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Background: The retraction of medical articles periodically occurs in most medical journals and can involve multiple article types. These retractions are beneficial if they remove flawed or fraudulent information from the medical literature. However, retractions may also decrease confidence in the medical literature and require significant amounts of time by editors., Methods: One publisher (Hindawi) announced that it will retract over 1200 articles. Given this, the PubMed database was searched to identify retracted publications on or related to COVID-19, and articles retracted by journals sponsored by the publisher Hindawi were then identified., Results: These journals retracted 25 articles and, in most cases, did not provide an exact explanation about the particular problem(s) resulting in the retraction. The time to retraction was 468.7 ± 109.8 days (median =  446 days). These articles had 9.3 ± 9.9 citations., Conclusion: Analysis of the titles and abstracts of the articles suggests that their removal from the medical literature would have limited effects on the near-term management decisions during the COVID-19 pandemic. Nevertheless, retraction of medical articles creates uncertainty in medical care and science and in the public regarding the validity of medical research and related publications and the level of professionalism of the individuals submitting these articles., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Background: There are no specific biomarkers for microscopic colitis (MC), and the diagnosis depends on histopathological tissue obtained during colonoscopy. Studies on the role of fecal calprotectin (FCP) in MC are limited. A literature search of PubMed, Embase, and Scopus was conducted from each database's inception through September 2022., Methods: A DerSimonian-Liard random-effects meta-analysis was performed to examine the standardized mean difference (SMD) in FCP levels between patients with MC and control patients with chronic diarrhea., Results: Six studies with 96 active MC patients and 200 controls were included in the meta-analysis. Random effects meta-analysis revealed that FCP was significantly and moderately elevated in patients with MC compared to the control group (SMD = 0.6 [95% CI 0.3, 1.0], P  = 0.001). Imputing one effect size confirmed the observation that FCP is significantly higher in patients with MC than control subjects with chronic diarrhea (SMD = 0.5 [95% CI 0.2, 0.9], P  = 0.004). Study heterogeneity between the SMDs was not significant ( I 2 = 41%, P  = 0.1)., Conclusion: These results indicate that FCP levels in patients with chronic diarrhea can help identify patients with MC. More studies with serial measurements of FCP would provide a better understanding of its utility in MC., Competing Interests: No funding or potential conflict of interest was reported by the authors., (Copyright © 2023 Baylor University Medical Center.)

Patients undergo colonoscopies for colorectal cancer screening and for the evaluation of gastrointestinal symptoms. Analysis of large administrative databases has demonstrated that some patients undergo repeat colonoscopies at intervals inconsistent with current recommendations, but these studies do not provide patient-level details. The medical records of 110 patients undergoing repeat colonoscopies within 1 year of their index colonoscopies at a tertiary care hospital-based endoscopy center were retrospectively reviewed to determine patient demographics, gastrointestinal symptoms, and endoscopic findings. Thirty-five patients had poor bowel preparations, and 11 patients had a history of colorectal cancer. Thirty-four patients had polyps identified during their index colonoscopies, and 28 patients had no polyps identified during their index colonoscopies. Eleven patients in the nonpolyp group had new endoscopic findings identified during the repeat colonoscopies. Twenty patients who had polyps identified on their index colonoscopies had 44 polyps identified on repeat colonoscopies. Repeat colonoscopies within 1 year occurred relatively infrequently in this endoscopy center. Indications included poor bowel preparation with incomplete studies, colonic polyps with incomplete resection, multiple polyps resulting in the possibility of missed polyps, and new gastrointestinal symptoms., Competing Interests: No funding or potential conflict of interest was reported by the authors., (Copyright © 2023 Baylor University Medical Center.)

Editors of medical journals have important responsibilities and depend on peer reviewers to evaluate the quality of submitted manuscripts. However, invitations to undertake peer review are often declined, and in some cases the reviewer fails to provide a review in a reasonable timeframe. Baylor University Medical Center Proceedings surveyed recent reviewers to determine their motivations for undertaking a review and possible benefits associated with reviewing. Sixty-seven reviewers (12.4%) out of 540 responded to the survey request. Reviewer characteristics included long-standing involvement in research (50 reviewers in research ≥11 years) and prior publication (50 reviewers ≥6 articles). Many reviewers thought that reviewing articles represented a responsibility and provided an opportunity for them to contribute to scientific efforts and medical publications and to learn new information. Survey respondents suggested that recognition by the journal was an adequate benefit. This survey, like others, indicates that editors will continue to depend on a core set of reviewers who consider this activity both an opportunity and a responsibility., Competing Interests: No potential conflict of interest was reported by the author(s)., (Copyright © 2022 Baylor University Medical Center.)

