Monthly Archives: December 2023

Cardiology

The benefits of implementing FFR-CT in clinical practice – Cardiovascular Business

He said the integration of FFR-CT not only informs medical decisions, but also profoundly impacts patient care. Gupta said the images can be shown to patients to help explain their condition to empower them with a deeper comprehension of their condition. Sharing FFR-CT results and images with referring providers and patients also fosters a collaborative approach, ensuring everyone involved comprehends the nuances of the diagnosis and treatment strategy.

Valley Health System sends about 25-29% of patients undergoing coronary CT exams to also undergo a HeartFlow analysis. Rather than employing FFR-CT universally, Gupta's team judiciously selects patients falling within the intermediate category, typically encompassing those with coronary disease that appears to block from 40% to 90% of a vessel. This selective approach allows for a nuanced assessment of patients who stand to benefit most from FFR information. It is not merely about determining who needs a catheterization procedure, but understanding the physiology of the disease for appropriate decision-making.

"We make sure that the referring providers, who are many times interventionalists, understand what the disease is, the severity of disease and if the patient is going to benefit form an invasive procedure. Alternatively, we would do FFR and we will find disease, which in some cases may not necessarily need invasive angiogram, despite knowing that there is significant disease. This is partly because we know from medical literature that medical management is equally good if not better, especially in a lower risk population. So we are trying to stratify the patient population. Thirdly, I think it provides a peace of mind to the patients, because they understand their disease better," Gupta explained.

Efficiency is paramount in cardiac care, and Gupta underscored the fast turnaround times for FFR-CT results. Reports are usually available within a day, he said, and it can be even quicker in emergency cases.

Implementing FFR-CT as a gatekeeper has impacted cath lab utilization. While diagnostic catheterizations may see a reduction, the precision of FFR-CT aids interventionalists in planning procedures more efficiently. Guta said this can help reduce radiation exposure and optimize contrast use. Also, the 3D FFR-CT images can serve as a clear roadmap for interventions, contributing to enhanced patient safety and procedural efficacy.

"I believe that it is actually helping the interventionalist plan the procedure in which we are finding frequently, at least at our center, they would either take very limited pictures of the coronary arteries or use special kinds of catheters where they can directly go for intervention based on what the study results shows on the CT and the FFR. They also know upfront exactly what to fix and what not to fix," Gupta explained.

One unique factor about Valley Health System is it uses a collaborative model for reading cardiac exams, combining the expertise of both radiologists and cardiologists. Gupta said their joint efforts, coupled with robust quality control processes, ensure the optimal integration of FFR-CT into clinical practice.

"We basically thrive on each other's strength. So we have a couple of very high-quality radiologists working with a couple of high-quality cardiologists and we are continually expanding our team," Gupta said.

Beyond its conventional use in coronary artery stenosis, Gupta's team is exploring other novel applications of FFR-CT. This includes evaluating anomalous coronary artery physiology, studying gender-based differences in chest pain presentations and evaluating patients during transcatheter aortic valve replacement (TAVR) pre-procedural workups.

"We are able to do a CT angiogram at the same time of a TAVR evaluation for the coronary arteries. We combine it with FFR data to try to risk prognosticate what is the risk of any event during the TAVR procedure and determine if they need an invasive angiogram or any kind of interventional procedure. So it really helps optimize high-risk, frail patients in terms of more optimal outcome," Gupta said.

FFR-CT was included as a recommendation in the 2021 ACC/AHA chest pain guidelines to evaluate chest pain. It was the first clinical artificial intelligence (AI) algorithm to be included in any U.S. cardiology guidelines.

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The benefits of implementing FFR-CT in clinical practice - Cardiovascular Business

Cardiology

Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI – Physician’s Weekly

The following is a summary of Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy, published in the December 2023 issue of Cardiology by Steen et al.

Researchers conducted a retrospective study to assess whether myocardial strain and T1 mapping derived from Fast Strain-Encoded Cardiac Magnetic Resonance (SENC-CMR) could effectively differentiate between Hypertrophic Cardiomyopathy (HCM) and Cardiac Amyloidosis.

They analyzed 99 patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis). Assessed were LV-ejection fraction, LV-mass index, septal wall thickness, and native T1 mapping values. Global and segmental circumferential/longitudinal strain were calculated in basal, mid-ventricular, and apical segments and constructed as a ratio by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).

