Internal_Medicine RSS : Gourt

Breastfeeding and allergies: time for a change in paradigm?.

Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R

New aspects in allergic contact dermatitis.

Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

How to break the vicious circle of antibiotic resistances?.

Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude

Benefits of high-protein weight loss diets: enough evidence for practice?.

Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b

Chronic pancreatitis.

Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Page: 577DOI: 10.1097/MCI.0b013e32831dae94Authors: Alberio, Lorenzo

Long-term prognosis after deep venous thrombosis.

Page: 586DOI: 10.1097/MCI.0b013e32831daea9Authors: Shbaklo, Hadia a; Kahn, Susan R a,b

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Page: 591DOI: 10.1097/MCI.0b013e32831daed2Authors: DuPont, Herbert L a,b,c; Garey, Kevin b,c,d; Caeiro, Juan-Pablo b,c; Jiang, Zhi-Dong a

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Page: 599DOI: 10.1097/MCI.0b013e32831daeffAuthors: Ryan, Michael J a; Tuttle, Katherine R a,b

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Page: 606DOI: 10.1097/MCI.0b013e32831daf11Authors: Gaddam, Krishna K; Oparil, Suzanne

Diabetic polyneuropathy: an update.

Page: 613DOI: 10.1097/MCI.0b013e32831dae0bAuthors: Zochodne, Douglas W

Drug-induced myopathies.

Page: 620DOI: 10.1097/MCI.0b013e32831dae1cAuthors: Klopstock, Thomas

Evolving epidemiology of malignancies in HIV.

Page: 626DOI: 10.1097/MCI.0b013e32831dae71Authors: Bonnet, Fabrice a,b,c; Chene, Genevieve a,b

Vaccines against cervical cancer.

Page: 633DOI: 10.1097/MCI.0b013e32831dae88Authors: Rogers, Linda J; Eva, Lois J; Luesley, David Michael

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Page: 638DOI: 10.1097/MCI.0b013e32831dad76Authors: Zamanian, Roham T a,b; Gould, Michael K a,c

Update on biologics in juvenile idiopathic arthritis.

Page: 643DOI: 10.1097/MCI.0b013e32831dae32Authors: Ilowite, Norman T

Recommended Adult Immunization Schedule: United States, 2012.

Recommended Adult Immunization Schedule: United States, 2012. Ann Intern Med. 2012 Jan 31; Authors: PMID: 22298576 [PubMed - as supplied by publisher]

Adult Immunization 2012: Politics, Process, and Progress.

Adult Immunization 2012: Politics, Process, and Progress. Ann Intern Med. 2012 Jan 31; Authors: Fryhofer SA PMID: 22298575 [PubMed - as supplied by publisher]

On Motivating Patients: A Picture, Even If Worth a Thousand Words, Is Not Enough [Editorial]

Positive Affect and Self-affirmation Are Beneficial, but Do They Facilitate Maintenance of Health-Behavior Change?: Comment on "A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans" [Invited Commentary]

Impact of Carotid Plaque Screening on Smoking Cessation and Other Cardiovascular Risk Factors: A Randomized Controlled Trial [Original Investigation]

Background Screening of peripheral atherosclerosis is increasingly used, but few trials have examined its clinical impact. We aimed to assess whether carotid plaque screening helps smokers to improve their health behaviors and cardiovascular risk factors. Methods We randomly assigned 536 smokers aged 40 to 70 years to carotid plaque ultrasonographic screening (US group) vs no screening (control group) in addition to individual counseling and nicotine replacement therapy for all participants. Smokers with at least 1 plaque received pictures of their plaques with a 7-minute structured explanation. The outcomes included biochemically validated smoking cessation at 12 months (primary outcome) and changes in cardiovascular risk factor levels and Framingham risk score. Results At baseline, participants (mean age, 51.1 years; 45.0% women) smoked an average of 20 cigarettes per day with a median duration of 32 years. The US group had a high prevalence of carotid plaques (57.9%). At 12 months, smoking cessation rates were high, but did not differ between the US and control groups (24.9% vs 22.1%; P = .45). In the US group, cessation rates did not differ according to the presence or absence of plaques. Control of cardiovascular risk factors (ie, blood pressure and low-density lipoprotein cholesterol and hemoglobin A1c levels in diabetic patients) and mean absolute risk change in Framingham risk score did not differ between the groups. The mean absolute risk change in Framingham risk score was +0.6 in the US group vs +0.3 in the control group (P = .56). Conclusion In smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling is not associated with increased rates of smoking cessation or control of cardiovascular risk factors. Trial Registration clinicaltrials.gov Identifier: NCT00548665

Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation: A Randomized Trial [Original Investigation]

Background Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. Methods We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007; of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. Results Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (P = .65) and increased by 415 (95% CI, 76-754; P = .02) and 398 (95% CI, 145-652; P = .002) kcal/wk, respectively, with no difference between groups (P = .94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all P < .10, 2-sided test). Conclusions A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial. Trial Registration clinicaltrials.gov Identifier: NCT00195117

Randomized Controlled Trial of Positive Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention [Original Investigation]

Background Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index. Methods Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n = 118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive affect/self-affirmation (PA) intervention group (n = 124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months. Results Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P = .007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P = .03). Conclusion Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00248846

A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans [Original Investigation]

Background Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes. Methods This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months. Results The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P = .049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P = .98) and diastolic BP (–1.59 mm Hg vs –0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant. Conclusions A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175

Effect of Aspirin on Vascular and Nonvascular Outcomes: Meta-analysis of Randomized Controlled Trials [Review Article]

