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Jumpstarting Academic Careers with a Novel Intern Research Rotation: the AIMS RotationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Accreditation Council for Graduate Medical Education (ACGME) requirements for residency education in internal medicine specifically state that the program must advance residents' knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. Further, residents should participate in scholarly activity, and the sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities. The scholarly activity requirement may be satisfied with projects other than research, in...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Tonya L. Fancher, Ted Wun, Christine S. Hotz, Mark C. Henderson Tags: APM perspectives Source Type: journals

Adequacy of Vitamin D Replacement in Severe Deficiency Is Dependent on Body Mass IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Obesity is associated with hypovitaminosis D. Whether body mass index (BMI) determines the replacement dose of vitamin D to achieve sufficiency is unclear.Objective: To determine the relationship between BMI and serum 25-OH vitamin D concentrations and whether the increase in serum 25-OH vitamin D concentrations with vitamin D replacement is dependent on BMI.Methods: Retrospective review of anthropometric data and serum 25-OH vitamin D concentrations in 95 patients attending an outpatient clinic in a tertiary hospital. In a second component of the study, 17 hospital inpatients with severe vitamin D de...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Paul Lee, Jerry R. Greenfield, Markus J. Seibel, John A. Eisman, Jacqueline R. Center Tags: Brief observation Source Type: journals

The ReplyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It has long been appreciated that Cullen's and Grey Turner's signs are both not specific for acute pancreatitis but can occur in a myriad of pathologic processes all involving intra- and retroabdominal hemorrhage. Indeed, reports in the literature also comprise cases of metastatic thyroid cancer, esophageal cancer, intra-abdominal non-Hodgkin's lymphoma, and amoebic liver abscess that are rarely associated with the occurrence of these body wall ecchymoses. This list also encompasses a variety of other clinical conditions. However, many cases with Cullen's or Grey Turner's signs are attributable to acute pancreatitis. Hemor...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Markus Bosmann, Oliver Schreiner, Peter R. Galle Tags: Letters Source Type: journals

Regarding the Coexistence of Cullen's and Grey Turner's Signs in Acute PancreatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is with deep interest that we read Bosmann et al's description of Cullen's and Grey Turner's signs. As the art of medicine is being lost and its science also threatened, and clinicians' reasoning replaced by following practice guidelines, it is heartening to see that the tradition of clinical examination survives. This reminds us that close observation of patients (history and physical examination) can lead one to correct diagnosis hours, days, and even weeks before it can be achieved by those who rely solely on modern technology. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Fuad Jan, Suhail Allaqaband, Hina Mahboob Tags: Letters Source Type: journals

64-Slice Multidetector Computed Tomography (MDCT) Reduces Other Diagnostic Studies for Coronary Artery DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We read with interest the report of Auseon et al, who reported the impact of multidetector computed tomography (MDCT) on invasive coronary angiography (ICA), interventional volumes, and stress testing once MDCT became available. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Ronald P. Karlsberg, Mathew J. Budoff, Daniel S. Berman, Louise E.J. Thomson, John D. Friedman Tags: Letters Source Type: journals

Guidelines for Bedside TeachingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Bedside teaching is a combination of the art of medicine and the aspect of teaching. Medicine is still an art and a science, but unfortunately we have dropped the aspect of teaching the art of medicine in favor of the science of medicine. Bedside teaching is critically important in the interaction between the health care provider and the patient; this interaction serves as a basis to unwind the clinical reasoning process to reach a diagnosis. I think bedside teaching is best done by primary care physicians, thus, I have come up with 7 guidelines: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Sandy Sorrentino Tags: Letters Source Type: journals

Chronic Diarrhea Responding to Proton Pump Inhibitors: A Clinical Sign of Zollinger-Ellison SyndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In July 2003, a 43-year-old man presented for workup of chronic painless diarrhea of 3 years' duration. Passing 3 to 5 watery stools per day without pathologic admixtures, he had lost 3 kg of weight. At the onset of symptoms, colonoscopy had been performed without pathologic findings, and irritable bowel syndrome was assumed. He did not take any regular medication, and family history was negative for endocrinopathies or cancer. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Vincent Zimmer, Martin K. Schilling, Arno Buecker, Frank Lammert, Jochen Raedle Tags: Clinical communications to the editor Source Type: journals

