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Interest in primary care careers has been dwindling among medical trainees over the past decade, with poor quality of life among the perceived disadvantages. We sought to evaluate factors influencing career satisfaction among graduates of Brown's General Internal Medicine (GIM)/Primary Care residency program and assess its contribution to the primary care work force.Using an anonymous online survey, we queried GIM alumni from 1981-2012 to obtain information about demographics, job characteristics and career satisfaction measures.Fifty-nine percent of Brown's GIM/Primary Care residency graduates practice primary care, a rate higher than most primary care track programs. Seventy-six percent of respondents were "satisfied" or "very satisfied" with their current jobs. Career satisfaction correlated with self-rating of physical and emotional health and did not correlate with age, gender, income, debt burden, or practice setting.Among the diverse factors associated with attaining career satisfaction, attention to personal health plays a central role.

Training in gastrointestinal (GI) disorders in pregnancy is required for all gastroenterology fellows. Nevertheless, the actual role of the gastroenterologist in the management of pregnant patients is unknown. Establishing the characteristics of GI consultations in pregnancy can help focus trainee education and prepare gastroenterologists for future practice. The purpose of this study was to determine the indications for consultations in pregnancy and the gastroenterologist's role in the evaluation and management of the pregnant patient.A chart review was performed of all consecutive outpatient GI consultations for pregnant women at a high-volume obstetrics hospital over a 3-year period. Referring source, patient characteristics, indication(s) for consultation, diagnosis(es), change in management after consultation, and need for follow-up were recorded.We reviewed 370 charts. The mean age (±standard deviation [SD]) at referral was 28.7 years ± 6.5, and mean weeks of gestation (±SD) was 21.3 ± 8.8. Obstetrician/gynecologists requested most consultations (70.1%). New GI symptoms arising in pregnancy comprised 35.4% of consultations, and worsening of a preexisting GI disorder comprised 24.4%. The most common indications for consultation were viral hepatitis (20.2%), nausea and vomiting (18.9%), and nonspecific abdominal pain (13.5%). The most common diagnoses were acute or chronic viral hepatitis (17.8%), hyperemesis gravidarum (15.1%), gastroesophageal reflux disease (14.3%), and constipation (13.0%). Consultation changed the diagnosis in 25.1% of patients and changed management in 78.6%. Follow-up was required in 77.3% of cases during pregnancy and 37.8% postpartum.GI consultation in pregnancy is sought more frequently for the evaluation and management of GI disorders not unique to pregnancy than for pregnancy-unique disorders. Although GI consultation changed the diagnosis in a minority of cases, it changed management in the majority. Gastroenterologists should be familiar with the most common indications for consultation in pregnancy and be prepared to evaluate and manage pregnant women with GI disorders.

Study objective The literature on the costs of treating alcohol-impaired motor vehicle crash victims is largely based on inpatient data. Less is known about the more frequent emergency department (ED) evaluations for those who are discharged home. Our objective is to measure the difference in charges and length of stay between alcohol-impaired and nonimpaired drivers in this population. Methods This was a retrospective study of charts and billing data for all drivers in motor vehicle crashes, aged 21 to 65 years, treated at an urban Level I trauma center in 2005 and discharged home from the ED. Patients were divided into alcohol-positive and -negative groups according to alcohol level, documentation of recent alcohol use, or clinical intoxication. Itemized charges were tabulated and compared across groups. Results Of 1,618 eligible patients, median charges were higher for alcohol-positive patients by $4,538 (95% confidence interval [CI] $2,755 to $5,665). Imaging was 69% of the charge differential because of a higher frequency of imaging (91% versus 70%) and more expensive studies (median difference $2,464; 95% CI $1,507 to $3,400) for alcohol-positive patients. Median length of stay was higher for alcohol-positive patients by 3.3 hours (95% CI 2.7 to 4.1 hours). When stratified by trauma-protocoled triage destination, median charges were higher for alcohol-positive versus -negative patients in non–critical care beds by $2,229 (95% CI $1,039 to $2,693). For patients triaged to critical care beds, the difference in charges was only $132 (95% CI –$1,677 to $1,233). Conclusion The presence of alcohol substantially increased charges and length of stay for ED evaluations of injured drivers discharged home, especially for patients who were triaged to non-critical care beds. The magnitudes are striking for this minimally injured population and represent an underreported burden of alcohol-impaired driving.

This study was designed to test the hypothesis that raising myocardial O2 via diffusion of a hyperbaric oxygen solution (AO) administered through the anterior interventricular vein (AIV) will reduce infarct size by reducing reperfusion injury associated with reduced neutrophil activation. In three pilot open-chest swine experiments, myocardial tissue Po2 was monitored using an oxygen probe during coronary occlusion (Occl) and reperfusion (Rep). One control experiment had no AIV infusion; a second control received arterial blood drawn from the femoral artery infused into the AIV during Rep. In a third open-chest experiment, AO mixed with arterial blood was infused through the AIV at Rep. In controls, tissue Po2 in the risk region (RR) rose early in Rep and then fell to Occl levels, whereas in AO-treated animals, myocardial Po2 remained above baseline. The following three groups of five swine then underwent 60 min of left anterior descending coronary artery Occl and Rep: 1) arterial blood infused at Rep as controls (Con), 2) AO infused beginning 30 min after Rep (AO 30 min), and 3) AO infused immediately at Rep (AO 0 min). There were no differences among the three groups in hemodynamics or myocardial blood flow during baseline (BL) or Occl or in RR size. However, endocardial blood flow was significantly higher in RR during Rep in AO 0 min vs. control and AO 30 min ( P = 0.01). Both infarct size (IS) as %heart and IS as %RR were lower in AO 0 min compared with Con and AO 30 min ( P < 0.01 for both), and myeloperoxidase values were lower for epicardial ( P < 0.001), midmyocardial ( P = 0.03), and endocardial ( P < 0.001) layers in AO 0 min. AO infused into the AIV immediately at Rep diffuses into the RR and reduces IS by reducing Rep injury associated with neutrophil activation.

To evaluate the efficacy of a 40-mg/kg dose of intravenous magnesium sulfate for moderate to severe asthma exacerbations in pediatric patients.Double-blind placebo-controlled trial.Two urban tertiary care pediatric emergency departments.Thirty patients, aged 6 to 17.9 years, being treated for an acute asthma exacerbation.Eligible patients received either a magnesium sulfate infusion of 40 mg/kg or saline solution.At 20 minutes, the time at which the infusion was completed, the magnesium group had a significantly greater percentage of absolute improvement from baseline in each of the following: predicted peak expiratory flow rate (8.6% vs 0.3%, P. 001), forced expiratory volume in 1 second (7.0% vs 0.2%,P.001), and forced vital capacity (7.3% vs -0.7%, P.001). The improvement was greater at 110 minutes: peak expiratory flow rate (25.8% vs 1.9%, P.001), forced expiratory volume in 1 second (24.1% vs 2.3%; P. 001), and forced vital capacity (27.3% vs 2.6%, P.001). Patients who received intravenous magnesium were more likely to be discharged to their homes than those who received the placebo (8/16 vs 0/14; P=. 002).Children treated with 40 mg/kg of intravenous magnesium sulfate for moderate to severe asthma showed remarkable improvement in short-term pulmonary function.