Background The net benefit of aspirin in prevention of CVD and nonvascular events remains unclear. Our objective was to assess the impact (and safety) of aspirin on vascular and nonvascular outcomes in primary prevention. Data Sources MEDLINE, Cochrane Library of Clinical Trials (up to June 2011) and unpublished trial data from investigators. Study Selection Nine randomized placebo-controlled trials with at least 1000 participants each, reporting on cardiovascular disease (CVD), nonvascular outcomes, or death were included. Data Extraction Three authors abstracted data. Study-specific odds ratios (ORs) were combined using random-effects meta-analysis. Risks vs benefits were evaluated by comparing CVD risk reductions with increases in bleeding. Results During a mean (SD) follow-up of 6.0 (2.1) years involving over 100 000 participants, aspirin treatment reduced total CVD events by 10% (OR, 0.90; 95% CI, 0.85-0.96; number needed to treat, 120), driven primarily by reduction in nonfatal MI (OR, 0.80; 95% CI, 0.67-0.96; number needed to treat, 162). There was no significant reduction in CVD death (OR, 0.99; 95% CI, 0.85-1.15) or cancer mortality (OR, 0.93; 95% CI, 0.84-1.03), and there was increased risk of nontrivial bleeding events (OR, 1.31; 95% CI, 1.14-1.50; number needed to harm, 73). Significant heterogeneity was observed for coronary heart disease and bleeding outcomes, which could not be accounted for by major demographic or participant characteristics. Conclusions Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

Reducing Inappropriate Urinary Catheter Use: A Statewide Effort [Original Investigation]

Background Indwelling urinary catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use. Methods Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate urinary catheter indications. The data were collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence to appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to estimate rates over time while accounting for the clustering of patients within hospital units. Results The urinary catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8% (95% CI, 12.9%-14.8%) at end of year 2 (P < .001). The proportion of catheterized patients with appropriate indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of year 2 (P = .005). Conclusions A statewide effort to reduce inappropriate urinary catheter use was associated with a significant reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years.

Aspirin Therapy in Primary Prevention: To Use or Not to Use?: Comment on "Effect of Aspirin on Vascular and Nonvascular Outcomes" [Invited Commentary]

Supplemental Oxygen Therapy in Medical Emergencies: More Harm Than Benefit? [Research Letters]

Improving Use of the "Other" Catheter: An Important Opportunity to Reduce Hospital Infections: Comment on "Reducing Inappropriate Urinary Catheter Use" [Invited Commentary]

Importance of More Judicious Catheter Use: Comment on "Reducing Inappropriate Urinary Catheter Use" [Editor's Note]

Important Data After Drug Approval: Comment on "Dabigatran Association With Higher Risk of Acute Coronary Events" [Editor's Note]

Dabigatran: Do We Have Sufficient Data?: Comment on "Dabigatran Association With Higher Risk of Acute Coronary Events" [Invited Commentary]

Dabigatran Association With Higher Risk of Acute Coronary Events: Meta-analysis of Noninferiority Randomized Controlled Trials [Review Article]

Background The original RE-LY (Randomized Evaluation of Long-term Anticoagulant Therapy) trial suggested a small increased risk of myocardial infarction (MI) with the use of dabigatran etexilate vs warfarin in patients with atrial fibrillation. We systematically evaluated the risk of MI or acute coronary syndrome (ACS) with the use of dabigatran. Methods We searched PubMed, Scopus, and the Web of Science for randomized controlled trials of dabigatran that reported on MI or ACS as secondary outcomes. The fixed-effects Mantel-Haenszel (M-H) test was used to evaluate the effect of dabigatran on MI or ACS. We expressed the associations as odds ratios (ORs) and their 95% CIs. Results Seven trials were selected (N = 30 514), including 2 studies of stroke prophylaxis in atrial fibrillation, 1 in acute venous thromboembolism, 1 in ACS, and 3 of short-term prophylaxis of deep venous thrombosis. Control arms included warfarin, enoxaparin, or placebo administration. Dabigatran was significantly associated with a higher risk of MI or ACS than that seen with agents used in the control group (dabigatran, 237 of 20 000 [1.19%] vs control, 83 of 10 514 [0.79%]; ORM-H, 1.33; 95% CI, 1.03-1.71; P = .03). The risk of MI or ACS was similar when using revised RE-LY trial results (ORM-H, 1.27; 95% CI, 1.00-1.61; P = .05) or after exclusion of short-term trials (ORM-H, 1.33; 95% CI, 1.03-1.72; P = .03). Risks were not heterogeneous for all analyses (I2 = 0%; P ≥ .30) and were consistent using different methods and measures of association. Conclusions Dabigatran is associated with an increased risk of MI or ACS in a broad spectrum of patients when tested against different controls. Clinicians should consider the potential of these serious harmful cardiovascular effects with use of dabigatran.

Young-Onset Colorectal Cancer: Is It Time to Pay Attention? [Research Letters]

Maintaining Planned Readmissions [Editor's Note]

Planned Readmissions: A Potential Solution [Commentary]

About This Journal [About This Journal]

In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]

Reconsidering Transfer for Percutaneous Coronary Intervention Strategy: Time Is of the Essence [Editorial]

How Can We Know So Little About Physician Referrals? [Editorial]

Effect of Exercise Training on Depressive Symptoms Among Patients With a Chronic Illness: A Systematic Review and Meta-analysis of Randomized Controlled Trials [Review Article]

Background Physical inactivity and comorbid depressive symptoms are prevalent among patients with a chronic illness. To our knowledge, randomized controlled trials of the effects of exercise training on depressive symptoms among patients with a chronic illness have not been systematically reviewed. We estimated the population effect of exercise training on depressive symptoms and determined whether the effect varied according to patient characteristics and modifiable features of exercise exposure and clinical settings. Methods Articles published before June 1, 2011, were located using the Physical Activity Guidelines for Americans Scientific Database, Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Ninety articles involving 10 534 sedentary patients with a chronic illness were selected. Included articles required (1) randomized allocation to an exercise intervention or nonexercise comparison condition and (2) a depression outcome assessed at baseline and at mid- and/or postintervention. Hedges d effect sizes were computed, study quality was evaluated, and random effects models were used to estimate sampling error and population variance of the observed effects. Results Exercise training significantly reduced depressive symptoms by a heterogeneous mean effect size delta () of 0.30 (95% CI, 0.25-0.36). Larger antidepressant effects were obtained when (1) baseline depressive symptoms were higher, (2) patients met recommended physical activity levels, and (3) the trial primary outcome, predominantly function related, was significantly improved among patients having baseline depressive symptoms indicative of mild-to-moderate depression. Conclusions Exercise reduces depressive symptoms among patients with a chronic illness. Patients with depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves function-related outcomes achieve the largest antidepressant effects.

Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention [Original Investigation]

Background Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI). However, little is known regarding the factors associated with 30-day readmission after PCI. Methods To assess the demographic, clinical, and procedural factors associated with 30-day readmission rates after PCI, we identified 15 498 PCI hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 at Saint Marys Hospital, Rochester, Minnesota. All were included in this analysis. Multivariate logistic regression models were used to estimate the adjusted association between demographic, clinical, and procedural variables and 30-day readmission. The association between 30-day readmission and 1-year mortality was estimated using Cox proportional hazards models with readmission as a time-dependent covariate and by using landmark analysis. The main outcome measures were all-cause 30-day readmission to any hospital following PCI and 1-year mortality. Results Overall, 9.4% of PCIs (n = 1459) were readmitted, and 0.68% of PCIs (n = 106) resulted in death within 30 days after discharge. After multivariate analysis, female sex, Medicare insurance, having less than a high school education, unstable angina, cerebrovascular accident or transient ischemic attack, moderate to severe renal disease, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer, and a length of stay of more than 3 days were associated with an increased risk of 30-day readmission after PCI. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality (adjusted hazard ratio, 1.38; 95% CI, 1.08-1.75; P = .009). Conclusions Nearly 1 in 10 patients undergoing PCI were readmitted within 30 days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality.

Prediction Is Very Hard, Especially About the Future: Comment on "Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention" [Invited Commentary]

Towers of Cuzco's Cathedral--Peru [Images From Our Readers]

Nocturnal Leg Cramps and Prescription Use That Precedes Them: A Sequence Symmetry Analysis [Original Investigation]

Background The use of diuretics, statins, and inhaled long-acting β2-agonists (LABAs) is linked to muscle cramps but largely by anecdotal evidence. This study sought population-level data to better evaluate these associations. Methods Linked health care databases containing prescribing information (December 1, 2000, to November 30, 2008) about 4.2 million residents of British Columbia, Canada, were evaluated using sequence symmetry analysis to determine in adults 50 years or older whether new quinine prescriptions (initiations of cramp treatment) increase in the year following diuretic, statin, or LABA starts. The statistic of interest was the sequence ratio: the number of quinine starts in the year following index drug introduction compared with the number of quinine starts in the preceding year (adjusted for age and time trends in population prescribing). Results Adjusted sequence ratios (95% CIs) for the 3 drug classes were 1.47 (1.33-1.63 [P < .001]) for diuretics, 1.16 (1.04-1.29 [P = .004]) for statins, and 2.42 (2.02-2.89 [P < .001]) for LABAs. For diuretic subclasses, adjusted sequence ratios (95% CIs) were 2.12 (1.61-2.78 [P < .001]) for potassium sparing, 1.48 (1.29-1.68 [P < .001]) for thiazidelike, and 1.20 (1.00-1.44 [P = .07]) for loop. For LABA subclasses, adjusted sequence ratios (95% CIs) were 2.17 (1.56-3.02) for LABAs alone and 2.55 (2.06-3.12) for LABAs-corticosteroids (P < .001 for both). Conclusions Cramp treatment was substantially more likely in the year following introduction of LABAs, potassium-sparing diuretics, or thiazidelike diuretics, and 60.3% of quinine users (individuals experiencing cramp) received at least 1 of these medications during a 13-year period. In contrast, statin and loop diuretic associations were small. Physicians should be mindful that the use of these medications may worsen symptoms in patients experiencing nocturnal leg cramps.

Tests and Expenditures in the Initial Evaluation of Peripheral Neuropathy [Original Investigation]

Background Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing. Methods We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims–linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods. Results Of the 12 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14 362 vs $8067, P < .001). Conclusions Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.

Diagnosis of Neuropathy: Comment on "Tests and Expenditures in the Initial Evaluation of Peripheral Neuropathy" [Invited Commentary]

Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections: A Multicenter, Randomized Controlled Trial [Original Investigation]

Background Studies have shown that radiologic imaging does not improve outcomes in most patients with back pain, though guidelines endorse it before epidural steroid injections (ESIs). The objective of this study was to determine whether magnetic resonance imaging (MRI) improves outcomes or affects decision making in patients with lumbosacral radiculopathy referred for ESI. Methods In this multicenter randomized study, the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on treatment after reviewing the MRI findings. In group 1 subjects, an independent physician proposed a treatment plan after reviewing the MRI, which was compared with the treatment the patient received. Results Slightly lower leg pain scores were noted in the group 2 at 1 month compared with MRI-blinded patients in group 1 (mean scores, 3.6 vs 4.4) (P = .12). No differences were observed in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4% at 3 months in group 1 vs 40.7% in group 2). Among subjects in group 1 who received a different injection than that proposed by the independent physician, scores for both leg pain (4.8 vs 2.4) (P = .01) and function (38.7 vs 28.2) (P = .04) were inferior to patients whose injection correlated with imaging. Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an ESI after the MRI was reviewed. Conclusion Magnetic resonance imaging does not improve outcomes in patients who are clinical candidates for ESI and has only a minor effect on decision making. Trial Registration clinicaltrials.gov Identifier: NCT00826124

