Internal_Medicine RSS : Gourt

30 minutes south of Boston :: Massachusetts :: New England Physician Recruitment Center

Needed to join well-established multispecialty group practice of 40+ physicians, 30 minutes south of Boston. Position is full-time office-based practice. Affiliated with several large multispecialty groups

Waterbury and Thomaston :: Connecticut :: New England Physician Recruitment Center

Medicine Associates with locations in Waterbury and Thomaston, Connecticut seeks BC/BE internist or internist/endocrinologist to join busy six-physician practice with focus on outpatient care. The practice

20 miles west of Boston :: Massachusetts :: New England Physician Recruitment Center

BC/BE Internist sought by well-established Primary Care group located 20 miles west of Boston. Collegial atmosphere, suburban environment. Shared call 1:15. Guaranteed salary leading to stockholdership

Burlington and Peabody :: Massachusetts :: New England Physician Recruitment Center

Discover opportunities in General Internal Medicine. Medical Centers in Burlington and Peabody- in addition Community Medicine with locations throughout eastern Massachusetts- are all just a short

Mid-coastal region :: Maine :: New England Physician Recruitment Center

BEAUTIFUL COAST OF MAINE - BC/BE FAMILY PRACTICE/INTERNIST: Multi-specialty community hospital in mid-coast region seeks full-time physician. Safe, smog-free and rapidly growing city with excellent schools

Southern Coastal :: Maine :: New England Physician Recruitment Center

Internal medicine- IM - . Join a large MSG of over 40 physicians adding IM to group practice. The group offers primary care as well as a variety of specialties. The offices are located in Southern

Torrington Area :: Connecticut :: New England Physician Recruitment Center

-Internal Medicine--Internal Medicine -CT.. Four (4) full-time opportunities are available within existing practices in CT . These include multiple-provider practices located in the communities of

Great Community :: Vermont :: New England Physician Recruitment Center

Internal Medicine Vermont-GROUP PRACTICE / L VT / MEDICAL CENTER Description: Vermont 's second largest health care facility. beds and more than 120 physicians trained in 35 specialty areas. Providing

Hartford area :: Connecticut :: New England Physician Recruitment Center

Primary Care Practice Opportunities. seeking BC/BE Internal Medicine, Family Practice and Pediatric physicians to fill several practice opportunities in the greater Hartford area. We are accepting CVs

South Eastern :: Massachusetts :: New England Physician Recruitment Center

Trad.IM practice-SE MA-close to Providence-Expanding MSG seeking traditional IM's for the Wareham region. Can join a existing group or establish solo office. Call 1:4 or better. A hospitalist program

Wayne County :: New York :: New England Physician Recruitment Center

Internal medicine-NY-Join a multispecialty group consisting of 11 IM's, 11 peds, 3 ob/gyn's, 1 nurse midwife, 4 PA's, 2 NP's. They have 5 office sites and had 114,640 patient visits last year. Formal

South West :: Connecticut :: New England Physician Recruitment Center

-Internal Medicine -Internal Medicine-SW CT region- very busy offices (located 2 1/2 miles apart): Bridgeport and Trumbull, CT. Looking to add one full time Internal Medicine physician and one ID /

Providence :: Rhode Island :: New England Physician Recruitment Center

-Rhode Island-Outside of Providence----group practice--Providence RI region..Internal Medicine--Join 1 other physician, 2 PA as well as 9 other office staff including 3 medical assistants. The practice

Western :: Massachusetts :: New England Physician Recruitment Center

Western MA on the NY border-BC/BE Internal Medicine physicians needed for hospital-based and private practice opportunities in western Massachusetts. Unique opportunity to practice in a four-season resort

Central :: Massachusetts :: New England Physician Recruitment Center

Central MA region close to Springfield, For BC/BE physicians to work at Hospital and Medical Centers , part of UMass Memorial Health Care. Nestled in the Pioneer Valley, is adding a brand new 58,000

Coastal :: Maine :: New England Physician Recruitment Center

BEAUTIFUL COASTAL MAINE: Full-time physician to join an internal medicine group . about 30 minutes north of Portland). Group is a four-physician practice looking to add a fifth physician due to growth.

