The clinical clerkship in Canadian Medical Schools is intended to provide senior medical students with opportunities to gain practical knowledge of clinical medicine, develop technical skills, learn to use judgement and experience first-hand clinical decision making. Assessment of rotations in internal medicine were undertaken in order to understand more fully the nature of medical clerkship experiences. We found that medical clerks in our programme were exposed to a high proportion of undifferentiated problems and an adequate case mix. They performed a wide range of technical procedures. There were, however, certain gaps in the clerks' experiences both in the specialty areas, and in therapeutic and technical procedures. Recognition of these gaps in the clerkship experiences suggest that further deliberation of goals and objectives is required and issues of achievement of competencies need to be addressed.
A comparison was undertaken between the frequencies of admission of medical patients over the age of 64 years and long-term/geriatric patients admitted to a large county hospital. The pattern of readmission is described in relation to the age groups and sex. The period of observation was nine months. In the investigation, the relationship between the distribution of men and women in the normal population was taken into consideration and a correction factor was calculated. A total of loll patients (CP) discharged from an acute medical department (AM) had 1954 readmissions (GI). In the long-term medical department (LMA) 158 CP had a total of 328-GI. The number of CP readmitted in each age group and sex reflects the representation of the group concerned in the background population, although a tendency was observed for slightly more admissions, the older the CP were. No difference in the pattern of readmission was observed concerning CP readmitted from AM and readmitted to all departments including AM. Similarly, despite some scatter, there was no difference in the GI pattern in CP discharged from LMA and readmitted to all departments including LMA. In addition, no significant difference in the GI pattern was observed as compared with the AM patient group and the LMA patient group. As patients referred to LMA have, quite naturally, poorer performance than the patients who were discharged directly from medical or surgical departments, it may be concluded that, after treatment in LMA, no difference between the patient groups was found if the GI frequency was taken as a yardstick. As GI, just as other measurements of turnover, only provides an expression of the status at a given moment, the author considers that it is of importance both for the departmental and the political planning that the GI frequency is followed as part of the current assessment.
This is an intervention-study discussing the long-term effects of a 3-day "Train the trainers course" (TTC). In the intervention (I) group 98.4% of doctors participated in a TTC, both specialists and trainees. Knowledge about teaching skills increased in the I group by 25% after the TTC; a result which was sustained at six months. Teaching behaviour was significantly changed as the use of feedback and supervision had increased from a score of 4 to 6 (max. score = 9).
A 3-day residential TTC has a significant impact on knowledge gain concerning teaching skills, teaching behaviour and clinical learning culture after six months.
Follow-up of 2400 patients aged 17-84 who had previously had influenza or other acute respiratory diseases documented aggravation of the background illness in 34.1% of them. Because of the aggravation 15.3% of the cases were referred to hospitals. Augmentation of symptoms was primarily observed in chronic nonspecific pulmonary lesions (57.9%), bronchial asthma (30.5%), rheumatic fever (38.1%), peptic ulcer (31.6%), renal (42.7%) and thyroid (42.9%) diseases, climacteric neurosis (31.3%), neurovegetative disorders (61.1%). Typical symptoms and syndromes of aggravated background illnesses, principles of managing combined diseases and of respiratory affections prevention in the above patients are presented.
Postdischarge safety is an area that has long been neglected. Recent studies from the United States and Canada found that about one in five patients discharged home from the general internal medicine services of major teaching hospitals suffered an adverse event.
MEDLINE, Cochrane databases, and reference lists of retrieved articles were used in a literature search of articles published from 1966 through May 2007.
Patient safety research has focused mostly on adverse events in hospitalized patients. Although some data are available about the ambulatory setting, even fewer studies have been done focusing on adverse events following hospital discharge. Only two studies conducted in North America have examined the incidence rate of all types of postdischarge adverse events. On the basis of the available evidence, key areas of opportunity to improve postdischarge care are as follows: (1) improving transitional care, (2) improving information transfer through strategic use of electronic health records, (3) medication reconciliation, (4) improving follow-up of test results, and (5) using screening methods to identify patients with adverse events.
Limited evidence suggests that about one in five internal medicine patients suffers an adverse event after discharge from a North American hospital. The risk of postdischarge adverse events should be recognized by patient safety experts as an important area of concern.
The aim of the study was to investigate factors of significance for readmission of patients in a department of internal medicine. The study was based on hospital computerized data files. All admissions from the 1st of January to the 31st of December 1995 were included. During that period the department had 6061 admissions of 4152 patients. The readmission rate was 1.46. All patients were followed three months after discharge. Within that period 1119 (27%) of the patients were readmitted. A high frequency of readmission was especially found within the first ten days after discharge. Length of stay in hospital did not influence readmission rate. Women, patients in the age group 71-90 years and patients with chronic diseases were more likely to be readmitted. The demonstrated factors relating to a high readmission rate are difficult to influence. A prospective study including the primary health care system and a clinical evaluation of the patients is needed to examine causes of the high number of readmission within the first ten days after discharge.
Medical and social data on 980 consecutive admissions to the Medical Department, Aker Hospital, Oslo, were recorded prospectively with emphasis on patients' requirements and the Department's use of available resources. 73% of the admissions were acute, 4% were considered unnecessary. Half were because of chronic illness. Although 88% of the patients' requirements could have been met at a local hospital, 59% were treated in specialized units. 12% were admitted to the day unit at reduced cost for an average stay of three days. 41% of the patients were over 70 years of age, 37% lived alone and 14% needed rehabilitation. A main reason for admission was the patient's inability to take care of him/herself at home, in nearly all cases the main reason being acute illness or deterioration. Therefore many of the patients seemed to need care in an acute geriatric unit. At any one time the reason for 20-25% of the patients being in the department was delay in providing care at home or in a nursing home.
To assess the occurrence and pattern of adverse drug reactions as a cause for acute hospital admission.
In 681 randomly selected patients, acutely admitted to a clinic of internal medicine at a Swedish university hospital, information was collected from their medical records about current symptoms and use of drugs, previous diseases and the results of medical investigations and tests. In addition, a standardized interview according to a questionnaire was carried out. A group of experts in clinical pharmacology assessed the data obtained from the patients' case records and the results of the interviews, and then, according to WHO criteria, judged the probability that an adverse drug reaction could have caused or contributed to the actual admission to hospital.
Out of the 681 cases included, 94 (13.8%) had symptoms and signs that were judged as drug-related and that had caused or contributed to the admission. Eighty-two patients (12.0%) had altogether 99 symptoms that were classified as adverse drug reactions. Of these, 91% were type A reactions. The relationship between the medication and the reaction was judged certain in eight, probable in 17, and possible in 74 cases. The most common adverse drug reactions were cardiovascular (36.3%). Twelve patients (1.8%) had symptoms indicating intoxications.
The prevalence of drug-related problems causing or contributing to admission to a clinic of internal medicine is high and is dominated by type A reactions, i.e. reactions in principle predictable and preventable. This implies a possibility to increase drug safety by preventive measures.