Yale Internal Medicine Reflects on Past 10 Years in New Report Yale School of Medicine
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Category Archives: Internal Medicine
Meet ABIMs new leader: The future is bright for internal medicine – Medical Economics
Should neonatal-perinatal medicine move to two-year fellowships? | Journal of Perinatology – Nature.com
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Vigorous exercise may preserve cognition in high-risk patients with hypertension – EurekAlert
image:
Richard Kazibwe, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine
Credit: Wake Forest University School of Medicine
WINSTON-SALEM, N.C. June 6, 2024 People with high blood pressure have a higher risk of cognitive impairment, including dementia, but a new study from researchers at Wake Forest University School of Medicine suggests that engaging in vigorous physical activity more than once a week can lower that risk.
The findings appear online today in Alzheimers & Dementia: The Journal of the Alzheimers Association.
We know that physical exercise offers many benefits, including lowering blood pressure, improving heart health and potentially delaying cognitive decline, said Richard Kazibwe, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine and lead author of the study. However, the amount and the intensity of exercise needed to preserve cognition is unknown.
In 2015, published findings from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure management reduced cardiovascular disease and lowered the risk of death.
SPRINT began in the fall of 2009 and included more than 9,300 participants with hypertension ages 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States. Participants were randomly assigned to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment) or less than 140 mm Hg (standard treatment). The National Institutes of Health (NIH) stopped the blood pressure intervention earlier than originally planned to quickly disseminate the significant preliminary results, resulting in a new set of guidelines for controlling blood pressure.
In 2019, results of the ancillary SPRINT MIND trial, led by Wake Forest University School of Medicine, showed that intensive control of blood pressure in older people significantly reduced the risk of developing mild cognitive impairment, a precursor of early dementia.
In a secondary analysis of the SPRINT MIND study, Kazibwe and team examined the effect of self-reported sessions of vigorous physical activity (at least once a week) on the risk of mild cognitive impairment and dementia.
People who engaged in one or more sessions of vigorous physical activity per week had lower rates of mild cognitive impairment and dementia.
Kazibwe said that nearly 60% of study participants reported vigorous physical activity at least once a week, even among those aged 75 and up.
It is welcome news that a higher number of older adults are engaging in physical exercise. This also suggests that older adults who recognize the importance of exercise may be more inclined to exercise at higher intensity, Kazibwe said.
However, the research team found the protective impact of vigorous exercise was more pronounced for those under 75.
While this study provides evidence that vigorous exercise may preserve cognitive function in high-risk patients with hypertension, more research is needed to include device-based physical activity measurements and more diverse participant populations, Kazibwe said.
Alzheimer s & Dementia
People
Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension
6-Jun-2024
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Vigorous exercise may preserve cognition in high-risk patients with hypertension - EurekAlert
Studying the effects of probiotics for idiopathic epilepsy – DVM 360
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Canine idiopathic epilepsy (IE) is one of the most commonly diagnosed and treated chronic neurological conditions, according to Zoe Bailey, DVM, neurology/neurosurgery resident at the University of Wisconsin-Madison.1 The cause of this epilepsy type is unknown, but a higher prevalence has been seen in purebred dogs vs mixed breed dogs, and male dogs are more commonly affected than females.2
To treat IE, starting an antiepileptic drug (AED) is the most common route and usually the first line therapy. However, this is not always the best option for every patient and client. Bailey explained in her lecture at the 2024 American College of Veterinary Internal Medicine Forum in Minneapolis, Minnesota, that adverse effects of this medication can negatively impact the clients perception of their dogs quality of life. Additionally, approximately 30% of dogs will be drug resistant to this specific treatment.1 Bailey noted some other therapies for this condition can include dietary changes, use of cannabidiol products, neurostimulation, and more.