Stuck in the Wrong PlaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
An 88-year-old woman was referred to our clinic for evaluation of dyspnea on minimal exertion for the past year. There was no history of chest pain or palpitations. She had experienced light-headedness on occasion but denied any loss of consciousness. She had been diagnosed with end-stage renal disease secondary to hypertension and diabetes mellitus and had been receiving hemodialysis 3 times a week for the last 3 years. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Majid M. Mughal, William A. Broughton, Ghulam M. Awan Tags: Clinical communications to the editor Source Type: journals

Pulmonary Langerhans' Cell HistiocytosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 51-year-old black man with a 30 pack-year history of smoking presented with progressive dyspnea, nonproductive cough, and decreased exercise tolerance over the last 2 years. The patient had no history of tuberculosis, recent travel, sick contacts, or fevers. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Chakra P. Chaulagain Tags: Clinical communications to the editor Source Type: journals

Catastrophic Complication of Chiropractic Manipulation: A Report of QuadriparesisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report an occurrence of quadriparesis after chiropractic manipulation. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Siva K. Talluri, Jyothsna Talluri, Siddesh Besur, Radhika Kakarala, Naveed Klair Tags: Clinical communications to the editor Source Type: journals

Extraordinary Hypertension after a Lunar MissionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
“The farther backward you can look, the farther forward you are likely to see.”Winston Churchill According to information obtained in 2006 through the Freedom of Information Act, 41-year-old James Irwin returned from his 12-day Apollo 15 mission in 1971 with extraordinary stress test hypertension (>275/125 mm Hg) by the third minute of exercise, probably the day after return, because there was a drop in stress test blood pressures subsequently. NASA (National Aeronautics and Space Administration) had not published this. There was no evidence of an acute renal insult. On the day of return, Irwin showed cyanosis of the ...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: William J. Rowe Tags: Clinical communications to the editor Source Type: journals

Quality of Life after Bariatric Surgery: A Population-based Cohort StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Bariatric surgery leads to profound weight loss, but postoperative complications and psychosocial issues may impact long-term quality of life. The primary aim of this project was to examine whether such patients have better quality of life and self-reported functional status compared with obese adults who do not have bariatric surgery.Methods: This population-based study of patients evaluated for Roux-en-Y gastric bypass surgery involved a survey consisting of baseline and follow-up single-item overall quality-of-life items (Linear Analogue Self-Assessment Questionnaire; LASA), follow-up quality of li...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: John A. Batsis, Francisco Lopez-Jimenez, Maria L. Collazo-Clavell, Matthew M. Clark, Virend K. Somers, Michael G. Sarr Tags: Clinical research studies Source Type: journals

Diagnostic and Prognostic Value of Uric Acid in Patients with Acute DyspneaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: Uric acid was shown to predict outcome in patients with stable chronic heart failure. Its impact in patients admitted in the Emergency Department with acute dyspnea, however, remains unknown.Methods: We prospectively investigated the diagnostic and prognostic value of uric acid in 743 unselected patients presenting to the Emergency Department with acute dyspnea.Results: Uric acid at admission was higher in patients with acute decompensated heart failure (51% of the cohort) as compared with patients with noncardiac causes of dyspnea (median, 447 μmol/L vs 340 μmol/L, P (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Tobias Reichlin, Mihael Potocki, Tobias Breidthardt, Markus Noveanu, Sabine Hartwiger, Emanuel Burri, Theresia Klima, Claudia Stelzig, Kirsten Laule, Alexandre Mebazaa, Michael Christ, Christian Mueller Tags: Clinical research studies Source Type: journals