Coastal :: New Hampshire :: New England Physician Recruitment Center

Internal medicine .-Internal Medicine-Coastal NH.. Seacoast of New Hampshire adding total outpatient and 2 traditional IMs. Outpatient practice uses 24/7 hospitalist group. Located 5 minutes from

Coastal :: Maine :: New England Physician Recruitment Center

Internal medicine .Coastal Maine - Central region.Group adding on the coast one of the top living areas in Maine This is a 45-bed, acute care, not for profit community hospital located in one of the

Central :: New Hampshire :: New England Physician Recruitment Center

Internal medicine. Central NH (in ski country close to maine border) Join a group of providers: 4 primary care, 4 urgent care, 2 peds, 2 part time gyn, 1 mental health counselor, 1 acupuncturist, 1 pedi

Boston :: New Hampshire :: New England Physician Recruitment Center

Private IM practice looking for BE/BC Internist. Well-established nine-member group in thriving southern NH community. Great location just one hour from Boston, the coast, or the mountains. Generous salary

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

In the clinic. Influenza.

In the clinic. Influenza. Ann Intern Med. 2009 Nov 3;151(9):ICT5-1-ICT5-15; quiz ICT5-16 Authors: Hessen MT PMID: 19894285 [PubMed - in process]

About This Journal [About This Journal]

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

Adverse Events in Randomized Trials: Neglected, Restricted, Distorted, and Silenced [Editorial]

Women's Cardiovascular Health: Prevention Is Key [Editorial]

Nondaily and Social Smoking: An Increasingly Prevalent Pattern [Commentary]

Going Off-label Without Venturing Off-Course: Evidence and Ethical Off-label Prescribing [Commentary]

The Potency of Team-Based Care Interventions for Hypertension: A Meta-analysis [Review Article]

Background Team-based care is the strategy that has had the greatest effect on improving blood pressure (BP). The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists. Methods A MEDLINE search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by 2 reviewers who independently abstracted data and classified the different intervention components. Results Thirty-seven articles met the inclusion criteria. Education about BP medications was significantly associated with a reduction in mean BP (–8.75/–3.60 mm Hg). Other strategies that had large effect sizes on SBP include pharmacist treatment recommendations (–9.30 mm Hg), intervention by nurses (–4.80 mm Hg), and use of a treatment algorithm (–4.00 mm Hg). The odds ratios (95% confidence intervals) for controlled BP were: nurses, 1.69 (1.48-1.93); pharmacists within primary care clinics, 2.17 (1.75-2.68); and community pharmacists, 2.89 (1.83-4.55). Mean (SD) reductions in SBP were: nursing studies, 5.84 (8.05) mm Hg; pharmacists in clinics, 7.76 (7.81) mm Hg; and community pharmacists, 9.31 (5.00) mm Hg. There were no significant differences between the nursing and pharmacy studies (P ≥ .19). Conclusions Team-based care was associated with improved BP control, and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in health care organizational structure to include important components of team-based care.

Reporting of Safety Results in Published Reports of Randomized Controlled Trials [Original Investigation]

Background Reports of clinical trials usually emphasize efficacy results, especially when results are statistically significant. Poor safety reporting can lead to misinterpretation and inadequate conclusions about the interventions assessed. Our aim was to describe the reporting of harm-related results from randomized controlled trials (RCTs). Methods We searched the MEDLINE database for reports of RCTs published from January 1, 2006, through January 1, 2007, in 6 general medical journals with a high impact factor. Data were extracted by use of a standardized form to appraise the presentation of safety results in text and tables. Results Adverse events were mentioned in 88.7% of the 133 reports. No information on severe adverse events and withdrawal of patients owing to an adverse event was given in 27.1% and 47.4% of articles, respectively. Restrictions in the reporting of harm-related data were noted in 43 articles (32.3%) with a description of the most common adverse events only (n = 17), severe adverse events only (n = 16), statistically significant events only (n = 5), and a combination of restrictions (n = 5). The population considered for safety analysis was clearly reported in 65.6% of articles. Conclusion Our review reveals important heterogeneity and variability in the reporting of harm-related results in publications of RCTs.

Sex-Specific Trends in Midlife Coronary Heart Disease Risk and Prevalence [Original Investigation]