Multiple extrapulmonary symptoms have been described in individuals with elevated inflammatory markers after COVID infection, which have been grouped and classified as a new inflammatory syndrome, called multisystem inflammatory syndrome in adults (MIS-A). However, little is known about MIS-A, including its prevalence, predisposing conditions, or patient outcomes. We report a case of severe postvaccination symptoms that occurred after administration of the Moderna vaccine in an individual with no prior history of COVID infection. We also review a case series that fulfills the criteria for MIS-A reported in the literature and summarize the characteristics of patients developing MIS-A after COVID-19 vaccination., (Copyright © 2022 Baylor University Medical Center.)

Echocardiograms provide important information for the evaluation and management of patients with pulmonary hypertension. Right ventricular free wall strain measurements provide additional information about the longitudinal contractile function of the right ventricle. Clinical information, including echocardiographic measurements and right heart hemodynamic parameters, on patients undergoing right heart catheterization for evaluation of possible pulmonary hypertension was collected retrospectively. This study included 60 patients (35 women) with a mean age of 62.6 ± 14.8 years. For World Health Organization categories, 32 patients were in Group 1, 12 in Group 2, 4 in Group 3, 3 in Group 4, and 7 had mixed clinical features of both Group 2 and Group 3. The mean pulmonary artery pressure was 40.6 ± 13.2 mm Hg. The right atrial volume index had significant positive correlations with the brain natriuretic peptide level, right ventricular volume index, left atrial volume index, and right atrial pressure and negative correlations with the cardiac index and mixed venous oxygen saturation. The mean right ventricular free wall strain was -17.85 ± 5.56%; it did not have significant correlations with right heart hemodynamic parameters. Therefore, the right atrial volume index but not the right ventricular strain index provides important objective information for the evaluation of patients with possible pulmonary hypertension., (Copyright © 2022 Baylor University Medical Center.)

Cutaneous manifestations of COVID-19 infections include "COVID toes." These are pernio-like, pale purple, painful, ill-defined cyanotic lesions that have inflammatory infiltrates on histologic studies. COVID toes can also develop following COVID vaccination. COVID toes was reported by 29 individuals to the Vaccine Adverse Event Reporting System maintained by the Centers for Disease Control and Prevention through May 25, 2021. The mean age of these individuals was 52 ± 18 years; 23 (79%) were women. They had received both mRNA vaccines and the adenovirus vector-based vaccine. This discoloration developed 4.5 ± 9.8 days following vaccination, usually after the first dose. Four individuals required hospitalization for systemic symptoms, and one died. This information indicates that some individuals develop important clinical syndromes following vaccination and suggests that some of the manifestations of COVID-19 infection represent immune responses and not necessarily active tissue infection., (Copyright © 2022 Baylor University Medical Center.)

Peer review continues to be a crucial part of the scientific publishing process. Many editors have reported difficulty recruiting potential reviewers and receiving timely recommendations. Poor reviewer acceptance and completion rates can complicate and delay publication. However, few studies have examined these rates in detail. Here we analyze reviewer invitation, acceptance, and completion data from the Baylor University Medical Proceedings ., (Copyright © 2022 Baylor University Medical Center.)

In 1905, Felix Gaisbock, MD, described a syndrome in patients with hypertension, elevated hematocrit levels, plethoric appearances, and no splenomegaly. He postulated this relative erythrocytosis was due to stress. In this case report, a 40-year-old Caucasian man with obesity was admitted with recurrent deep vein thrombosis and increasing oxygen requirements 2 weeks after hospitalization with COVID-19 pneumonia. This patient had a 10-year history of untreated hypertension and erythrocytosis. He had a ruddy appearance, a normal erythropoietin level, and a negative JAK2 V617 mutation. In this case, Gaisbock syndrome was suspected., (Copyright © 2022 Baylor University Medical Center.)

