scholarly journals The Rebirth of General, ‘Acute’ Medicine: will the baby survive?

2011 ◽  
Vol 10 (1) ◽  
pp. 3-4
Author(s):  
Professor Sir George Alberti ◽  
Keyword(s):  
General Medicine ◽  
Working Hours ◽  
Diagnostic Tools ◽  
Major Focus ◽  
Medical Specialties ◽  
Acute Medicine ◽  
General Internal ◽  
General Physicians ◽  
Proper Training ◽  
And Training

During the 1980s and 1990s general medicine was progressively displaced by medical specialties as the major focus of a consultant physician’s career. Fewer and fewer people were appointed as ‘general physicians with a specialist interest’, which had been the norm prior to this. Specialists whose main focus was their ‘ology’ were continuing to be expected to take their share of acute medical “takes”. Training for most medical specialties still encompassed training in General Internal Medicine (GIM). However, this often was truncated in favour of the main specialty and was even resented, by some, as interfering with their “proper” training. None of this was surprising: medical specialties were becoming more complex & many more treatments, interventions and diagnostic tools were becoming available. Simultaneously, working hours were decreasing, and training was taking place within a much more formalised structure.

Editorial

2003 ◽  
Vol 2 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Emergency Services ◽  
Case Reports ◽  
Community Acquired Pneumonia ◽  
Rapid Expansion ◽  
Medical Specialties ◽  
Acute Medicine ◽  
General Internal ◽  
Competency Based ◽  
Exciting Time ◽  
The Uk

It could be said that the past 12 months have been an exciting time in the field of acute medicine. In addition to the high profile afforded by the publication of Reforming Emergency Care and the ongoing Emergency Services Collaborative, the significance of the recent acquisition of subspecialty status for Acute Medicine cannot be understated. This, in turn has enabled approval of a new competency-based training curriculum by the JCHMT. Hopefully within the next few months, specialist registrars in General Internal Medicine with Acute Medicine will be appointed to the first few numbered posts in this discipline. Clearly a rapid expansion in posts of this nature will be required in the next few years in order to meet the enormous demand for consultants in Acute Medicine. Recently, in common with other medical specialties, hospitals have experienced difficulties in recruiting suitable applicants for such posts resulting in many vacancies across the UK. One challenge for those of us already working in the field is to maintain enthusiasm for the concept, while we are waiting for the trainees to mature into competent consultants. This edition includes another varied selection of reviews. Community acquired pneumonia may be of particular relevance over the remaining winter months, although hopefully the brief mention of SARS in this paper will now only be of historical significance. Patients with hypercalcaemia, dysphagia and Guillan Barre syndrome may be less frequent attenders, but nonetheless often create management dilemmas with which the admitting physician needs to be familiar. In a departure from our previous format, we have included two case reports this time, both highlighting an important clinical scenario. Power kite flying may not be a familiar activity for many readers, but the outcome described by Merrison and colleagues justifies its inclusion as ‘a case to remember’. Mark Mallett, on the other hand, reminds us that syncope can, on occasions, reflect significant underlying pathology, even in an apparently healthy member of the hospital portering staff. Once again we would like to encourage similar submissions for future editions of the journal. After several years of association with CPD Acute Medicine and its predecessor, it is with great sadness that this edition is Paul Jenkins ’last as sub-editor. We wish him well as he moves on to new challenges in his role as President of the Society for Acute Medicine, and gratefully acknowledge all of his hard work in establishing the journal.

Diagnostic scales for suicide risk assessment

2020 ◽  
pp. 67-79
Author(s):  
L. Gelda ◽  
L. Nesterovich
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Medical Research ◽  
Suicide Risk ◽  
General Medicine ◽  
Diagnostic Tools ◽  
Suicide Risk Assessment ◽  
Research And Practice ◽  
Psychometric Instruments ◽  
High Incidence

The problem of adequate diagnostic tools use for suicide risk assessment т medical research and practice is of extreme importance because of the high incidence of suicide in the population of psychotic patients and the high vulnerability of the latter to the known risk factors. The article provides ап overview of the existing psychometric instruments (scales) used to assess the risk of suicide in psychiatry as well as in general medicine.

scholarly journals A Novel Cough Simulation Device for Education of Risk Mitigation Techniques During Aerosol-Generating Medical Procedures