Bailey participated in a study aimed at investigating the microbiota-gut-brain axis and its impact on epilepsy. In humans, probiotics have been found to decrease seizure frequency and severity,3 however, there has yet to be a large-scale study on dogs with IE. Bailey and other researchers used a probiotic (Visbiome Vet) with 42-client owned dogs previously diagnosed with IE and already taking a prescription AED. Dogs in this study were between the ages of 1 and 9 years and had a seizure history of at least 6 months, with a frequency of at least 1 every 3 months. Dogs were enrolled on a rolling basis from January 2022 through May of 2023. So we did a prospective, placebo controlled, masked, crossover clinical trial, both with a 9- or 12-month period, there was a total of 3 or 4 phases, each of which was 3 months in duration, Bailey explained during the ACVIM session.1
The first phase was used as an observational period, also to have some control data as a basis before moving forward in the study. The second phase administered a daily placebo capsule provided by Visbiome Vet to the enrolled dogs. A daily dose of the probiotic from Visbiome Vet was given during phase 3 and adjusted based on the dogs body weight. The study concluded with phase 4 in which dogs were observed again, now evaluating any changes in data with the introduction of a regular dose of probiotics.
By the end of the study, only 21 dogs had completed all 4 phases. The other 21 dogs were excluded at various time points throughout the study due to the development of new diseases, the need for additional non-AED medications, dietary modifications, owner compliance, and death due to other circumstances, said Bailey.
Seizure logs were maintained by owners and every seizure was documented. At the start of the study, 17 of the 21 completed dogs were on 2 or more AEDs and 12 of 21 dogs had their AED prescription adjusted by their veterinarian.
The study results revealed the following:
Bailey concluded that, although there was some improvement discovered, the measurement of seizure frequency was not statistically significant enough to prove the use of probiotics improves the outcomes of dogs with IE. Some of the limitations of this particular study was a small population size and reliance on owners for seizure detection and documentation. So really, the next steps that we're still in progress with are evaluating the microbiome of this population of dogs with refractory idiopathic epilepsy. And then [also] to determine if this biome alters their microbiome, Bailey said.
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Studying the effects of probiotics for idiopathic epilepsy - DVM 360
Pride Celebrated at UConn Health – UConn Today – University of Connecticut
UConn Health believes in health care for all and provides equitable and inclusive care to lesbian, gay, bisexual, transgender, and queer/questioning+ members of our community.
Students from Reach Out, a student organization at UConn Health dedicated to LGBTQIA+ awareness, education, and activism in the UConn medical and dental communities, proudly raised the flag. The UConn School of Medicine students were fourth-year medical students Cailyn Regan, Sarah Hartmann, and Ryan Hannon.
Reach Out aims to bring students of any gender or sexual identity together, make an impact through service in the greater Hartford community, and provide education amongst the next generation of clinicians who strive for excellence in well-rounded patient care.
The students were supported by the newly appointed UConn Health CEO Dr. Andy Agwunobi, Chief Diversity Officer Dr. Jeffrey Hines, and their Reach Out faculty advisor Zita Lazzarini, JD, MPH.
Also, in attendance were Internal Medicine Resident Dr. Nicholas Harriel, who will be entering his third year of graduate medical education training (GME) at UConn Health and Ian Shick, assistant director of the Rainbow Center at UConn.
A special thanks to UConn Fire Departments Captain Anthony Ruggiero and Deputy Chief Christopher Renshaw for their special assistance of the UConn Health students with the flag raising, along with UConn Police Officer Nolan Hurst.
This month UConn Healths campus is also being illuminated in rainbow.
Learn more about UConn Health and its LGBTQIA+ Services.
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Pride Celebrated at UConn Health - UConn Today - University of Connecticut
Residents and Faculty Shine at Internal Medicine Annual Meeting – Washington State University
Residents and faculty from the WSU College of Medicine and Internal Medicine Residency Program in Everett were showcased via multiple posters, oral presentations, and workshops at the highly competitive Society of General Internal Medicine annual meeting in Boston. The conference was attended by approximately 2700 clinicians.
The list of presentations and leadership roles by WSU colleagues represents an incredible level of engagement and highlights WSU COMs growing national reputation.
