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This article gives a brief introduction to the development of sleep medicine in Germany and then focuses on insomnia as a common somnological disorder. [ABSTRACT FROM AUTHOR]

The author offers observation on the number of hours it would take the typical doctor seeing the typical number of patients in an eight-hour-long workday to perform and document the care, following guidelines issued by 'official medical bodies'. Topics discussed include his criticism on the guidelines, and importance for doctors to demand a higher standard before they agree to maintain or add new guidelines.

Problem/Condition: Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/ tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of > 100 morphine milligram equivalents (MMEs) per day. Period Covered: 2013. Description of System: The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. population. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. Results: In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines. Prescribing rates by drug class varied widely by state: twofold for opioids, fourfold for stimulants, almost twofold for benzodiazepines, and eightfold for carisoprodol, a muscle relaxant. Rates for opioids and benzodiazepines were substantially higher for females than for males in all states. In most states, opioid prescribing rates peaked in either the 45--54 years or the 55--64 years age group. Benzodiazepine prescribing rates increased with age. Louisiana ranked first in opioid prescribing, and Delaware and Maine had relatively high rates of use of long-acting (LA) or extended-release (ER) opioids. Delaware and Maine ranked highest in both mean daily opioid dosage and in the percentage of opioid prescriptions written for > 100 MMEs per day. The top 1 % of prescribers wrote one in four opioid prescriptions in Delaware, compared with one in eight in Maine. For the five states whose PDMPs collected the method of payment, the percentage of controlled substance prescriptions paid for in cash varied almost threefold, and the percentage paid by Medicaid varied sixfold. In West Virginia, for 1 of every 5 days of treatment with an opioid, the patient also was taking a benzodiazepine. Multiple-provider episode rates were highest in Ohio and lowest in Louisiana. Interpretation: This report presents rates of population-based prescribing and behavioral measures of drug misuse in the general population that have not been available previously for comparison among demographic groups and states. The higher prescribing rates for opioids among women compared with men are consistent with a higher self-reported prevalence of certain common types of pain, such as lower back pain among women. The trend in opioid prescribing rates with age is consistent with an increase in the prevalence of chronic pain with age, but the increasing prescribing rates of benzodiazepines with age is not consistent with the fact that anxiety is most common among persons aged 30^4 years. The variation among states in the type of opioid or benzodiazepine of choice is unexplained. Most opioid prescribing occurs among a small minority of prescribers. Most of the prescriptions by top-decile prescribers probably are written by general, family medicine, internal medicine, and midlevel practitioners. The source of payment varied by state, for reasons that are unclear. Persons who are prescribed opioids also are commonly prescribed benzodiazepine sedatives despite the risk for additive depressant effects. Public Health Actions: States can use their prescription drug monitoring programs to generate population-based measures for the prescribing of controlled substances and for behaviors that suggest their misuse. Comparing data with other states and tracking changes in these measures over time can be useful in measuring the effect of policies designed to reduce prescription drug misuse. [ABSTRACT FROM AUTHOR]

The measurement and management of cholesterol levels are essential to reduce the risk of developing heart disease. Nursing staff play a key role in the detection and treatment of high cholesterol levels and the promotion of good nutritional health. This article focuses on the process of and rationale for cholesterol testing. [ABSTRACT FROM AUTHOR]

This is a reflective account of an ethical dilemma encountered while on placement on a cardiology ward. Reflection is a process which allows practitioners to reveal and expose thoughts, behaviours and feelings that are present at a particular time. All reflective models are based on the principle that purposeful reflection results in a better understanding and awareness, thus enhancing clinical practice (Driscoll and Teh 2001). The Gibbs' Reflective Cycle has been selected for its simplicity and ease of use to aid personal development. The dilemma was identified and analysed from a professional, ethical and legal perspective. Pseudonyms are used to maintain confidentiality and protect the identities of all parties involved. [ABSTRACT FROM AUTHOR]

This article outlines the diagnosis, treatment and nursing management of patients with Clostridium dufficile-associated diarrhoea. [ABSTRACT FROM AUTHOR]

Results from a national comparative audit of bedside transfusion practice show that patients in the UK are at risk of misidentification and poor monitoring when undergoing a blood transfusion. A commonly identified reason for poor compliance with guidelines from the British Committee for Standards in Haematology (BCSH et at 1999) is a lack of awareness of good transfusion practice (National Blood Service (NBS) 2005). This article discusses the implications of the audit findings for the administration of blood at the bedside and examines initiatives to support hospital staff in their efforts to improve blood transfusion safety. [ABSTRACT FROM AUTHOR]

This article discusses the key issues involved in setting up and running an effective nurse-led cardiology clinic. These include: developing clear aims and objectives for the service, techniques to reduce resistance from colleagues who are affected by the change in service provision, professional development, audit and evaluation. [ABSTRACT FROM AUTHOR]

This article presents a study results, announced at the American College of Cardiology in March, added to rising concern about the use of beta-blockers. There is substantial evidence of the superiority of some drugs in certain special situations. Examples include the use of ACE inhibitors or angiotensin 2 antagonists in diabetics with microalbuminuria or proteinuria and in patients with left ventricular dysfunction, and the use of beta-blockers and ACE inhibitors after acute myocardial infarction and in the presence of stable angina.