Background While recent data indicate that stroke prevalence in women at midlife is double that of similarly aged men in the United States, little is known about current sex-specific trends in symptomatic cardiovascular disease. This study aimed to determine sex-specific midlife prevalence of myocardial infarction (MI) and risk of future coronary heart disease. Methods We assessed the sex-specific MI prevalence and the Framingham coronary risk score (FCRS) among US adults aged 35 to 54 years who participated in the National Health and Nutrition Examination Surveys (NHANES), cross-sectional, nationally representative surveys, during 1988 to 1994 and 1999 to 2004. Results In both epochs, men aged 35 to 54 years had a higher prevalence of MI than similarly aged women, but the gap narrowed in recent years as MI prevalence decreased among men and increased among women (2.5% vs 0.7% in NHANES 1988-1994 [P < .01] and 2.2% vs 1.0% in NHANES 1999-2004 [P < .01]). Among men, the mean FCRS showed an improving trend (8.6% in NHANES 1988-1994 vs 8.1% in NHANES 1999-2004 [P = .07]), while among women, the mean FCRS worsened (3.0% in NHANES 1988-1994 vs 3.3% in NHANES 1999-2004 [P = .02]). Temporal trends in FCRS components revealed that men had more improvements in vascular risk factors than women, but diabetes mellitus prevalence increased in both sexes. Conclusions Over the past 2 decades, MI prevalence has increased among midlife women, while declining among similarly aged men. Also, although the risk of future hard cardiovascular events remains higher in midlife men compared with midlife women, the gap has narrowed in recent years. Greater emphasis on vascular risk factor control in midlife women might help mitigate this worrisome trend.

Sex Differences in Mortality After Acute Myocardial Infarction: Changes From 1994 to 2006 [Original Investigation]

Background Previous studies have shown that women younger than 55 years have higher hospital mortality rates after acute myocardial infarction (MI) than age-matched men. We examined whether such mortality differences have decreased in recent years. Methods We investigated temporal trends in the hospital case-fatality rates of MI by sex and age from June 1, 1994, through December 31, 2006. The study population included 916 380 patients from the National Registry of Myocardial Infarction with a confirmed diagnosis of MI. Results In-hospital mortality decreased markedly between 1994 and 2006 in all patients but more so in women than men. The mortality reduction in 2006 relative to 1994 was largest in women younger than 55 years (52.9%) and lowest in men younger than 55 years (33.3%). In patients younger than 55 years, the absolute decrease in mortality was 3 times larger in women than men (2.7% vs 0.9%). As a result, the excess mortality in younger women (<55 years) compared with men was less pronounced in 2004-2006 (unadjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.67) than it was in 1994-1995 (unadjusted odds ratio, 1.93; 95% confidence interval, 1.67-2.24). The sex difference in mortality decrease was lower in older patients (P = .004 for the interaction among sex, age, and year). Changes in comorbidity and clinical severity features at admission accounted for more than 90% of these mortality trends. Conclusions In recent years, women, particularly younger ones, experienced larger improvements in hospital mortality after MI than men. The narrowing of the mortality gap between younger women and men is largely attributable to temporal changes in risk profiles.

Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels [Original Investigation]

Background The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events. Methods Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of β-blockers) were then added to the model. Interactions between blood lipid levels were also explored. Results The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C. Conclusions Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events.

Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness [Original Investigation]

Background Cardiorespiratory fitness (CRF) in adults decreases with age and is influenced by lifestyle. Low CRF is associated with risk of diseases and the ability of older persons to function independently. We defined the longitudinal rate of CRF decline with aging and the association of aging and lifestyle with CRF. Methods We studied a cohort of 3429 women and 16 889 men, aged 20 to 96 years, from the Aerobics Center Longitudinal Study who completed 2 to 33 health examinations from 1974 to 2006. The lifestyle variables were body mass index, self-reported aerobic exercise, and smoking behavior. Cardiorespiratory fitness was measured by a maximal Balke treadmill exercise test. Results Linear mixed models regression analysis stratified by sex showed that the decline in CRF with age was not linear. After 45 years of age, CRF declined at an accelerated rate. For each unit of increase in body mass index, the CRF of women declined 0.20 metabolic equivalents (METs) (95% confidence interval, –0.21 to –0.19); that of men, 0.32 METs (–0.33 to –0.20). Current smokers of both sexes also had lower CRF (–0.29 METs [95% confidence interval, –0.40 to –0.19] for women and –0.41 METS [–0.44 to –0.38] for men). Cardiorespiratory fitness was positively associated with self-reported physical activity. Conclusions Cardiorespiratory fitness in men and women declines at a nonlinear rate that accelerates after 45 years of age. Maintaining a low BMI, being physically active, and not smoking are associated with higher CRF across the adult life span.

