管家婆心水论坛

November 2014

Register Today for ACP's 100th Anniversary Internal Medicine Meeting!

Register for Internal Medicine 2015 by January 31 to receive the lowest registration rate. Join ACP and thousands of your colleagues in Boston, Massachusetts, from April 30 - May 2, 2015 and transform the way you practice medicine. Internal Medicine 2015 will allow you multiple opportunities to refresh your internal medicine knowledge, sharpen your practice management skills, network with colleagues from around the world in a beautiful location.

For the 100th anniversary, ACP is offering special registration and delegation rates for many international attendees. ACP members in low income/low middle income countries and upper middle income countries, as defined by the World Bank Economic Indicators, will be offered these special discount registration rates for ACP Internal Medicine 2015 in Boston. Discounts will apply to individual registrations as well as group delegations.

To see the individual registration rates by country of residence, visit the International Rates page .

Consider forming a delegation of 10 or more attendees to receive the greatest registration discounts. More information can be found on ACP's website at .

If you have questions, please contact internationaloffice@acponline.org.

 

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Spanish Language Interpretation of Select Courses at IM 2015

This year, for the first time, ACP will be offering simultaneous interpretation of select scientific courses for attendees who would prefer to hear lectures in Spanish. Headsets will be available for pickup onsite for those who are interested. The courses that will be interpreted into Spanish include:

Friday, May 1, 2015

  • Update in Hospital Medicine - 8:15-9:15 AM
  • Update in Critical Care - 9:30-10:30 AM
  • Update in Women's Health - 11:15-12:45 PM
  • Update in Cardiology - 2:15 - 3:45 PM

Saturday, May 2, 2015

  • Update in Geriatric Medicine - 8:15-9:15 AM
  • Update in Nephrology - 9:30-10:30 AM
  • Update in Infectious Diseases - 11:15-12:45 PM
  • Update in Pulmonary Medicine - 2:15-3:45 PM

All courses will be conveniently located in Ballroom East of the Convention Center.

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Internal Medicine: Global Perspectives

Martin Herrera-Cornejo, MD, MSc, MBA, FACP
Governor, ACP Mexico Chapter

 

Mexico is a federal republic in North America comprised of thirty-one states and a Federal District, the country's capital Mexico City. The country is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of Mexico. Covering over 760,000 sq mi, Mexico is the fifth largest country in the Americas. With an estimated population of over 113 million, it is the eleventh most populous and the most populous Spanish-speaking country in the world.

Mexico has one of the world's largest economies. It is the largest silver producer and tenth largest oil producer in the world, and has the 23rd highest income from tourism in the world, and the highest in Latin America. According to the World Tourism Organization it is the most visited country in the Americas, after the United States. The most notable attractions are the Meso-American ruins, cultural festivals, colonial cities, nature reserves and the beach resorts. High altitudes prevail throughout the Mexican central and northern territories which are home to four different mountain ranges, and the Tropic of Cancer effectively divides Mexico into temperate and tropical zones, producing one of the world's most diverse weather systems.

*source: Wikipedia

 

Dr. Herrera, what made you want to become a doctor?

When I was young, I was intrigued by science, especially biology. As I got older, I wanted to learn more and more about the human body and how to diagnose illness.

Why did you choose internal medicine?

I chose Internal Medicine because the related subspecialties intrigued me. I also liked the depth and breadth of it and evaluating and treating the patient as a whole was important to me.

In what area of medicine-clinical practice, education, or administration-do you spend most of your time?

I dedicate most of my time to management and education. I have been Head of Internal Medicine at Hospital Juarez de Mexico for 23 years.

What do you enjoy most about the work that you do?

I enjoy planning medical education meetings, preparing strategies to improve the quality of medical care, and lecturing.

What is the role of the internist in Mexico (e.g. primary care, specialist, consultant)? What are the education and training requirements needed to practice internal medicine?

