The continued success and growth of distributed medical education into geographically dispersed communities has resulted in a dramatic increase in the number of community-based clinician teachers. We have created a simple mnemonic to help capture, translate and review classic and contemporary teaching concepts for the busy community preceptor. The ―BETTER TEACHER‖ guide was designed to provide practical teaching tips for busy clinicians, and to act as a resource for those teachers looking to expand their own understanding of current concepts in medical education. Although presented from a Family Medicine teaching perspective, the fundamental concepts discussed here can be applied widely to include training in various Allied Health programs and beyond.
{"title":"The �BETTER TEACHER� mnemonic: A Practical Guide for Busy Community-Based Clinical Teachers","authors":"Michael Ward","doi":"10.15640/ijmp.v7n2a2","DOIUrl":"https://doi.org/10.15640/ijmp.v7n2a2","url":null,"abstract":"The continued success and growth of distributed medical education into geographically dispersed communities has resulted in a dramatic increase in the number of community-based clinician teachers. We have created a simple mnemonic to help capture, translate and review classic and contemporary teaching concepts for the busy community preceptor. The ―BETTER TEACHER‖ guide was designed to provide practical teaching tips for busy clinicians, and to act as a resource for those teachers looking to expand their own understanding of current concepts in medical education. Although presented from a Family Medicine teaching perspective, the fundamental concepts discussed here can be applied widely to include training in various Allied Health programs and beyond.","PeriodicalId":422929,"journal":{"name":"INTERNATIONAL JOURNAL OF MEDICINE AND PHARMACY","volume":"80 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130865854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Background: Systemic corticosteroids are recommended for treatment of chronic obstructive pulmonary disease (COPD) exacerbations. Studies suggest nebulized budesonide may beequivalent to systemic corticosteroids in COPD exacerbations. However, there is limited data on benefits or risks of concomitant nebulized and systemic corticosteroid use during COPD exacerbations. Methods: This was a single-center, retrospective study evaluating subjects admitted with a COPD exacerbation who received systemic corticosteroids with or without nebulized budesonide. Subjects were included if they had a COPD exacerbation, received systemic corticosteroids of at least 40 mg prednisone equivalents daily for at least 48 hours, and received nebulized budesonide for at least 48 hours if in the budesonide arm. Exclusion criteria included subjects with asthma, active cancer or other forms of immunosuppression, recent systemic corticosteroid usage, or active fungal infection(s). The primary outcome was to compare length of stay between treatment groups. Secondary outcomes were to compare adverse effect rates. Results: 645 subject charts were reviewed and 75 subjects were included(n=41 in the budesonide group; n=34 in the non-budesonide group). Length of stay averaged 4.63 and 3.62 days (p = 0.18) in the budesonide and non-budesonide arms, respectively. Hyperglycemic events occurred significantly more often in the budesonide group (n=164 vs. 92 (p = 0.02)) while thrush diagnoses were not significantly different (n=4 vs. 0 (p = 0.12)). Conclusion: Nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation does not decrease hospital length of stay and significantly increases the risk of hyperglycemic events. A Other shown that nebulized budesonide appears to be equivalent to systemic corticosteroids as and prednisone in improving pulmonary function, forced expiratory volume in 1 second (FEV saturation of peripheral oxygen (SpO 2 ),in reducing symptoms, and treating COPD exacerbations. Recent practice trends within certain institutions have included utilizing nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation. Currently, only one study has evaluated this particular corticosteroid combination therapy and showed that hospital length of stay was longer in patients receiving both systemic and corticosteroids.
