From the Bedside to Capitol Hill: Student Lobby Day in D.C.

On March 30, 2008 over 300 students, residents and fellows met with nearly 150 Congressional House and Senate offices to discuss important issues in healthcare, including improving medical student loan deferment, impending Medicare physician payment cuts, and reform for expanding health insurance coverage. This piece provides a brief on those topics and their current standing Congress, and reviews one student’s experience of the annual AMA Lobby Day

Substituent effects on the nitrogen-15 and carbon-13 shieldings of some N-arylguanidinium chlorides

The 13C and 15N chemical shifts of five N-arylguanidinium chlorides carrying polar substituents, ranging in character from 4-methoxy to 4-nitro groups, have been determined by NMR spectroscopy at the natural-abundance level of 13C and 15N in dimethyl sulfoxide solution. Comparison of the 13C shifts of these salts with those of monosubstituted benzenes shows that the guanidinium group induces an average downfield shift of -5.8 ppm of the resonance of the aryl carbon to which it is attached (C1), an average upfield shift of +4.2 ppm for C2 and C6, and a small upfield shift of +1.9 ppm for C4. The shifts of C3 and C5 are small and erratic relative to the corresponding carbons in monosubstituted benzenes. The 15N resonances of the guanidinium nitrogens are quite sensitive to electric effects resulting from substitution of polar groups at C4. The 15N shift of the ==NAr nitrogen relative to that of the salts suggests that the predominant tautomer for N-arylguanidines is (H2N)2C==NAr. The 15N shifts of the (NH2) 2 nitrogens correlate rather well with σp- parameters, whereas the shifts of the -NHAr nitrogens seem to correlate only with R values derived from the σp- substituent constants

The Prevalence of Comorbid Chronic Disease in Virginia\u27s Adult Patient Population during the Years 2001 and 2004

Objective: Chronic disease comorbidities, on the rise in the U.S. and Virginia, represent a new challenge to the way medicine is practiced and prescribed. This descriptive study uses Virginia hospital discharge data to describe the prevalence and trends of chronic disease comorbidities present in the state\u27s over-45 population during the years 2001 and 2004.Methods: Data collected by Virginia Health Information was utilized. Adults over the age of 45 years and who selected for race and location were included in this analysis, with an aggregate sample size of 813,336 (N=458,593 [2001]; N=364,743 [2004]). Pearson chi-square analyses determined significant sample population differences with respect to age, race, sex, location, number of diagnoses (up to 9) and number of chronic comorbid conditions (up to 7). Binary logistic regression predicted odds ratios (ORs) for these comorbid conditions across demographic variables. SPSS 13.0 was used for all analysis. Results: Chronic comorbidities and their component conditions increased in Virginia\u27s inpatient population from 2001 to 2004. Chronic cardiovascular disease (CCV), chronic liver disease (CLV), chronic renal disease (CRN), chronic pulmonary disease (COP), and cerebrovascular degeneration (CCE) comorbidities all increased in diagnoses prevalence (0.3% -1.8%), while comorbid cancer (CCA) remained constant at 7.4% and comorbid diabetes (CDI) decreased 0.6%. Mean comorbid diagnoses increased with age. Demographic factors (race, sex, age and location) as well as certain constituent conditions were predictive of one or more comorbidities. Conclusions: In general, the findings of this report complement current chronic disease monitoring data for the Commonwealth of Virginia. While expected comorbidities did exist (e.g. obesity with diabetes), unpredicted findings such as the highly-comorbid fluid and electrolyte disorders or the highly-comorbid deficiency anemias were also noted

The Best Patients in the World: A Commentary on Military Medicine

It was a sunny day last August and he had not been in Afghanistan more than a few months when my patient\u27s platoon came under RPG fire from a Taliban group. That same day I was in the middle of an Orthopaedics rotation in New York. After two months of Navy surgical training for me and a painful recovery process in Germany for him, our paths crossed at the National Navy Medical Center in Bethesda, MD. The ensuing interaction inspired this reflection on my time with military medicine thus far, and my career as a Navy physician ahead

Code Red, White and Blue; Doctor, You\u27re Needed on the Hill: Healthy Policy and You Redux

As this administration and congress hopefully move efficiently from rhetoric to revamping, we have the duty as stakeholders and consumers of our American health care system to be there. One of our most powerful tools is the grassroots lobby. The government is more receptive than ever and a new commitment to changing our system will be affecting us all. This is a review of what has happened in the AMA\u27s lobbying agenda over the last year and what to expect ahead

The effectiveness of using homicide and auto theft rates as indicators of violent and property crime in the United States

The primary goal of this study is to determine whether the use of homicide and motor vehicle theft rates can predict overall violent and property crime rates respectively. Recent studies indicate that homicide rates seem to act as a primary and reliable representation of other violent crime rates, while motor vehicle theft rates seem to act as a primary representation of other property crime rates. This research for the author\u27s thesis indicates otherwise. Measures considered include the Uniform Crime Report, the National Crime Victimization Survey, and the National Incident-Based Reporting System