In Mexico, the role of the internist depends on where we work. In hospitals we act as specialists and consultants and treat patients with various diseases and co- morbidities. In clinics or offices we act as specialists or primary care physicians.

In Mexico, internal medicine residents must be approved and are required to pass a national exam. Approximately 1 in 10 applicants are selected. Then, they complete a four-year university program where they have contact with patients and perform procedures related to their specialty.

What illnesses and problems do internists in your country treat most often? Are there any trends in chronic illness or disease that you are particularly concerned about?

We attend patients suffering from obesity, systemic arterial hypertension, metabolic syndrome, type 2 diabetes mellitus, dyslipidemias, chronic obstructive pulmonary disease, chronic renal failure, pneumonias, several thrombosis, strokes, etc.

Do internists work most often in private offices or in hospital settings? To what extent do physicians and hospitals use electronic health records?

Most internists work in public hospitals, but the number of physicians in private hospitals and in private offices is increasing, a trend that is expected to continue. The use of electronic health records is increasing and making the work easier. having access to a database is very important. Now we can see medical images and laboratory reports from our electronic devices.

Does everyone in Mexico have access to health care? Who pays for health care services-patients, employers, or the government?

Yes, everyone in Mexico has access to health care through the Mexican Institute of Social Security (IMSS), State Workers's Institute of Services and Social Security (ISSSTE) and Popular Insurance from the Health Ministry (SS). It is a combined payment system, by a tripartite commission (goverment, employers and patients) in IMSS and ISSSTE, and by contributions from goverment and patients in Popular Insurance.

Are enough young physicians choosing to be internists? What makes them choose (or not choose) to practice internal medicine?

Currently, there are still enough, but each year there are fewer applicants. Those who select internal medicine do so because it is such an interesting field, but others are discouraged due to the low-incomes related to internal medicine

Is access to the internet or social media influencing the patient-physician relationship?

Yes, definitely. Patients are better informed, but are also more demanding.

What are some of the most significant challenges that physicians in your country face? What are your thoughts on the best way to meet those challenges?

Because patients are more informed, there is an increasing demand for services and we must do more with less. We must find ways to be more efficient and effective, and continue updating our knowledge for best practice.

What do you consider to be the best aspects or attributes of the Mexican healthcare system?

Social security for the majority of our population is a huge benefit, but there is still a percentage of patients who are not covered.

What goals and objectives do you have in your role as Governor of ACP's Mexico Chapter? Are there any specific achievements or plans you'd like to share?

My goals are to increase our membership and promote the ACP and Mexico Chapter activities. Soon, we'll have webinars on several topics. We will continue our meetings and begin with periodic publications, including books.

What have you enjoyed most about being an ACP Governor?

The various ACP activities and interacting with members of my Class (2016) and College members worldwide.

Why is it important for physicians to belong to professional organizations like ACP?

The ACP provides a lot of resources and helps us improve our practice. I am proud to belong to this organization, one of the greatest in the world.

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Available now: ACP Smart Medicine module on Ebola and Marburg viruses

In response to the recent outbreak of the Ebola virus, ACP 's module on Ebola and Marburg viruses is being offered free to all members of the health care community and the public at large. The is designed to help physicians treat patients who present with fever and nonspecific symptoms and who traveled to rural sub-Saharan Africa or had possible occupational exposure.

ACP Smart Medicine is a Web-based clinical decision support tool developed specifically for internal medicine physicians and contains 500 modules that provide guidance and information on a broad range of diseases and conditions. The Ebola module and other disease-related modules include helpful glossaries for clinical terms and acronyms and provide evidence-based recommendations concerning prevention, screening, diagnosis, therapy, consultation, patient education, and follow-up.

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Update Your Knowledge with MKSAP 16 Q & A

The new Medical Knowledge Self-Assessment Program庐 (MKSAP庐 16) provides you with the most current and critical information in the core of internal medicine and its subspecialties so you can stay aware of what you need to know as a practicing physician in internal medicine today.

