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Anxiety often remains unrecognized or untreated among patients with a chronic medical illness. Exercise training may help improve anxiety symptoms among medical patients. A systematic review of randomized controlled trials was conducted to summarize the effect of exercise training on anxiety symptoms among sedentary adults with a chronic medical illness. Forty investigations that included both an anxiety outcome and randomization to either exercise training or a nonexercise comparison condition were selected. A meta-regression analysis examined whether selected variables of theoretical or practical importance moderated the estimated population effect. Exercise programs lasting up to 12 weeks, sessions lasting more than 30 minutes, and a time frame of more than 1 week for reporting anxiety symptoms were associated with the largest anxiety symptom reductions.
It is unclear if efforts to reduce hospital costs will adversely affect quality or increase downstream costs. In this study, Chen et al focus on 2 conditions, congestive heart failure and pneumonia, and use Medicare data to analyze the relationship between hospitals' cost of care and quality of care and between hospitals' cost of care and mortality rates. They also examine whether evidence supports the “penny-wise, pound-foolish” hypothesis, ie, that low-cost hospitals discharge patients earlier but have higher rates of readmission and higher downstream costs.
Education in Internal Medicine (IM) spans the spectrum of clinical practice, where it is both best learned but most difficult to teach. Academic settings are where some of our keenest insights are gleaned and our most vexing issues are confronted, often through research by the learners themselves. In this issue, there is a group of articles that have particular relevance to salient issues for residents in training in IM, such as communication skills in optimally handling demand management; professionalism and relationships with industry; and patient safety, specifically, refining the risk estimate associated with a common IM procedure (thoracentesis), and the expanding role of internists in assisting our surgical colleagues with perioperative comanagement of patients in hospital-based settings. We hope these articles not only shed light on important issues for our internists but also stimulate interest in studying and sharing insights about common issues related to the optimal clinical practice and teaching of IM in academic settings1.
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In this issue, Sharma and colleagues examined the extent of comanagement among 694 806 Medicare beneficiaries hospitalized for a common surgical procedure in the United States. Between 1996 and 2006, 35.2% were comanaged by a medicine physician (general physicians or internal medicine subspecialists): 23.7% by a generalist physician and 14% by an internal medicine subspecialist (2.5% were comanaged by both). Comanagement by a generalist physician rose sharply between 2001 and 2006. All of the growth in comanagement was attributed to increased comanagement by hospitalist physicians. Patients with advanced age, with comorbidities, and who were receiving care at a nonteaching hospital were more likely to be comanaged. To meet this growing need for comanagement, training in internal medicine should include medical management of surgical patients.
Clinical documentation and clerical duties are substantial activities for internal medicine residents. Oxentenko et al reviewed survey data obtained during the 2006 US Internal Medicine In-Training Examination and found that more than two-thirds of residents (67.9%) reported spending in excess of 4 hours daily on documentation during inpatient rotations, while only 38.9% reported spending this amount of time in direct patient care. The majority of residents and program directors believed that feedback on resident documentation occurred less than 50% of the time, despite 73.2% of program directors and 58.6% of residents viewing documentation feedback as highly important. These findings suggest that further evaluation to understand specific inpatient activities of residents and the educational value of those activities is essential.
Perceived time spent daily on patient care documentation (n = 15 889) and face-to-face contact with patients (n = 15 417) by internal medicine residents on inpatient services.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2010;170(4):316. doi:10.1001/archinternmed.2009.532