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Permanent Internal Medicine Job in Coatesville Pennsylvania with Community Health Systems
Join Another in an Established Practice Brandywine Hospital located in beautiful Chester County in southeastern Pennsylvania is seeking a general Internal Medicine Physician to join a well-established
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Oak Hill -- 1 hr from Charleston. Seeking BC/BE internist to join a two person group. Plateau Medical is a 25-bed critical access hospital in Oak Hill located 50 miles outside of Charleston, the state
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San Angelo Community Medical Center is searching for a BC/BE Internal Medicine physician. Comprehensive recruitment or employment package which may include: Sign on/Commencement bonus Student Loan

Current Opinion in Internal Medicine - Current Table Of Contents

Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

PubMed: 0003-4819

The Vanderbilt method for resolving unprofessional behavior.
Dupras DM, Edson RS Related Articles The Vanderbilt method for resolving unprofessional behavior. Ann Intern Med. 2008 Nov 18;149(10):775-6 Authors: Dupras DM, Edson RS PMID: 19017609 [PubMed - in process]
ADVANTAGE: Merck does say "no".
Rabin A Related Articles ADVANTAGE: Merck does say "no". Ann Intern Med. 2008 Nov 18;149(10):774 Authors: Rabin A PMID: 19017608 [PubMed - in process]
ADVANTAGE: Merck does say "no".
Edelman JM Related Articles ADVANTAGE: Merck does say "no". Ann Intern Med. 2008 Nov 18;149(10):774-5; author reply 775 Authors: Edelman JM PMID: 19017607 [PubMed - in process]
ADVANTAGE: science first, marketing second.
Edelman JM Related Articles ADVANTAGE: science first, marketing second. Ann Intern Med. 2008 Nov 18;149(10):773; author reply 773-4 Authors: Edelman JM PMID: 19017606 [PubMed - in process]
What conclusions should be drawn between critical care physician management and patient mortality in the intensive care unit?
Zilberberg MD, Shorr AF Related Articles What conclusions should be drawn between critical care physician management and patient mortality in the intensive care unit? Ann Intern Med. 2008 Nov 18;149(10):771-2; author reply772 Authors: Zilberberg MD, Shorr AF PMID: 19017605 [PubMed - in process]
What conclusions should be drawn between critical care physician management and patient mortality in the intensive care unit?
Manthous C, Amoateng-Adjepong Y Related Articles What conclusions should be drawn between critical care physician management and patient mortality in the intensive care unit? Ann Intern Med. 2008 Nov 18;149(10):770; author reply 772 Authors: Manthous C, Amoateng-Adjepong Y PMID: 19017604 [PubMed - in process]

Archives of Internal Medicine current issue

ABOUT THIS JOURNAL: About This Journal
Mon, 24 Nov 2008 00:00:00 -0000

IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE: In This Issue of Archives of Internal Medicine
Mon, 24 Nov 2008 00:00:00 -0000

EDITORIAL: The Natural History of Breast Cancer
Kaplan, R. M., Porzsolt, F. Mon, 24 Nov 2008 00:00:00 -0000

