Internal medicine physician job satisfaction in rural Montana and Northern Wyoming- a qualitative analysis

Background: Shortage of physicians in rural areas within the USA is an ongoing issue. There are limited data about why internal medicine physicians ('internists') practice in rural areas throughout the USA. We explored reasons why internists chose rural practice locations in Montana and Northern Wyoming, and reasons for overall job satisfaction in these areas. Methods: We used the phenomenological method of qualitative analysis for the study. The principal investigator (RR) conducted and voice recorded 17 semi-structured interviews, throughout Montana and two counties in Northern Wyoming. The voice recordings were transcribed and analyzed according to thematic analysis. Results: Four main themes emerged, outlining why internists chose to practice in rural areas, and why internists reported overall job satisfaction. The main reason internists reported for choosing rural practices was a rural background or the appeal of rural lifestyle. Reasons reported for overall job satisfaction by internists in rural areas included wide breadth of practice, flexibility of rural practice model and the work environment and administrative support for practice. Conclusion: Despite shortages of health care providers in rural areas, a number of internists show ongoing commitment to practicing in these areas. Hopefully, our study will help rural practices, hospitals and residency programs in Montana and Northern Wyoming with future hiring decisions

Invasive cryptococcal disease in COVID-19: systematic review of the literature and analysis

During the Coronavirus Disease 2019 (COVID-19) pandemic, an increasing number of fungal infections associated with SARS-CoV-2 infection have been reported. Among them, cryptococcosis could be a lifethreatening disease. We performed a Systematic Review (PRISMA Statement) of cryptococcosis and COVID-19 co-infection, case report/series were included: a total of 34 cases were found, then we added our case report. We collected patients’ data and performed a statistical analysis comparing two groups of patients sorted by outcome: “dead” and “alive”. Three cases were excluded for lack of information. To compare categorical data, we used a Fisher-exact test (a=0.05). To compare quantitative variables a U Mann-Whitney test was used (a=0.05), with a 95% Confidence Interval. A total of 32 co-infected patients were included in the statistical analysis. Mortality rate was 17/32 (53.1%): these patients were included in “dead” group, and 15/32 (46.9%) patients survived and were included in “alive” group. Overall, males were 25/32 (78.1%), the median age was 60 years (IQR 53-70) with non-statistically significant difference between groups (p=0.149 and p=0.911, respectively). Three variables were associated with mortality: ARDS, ICU admission and inadequate treatment. Overall, 21 out of 24 (87.5%) patients were in ARDS with a statistically significant difference among two groups (p=0.028). ICU admission for COVID-19 was observed in 18/26 (69.2%), more frequently among dead group (p=0.034). Finally, 15/32 (46.9%) patients had adequate treatment (amphotericin B + flucytosine for invasive cryptococcosis) mostly among alive patients (p=0.039). In conclusion, mortality due to cryptococcal infection among COVID-19 patients remains high but an early diagnosis and appropriate treatment could reduce mortality

Psychiatry Questions and Answers

Chapter 12 presents multiple-choice, board review questions on psychiatry including mood disorders, anxiety disorders, substance abuse, and pharmacologic treatment. Full explanations are provided with the correct answers.</p

Cross-Content Area Questions and Answers

Chapter 15 presents multiple-choice, board review questions on cross-content areas including geriatrics, preventive medicine, women’s health, general internal medicine, quality improvement, medical ethics, palliative care, and perioperative medicine. Full explanations are provided with the correct answers.</p

Oncology Questions and Answers

Chapter 8 presents multiple-choice, board review questions on oncology including lung cancer, colon cancer, ovarian cancer, breast cancer, and prostate cancer. Full explanations are provided with the correct answers.</p

Infectious Diseases Questions and Answers

Chapter 5 presents multiple-choice, board review questions on infectious diseases including travel medicine, zoonoses, bioterrorism, pneumonia, mycobacterial infections, skin and soft tissue infections, bone and joint infections, urinary tract infections, sexually transmitted infections, gastrointestinal tract infections, and HIV infection. Full explanations are provided with the correct answers.</p

Allergy Questions and Answers

Chapter 11 presents multiple-choice, board review questions on allergic diseases including seasonal allergies, angioedema, anaphylaxis, asthma, drug allergy, and stinging insect allergy. Full explanations are provided with the correct answers.</p

Rheumatology Questions and Answers

Chapter 6 presents multiple-choice, board review questions on rheumatologic diseases including nonarticular rheumatism, vasculitis, osteoarthritis, rheumatoid arthritis, antirheumatic drugs, spondyloarthropathies, and miscellaneous rheumatic conditions. Full explanations are provided with the correct answers.</p

Pulmonary Diseases Questions and Answers

Chapter 4 presents multiple-choice, board review questions on pulmonary medicine including critical care medicine, diffuse lung disease, occupational lung disease, pulmonary vascular disease, pulmonary embolism, pulmonary hypertension, signs and symptoms, and chest radiographs. Full explanations are provided with the correct answers.</p