April 2012

Feature: Live or Die, Khatami

I'd never felt conflict on so many intellectual levels before. I didn't want my patient to die, or suffer. I didn't want the minutiae of the law to keep me from doing what was right or to let me do something I felt was wrong. I didn't want to burden our health care system with futile procedures, and I didn't want to lose my heart. The way I was thinking finally hit me—I was focused too much on what I didn't want because I was afraid of the consequences. I needed to figure out what I did want.

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Medical Student Perspectives: Medical School in the Jungle: A Personal Reflection on International Rotations

I visited a hospital in a small city where the wards consisted of two large rooms full of hospital beds, one room for men and the other for women. In these wards, there were no concerns of Health Insurance Portability and Accountability Act violations and no thoughts toward maintaining patient privacy. The patients in these shared wards, in beds just 3 feet apart from each other, had conditions ranging from pneumonia to dehydration to post-op recovery. The maternity ward was another large, open room filled with a mixture of women in labor and new moms who had recently delivered in the separate, sterile delivery room.

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My Kind of Medicine: Real Lives of Practicing Internists: Ashish D. Parikh, MD, FACP

Dr. Ashish Parikh has lived in many diverse places in his life, including Calcutta; Mumbai, Tallahassee, Los Angeles, and New Orleans, Louisiana. However, out of all of the places that he has lived, Dr. Parikh feels the most at home in Livingston, New Jersey, where he is the Director of the internal medicine residency program at Saint Barnabas Medical Center. The son of a scientific researcher, Dr. Parikh and his family moved often. His father passed along his love of science to Dr. Parikh and inspired him to pursue a career in medicine. "My father often reminded us that we should always do more to help people and to go beyond what is expected of us." While in high school, Dr. Parikh was accepted into the prestigious Honors Program in Medicine Education at the University of Miami in Florida, a dual-degree program that allowed him to receive a both a Bachelor of Science and a Doctor of Medicine. After completing medical school, Dr. Parikh did his residency and internship at Miriam Hospital, which is associated with Brown University in Providence, Rhode Island, where he received "The Best Teaching Resident Award" two years in a row.

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Internal Medicine Interest Group of the Month: Texas Tech University Health Sciences Center Paul L. Foster School of Medicine

The IMIG at the Paul L. Foster School of Medicine assist the El Paso County Medical Society with their production of the public television program The El Paso Physician. This monthly program provides health information to the community on a wide variety of topics presented by a panel of local physicians and healthcare administrators.

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Ask the Program Director: International Rotations

Are international experiences valued in a residency application? What types of international experiences do program directors prefer to see from an applicant (clinical work abroad, medical courses in other languages, medical mission trips, etc)? How does an international experience contribute to a candidate´s overall application?

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Advocacy Update: Supreme Court Hears Oral Arguments Against Health Care Reform

From March 26 to 28 the Supreme Court heard oral arguments in the case against several key elements of the health care reform law, the Affordable Care Act. The three days of arguments covered the constitutionality of both the "individual mandate" and Medicaid expansion that are included in the law. The court is expected to issue a decision in the case sometime in June.

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Winning Abstracts from the 2011 Medical Student Abstract Competition: Rheum for Debate

Felty's Syndrome (FS) is classically defined as a triad of rheumatoid arthritis, splenomegaly, and neutropenia, and is found in 1-3% of patients with rheumatoid arthritis. First described in 1924 there are new definitions and concurrent debate over therapy. There are no randomized control trials on treatment of Felty's syndrome; current goals of treatment focus on increasing the neutrophil count, preventing infections, addressing the splenomegaly, and/or treatment of rheumatoid arthritis

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Subspecialty Careers: Endocrinology, Diabetes, and Metabolism

Endocrinology is the diagnosis and care of disorders of the endocrine system. The principle endocrine problems include goiter, thyroid nodules, thyroid dysfunction, diabetes mellitus, hyper- and hypocalcemia, adrenal cortex dysfunction, endocrine hypertension, gonadal disorders, disorders of sodium and water balance, manifestations of pituitary disorders, disorders of bone metabolism, and hyperlipidemia. While not strictly an endocrine disorder, obesity is considered part of the spectrum of endocrinology because it often enters into the differential diagnosis of endocrine disease and is a major element in the management of type 2 diabetes. Prevention focuses on the complications of obesity, diabetes, hyperlipidemias, thyroid disease, and the iatrogenic effects of glucocorticoids.

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In the Clinic: Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA), the complication of diabetes mellitus that causes the greatest risk for death, is characterized by hyperglycemia and metabolic acidosis due to the accumulation of ketones from the breakdown of free fatty acids. Treatment requires hospitalization to correct hyperglycemia as well as serious volume depletion and electrolyte abnormalities. DKA occurs primarily in patients with type 1 diabetes mellitus but can also occur in those with type 2 diabetes. In a multicenter study of nearly 15 000 children and adolescents, DKA was the initial presentation of type 1 diabetes for 21.1%, and this proportion did not change substantially from 1997 to 2007 (1).

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In the Clinic is a monthly feature in Annals of Internal Medicine that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care. Many internal medicine clerkship directors recommend this series of articles for students on the internal medicine ambulatory rotation.

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What's the diagnosis?

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Highlights from ACP Internist® & ACP Hospitalist®

Mobile devices offer advantages, challenges
Internists are piecing together technology to improve their practice management, but too many pieces are more of a puzzle than a picture. All the new devices ultimately need to lead to better care, the experts urge.

Gray Matters: Decisional conflict: Balancing risks, benefits for each patient
A 73-year-old man struggles with the decision to consider anticoagulation for atrial fibrillation, a "decisional conflict" that affects many trying to balance risks and rewards of medical treatments. Doctors should help the patients choose, but then abide by that decision.

Transitions of Care: Take the C-TraIn: Hospital-funded transitions-of-care program targets underserved patients
Oregon Health & Science University helped improve transitions by paying community clinics to serve as medical homes for low-income patients.

Clostridium difficile infections on the increase
In 2010 I predicted that Clostridium difficile would become a household name. C. diff. is a bacterium that infects the colon causing severe, sometimes life-threatening, diarrhea. C. diff infection is frequently a complication of antibiotic use. Antibiotics can kill the normal bacteria in the colon and establish an opportunity for C. diff to proliferate. After a course of antibiotics, a person can remain susceptible for a few months, and subsequent exposure to C. diff, usually in a health care setting, can lead to infection.

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