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PubMed1985

The Second International Reference Preparation of Thyroid-Stimulating Hormone, Human, for Immunoassay: calibration by bioassay and immunoassay in an international collaborative study.

Four batches of ampouled materials in ampoules coded 80/558, 81/502, 81/565 and 81/615 were evaluated by 22 laboratories in nine countries in an international collaborative study for their suitability to serve as a replacement for the First International Reference Preparation (IRP) of TSH, Human, for Immunoassay. The ampouled preparations were calibrated by immunoassay and bioassay. The preparation coded 80/558 had satisfactory stability and contained acceptably low levels of contamination with FSH and LH. Estimates of the immunoreactive TSH content of a set of specimens of serum in terms of 80/558 showed agreement in ranking order and no increase in variability compared with estimates made by assay against the First IRP. On the basis of these results, with the agreement of the participants in the study, and with the authorization of the Expert Committee on Biological Standardization of the World Health Organization, the preparation coded 80/558 was established in 1983 as the Second International Reference Preparation of TSH, Human, for Immunoassay, with a defined potency of 37 mi.u./ampoule. Preparations coded 81/502, 81/565 and 81/615 were found suitable to serve as working standards.

Humans↗
PubMed2006

Fostering international collaboration in birth defects research and prevention: a perspective from the International Clearinghouse for Birth Defects Surveillance and Research.

The International Clearing-house for Birth Defects Surveillance and Research, formerly known as International Clearinghouse of Birth Defects Monitoring Systems, consists of 40 registries worldwide that collaborate in monitoring 40 types of birth defects. Clearinghouse activities include the sharing and joint monitoring of birth defect data, epidemiologic and public health research, and capacity building, with the goal of reducing disease and promoting healthy birth outcomes through primary prevention.We discuss 3 of these activities: the collaborative assessment of the potential teratogenicity of first-trimester use of medications (the MADRE project), an example of the intersection of surveillance and research; the international databases of people with orofacial clefts, an example of the evolution from surveillance to outcome research; and the study of genetic polymorphisms, an example of collaboration in public health genetics.

Abnormalities, Drug-Induced↗
PubMed1986

Lobbying for international health: the link between good ideas and funded programs: Bread for the World and the Agency for International Development.

Historically, the Agency for International Development (AIDS) health budget has been closely tied to overall development spending. A large increase in the international health appropriations in 1984 broke this pattern. Investigation shows that active grass roots organizing and congressional lobbying are the most likely responsible factors in the increase. Maintenance and expansion of this success will require increased recognition of and participation in these activities by individuals and organizations involved in international health.

Child Health Services↗
PubMed2005

A curricular initiative for internal medicine residents to enhance proficiency in internal jugular central venous line placement.

OBJECTIVE: To determine the feasibility, efficacy, and outcomes of teaching Internal Jugular (IJ) central venous line placement (CVLP) to internal medicine residents in a hands-on training experience with adult patients. SUBJECTS AND METHODS: Data were obtained from 47 residents during their 3-year residency program through questionnaires and a proprietary system that tracks resident procedures. Twenty-five postgraduate year (PGY) 2 residents at the Mayo Clinic in Rochester, Minn, were assigned to IJ-CVLP training in the cardiac catheterization laboratory from January 2001 to June 2001. Their experience, analyzed immediately after training and at completion of residency, was compared with that of 22 PGY-2 residents in the same class who were not assigned to IJ-CVLP training. RESULTS: The median Likert scores of the residents' self-reported perception of independence in IJ-CVLP increased from 3.0 (mean +/- SD score, 2.8+/-1.4) before the intervention to 5.0 (4.4+/-0.9) after the intervention (P<.001, signed rank test). At graduation, trained residents had performed more IJ-CVLPs than the control residents (mean +/- SD, 17.8+/-8.4 vs 9.8+/-6.3, respectively; P<.001). Residents who received IJ-CVLP training, compared with those who did not, showed a significant increase in the mean percentage of IJ-CVLPs performed independently between PGY-1 (2.2%) and PGY-3 (31.2%) (P=.008). CONCLUSIONS: Training internal medicine residents to perform IJ-CVLP is feasible in the cardiac catheterization laboratory with supervision from an attending cardiologist. Trained residents performed significantly more IJ-CVLPs independently during their third year compared with their first year of training. We believe this initiative may be implemented successfully in graduate medical education curriculums.

Adult↗
PubMed2004

In-house calibration of the international sensitivity index or calibration curve for determination of the international normalized ratio.