Reducing Blood Sample Hemolysis at a Tertiary Hospital Emergency DepartmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Purpose: To determine the causes for sample hemolysis and measure the effect of an intervention to reduce sample hemolysis in the Emergency Department of a large hospital.Methods: We conducted a phased, prospective, interventional study. In phase 1, factors associated with urea and electrolyte sample lysis were studied. Based on these results and a literature review, an educational program consisting of a 15-minute presentation was implemented. In phase 2, questionnaires were distributed to the doctors and medical students conducting blood sampling, and outcome data were collected after the samples were processed...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Marcus Eng Hock Ong, Yiong Huak Chan, Chin Siah Lim Tags: Clinical research studies Source Type: journals

A1c Control in a Primary Care Setting: Self-titrating an Insulin Analog Pre-mix (INITIATEplus Trial)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Purpose: To study glycemic control and hypoglycemia development upon initiation of insulin through a self-titration schedule in a 24-week trial, conducted with 4875 insulin-naïve patients with poorly controlled type 2 diabetes, predominantly in a primary care setting.Methods: Subjects initiated twice-daily biphasic insulin aspart 70/30 with 6 units prebreakfast and 6 units presupper, self-titrating according to self-measured blood glucose values. Subjects were randomized (1:1:1) to telephone counseling provided by a registered dietician: no counseling (NC), 1 counseling session (1C), or 3 sessions (3C).Results: ...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: David S. Oyer, Mark D. Shepherd, Franklin C. Coulter, Anuj Bhargava, Jason Brett, Pei-Ling Chu, Bruce S. Trippe, The INITIATEplus Study Group Tags: Clinical research studies Source Type: journals

Prevalence and Severity of Undiagnosed Urinary Incontinence in WomenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: These results suggest that a significant proportion of women in this managed care population are suffering from urinary incontinence that remains undiagnosed. Efforts should be made to encourage women and physicians to initiate conversations about urinary incontinence symptoms in order to decrease the unnecessary burden of this disease. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Lauren P. Wallner, Sima Porten, Richard T. Meenan, Maureen C. O'Keefe Rosetti, Elizabeth A. Calhoun, Aruna V. Sarma, J. Quentin Clemens Tags: Clinical research studies Source Type: journals

Recommendation of Low-Salt Diet and Short-term Outcomes in Heart Failure with Preserved Systolic FunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Clinicians document appropriate discharge instructions less frequently in heart failure with preserved systolic function than systolic heart failure. Selected heart failure patients with preserved systolic function who receive advice for sodium-restricted diet may have improved short-term outcomes after hospital discharge. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Scott L. Hummel, Anthony C. DeFranco, Stephen Skorcz, Cecelia K. Montoye, Todd M. Koelling Tags: Clinical research studies Source Type: journals

Risk Factors for Heart Failure: A Population-Based Case-Control StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: The relative contribution of risk factors to the development of heart failure remains controversial. Further, whether these contributions have changed over time or differ by sex is unclear. Few population-based studies have been performed. We aimed to estimate the population attributable risk (PAR) associated with key risk factors for heart failure in the community.Methods: Between 1979 and 2002, 962 incident heart failure cases in Olmsted County were age and sex-matched to population-based controls using Rochester Epidemiology Project resources. We determined the frequency of risk factors (coronary h...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Shannon M. Dunlay, Susan A. Weston, Steven J. Jacobsen, Véronique L. Roger Tags: Clinical research studies Source Type: journals

Bayesian Meta-analysis of Hormone Therapy and Mortality in Younger Postmenopausal WomenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Background: There is uncertainty over the risks and benefits of hormone therapy. We performed a Bayesian meta-analysis to evaluate the effect of hormone therapy on total mortality in younger postmenopausal women. This analysis synthesizes evidence from different sources, taking into account varying views on the issue.Methods: A comprehensive search from 1966 through January 2008 identified randomized controlled trials of at least 6 month's duration that evaluated hormone therapy in women with mean age (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Shelley R. Salpeter, Ji Cheng, Lehana Thabane, Nicholas S. Buckley, Edwin E. Salpeter Tags: Clinical research studies Source Type: journals