Imaging and Uncertainty in the Use of Lumbar Epidural Steroid Injections: Comment on "Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections" [Invited Commentary]

Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative [Original Investigation]

Background This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's Health Initiative (WHI). Methods The WHI recruited 161 808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up. The current analysis includes data through 2005. Statin use was captured at enrollment and year 3. Incident DM status was determined annually from enrollment. Cox proportional hazards models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other potential confounding factors. Subgroup analyses by race/ethnicity, obesity status, and age group were conducted to uncover effect modification. Results This investigation included 153 840 women without DM and no missing data at baseline. At baseline, 7.04% reported taking statin medication. There were 10 242 incident cases of self-reported DM over 1 004 466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). This association remained after adjusting for other potential confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin medications. Subset analyses evaluating the association of self-reported DM with longitudinal measures of statin use in 125 575 women confirmed these findings. Conclusions Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.

Increased Diabetes Mellitus Risk With Statin Use: Comment on "Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative" [Editor's Note]

Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism [Original Investigation]

Background Sudden exposure to high iodide levels may cause thyroid dysfunction. Despite compelling biological plausibility and clinical implication, the association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism has not been rigorously studied. Methods We performed a nested case-control study of patients treated between January 1, 1990, and June 30, 2010, who did not have preexisting hyperthyroidism or hypothyroidism. In parallel analyses, incident hyperthyroid or hypothyroid cases were defined by a change in thyrotropin level from normal (at baseline) to low or high (follow-up measurement). Euthyroid controls were selected using an incidence density sampling approach and were matched to cases on the basis of age, sex, race/ethnicity, estimated glomerular filtration rate, follow-up thyrotropin measurement date, and interval between baseline and the follow-up thyrotropin measurement date. Iodinated contrast media exposure was assessed using claims data for contrast-enhanced computed tomography or cardiac catheterization. Results In total, 178 and 213 incident hyperthyroid and hypothyroid cases, respectively, were matched to 655 and 779 euthyroid controls, respectively. Iodinated contrast media exposure was associated with incident hyperthyroidism (odds ratio [OR], 1.98; 95% CI, 1.08-3.60), but a statistically significant association with incident hypothyroidism was not observed (OR, 1.58; 95% CI, 0.95-2.62). In prespecified secondary analysis, iodinated contrast media exposure was associated with incident overt hyperthyroidism (follow-up thyrotropin level ≤0.1 mIU/L; OR, 2.50; 95% CI, 1.06-5.93) and with incident overt hypothyroidism (follow-up thyrotropin level >10 mIU/L; OR, 3.05; 95% CI, 1.07-8.72). Conclusion Iodinated contrast media exposure is associated with subsequent development of incident hyperthyroidism and incident overt hypothyroidism.

Iodine-Induced Thyroid Dysfunction: Comment on "Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism" [Invited Commentary]

Another Reason to Be Cautious About Imaging: Comment on "Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism" [Editor's Note]

Trends in Physician Referrals in the United States, 1999-2009 [Original Investigation]

Background Physician referrals play a central role in ambulatory care in the United States; however, little is known about national trends in physician referrals over time. The objective of this study was to assess changes in the annual rate of referrals to other physicians from physician office visits in the United States from 1999 to 2009. Methods We analyzed nationally representative cross-sections of ambulatory patient visits in the United States, using a sample of 845 243 visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2009, focusing on the decade from 1999 to 2009. The main outcome measures were survey-weighted estimates of the total number and percentage of visits resulting in a referral to another physician across several patient and physician characteristics. Results From 1999 to 2009, the probability that an ambulatory visit to a physician resulted in a referral to another physician increased from 4.8% to 9.3% (P < .001), a 94% increase. The absolute number of visits resulting in a physician referral increased 159% nationally during this time, from 41 million to 105 million. This trend was consistent across all subgroups examined, except for slower growth among physicians with ownership stakes in their practice (P = .02) or those with the majority of income from managed care contracts (P = .007). Changes in referral rates varied according to the principal symptoms accounting for patients' visits, with significant increases noted for visits to primary care physicians from patients with cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms. Conclusions The percentage and absolute number of ambulatory visits resulting in a referral in the United States grew substantially from 1999 to 2009. More research is necessary to understand the contribution of rising referral rates to costs of care.

Yellow-crowned night heron--Galapagos Islands [Images From Our Readers]

Overuse of Health Care Services in the United States: An Understudied Problem [Special Article]

Background Overuse, the provision of health care services for which harms outweigh benefits, represents poor quality and contributes to high costs. A better understanding of overuse in US health care could inform efforts to reduce inappropriate care. We performed an extensive search for studies of overuse of therapeutic procedures, diagnostic tests, and medications in the United States and describe the state of the literature. Methods We searched MEDLINE (1978-2009) for studies measuring US rates of overuse of procedures, tests, and medications, augmented by author tracking, reference tracking, and expert consultation. Four reviewers screened titles; 2 reviewers screened abstracts and full articles and extracted data including overuse rate, type of service, clinical area, and publication year. Results We identified 172 articles measuring overuse: 53 concerned therapeutic procedures; 38, diagnostic tests; and 81, medications. Eighteen unique therapeutic procedures and 24 diagnostic services were evaluated, including 10 preventive diagnostic services. The most commonly studied services were antibiotics for upper respiratory tract infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). Overuse of carotid endarterectomy and antibiotics for upper respiratory tract infections declined over time. Conclusions The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research.

