关键词： asthma   sleep apnea   sleep apnea symptoms   pulmonary epidemiology   Berlin Questionnaire  

摘要： Background: Obstructive sleep apnea (OSA) and asthma are common and share similar nocturnal symptoms. We hypothesized that the prevalence of OSA symptoms would be greater in asthmatics compared to a general internal medicine population. Methods: Patients in the Asthma Clinics (n = 177) and Internal Medicine Clinics (n = 328) at MetroHealth Medical Center, an urban academic institution, were surveyed for OSA risk. Patients completed the Berlin Questionnaire, a validated questionnaire with a positive predictive value (ppv) of 0.89 for determining the presence of OSA in primary care populations. All asthmatics had spirometry performed. Results: The asthma group had more females (p = 0.01) and a higher mean body mass index (33.2 vs. 31.2 kg/m(2), p = 0.02). However, the percentage with a body mass index >30 kg/m(2) was not different between the groups (p = 0.19). The internal medicine group had a much higher rate of hypertension (p = 0.002) and diabetes (p < 0.001). Asthmatics were more likely to report frequent snoring (18.5% vs. 8.0%, p < 0.001) and chronic sleepiness (46.1% vs. 34.3%, p = 0.01). OSA risk, as determined by the Berlin Questionnaire, was higher in the asthma group than in the internal medicine group (39.5% vs. 27.2%, p = 0.004). In the asthma group, risk for OSA did not correlate with asthma severity (p = 0.183). Conclusions: This study suggests a possible association between asthma and OSA. There is a higher prevalence of OSA symptoms in an asthmatic population when compared to a primary care population, independent of the severity of the asthma. (C) 2007 Elsevier B.V. All rights reserved.

关键词： medical education   scholarship   research design   research methods   writing  

摘要： To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.

关键词： Anxiety   Cancer patients and suicide and depression   trait   Gastrointestinal  

摘要： Objectives: To evaluate state and trait form of anxiety and current depression in patients affected by gastrointestinal diseases. Methods: We studied 1641 outpatients with gastrointestinal disorders, consecutively referred to our Internal Medicine outpatients from 1997 to 2005. State and trait anxiety were assessed by the State and Trait Anxiety Inventory. Current depression was assessed by the Zung self-rating depression scale. Results: Among patients, 1379 (84.1%) showed state anxiety, 1098 (67%) showed trait anxiety and 442 (27%) showed current depression. The number of gastrointestinal diseases was directly correlated to state anxiety (p < 0.001) and trait anxiety (p = 0.04). Females showed higher levels of anxiety and depression than males (p < 0.001). State anxiety was related to food allergies (p < 0.001), small intestinal bacterial overgrowth (SIBO) (p = 0.001), Hp infection (p = 0.01) and ulcerative colitis in active phase (p = 0.03). Trait anxiety was related to irritable bowel syndrome (IBS) (p < 0.001), Helicobacter pylori (Hp) infection (p = 0.001), food allergies (p = 0.001) and SIBO (p = 0.001). Current depression was related to IBS (p < 0.001) and coeliac disease (p = 0.01), SIBO (p = 0.02). A predicted probability of 0.77 +/- 0.16 to have state anxiety, of 0.66 +/- 0.12 to have trait anxiety and of 0.39 +/- 0.14 to have depression was found in these patients. Conclusions: Most of the patients who seek medical consultation for gastrointestinal problems show an associated affective disorder. These patients should be managed by a team including gastroenterologists, psychologists and/or psychiatrists, or by a gastroenterologist having expertise in the treatment of psychological disorders.

关键词： Internal Medicine  

摘要： Background: Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. Objective: To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Design: Retrospective cohort study. Setting: State licensing board disciplinary actions against physicians from 1990 to 2006. Participants: 66 171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Measurements: Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. Results: 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions;the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. Limitations: The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. . Conclusion: Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board a

关键词： 内科学   教学理念   教学质量  

摘要： 笔者从事临床工作多年后开始内科学教学工作,通过对教学规律及教学方法的研究和和实践活动的总结,形成了部分内科学课堂教学理念.

关键词： 临床见习课   中医内科学   教学方法   改革   医学本科教育   临床实践   中医药院校   执业中医师  

摘要： 临床医学是一门实践科学，临床见习课是医学生向医生角色转换的开始，是医学理论向临床实践的过渡，是将医学生培养成为合格临床医生的关键。因此，临床见习在医学本科教育中具有重要的地位。临床见习涵盖内、外、妇、儿、针灸等多个学科，而我院中医内科学见习课是中医药院校的主干课程，临床见习课是该学科临床实践的第一阶段，对学生至关重要，通过临床见习可以巩固学生专业思想，激发学习中医的热情，为下一步毕业实习乃至成为合格的执业中医师打下坚实基础。

关键词： 健康   接地   神经细胞膜   生物电   科学家   意大利   电位器   内科学  

摘要： 人体是个大电容 1791年，意大利科学家加伐尼发现，在青蛙肌肉中也蕴藏着电能，他把这种电称为“生物电”，这便是生物电名字的由来。19世纪，内科学家用电位器测得神经细胞膜突然受到刺激时会产生0．1伏特电。至此，人们不再怀疑生物电的存在，而且确认任何生物体中都有生物电。

关键词： 肝硬化腹泻   七味白术散   中华医学会传染病   寄生虫病学分会   《中医内科学》   治疗   标准参照   中医诊断  

摘要： 1临床资料47例均为肝硬化腹泻患者,肝硬化诊断标准符合中华医学会传染病与寄生虫病学分会、肝病学分会联合修订的病毒肝炎防治方案。男31例,女16例;年龄15－70岁;病程15d－6月。主要临床表现为纳差、乏力、腹胀、腹泻,腹泻次数日3－10次。中医诊断标准参照《中医内科学》,符合泄泻诊断依据。[第一段]

关键词： 口腔内科学   医学基础   牙体硬组织非龋性疾病   复合树脂修复   牙周病学   牙体牙髓   疗效评估  

摘要： 龋病及牙体硬组织非龋性疾病20080567后牙复合树脂修复各类洞形4年临床疗效评估／叶楠…∥牙体牙髓牙周病学杂志．-007，17（5）．