Sign of ThreeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this case, 2 normally unrelated abnormalities of the cardiovascular anatomy were found in 1 patient. The simultaneous occurrence of these 2 congenital abnormalities is extremely rare. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Sandeep Chauhan, Ram Singh, Harshabad Singh, Ravinder Kaur, Girish M. Palleda Tags: Images in radiology Source Type: journals

Clues to a Life-threatening DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Syncope, with its multiple underlying causes, represents a challenging clinical problem. Identification of the etiology, which can range from benign to potentially life-threatening disease, might require a complex diagnostic pathway. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Pasquale Santangeli, Giuseppe Ferrante, Maurizio Pieroni, Filippo Crea Tags: ECG image of the month Source Type: journals

Not What She Had in MindEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Are you hoping to dissuade patients from body piercing? One odd case might fortify your argument. A 19-year-old female, who had been wearing a nose ring since she was 15 years old, presented with a 9-month history of a slow-growing, pearly plaque on her right nasal ala at the site of the nostril piercing (). This did not cause pain or pruritus. She reported excellent general health and no significant past medical or family history. Her skin was Fitzpatrick phototype III—white- to olive; sometimes burns; slowly tans to light brown—and she had no previous episodes of sunburn or sun-bed exposure. Without seeking medical a...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Efstathios Rallis, Chrysovalantis Korfitis Tags: Images in dermatology Source Type: journals

Wiped OutEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
An insidious process was depleting the endurance of a 75-year-old athlete. An avid runner, he presented to the emergency department with progressive dyspnea on exertion. At baseline, he could run 4 miles per day, but over the course of 2 months, he noted a gradual decrease in exercise tolerance secondary to shortness of breath. One month prior to presentation, his exercise tolerance decreased to 1 mile per day, and 2 weeks prior to presentation, he could run only one-quarter mile per day. The review of systems was negative for cough, chest pain, fevers, chills, night sweats, and weight loss. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Priscilla Kaliopi Brastianos, Baligh Yehia, William Fischer, Alison Moliterno, Michael Streiff Tags: Diagnostic dilemmas Source Type: journals

A Prolonged, Perplexing PyrexiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present the puzzling case of a 28-year-old man who consulted us for a fever of several weeks duration. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: José L. Ruiz-Rivas, Daniel Val, Francisca García, Eva Estirado, María J. Alonso, Fernando Laguna Tags: Diagnostic dilemmas Source Type: journals

Improving Pregnancy Counseling for Women with Rheumatoid Arthritis Taking MethotrexateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 46-year-old female patient with a 1-year history of rheumatoid arthritis was treated with methotrexate, 15 mg per week. Because of clinical improvement and patient preference, her rheumatologist changed her treatment to minocycline, and her methotrexate dose was gradually reduced over several months. As she was making these medication changes, the patient discovered that she was pregnant. The methotrexate was soon discontinued, but she was still taking it for at least the first 3 weeks of her pregnancy. The patient delivered a full-term female infant who did not appear to have any methotrexate-related birth defects. The ...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Naama Neeman, Mark D. Aronson, Joanne E. Schulze, Robert H. Shmerling Tags: Clinical effectiveness Source Type: journals

Assessing Fracture Risk and Effects of Osteoporosis Drugs: Bone Mineral Density and BeyondEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the assessment of fracture risk in clinical practice, reviews currently and soon-available bone measurement tools, and details the impacts of osteoporosis therapies on fracture risk. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: K. Shawn Davison, David L. Kendler, Patrick Ammann, Douglas C. Bauer, David W. Dempster, Larry Dian, David A. Hanley, Steven T. Harris, Michael R. McClung, Wojciech P. Olszynski, Chui K. Yuen Tags: Reviews Source Type: journals

An Umbrella Review: Corticosteroid Therapy for Adults with Acute AsthmaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this “umbrella” review is to synthesize the evidence and provide clinicians a single report that summarizes the state of knowledge regarding the use of corticosteroids in adults with acute asthma. Systematic reviews in the Cochrane Library and additional clinical trials published in English from 1966 to 2007 in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL, and references from bibliographies of pertinent articles were reviewed. Results indicate that the evidence base is frequently limited to small, single-center studies. Findings suggest that therapy with systemic corticosteroids accelerates the resolu...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Jerry A. Krishnan, Steven Q. Davis, Edward T. Naureckas, Peter Gibson, Brian H. Rowe Tags: Reviews Source Type: journals