Overuse of Health Care: Where Are the Data? [Editor's Note]

Severe High-Density Lipoprotein Deficiency Associated With Autoantibodies Against Lecithin:Cholesterol Acyltransferase in Non-Hodgkin Lymphoma [Clinical Observation]

An antibody against the lecithin:cholesterol acyltransferase (LCAT) enzyme, which negates cholesterol esterification in plasma, causing severe high-density lipoprotein deficiency (HD), was identified in a woman with a large-cell non-Hodgkin lymphoma. Successful treatment of the lymphoma resulted in clearance of the antibody and complete correction of the defective cholesterol esterification and HD. To our knowledge, an acquired LCAT deficiency leading to severe HD has not been reported previously in association with a malignant disease, and this patient represents the first such documented case.

Strategies for Reducing Colorectal Cancer Among Blacks [Commentary]

Elmo's Story [Commentary]

Effects of Black Tea on Blood Pressure: A Randomized Controlled Trial [Research Letters]

Validation of 7 Type 2 Diabetes Mellitus Risk Scores in a Population-Based Cohort: CoLaus Study [Research Letters]

Frequent Fracture of TrapEase Inferior Vena Cava Filters: A Long-term Follow-up Assessment [Research Letters]

Fecal Transplant via Retention Enema for Refractory or Recurrent Clostridium difficile Infection [Research Letters]

Improvement in Revascularization Time After Creation of a Coronary Catheterization Laboratory at a Public Hospital [Research Letters]

The Clinical Utility of Prognostic Indices: The Proof of the Pudding Is in the Eating [Editor's Correspondence]

The Clinical Utility of Prognostic Indices: The Proof of the Pudding Is in the Eating--Reply [Editor's Correspondence]

Supermarkets: Components of Causality for Healthy Diets [Editor's Correspondence]

Supermarkets: Components of Causality for Healthy Diets--Reply [Editor's Correspondence]

What Is Professionalism? [Editor's Correspondence]

What Is Professionalism?--Reply [Editor's Correspondence]

Do Procalcitonin Algorithms Modify Mortality? [Editor's Correspondence]

Do Procalcitonin Algorithms Modify Mortality?--Reply [Editor's Correspondence]

Breastfeeding and allergies: time for a change in paradigm?.

Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R

New aspects in allergic contact dermatitis.

Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

How to break the vicious circle of antibiotic resistances?.

Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude

Benefits of high-protein weight loss diets: enough evidence for practice?.

Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b

Chronic pancreatitis.

Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Page: 577DOI: 10.1097/MCI.0b013e32831dae94Authors: Alberio, Lorenzo

Long-term prognosis after deep venous thrombosis.

Page: 586DOI: 10.1097/MCI.0b013e32831daea9Authors: Shbaklo, Hadia a; Kahn, Susan R a,b

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Page: 591DOI: 10.1097/MCI.0b013e32831daed2Authors: DuPont, Herbert L a,b,c; Garey, Kevin b,c,d; Caeiro, Juan-Pablo b,c; Jiang, Zhi-Dong a

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Page: 599DOI: 10.1097/MCI.0b013e32831daeffAuthors: Ryan, Michael J a; Tuttle, Katherine R a,b

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Page: 606DOI: 10.1097/MCI.0b013e32831daf11Authors: Gaddam, Krishna K; Oparil, Suzanne

Diabetic polyneuropathy: an update.

Page: 613DOI: 10.1097/MCI.0b013e32831dae0bAuthors: Zochodne, Douglas W

Drug-induced myopathies.

Page: 620DOI: 10.1097/MCI.0b013e32831dae1cAuthors: Klopstock, Thomas

Evolving epidemiology of malignancies in HIV.

Page: 626DOI: 10.1097/MCI.0b013e32831dae71Authors: Bonnet, Fabrice a,b,c; Chene, Genevieve a,b

Vaccines against cervical cancer.

Page: 633DOI: 10.1097/MCI.0b013e32831dae88Authors: Rogers, Linda J; Eva, Lois J; Luesley, David Michael

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Page: 638DOI: 10.1097/MCI.0b013e32831dad76Authors: Zamanian, Roham T a,b; Gould, Michael K a,c

Update on biologics in juvenile idiopathic arthritis.

Page: 643DOI: 10.1097/MCI.0b013e32831dae32Authors: Ilowite, Norman T

Internal Medicine jobs

All Internal Medicine jobs for Mon Feb 6 2012

Internal Medicine jobs in "Blue Ridge" - VA

101213-1473 Internal Medicine/Outpatient Only! - Virginia (Blue Ridge Mountain foothills - 50 Miles from Washington, DC) VA Fabulous opportunity for BC/BE internist with well-established group of

Internal Medicine jobs in "Live in One of America's Top Rated Mid-Sized Metros and Enjoy the Lifestyle Northern Colorado Has to Offer" - CO

JOB DETAILS Board Certified Or Board Eligible Internal Medicine Physician Sought For A Practice Opportunity In Our Northern Colorado Mid-Sized Metro This Position Offers A Strong Starting Salary

Internal Medicine jobs in "Internist for Outpatient Practice - Great Smoky Mountains Community near Asheville, NC" - NC

111210-1797 Internist for Outpatient Practice - Great Smoky Mountains Community near Asheville, NC NC Seeking BC/BE internal medicine physician for hospital employed opportunity All outpatient (schedule

Internal Medicine jobs in "Metro Philadelphia! All outpatient! This will fill quick - please call if interested." - PA

JOB DETAILS Well Established Practice Needs Someone For Patient Evaluations And Consults Incoming Physician Must Be Experienced With Trigger Point Injections Employed, Monday Through Friday Position

Internal Medicine jobs in "Federal Government All Outpatient Internal Medicine position outside Louisiana metro." - LA

JOB DETAILS Work As An Independent Contractor For The Federal Government Monday Through Friday, All Outpatient Position Job Security And Guaranteed Income. $170,000 Annual Salary COMMUNITY

