Annals of internal medicine
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To determine the role of the clinical training environment and a medical education community in reaffirming medical professionalism among physicians-in-training and faculty. ⋯ Establishment of a firm system with a core teaching faculty, creation of mentoring and role modeling programs, implementation of a longitudinal curriculum on medical professionalism, evaluation of physicians on professional conduct, and evaluation of the clinical training environment are suggested as strategies to re-establish an education community and reaffirm professionalism in medicine.
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A strategy is proposed for attracting trainees to careers in general internal medicine coupled with a program that attracts a smaller number of trainees to research careers without attracting trainees into careers in the practice of the subspecialties. A novel training track analogous to the Medical Scientist Training Program, the Specialty Training and Academic Research (STAR) Program has been established. It is anticipated that within the next 5 years, 80% of the trainees in the department of medicine at the University of California, Los Angeles, Medical Center will be training for practice in general internal medicine; the remaining 20% will be enrolled in the STAR Program.
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Comment Letter Case Reports
Hyperkalemia in elderly patients receiving standard doses of trimethoprim-sulfamethoxazole.
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Randomized Controlled Trial Clinical Trial
Utility of selective digestive decontamination in mechanically ventilated patients.
To assess selective digestive decontamination for preventing nosocomial pneumonia and mortality in mechanically ventilated patients. ⋯ Selective digestive decontamination in our mechanically ventilated patients significantly decreased the colonization rate of gram-negative bacilli and of Candida species but not of Staphylococcus aureus. It did not decrease the incidence of nosocomial pneumonia, mortality, length of stay, or the duration of mechanical ventilation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Lack of pharmacologic tolerance and rebound angina pectoris during twice-daily therapy with isosorbide-5-mononitrate.
To determine whether isosorbide-5-mononitrate (IS-5-MN), an active metabolite of isosorbide dinitrate, when given twice daily (in the morning and 7 hours later), prevents development of tolerance and reduction in exercise performance or is associated with a rebound increase in anginal attacks in patients with stable angina pectoris. ⋯ Isosorbide-5-mononitrate, 20 mg twice daily given 7 hours apart, was well tolerated and improved exercise performance for 7 hours after the morning dose and for 5 hours after the afternoon dose without evidence of development of pharmacologic tolerance. No rebound increase in anginal attacks was found.