The results showed equal myocardial strain distribution in apical and basal segments in HCM patients. At the same time, cardiac amyloidosis exhibited apical sparing with less impaired apical strain (apical-to-basal ratio of 1.01 0.23 versus 1.20 0.28, P<0.001). T1 values were significantly higher in amyloidosis than in HCM patients (1170.7 66.4 ms versus 1078.3 57.4 ms, P<0.001). The T1-to-basal segmental strain ratio showed high accuracy for differentiation (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.810.95, P<0.001). In multivariable analysis, age and the T1-to-basal-strain ratio were the most robust factors for HCM and cardiac amyloidosis differentiation.

Investigators concluded that T1-to-basal strain, a quick MRI measure, effectively distinguished heart conditions HCM and amyloidosis, skipping risky contrast injections.

Source: link.springer.com/article/10.1007/s00392-023-02348-4

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Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI - Physician's Weekly

Cardiology

5 Things Not to Do at Your Cardiologist Appointment – Livestrong

Lying to your cardiologist about your symptoms could be harmful to your health.

Image Credit: SDI Productions/E+/GettyImages

Before we dive into the things you shouldn't do at the cardiologist, let's start by saying it's great you're seeing a cardiologist in the first place. Taking care of your heart is important especially as you age.

Heart disease is responsible for one out of every five deaths in the U.S., according to the Centers for Disease Control and Prevention, but catching it early (or its risk factors like high blood pressure and elevated cholesterol) gives you enough time to treat it properly.

While seeing your cardiologist is a great first step, there are some things you may unintentionally do to sabotage these appointments, like withholding information or lying to your doctor.

Here, learn habits that cardiologists wish their patients would stop doing at checkups.

No, this doesn't mean dressing in your best outfit, but rather, telling your cardiologist what you think they want to hear, says Elizabeth Klodas, MD, FACC, a preventive cardiologist in Edina, MN and creator of Step One Foods.

For example, you might say you never eat fast food (when you do), or that you eat fruits and vegetables every day (when you don't). The thing is, this information may change the course of your treatment, if a condition is uncovered at an appointment.

"A statin [cholesterol-lowering medication] is much more likely to be prescribed to someone with high cholesterol who also reports eating a healthy diet and not drinking too much," Dr. Klodas says.

On the other hand, if you have high cholesterol but admit to a not-so-great diet, your doctor may suggest trying diet and lifestyle changes first before medication, if that makes sense with your health history, Dr. Klodas says.

"Physicians are not mind readers. They can only rely on what you tell them," Dr. Klodas says. "They've also seen and heard it all, so you don't have to worry that you will shock or disappoint them," she adds.

The internet can be a scary place, especially if you're worried about a certain health symptom and you recruit Google to get answers.

"Sometimes a patient has been Googling their symptoms and without proper context, pressures their doctor to order or prescribe certain things," says Mary Greene, MD, a cardiologist with Manhattan Cardiology in NYC and contributor to LabFinder.

The problem is that this can lead to "unnecessary and expensive" testing, she says.

While it's absolutely important to be an informed patient and advocate for yourself (especially if you feel your doctor's not listening to you), try to approach your appointment with a collaborative mindset, Dr. Greene says.

This means, it's OK to ask, "what do you think about this?" or "I read this online, does it apply to me?" and being open to what your doctor has to say. This will lead to a much more helpful discussion about what's best for you, Dr. Greene says.

Maybe you've found it difficult to walk up the stairs lately. Or, you've started circling the parking lot to find a parking space closest to the grocery store entrance. Dr. Klodas wants you to pay attention to those symptoms and report them to your cardiologist.

"No doubt our bodies become less cooperative as we age. But a lot of symptoms that people don't bother reporting (because they think they're a normal part of aging) can be clues to potentially reversible underlying health issues," she adds.

For instance, being short of breath during normal activities is a potential sign of cardiovascular disease not just a sign that you're out of shape or getting older.

Another interesting example? Erectile dysfunction can also be a "first clue" you have atherosclerosis, Dr. Klodas says. Even when you think it isn't related, it might be, so don't be afraid to speak up.

Similar to wanting to "look good" for your cardiologist, there's a specific tendency to hide how much alcohol you drink, whether you smoke cigarettes and whether you use recreational drugs, says Allan Stewart, MD, a cardiac surgeon in Miami, FL.

