The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call.

Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ2 test was used to perform comparisons between groups. Statistical significance was determined at P < .05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important ("neutral," "not important," or "important, but I don't have the time to focus on it right now"; P < .0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education.

Cannabinoid hyperemesis syndrome: Marijuana is both antiemetic and proemetic.

Although marijuana is sometimes used to treat chemotherapy-induced nausea and vomiting, when used long-term it can have a paradoxical hyperemetic effect known as cannabinoid hyperemesis syndrome. Knowledge of this phenomenon may reduce the ordering of unnecessary and expensive investigations, as well as inappropriate medical and surgical treatment in patients presenting with recurrent vomiting of unknown cause. This article reviews the pathophysiology, clinical presentation, diagnosis, and management of this emerging condition.

Hospital readmissions in patients with inflammatory bowel disease.

OBJECTIVES: We aimed to identify the frequency and costs of, and the disease predictors and inpatient process issues that may predispose to, 30-day readmission for an inflammatory bowel disease (IBD) patient. METHODS: IBD patients admitted to an inpatient gastroenterology service were followed for a time-to-readmission analysis assessing factors associated with readmission within 30 days. RESULTS: Index admissions were more costly among those readmitted than among those not readmitted. Patients admitted with evidence of increased inflammation, infection, or obstruction or for dehydration or pain control had a higher risk of readmission. Patients treated with opioid analgesia during index admission were no less likely to be readmitted, and there was a 2.2-fold increase in readmissions when patients were discharged with no opioid analgesia. Scheduling variability and outpatient follow-up compliance were associated with readmission. CONCLUSIONS: Predicting readmission is complex. A predictive model developed to be used at discharge yielded an area under the curve of 0.757.

Fecal microbiota transplantation for recurrent C difficile infection: ready for prime time?

Recurrent Clostridium difficile infection has been a major challenge for patients and clinicians. Recurrence of infection after treatment with standard antibiotics is becoming more common with the emergence of more-resistant strains of C difficile. Fecal microbiota transplantation is an alternative treatment for recurrent C difficile infection, but it is not yet widely used.