CONTEXT: The international normalized ratio (INR) has been used since 1983 to standardize prothrombin time results for patients on oral anticoagulants. However, significant interlaboratory variations have been noted. Attempts have been made to address these differences with the use of instrument-specific International Sensitivity Index (ISI) values and in-house calibration of ISI values. OBJECTIVE: To assess the performance of laboratories using a calibration curve for INR testing. DESIGN: Attempts to improve performance of the INR include the use of instrument-specific ISI values, model-specific ISI values, in-house calibration of ISI values, and more recently, the preparation of a calibration curve. Several studies have shown an improvement in performance using these procedures. In this study of licensed laboratories performing routine coagulation testing in the Province of Ontario, Canada, the determination of the INR by a calibration curve was compared with the laboratories' usual method of assessment. These methods were subsequently analyzed by comparing the results to instrument-specific ISI, model-specific ISI, and in-house calibrators. International normalized ratios derived by both methods were analyzed for accuracy and precision. The stability of a calibration curve was also investigated. RESULTS: Performance of INR testing has improved with use of a calibration curve or in-house calibrators. CONCLUSION: The results confirm that either in-house calibrators or the calibration curve improve performance of INR testing. The calibration curve may be easier to use and appears stable up to 4 months.

Calibration↗
PubMed1986

National Study of Internal Medicine Manpower: X. Internal medicine residency and fellowship training: 1985 update.

The number of medical school graduates entering internal medicine residency training was at an all-time high in 1984-85. Although the number of first-year residents who were foreign-trained physicians did not differ greatly from the 1983-84 census, the number of first-year residents who were U.S. medical school graduates was much higher than the previous year largely because the number of graduates from U.S. medical schools increased substantially in 1984. The number of internal medicine fellowship programs and the number of fellows in 1984-85 were also at an all-time high. Foreign-trained physicians represent 22% of those in residency training and 20% of those in fellowship training. Of every 100 who completed residency training, 61 went on to a first year of subspecialty fellowship training, a number up slightly from the previous year. The increasing numbers of residents and fellows being trained in internal medicine, combined with the preference for subspecialization and the substantial proportion of foreign-trained physicians being trained, are discussed against the background of pending legislation to reduce federal assistance for graduate medical education.

Education, Medical↗
PubMed1987

National Study of Internal Medicine Manpower: XI. Internal medicine residency and fellowship training in the 1980s.

The number of residents beginning training in internal medicine continued to increase slightly in 1985-86. However, the total number of residents in internal residency training decreased slightly from the previous year due to a decrease in the number of second- and third-year residents. The proportion of first-year residents who were foreign-trained physicians decreased from 21% to 20%, and the proportion of residents who finished training and went on to subspecialty training in 1985 decreased substantially to 56%. The number of physicians entering residency and fellowship training in internal medicine considerably exceeds the number projected by the Graduate Medical Education National Advisory Committee. In this article, we discuss implications of these trends for medical education and practice.

Fellowships and Scholarships↗
PubMed1989

National Study of Internal Medicine Manpower: XV. A decade of change in residency training in internal medicine.

We report on trends in the characteristics of residency training programs in internal medicine from 1976 to 1988 and make some comparisons with other specialties. Internal medicine is faring less well in the residency match compared with other specialties than it did 10 years ago. It has also increased the number of residency positions offered more than other major specialties. A sizable proportion of first-year residency positions in internal medicine are not filled through the Match. Foreign medical graduates account for almost 50% of the first-year resident (R1) positions filled outside the Match. Programs most dependent on foreign medical graduates are in hospitals with limited medical school affiliation, smaller size, operated by churches or the Veterans Administration, and located in eastern states and large metropolitan areas. Despite concerns about quality and oversupply, almost 50% of the program directors expected to increase the size of their programs in 1988-1990. Residents are not being scheduled for fewer hours per week than they were 12 years ago but they are being scheduled for fewer nights. No trends were noted toward increased ambulatory care training sites away from the hospital campus.

Ambulatory Care↗
PubMed1992

National Study of Internal Medicine Manpower: XIX. Trends in internal medicine residency training programs.

The National Study of Internal Medicine Manpower (NaSIMM) reports on the results of its 1989-1990 census of residency programs. The results are integrated into an organizational model identifying inputs, process, outputs, and environment of medical training programs. The number of residents entering internal medicine continues to grow at a relatively rapid pace. This growth is largely accounted for by foreign citizens who are graduates of foreign medical schools (AFMGs). Residents are spending an increasing proportion of their time in ambulatory care settings, but, thus far, this ambulatory care training has occurred primarily in hospital clinics and emergency rooms. The proportion of a program's residents entering general internal medicine was found in a multiple regression analysis to be negatively associated with the number of subspecialty programs located in the training hospital, the percent of AFMG residents in the program, and the presence of a preliminary track in the program.

Career Choice↗
PubMed1979

A national study of internal medicine and its specialties: I. An overview of the practice of internal medicine.

A nationwide study of 24 medical and surgical specialties has been conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. This article is the first in a series reporting findings for general internal medicine and 10 subspecialties of internal medicine. Populations for these 11 specialties are defined and enumerated, and the specialties are compared in terms of demographic and geographic distribution. Practice comparisons are presented based on characteristics such as workload, allocation of professional time, location of encounters with patients, distribution of primary problem diagnoses, and projections of annual patient encounters. Forthcoming specialty-specific articles will present highly detailed information for general internal medicine and for the subspecialties of cardiology, gastroenterology, pulmonary disease, allergy, hematology, endocrinology, nephrology, medical oncology, rheumatology, and infectious diseases.

