Journal of general internal medicine
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Diabetic acidosis (DA) and the diabetic hyperosmolar state (DHS) are generally considered to be two distinct clinical entities. However, clinical experience and the literature suggest that there may be some overlap. The purposes of this study were 1) to establish the proportion of overlap cases, 2) to identify any occurrence of DHS in diabetic patients under the age of 30 years (likely type I) and any occurrence of DA in diabetic patients over the age of 60 years (likely type II), 3) to describe clinical factors associated with the development of DA and DHS, and 4) to identify factors that influence the prognosis of DHS. ⋯ 1) many patients experience mixed DA (DKA) and DHS rather than either condition alone, 2) both DA (DKA) and DHS occur in young and old diabetic persons, 3) infection is the most common predisposing factor for either condition, and 4) higher osmolarity, older age, and nursing home residence are associated with nonsurvival in DHS.
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Comparative Study
Alumni perspectives comparing a general internal medicine program and a traditional medicine program.
To evaluate a primary care internal medicine curriculum, the authors surveyed four years (1983-1986) of graduates of the primary care and traditional internal medicine residency programs at their institution concerning the graduates' preparation. ⋯ These results suggest that the primary care curriculum has prepared residents in areas particularly relevant to primary care practice. Additionally, these individuals feel as well prepared as do their colleagues in the traditional medical disciplines, basic skills and knowledge, and procedural skills.
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To determine whether current fellowships in general internal medicine (FGIM) meet the perceived needs and objectives of physicians entering careers in academic internal medicine. ⋯ FGIM largely meet the expectations of their fellows for preparation for research responsibilities. However, several curricular elements concerned with preparation for future clinical and teaching responsibilities are perceived by graduates as underemphasized. These areas deserve increased emphasis during fellowship training to better prepare fellows for their future roles in academic general internal medicine.