Internal medicine is described by the European Federation of Internal Medicine as "the core medical discipline that is responsible for the care of adults with one or more complex, acute, or chronic illnesses".1 This patient centered specialty encompasses both hospital and community care, with a major role in the management of different subspecialties.1
This broad specialty can be divided into many further subspecialties; adolescent medicine, allergy and immunology, cardiology, critical care, endocrinology, gastroenterology, geriatrics, haematology, infectious disease, nephrology, oncology and...
A European study found that the three most common complaints on admission to internal medicine wards were; shortness of breath, chest pain and abdominal pain. On average, at the time of admission, patients had three chronic medical diagnoses and four prescribed drugs.2 The majority of patients admitted had existing cardiovascular disease and had subsequent diagnoses of an infectious disease, a general medical condition, gastrointestinal disorder and/or respiratory disease.2
The most important role of the internalist is to treat patients as a whole as apposed to the individual diseases that are managed by subspecialties.1 However, the role of internal medicine is becoming diluted as a specialty by increasing emphasis on subspecialties such as cardiology and oncology.1
An ageing population worldwide has meant that the prevalence of patients with multiple chronic diseases is steadily increasing.3 This will mean that the role of internal medicine will be come ever more important in the treatment and management of these patients.
1. Koebberling J. et al. Political Issues in Internal Medicine in Europe. A Position Paper. European Journal of Internal Medicine. June 2005 ; 16 (3) : 214-217.
2. Roger D. et al. Common Diagnoses in Internal Medicine in Europe 2009: A Pan-European, Multi-Centre Survey. European Journal of Internal Medicine. October 2010 ; 21 (5) : 449-452.
3. Kramer M.H.H. et al. Internal Medicine in Europe: How to Cope with the Future?: An Official EFIM Strategy Document. European Journal of Internal Medicine. June 2010 ; 21 (3) : 173-175.
Content on this page
- Internal Medicine Knowledge Centres
- Alzheimer's Disease
- Anti-Infectives Knowledge Centre
- Atopic Dermatitis
- Heart Failure
Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase1. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.
Complications associated with diabetes mellitus include hypertension, cardiovascular disease, retinopathy, kidney damage, foot ulceration and nerve damage. Discover more about the complications connected to diabetes mellitus, as well as acceptable blood glucose and HbA1C levels and how these differ in people with diabetes mellitus here.
The majority of patients with type 2 diabetes are obese and/or have an increased proportion of visceral fat, factors which in themselves are associated with insulin resistance. Other risk factors include increasing age and sedentary lifestyle. There is also a strong genetic predisposition to type 2 diabetes2.
Chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction and failure of various organ systems. Early diagnosis, adequate treatment to control hyperglycaemia, and management of associated risk factors and complications therefore are all essential to reduce the burden of diabetes. Effective screening strategies are therefore of particular importance in reducing this burden. Discover the diagnostic tests necessary to diagnose type 2 diabetes mellitus and intermediate hyperglycaemia or pre-diabetes.
The early and aggressive treatment and management of diabetes mellitus is important for a successful long term outcome in patients with diabetes mellitus. The use of oral agents and lifestyle changes are the generally accepted early treatments followed later by insulin therapy. Current treatment algorithms and IDF guidelines should be used to find the appropriate treatment regime for individual patients.
As with many diseases, our knowledge of diabetes mellitus is increasing through research. Recent developments include the use of new treatments and guidelines in clinical practice. There has been an update to the IDF guidelines concerning GLP-1 agonists. DPP-4 inhibitors are now used in the treatment of diabetes, and SGLT-2 inhibitors are being investigated for this use.
1. Unwin, N. et al. The IDF Diabetes Atlas: Providing Evidence, Raising Awareness and Promoting Action. Diabetes Res Clin Pract 87, 2-3 (2010).
2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 33 Suppl 1, S62-9 (2010).
