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[PMID]: 29381721 [Au] Autor: von Babo M; Chmiel C; Müggler SA; Rakusa J; Schuppli C; Meier P; Fischler M; Urner M [Ad] Endereço: Department of Internal Medicine, Waid City Hospital, Zurich, Switzerland. [Ti] Título: Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland. [So] Source: PLoS One;13(1):e0191752, 2018. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care. [Mh] Termos MeSH primário: Transfusão de Sangue/utilização Medicina Geral Hospitais de Ensino/organização & administração Padrões de Prática Médica [Mh] Termos MeSH secundário: Estudos Transversais Seres Humanos Medicina Interna Suíça [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180131 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0191752

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[PMID]: 29466595 [Au] Autor: Rosenberg LB [Ad] Endereço: Division of Geriatrics and Palliative Care, Massachusetts General Hospital, Boston, Massachusetts. [Ti] Título: A Teaching Case. [So] Source: JAMA;319(7):657-658, 2018 Feb 20. [Is] ISSN: 1538-3598 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Medicina Paliativa/educação Relações Médico-Paciente Doente Terminal [Mh] Termos MeSH secundário: Seres Humanos Medicina Interna/educação Internato e Residência Masculino Cuidados Paliativos [Pt] Tipo de publicação: JOURNAL ARTICLE; PERSONAL NARRATIVES [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180222 [St] Status: MEDLINE [do] DOI: 10.1001/jama.2018.0071

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[PMID]: 27778214 [Au] Autor: Card SE; Clark HD; Elizov M; Kassam N [Ad] Endereço: Division of General Internal Medicine, University of Saskatchewan, Department of Internal Medicine, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada. sharon.card@usask.ca. [Ti] Título: The Evolution of General Internal Medicine (GIM)in Canada: International Implications. [So] Source: J Gen Intern Med;32(5):576-581, 2017 May. [Is] ISSN: 1525-1497 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community. [Mh] Termos MeSH primário: Medicina Geral/tendências Medicina Interna/tendências Internacionalidade Médicos/tendências [Mh] Termos MeSH secundário: Canadá Competência Clínica/normas Medicina Geral/métodos Seres Humanos Medicina Interna/métodos Médicos/normas [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161026 [St] Status: MEDLINE [do] DOI: 10.1007/s11606-016-3891-z

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[PMID]: 29368497 [Au] Autor: Foster DS; Gupta R [Ti] Título: Choosing Wisely. [So] Source: W V Med J;112(6):12, 2016 Nov-Dec. [Is] ISSN: 0043-3284 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Tomada de Decisões Assistência à Saúde/economia Conhecimentos, Atitudes e Prática em Saúde Qualidade da Assistência à Saúde/economia [Mh] Termos MeSH secundário: Técnicas de Apoio para a Decisão Assistência à Saúde/normas Guias como Assunto Seres Humanos Medicina Interna/economia Educação de Pacientes como Assunto Qualidade da Assistência à Saúde/normas Estados Unidos Procedimentos Desnecessários/economia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180301 [Lr] Data última revisão: 180301 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180126 [St] Status: MEDLINE

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[PMID]: 28462597 [Au] Autor: Dias RD; Scalabrini Neto A [Ad] Endereço: a STRATUS Center for Medical Simulation , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA. [Ti] Título: Acute stress in residents during emergency care: a study of personal and situational factors. [So] Source: Stress;20(3):241-248, 2017 May. [Is] ISSN: 1607-8888 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room (ER) is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional observational study was carried out at an emergency department of a tertiary teaching hospital. All second-year internal medicine residents were invited to voluntarily participate in this study. Acute stress markers were assessed at baseline (T1), before residents started their ER shift, and immediately after an emergency situation (T2), using heart rate, systolic, and diastolic blood pressure, salivary α-amylase activity, salivary interleukin-1 ß, and the State-Trait Anxiety Inventory (STAI-s and STAI-t). Twenty-four residents were assessed during 40 emergency situations. All stress markers presented a statistically significant increase between T1 and T2. IL-1 ß presented the highest percent increase (141.0%, p < .001), followed by AA (99.0%, p = .002), HR (81.0%, p < .001), DBP (8.0%, p < .001), and SBP (3.0%, p < .001). In the multivariable analysis, time of residency had a negative correlation with HR during the emergency (adjusted R-square = .168; F = 8.69; p = .006), SBP response (adjusted R-square = .210; F = 6.19; p = .005) and DBP response (adjusted R-square = .293; F = 9.09; p = .001). Trait anxiety (STAI-t) was positively correlated with STAI-s (adjusted R-square = .326; F = 19.9; p < .001), and number of procedures performed during emergency care had a positive association with HR response (adjusted R-square = .241; F = 5.02; p = .005). In the present study, emergency care provoked substantial acute stress in residents. Resident experience, trait anxiety, and number of emergency procedures were independently associated with acute stress response. [Mh] Termos MeSH primário: Ansiedade/fisiopatologia Pressão Sanguínea Serviço Hospitalar de Emergência Frequência Cardíaca Internato e Residência Estresse Ocupacional/fisiopatologia Médicos/psicologia Estresse Psicológico/fisiopatologia [Mh] Termos MeSH secundário: Adulto Ansiedade/metabolismo Ansiedade/psicologia Estudos Transversais Emergências Feminino Seres Humanos Interleucina-1beta/metabolismo Medicina Interna/educação Masculino Estresse Ocupacional/metabolismo Estresse Ocupacional/psicologia Saliva/química alfa-Amilases Salivares/metabolismo Estresse Psicológico/metabolismo Estresse Psicológico/psicologia Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Interleukin-1beta); EC 3.2.1.1 (Salivary alpha-Amylases) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170503 [St] Status: MEDLINE [do] DOI: 10.1080/10253890.2017.1325866