Background Helicobacter pylon may have major implications for patients' wellbeing and future health. If a patient is found to be H. pylon positive it is important that the infection is eradicated because of the risk of associated peptic ulcers and gastric cancers. There are, however, great demands on NHS gastroenterology and endoscopy services and following the introduction of recent guidelines for dyspepsia some of these issues may be addressed. The literature suggests that a strategy of test and treat before endoscopy referral will benefit patients and be cost-effective. Conclusion There is evidence that, over a period of time, it is more prudent to test and treat H. pylon first and then review the patients condition before endoscopy is performed (if no other symptoms are identified). [ABSTRACT FROM AUTHOR]

The article offers news briefs related information technology as of December 2013. It offers information on the customer service application launched by Zappix Inc. It presents information on the Cochrane Learning, professional development resource launched by Wiley and the Cochran Collection. Information on the Foilo, ebook solution launched by HighWire Press is presented.

The article focuses on the trend among hospital organizations in the U.S. in hiring hospitalists. A large majority of hospitalists are trained in general internal medicine, while another are trained in general pediatric medicine. Critics of the practice note that savings hospitalists produce are small and that the effectiveness of programs vary by site and are influenced by factors such as physician experience.

The article discusses the results of a study conducted by Kannel and colleagues concerning the risk factors associated with the development of coronary heart disease and has established the basis for modern cardiology. The integration of many risk factors to arrive at a final risk assessment involves the use of a risk calculator to evaluate each risk factor and determine global risk for a particular patient.

The article discusses research on clinical trials. It references a study published in the March 24, 2008 issue of "Archives of Internal Medicine." The study focuses on phase three randomized clinical trials that were completed by the National Cancer Institute Cooperative groups since 1955. Study authors noted that the real benefit of a clinical trial is measured based on patient outcomes.

This section presents findings of several studies related to internal medicine. These include "National Trends in Staphylococcus Aureus Infection Rates: Impact on Economic Burden and Mortality Over a 6-Year Period," by G. A. Noskin, "Prevalence of Chronic Kidney Disease in the United States," by J. Coresh et al, and "Adiposity, Adult Weight Change, and Postmenopausal Breast Cancer Risk," by J. Ahn et al.

A quiz about internal medicine certification is presented.

This section offers news briefs on studies related to internal medicine. It discusses a study which examined the link between nonsteroidal anti-inflammatory drug use and breast cancer risk. It provides an overview of the research "Prospective Study of Leukocyte Count as a Predictor of Incident Breast, Colorectal, Endometrial, and Lung Cancer and Mortality in Postmenopausal Women," by K. L. Margolis et al. It also examines the effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea.

The article focuses on a study that showed that approximately 1 in 6 men with vasculogenic erectile dysfunction had documented asymptomatic coronary artery disease (CAD). According to Charalambos Vlachopoulos of the Department of Cardiology at the Athens Medical School in Greece, erectile dysfunction is sometimes the first manifestation of a generalized disease before CAD has become clinically evident.

This section offers updates on studies related to internal medicine. A study found that statin withdrawal is associated with an increased risk of death or dependency at 90 days post-ischemic stroke. Another study concluded that the regular use of nonsteroidal anti-inflammatory drugs is associated with a significant decrease in bladder cancer risk. A study revealed the link between coffee consumption and hypertension.

A quiz about internal medicine is presented.

This section offers news briefs related to internal medicine. Between 1993 and 2003, the incidence of Clostridium difficile colitis in hospitalized patients increased. A study showed that infection with hepatitis C virus (HCV) is an independent predictor of type 2 diabetes in groups. According to a study of participants in the Framingham Heart Study, middle-aged adults who consume softdrinks are at increased risk of developing metabolic syndrome.

The article discusses the highlights of the 2007 meeting of the Society of General Internal Medicine about prostate cancer screening (PSA). Physicians John Concato and Neil Fleshner debated the benefits of PSA. According to Fleshner, aggressively pursuing prostate cancer results in diminished disease-specific morbidity and that treatments are becoming less invasive, which allows greater preservation of sexual potency. Concato insisted that the limited efficacy of PSA testing in improving survival should be explained to patients.

A photo quiz on internal medicine is presented.

Lynne Pearce visits a hospital ward that is committed to investment in education and training. [ABSTRACT FROM AUTHOR]

A quiz related to disease management and internal medicine is presented.

Two letters to the editor are presented in response to articles in the May 2007 issue, including "In-Store Clinics: Threat or Help to Primary Care" and "Internal Medicine: Poised for a Face Lift."

This section offers news briefs on internal medicine as of July 2007. Hepatitis C virus (HCV) infection is associated with an increased risk of non-Hodgkin lymphoma and thyroiditis based on a study. A study revealed that the rate of progression to dementia in patient with mild cognitive impairment slows down with moderate daily consumption of alcohol or wine. An analysis of two studies concluded that less sodium intake may reduce long-term risk of cardiovascular (CV) events.