For more information on MKSAP 16, or to order your copy, visit

MKSAP 16 Q & A

A 78-year-old-woman is evaluated in the emergency department after she fell at home last night. She has long-standing sleeping difficulties and last night got out of bed and fell in her hallway. She had no loss of consciousness and notes left hip pain. She has hypertension, hyperlipidemia, and gastroesophageal reflux disease. Her current medications are lisinopril, simvastatin, and omeprazole.

On physical examination, she is afebrile. Blood pressure is 142/82 mm Hg supine and 138/76 mm Hg standing, and pulse rate is 76/min supine and 78/min standing. She appears frail with generalized weakness. There is mild tenderness in the left lateral hip and weakness of the quadriceps muscles bilaterally. There are no ecchymoses in the left hip area. She is slow getting up from a chair and has a slow walking speed but no ataxia. Distance vision using glasses without bifocal lenses evaluated with a Snellen chart is normal. There is mild difficulty with near vision evaluated using a near-vision testing card. Lungs are clear. The heart rhythm is regular with no murmur. There is no focal neurologic deficit. Radiograph of the left hip and femur reveals no fracture.

Acetaminophen is prescribed for pain. Arrangements are made for home physical therapy and for a visiting nurse to perform a home safety evaluation.

Which of the following is the most appropriate additional management of this patient?

A. Discontinue lisinopril
B. Prescribe vitamin D
C. Prescribe zolpidem at bedtime
D. Refer for prescription glasses with bifocal lenses

Click here for the answer and critique.

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ACP Leaders on the Road: South Korea

David A. Fleming, MD, MA, MACP
World Congress of Internal Medicine
October 25-28, 2014

I had the honor of representing the College at the 32nd World Congress of Internal Medicine (WCIM) October 25-28, 2014 in Seoul, South Korea. This year's theme of "Internal Medicine & Beyond: Toward a Healthier World" encompassed a broad range of public and population health concerns, including the burden of non-communicable disease, travel medicine, end of life care, issues on aging, the impact of culture and environment on health, and the future of medicine and internal medicine training. There were 7,348 attendees from 71 countries and faculty from over 30 countries, including 16 from the U.S. The WCIM is a bi-annual meeting, each time held in a different country and sponsored by the International Society of Internal Medicine (ISIM). The site of the WCIM is determined by a competitive bid by ISIM member organizations and awarded based on recommendations by the ISIM executive committee, then voted on by the Assembly of members that occurs at each Congress. Selections are made several years in advance. This year very slick oral and video presentation bids were heard from Russia and Mexico. The final vote was to hold the 2020 WCIM in Cancun, Mexico. Future meetings are scheduled for Bali, Indonesia in 2016 and South Africa in 2018. Another exciting turn of events during the Assembly is that our own Virginia Hood (past president of ACP) was elected to the ISIM Executive Committee. It's great that we will continue to be well represented.

Each World Congress is typically co-sponsored by the local society or college of internal medicine, which this year was the Korean Society of Internal Medicine (KSIM). The KSIM held their annual meeting during the WCIM and was heavily attended by many Korean young internists and residents due to the "board review" format and meaty scientific content of each session. Over 50 grants and awards were provided for travel, poster competition, and young investigators, which significantly bolstered the involvement of their young membership. The Congress provided a wonderful and energetic atmosphere of learning in each session, especially in and around the poster display and contest. One consistent theme I have found in the international meetings I have attended is the substantive presence of residents and young physicians, much as we experience at Internal Medicine each year.