California↗
PubMed1979

A national study of internal medicine and its specialties: II. Primary care in internal medicine.

A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.

Consultants↗
PubMed2002

[Basic directions and prospects for international collaboration in gerontology. Role of the International Association of Gerontology].

The overview presents data on the international collaboration in gerontology in the following spheres: 1) organizational basis of collaboration; 2) coordination of research; 3) coordination in the training of specialists; 4) collaboration in the organization of geriatric services; 5) collaboration in social care for the elderly. Role of the International Association of Gerontology and other international organizations in the promotion of gerontology and geriatrics in each of these spheres is shown by the example of Russia.

Aged↗
PubMed2002

Aims of the 3rd international course on the Law of Armed Conflict of the International Committee for Military Medicine.

The International Committee for Military Medicine (ICMM) decided at the 32nd Congress in Vienna in 1998 to give the Surgeon General of the Swiss Armed Forces the mandate to organize its international courses on the Law of Armed Conflict (LOAC). The Swiss Federal Government fully honored and endorsed its obligation to organize these important international courses. It is in the continuing tradition of Switzerland, as a small neutral state, to support humanitarian help and all efforts to prevent war. As decided by the head of the government on April 3, 1998, the mandate of the LOAC Courses will be funded by the Swiss Confederation.

Education, Medical, Continuing↗
PubMedDate not supplied

[Internal maxillary artery and collateral circulation in thrombosis of internal carotid artery (author's transl)].

From 53 cases of thrombosis of the internal carotid artery in the neck, collateral circulation through external carotid branches was angiographically demonstrated in 34 subjects. Anastomosis between external and intracranial circulations was seen to take place through three ways formed by internal maxillary, superficial temporal and facial arteries. The role of internal maxillary artery is emphasised as the most important pathway in the connections between the two circles.

Adult↗
PubMed2002

[Contribution of Galician hospitals to national and international Internal Medicine scientific meetings].

OBJECTIVES: To evaluate the scientific contributions of internal medicine services from Galicia to nationals and internationals specialty meetings and to describe theirs preferences in clinical research. MATERIAL AND METHOD: We analysed the communications from the Abstracts books of the last four Spanish Internal Medicine National Congress (1994-2000 period) in comparison with that of 1984, the last two European Congress (1999 and 2001) and the last World Congress (2000). Case reports were excluded. RESULTS: An increasing number of communicating hospitals and a sustained number of reports was observed with a minimum of 2 hospitals (1984) to a maximum of 12 (1996) with 5-6 hospitals on average. Number of communications became stable and reached 5% of the whole spanish reports. Cardiovascular and AIDS-Infectious diseases were the preferred research fields. CONCLUSIONS: An increment of scientific communications from a growing number of galician hospitals was observed. This scientific production became continuous and stabilized notoriously on cardiovascular and AIDS-infectious disease fields.

Bibliometrics↗
PubMed2003

Bilateral aberrant internal carotid arteries with bilateral persistent stapedial arteries and bilateral duplicated internal carotid arteries.

A 5-year-old boy was evaluated for a left retrotympanic mass found at otoscopy. Subsequent petrous bone CT and MR angiographic examinations demonstrated bilateral aberrant internal carotid, bilateral stapedial artery persistence, and bilateral duplicated internal carotid arteries. Imaging findings and their clinical relevance are discussed. A second case of unilateral aberrant internal carotid artery with a persistent stapedial artery is included for comparison.

Carotid Artery, Internal↗
PubMed2003

[An experimental evaluation of a hospital's internal clinical guideline system. Randomized, controlled crossover pilot study on the efficacy of Intranet-based guidelines for General Internal Medicine at the Park Clinic Weissenssee in Berlin]].

Randomised, controlled crossover pilot study on the efficacy of Intranet-based guidelines for General Internal Medicine at the Park-Klinik Weissensee in Berlin. As part of the evaluation programme for the intranet-based internal guideline system at the Park-Klinik Weissensee in Berlin, an experimental randomised, controlled trial was conducted in which 12 medical students in their final year were asked to solve 10 clinical vignettes each. A number of written and electronic sources of medical information was available. In addition, the students were allowed to use the internal guideline system for one half of the vignettes in a crossover fashion. There was a sample size-related non-significant trend in favour of the guideline system concerning the primary endpoint "time to right solution" (mean 2.8 min; 95% CI -1.6 to 7.3). A per-protocol-analysis revealed a great variability in the actual use of the guidelines available. There was an inverse "dose-response relationship" between the intensity of guideline usage and the endpoint.

Berlin↗
PubMed1989

[The department of general internal medicine--a model of synoptic internal medicine at a university with primary care responsibilities].

It is reported on the department of general internal medicine of the Friedrich Schiller University Jena and its position in the complex of the internal medical basic care. It is particularly dealt with the cooperation with the specialists for general medicine and the subspecialists. At this example the role of the "general" internal specialists and his tasks in care, research and education in a university clinic are discussed and the necessity of a profile determination is made clear.

Germany, East↗