These things are important to disclose at checkups, especially if you need heart surgery in the future. Why? Because it can affect your post-op recovery.

For example, if you drink every day and then go into surgery, you may have symptoms of alcohol withdrawal during recovery, and these symptoms can mimic a stroke, Dr. Stewart says. You may then be prescribed lots of expensive testing, which will also delay alcohol withdrawal treatment.

Dr. Stewart also says that smoking affects your recovery, while recreational drug use may affect the heart's response to medications and anesthesia.

"Surgeons are not judgmental people. We just want to know all of the possible issues we may face, so we can properly plan for your safe recovery," Dr. Stewart says.

The best time to talk about these things is during an in-office visit, when that planning can be done.

Not all of your concerns can or will be resolved in one office visit, Dr. Greene says. "Whenever you see any doctor, expect there to be some follow up," she says.

When it comes to specific heart issues, it may take time (and often multiple tests) to figure out what's going on. After these tests are complete, your cardiologist can come up with a personalized treatment plan.

Try to schedule any follow-up appointments at the end of your initial visit. And aim to see the same cardiologist each time, so they can continue the conversation about your specific needs.

"Building this doctor-patient relationship takes time, but can be helpful in getting the best treatment possible," Dr. Greene says.

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5 Things Not to Do at Your Cardiologist Appointment - Livestrong

Cardiology

Hybrid coronary revascularization vs. CABG for multivessel CAD: New meta-analysis tracks long-term outcomes – Cardiovascular Business

Hybrid coronary revascularization (HCR) and coronary artery bypass grafting (CABG) are associated with comparable long-term mortality rates among patients with multivessel coronary artery disease (MVCAD), according to new data published in the American Journal of Cardiology.[1] However, HCR patients were more likely to experience certain adverse events.

HCR, as the name suggests, is a combination of two different revascularization techniques. It includes both minimally invasive for the left anterior descending (LAD) coronary artery and traditional percutaneous coronary intervention (PCI) for non-LAD lesions.

Previous studies showed the short-term benefits of HCR, including comparable mortality, reduced lengths of intubation and hospital stay, and less transfusion than CABG, wrote first author Junichi Shimamura, MD, with the division of cardiothoracic surgery at Westchester Medical Center in New York, and colleagues. However, the current guidelines do not recommend HCR as a routine procedure. This is partly because the previous analyses were based on retrospective data, and there is a lack of randomized controlled trials and meta-analyses in a large population with a long-term outcome.

Shimamura et al. tracked data from 13 different studies comparing the two techniques. The mean patient age was 64.3 years old, and the mean follow-up period was 5.1 years.

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Hybrid coronary revascularization vs. CABG for multivessel CAD: New meta-analysis tracks long-term outcomes - Cardiovascular Business

Internal Medicine

Adventist Health Tillamook welcomes new top Internal Medicine Provider – Tillamook Headlight-Herald

December 5, 2023 (Tillamook, Ore.) Adventist Health Tillamook is proud to announce another enhancement to healthcare services in Tillamook County with its exceptional team of local, community-focused internal medicine providers, including Tana Haynes, MD, Amy Echelberger, MD, and the newest addition, James Borden, MD, FACP, starting January 2 at Adventist Health Medical Office Plaza in Tillamook at 1100 Third Street in Tillamook.

Meet Our Internal Medicine Providers

Dr. James Borden, board-certified with over 30 years of primary care experience in Northwest Portland, is known for his compassionate care and transparent communication. His approachable nature and dedication to building patient connections make him an invaluable asset to our community.

Dr. Tana Haynes, who began her tenure in 2020 at Adventist Health Medical Office Plaza, is a board-certified internal medicine physician with experience in both inpatient and outpatient settings. Passionate about individualized care, she specializes in preventive and wellness care as well as managing complex medical issues.

Dr. Amy Echelberger, joining Adventist Health Medical Office Manzanita in 2021, is a board-certified internal medicine specialist with roots in Idaho. Having graduated from Southern Illinois University School of Medicine and completed her residency at Wayne State University, Dr. Echelberger brings a wealth of knowledge and dedication to the Oregon Coast.

What is Internal Medicine?

