What is the prognosis of postherpetic neuralgia?

Postherpetic neuralgia occurs rarely among patients aged 70 years, 25% had some pain at 3 months, but only 10% had pain at 1 year, and none had severe pain. Only a few patients have pain that persists for years (strength of recommendation: A, based on a well-done prospective cohort study)

How should patients with mitral regurgitation be followed?

Patients with mild to moderate mitral regurgitation should be assessed periodically for a worsening condition; those with severe mitral regurgitation should be monitored for development of congestive heart failure, atrial fibrillation, and decline in left ventricular ejection fraction or increase in left ventricular end-diastolic diameter (strength of recommendation [SOR]=B). Cardiologists and general internists perform equally well in identifying severe mitral regurgitation among patients with known mitral regurgitation. Grade I or II murmurs indicate mild or moderate mitral regurgitation; grade IV or greater murmurs indicate severe mitral regurgitation, and grade III murmurs are indeterminate (SOR=B). The optimal frequency of evaluation is uncertain. Patients with severe regurgitation should be followed more frequently, with a combination of physical examination and echocardiography (SOR=B)

Predoctoral directors: Who are they and what do they do in these trying times?

BACKGROUND AND OBJECTIVES: Family medicine faces declining student interest and funding. Predoctoral directors will help lead efforts to overcome these challenges. Academic success will be important for predoctoral directors to be effective leaders in academic health centers. We therefore sought to describe predoctoral directors and factors associated with their academic success. METHODS: We carried out a cross-sectional survey of all family medicine predoctoral directors at US allopathic medical schools using a Web-based questionnaire. The response rate was 82%. We measured academic success using a variable combining rank and tenure status. We used bivariate analysis and multiple linear regression analysis to identify factors associated with academic success. RESULTS: The mean age of predoctoral directors is 47, and 45% are women. Forty-two percent are assistant professors, 36% associate professors, 20% full professors, and 33% are on a tenure track. Sixty-four percent of predoctoral programs receive Title VII funding, and 63% of predoctoral directors believe that loss of Title VII funding will adversely affect student education. Factors associated with academic success include years since residency, total publications, years as predoctoral director, male gender, state funding for predoctoral family medicine programs, and participation in an academic fellowship. Involvement in educational research was associated with number of publications. CONCLUSIONS: Providing predoctoral directors with the skills and support needed to study their educational undertakings and publish their findings may help them achieve academic success. Medical educators must assess the effects of loss of Title VII funding on predoctoral education while seeking new sources of funding

Residents' views about family medicine specialty education in Turkey

<p>Abstract</p> <p>Background</p> <p>Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training.</p> <p>Methods</p> <p>This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact.</p> <p>Results</p> <p>A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered necessary. The presence of a department office and the clinical competency of the educators were more favored by state residents.</p> <p>Conclusions</p> <p>This study gave the Board the chance to determine the needs of the residents that had not been taken into consideration sufficiently before. The length and the content of the programme will be revised according to the needs of the residents.</p

Academic-community partnerships improve outcomes in pediatric trauma care

BackgroundTo address the specialized needs of injured children, pediatric trauma centers (PTCs) were established at many large, academic hospitals. This study explores clinical outcomes observed for injured children treated at an academic-sponsored community facility.MethodsIn partnership with an academic medical center in a major metropolitan area, a not-for-profit community hospital became a designated Level II PTC in October 2010. Data for injured children &lt;15 years old treated prior to PTC designation from January 2000 to September 2010 were prospectively collected using the Trauma and Emergency Medicine Information System and compared to data collected after PTC designation from January 2011 to December 2013.ResultsOverall, 681 injured children were treated at the community hospital from January 2011 to December 2013. Children treated after PTC designation were less likely to undergo computed tomography (CT) (50.9% vs. 81.3%, p&lt;0.01), even when controlling for age, gender, injury type, injury severity, and year (OR 0.18, 95%CI 0.08-0.37). Specifically, fewer head (45.7% vs. 68.7%, p&lt;0.01) and abdominal CTs (13.2% vs. 26.5%, p&lt;0.01) were performed. Hospital length of stay was significantly shorter (2.8 ± 3.7 days vs. 3.7 ± 5.9 days, p&lt;0.01). Mortality was low overall, but also decreased after PTC designation (0.4% vs. 2.0%, p=0.02).ConclusionsThese results indicate that academic-community partnerships in pediatric trauma care are a feasible alternative and may lead to improved outcomes for injured children

