Psychosocial training in U.S. internal medicine and family practice residency programs.

PURPOSE: Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs. METHODS: In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency programs were surveyed regarding the format, content, and quantity of psychosocial training provided in their programs, their opinions on topics related to psychosocial training, and demographics of their programs. RESULTS: The response rate was 61%. Ninety-nine percent of FP and 62% of IM program directors reported requiring at least one psychosocial training experience. Family practice programs required an average of 352 hours (SD +/- 175; range 27-2,664) of psychosocial training compared with 118 hours (SD +/- 272; range 0-1,050) for IM programs. Most IM and FP program directors expected residents to achieve at least basic competency in virtually all psychosocial topic areas; however, FP programs provided a greater range of psychosocial experiences. FP program directors most often identified psychologists and IM program directors most often identified internists as providing the most psychosocial training in their programs. Both IM and FP program directors considered lack of curricular time to be the main obstacle to development of psychosocial training. CONCLUSION: Residents' competence in psychosocial areas is important to both IM and FP program directors. However, content and time devoted to psychosocial training vary considerably both within and between program types.

Relation between number of cardiovascular risk factors/events and noninvasive Doppler ultrasound assessments of aortic compliance.

The aim of this study was to establish the relation between noninvasive Doppler ultrasound assessments of aortic compliance, based on "foot-to-foot" aortic pulse wave velocity measurements, and presumed atherosclerotic load in patients with vascular disease and/or diabetes mellitus. One hundred ten patients with vascular disease and/or diabetes mellitus (arteriopaths) underwent measurement of in vivo aortic compliance using Doppler ultrasound. Demographic data on these subjects were recorded along with details of cardiovascular risk factors and events. Aortic compliance values were compared with data from 51 age-matched healthy, asymptomatic subjects putatively free of vascular disease (controls). Data are expressed as mean+/-SD. Arteriopaths were aged 64.1+/-8.4 years and had total cholesterol levels of 5.9+/-1.1 mmol/L and aortic compliance of 0.78+/-0.42%/10 mm Hg [1.33 kPa]. Most arteriopaths had 2 or more cardiovascular risk factors and events: diabetes (n=41), hypertension (n=45), smoking (n=86), cerebrovascular/transient ischemic event (n=13), myocardial infarction (n=44), angina (n=51), and/or peripheral vascular disease (n=33). Controls were aged 64.3+/-12.1 years with total cholesterol of 6.1+/-1.1 mmol/L and aortic compliance of 1.14+/-0.46%/10 mm Hg [1.33 kPa] (P<0.002 versus arteriopaths). Subset analysis revealed that patients with the greatest number of cardiovascular risk factors and events (n=5) had the stiffest aortas (aortic compliance, 0.58+/-0.15%/10 mm Hg [1.33 kPa]) compared with those patients with the median and mean (n=2) number of risk factors and events (aortic compliance, 0.80+/-0.50%/10 mm Hg [1.33 kPa]; P<0.02). The data suggest that a significant inverse relation exists between presumed atherosclerotic load (as assessed by the number of cardiovascular risk factors and events) and aortic compliance determined noninvasively based on aortic pulse wave velocity measurements. If these findings are confirmed by prospective, longitudinal follow-up studies, such measurements may prove useful as a noninvasive marker of vascular risk.

Genitourinary tract gas: imaging evaluation.

Gas-forming infections of the genitourinary tract may manifest as life-threatening conditions, often requiring aggressive medical and surgical management. Accurate interpretation of the radiologic studies is essential for early and accurate diagnosis of gas within the renal parenchyma or collecting system, bladder, uterus, and scrotum. Three distinct entities are associated with renal or perirenal gas: emphysematous pyelonephritis, emphysematous pyelitis, and gas-forming perirenal abscess. Gas in the bladder may occur secondary to emphysematous cystitis or a vesicoenteric fistula and must be differentiated from air introduced by means of instrumentation. Uterine gas usually indicates an underlying infection or a neoplasm. Gas in the scrotum is most commonly due to an infectious process or bowel herniation into the scrotal sac. Before institution of a specific therapeutic regimen, an effort should be made to establish the exact location of gas in the genitourinary tract. Plain radiography, including tomography, and ultrasonography are useful screening modalities. Although in some cases urography, barium enema studies, and other contrast material-enhanced studies enable a diagnosis to be made, in many patients computed tomography is the definitive diagnostic technique.

Renal vein thrombosis in utero: duplex sonography in diagnosis and follow-up.

Neonatal renal vein thrombosis (RVT) is a well-described entity which is traditionally associated with a variety of perinatal stresses. Prenatal RVT is much less commonly detected. We describe a case in which a screening obstetrical ultrasonogram detected a fetal renal abnormality which was incorrectly interpreted as a suspected neoplasm of the fetal kidney. Ultrasonographic examinations during the first week of life confirmed the diagnosis of RVT, and both gray-scale and Doppler techniques were used to follow the resolution of the thrombosis and the fate of the kidney.

CT appearance of uterine leiomyomas.

Uterine leiomyomas, commonly known as fibroids, are one of the most common pelvic tumors found in women. Ultrasonography is the primary modality for evaluating leiomyomas. However, frequently these tumors are not accompanied by symptoms, and they are found incidentally during computed tomographic (CT) examinations performed for other indications. Because leiomyomas may first be noted on CT scans, radiologists should become familiar with their characteristic appearance. The authors describe the CT findings of uterine leiomyomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration, and sarcomatous degeneration.