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Traditional/Outpatient Practice in Houston Suburb :: Texas :: Enterprise Medical Service
Internal Medicine provider needed for Traditional or Outpatient practice in Houston suburbs. Need is in Tomball, TX, very close to The Woodlands. Position can be Traditional or Outpatient. Join 2 IM's
Visalia, CA Seeks 3rd Internal Medicine Provider :: California :: Enterprise Medical Service
Practice site currently has 2 IMs, 1 FP, and 1 Ped. Hospital call would be shared on a 1 in 4 rotation, as the FP participates in the adult schedule. Admissions and patient management are done at one
Ontario County, NY on the shores of Seneca Lake :: New York :: Enterprise Medical Service
Terrific hospital employed FP opportunity right off Seneca Lake!! Monday thru Friday strictly outpatient practice. No inpatient responsibilities!! Work out of Physician Office Building on grounds

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

Hypomagnesemia Induced by Several Proton-Pump Inhibitors.
Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW Hypomagnesemia Induced by Several Proton-Pump Inhibitors. Ann Intern Med. 2009 Nov 17;151(10):755-756 Authors: Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW PMID: 19920278 [PubMed - as supplied by publisher]
Similarities and Differences Between REPEAT and EPIC3.
Poynard T, Shiff E Similarities and Differences Between REPEAT and EPIC3. Ann Intern Med. 2009 Nov 17;151(10):754 Authors: Poynard T, Shiff E PMID: 19920277 [PubMed - as supplied by publisher]
Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk.
Kerlikowske K Evidence-Based Breast Cancer Prevention: The Importance of Individual Risk. Ann Intern Med. 2009 Nov 17;151(10):750-752 Authors: Kerlikowske K PMID: 19920276 [PubMed - as supplied by publisher]
Handy Point-of-Care Decision Support.
Rothschild JM Handy Point-of-Care Decision Support. Ann Intern Med. 2009 Nov 17;151(10):748-749 Authors: Rothschild JM PMID: 19920275 [PubMed - as supplied by publisher]
Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms.
Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms. Ann Intern Med. 2009 Nov 17;151(10):738-747 Authors: Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Background: Despite trials of mammography and widespread use, optimal screening policy is controversial. Objective: To evaluate U.S. breast cancer screening strategies. Design: 6 models using common data elements. Data Sources: National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects. Target Population: A contemporary population cohort. Time Horizon: Lifetime. Perspective: Societal. Interventions: 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome Measures: Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. Results of Base-Case Analysis: The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. Results of Sensitivity Analysis: Varying test sensitivity or treatment patterns did not change conclusions. Limitation: Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment. Conclusion: Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. Primary Funding Source: National Cancer Institute. PMID: 19920274 [PubMed - as supplied by publisher]
Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force.
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17;151(10):727-737 Authors: Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L Background: This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. Purpose: To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. Study Selection: Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. Data Extraction: Relevant data were abstracted, and study quality was rated by using established criteria. Data Synthesis: Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. Limitation: Studies of older women, digital mammography, and magnetic resonance imaging are lacking. Conclusion: Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 19920273 [PubMed - as supplied by publisher]

Archives of Internal Medicine current issue

Is It Time to Eliminate Consultation Codes?: An Analysis of Impact and Rationale [Special Article]
Shalowitz, J. I.Background  As issues of health care cost escalation and parity of payment between primary care and other physicians have become more important, one proposal has been to eliminate consultation codes. Little is known about the current payment accuracy or financial impact of such a change.Methods  To assess the impact of consultation code elimination, 2 assessments were conducted. First, from June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were reviewed and matched with claims for accuracy of coding and billing. Second, to evaluate the financial impact of this change, year 2007 data on outpatient consultations from the Centers for Medicare and Medicaid Services were reviewed.Results  Of the 500 claims reviewed, 466 were appropriate for analysis. Overall, the coding error rate was 32.4%. When the requesting physician ordered a consultation, the error rate was 5.5%; however, with lower paid referral requests, the error rate was 78.0%. Changing ambulatory consultation codes to those for new patient visits would save Medicare $534.5 million per year.Conclusions  Consultation codes are being billed erroneously at a high rate. Furthermore, the differential cost to Medicare of these codes over those for new patient evaluation and management codes is over half a billion dollars per year. With the growing needs for cost savings as well as encouraging payment parity for cognitive services for primary care physicians, it is time these codes are reevaluated.Published online November 9, 2009 (doi:10.1001/archinternmed.2009.446).
About This Journal [About This Journal]

In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]

