Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.

Background: Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied.

Purpose: We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data.

Disruptions and satisfaction in internal medicine resident continuity clinic differ between inpatient and outpatient rotations.

Background: Little is known about whether assignment to simultaneous inpatient and outpatient clinical duties causes disruptions during internal medicine resident continuity clinic and impacts trainee satisfaction.

Purpose: Our purpose was to determine whether dual inpatient and continuity clinic responsibilities impact resident stress and document the number, type, and immediacy of interruptions in continuity clinics.

Methods: Methods included a prospective 2-residency survey of 70 internal medicine residents performing 240 half-day continuity clinic sessions.

Principles of effective consultation: an update for the 21st-century consultant.

Background: Little information in the literature exists to guide consult interactions between different medical specialties.

Methods: A total of 323 general internists, family medicine physicians, general surgeons, orthopedic surgeons, and obstetricians/gynecologists (OB/GYNs) from 3 academic medical centers completed a survey addressing their ideal relationship with consultants. Differences between surgeons and nonsurgeons were calculated using logistic regression, adjusting for location and trainee status.

Impact of perioperative cardiac assessment guidelines on management of orthopedic surgery patients.

Purpose: The study assessed whether the American College of Cardiology/American Heart Association (ACC/AHA) preoperative cardiac assessment guidelines impact patient management and predict major cardiac events in patients undergoing orthopedic surgery.

Subjects And Methods: We conducted a retrospective review of 338 consecutive orthopedic preoperative evaluations performed by internal medicine consultants. Major cardiac events were defined as myocardial infarction, congestive heart failure, and sudden cardiac death.

Changing habits of practice. Transforming internal medicine residency education in ambulatory settings.

Purpose: The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance.

Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis.

Oral pseudoephedrine is commonly used to treat symptoms of rhinitis and rhinorrhea, but its effect on blood pressure (BP) and heart rate (HR) remains uncertain. We assessed whether pseudoephedrine causes clinically meaningful elevations in HR or BP. We searched MEDLINE, EMBASE, and the Cochrane Library for English-language, randomized placebo-controlled trials of oral pseudoephedrine treatment in adults.

Interactive faculty development seminars improve the quality of written feedback in ambulatory teaching.

We performed a pre-post study of the impact of three 90-minute faculty development workshops on written feedback from encounters during an ambulatory internal medicine clerkship. We coded 47 encounters before and 43 after the workshops, involving 9 preceptors and 44 third-year students, using qualitative and semiquantitative methods. Postworkshop, the mean number of feedback statements increased from 2.

Competency in interpretation of 12-lead electrocardiograms: a summary and appraisal of published evidence.

Background: There have been many proposals for objective standards designed to optimize training, testing, and maintaining competency in interpretation of electrocardiograms (ECGs). However, most of these recommendations are consensus based and are not derived from clinical trials that include patient outcomes.

Purpose: To critically review the available data on training, accuracy, and outcomes of computer and physician interpretation of 12-lead resting ECGs.

Training and competency evaluation for interpretation of 12-lead electrocardiograms: recommendations from the American College of Physicians.

This paper is part 1 of a 2-part series on interpretation of 12-lead resting electrocardiograms (ECGs). Part 1 is a position paper that presents recommendations for initial competency, competency assessment, and maintenance of competency on ECG interpretation, as well as recommendations for the role of computer-assisted ECG interpretation. Part 2 is a systematic review of detailed supporting evidence for the recommendations.

The teacher and learner interactive assessment system (TeLIAS): a new tool to assess teaching behaviors in the ambulatory setting.

Background: There are no objective tools to assess ambulatory teaching, an increasingly important component of medical education.

Purpose: To develop and describe an objective ambulatory teaching tool.

Methods: Exactly 30 consecutive ambulatory teaching encounters were audio taped.

Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting.

Objective: While several models of medical student instruction in the ambulatory setting exist, few have been formally studied. We wished to assess the impact of a faculty development workshop based on the One-Minute Preceptor model on the amount and quality of feedback in the outpatient setting.

Design: Ambulatory teaching behaviors were studied during consecutive outpatient precepting sessions before and after 3 faculty development workshops.

The effect of antidepressant treatment on chronic back pain: a meta-analysis.

Background: Back pain is one of the most common problems in primary care. Antidepressant medication is often prescribed, especially for chronic back discomfort, to alleviate pain and restore the patient's ability to conduct activities of daily living.

Objective: To assess the efficacy of antidepressants in treating back pain in adults.

Calcium channel antagonists.

Preview The success of calcium channel antagonists in controlling hypertension, angina pectoris, and arrhythmias is well known. In recent years, second-generation agents have been introduced that are also effective against migraine headaches and Raynaud's phenomenon and appear to improve atherosclerosis and congestive heart failure. The authors summarize the characteristics that calcium channel antagonists have in common and describe the specific niche filled by the newer agents, particularly those of the dihydropyridine class.