to surgery were considered in patients who failed to PCD. Clinical outcomes: primary outcomes were changes in laboratory parameters before and after treatment, recovery days of inflammatory parameters (WBC, CRP). Secondary outcomes were the incidence of complication, mortality and hospital stay. Results: In the study group PCD period was 30 (median) days (9-91, range). PCD was unsuccessful in 9 (36.0%) patients, who required eventually cross over to necrosectomy. All laboratory parameters (WBC, CRP, serum amylase, blood glucose, serum calcium) were improved after therapy compared to before therapy in both groups (p<0.05). The post treatment comparison showed the level of WBC, CRP, serum amylase and blood glucose in the study group were significantly lower than those in the control group (p<0.05). In PCD group recovery days of WBC, CRP was significantly decreased compared to control group (p<0.05). In study group incidence of new-onset organ failure, intra-abdominal bleeding and incisional hernia significantly reduced than those in the control group (p<0.05). Finally, the mortality rate in  the study group was lower than control group and study group had shorter hospital stays compared to control group (p<0.05). Conclusion: Ultrasound-guided PCD can reduce the need of surgical treatment and step-up approach (PCD followed by surgery) may decrease mortality than primary necrosectomy by minimizing pancreatic injury.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77530540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}