Internal medicine provides comprehensive care for adults, encompassing preventive services, wellness care and the diagnosis and management of complex medical conditions. Our providers are committed to understanding each patients unique health needs and goals, offering a holistic approach to healthcare.

Enhancing Community Health

With these skilled physicians, Adventist Health Tillamook continues its commitment to providing top-tier medical support, focusing on the unique healthcare needs of coastal communities. This expansion underscores our dedication to ensuring residents receive the best possible care from providers who work and live in the community.

For more information about our internal medicine services and the exceptional care provided by Drs. Haynes, Echelberger, and Borden, please visit our website at adventisthealthtillamook.org or call to schedule an appointment at 503-815-2292.

Since 1973, Adventist Health Tillamook is a faith-based, nonprofit healthcare organization that includes: a 25-bed critical access medical center located in Tillamook, Oregon; the largest hospital-based ambulance service in Oregon with four stations located throughout Tillamook County; and rural health clinics and urgent care medical offices serving the northern Oregon coast as well as the communities of Sheridan, Vernonia, Estacada and Welches. Adventist Health Tillamook employs over 550 associates and healthcare providers and is part of Adventist Health, a faith-based, nonprofit integrated health system serving more than 80 communities in California, Hawaii and Oregon. For more information about Adventist Health Tillamook, visit AdventistHealthTillamook.org.

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Adventist Health Tillamook welcomes new top Internal Medicine Provider - Tillamook Headlight-Herald

Internal Medicine

Perceived Preparedness of Internal Medicine Interns for Residency and the Value of Transition to Residency Courses – Cureus

Specialty

Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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Perceived Preparedness of Internal Medicine Interns for Residency and the Value of Transition to Residency Courses - Cureus

Internal Medicine

Remembering Vice Adm. Michael Cowan, the 34th Surgeon General of Navy Medicine (2001-2004) – American Military News

On December 10, 2023, Vice Adm. Michael L. Cowan, the 34th Surgeon General of the Navy died. He was 78.

Vice Adm. Cowan served in a wide-variety of clinical, operational, staff and leadership positions over the course of his 33-year career. His career culminated in 2001 with his selection as the 34th Surgeon General of the U.S. Navy and Chief of the Bureau of Medicine and Surgery (BUMED).

Cowans career legacy includes pioneering the concept of Force Health Protection, redefining deployable medicine in the 21st century, and serving as the Navy Surgeon General during the attacks on September 11th, 2001, and the start of the wars in Iraq and Afghanistan.

It could be stated that medicine was always in the sights of the Fort Morgan, Colorado native. Following pre-med at the University of Colorado at Boulder and after attending medical school at the Washington University School of Medicine, Cowan went to Temple University to study internal medicine and hematology under his mentor Dr. Sol Sherry (1907-1983). Sherry was already a medical giant whose research led to the development of clot-dissolving drugs to treat heart attacks. Cowan envisioned following in Sherrys footsteps and spending his career in academic medicine, but all that would change in 1971 when he was drafted into service.

At the time I was a free spirit, related Cowan. My hair was too long, and I could have put it into a ponytail. I had the attitude that most people had in 1971 about the militaryI was very anti-war, anti-military. I really knew nothing about the military, and everything I thought I knew was wrong.

Although he entered the Navy, as he later jokingly remarked, kicking and screaming, he was soon hooked. While serving as a general medical officer at Naval Hospital Camp Lejeune, N.C., Cowan learned the important role the Navy played in supporting the Marines. I particularly took pride that I was taking care of these young men and women who were serving their country, said Cowan. And it felt good as a physician to know that I didnt have to worry about their insurance. The phrase I always used was, I didnt have to ask them how sick they could afford to be. My job was just to take care of them to the best of my ability, and my paycheck didnt depend on anything else.

Camp Lejeune would remain a special place for Cowan throughout his career. Just over twenty years after entering the Navy, while serving as the Commanding Officer of Naval Hospital Camp Lejeune (1993-1996), he was selected for flag rank.

In 1972, Cowan continued his residency in internal medicine followed by a hematology/oncology fellowship at the National Naval Medical Center (NNMC) in Bethesda, Maryland. It was at Bethesda that his love for Navy Medicine was born, and his decision to stay in the Navy was made.