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[PMID]: 29209722 [Au] Autor: Blumenthal DM; Olenski AR; Tsugawa Y; Jena AB [Ad] Endereço: Cardiology Division, Massachusetts General Hospital, Boston. [Ti] Título: Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries. [So] Source: JAMA;318(21):2119-2129, 2017 12 05. [Is] ISSN: 1538-3598 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Importance: Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. Objective: To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. Design, Setting, and Participants: A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Exposures: Treatment by locum tenens general internal medicine physicians. Main Outcomes and Measures: The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Results: Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%). Conclusions and Relevance: Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians. [Mh] Termos MeSH primário: Serviços Contratados Custos Hospitalares Mortalidade Hospitalar Hospitalização/economia Hospitais/recursos humanos Medicina Interna Medicare Qualidade da Assistência à Saúde [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Planos de Pagamento por Serviço Prestado Feminino Seres Humanos Tempo de Internação Modelos Logísticos Masculino Medicare/economia Readmissão do Paciente Admissão e Escalonamento de Pessoal Estados Unidos/epidemiologia [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171207 [St] Status: MEDLINE [do] DOI: 10.1001/jama.2017.17925

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[PMID]: 29429506 [Au] Autor: Jachiet M; Rybojad M; Bouaziz JD [Ad] Endereço: Service de dermatologie, hôpital Saint-Louis, INSERM U976, université Paris-Diderot-Paris VII, Sorbonne-Paris-Cité, Paris, France. [Ti] Título: [What's new in internal medecine?] [Ti] Título: Quoi de neuf en médecine interne ?. [So] Source: Ann Dermatol Venereol;143 Suppl 3:S23-S28, 2016 Dec. [Is] ISSN: 0151-9638 [Cp] País de publicação: France [La] Idioma: fre [Ab] Resumo: Answering the question « what's new in internal medecine in 2016? ¼ is very challenging. We used 3 methods of article selection to reduce the selection bias: 3 authors, a systematic review of the articles discussed in the weekly bibliographic meeting of our unit (Dermatology department, Saint-Louis Hospital, Paris, France) and a selection of the best articles by several internal medecine practitioners in Paris. Eleven « hot topics ¼ were analyzed: i/lowering cholesterol level but not blood blessure has a significant impact on cardiovascular morbi-mortality in cardiovascular intermediate risk patients; ii/the « treat to treat target ¼ is efficient in psoriatic arthritis; iii/ a genotype/ phenotype correlation favors the separation of ileal Crohn's disease, colonic Crohn's disease and ulcerative colitis; iv/ tocilizumab treatment (anti-IL-6 monoclonal antibody ) is very efficient in giant cell arteritis and slightly efficient in systemic sclerosis; v/ combination therapy using methotrexate plus steroids compared with steroids alone becomes the « gold standard ¼ treatment for juvenile dermatomyositis; vi/ dupilumab treatment (antibody blocking IL-4 and IL-13 receptors) is not only efficient in atopic dermatitis but also in asthma; vii/ think of eosinophilic oesophagitis in a patient with atopic dermatitis and dypshagia or food impaction; viii/ genetic A2 protein dysfunction induces NF-kB hyperactivation and an autoinflammatory disorder with features similar to Behcet's disease; ix/ no new biotherapies have shown high efficacy in systemic lupus erythematosus; x/ nanoparticles loaded with autoantigens induce Tregs and Bregs and may be a promising therapeutic option to treat auto-immune disease in the future; xi/ ipilimumab treatment (anti-CTLA4 antibody, immune checkpoint inhibitor) may induce complete remission in acute myeloid leukemia patients relapsing after haematological stem cell transplantation. Year 2016 is full of great discoveries in internal medicine keeping the dermatologist brain fully open minded. [Mh] Termos MeSH primário: Medicina Interna [Mh] Termos MeSH secundário: Anticorpos Monoclonais/uso terapêutico Anti-Hipertensivos/uso terapêutico Antineoplásicos Imunológicos/uso terapêutico Artrite Reumatoide/tratamento farmacológico Asma/tratamento farmacológico Doenças Autoimunes/tratamento farmacológico Síndrome de Behçet/genética Doenças Cardiovasculares/prevenção & controle Seres Humanos Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico Doenças Inflamatórias Intestinais/genética Ipilimumab/uso terapêutico Dermatopatias/terapia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Antibodies, Monoclonal); 0 (Antihypertensive Agents); 0 (Antineoplastic Agents, Immunological); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Ipilimumab); 0 (SAR231893) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180221 [Lr] Data última revisão: 180221 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180213 [St] Status: MEDLINE