背景:全身皮质类固醇被推荐用于慢性阻塞性肺疾病(COPD)恶化的治疗。研究表明，布地奈德雾化治疗慢性阻塞性肺病加重可能相当于全身性皮质类固醇。然而，关于慢性阻塞性肺病加重期间雾化和全身性使用皮质类固醇的获益或风险的数据有限。方法:这是一项单中心、回顾性研究，评估接受系统性皮质类固醇治疗的慢性阻塞性肺病加重患者，这些患者有或没有雾化布地奈德。如果受试者有COPD加重，每天接受至少40 mg强的松等量的全身皮质类固醇治疗至少48小时，如果布地奈德组接受雾化布地奈德治疗至少48小时，则纳入受试者。排除标准包括哮喘、活动性癌症或其他形式的免疫抑制、近期全身性使用皮质类固醇或活动性真菌感染的受试者。主要结果是比较治疗组之间的住院时间。次要结局是比较不良反应发生率。结果:共回顾645例受试者图表，纳入75例受试者(布地奈德组n=41;非布地奈德组N =34)。布地奈德组和非布地奈德组的平均住院时间分别为4.63天和3.62天(p = 0.18)。布地奈德组高血糖事件的发生率明显高于对照组(n=164 vs. 92 (p = 0.02))，而鹅口疮的诊断无显著差异(n=4 vs. 0 (p = 0.12))。结论:在慢性阻塞性肺病加重期间，除全身皮质类固醇外，雾化布地奈德不会减少住院时间，反而会显著增加高血糖事件的风险。另一项研究表明，雾化布地奈德在改善肺功能、1秒用力呼气量(FEV外周氧饱和度(SpO 2))、减轻症状和治疗COPD加重方面与全体性皮质类固醇和泼尼松相当。在某些机构中，最近的实践趋势包括在慢性阻塞性肺病加重期间，除全身性皮质类固醇外，还使用雾化布地奈德。目前，只有一项研究评估了这种特殊的皮质类固醇联合治疗，并表明同时接受全身和皮质类固醇治疗的患者住院时间更长。
{"title":"Evaluation of Risks versus Benefits with Concomitant Use of Budesonide Nebulizers and Systemic Corticosteroids in COPD Exacerbations","authors":"J. B. Hill, Jon P. Wietholter","doi":"10.15640/ijmp.v7n2a1","DOIUrl":"https://doi.org/10.15640/ijmp.v7n2a1","url":null,"abstract":": Background: Systemic corticosteroids are recommended for treatment of chronic obstructive pulmonary disease (COPD) exacerbations. Studies suggest nebulized budesonide may beequivalent to systemic corticosteroids in COPD exacerbations. However, there is limited data on benefits or risks of concomitant nebulized and systemic corticosteroid use during COPD exacerbations. Methods: This was a single-center, retrospective study evaluating subjects admitted with a COPD exacerbation who received systemic corticosteroids with or without nebulized budesonide. Subjects were included if they had a COPD exacerbation, received systemic corticosteroids of at least 40 mg prednisone equivalents daily for at least 48 hours, and received nebulized budesonide for at least 48 hours if in the budesonide arm. Exclusion criteria included subjects with asthma, active cancer or other forms of immunosuppression, recent systemic corticosteroid usage, or active fungal infection(s). The primary outcome was to compare length of stay between treatment groups. Secondary outcomes were to compare adverse effect rates. Results: 645 subject charts were reviewed and 75 subjects were included(n=41 in the budesonide group; n=34 in the non-budesonide group). Length of stay averaged 4.63 and 3.62 days (p = 0.18) in the budesonide and non-budesonide arms, respectively. Hyperglycemic events occurred significantly more often in the budesonide group (n=164 vs. 92 (p = 0.02)) while thrush diagnoses were not significantly different (n=4 vs. 0 (p = 0.12)). Conclusion: Nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation does not decrease hospital length of stay and significantly increases the risk of hyperglycemic events. A Other shown that nebulized budesonide appears to be equivalent to systemic corticosteroids as and prednisone in improving pulmonary function, forced expiratory volume in 1 second (FEV saturation of peripheral oxygen (SpO 2 ),in reducing symptoms, and treating COPD exacerbations. Recent practice trends within certain institutions have included utilizing nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation. Currently, only one study has evaluated this particular corticosteroid combination therapy and showed that hospital length of stay was longer in patients receiving both systemic and corticosteroids.","PeriodicalId":422929,"journal":{"name":"INTERNATIONAL JOURNAL OF MEDICINE AND PHARMACY","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132265068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zeinab Ibrahim Swar Eldahab, Mohamed Al Seiddig, Gaffar Alemam,Mohammed Ishag