I was at a change of command ceremony at Bethesda, and as the band started playing the march, as the flags came in, I got a tingle, recalled Cowan. As we were standing at attention in front of the flags about to witness this time-honored, old military ceremony, the hair on the back of my neck went up and I thought, Okay, thats it, thats the answer to my friends question as to why I stay in. The hair on the back of my neck goes up and Im reminded of what this is all about.

Over the ensuing years, Cowans love for the Navy and his role as, he described it, a physician-leader continued to grow. He served as Chief, Internal Medicine, at Naval Hospital Rota, Spain (1975-1976), and Chief of Clinical Investigations for the Navy Malaria Vaccine Research Program at the Naval Medical Research Institute (forerunner of todays Naval Medical Research Command) (1979-1982).

In 1982, Cowan was selected by Dr. Jay Sanford (1928-1996), president of the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, to serve as the schools Deputy Director of Operational and Emergency Medicine in the Department of Military Medicine. In this position, Cowan taught the military medicine course and led fourth-year medical students through the Bushmaster exercise. It was a role that would leave an indelible mark on hundreds of future military physicians.

In Bushmaster, we wanted to push people to their limits in a controlled way, explained Cowan. It was a leadership lab that tested what people are really made of when they are really tired and frustrated and just dont think they can do it anymore. Over time we learned how to push people to grow, but in the early days we didnt know how far to push.

On one of his earliest Bushmasters, Cowan, Dr. Sanford, and his team of instructors, started a drill at eleven oclock at night after the students had had a long day. We simulated an attack on the camp with boomers and machinegun fire, recalled Cowan. They were supposed to respond, but they didnt come out.

Cowans team then threw several tear gas canisters around the tent. But still no response. Dr. Sanford slowly walked over, picked up the tent flap, kicked a tear gas canister under the tent flap and walked to the observation area. Still nothing. Cowan and Sanford then turned to each other and at that point knew they had overworked the students and called it a day. The students had just had it, so they had put their gas masks on, pulled their sleeping bags up over themselves the best they could, and just stayed there, recalled Cowan. They slept in their gas masks.

One of his students forever impacted by Cowan and the Bushmaster was Vice Adm. (ret.) C. Forrest Faison III, the 38th Surgeon General of the Navy and a USUHS graduate.

I dreaded this course all four years [at USUHS], recalled Faison. Over the next two weeks we started running back-to-back mass casualty, and combat scenarios. Youre doing this around the clock, and youre exhausted. Then comes the main event, which is a main mass casualty drill where they wrap it all together, and were so sleep deprived. Its hot, its muddy, and its just nasty. And we get through the scenario and were doing a hot wash, and Admiral Cowan gets up there and he goes, Youre cold, youre wet, youre tired, youre hungry. So why do you do it? You do it because that guy on the stretcher is depending on you to do it. And his family back home are depending on you to do it. And its the right thing to do.

Cowans time leading the Bushmaster would follow him throughout his career, even to distant places around the globe. While serving as Task Force Surgeon, Operation Restore Hope in Mogadishu, Somalia (1992-1993), Cowan recalled that many of his former students were serving as medical officers in Marine units and as command surgeons. I was able to delegate far more and had far more confidence in the abilities of these folks than I ever would have if they never had that field experience.

It was in Somalia that Cowan also recognized the unique values of each service, a piece of knowledge that would later serve him well as Joint Staff Surgeon (1997-1999); Chief of Staff, Office of Assistant Secretary of Defense for Health Affairs, The Pentagon (1999-2000); and Deputy Director and Chief Operating Officer, TRICARE Management Activity (2000-2001).

Cowan took the helm as the 34th Surgeon General of the Navy in August 2001. He was on the job for just 30 days when the attacks on September 11th occurred. Instantly, the world had changed, and Navy Medicines course would forever be altered to meet the new challenges ahead. He recalled, On September 11th, I walked to my desk about 10:30 in the morning and threw [my priorities] in the trash can. Priorities had just changed.

Within 24-hours of the attack Cowan updated the Navy Medicines motto from Standing by to assist to Steaming to assist and deployed the hospital ship USNS Comfort to New York City where it served as a relief valve for the rescue workers.