In the early stages in particular, dementia is often difficult to diagnose, since many symptoms are not recognized as such or are trivialized by the patient. 20% of actual dementia cases are reported to be incorrectly diagnosed as a different disease.
In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.
In general two main groups of dementia can be distinguished, requiring different types of treatment:
Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible.
The last decade has seen an increase in the incidence and severity of Clostridium difficile infections (CDI), making it one of the most talked about disease topics with many recent congresses focusing on the disease.
As the leading cause of nosocomial diarrhoea in industrialised countries1 detection and treatment of CDI is extremely important. The ESCMID guidelines recommend that diagnosis is based upon both signs and symptoms and laboratory evidence of toxin producing C. difficile in stools.1,2 In addition antibiotic treatment to eradicate severe C. difficle infection is recommended in these guidelines.2
The management of systemic fungal infections is also a major challenge for healthcare professionals. Due to the invasive nature of fungal infections, many treatments are pre-emptive and are therefore initiated without identifying the specific fungus involved. Targeted approaches will become a more viable option as the speed and delivery of diagnostic methods improve.
The Anti-infectives Knowledge Centre aims to provide you with the most recent information in the areas of both CDI and systemic fungal infections with regularly updated content to help assist in the fight against these diseases.
The Knowledge Centre currently provides information on CDI, including:
- Prevalence – the incidence of CDI and the factors that have been attributed to the rise in these infections
- Symptoms – the symptoms of CDI, including how pseudomembranous colitis manifests
- Recurrence – the impact of recurring infection on patient outcomes
- Diagnosis – the importance of early diagnosis and the diagnostic tests available
- Treatment – treatment options recommended by the current ESCMID guidelines
Additional information on systemic fungal infections will be added soon.
Enter the Anti-infectives Knowledge Centre
1. Crobach MJ, et al. Clin Microbiol Infect 2009; 15: 1053‐1066
2. Bauer MP, et al. Clin Microbiol Infect 2009; 15: 1067‐1079
Date of preparation November 2012 AI/12/0038/EUc
Atopic dermatitis is a chronic inflammatory non-communicable skin disorder characterised by periods of exacerbations, interspersed with periods of apparent remission. This highly prevalent disease has a significant impact on the quality of life of both patients and carers.
The current understanding of atopic dermatitis is that there are two forms, extrinsic and intrinsic. The cause of the former is best understood. A hypersensitivity reaction to environmental allergens (food, air-borne particles, soaps, perfumes and fabrics) generates an inflammatory response which in turn generates the release of histamine that contributes to the development of pruritus. Intrinsic atopic dermatitis causes identical symptoms in the absence of an initial hypersensitive response.
The evidence available that supports disease modification in atopic dermatitis has been well documented; however currently there is no clear definition of disease modification in atopic dermatitis.
Clinical management of atopic dermatitis is dependent on the severity of patient’s symptoms, however all patients should receive help and advice to aid in lifestyle changes that will decrease the risk of a disease flare. In addition to this, treatment with non-pharmaceutical products such as emollients and pharmaceutical agents such as topical corticosteroids is standard practice.
The Atopic Dermatitis Knowledge Centre is developed in collaboration with Astellas Pharma Europe Ltd.
August 2012 DERM/12/0009/EUd
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease of the respiratory system resulting in decreased lung function, which is a growing cause of morbidity and mortality worldwide. It has been estimated by The WHO Global Burden of Disease project that COPD was the fourth leading cause of death in 2004 and predicts that by 2030 it will be the third.1 However it is thought that the current prevalence is an underestimate, due to a lack of awareness among primary care physicians.
The three main symptoms of COPD are dyspnoea (breathlessness), cough and sputum production.2 In addition to these symptoms, many patients also experience mild to moderate pulmonary hypertension, cor pulmonale, weight loss and a general deterioration in their feeling of well-being.3-5
1. WHO The global burden of disease: 2004 update. Part 2 – Causes of death. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf (Accessed 11 November 2011).
2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2010). Available at: http://www.goldcopd.com/ - (accessed 11 November 2011).