Meeting proceedings will be published in a supplemental issue of the Journal of General Internal Medicine.
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Residents and Faculty Shine at Internal Medicine Annual Meeting - Washington State University
Opinion | Smoking Isn’t the Only Source of Nicotine Addiction in Town – Medpage Today
Benowitz is a professor of medicine, and a nicotine and tobacco researcher.
E-cigarettes were introduced in the early 2000s as a way for smokers to manage their nicotine addiction without exposing themselves to the well-documented harms associated with the toxins and carcinogens in combustible cigarette smoke. These harms include increased risks of cancer, cardiovascular disease, chronic lung disease, and a number of other debilitating or life-threatening diseases. While many people have used e-cigarettes to quit smoking, other non-smokers have taken up e-cigarette use, particularly young adults.
However, the use of e-cigarettes, commonly known as vaping, is not without harm. Based on a review of the published data available at the time, an expert committee of the National Academies of Sciences, Engineering, and Medicine issued a report in 2018 finding conclusive evidence that although substituting e-cigarettes for combustible cigarettes reduced exposure to numerous toxins and carcinogens, e-cigarette use is not risk-free.
What are some of the harms? People who vape continue to be exposed to nicotine, which is highly addictive, making quitting e-cigarettes difficult for some. In addition, vapers may be subject to social stigma, and they incur expenses for purchasing vaping devices and liquids. Many people who have taken up vaping, either to help themselves quit smoking or as a primary form of recreational drug use, would like to quit. Furthermore, some healthcare professionals are supportive of the use of e-cigarettes to quit smoking but would like their patients to stop use when they are confident they will not relapse to smoking, due to the possible risks of nicotine use.
A study recently published in JAMA Internal Medicine is the first randomized, placebo-controlled trial to report a successful e-cigarette cessation benefit with pharmacological treatment. As a member of the Data and Safety Monitoring Committee for this study and an author on the publication, I believe the findings are an important step in addressing a relatively new source of nicotine addiction. This publication provides an opportunity for clinicians and the public health community to revisit how we think and talk about the harms associated with smoking, vaping, and nicotine addiction, and to reconsider how we can best take action to help reduce these harms.
Help or Harm: How Do We Discuss Vaping With Patients?
The fact that vaping can be associated with a high degree of dependence and a possible risk to health creates a challenge in counseling patients about their use of e-cigarettes. Given the extreme dangers associated with cigarette smoking, I believe that vaping can be a useful tool for harm reduction. I also believe that overcoming nicotine addiction -- in any form -- provides health, social, and economic benefits to those who can quit.
Healthcare professionals are solutions-oriented, and we strive to help patients set and achieve goals that can improve their physical and mental health and their quality of life. The lack of effective vaping cessation medications is an important missing piece of the puzzle when discussing the relative risks and benefits of smoking, vaping, and overcoming nicotine dependence. Survey data show that more than half of adults vaping nicotine plan to quit using e-cigarettes, and approximately 15% had already tried to quit in the prior year. Some succeeded, but additional tools are likely needed to help others. Is it realistic to counsel patients to quit vaping without addressing the very real biochemical basis of their nicotine addiction?
Hope for an Effective Vaping Cessation Therapy
Our data in JAMA Internal Medicine suggest we may be moving closer to finding an important intervention for e-cigarette-related nicotine dependence. The Phase II randomized clinical trial ORCA-V1 found that e-cigarette cessation rates were significantly higher for participants receiving 12 weeks of cytisinicline plus behavioral support compared with those receiving behavioral support alone. Cytisinicline is a partial agonist at 42 nicotinic acetylcholine receptors that mediate nicotine dependence and has shown efficacy for cigarette smoking cessation.