Primary care and physical therapy and messmen and general duty hospital corpsmen boarded he Comfort, and they steamed up to New York, related Cowan. While there they provided up to 1,000 people a day [with] hot meals, a shower, a berth, and laundry service. So, youd go aboard, theyd take your dirty laundry, feed you, put you to bed, give you a shower, wake you up, give you your clean clothes back, or new clothes, and send you back to work. We took criticism for that. There were people who thought that that was an undignified mission for a war ship of the United States Navy and I shouldnt have done that.

Yet, it had a positive impact.

A year later, while attending a reception for exercise BALTIC OPERATIONS (BALTOPS 22), he walked over to a group of Navy messman to congratulate them on doing a nice job. As we were talking and laughing, I said, By the way, how many of you were on the Comfort last year? And most of the hands went up, said Cowan. And this one kid, a 22-year old, kept trying to put his hand up and the others kept slapping him down, good naturedly. He said, I was on the Comfort in New York, but I wasnt crew. I was a New York City fireman. After seeing what the Navy did in New York I was so impressed that I joined the Navy under the condition that I become a messman assigned to the Comfort.

Admiral Cowan was a soft-spoken, caring, and impactful leader who always saw the bigger picture and thought outside the box, said Rear Adm. Darin Via, the 40th Navy Surgeon General. He was way ahead of his time and Navy Medicine is stronger because if him.

One of Vice Adm. Cowans greatest legacies was a humble leadership and his trust of others. This is captured when describing his philosophy of service:

I think a big part of my philosophy was formed by a phrase my dad used to use that I really glommed onto. He said, Your life finds you far more often than you find your life, stated Cowan. Had I not been drafted I never would have come into the military. I would have been an academic, probably stayed at Temple [University] . . . That would have been my life, and I would have been very happy. But this detour happened, and it became a better life, one that I would have never sought after and the direction of that detour I would have never sought out. My whole life found me almost against my will.

So, when people, young officers in particular, ask me, Can you give me some career advice? I say, I will, but its not going to be very good. What Im going to tell you youve got to take with a grain of salt. I tell them, Just dont worry about it. The one thing you must do in life is to do your job. No matter what job youve got, do the hell out of it and then position yourself to try to get jobs you enjoy doing. If you enjoy a job, youll do it well; if you dont enjoy your work, then life isnt worth living.

Admiral Cowan was predeceased by his wife of 60 years, Linda, and son Dr. Mark Cowan, both passing earlier this year.

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Remembering Vice Adm. Michael Cowan, the 34th Surgeon General of Navy Medicine (2001-2004) - American Military News

Internal Medicine

Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis – Cureus

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Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis - Cureus

Internal Medicine

The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations … – Cureus

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Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations ... - Cureus

Internal Medicine

James Murray named head doctor at Confluence Health – Source ONE News

WENATCHEE Confluence Health has officially named Dr. James Murray as its new Chief Medical Officer (CMO), marking a significant leadership transition for the healthcare system. This decision follows a thorough evaluation by the Confluence Health Board.

Previously holding the position of interim CMO since July 2023, Dr. Murray steps into the permanent role, succeeding Dr. Jason Lake. His extensive background in medical practice and healthcare leadership positions him as a key figure in advancing Confluence Health's mission of delivering exemplary local healthcare.

"Dr. Murray brings many years of experience to this position, not only in medicine and healthcare leadership, but in understanding our community and its needs," said Dr. Jennifer Jorgensen, president of the Wenatchee Valley Medical Group, the largest physician group affiliated with Confluence Health.

Dr. Murray's medical credentials are robust. He is board certified by the American Board of Internal Medicine and joined Confluence Health in 2005. His academic foundation includes a medical degree from Loyola University and a residency in internal medicine at Grand Rapids Medical Education and Research. Dr. Murray's career at Confluence Health has been marked by his roles in critical care and medical education, including serving as the medical director for inpatient medicine and for specialty and ancillary medicine.

"I am in full support of the Confluence Health Boards selection and know that Dr. Murrays years of leadership experience and the respect he has earned among his colleagues will make him an excellent CMO," Dr. Andrew Jones, CEO of Confluence Health, commented. He praised Dr. Murray's adept handling of the interim CMO responsibilities, emphasizing his rapid adaptation to the challenges and opportunities within the healthcare system.

Confluence Health's medical networth covers a vast region of over 12,000 square miles across Okanogan, Grant, Douglas, and Chelan counties.

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James Murray named head doctor at Confluence Health - Source ONE News