Internal Medicine jobs in "$350K Earning Potential, Loan Repayment and $20K Signing Bonus near Gulf Coast Beach" - AL

JOB DETAILS Join 6 Family Physician, 2 ObGyns, 2 Pediatricians And A Cardiologist In A Successful Multi-Specialty Group Situated Near The Beaches Of The Gulf Coast $180,000 Income Guarantee Production

Internal Medicine jobs in "Long Beach" - CA

Internal Medicine need in Orange County, A few minutes to the famous Queen Mary, or the Fantastic Orange county Beaches, Live the California

Internal Medicine jobs in "New York" - NY

JOB DETAILS Spanish Speaking Internist Needed In An Office Based Practice. Nearly 50% Of The Patient Population Is Hispanic. Employed Position. Base Salary Provided By The Hospital, Quarterly

Internal Medicine jobs in "Great Gulf Coast community with immediate access to metro. 175K to start" - AL

JOB DETAILS Monday Through Friday All Outpatient Position. 175K Base Salary With Production Incentives. First Year Earnings Of Over 220K Possible For Hard-worker Clinic Located In Great Neighborhood

Internal Medicine jobs in "Eastern" - KY

110715-1613 Internal Medicine (Mostly Outpatient) - Eastern Kentucky & Southern Ohio KY Seeking BC/BE internal medicine physicians for family care centers American medical school training required

Internal Medicine jobs in "$300,000 Earning Potential with Partnership from Day 1 with No Buy In!" - WV

JOB DETAILS $190,000 Annual Salary Production Incentive Earning Potential Of $300,000 Office Hours Of Monday Through Friday 8:00 AM To 5:00 Exceptionally Comprehensive Benefits Package Signing

Internal Medicine jobs in "San Bernardino" - CA

Internist need located in Palm Springs ; home of the Bob Hope & Dina Shore Golf Classic, Five Star resorts, extensive fine dining, top

Internal Medicine jobs in "Outpatient Opening in Birmingham, Alabama. $350,000 Earning Potential" - AL

JOB DETAILS Outpatient Work! $190,000 Salary Or Income Guarantee Production Incentive Earning Potential Of $350,000 Call, 1:5 Schedule Well Established Physician Team Of 6 Employee W/ Partnership

Internal Medicine jobs in "All Outpatient Job in One of Washington's Fastest Growing Communities" - WA

JOB DETAILS Starting Salary In The $175,000-$180,000 Range The Incoming Physician Can Expect To See 21-28 Patients Per Day We Offer A Competitive Benefits Package, Including Medical, Dental ,

Internal Medicine jobs in "Sacramento" - CA

Internal Medicine for a Bay Area Commuter Community only 30 minutes to the East Bay , less than to hour to Sacramento, this pleasant

Internal Medicine jobs in "$190K Starting Salary + Sign On Bonus Near MAJOR METRO Amenities!!" - NY

JOB DETAILS $190,000 Annual Salary Production Incentive Top Earning Potential! Signing Bonus Strong Benefits Package To Be Included Employee COMMUNITY INFO Excellent Water Recreation

Internal Medicine jobs in "San Diego" - CA

Oceanside A North San Diego County Beach City, famous for its spectacular beaches, historic Pier, and the home of Camp

Internal Medicine jobs in "Internal Medicine For Womens Health/Outpatient Only - South Dakota" - SD

110118-1514 Internal Medicine For Womens Health/Outpatient Only - South Dakota SD Seeking BC/BE internist with interest in womens health or has fellowship Women's health plaza is bringing a synergy

Internal Medicine jobs in "Join Respected, Established Practice an Hour & a Half to Dallas!" - OK

JOB DETAILS Well Established Group Of Physicians Office Is A Few Blocks From Hospital & Includes Modern Lab & EMR Equipped In-House Billing & Only 50% Overhead Signing Bonus Call, 1:5 Schedule

Internal Medicine jobs in "North" - SC

JOB DETAILS Busy Three Member Group Needs To Add A Fourth Physician Traditional Internal Medicine Position With Hospitalist For Weekend Coverage Three Mid-levels For Additional Support Take Advantage

Internal Medicine jobs in "$250K+ Earnings With 4 Day Work Week Near Metro Amenities!!" - ID

JOB DETAILS Production Incentive Earning Potential Of $250,000 Call, Minimal Schedule Strong Benefits Structure 4 Day Work Week Average 15 Patients/Day Established Physician Group Optional

Internal Medicine jobs in "Internal Medicine/ 30 Minutes to the Coast - North Carolina" - NC

111215-1825 Internal Medicine/ 30 Minutes to the Coast - North Carolina NC Seeking a BC/BE Internal Medicine physician for a solo, outpatient clinic. Schedule is M-F, 8 am5 pm Affiliated with 114-bed

Internal Medicine jobs in "Northeastern Iowa. $255,000 Earnings with Loan Forgiveness" - IA

JOB DETAILS Board Certified Or Board Eligible Internal Medicine Physician Needed For A Practice Opportunity Near The Wisconsin Border The Starting Salary For This Opportunity Is $200,000 Plus RVU-Based

Internal Medicine jobs in "Cleveland" - OH

JOB DETAILS Board Certified Or Board Eligible Family Physician Sought To Join A Successful Group Of Two Primary Care Physicians This Partnership Track Opportunity Offers A Strong Starting Salary

Internal Medicine jobs in "New York-Newark-Bridgeport Metropolitan Statistical Area" - NY

JOB DETAILS Short Partnership Track With Full Partners Earning In The MGMA 90th Percentile Production Incentive Full Benefits Package With Malpractice, Full Family Medical Insurance, Flex Spending

Internal Medicine jobs in "San Diego" - CA

North San Diego County Beach Cities, Oceanside, Carlsbad and Vista, famous for its spectacular beaches, historic Pier, and Camp Pendleton, live the ultimate California Coastal lifestyle, World