{"title":"Psychosocial Impact of COVID 19 Pandemic on Healthcare Workers in Selected Hospitals in Khartoum State, Khartoum, Sudan, 2020","authors":"Zeinab Ibrahim Swar Eldahab, Mohamed Al Seiddig, Gaffar Alemam,Mohammed Ishag","doi":"10.15640/ijmp.v9n1a5","DOIUrl":"https://doi.org/10.15640/ijmp.v9n1a5","url":null,"abstract":"","PeriodicalId":422929,"journal":{"name":"INTERNATIONAL JOURNAL OF MEDICINE AND PHARMACY","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125653387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Igala, M. Machado, B. Neugaard, P. Foulis, J. Gomez-Daspet
Purpose: Determine the medical evaluation completed and the clinical progression observed in subjects with Endogenous Subclinical Hyperthyroidism (ESCH).Method: This is a single site retrospective chart review of subjects who visited the Ambulatory Care Clinics at the James A. Haley VA Hospital (JAHVA), Tampa, Florida. Subjects were selected and charts reviewed using the automatic data mining tool. Inclusion criteria encompassed subjects’ low thyroid stimulating hormone (TSH) and normal T4 and T3 levels.Results: 95 subjects met criteria for inclusion. At the end of one year, 48 (51%) had normal thyroid function tests (TFTs), 43 (45%) had persistent ESCH and 4 (4%) had overt hyperthyroidism. A radioiodine thyroid uptake/scan was completed in 32 (33%) subjects. Only 9 (10%) had thyroid stimulating Immunoglobulin (TSI) or anti-thyroid peroxidase antibody (anti-TPO) studies. A bone density study was not completed. Conclusions: Out of the 95 subjects with ESCH, at the end of one year 51% had normal TFTs, 45% had persistent ESCH and 4% had hyperthyroidism. Less than 50% of the subjects received further tests. It is recommended that subjects with ESCH be followed periodically with TFTs and further evaluation may be required to assess cause, severity, risk of complications and need for treatment.
{"title":"Subclinical Hyperthyroidism, an Under-Recognized Entity","authors":"S. Igala, M. Machado, B. Neugaard, P. Foulis, J. Gomez-Daspet","doi":"10.15640/IJMP.V7N1A1","DOIUrl":"https://doi.org/10.15640/IJMP.V7N1A1","url":null,"abstract":"Purpose: Determine the medical evaluation completed and the clinical progression observed in subjects with Endogenous Subclinical Hyperthyroidism (ESCH).Method: This is a single site retrospective chart review of subjects who visited the Ambulatory Care Clinics at the James A. Haley VA Hospital (JAHVA), Tampa, Florida. Subjects were selected and charts reviewed using the automatic data mining tool. Inclusion criteria encompassed subjects’ low thyroid stimulating hormone (TSH) and normal T4 and T3 levels.Results: 95 subjects met criteria for inclusion. At the end of one year, 48 (51%) had normal thyroid function tests (TFTs), 43 (45%) had persistent ESCH and 4 (4%) had overt hyperthyroidism. A radioiodine thyroid uptake/scan was completed in 32 (33%) subjects. Only 9 (10%) had thyroid stimulating Immunoglobulin (TSI) or anti-thyroid peroxidase antibody (anti-TPO) studies. A bone density study was not completed. Conclusions: Out of the 95 subjects with ESCH, at the end of one year 51% had normal TFTs, 45% had persistent ESCH and 4% had hyperthyroidism. Less than 50% of the subjects received further tests. It is recommended that subjects with ESCH be followed periodically with TFTs and further evaluation may be required to assess cause, severity, risk of complications and need for treatment.","PeriodicalId":422929,"journal":{"name":"INTERNATIONAL JOURNAL OF MEDICINE AND PHARMACY","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125942937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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