A quiz about internal medicine is presented.

A quiz concerning internal medicine is presented.

A photo quiz about internal medicine is presented.

The article offers updates on issues concerning internal medicine in the U.S. A study reveals that statin therapy improves survival following an exacerbation of chronic obstructive pulmonary disease. According to a study, a decrease in serum total cholesterol levels may be an early warning sign of dementia. A research found that the daily use of selective serotonin reuptake inhibitors is associated with an increased risk of fracture in older persons.

Gastrointestinal (GI) services have been something of a poor relation in terms of funding. A strategy for services in which nurses have a major role has been produced by the British Society of Gastroenterology. [ABSTRACT FROM AUTHOR]

Early detection of heart attack means that potentially life saving treatment can begin immediately. HealthWatch offers a distant monitoring service via a call centre run by nurses and doctors to offer reassurance or enable early A&E attendance if required. [ABSTRACT FROM AUTHOR]

The article presents information on optical coherence tomography (OCT). OCT is a relatively new technique for two and three-dimensional imaging of tissues at the histological level. The technique is based on optical technology and commercially available fiber-optic components adapted for ophthalmic use. OCT is a non-invasive technique that does not utilize ionizing radiation to provide in vivo images. OCT has numerous potential clinical applications and, in effect creates optical biopsies of tissues. It has also been used in the detection, characterization and management of skin tumors and other dermatological diseases, cardiology and intravascular disease. OCT may be able to contribute to early diagnosis of vulnerable atherosclerotic lesions.

Presents news briefs on medical care in the U.S., as of October 2002. Information on a contract dispute between Advocate Health Care and BlueCross BlueShield of Illinois; Details of the merger of the Association of Professors of Medicine and the Association of Program Directors in Internal Medicine; Discussion on a study regarding the cost of outpatient hospital care.

The article reports on a study published in "Archives of Internal Medicine" which revealed that weight training exercises could reduce the risk of developing type 2 diabetes in men.

The author reflects on the status of internal medicine in the U.S. He expresses his concern about the hiring of internists as primary care providers by two medical groups in California. He states that no internist today is likely to practice under the rubric of internal medicine and diagnostics as was once the case. He asserts that there is general acceptance that good internists improve quality and help control the ultimate cost of medical care.

This section offers world news briefs related to internal medicine. Wayne Gulliver, chairman of the Division of Dermatology at Memorial University in Newfoundland, states that physicians should consider conducting a comprehensive assessment of patients with psoriasis for potential comorbidities that may be linked to the disease. According to a study, war stress is a risk factor for multiple sclerosis flare-up. British investigators suggest that more efforts must be made to educate general practitioners about hepatitis C and its sequelae.

This section offers news briefs on issues related to internal medicine. According to the European Cancer Conference, the oral multikinase inhibitor sorafenib (Nexavar) offers a significant survival benefit in patients with late-stage hepatocellular carcinoma. It shows that the investigational agent aclidinium bromide provides important improvements in key lung function measures in patients with chronic obstructive pulmonary disease. It reveals the effect of the thrombin inhibitor bivalirudin (Angiomax) on patients with acute coronary syndromes.

The article reports on the updated guidelines for the diagnosis and treatment of Helicobacter pylori infection issued by the American College of Gastroenterology. Primary author Doctor William Chey, says the likelihood of H. pylori infection is a coin toss and testing is critically important, because missing H pylori increases the chances of ulcer recurrence and its complications.

This section offers news briefs related to internal medicine. An article published in "Harefuah" reveals that about 10 percent of people who use the Internet are addicted to it. A study found that hand-rolled cigarettes are more likely to cause lung cancer than manufactured cigarettes. Researchers at Warwick University in Coventry, England suggest that individuals who are overweight are quick to lay the blame for their excess weight on anything but themselves.

The article discusses various reports published within the issue including one on the potential consequences to the physician more than to the patient associated with prescribing drug therapies and another on the role of doctors as educators.

A graph is presented that shows trends in internal medicine subspecialty certification issued from 1940s to 2000s.

The article offers information on a study discussed at the Society of General Internal Medicine annual meeting on the effect of diet-related weight loss during menopause on bone loss. Reasons for weight loss are cited. According to Molly B. Conroy, the key outcome measure was bone mineral density (BMD). The article also discusses the limitations of the study and other studies concerning bone loss.

The article discusses the results of the National Survey of Family Growth, presented at the Society of General Internal Medicine annual meeting by Eleanor Bimla Schwarz. The survey included teenaged and reproductive-aged women who reported having sex with men. The results revealed that the use of emergency contraception was commonly prompted by a concern about contraceptive failure at last intercourse and the lack of use of any form of contraception.

An interview with the professor of cardiac nursing at Coventry University, Tom Quinn is presented. When asked about the reason he chooses such specialty of cardiology nursing, he refers to his fascination and interest in the field. He believes that his research on acute coronary syndromes has improved nursing practice. He suggests that junior nurses should learn about critical appraisal and start the career as early as possible.