Internal Medicine jobs in "Internal Medicine Jobs near Cape Girardeu, Missouri" - MO

JOB DETAILS Strong Starting Salary Production Incentive Earning Potential Of $300,000 Signing Bonus Choose Solo, Employed Or Established Multi-Specialty Group All Outpatient Option Available

Internal Medicine jobs in "Quad Cities Area Internal Medicine Job Opportunity" - IL

JOB DETAILS Board Certified Or Board Eligible Internal Medicine Physician Need For A Practice Opportunity In The Quad Cities Area This Position Offers A Strong Starting Salary Based On MGMA With

Internal Medicine jobs in "Internal Medicine/Outpatient Only - North Carolina" - NC

110826-1678 Internal Medicine/Outpatient Only - North Carolina NC Seeking BC/BE internist to join 7 members in very established multi-specialty group Group has 40 providers encompassing 10 physician

Internal Medicine jobs in "Central Coast Wine Country near San Luis Obispo" - CA

Internal Medicine for the Central California Coast , this rural community is renowned for its Horse Ranches, World Class Wine

Internal Medicine jobs in "San Luis Obispo on the Central California Coast" - CA

San Luis Obispo the Jewel of the Central Coast , located on the Beautiful Central California Coast between Los Angeles and San Francisco, known

Internal Medicine jobs in "Internal Medicine/Outpatient Only - Dayton, OH" - OH

110825-1674 Internal Medicine/Outpatient Only - Dayton, OH OH Seeking BC/BE internist for private group of 4 members Strictly outpatient Affiliated with 368-bed facility Competitive compensation

Internal Medicine jobs in "Cedar Rapids, Iowa Internal Medicine Position" - IA

JOB DETAILS We Are Actively Seeking An Internal Medicine Physician For Our Cedar Rapids Based Practice This Opportunity Provides An MGMA Based Salary Guarantee Of $190,000 Plus Productivity Incentives

Internal Medicine jobs in "$240,000 Income Guarantee in Fayetteville, NC" - NC

JOB DETAILS $240,000 Income Guarantee Earning Potential Of $300,000 Call, 1:3 Schedule Average 18-22 Patients/Day Join Well Established Physician Team Excellent Benefits Included! Employee

Internal Medicine jobs in "Internal Medicine/All Outpatient - Minnesota" - MN

101109-1418 Internal Medicine/All Outpatient - Minnesota MN Seeking BC/BE internist to join multi-specialty group Any sub-specialty training or interests beneficial 4 - 4 1/2 day work week Full

Internal Medicine jobs in "Louisville" - KY

JOB DETAILS Our Practice Is In Need Of An Additional Internal Medicine Physician To Meet The Increase In Demand For Services Earn A Base Salary Of $200,000 Plus RVU Based Production Incentives

Internal Medicine jobs in "Internal Medicine/Outpatient Only - Ohio" - OH

110825-1670 Internal Medicine/Outpatient Only - Ohio OH Seeking BC/BE internist to join hospital owned primary care network H1B visa applicants welcome Offices located throughout metro area

Internal Medicine jobs in "Nashville" - TN

JOB DETAILS $190,000 Income Guarantee Production Incentive Earning Potential Of $250,000 Equal Partnership Option With No Buy In $25,000 Signing Bonus Call, Greater Than 1:7 Schedule COMMUNITY

Internal Medicine jobs in "Suburban Pittsburgh, Pennsylvania" - PA

JOB DETAILS We Are Actively Seeking A Board Certified Or Board Eligible Internal Medicine Physician For A Practice Opportunity Located In Suburban Pittsburgh This Position Provides A Very Competitive

Internal Medicine jobs in "Internal Medicine - South Dakota" - SD

110118-1515 Internal Medicine - South Dakota SD Seeking BC/BE internist to join group of physicians and mid-level providers Typical patient load would be 20-25 patients per day depending on how

Internal Medicine jobs in "Easy Access to Denver, Colorado" - CO

JOB DETAILS Immediate Need For A Board Certified Or Board Eligible Internal Medicine Physician This Employed Position Offers A Salary Of $180,000 Along With RVU Based Production Incentives The

Internal Medicine jobs in Pennsylvania

All Internal Medicine jobs in Pennsylvania for Mon Feb 6 2012

Internal Medicine jobs in "Internal Medicine â€“ Minnesota" - MN

110813-1659 Internal Medicine Minnesota MN Seeking BC/BE internist to join multi-specialty group Employed position with highly regarded, well-known healthcare system Department consists of internists

Internal Medicine jobs in "Internal Medicine - Dayton, OH" - OH

111215-1830 Internal Medicine - Dayton, OH OH Seeking BC/BE internist for well established private group of 4 members Partner track opportunity Practice includes 4 Internists, 2 mid-level providers

Internal Medicine jobs in "Internal Medicine - Dayton, OH" - OH

111213-1820 Internal Medicine - Dayton, OH OH Seeking BC/BE Internal Medicine physician to join 4 member group that is getting busier This is a traditional practice model and is offering an income

Internal Medicine jobs in "Internal Medicine - Minnesota" - MN

101109-1428 Internal Medicine - Minnesota MN Seeking BC/BE internist for multi-specialty group Caseload includes inpatient vent/resp care, ICCU, and outpatient clinic coverage Any specialty training

Internal Medicine jobs in "Internal Medicine - Minnesota" - MN

101022-1376 Internal Medicine - Minnesota MN Seeking BC/BE internist for multi-specialty group Practice medicine with a team of 5 family practice physicians Teaching opportunities available

Internal Medicine jobs in "Internal Medicine - Indiana" - IN

110726-1618 Internal Medicine - Indiana IN Excellent opportunity exists for BE/BC internist to practice as hospital employee or in multi-specialty group No visa sponsorship available Will accept