2021 ◽  
pp. 019459982110003
Author(s):  
Ernest D. Gomez ◽  
John J. Ceremsak ◽  
Akiva Leibowitz ◽  
Scharukh Jalisi
Keyword(s):  
User Study ◽  
Risk Mitigation ◽  
Medical Procedures ◽  
Medical Specialties ◽  
Aerosol Generation ◽  
Safety Awareness ◽  
Potential Mode ◽  
Educational Need ◽  
And Training ◽  
Design Construction

The COVID-19 pandemic has drawn attention to aerosol-generating medical procedures (AGMPs) in health care environments as a potential mode of transmission. Many organizations and institutions have published AGMP safety guidelines, and several mention the use of simulation in informing their recommendations; however, current methods used to simulate aerosol generation are heterogenous. Creation of a high-fidelity, easily producible aerosol-generating cough simulator would meet a high-priority educational need across all medical specialties. In this communication, we describe the design, construction, and user study of a novel cough simulator, which demonstrates the utility of simulation in raising AGMP safety awareness for providers of all roles, specialties, and training levels.

DOES THIS SOUND FAMILIAR?

PEDIATRICS ◽  
1975 ◽  
Vol 55 (2) ◽  
pp. 286-286
Author(s):  
R. G. Petersdorf
Keyword(s):  
General Medicine ◽  
House Staff ◽  
Teaching Load ◽  
General Physicians

The major problems of departments of medicine are increased in teaching load, dispersion of house staff through several affiliated hospitals, a lack of resources to do all the tasks asked of them, and a schizophrenia concerning the departments' mission to tertiary subspecialty medicine as opposed to primary or general medicine. The major issue confronting departments of medicine is a solution to the problem of training general physicians.

WORK–LIFE BALANCE IN THE CURRENT JAPANESE CONTEXT

2021 ◽  
Vol 9 (4) ◽  
pp. 57-64
Author(s):  
Akizumi Tsutsumi
Keyword(s):  
Working Hours ◽  
Work Conditions ◽  
Work Life ◽  
Work Life Balance ◽  
Life Balance ◽  
Medical Specialties ◽  
Long Working Hours ◽  
Family Work ◽  
Overtime Work ◽  
Work Style

Background: Work style reform in Japan is under way in response to a predicted shortfall in the workforce owing to the country’s low birth rate and high longevity, health problems due to excessive working hours, and the need for diversification of employment. A legal limit for physicians’ overtime work will be introduced in 2024. Objectives: This study examines the work–life balance among Japan’s doctors in the context of ongoing work style reform. Methodology: The study applied included selective reviews of demographic shifts, legislation against long working hours, and trends in doctors’ participation in the labor force. Results: Japan’s doctors work long hours, which creates a conflict between their working and private lives. The proportion of female doctors in Japan is the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. Employment trends among women doctors by age group show an M-curve: many quit their jobs upon marriage or childbirth. Gender role stereotyping has led male Japanese doctors to devote themselves entirely to their professions and working excessively long hours: they leave all family work to their female partners. This stereotyping obliges female doctors to undertake household chores in addition to their career tasks, which makes it difficult for them to re-enter their careers. Because of the harsh working conditions (including long working hours), there has been a decline in newly graduated doctors in some medical specialties. Conclusions: For sustainable, effective health care in Japan, it is necessary to improve the work conditions for Japan’s doctors towards achieving work–life harmony.

P–047 Knowledge, professional attitudes and training of health professionals on male contraceptive methods

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Perrin ◽  
J Tcherdukian ◽  
A Netter ◽  
E Lechevalier ◽  
F Bretelle ◽  
...  
Keyword(s):  
General Practitioners ◽  
Health Professionals ◽  
Large Scale ◽  
Hormonal Contraception ◽  
Male Contraception ◽  
Contraceptive Methods ◽  
Medical Specialties ◽  
Professional Attitudes ◽  
Male Contraceptive ◽  
And Training

Abstract Study question Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods? Summary answer The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more. What is known already The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC). Study design, size, duration Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France. Participants/materials, setting, methods The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception. Main results and the role of chance The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p < 0.001). More than half (55%) of the population never or infrequently offered MC during a couple’s contraceptive request consultation. Female practitioners offered MC significantly more often than male practitioners (48% vs. 26%; p = 0.033). Only 14% of the population had ever participated in training on MC, 96% wished to be better trained on MC, and 86% expressed a willingness to participate in such a training. Limitations, reasons for caution The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives. Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception. Trial registration number 2020–01–23–03

scholarly journals The use of smartphones on General Internal Medicine wards

2014 ◽  
Vol 05 (03) ◽  
pp. 814-816 ◽  
Author(s):  
D. Morra ◽  
V. Lo ◽  
S. Quan ◽  
R. Wu ◽  
K. Tran
Keyword(s):  
Internal Medicine ◽  
Mixed Methods ◽  
Health Information ◽  
General Internal Medicine ◽  
Mixed Methods Study ◽  
Personal Health Information ◽  
Medical Specialties ◽  
General Internal ◽  
Work Related ◽  
Internal Medicine Wards