In the study, 160 participants were randomized 2:1 to 3 mg cytisinicline taken three times daily or placebo for 12 weeks. All participants received weekly behavioral support. The primary endpoint was biochemically verified continuous abstinence from nicotine e-cigarette use, measured during the last 4 weeks of treatment. Participants receiving 12 weeks of cytisinicline treatment had 2.6 times higher odds of having quit vaping during the last 4 weeks of treatment compared with subjects who received placebo, with vaping cessation rates during weeks 9-12 of 31.8% and 15.1%, respectively. No treatment-related serious adverse events were reported, and rates of adverse events were similar between the cytisinicline (50.9%) and placebo (54.7%) arms.
Acting Today While Awaiting Tomorrow's Advances
Although additional studies are needed to confirm the efficacy and safety of cytisinicline as a vaping cessation therapy, the ORCA-V1 results show that pharmacological tools may help to address the complex role that vaping plays in the continuum of reducing harms from cigarette smoking while sustaining nicotine addiction. These findings are particularly encouraging given the increasing prevalence of e-cigarette use among adults -- especially young adults -- in the U.S. Moreover, as a plant-based alkaloid, cytisinicline may appeal to those who prefer natural products as well as those who have tried and failed to quit smoking or vaping using other pharmacologic agents.
As we await additional data supporting the use of cytisinicline as a vaping cessation therapy, those of us who counsel patients who smoke cigarettes or vape nicotine should not shy away from having candid discussions about smoking, vaping, and overcoming nicotine addiction. We should be able to explain the risks and benefits of vaping and our patients' ability to make decisions that meet their personal health and lifestyle goals. With additional research, I hope those discussions will one day soon include the availability of safe and effective vaping cessation therapy.
Neal L. Benowitz, MD, is professor emeritus in the Department of Medicine at the University of California San Francisco.
Disclosures
Benowitz reported personal fees from Achieve Life Sciences while the JAMA Internal Medicine study was being conducted, as well as personal fees as a tobacco litigation expert witness in litigation against tobacco companies.
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Opinion | Smoking Isn't the Only Source of Nicotine Addiction in Town - Medpage Today
Benefis gets approval for Internal Medicine residency program – KRTV NEWS Great Falls
Benefis Health System recently earned approval for its new Internal Medicine Residency Program from the Accreditation Council for Graduate Medical Education, bringing more health care professionals to the central Montana area.
Physicians coming out of medical school become residents to further learn their specialty. It works like an apprenticeship with gradually escalating responsibilities and autonomy. Internal medicine providers for adult patients over time, treating chronic illness and monitoring wellness. Residents in the program will learn to take care of hospitalized patients and learn preventative medicine.
Internal Medicine Residency Program Director Michael Sheffield says, Statistics say that when you finish your training, wherever you are, 60 to 70% of those residents will remain in the area. So if we train them here, we have a good chance of keeping about two thirds of them in the area to provide care for the future patient, future generations in this area.
After the three year program, most residents will become internal medicine providers and later move on to a speciality like cardiology or critical care. Program leaders hope to gear residents towards relevant specialities like geriatrics and addiction medicine. With the new residency, patients will be interacting with students and residents which may take more time, but all care and decisions will be supervised by medical professionals.
Sheffield describes, as patients become accustomed to it, the nursing staff, respiratory therapy, all of the staff will begin to work with residents more directly and change the way they work, and so forth in the way patients receive their care.
Sheffield explains he is most excited for the residents energy, curiosity are things that are refreshing every day. And so looking forward to having them here to have those discussions, to remember back when and what it was like when I started and what it's like now, to make sure they get the same sort of joy and excitement that we all had when we were training.
The first graduates from Touro College of Osteopathic Medicine in Great Falls, as well as will be eligible to apply for the Internal Medicine Residency in Fall 2025, in the programs second year.
Benefis will be accepting applications this fall, with the first ten Internal Medicine Residents starting in July 2025.
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Benefis gets approval for Internal Medicine residency program - KRTV NEWS Great Falls
Marquis Who’s Who Honors H. Kenneth Fisher, MD, for Expertise in Medicine – 24-7 Press Release
He became a Diplomate of the American Boards of Sleep Medicine, Pulmonary Medicine, and Internal Medicine, all after the age of 65.