Alternative metrics are unique bibliometrics comprising social, news, and other sources of media outside of traditional academic citations. Some have suggested that these metrics can complement traditional metrics of research impact, including public engagement with research. The COVID-19 pandemic provides a unique opportunity to study alternative metrics and the dissemination of scientific research given the heightened academic and public interest. This study analyzed Altmetric Attention Scores for the top 25 publications on COVID-19 and the top 25 non-COVID-19 publications in 2020. There were significantly higher levels of social attention scores across multiple metrics for COVID-19 articles than for non-COVID-19 articles for that year. There was a slightly higher goodness of fit between Altmetric Attention Scores and academic citations for COVID-19 publications than for non-COVID-19 publications, although trendline differences were not significant. These results suggest that researchers should be aware that their studies can become highly visible on publicly available social and news media platforms, especially during events of high interest (such as a global pandemic)., (Copyright © 2021 Baylor University Medical Center.)

This study aimed to assess gender differences in hospitalization incidence, 30-day mortality, and 30-day readmission rates for acute myocardial infarction (AMI) in a Southwestern US medical center. Hospital billing records for AMI admissions were compiled from January 2013 to June 2019, resulting in a sample size of 2394. Billing data included gender, age, principal procedure, insurance status, principal diagnosis, and race/ethnicity. Multivariate logistic regression was used to estimate gender differences in mortality after adjustment for the aforementioned factors. Men were hospitalized for AMI over twice as frequently, yet women had higher AMI mortality than men (9.3% vs. 6.1%, P  < 0.01). Female AMI patients were older on average and slightly less likely to undergo percutaneous transluminal coronary angioplasty than men. Thirty-day readmission rates did not differ by gender. In absolute terms, AMI hospitalizations and deaths are larger in number in men, but AMI hospitalizations more frequently end in death in women., (© 2021 The Author(s). Published with license by Taylor and Francis Group, LLC.)

The presence of air in the mediastinum is a rare finding called pneumomediastinum. Spontaneous pneumomediastinum is typically benign. Marijuana use has been rarely reported to cause pneumomediastinum. Our case series presents two young men with no significant past medical history who had a history of marijuana use and developed pneumomediastinum after multiple episodes of intractable vomiting. The pathophysiology of spontaneous pneumomediastinum in marijuana users includes cyclic vomiting or microperforation of the esophagus or barotrauma during breathing maneuvers. Most cases can be managed conservatively., (Copyright © 2020 Baylor University Medical Center.)

Currently, the world is facing a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. So far, there are no clear recommendations regarding hospital discharge and aftercare for COVID-19. Here, we briefly discuss the current understanding of recommendations for discharge criteria, discharge treatment regimens, and follow-up., (Copyright © 2020 Baylor University Medical Center.)

Health care under the jurisdiction of the Texas Department of Criminal Justice has evolved over time to provide prisoners greater access to medical care, including psychiatric care and substance abuse assistance. Mental illness and chronic conditions, such as hypertension, chronic obstructive pulmonary disease, diabetes, and heart disease, are common in prisoners in Texas and across the nation and increase the cost of health care. The average annual health care cost per prisoner in Texas was $4077 in 2015. Although the Texas prison system has undergone changes, such as the use of telemedicine and protocols for preventive measures, to address the varying medical needs of prisoners in correctional facilities, there is still considerable criticism regarding prison policies and incomplete access to medical care. In addition, the ongoing COVID-19 pandemic has added significant stress to correctional health care in Texas and highlights the importance of organized health care for prisoners. This report reviews the history and evolution of health care delivery in Texas's correctional facilities, outlines ongoing efforts to improve medical care in prison facilities, and describes current policies to limit COVID-19 infections in Texas prisons., (Copyright © 2020 Baylor University Medical Center.)

This study investigated the association between hematologic inflammatory markers derived from complete blood counts and obesity. We undertook a cross-sectional study that included self-reported healthy subjects above the age of 18 years from the 2011-2016 National Health and Nutrition Examination Survey, a US population database. Study parameters included mean corpuscular volume, red cell distribution width, mean platelet volume, total platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index. Body mass index was used as an index of obesity and was correlated with each hematologic inflammatory marker. Our analysis found a statistically significant association between each inflammatory parameter and higher body mass indices. We demonstrated an association between complete blood count-derived indices of inflammation and obesity, and these results provide the basis for future studies using complete blood count-derived variables and outcomes in patients with some chronic diseases., (Copyright © 2020 Baylor University Medical Center.)

