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NIGMS supports the development and application of imaging technologies to better understand basic cell biology. Such visualization at the cellular and subcellular level will lead to fundamental breakthroughs in understanding cell structure and function and how they are dynamically regulated.
National Institute of General Medical Sciences (Internal medicine) - Mon, 18 July 2011
http://www.nigms.nih.gov/
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At a time when most authorities believe that the country desperately needs more generalists, the American Board of Internal Medicine (ABIM) is adding new subspecialties. In addition, the ABIM has received requests from specialty societies to approve several new subspecialties, including medical informatics, clinical pharmacology, vascular medicine, addiction medicine, and obesity medicine. Each of these applications raises issues of a societal nature (i.e., the benefits to the public of having clear standards for emerging areas of medical specialization) versus issues of practicality (e.g., the cost of creating and maintaining certification examinations and the ongoing worry about fragmentation of care). These issues have been coupled with the concerns of different specialties that favored or opposed particular subspecialty designations. Most important, we receive clear but contradictory messages from physicians: on the one hand, “recognize what I do” (i.e., create a subspecialty for my niche practice); on the other hand, “stop fragmenting an already overfragmented system.”
New England Journal of Medicine (Internal medicine) - Mon, 28 March 2011
http://www.nejm.org
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An 80-year-old man presents with a 2-day history of right-sided chest pain that was sudden in onset, is constant, and is exacerbated by coughing and deep inspiration. What is the diagnosis?
Medscape (Internal medicine) - Mon, 28 March 2011
http://www.medscape.com
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An exploratory analysis of the CRASH-2 randomised controlled trial
showed that tranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful.
The Lancet (Internal medicine) - Mon, 28 March 2011
http://www.thelancet.com
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Any screening for coronary artery calcification (CAC) for primary prevention of cardiovascular disease (CVD) is still an unproven strategy to improve health outcomes. A brief summary of the evidence to date would conclude that CAC, measured with fast computed tomography (CT) protocols, is a valid marker of underlying atherosclerosis, correlates with the burden of coronary atherosclerosis, confers independent added prognostic value to conventional risk prediction, and may be valuable in refining risk prediction in such a way as to alter decision making about medical therapies (although, to my knowledge, there is no randomized trial evidence to prove this). However, there is ample reason to be wary of screening for CAC. First, we do not know whether it results in improved outcomes. One randomized trial that tested its motivational effect did not show any improvement on cardiovascular risk factors.
Archives of Internal Medicine (Internal medicine) - Thu, 17 December 2009
http://archinte.ama-assn.org/
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Accurate information on harms of medical interventions is essential for evidence-based practice. Most newly introduced treatments usually have small, incremental benefits, if any, against already available interventions, and differences in the profile of harms should play a key role on treatment choice. Randomized trials offer an excellent opportunity to evaluate harms of interventions using the most robust experimental design available in clinical research. However, several empirical evaluations (Table) have shown that many trials do not report harms or report them in a fragmented or suboptimal way. In this issue, an excellent study by Pitrou et al1 adds more evidence on this issue.
Archives of Internal Medicine (Internal medicine) - Fri, 30 October 2009
http://archinte.ama-assn.org/
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There has been a dramatic increase in the incidence of type 2 diabetes mellitus in developed countries during the last 50 years. In the United States, the prevalence of diabetes has increased from 0.9% in 1958 to 4.4% in 2000 and is projected to reach 7.2% by 2050.2 Diabetes causes substantial morbidity, disability, and mortality and is a major contributor to increased health care costs. In 2007, medical expenses related to diabetes totaled an astronomical $116 billion in the United States. We are therefore in great need of interventions to reduce the incidence of this disease
Archives of Internal Medicine (Internal medicine) - Fri, 16 October 2009
http://archinte.ama-assn.org/
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The concept of patient-centered care—that medical care providers should respect patients' preferences, wants, and needs; solicit patients' input into decisions; and customize treatment recommendations—is not new.
Archives of Internal Medicine (Internal medicine) - Mon, 5 October 2009
http://archinte.ama-assn.org/
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In this issue, in an article examining the association between hospitalists and performance on hospital-level quality indicators, López and colleagues1 found that hospitals with hospitalists have higher "quality of care" scores than those without hospitalists and attribute these improvements to the hospitalists' presence. This article provides interesting data, which unfortunately are not persuasive enough to support that conclusion.
Archives of Internal Medicine (Internal medicine) - Fri, 28 August 2009
http://archinte.ama-assn.org/
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The critical appraisal of any medical test or strategy requires careful assessment of its potential risks, benefits, and costs. Accurate definition of the risks, benefits, and costs of the use of coronary artery calcium (CAC) scanning with computed tomography (CT) in asymptomatic individuals remains an elusive goal.
Archives of Internal Medicine (Internal medicine) - Mon, 20 July 2009
http://archinte.ama-assn.org/