Donald E. Girard

Current concepts: Wernicke's encephalopathy

Despite its description over a century ago, Wernickes encephalopathy continues to be underrecognized in both alcoholic and nonalcoholic populations. Recent studies suggest that Wernickes encephal...

Vitamins and minerals in HIV infection

THE ROLE OF VITAMINS AND MINERALS i n t h e c l i n i c a l m a n i f e s t a t i o n of human immunodeficiency virus (HIV) infection has not been well defined. However, a growing number of studies have suggested important links between vitamins and trace minerals and HIV infection. Certain vitamins and trace minerals are frequently deficient in patients who have HIV infection. Selected states of vitamin deficiency appear to be related to altered immune and neurologic status in these patients while others may serve as prognostic indicators of disease progression. This paper reviews current information about vitamins and trace minerals and their potential roles in HIV infection. For each vitamin or trace mineral, the review includes the available data defining the prevalences of deficiency and excess, their pathogeneses when known, the significance of the altered state, and the response to and implications of treatment. At the outset, two notes of caution should be raised. First, it should be acknowledged that serum vitamin and mineral levels may not always be sensitive or specific indicators of states of deficiency or excess. Levels do not always reliably reflect nutrient status. In addition, they may be technically difficult to measure accurately or they may be artificially skewed by unacknowledged patient intake of supplements or self-restricted dietary habits. Second, it is generally assumed that some of the deficiency states seen in HIVinfected patients result from the cachexia and proteincaloric malnutrition seen as the disease advances. However, many authors have reported deficiency states relatively early in HIV infection, suggesting that selective malabsorption of certain vitamins and minerals may occur long before generalized wasting occurs. This information may have implications for screening.

''If You Build It, They Will Come'': Attitudes of Medical Residents and Fellows About Seeking Services in a Resident Wellness Program

BACKGROUND High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling. INTERVENTION A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services. METHODS In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP. RESULTS Of the 88% of trainees who knew about the RWP, 87% indicated they would be very likely or somewhat likely to seek out services. Time remained the biggest barrier for residents to getting help. Being male (odds ratio [OR]  =  0.54, 95% confidence interval [CI] 0.34-0.84) or an ethnic/racial minority (OR  =  0.49, 95% CI 0.28-0.85) was associated with greater unwillingness to seek counseling. Reluctance to access the RWP was associated with concerns about helpfulness, confidentiality, being unable to take a break, and stigma. Women (OR  =  1.60, 95% CI 1.06-2.42) and primary care residents (OR  =  1.58, 95% CI 0.98-2.54) were more likely to be concerned about taking a break. Men were more likely to question the helpfulness of counseling (OR  =  0.55, 95% CI 0.36-0.85). CONCLUSIONS The RWP removed barriers of cost and knowledge about counseling services. More educational outreach is needed to address sex and ethnic differences about RWP utilization and attitudes in medical culture about a physicians right to address personal health care needs.

Disseminated histoplasmosis diagnosed from peripheral blood film

Demonstration of Histoplasma capsulatum in conventional films of peripheral blood establishes the diagnosis of disseminated histoplasmosis. We describe two new examples of this pnenomenon and tabulate relevant data from 11 similar cases.

Therapy for Collagenous Colitis

Excerpt To the editor: Recently, we had the opportunity to diagnose collagenous colitis (1, 2) and discover the utility of a therapeutic regimen different from those reported in the literature. Thi...

Plug the leak: align public spending with public need.

We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.

Obesity: pathophysiology and practical management.

WHILE AMERICANS SPEND over ten billion dollars annually in attempts to lose weight, ~ the proliferation of diet books, weight loss aids, and reducing clinics reflects the lack of sustaining success that a n y of these provides. Obesity, a state of altered body composition with an increase in the proportion of body fat, is defined as 20% above desirable weight. 2 A weight above this level is associated with inc reased prevalences of hypertension, hyperlipidemia, diabetes, and certain malignancies, z 3 Despite recognition of obesitys link to increased morbidity and mortality, health care providers traditionally receive little education about techniques avai lable for weight reduction. 4 In this article, we present background information about the pathophysiology of obesity and review weight loss methods. Recommendat ions are provided to aid in caring for overweight patients.

Resident wellness: institutional trends over 10 years since 2003

Background The surveys in this study were carried out at the Graduate Medical Education Division at Oregon Health & Science University (OHSU). OHSU implemented two significant wellness initiatives: a wellness program in 2004, and a policy allowing 4 half-days off each academic year to pursue personal or family health care needs in 2010. This study provides a secondary data analysis of five cross-sectional surveys of career satisfaction of resident and fellow trainees. Methods All trainees were surveyed five times over a 10-year period using anonymous, cross-sectional web-based survey instruments. Surveys included questions about career satisfaction, perceived stress, sleep hours, burnout, and related factors. Results This represents 10 years of accumulated responses from over 2,200 residents with results showing continual improvement in their career satisfaction. Response rates ranged from 56% to 72%. During the study period, there was a significant positive change in overall resident career satisfaction, with little change in factors traditionally considered to be predictive of overall career satisfaction such as sleep hours or perceived stress level. In addition, our data support that availability of time for personal tasks could positively impact the overall training experience. Conclusion We postulate that the improvements in satisfaction relate to two major institutional innovations designed to promote resident wellness.

Scholarship in General Internal Medicine

Excerpt To the editor: The article by Friedman and Pozen (1) and the editorial comment by Karpf and Levey (2) raise concerns about the viability of the academic general internist. All agree that th...

Education for Clinical Medicine: An Annotated Bibliography of Recent Literature

Excerpt This bibliography was born from a perceived need for a current and concise reference library for internists involved in undergraduate and postgraduate clinical education. Although in the pa...