Overview of Best Management Practices used to Mitigate Environmental Impacts from Large- Scale Oil and Gas and Renewable Energy Development Projects on Public Lands Managed by the Bureau of Land Management

Since 2009, the Bureau of Land Management (BLM) has approved 17,830 applications for permit to drill oil and gas wells and approximately 5,085 associated pipeline, power and production facility rights-of- way. During this same timeframe, BLM authorized 33 renewable energy projects capable of producing over 10,000 megawatts of power or enough energy to power 3.5 million homes. The approved renewable energy projects include 18 utility-scale solar facilities, seven wind farms and eight geothermal plants, with associated transmission corridors and infrastructure enabling these projects to provide power to nearby transmission grids. In Fiscal Year 2011, over 117 million barrels of oil were produced from public and Indian lands. In addition, the nearly 3 trillion cubic feet of natural gas produced from public lands made 2011 the second-most productive year for natural gas on record. Renewable energy production from wind, solar, geothermal and biomass that – together with conventional oil and gas energy resources – contribute to the Nation’s energy security and to the clean energy economy of the future. These resources are a significant source of economic development and employment. While the oil and gas industry and BLM are working together to address environmental impacts of development and to achieve higher standards, renewable energy developers are working to create a new energy industry, incorporating clean, safe standards from the outset. In delivering new energy to America, BLM is working with Federal partners, States, and local communities guided by the belief that energy development where promoted and sited in a thoughtful way, can fully contribute to conservation and protection of the environment. This presentation will briefly touch on best management practices (BMPs) that have been used to mitigate environmental impacts from large-scale oil and gas and renewable energy development projects on public lands administered by BLM. These BMP approaches are based upon comprehensive master project planning concepts which include: reduction in initial and interim surface disturbance areas; consolidation of linear infrastructure into well designed corridors; consolidation of development and operational infrastructure to a limited number of sites; elimination of hazards to wildlife, noise reduction, and use of remote operations and monitoring technology. James Gazewood, Renewable Energy Program Coordinator, BLM Utah, 440 West 200 South, Suite 500, Salt Lake City, UT, 84101, [email protected] Jim Gazewood serves as BLM Utah’s Renewable Energy Program Coordinator overseeing wind, solar, geothermal and biomass energy development. Jim has B.S. in Petroleum Engineering from the University of Wyoming and a Master’s Certificate in Project Management from George Washington University. During the past 29 years, Jim has held various petroleum engineering, project and program management positions with BLM. Among his accomplishments include serving as the Acting Oil and Gas Program Deputy Manager in Washington; as a project manager overseeing the development of a large bureau-wide automated oil and gas well permitting and field inspection and enforcement system; serving as a Co-chairman on the American Petroleum Institute’s - Petroleum Industry Data Interchange (API-PIDX) Regulatory User’s Group (REGS) to develop an electronic well permitting data exchange standard for use by industry with MMS Offshore, BLM Onshore, and state oil and gas commissions; as BLM Wyoming’s Powder River Basin Coal Bed Methane Program Coordinator working on BLM’s largest oil and gas project approval to date; and the completion of a Report to Congress for the Energy Policy Act of 2005, Section 365, Federal Oil and Gas Permit Streamlining Pilot Project that encompassed seven major oil and gas permitting offices located in Colorado, Montana, New Mexico, Wyoming, and Utah. Prior to joining BLM, Jim worked seven years in natural gas well drilling and production operations throughout the Rockies with Santa Fe Energy and Mountain Fuel Supply Companies