The Effects of a Nurse Case Manager and a Community Health Worker Team on Diabetic Control, Emergency Department Visits, and Hospitalizations Among Urban African Americans With Type 2 Diabetes Mellitus: A Randomized Controlled Trial [Original Investigation]

Background Although African American adults bear a disproportionate burden from diabetes mellitus (DM), few randomized controlled trials have tested culturally appropriate interventions to improve DM care. Methods We randomly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group. The intensive intervention group consisted of all components of the minimal intervention plus individualized, culturally tailored care provided by a nurse case manager (NCM) and a community health worker (CHW), using evidence-based clinical algorithms with feedback to primary care providers (eg, physicians, nurse practitioners, or physician assistants). The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings. Data on diabetic control were collected at baseline and at 24 months by blind observers; data emergency department (ER) visits and hospitalizations were assessed using administrative data. Results At baseline, participants had a mean age of 58 years, 73% were women, and 50% were living in poverty. At 24 months, compared with the minimal intervention group, those in the intensive intervention group were 23% less likely to have ER visits (rate difference [RD], –14.5; adjusted rate ratio [RR], 0.77; 95% confidence interval [CI], 0.59-1.00). In on-treatment analyses, the rate reduction was strongest for patients who received the most NCM and CHW visits (RD, –31.0; adjusted RR, 0.66; 95% CI, 0.43-1.00; rate reduction 34%). Conclusion These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM. Trial Registration clinicaltrials.gov Identifier: NCT00022750

Trial of Family and Friend Support for Weight Loss in African American Adults [Original Investigation]

Background Family and friend participation may provide culturally salient social support for weight loss in African American adults. Methods SHARE (Supporting Healthy Activity and eating Right Everyday) was a 2-year trial of a culturally specific weight loss program. African American women and men who enrolled alone (individual stratum, 63 index participants) or together with 1 or 2 family members or friends (family stratum, 130 index participants) were randomized, within strata, to high or low social support treatments; 90% were female. Results At 6 months, the family index participants lost approximately 5 to 6 kg; the individual index participants lost approximately 3 to 4 kg. The mean weight change was not different in high vs low social support in either stratum and generally not when high or low support treatments were compared across strata. The overall intention-to-treat mean weight change at 24 months was –2.4 kg (95% confidence interval, –3.3 kg to –1.5 kg). The family index participant weight loss was greater among the participants whose partners attended more personally tailored counseling sessions at 6 months in the high-support group and at 6, 12, and 24 months in the low-support group (all P < .05). Also, in the 6-month intention-to-treat analysis, the percentage of weight loss of the family index participants was greater if partners lost at least 5% vs less than 5% of their baseline weight (respectively, –6.1% vs –2.9% [P = .004], high support; and –6.1% vs –3.1% [P = .01], low support). Conclusions Being assigned to participate with family members, friends, or other group members had no effect on weight change. Enrolling with others was associated with greater weight loss only when partners participated more and lost more weight. Trial Registration clinicaltrials.gov Identifier: NCT00146081

The Interdisciplinary Approach to Culturally Tailored Medical Care: "Social Networking" for Decreasing Risk: Comment on "The Effects of a Nurse Case Manager and and a Community Health Worker Team on Diabetic Control, Emergency Department Visits, and Hospitalizations Among Urban African Americans With Type 2 Diabetes Mellitus: A Randomized Controlled Trial " and "Trial of Family and Friend Support for Weight Loss in African American Adults" [Invited Commentary]

Vitamin D2 Treatment for Vitamin D Deficiency and Insufficiency for Up to 6 Years [Research Letters]

Physicians' Experience and Satisfaction With Chaplains: A National Survey [Research Letters]

ALLHAT Findings Revisited in the Context of Subsequent Analyses, Other Trials, and Meta-analyses [Editor's Correspondence]

ALLHAT Findings Revisited in the Context of Subsequent Analyses, Other Trials, and Meta-analyses--Reply [Editor's Correspondence]

Medical Oncologists' Experience in Attending a Funeral and Communicating Condolences [Editor's Correspondence]

Medical Oncologists' Experience in Attending a Funeral and Communicating Condolences--Reply [Editor's Correspondence]

What Is Acupuncture After All? [Editor's Correspondence]

Acupuncture Research: Placebos by Many Other Names [Editor's Correspondence]

Acupuncture Research: Placebos by Many Other Names--Reply [Editor's Correspondence]

Concerns About a Meta-analysis of Computer Smoking Cessation Programs [Editor's Correspondence]

Concerns About a Meta-analysis of Computer Smoking Cessation Programs--Reply [Editor's Correspondence]

Informatics Aids to Reduce Failure Rates in Notification of Abnormal Outpatient Test Results [Editor's Correspondence]

EMRs Do Not Improve Reporting Rates of Abnormal Laboratory Results? [Editor's Correspondence]

Giving Patients Their Results Online Might Be the Answer [Editor's Correspondence]

Giving Patients Their Results Online Might Be the Answer--Reply [Editor's Correspondence]

When History Really Is Not Applicable or Relevant [Editor's Correspondence]

The 300-Year-Old Health Care Solution [Editor's Correspondence]

The 300-Year-Old Health Care Solution--Reply [Editor's Correspondence]