Annals of internal medicine
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The procedural skills of internists have been scrutinized recently because of concern for quality of care and because of economic and liability issues. The findings of recent surveys of program directors and practicing internists about procedural skills are reviewed. The results of these surveys in relation to the American Board of Internal Medicine's (ABIM) new training requirements and New York State's new policy requiring credentialing of residents in training are also discussed. ⋯ Programs in internal medicine need to decide which procedures their residents will master and assure that their residents receive the training and testing necessary for competency and for formal certification of mastery in each procedure. Programs may restructure rotations to assure adequate experience. In the new era of accountability, certification of training and of competence in procedural skills will be an important function of training programs.
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Randomized Controlled Trial Clinical Trial
Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study.
To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation. ⋯ Patients receiving glutamine-supplemented parenteral nutrition after bone marrow transplantation had improved nitrogen balance, a diminished incidence of clinical infection, lower rates of microbial colonization, and shortened hospital stay compared with patients receiving standard parenteral nutrition. These effects occurred despite no differences between groups in the incidence of fever, antibiotic requirements, or time to neutrophil engraftment.
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Randomized Controlled Trial Clinical Trial
Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position.
To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients. ⋯ We conclude that the supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents. Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.
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Randomized Controlled Trial Clinical Trial
Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange.
To determine the efficacy of acetazolamide in the treatment of patients with acute mountain sickness and the effect of the drug on pulmonary gas exchange in acute mountain sickness. ⋯ In established cases of acute mountain sickness, treatment with acetazolamide relieves symptoms, improves arterial oxygenation, and prevents further impairment of pulmonary gas exchange.