I was asked to give a lecture on "Future Directions of Internist Training" and also joined speakers from Japan, Korea and Australia to offer perspectives on the "Past, Present, and Future of Internal Medicine" in our respective countries. These were robust discussions with a high level of interest in what ACP is doing to foster high value care, expand the primary care work force, and deal with the expanding health care needs of our aging population. There was also a curious interest in the singular challenge U.S internists are having in meeting requirements of maintenance of certification compared to the rest of the world. My comments on physician burnout resonated with internists from many other countries dealing with similar concerns. One constant theme as I visit with internists from around the world is the depth of respect and appreciation for ACP and what we represent in providing leadership and resources in education, practice support, professional development, and policy development. The Physician's Charter that we (ACP Foundation) coauthored in 2002 with the American Board of Internal Medicine (ABIM) Foundation and the European Federation of Internal Medicine has been held up not infrequently as an example of what we are doing to foster professionalism in practice and training around the world.

My experience at the WCIM is added to a long list of wonderful experiences I have had in representing ACP internationally. It is important that we continue to remind ourselves that ACP is a critically important citizen of the world health community. We are looked upon to provide leadership and substance to the efforts of internists worldwide to serve society and make the lives of patients better. I can't thank you enough for the opportunity to serve in this way.

Pictured: Leaders present at the World Congress of Internal Medicine. David A. Fleming, MD, MA, MACP is seated front row, far right.

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ACP Leaders on the Road: Abu Dhabi, UAE

Molly Cooke, MD, MACP, Immediate Past President, ACP
Sheikh Khalifa Medical City Multispecialty Conference
October 28 - November 1, 2014

It was an honor for me to attend the Sheikh Khalifa Medical City (SKMC) Multispecialty Conference: Board Reviews and Clinical Updates, 2014, held October 28 - November 1, 2014 at the Beach Rotana Hotel in Abu Dhabi, United Arab Emirates. The conference focused on providing the latest, evidence-based information in a case-based format across a wide range of clinical areas within Internal Medicine and Pediatrics. The goals of the program were to complement and extend the clinical training of residents and to assist in the preparation of clinical practitioners for the board certification and recertification examinations. The conference was sponsored and endorsed by the Abu Dhabi Health Services (SEHA) and the 管家婆心水论坛. Approximately 750 attendees registered for the meeting. I presented two sessions, one focusing on Doctors of the Future and another on Common Outpatient Internal Medicine Problems. ACP also exhibited at the meeting and attendees demonstrated a great deal of interest in ACP membership and its products and services, particularly its Medical Knowledge Self-Assessment Program庐 (MKSAP庐 16).

Pictured: Molly Cooke, MD, MACP, Immediate Past President, ACP and Bisher Mutafa, MD, Head of Internal Medicine Scientific Committee, SKMC Multispecialty Conference, and Program Director, Internal Medicine Residency, Sheikh Khalifa Medical City.

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Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in Taiwan and Panama City.

A complete list of other Future Worldwide Internal Medicine Meetings is available here.

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New International Fellows

ACP is pleased to announce the following newly elected International Fellows, who were recommended by the Credentials Committee and approved for election by the Board of Regents as of November 1, 2014. They are listed by current location and may have been credentialed through a different Chapter.

Canada

  • Isabelle Hebert, MD, FACP - Quebec

Colombia

  • Jose Javier Arango-Alvarez, MD, FACP - Armenia Quindio

  • Virgil Carballo Zarate, MD, FACP - Cartagena Bolivar
  • Ana Maria Granada Copete, MD, FACP - Bogota
  • Alvaro Granados, MD, FACP - Cucuta Norte De Santander
  • Gabriel Martinez Arciniegas, MD, FACP - Bogota
  • Ramon Murgueitio, MD, FACP - Bogota
  • Alex Arnulfo Rivera Toquica, MD, FACP - Pereira, Risaralda
  • Rita Magola Sierra, MD, FACP - Cartegena Bolivar

  • Walter Hernando Villalobos, MD, FACP - Chia Cundinamarca

England

  • Abdelnassir M. Abdelgabar, MBBS, FACP - Cleethorpes

Guatemala

  • Joaquin E. Ligorria, MD, FACP - Guatemala City

India

  • Ranjit Mohan Anjana, MBBS, MD, PhD, FACP - Chennai

  • Shashi B. Gupta, MBBS, MD, FACP - Mumbai
  • Srinivasan A. Kasthuri, MD, FACP - Bangalore
  • Nikhil S. Kulkarni, MD, FACP - Mumbai
  • Jatinder Kumar Mokta, MD, FACP - Shimla
  • R. N. Sarkar, MD, FACP - Kolkata
  • Kuljeet Singh Anand, MD, FACP - Delhi