Patients with complex chronic disorders, such as asthma, present clinicians with important management problems. The identification of a clinical syndrome usually leads to the diagnosis of the disease entity. The next concern involves classification and a choice as to whether to use a few inclusive categories or multiple exclusive categories. Patients with asthma have multiple clinical syndromes, and these can be described as phenotypes. The use of cluster analysis allows investigators to identify phenotypes with less clinical bias. However, the identification of a particular phenotype does not necessarily provide much insight into the underlying pathogenesis. In asthma, the pathogenetic events are complex and multiple and require a classification based on endotypes. This difficulty introduces the idea of causation and models for causation. Asthma probably does not have a single universal necessary cause. However, it does have multiple sufficient component causes. Understanding these components and their interactions potentially leads to better treatment trials and more focused drug therapy. Clinicians need to identify asthmatic patients and classify them into particular phenotypes; they should also wonder about causation. Clinical investigators need to use these phenotypes to identify more homogenous groups of patients to study the underlying pathogenesis and establish endotypes. Focusing on causation can improve our understanding of disease entities, disease classification, and disease causation. This review outlines ideas relevant to causation in nearly all diseases., (Copyright © 2020 Baylor University Medical Center.)

Mean platelet volume (MPV) is a measure of platelet activation, and C-reactive protein (CRP) is an established marker of inflammation. Studies on the correlation between MPV and CRP have produced ambiguous results. We undertook a population study with the National Health and Nutrition Examination Survey (NHANES) data (2005-2010) to investigate the relationship between CRP and MPV. CRP was analyzed both as a continuous variable and as a categorical variable (low, intermediate, or high). Multivariate ordinary least squares regression analysis was used to predict the association. Statistical analyses were performed with Stata MP 15.1. In 16,329 participants, mean MPV was 7.9 fL (standard deviation 0.87). Overall mean CRP in the population was 0.4 mg/dL (standard deviation 0.78). In adjusted regression models with CRP as a continuous measure, individuals with high CRP had significantly lower MPV (b = -0.04; standard error 0.01; 95% confidence interval -0.06 to -0.01; P  = 0.002). In adjusted regression models using CRP categories, participants with high CRP (>3 mg/dL) had significantly lower MPV compared with the low CRP group (b = -0.20; standard error 0.09; 95% confidence interval -0.38 to -0.01; P  = 0.035). Our study revealed a significant inverse correlation between MPV and CRP in NHANES participants., (Copyright © 2020 Baylor University Medical Center.)

The importance of glucose metabolism in patients with acute coronary syndrome has been increasingly recognized. We conducted a retrospective study of the associations between prior glycated hemoglobin (HbA1c) levels, admission glucose values, HbA1c-derived estimated average glucose levels (eAG), admission glucose delta (admission glucose - eAG), and mortality in patients presenting with ST-segment elevation myocardial infarction. A total of 676 and 566 patients were included in the in-hospital and 12-month mortality models, respectively. Mean admission blood glucose values were higher in the in-hospital and 12-month mortality groups in patients with no prior diagnosis of diabetes ( P < 0.001). Pre, post, and admission HbA1c levels and eAG levels were not associated with in-hospital or 12-month all-cause mortality. The admission glucose delta was higher in patients with in-hospital mortality (87.3 ± 122.7 mg/dL) than in patients who survived (35.88 ± 81.23 mg/dL; P  = 0.040). The in-hospital death rate was significantly higher (17% vs 4%, P  = 0.017) for patients with admission glucose delta ≥140 mg/dL compared to lower values. In conclusion, HbA1c-derived admission glucose delta is associated with in-hospital mortality in patients with ST-segment elevation myocardial infarction. The mechanisms for the association of acute hyperglycemia with increased acute coronary syndrome mortality are unclear.