Medicare's New Regulations for Deep Vein Thrombosis as a “Never Event”: Wise or Worrisome?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism estimates that more than 100,000 deaths occur annually from pulmonary embolism in the US alone. Many of these deaths are preventable by prescribing proved prophylactic measures during hospitalization. In addition, venous thromboembolism and its complications place a substantial burden on the US health care system. The sequelae of deep vein thrombosis and pulmonary embolism—post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension—respectively, are sources of morbidity, diminished quality of life, and loss in fun...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Juwono L. Sutedjo, Roger K. Ng, Gregory Piazza, Samuel Z. Goldhaber Tags: Commentaries Source Type: journals

Should We Maintain an Open Mind about Homeopathy?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Once upon a time, doctors had little patience with the claims made for alternative medicines. In recent years the climate has changed dramatically. It is now politically correct to have an open mind about such matters; “the patient knows best” and “it worked for me” seem to be the new mantras. Although this may be a reasonable approach to some of the more plausible aspects of alternative medicine, such as herbal medicine or physical therapies that require manipulation, we believe it cannot apply across the board. Some of these alternatives are based on obsolete or metaphysical concepts of human biology and physiolo...
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Michael Baum, Edzard Ernst Tags: Commentaries Source Type: journals

Back to the Future: Medical Students Can Matter AgainEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Over the last 5 years, we have spent considerable time directly teaching students and housestaff and have been involved in numerous meetings of academic physicians concerned about the apparent erosion in quantity and quality of medical student and resident teaching at our medical schools and teaching hospitals. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2009 Category: Journals (General) Authors: Joseph S. Alpert, Brian F. Mandell Tags: Editorial Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Tags: Frontmatter Source Type: journals

Edward Hopper's Corner Drug StoreEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
“We have listened too long to the courtly muses of Europe…I ask not for the great, the remote, the romantic…I embrace the common, I explore and sit at the feet of the familiar, the low. Give me insights into to-day, and you may have the antique and future worlds.”Ralph Waldo Emerson (1803-1882). In her definitive biography of the American realist painter Edward Hopper (1882-1967), Gail Levin points out that Emerson's call for a new American art depicting everyday, even low, American phenomena figured centrally in Hopper's thinking. Born in Nyack, New York, Hopper is an American master in the true Emersonian sense o...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Helle Mathiasen Tags: Medical humanities perspectives Source Type: journals

Interim Department Chairs in Academic MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Academic health centers are experiencing more frequent turnover of department chairs. In departments of obstetrics and gynecology, doubling of annual turnover rates for chairs occurred between 1981 and 2005 (6.0% to 12.7%). During the time period from 1993 to 2003, the median length of service of chairs in pediatric departments was 5 years with a mean annual turnover rate of 17%. Only 10% of individuals served as chair for the entire 11-year period of the study. The average tenure for chairs of departments of internal medicine at US medical schools declined from 5.2 years in the 1970s to 3.9 years in the 2000s. Conversely,...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: David A. Quillen, Robert C. Aber, R. Kevin Grigsby Tags: APM perspectives Source Type: journals

Does He Deserve a Pacemaker?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 32-year-old man, with a history of an episode of paroxysmal atrial fibrillation 3 years prior, came to our Department as an outpatient for a routine re-evaluation. His medical history also was notable for a depression disorder treated with venlafaxine (serotonin-norepinephrine reuptake inhibitor), which was discontinued 3 years prior. He did not report smoking, alcohol, or illicit drug abuse, and his family medical history was not remarkable for coronary artery disease or rhythm-conduction disorders. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: George Lazaros, Panagiota Pietri, Polychronis Dilaveris, Dimitris Tsiachris, Petros Arsenos, Konstantinos Gatzoulis, Christodoulos Stefanadis Tags: Clinical communications to the editor Source Type: journals