LOS ANGELES, CA, May 31, 2024 /24-7PressRelease/ -- H. Kenneth Fisher, MD, has been recognized for inclusion in Marquis Who's Who. As in all Marquis Who's Who biographical volumes, individuals profiled are selected on the basis of current reference value. Factors such as position, noteworthy accomplishments, visibility, and prominence in a field are all taken into account during the selection process.
Dr. Fisher's distinguished medical career, particularly in pulmonary and sleep medicine, illustrates his dedication and expertise in the field. After completing his formal training to become a specialist in internal medicine and pulmonary disorders, he was a medical school professor for a decade. In this role he guided the education of doctors-in-training, conducted original research, and supervised care of patients with severe lung disorders.
For 30 years after that, he served the communities of West Los Angeles and Beverly Hills in private practice, applying his extensive knowledge and experience directly to patient care. His role was as a specialist in Internal Medicine and as a consultant to other physicians for patients with pulmonary disorders and sleep problems. He became a Diplomate of the American Boards of Sleep Medicine, Pulmonary Medicine, and Internal Medicine, all after the age of 65. He was named by The Consumers Research Council of America as one of America's Top Physicians and named as a Southern California Super-Doctor by Los Angeles Magazine. In addition to his Los Angeles practice, he helped identify and treat sleep disorders with Cardiopulmonary Services of Casper, WY, and with Sleep Medicine Consultants of Central Texas, Austin.
Before entering private practice, Dr. Fisher's academic career included faculty posts at the University of Washington, the University of Arizona, and the University of California, Los Angeles. Throughout his career, Dr. Fisher has been recognized as an expert in his field. His voluntary work included serving as Chairman of the Research Review for the American Thoracic Society and as a member of the Scientific Advisory Board of the Sjogrens Syndrome Foundation. His formal teaching earned the highest rankings from medical students at the University of California. In early 2024 he completed a book titled: Sleep: A Users Guide, which will be published in the second half of this year. The book highlights Dr. Fisher's expertise and his ability to communicate complex medical concepts understandably.
Dr. Fisher's previous academic background is equally impressive. He earned a Bachelor of Arts degree in Chemistry from Carleton College in 1955 and a second degree in Chemistry from the University of Oxford in 1957 as a Rhodes Scholar. Dr. Fisher pursued coursework in industrial management at the Massachusetts Institute of Technology. He then completed his medical training with an MD from Washington University School of Medicine in 1962, followed by two years' residency at Barnes Hospital, and another two years of specialty training at Albert Einstein College of Medicine in New York. His research training was at the Cardio Vascular Research Institute, University of California, San Francisco.
Beyond his professional endeavors, Dr. Fisher has engaged with various civic organizations and contributed to academia through gifts and volunteer work for Carleton College, Washington University, Oxford University, and MIT. His scholarly achievements have been recognized with such awards as the Baker Scholarship, the Rhodes Scholarship, and the John Hay Whitney Fellowship of the Institute at MIT.
In his personal life, Dr. Fisher is a father to three sons. He enjoys tennis, photography, overseas travel, and reading. During the Covid Pandemic, he practiced internal medicine and sleep medicine remotely, demonstrating his ongoing commitment to advancing health care to the very edge of retirement.
About Marquis Who's Who: Since 1899, when A. N. Marquis printed the First Edition of Who's Who in America, Marquis Who's Who has chronicled the lives of the most accomplished individuals and innovators from every significant field of endeavor, including politics, business, medicine, law, education, art, religion and entertainment. Marquis celebrates its 125th anniversary in 2023, and Who's Who in America remains an essential biographical source for thousands of researchers, journalists, librarians and executive search firms around the world. Marquis publications may be visited at the official Marquis Who's Who website at http://www.marquiswhoswho.com.
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Marquis Who's Who Honors H. Kenneth Fisher, MD, for Expertise in Medicine - 24-7 Press Release