Summary Objective: To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use. Methods: A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys. Results: Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity. Conclusion: Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians. Citation: Tran K, Morra D, Lo V, Quan S, Wu R. The use of smartphones on General Internal Medicine wards: A mixed methods study. Appl Clin Inf 2014; 5: 814–823http://dx.doi.org/10.4338/ACI-2014-02-RA-0011

Journal Impact Factors Do Not Equitably Reflect Academic Staff Performance in Different Medical Subspecialties

2004 ◽  
Vol 52 (8) ◽  
pp. 531-536
Author(s):  
Richard J. Epstein
Keyword(s):  
Academic Staff ◽  
General Medicine ◽  
Distribution Patterns ◽  
Skewed Distribution ◽  
Impact Factors ◽  
Separate Analysis ◽  
Medical Specialties ◽  
Staff Performance ◽  
The Impact

BackgroundThe simplest variables to quantify on an academic curriculum vitae are the impact factors (IFs) of journals in which articles have been published. As a result, these measures are increasingly used as part of academic staff assessment. The present study tests the hypotheses that IFs exhibit patterns that are consistent between journals of different specialties and that these IFs reflect the quality of staff academic performance.MethodsThe IFs of a sample of journals from each of four medical specialties—medicine, oncology, genetics, and public and occupational health—were downloaded from the Science Citation Index and compared. Overall and specialty-specific journal IF frequencies were analyzed with respect to distribution patterns, averages, and skew.ResultsApproximately 91% of journal IFs fell within the 0 to 5 range, with 97% being less than 10. The overall IF distribution featured a positive skew and a mean of 2.5. Separate analysis of the journal specialty subsets revealed significant differences in IF means (genetics 3.4 > oncology 3.1 > medicine 2.0 > public health 1.6; p < .006), all of which well exceeded the respective IF medians. Journals from the general medicine category exhibited both the lowest IF median (0.7) and the most positively skewed distribution.ConclusionThe distribution of IFs exhibits degrees of skew, numeric average, and spread that differ significantly between journal specialty subsets. This suggests that factors other than random variations underlie much of the IF variation between specialty journals and reduces the plausibility of a reliable correlation between IFs and the quality of academic staff performance. It is concluded that a dominant emphasis on IFs in academic recruitment and promotion may select for long-term faculty characteristics other than academic quality alone.

The Puzzle of Work: Insecurity and Stress and Autonomy and Commitment

2005 ◽  
Author(s):  
Edwards Paul
Keyword(s):  
Private Sector ◽  
Working Hours ◽  
Temporary Workers ◽  
Skill Levels ◽  
Sectoral Shifts ◽  
The Public ◽  
Lack Of Control ◽  
Part Time ◽  
Work Insecurity ◽  
And Training

This chapter suggests that the nature of work in Britain changed dramatically during the last thirty years of the twentieth century. Sectoral shifts included a move from manufacturing towards services. There were also major shifts from the public sector to the private sector: between 1980 and 1998 the proportion of employees accounted for by private sector services rose from 26% to 44%. Part-time and temporary workers also became more common. These changes are often claimed to be associated with some more general transformations in the nature of work in Britain. One view holds that there have been improving levels of skills and training and better communication in the workplace. Another view holds that there have been increased levels of effort and stress. This chapter attempts to explain why rising skill levels, employee autonomy and commitment have been accompanied by widespread reports of increases in stress, lengthening working hours and a sense of a lack of control over one's working life.

Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data

2020 ◽  
Vol 29 (11) ◽  
pp. 905-911 ◽  
Author(s):  
Amol A Verma ◽  
Alexander Kumachev ◽  
Sonam Shah ◽  
Yishan Guo ◽  
Hae Young Jung ◽  
...  
Keyword(s):  
General Medicine ◽  
Cross Sectional Study ◽  
Charlson Comorbidity Index Score ◽  
Severe Illness ◽  
Hospital Data ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
General Internal ◽  
Medical Inpatients ◽  
Hospital Administrative

BackgroundPeripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).MethodsThis was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.ResultsAmong 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.ConclusionsClinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

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