Diagnosis of Munchausen's Syndrome by an Electronic Health Record SearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 29-year-old man presented to the hospital complaining of seizures, galactorrhea, and acromegaly. He reported a family history of multiple endocrine neoplasia type 2 in both parents, and “genetically proven” multiple endocrine neoplasia type 2 in 2 of 17 siblings. His stated occupation was fraud investigator for a telephone company. He reported a recent hospitalization for the same symptoms at a different medical center, and consented to release of information from other hospitals and family members. Multiple attempts to contact family members were unsuccessful, and there was no record of admissions to other hospitals...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Thomas G. Van Dinter, Brian J. Welch Tags: Clinical communications to the editor Source Type: journals

Purple Urinary Bag SyndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Purple urine bag syndrome is a rare condition that was first described in the literature in 1978. It is characterized by the purple discoloration of a catheter bag and tubing over hours to days (). This phenomenon is due to the combination of bowel stasis, a complicated breakdown of tryptophan, and the presence of a urinary tract infection. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Hussain Al-Sardar, Daniel Haroon Tags: Clinical communications to the editor Source Type: journals

Screening for Obstructive Sleep Apnea on the Internet: Randomized TrialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusion: An online screening intervention is feasible and likely effective in encouraging members of an Internet weight-loss community to discuss obstructive sleep apnea with their healthcare provider. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Kevin O. Hwang, Abdurrahman M. Hamadah, Craig W. Johnson, Eric J. Thomas, G. Ken Goodrick, Elmer V. Bernstam Tags: Clinical research studies Source Type: journals

Appropriateness of Collaborations between Industry and the Medical Profession: Physicians' PerceptionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Physicians' broadly perceived most collaboration with the pharmaceutical and medical device industries, and of receiving payment for collaboration, as appropriate. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Joseph S. Ross, Salomeh Keyhani, Deborah Korenstein Tags: Clinical research studies Source Type: journals

Side Effects of Phytoestrogens: A Meta-analysis of Randomized TrialsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Based on the available evidence, phytoestrogen supplements have a safe side-effect profile with moderately elevated rates of gastrointestinal side effects. Rates of vaginal bleeding, endometrial hyperplasia, endometrial cancer, and breast cancer were not significantly increased among phytoestrogen users in the investigated studies. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Clemens B. Tempfer, Georg Froese, Georg Heinze, Eva-Katrin Bentz, Lukas A. Hefler, Johannes C. Huber Tags: Clinical research studies Source Type: journals

Bubble-wrappedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Illness during pregnancy poses a unique challenge to clinicians, who must consider both maternal and fetal welfare during diagnosis and management. Here, we present the case of a 29-year-old pregnant woman who came to the emergency department with complaints of dyspnea, retrosternal pleuritic chest discomfort, and swelling of the neck and both upper arms. She described the swelling as making her “feel like bubble wrap.” Although her pregnancy, at 34 weeks, had been uneventful, she had been experiencing symptoms of upper respiratory tract infection for 1 week and severe coughing spells for 2 days prior to presentation. ...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Kiran V. Sarikonda, Abhimanyu Beri Tags: Images in radiology Source Type: journals

Right Rhythm, Right Patient, Right VentricleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A wide-complex tachycardia calls for immediate attention, as it often signals hemodynamic instability and can be the harbinger of sudden death. As this case illustrates, however, not all wide-complex tachyarrhythmias are potentially lethal. The challenge is to discern those that are from those that are not. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Alec J. Moorman, Marshall A. Corson, Zachary D. Goldberger Tags: ECG image of the month Source Type: journals

A Unique Complication of a Broken HeartEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This case highlights the critical value of echocardiography in providing a complete anatomic, functional, and hemodynamic assessment of a complicated left-ventricular heart lesion, leading to prompt treatment and a successful outcome. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Ramesh C. Bansal, Terence Lin, Rimon Shaker, Alfredo Rasi, Kenneth R. Jutzy, Anees Razzouk Tags: Diagnostic dilemmas Source Type: journals