Internal Medicine jobs in "Internal Medicine - Iowa" - IA

110812-1649 Internal Medicine - Iowa IA Seeking BC/BE internist to join 17-member multi-specialty group Affiliated with highly regarded, well-known health system Group includes 7 family medicine

Internal Medicine jobs in "Metropolitan Georgia" - GA

JOB DETAILS Group Of 8 Internal Medicine Physicians Seeking An Additional Colleague Due To An Increase In Demand In The Community This Opportunity Provides Terrific Earning Potential Full Benefits

Internal Medicine jobs in "Inquire for details" - SC

Great Internal Medicine opportunity in South Carolina *17 weeks paid time off per year *Desirable 3 1/2 day work schedule/Full time compensation *Call 1:5 For more details please contact Boyd Waters at

Internal Medicine jobs in "Inquire for details" - OR

Affiliated with Coquille Valley Hospital, a progressive, growth-oriented, full service, 25-bed, critical access, community hospital, this well-established, highly successful practice, with ample room

Internal Medicine jobs in "Inquire for details" - OR

Candidates needed for 2 retiring Internal Medicine Physicians. Candidate needs to be BC/BE. J-1/H1B visa candidates may apply. Employment options available: hospital employment, employment with future

Internal Medicine jobs in "Great Location" - TX

Great opportunity in DFW! Client needs Internist 3/12-3/16. BC preferred, will work M-F 8-5 with call, seeing around 8-12 patients. Onyx MD is physician owned and operated...we understand physicians.

Internal Medicine jobs in "Great Location" - TX

Client needs Internal Medicine physician ASAP for ongoing coverage in TX. BC/BE within 5 years of residency, outpatient coverage. Will work 3 days a week, days cannot be consecutive, no call. Onyx

Internal Medicine jobs in "Great Location" - MN

Locums to Permanent Board Certified Internal Medicine physician needed in beautiful MN in a state of the art facility! Prefers active MN license. Clinic/outpatient coverage; M-F; 8a-5p with no call.

Internal Medicine jobs in "Great Location" - CA

Locums Internal Medicine physician needed in Central CA for clinic and call work. About 20 patients per day in clinic and very light call. Wonderful location with loads to do. Onyx MD is physician

Internal Medicine jobs in "Great Location" - MI

Client needs Traditional IM in MI starting 3/1 for ongoing coverage. M-F 8-5, will see around 20-25 patients per day and do inpatient rounding if needed in hospital. Light call, one week a month.

Internal Medicine jobs in "Great Location" - MI

Client in MI needs Internal Medicine Physician ASAP for ongoing coverage. Traditional IM position, will work in clinic and round on patients in the hospital. BC preferred, will see around 15-20 patients

Internal Medicine jobs in "Not Disclosed" - NC

A Health System in Northeastern North Carolina is seeking permanent candidates for an Internal Medicine physician's office. The candidates can be Board Eligible or Board Certified for this strictly outpatient

Internal Medicine jobs in "Not Disclosed" - MT

A group in north central Montana is seeking a Board Certified or Board Eligible Internal Medicine physician. Enjoy a lucrative compensation package with a 2 year income guarantee of $180-200k followed

Internal Medicine jobs in "Myrtle Beach" - SC

INTERNIST -PARTENERSHIP TRACK- MYRTLE BEACH, SC - COASTAL METRO, GREAT LOCTION AND OPPORTUNITY- Golfer paradise. Join a busy traditional Internal Medicine Group, Office is open M-F 7 am to 5 pm. It

Internal Medicine jobs in "Myrtle Beach" - SC

INTERNIST -PARTENERSHIP TRACK- MYRTLE BEACH, SC - COASTAL METRO, GREAT LOCTION AND OPPORTUNITY- Golfer paradise. Join a busy traditional Internal Medicine Group, Office is open M-F 7 am to 5 pm. It

Internal Medicine jobs in "Northwestern" - PA

I have an Internal Medicine position available in northwestern Pennsylvania. Based on office or hospital averages, patient load is approximately 20-25 per day, with approximately 36 hours per week in

Internal Medicine jobs in "Boston subs" - MA

INTERNAL MEDICINE – Massachusetts - Physician needed - South East Massachusetts - Very High Earning Potential! Premier medical group 30 minutes to Boston. Member of

Internal Medicine jobs in "NorthWest" - AR

Internist needed to join an established busy practice. Excellent incentive plan, Vacation, CME, Possible sign on/commencement bonus, Relocation assistance, Medical education loan assistance available

Internal Medicine jobs in "New Haven" - CT

Internal Medicine - Southwest Connecticut - Outpatient Primary Care – 2 Year Salary Guarantee! Brand new office to open June 2012. Shared call 1:7. Weekend call 1:8 (inpatient) See approx.

Internal Medicine jobs in "Savannah" - GA

INTERNIST - GROUP PRACTICE - PARTNERSHIP TRACK - GREAT COASTAL METRO LOCATION - Savannah is the largest coastal metro in GA. Known for outstanding Medical Services and Hospitals. Excellent Quality of

Internal Medicine jobs in "Northern" - ME

Facility in Northern Maine is recruiting for a Family Practice Physician. 9 Internists (including 3 Hospitalists) and 3 Family Practitioners on staff. Obstetrical services one day per week. Hospitalists

Internal Medicine jobs in "Northern" - OK

Hospital-sponsored solo practice. Flexible call sharing, income guarantee. Signing bonus.The Medical Center consists of 245 licensed beds and offers a full complement of outpatient services. Areas of

Internal Medicine jobs in "Western" - NJ

Four person group recruiting a new member. Very busy practice (40 patients per doctor combined hospital/office). Call is 1:9 (shares call with another group). The medical staff includes more than 120