Three Versus Six Months of Adjuvant Doublet Chemotherapy for Patients With Colorectal Cancer: A Multi-Country Cost-Effectiveness and Budget Impact Analysis.

Background: The Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority, less toxicity, and cost-effectiveness from a UK perspective of 3 versus 6 months of oxaliplatin-based chemotherapy for patients with colorectal cancer. This study assessed the cost-effectiveness of shorter treatment and the budget impact of implementing trial findings from the perspectives of all countries recruited to SCOT: Australia, Denmark, New Zealand, Spain, Sweden, and the United Kingdom.

Patients And Methods: Individual cost-utility analyses were performed from the perspective of each country.

Cerebrovascular complications of coccidioidomycosis meningitis: Case report and systematic review.

Coccidioidomycosis exposure is common in the southwest United States and northern Mexico. Dissemination to the meninges is the most severe form of progression. Although ischemic strokes are well-reported in these patients, other cerebrovascular complications of coccidioidomycosis meningitis (CM), as well as their treatment options and outcomes, have not been systematically studied.

Porosity Measurement of Low Permeable Materials Using Gas Expansion Induced Water Intrusion Porosimetry (GEIWIP).

Porosity measurement is a key factor to identify the hydraulic performance of low permeable porous materials (e.g. rock or concrete).

Lessons learned from rapid environmental risk assessments for prioritization of alien species using expert panels.

Limiting the spread and impacts of invasive alien species (IAS) on biodiversity and ecosystems has become a goal of global, regional and national biodiversity policies. Evidence based management of IAS requires support by risk assessments, which are often based on expert judgment. We developed a tool to prioritize potentially new IAS based on their ecological risks, socio-economic impact and feasibility of management using multidisciplinary expert panels.

Spiraling Out of Control.

A 22-year-old man presented to the emergency department on Christmas Day with a 5-day history of myalgias, cough, dyspnea, nonbilious emesis, and nonbloody diarrhea. Although he had been ill for several days, he ultimately sought treatment because of intractable vomiting. He reported feeling feverish, although he had not measured his temperature, and noted one episode of hemoptysis.

Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States Internal Medicine Residency Training.

Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards.

Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF-PRIME Internal Medicine Residency Program.

Problem: The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education.

Intervention: We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF).

How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study.

Purpose: Although residents trust interns to provide patient care, little is known about how trust forms.

Method: Using a multi-institutional mixed-methods study design, the authors interviewed (March-September 2014) internal medicine (IM) residents in their second or third postgraduate year at a single institution to address how they develop trust in interns. Transcript analysis using grounded theory yielded a model for resident trust.

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Purpose: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice.

Improved Recharge Estimation from Portable, Low-Cost Weather Stations.

Groundwater recharge estimation is a critical quantity for sustainable groundwater management. The feasibility and robustness of recharge estimation was evaluated using physical-based modeling procedures, and data from a low-cost weather station with remote sensor techniques in Southern Abbotsford, British Columbia, Canada. Recharge was determined using the Richards-based vadose zone hydrological model, HYDRUS-1D.

Identifying entrustable professional activities in internal medicine training.

Background: Entrustable professional activities (EPAs) can form the foundation of competency-based assessment in medical training, focused on performance of discipline-specific core clinical activities.

Objective: To identify EPAs for the Internal Medicine (IM) Educational Milestones to operationalize competency-based assessment of residents using EPAs.

Methods: We used a modified Delphi approach to conduct a 2-step cross-sectional survey of IM educators at a 3-hospital IM residency program; residents also completed a survey.

The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement.

Background: Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging.

Methods: We conducted a year-long quality improvement project involving internal medicine residents at an academic medical centre. Resident champions designed and implemented a discharge summary improvement bundle, which employed an educational curriculum, an electronic discharge summary template, regular data feedback and a financial incentive.

Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study.

Background: Graduate medical education programs assess trainees' performance to determine readiness for unsupervised practice. Entrustable professional activities (EPAs) are a novel approach for assessing performance of core professional tasks.

Aim: To describe a pilot and feasibility evaluation of two EPAs for competency-based assessment in internal medicine (IM) residency.

The effect of a resident-led quality improvement project on improving communication between hospital-based and outpatient physicians.

This article reports on a resident-led quality improvement program to improve communication between inpatient internal medicine residents and their patients' primary care physicians (PCPs). The program included education on care transitions, standardization of documentation, audit and feedback of documented PCP communication rates with public reporting of performance, rapid-cycle data analysis and improvement projects, and a financial incentive. At baseline, PCP communication was documented in 55% of patients; after implementation of the intervention, communication was documented in 89.

Antidepressants in the treatment of depression: the clinician and the controversy.

This article considers the controversy over the effectiveness of treatment with antidepressant medication versus placebo. In this journal issue, Kirsch and Low find that antidepressants were not clinically significantly more effective than placebo except possibly for persons with severe depression, as measured by score changes on the Hamilton Rating Scale for Depression (HAM-D). The present article summarizes some selected research studies that reach different conclusions, finding effective treatment outcomes with use of antidepressants, including a different meta-analysis of antidepressant drug trials that showed medication has a small, but nevertheless clinically significant effect over placebo use.

Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program.

Background: Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices.

Context And Purpose: To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data.

Educating generalists: factors of resident continuity clinic associated with perceived impact on choosing a generalist career.

Background: Fewer residents are choosing general internal medicine (GIM) careers, and their choice 5 be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career.

Methods: We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey-a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience.

Shifting indirect patient care duties to after hours in the era of work hours restrictions.

Purpose: Few data describe how often residents defer indirect patient care tasks to after hours or show whether residents report this time in duty hours logs. Thus, the authors examined how often residents perform one such task, discharge dictation, outside scheduled hours.

Method: The authors tracked all discharge summaries dictated by internal medicine residents at a single teaching hospital from January to June 2009.