Cocktail ParalysisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Those bartenders, celebrities, and marketing wizards who invent and name cocktails apparently favor the quirky, scandalous, or extreme. The “vodka paralyzer” cocktail contains vodka, tequila, Kahlua coffee liqueur, light cream, and Coca-Cola. The unusual medical case presented here suggests that the “paralyzer” appellation might be better applied to another type of cocktail. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Karsten Hammond, Merne Wilson, Stephen Sanche, Thomas W. Wilson Tags: Diagnostic dilemmas Source Type: journals

Office Management of Deep Venous Thrombosis in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Deep venous thrombosis is common in the elderly. Diagnosis and management are now a part of office practice. As signs and symptoms are inconsistent and nonspecific, diagnostic testing is necessary. For patients with a low clinical probability, a normal D-dimer result can rule out disease. For patients with a high clinical suspicion or an elevated D-dimer, duplex ultrasonography may confirm the diagnosis. Anticoagulation, usually with low-molecular-weight heparin, should begin on suspicion and continue, along with warfarin, until the international normalized ratio is therapeutic. Arrangements for the initial daily...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Laurie G. Jacobs, Henny H. Billett Tags: Update in office management Source Type: journals

Long-term Safety Concerns with Proton Pump InhibitorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide. Their use has resulted in dramatic improvements in treatment of peptic ulcer disease and gastroesophageal reflux disease. Despite an acceptable safety profile, mounting data demonstrate concerns about the long-term use of PPIs. To provide a comprehensive review regarding the concerns of long-term PPI use, a literature search was performed to identify pertinent original and review articles. Despite study shortcomings, the collective body of information overwhelmingly suggests an increased risk of infectious complications and ...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Tauseef Ali, David Neil Roberts, William M. Tierney Tags: Reviews Source Type: journals

Hypertension in Pregnancy and Women of Childbearing AgeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Hypertension in women of childbearing age is a challenging medical problem with increasing prevalence. Essential hypertension remains the most common diagnosis in young women. Reproductive goals and possible teratogenic effects must be considered when initiating therapy. Hypertensive disorders of pregnancy are frequent causes of maternal/fetal morbidity and mortality, the most common being preeclampsia/eclampsia. Pregnant patients should be screened routinely. Early recognition and prompt care from a multidisciplinary service, including obstetrics, cardiology, and intensive medicine, are required to prevent delet...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Scott R. Yoder, Loralei L. Thornburg, John D. Bisognano Tags: Reviews Source Type: journals

John Stone, MDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
“For there will be the arts and some will call these soft data whereas in fact they are the hard data by which our lives are livedFor everyone comes to the arts too late.”John H. Stone III, MD (1936-2008) (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Jay W. Smith Tags: Editorials Source Type: journals

The Patient–Physician–Industry–Government Partnership: A Societal GoodEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
I recently celebrated the 40th anniversary of my graduation from medical school at a class reunion in Boston. While reminiscing with my former classmates about the joys and tribulations of living as a student during the 1960s, a discussion arose regarding what was available to us then in the area of pharmacotherapeutics compared with what is now available for practicing physicians. In regard to treatments for cardiovascular disease, my area of internal medicine subspecialty, we had nitrates for angina pectoris; digitalis preparations and furosemide for heart failure; hydrochlorothiazide, reserpine, guanethidine, hydralazin...
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: William H. Frishman Tags: Editorials Source Type: journals

“Don't Look Back; Something Might Be Gaining on You.”Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The title of this editorial is a quote from Satchel Paige, professional baseball player and the first African American pitcher to play in the major leagues. Satchel Paige is generally acknowledged at 60 years old plus to have been the oldest professional to play in US baseball's major leagues. In one interview with the press, he was asked why someone his age was still trying to compete. The quote cited above was his response. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 29, 2009 Category: Journals (General) Authors: Joseph S. Alpert Tags: Editorials Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 21, 2009 Category: Journals (General) Tags: Frontmatter Source Type: journals