Orienting Health Care Reform Around Universal Access [Commentary]
Cerise, F. P., Chokshi, D. A.
Controlling Health Care Costs in Massachusetts After Health Care Reform: There Is No Silver Bullet [Editorial]
Bigby, J.
Emergency Care: The Increasing Weight of Increasing Waits [Editorial]
Hsia, R. Y., Tabas, J. A.
Treatment of Polymyalgia Rheumatica: A Systematic Review [Review Article]
Hernandez-Rodriguez, J., Cid, M. C., Lopez-Soto, A., Espigol-Frigole, G., Bosch, X. Background  Polymyalgia rheumatica (PMR) treatment is based on low-dose glucocorticoids. Glucocorticoid-sparing agents have also been tested. Our objective was to systematically examine the peer-reviewed literature on PMR therapy, particularly the optimal glucocorticoid type, starting doses, and subsequent reduction regimens as well as glucocorticoid-sparing medications. Methods  We searched Cochrane Databases and MEDLINE (1957 through December 2008) for English-language articles on PMR treatment (randomized trials, prospective cohorts, case-control trials, and case series) that included 20 or more patients. All data on study design, PMR definition criteria, medical therapy, and disease outcomes were collected using a standardized protocol. Results  Thirty studies (13 randomized trials and 17 observational studies) were analyzed. No meta-analyses or systematic reviews were found. The PMR definition criteria, treatment protocols, and outcome measures differed widely among the trials. Starting prednisone doses higher than 10 mg/d were associated with fewer relapses and shorter therapy than were lower doses; starting prednisone doses of 15 mg/d or lower were associated with lower cumulative glucocorticoid doses than were higher starting prednisone doses; and starting prednisone doses higher than 15 mg/d were associated with more glucocorticoid-related adverse effects. Slow prednisone dose tapering (<1 mg/mo) was associated with fewer relapses and more frequent glucocorticoid treatment cessation than faster tapering regimens. Initial addition of oral or intramuscular methotrexate provided efficacy at doses of 10 mg/wk or higher. Infliximab was ineffective as initial cotreatment. Conclusions  The scarcity of randomized trials and the high level of heterogeneity of studies on PMR therapy do not allow firm conclusions to be drawn. However, PMR remission seems to be achieved with prednisone treatment at a dose of 15 mg/d in most patients, and reductions below 10 mg/d should preferably follow a tapering rate of less than 1 mg/mo. Methotrexate seems to exert glucocorticoid-sparing properties.
Fifty Years of Thiazide Diuretic Therapy for Hypertension [Review Article]
Moser, M., Feig, P. U. Background  The use of thiazide diuretics has decreased over the past 30 years despite data from many well-controlled clinical trials demonstrating that the use of these agents as monotherapy or in combination with other antihypertensive agents will reduce blood pressure and decrease cardiovascular as well as cerebrovascular events. Methods  We reviewed clinical and experimental data on thiazide diuretics since their introduction in the late 1950s. Results  The results of thiazide-based therapy in young and old are consistently positive despite concerns about some metabolic changes, eg, insulin resistance or hypokalemia, that may occur. Conclusion  We conclude that these agents are safe, effective, and well tolerated and should continue to be used either as monotherapy or with other medications in the management of hypertension.
Percentage of US Emergency Department Patients Seen Within the Recommended Triage Time: 1997 to 2006 [Original Investigation]
Horwitz, L. I., Bradley, E. H. Background  The wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds. Methods  Using a stratified random sampling of 151 999 visits, representing 539 million ED visits from 1997 to 2006, we examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity. Results  The percentage of patients seen within the triage target time declined a mean of 0.8% per year, from 80.0% in 1997 to 75.9% in 2006 (P < .001). The percentage of patients seen within the triage target time declined 2.3% per year for emergent patients (59.2% to 48.0%; P < .001) compared with 0.7% per year for semiurgent patients (90.6% to 84.7%; P < .001). In 2006, the adjusted odds of being seen within the triage target time were 30% lower than in 1997 (odds ratio, 0.70; 95% confidence interval, 0.55-0.89). The adjusted odds of being seen within the triage target time were 87% lower (odds ratio, 0.13; 95% confidence interval, 0.11-0.15) for emergent patients compared with semiurgent patients. Patients of each payment type experienced similar decreases in the percentage seen within the triage target over time (P for interaction = .24), as did patients of each racial/ethnic group (P = .05). Conclusions  The percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time. Patients of all racial/ethnic backgrounds and payer types have been similarly affected.

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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