  • Ranjit Unnikrishnan, MBBS, MD, FACP - Chennai

Indonesia

  • Simon Salim, MD, FACP - Tangerang Banten

Japan

  • Takeshige Kunieda, MD, FACP - Hashima Gifu

Mexico

  • Mario A. Santoscoy-Gomez, MD, FACP - Mexico DF

Panama

  • Ana Belen Arauz Rodriguez, MD, FACP - Panama

  • Alfonso V. Gordon, MD, FACP - Panama
  • Gaspar M. Perez Jimenez, MD, FACP - Panama

  • Miguel A. Mayo De Bello, MD, FACP - Panama

Philippines

  • Priscilla B. Caguioa, MD, FACP - Quezon City

Saudi Arabia

  • Wafa A. Ababtain, MD, FACP - Dammam

  • Hamza Hussein Al-Badr, MBBS, FACP - Madina
  • Ali M. Albarrak, MBBS, FACP - Riyadh

  • Aamir N. Sheikh, MBBS, FACP - Riyadh

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist October 2014


  • The challenge in diabetes treatment used to be getting patients' blood glucose low enough. But recent evidence has shown that, at least for elderly diabetics, hypoglycemia may be as much or more of a problem as hyperglycemia.
     

  • Palliative care doctors are working on introducing the concept of palliative care across disciplines, with a particular focus on primary care. The goal is to introduce it earlier in the process of patient care, and earlier in the educational process of the physicians themselves.
     

  • Physicians should focus not only on influenza vaccinations but on treating patients who will get the disease whether they have been vaccinated or not.
     

ACP Hospitalist October 2014


  • Strategies for achieving efficient, high-quality care.
     

  • First-rate communication is key.
     

  • Once seen as children's diseases, one-fourth of cases are now diagnosed in adulthood.
     
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    MKSAP 16 Answer & Critique

    Answer: B, Prescribe vitamin D

    Educational Objective: Manage a fall in an elderly patient.

    Critique: In this patient with generalized weakness as well as leg muscle weakness, slow gait, and a recent fall, it is appropriate to prescribe vitamin D. Vitamin D deficiency increases the risk for falls in the elderly and vitamin D supplementation reduces this risk. According to U.S. Preventive Services Task Force recommendations, vitamin D supplementation can be prescribed without first obtaining a serum vitamin D level for patients with an increased risk of falling. The proposed mechanism of action of vitamin D is its beneficial effect on muscle strength and function and on gait. Although calcium supplementation may have a beneficial effect on bone loss, there is no clear benefit to adding calcium in reducing falls.

    Discontinuing lisinopril is not appropriate because she does not demonstrate orthostatic blood pressure changes that would account for her fall, and discontinuing antihypertensive medication would likely result in elevated blood pressure.

    Zolpidem is a nonbenzodiazepine sedative hypnotic with a short half-life that can be prescribed for a limited time period for insomnia. Caution must be exercised, however, because of adverse effects, including an increased risk for falls, especially among older adults. Reviewing sleep hygiene would be a better first step in managing her insomnia.

    Although this patient demonstrates a mild near-vision deficit, it is not likely that this deficit contributed significantly to her fall. Furthermore, bifocal lenses are associated with an increased risk for falling. If needed, reading glasses could be obtained.

    Key Point: Vitamin D supplementation reduces the risk for falls in elderly patients, and can be prescribed without obtaining a serum vitamin D level in patients with an increased risk of falling.

    Bibliography:

    Kalyani RR, Stein B, Valiyil R, et al. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc. 2010;58(7):1299-1310. [PMID: 20579169]

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