Medical News

Dr. Cheng Xiaoci, in Collaboration with Five Experts from Shanghai, Lends Experimental Confirmation to the Fundamental Theory of Traditional Chinese Medicine. Jin Yueyuan, journalist of the newspaper Jiankangbao, has learnt from the International Symposium on Traditional Chinese Medicine and Pharmacology held recently in Nanjing while a considerable number of foreign scholars are still pondering over the fundamental theory of classical     

医学诊断检验Medical Diagnostic test

本文系美国杰佛逊医学院许岗教授．为该院的医学博士研究生讲课稿．共计15讲，全文深入浅出，内容新颖丰富，特选登以供同道学习参考。     

Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

BACKGROUND

Physicians may counsel patients who leave against medical advice (AMA) that insurance will not pay for their care. However, it is unclear whether insurers deny payment for hospitalization in these cases.

OBJECTIVE

To review whether insurers denied payment for patients discharged AMA and assess physician beliefs and counseling practices when patients leave AMA.

DESIGN

Retrospective cohort of medical inpatients from 2001 to 2010; cross-sectional survey of physician beliefs and counseling practices for AMA patients in 2010.

PARTICIPANTS

Patients who left AMA from 2001 to 2010, internal medicine residents and attendings at a single academic institution, and a convenience sample of residents from 13 Illinois hospitals in June 2010.

MAIN MEASURES

Percent of AMA patients for which insurance denied payment, percent of physicians who agreed insurance denies payment for patients who leave AMA and who counsel patients leaving AMA they are financially responsible.

KEY RESULTS

Of 46,319 patients admitted from 2001 to 2010, 526 (1.1%) patients left AMA. Among insured patients, payment was refused in 4.1% of cases. Reasons for refusal were largely administrative (wrong name, etc.). No cases of payment refusal were because patient left AMA. Nevertheless, most residents (68.6%) and nearly half of attendings (43.9%) believed insurance denies payment when a patient leaves AMA. Attendings who believed that insurance denied payment were more likely to report informing AMA patients they may be held financially responsible (mean 4.2 vs. 1.7 on a Likert 1–5 scale, in which 5 is “always” inform, p < 0.001). This relationship was not observed among residents. The most common reason for counseling patients was “so they will reconsider staying in the hospital” (84.8% residents, 66.7% attendings, p = 0.008)

CONCLUSIONS

Contrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-012-1984-x) contains supplementary material, which is available to authorized users.KEY WORDS: patient discharge, financial responsibility, hospital reimbursement     

Graduate Medical Education—Accelerated Change

Graduate medical education (GME) is a critical link in the educational chain for physicians. Graduating from a strict apprenticeship model, GME has become a highly structured educational system whose peer-review organization provides an intentional and direct approach to ensuring that GME not only addresses the public’s expectations of the profession but also positions itself to be a foundational structure in the outcomes-focused healthcare environment of the nation. GME is currently in a state of accelerated change—grounded in both educational and patient outcomes. This article provides an update on the significant changes that have occurred in GME over the past 10 years, a review of current initiatives and the perspectives related to educating physicians-in-training. Additionally, an analysis is provided on the future of GME, including areas of continued focus and uncertainty.     

Changes in U.S. Medical Students’ Specialty Interests over the Course of Medical School

Background  Studies have examined factors affecting medical students’ specialty choice, but little research exists on stability of these specialty interests. Objective  To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention. Design  Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year. Participants  This analysis used data from 942 students who completed all 3 surveys. Measurements  In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing. Results  The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%). Conclusions  Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.     

St.Jude Medical 人造心脏瓣膜

本文介绍一种新型的二瓣叶结构的机械瓣,它由 St.Jude Medical 器械公司设计制造,因而被命名为 St.Jude Medical 瓣膜(以下简称 SJM 瓣膜)。SJM 瓣膜的结构和性能1972年,Nicoloff 和 Passes 开始研制一种低柱身中央血流型 SJM 机械瓣膜。全部瓣膜结构是由一瓣环、二瓣叶和一瓣膜缝合环制成。瓣环由热解碳制成。瓣叶中掺入5～10%钨,目的是使瓣叶不透 X 线,便于检查。二片瓣叶将瓣口分成三部分。缝合环外包双层带有90～125微米小孔的涤纶布。     

Medical therapy of Crohn’s disease

Opinion statement There is no medical or surgical treatment that provides a permanent cure for Crohn’s disease (CD). However, an evolving understanding of the pathogenesis of CD has provided clinicians with a diversity of medical treatment options for the disease. The goal of therapy is to induce and maintain clinical remission. The efficacy of immune-modifying agents such as azathioprine/6-mercaptopurine and infliximab have supported a paradigm shift in CD treatment in which maintenance agents are introduced earlier in the disease course. At the same time, it is imperative to balance the efficacy, safety, and tolerability of medical therapy. Given the variable and relapsing clinical course of CD, the physician and patient should ideally develop an ongoing relationship that allows for individualization of treatment regimens, monitoring of response and side effects, and modification of the therapeutic strategy in the absence of improvement.     

China Medical Abstracts (Internal Medicine)SUBJECT INDEX

α-melanocyte-stimulation hormone,rhabdomyolysis,acute renalfailure,monocyte chemoattractant protein-1,2007467α-smooth muscle actin,gene,transforming growth factor-β1,myofi-broblasts,2007212 -tacrolimus,diabetic nephropathy,calcineurin,2007248β-catenin,survivin, rectal carcinoma, immunohistochemistry,200735199Tcmpertechnetate,liver neoplasms, sodium/iodide symporter,gene expression,200723814-3-3 protein,cerebrospinal fluid,multiple sclerosis,20070202-methoxyestradiol,telomerase, cell apoptos…