The indications for endotracheal intubation (ETI) during an esophagogastroduodenoscopy (EGD) procedure remain unclear. This study performed a descriptive analysis of patients who underwent prophylactic tracheal intubation during or before an EGD to prevent pulmonary aspiration. We selected patients with an upper gastrointestinal bleed in an intensive care unit who underwent EGD between 2000 and 2013. Eighty-nine patients who underwent pre-EGD tracheal intubation were analyzed. The main outcomes in this study were pulmonary aspiration, length of stay, and mortality. The average age of patients undergoing pre-EGD intubation was 61 years. The incidence of pulmonary aspiration was 38% in patients who underwent pre-EGD tracheal intubation. The patients requiring tracheal intubation had a mortality rate of 22% during hospitalization. Other complications in pre-EGD ETI patients included myocardial infarction (9%), acute respiratory distress syndrome (10%), and pulmonary edema (7%). In conclusion, the incidence of pulmonary aspiration with pre-EGD tracheal intubation in our patients was high (38%). Cardiopulmonary complications including myocardial infarction, acute respiratory distress syndrome, and pulmonary edema were high in intubated patients.

The business model, editorial policies, and content quality vary significantly in online medical journals. Some online journals have been labeled as predatory journals because their main effort involves collecting article processing charges with little interest in content, peer review, or manuscript presentation. Some of these journals send frequent email solicitations for submissions. One author affiliated with a department of internal medicine collected all email requests for submissions to online journals over a 6-month period. These emails included 210 unique journal names that covered over 40 medical fields and requested 15 different article types. Most of these journals were not listed in PubMed or the Directory of Open Access Journals. One hundred and eighty two were on Beall's list of predatory journals. The median article processing charge was $1035. Faculty and trainees at medical schools receive multiple requests for submissions, but it is difficult to determine the quality of the journal sending these requests. At a minimum, a journal should be listed in the Directory of Open Access Journals and have very clear editorial and publication policies.

A literature search was performed through May 2017. Studies that compared the risk of developing Clostridium difficile infection (CDI) and/or the clinical outcomes of CDI in patients who received statin treatment versus those who did not receive statins were included. Ten observational studies with 37,109 patients were included. Compared to no treatment, statins reduced the risk of CDI development (odds ratio [OR] = 0.66, 95% confidence interval [CI], 0.44-0.99). However, among patients who developed CDI, the use of statins did not significantly reduce recurrent CDI risk (OR = 0.69, 95% CI, 0.28-1.71) or 30-day mortality (OR = 0.77, 95% CI, 0.51-1.14). In conclusion, our study demonstrates a significant association between statin use and a reduced risk of CDI development. However, the findings of our study suggest no significant associations between statin use and improvement in clinical outcomes of CDI. These findings might impact the clinical management and primary prevention of CDI.

Ascites is a debilitating condition affecting patients with end-stage liver disease and advanced abdominal malignancies. Serial paracentesis can reduce symptoms in these patients; indwelling peritoneal catheters provide an alternative approach that allows patients to manage their symptoms at home. A literature search was conducted to identify studies with at least 20 patients published in the last 15 years that reported indwelling catheter placement in patients with chronic ascites. Fourteen studies with 957 patients (687 with malignancy and 270 with cirrhosis) were reviewed. Symptom improvement was reported in all studies. The most common complication in patients with malignant ascites was catheter dysfunction (39/687). Infection rates for patients with malignancy and patients with nonmalignant ascites were 5.4% (37/687) and 12.2% (33/270), respectively. Infection risk significantly increased with devices in place for >12 weeks. The average survival time after catheter placement was 7.2 weeks for patients with malignancy and 164 weeks for patients without malignancy. In conclusion, indwelling peritoneal catheters are an effective alternative to paracentesis for palliation in patients with refractory ascites. Peritonitis is a definite risk in patients with nonmalignant ascites in whom prolonged use is expected.