3. Rennard S, Decramer M, Caverley PMA et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799-805.
4. Kumar P and Clark M (Eds.) Chapter 13 – Cardiovascular disease. In: Clinical Medicine 6th ed. Philadelphia, PA: Elsevier Saunders, 2005.
5. Agustí A. Systemic effects of chronic obstructive pulmonary disease – what we know and what we don't know (but should). Proc Am Thorac Soc 2007; 4: 522-525.
Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.
Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.4
The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.5
Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.6
Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.
Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.
The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:
- Symptoms and Diagnosis
- Treatment Options
- Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
- Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
- Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
- Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
- Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
- NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.
Takeda Pharmaceutical Company Limited announced results of a Phase III clinical trial (CCT-003) of fasiglifam (TAK-875) for the treatment of Type 2 Diabetes presented at the 56th Annual Meeting of the Japan Diabetes Society.
The results show that 25 mg and 50 mg fasiglifam, when administered once-daily, showed statistically significant and clinically relevant HbA1c lowering effect...
Results of a pivotal Phase III trial in women with HER2 positive (HER2+) advanced Breast Cancer showed that Afinitor (everolimus) tablets, from Novartis, in combination with Herceptin (trastuzumab) and vinorelbine significantly extended progression-free survival (PFS) after prior therapy when compared to treatment with placebo plus trastuzumab and vinorelbine, meeting the study's primary...
Sanofi has announced that the pivotal study, JAKARTA, examining the selective JAK2 inhibitor SAR 302503 for Myelofibrosis versus placebo in 289 patients, met its primary endpoint in both dose groups. The primary endpoint assessed the proportion of patients achieving >35% reduction of spleen volume. Consistent with data reported in previous trials, the most common adverse events were anemia,...
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REYATAZ is indicated for the treatment of HIV-1 infected adults in combination with other antiretroviral medicinal products. In antiretroviral treatment experienced patients, the demonstration of...
Post Myocardial Infarction Adjuvant treatment in secondary prevention after myocardial infarction, in addition to other standard therapy (e.g. statins, anti-platelet medicinal products, ...
Aprovel is indicated in adults for the treatment of essential hypertension. It is also indicated for the treatment of renal disease in adult patients with hypertension and type 2 diabetes mellitus...
Vulvodynia: An Under-recognized Pain Disorder Affecting 1 in 4 Women and Adolescent Girls - Integrating Current Knowledge Into ClinicalApr 2013
The Pharmacokinetics of MK-7145 Following Single Dose Administration in Participants With Moderate Renal Insufficiency (MK-7145-018)11-04-2013
The primary purpose of this study is to obtain a preliminary pharmacokinetic profile of MK-7145 2 mg immediate release (IR) following single-dose administration in male participants with moderate renal insufficiency. In addition, the study will evaluate the pharmacodynamic effect of a single dose of MK-7145 2 mg IR on..
Multi-Center Randomized Clinical Trial Irreversible Electroporation for the Ablation of Localized Prostate Cancer08-04-2013
Multi-centre Randomized Clinical Trial: 200 patients with confirmed unilateral high-volume low risk (Gleason score 3 + 3) or intermediate risk prostate cancer (Gleason score 3 + 4) will undergo an IRE treatment. These patients will be randomized into one of the two groups of the study. Group 1: Hemi-ablation of the..
Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: A systematic review
Cancer Treatment Reviews
Background and aims; The use of oral anticancer drugs has increased in modern oncology treatment. The move from intravenous treatments towards oral anticancer drugs has increased the patients’ own responsibility to take oral anticancer drugs as being prescribed. High rates of non-adherence to oral anticancer drugs have..
Cancer Treatment Reviews
By the introduction of molecularly targeted anti-cancer drugs, that are designed to intervene with specific pathways aberrant in cancers with distinct mutations, the type of adverse events encountered has changed greatly compared to the adverse events profile of classical chemotherapeutic agents. Ocular toxicities,..
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