SPECIAL ARTICLE: Assessing New Biomarkers and Predictive Models for Use in Clinical Practice: A Clinician's Guide
McGeechan, K., Macaskill, P., Irwig, L., Liew, G., Wong, T. Y. Mon, 24 Nov 2008 00:00:00 -0000
New biomarkers and predictive models that aim to improve the identification of people at risk of cardiovascular disease are constantly proposed. Clinicians need to be aware of the various methods used to assess these biomarkers and models and how these should be interpreted. New biomarkers and models are assessed in terms of their contribution to global fit, discrimination, calibration, and reclassification. These measures, when used in isolation, do not address the clinically important questions of whether the new model predicts risk more accurately than existing models and whether the risks predicted for individuals are sufficiently different to warrant a change in treatment decisions. We recommend that these measures be supplemented with graphical displays such as a calibration plot for the Hosmer-Lemeshow test and a scatterplot of the risks predicted by the models being compared. We encourage researchers to report such analyses from studies on the clinical utility of new biomarkers because this information is pertinent for the clinician who must decide whether to test for a new biomarker in their clinical practice.
ORIGINAL INVESTIGATION: The Natural History of Invasive Breast Cancers Detected by Screening Mammography
Zahl, P.-H., Maehlen, J., Welch, H. G. Mon, 24 Nov 2008 00:00:00 -0000
Background  The introduction of screening mammography has been associated with sustained increases in breast cancer incidence. The natural history of these screen-detected cancers is not well understood. Methods  We compared cumulative breast cancer incidence in age-matched cohorts of women residing in 4 Norwegian counties before and after the initiation of biennial mammography. The screened group included all women who were invited for all 3 rounds of screening during the period 1996 through 2001 (age range in 1996, 50-64 years). The control group included all women who would have been invited for screening had there been a screening program during the period 1992 through 1997 (age range in 1992, 50-64 years). All women in the control group were invited to undergo a 1-time prevalence screen at the end of their observation period. Screening attendance was similar in both groups (screened, 78.3%, and controls, 79.5%). Counts of incident invasive breast cancers were obtained from the Norwegian Cancer Registry (in situ cancers were excluded). Results  As expected, before the age-matched controls were invited to be screened at the end of their observation period, the cumulative incidence of invasive breast cancer was significantly higher in the screened group than in the controls (4-year cumulative incidence: 1268 vs 810 per 100 000 population; relative rate, 1.57; 95% confidence interval, 1.44-1.70). Even after prevalence screening in controls, however, the cumulative incidence of invasive breast cancer remained 22% higher in the screened group (6-year cumulative incidence: 1909 vs 1564 per 100 000 population; relative rate, 1.22; 95% confidence interval, 1.16-1.30). Higher incidence was observed in screened women at each year of age. Conclusions  Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.
ORIGINAL INVESTIGATION: Sex Differences in Hospital Risk-Adjusted Mortality Rates for Medicare Beneficiaries Undergoing CABG Surgery
Culler, S. D., Simon, A. W., Brown, P. P., Kugelmass, A. D., Reynolds, M. R., Rask, K. J. Mon, 24 Nov 2008 00:00:00 -0000
Background  The primary purpose of this study was to rank US hospitals performing coronary artery bypass graft (CABG) surgery on Medicare beneficiaries into 4 performance tiers and determine if there were overall and sex-specific differences in the risk-adjusted mortality rates across performance tiers. Methods  A retrospective analysis was done using a Medicare Provider Analysis and Review (MEDPAR) file of all Medicare beneficiaries who underwent CABG surgery without valve repair or replacement during fiscal years 2003 and 2004. Logistic regression models controlling for demographic characteristics, comorbidities, and cardiac risk factors were used to predict the probability of in-hospital mortality. Hospitals performing at least 52 CABG surgeries during a fiscal year (at least 17 female patients) were ranked into 4 tiers. Rankings were based on the number of lives saved, calculated as the expected number of risk-adjusted deaths minus the actual number of deaths in the hospital during each fiscal year. Results  Average risk-adjusted mortality rate was stable and declining over the 2 years: 3.68% in 2003 and 3.61% in 2004. In 2004, the average risk-adjusted mortality rate ranged from 1.39% in tier 1 hospitals to 6.40% in tier 4 hospitals. The sex-specific mortality rate was consistently higher for women in all tiers, with the differential smallest (0.68%) in tier 1 hospitals and greatest (2.67%) in tier 4 hospitals. Conclusion  The sex differential increases from top- to bottom-tier hospitals, suggesting female beneficiaries could benefit from having CABG performed at tier 1 hospitals.
INVITED COMMENTARY: Sex Differences in Hospital Risk-Adjusted Mortality Rates for Medicare Beneficiaries Undergoing CABG Surgery--Invited Commentary
Hernandez, A. F., O'Brien, S. M. Mon, 24 Nov 2008 00:00:00 -0000

ORIGINAL INVESTIGATION: Lung Cancer Risk Following Detection of Pulmonary Scarring by Chest Radiography in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
Yu, Y.-Y., Pinsky, P. F., Caporaso, N. E., Chatterjee, N., Baumgarten, M., Langenberg, P., Furuno, J. P., Lan, Q., Engels, E. A. Mon, 24 Nov 2008 00:00:00 -0000
Background  Fibrotic scars are frequently found in proximity to lung cancer at the time of cancer diagnosis. However, the nature of the relationship between pulmonary scarring and lung cancer remains uncertain. Our objective was to test whether localized pulmonary scarring is associated with increased lung cancer risk. Methods  Cohort analysis of data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. We included 66 863 cancer-free trial participants aged 55 to 74 years, who received a baseline chest radiographic examination and were followed up subsequently for up to 12 years. We used proportional hazards models to estimate hazard ratios (HRs) for lung cancer associated with scarring, adjusting for age, sex, race, and cigarette smoking, and in relation to laterality of scarring. The main outcome measure was incident lung cancer. Results  Scarring was present on the baseline chest radiograph for 5041 subjects (7.5%). Scarring was associated with elevated lung cancer risk (809 lung cancer cases [HR, 1.5; 95% confidence interval {CI}, 1.2-1.8]). This association was specific for cancer in the lung ipsilateral to the scar (HR, 1.8; 95% CI, 1.4-2.4) and absent for contralateral cancer (HR, 0.9; 95% CI, 0.7-1.2). Ipsilateral lung cancer risk was elevated throughout the follow-up period (interval-specific HRs, 1.6, 2.0, 2.1, and 1.7 during 0.01-2.00, 2.01-4.00, 4.01-6.00, and 6.01-12.00 years after baseline chest radiography, respectively). Conclusions  The relationship between pulmonary scarring and lung cancer was specific to the same lung and extended over time. These findings are consistent with the hypothesis that localized inflammatory processes associated with scarring promote the subsequent development of lung cancer.
INVITED COMMENTARY: Lung Cancer Risk Following Detection of Pulmonary Scarring by Chest Radiography in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial--Invited Commentary
Weitzman, S. A. Mon, 24 Nov 2008 00:00:00 -0000


Current Opinion in Internal Medicine - Current Table Of Contents

Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A
How to break the vicious circle of antibiotic resistances?.
Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude
Benefits of high-protein weight loss diets: enough evidence for practice?.
Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b
Chronic pancreatitis.
Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

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