The undead have a significant role in mythology, religion, folklore, and literature. In the 1800s, the word zombie was used to describe reanimated corpses in the Caribbean who often worked on plantations doing long, arduous field work. The movie White Zombie was released in 1932 and exploited this folklore, but it ignored the fact that zombies represent one outcome in Vodou religious beliefs regarding death and the migration of spirits following death. The interest in zombies eventually led to sociological and medical investigations into zombification. Wade Davis reported that powders used by malevolent priests (bokors) contained tetrodotoxin, which could cause the neurologic changes underlying the zombie phenotype. Recent clinical studies have indicated that synthetic cannabinoids and synthetic cathinones can cause bizarre zombie-like behavior. According to Haitian folklore, zombies can develop when bokors reanimate someone who suddenly died from an acute illness or who was purposely poisoned. Recent studies in molecular biology suggest that the sequence of programmed cell death can be reversed when the stressor is removed and that cells, tissues, and bodies (at least in Drosophila flies) can recover. These scientific studies would support the remote possibility that the near dead might recover under certain circumstances but have residual neuropsychological dysfunction. Alternatively, the bokors could maintain control of their victims using drugs with properties similar to those of synthetic cannabinoids. The concept of zombification needs to be considered in the context of culture, religion, and science.

Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2-4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis.

Electronic cigarettes (e-cigarettes) are an increasingly popular source of nicotine and an increasingly popular topic in the media. Concerns about potential hazards associated with e-cigarette use and advertising, especially to adolescents, have led to studies on e-cigarettes in both traditional media (TV, mail, print, and outdoor advertising) and social media (websites, social networking sites, blogs, and e-mails). This review presents a narrative description of available studies related to e-cigarettes in the media. These articles have focused on promotion in both traditional and social media across a broad range of topics and have concentrated on target audiences, smoking cessation, harm reduction, and advertising. E-cigarette advertising is the most frequent topic in the published articles. Identifying the target audience also is a common objective in articles. The representation of e-cigarettes as a "healthier alternative" to traditional cigarettes and their use as a "smoking cessation aid" are main themes presented through all types of media.

This study was designed to assess evidence for an association between the treatment of gastroesophageal reflux disease (GERD) with proton pump inhibitors (PPIs) and improvement in obstructive sleep apnea (OSA). We conducted a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies to evaluate the treatment effect of PPIs on OSA symptoms and indices in patients with GERD. EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were reviewed up to October 2014. From 238 articles, two randomized trials and four prospective cohort studies were selected. In four cohort studies there were no differences in the apnea-hypopnea indices before and after treatment with PPIs (standard mean difference, 0.21; 95% confidence interval, -0.11 to 0.54). There was moderate heterogeneity among these studies. Two cohort studies revealed significantly decreased apnea indices after treatment (percent change, 31% and 35%), but one showed no significant difference. A significant improvement in the Epworth Sleepiness Scale was observed in three cohort studies and one trial. The frequency of apnea attacks recorded in diaries was decreased by 73% in one trial. In conclusion, available studies do not provide enough evidence to make firm conclusions about the effects of PPI treatment on OSA symptoms and indices in patients with concomitant GERD. Controlled clinical trials with larger sample sizes are needed to evaluate these associations. We recommend PPIs in OSA patients with concomitant GERD to treat reflux symptoms. This treatment may improve the quality of sleep without any effect on apnea-hypopnea indices.

Since restricted resident work hours have reduced resident participation in traditional educational activities, we wanted to evaluate e-mail-based education in an internal medicine residency. One internal medicine faculty member sent four clinical case-based questions per week to all internal medicine residents over a 10-month period (132 questions total). The mean percentage of participation on a set of questions was 69% (range, 43% to 97%). The mean percentage of correct answers on all questions for all residents was 70% (range, 15% to 100%). Seventy-three percent of the question sets resulted in an electronic interaction between the residents and the faculty sponsor. Based on an anonymous survey, 96% of the residents found the program useful. The faculty sponsor spent 60 to 150 minutes per week on this activity. We think that this program increased overall reading since it did not replace any traditional activity; further, it provided practice with board-type questions. This approach can supplement the educational curriculum for internal medicine training.

Case report publications introduce new information into the current body of medical information and provide trainees with an opportunity to develop skills that enhance patient care. However, opportunities for publication are limited because journals often have other editorial priorities and some journals do not want to publish articles that might decrease their impact factors. Using PubMed and Google Scholar, we identified the case report articles published by our residents who completed training between 2008 and 2013. Sixty-one residents published 55 case reports and/or letters. Twenty-five of these publications had 87 citations in the years of publication and up 5 years after publication. Most of these citations occurred in other case reports (36) or in review articles (24). In conclusion, publishing case reports by residents has important benefits for the individual resident and the residency program and provides another resource for medical care.