There existed considerable concern that participation in Maintenance of Certification by board-certified physicians would be less than optimal when it was introduced by the
The NIPDD 9-month fellowship provides instruction, education, and formative experiences designed for family medicine physician educators to enhance and develop the knowledge, skills, and attitudes to be effective leaders as directors of residency programs. 1 Historically, postgraduate training program directors in family medicine faced many challenges without signifi cant training in fi nance or administration. For those reasons, and because family medicine directors might not have support from other program directors, the sessions on stress and burnout were always full at the Program Directors Workshop. In 1994, during a strategic planning meeting of AFMRD, the idea of a school for program directors surfaced. At the same time, the ABFM was seeking a way to educate program directors on policies and procedures to assure resident eligibility for the certifi cation exam. With major fi nancial support from the ABFM, the idea became reality. In-kind staff support from the AAFP and AFMRD, and the interface with AFMRD, AAFP, STFM, RAP, and ABFM initiated the creation of the Academic Council by selecting representatives of those organizations to participate as members of the Council and to teach in the fellowship. 1 The Academic Council reports to the AFMRD Board of Directors through the Council Chair. Each element of the fellowship receives CME credit from the appropriate medical specialty organizations and the American College of Physician Executives (ACPE).
Diarrhea is a common gastrointestinal problem in diabetes, and its prevalence has been underestimated. The cause of diabetic diarrhea is unknown, but it is probably related to gastrointestinal motility disturbances secondary to diabetic autonomic neuropathy. Other causes (especially primary malabsorption syndromes and islet cell tumors) must be excluded. Treatment of diabetic diarrhea is largely symptomatic and only moderately effective. Antidiarrheal agents may ameliorate acute episodes. Broad-spectrum antibiotics and clonidine hydrochloride (Catapres) have had some success in long-term control. Most recently, subcutaneous administration of somatostatin analogues has been shown to be helpful, the main side effects being drowsiness and vomiting.
Hypertension is a chronic problem commonly seen by primary care physicians. Inadequate treatment may result in significant morbidity and even death. Therefore, all patients with hypertension or at risk for hypertension should be educated about nonpharmacologic measures to control blood pressure. Weight reduction and sodium restriction are cornerstones of nonpharmacologic management of hypertension. Although studies of the effects of aerobic exercise on blood pressure are not well designed, data confirm the value of such exercise. Relaxation therapy has been shown to lower blood pressure, but effects may be transient. Potassium and calcium supplementation has lowered blood pressure, but because study results are contradictory, the exact clinical criteria for use of such supplements have not been determined. Vegetarians have lower blood pressure than nonvegetarians, but no specific dietary components (eg, fiber, fat) have been documented as the beneficial factors. Because of its significant pressor effect, alcohol should be avoided by hypertensives. A low-fat diet is recommended to decrease cardiovascular risk and assist in weight control.
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