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[PMID]: 29406067 [Au] Autor: Miner MM; Heidelbaugh J; Paulos M; Seftel AD; Jameson J; Kaplan SA [Ad] Endereço: Department of Family Medicine and Urology, The Men's Health Center, The Miriam Hospital, The Warren Alpert Medical School of Brown University, 164 Summitt Avenue, Providence, RI 02906, USA. Electronic address: Martin_Miner@Brown.edu. [Ti] Título: The Intersection of Medicine and Urology: An Emerging Paradigm of Sexual Function, Cardiometabolic Risk, Bone Health, and Men's Health Centers. [So] Source: Med Clin North Am;102(2):399-415, 2018 Mar. [Is] ISSN: 1557-9859 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Men's mental health and how they think about their health are critical to the future of men's health. Poor health choice patterns are established under age 50, when men are twice as likely to die than women. As the future of medicine focuses on quality and value, a better understanding of the social determinants of men's health will identify areas for improvement. The presentation of a man to a clinician's office with a sexual health complaint presents an opportunity for more complete evaluation. The future of men's health will be well served by integrated men's health centers that focus on the entire man. [Mh] Termos MeSH primário: Medicina Interna Saúde do Homem Urologia [Mh] Termos MeSH secundário: Instituições de Assistência Ambulatorial Doenças Ósseas Doenças Cardiovasculares Seres Humanos Masculino Saúde Mental Educação de Pacientes como Assunto Medição de Risco Disfunções Sexuais Fisiológicas Disfunções Sexuais Psicogênicas Saúde Sexual [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180208 [Lr] Data última revisão: 180208 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180207 [St] Status: MEDLINE

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[PMID]: 29406055 [Au] Autor: Arora HC; Fascelli M; Zhang JH; Isharwal S; Campbell SC [Ad] Endereço: Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA. [Ti] Título: Kidney, Ureteral, and Bladder Cancer: A Primer for the Internist. [So] Source: Med Clin North Am;102(2):231-249, 2018 Mar. [Is] ISSN: 1557-9859 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence. [Mh] Termos MeSH primário: Carcinoma de Células Renais/diagnóstico Carcinoma de Células de Transição/diagnóstico Hematúria/etiologia Neoplasias Renais/diagnóstico Neoplasias Ureterais/diagnóstico Neoplasias da Bexiga Urinária/diagnóstico [Mh] Termos MeSH secundário: Carcinoma de Células Renais/complicações Carcinoma de Células de Transição/complicações Cistoscopia Seres Humanos Medicina Interna Neoplasias Renais/complicações Neoplasias Renais/diagnóstico por imagem Imagem por Ressonância Magnética Encaminhamento e Consulta Tomografia Computadorizada por Raios X Neoplasias Ureterais/complicações Neoplasias Ureterais/diagnóstico por imagem Neoplasias da Bexiga Urinária/complicações Neoplasias da Bexiga Urinária/diagnóstico por imagem Urologia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180208 [Lr] Data última revisão: 180208 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180207 [St] Status: MEDLINE

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[PMID]: 28460392 [Au] Autor: Cutrona SL [Ad] Endereço: From University of Massachusetts Medical School, Worcester, Massachusetts. [Ti] Título: Teach Us to Care. [So] Source: Ann Intern Med;166(9):679, 2017 May 02. [Is] ISSN: 1539-3704 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Medicina Interna/educação Médicos/psicologia [Mh] Termos MeSH secundário: Seres Humanos [Pt] Tipo de publicação: JOURNAL ARTICLE; PERSONAL NARRATIVES [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180108 [Lr] Data última revisão: 180108 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE [do] DOI: 10.7326/M16-1772

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