matthew liang | Harvard Medical School (original) (raw)

Papers by matthew liang

Archives of internal medicine, Aug 1, 1976

A teaching module in ambulatory internal medicine has been added to a residency program in a larg... more A teaching module in ambulatory internal medicine has been added to a residency program in a large referral hospital. The effort was directed to structure a program of instruction reflecting common problems seen by primary care internists. Patients were screened by supervising staff to make the rotation an efficient learning experience. Experienced nurse clinicians were used to monitor patients with stabilized medical problems, thus freeing the housestaff for problems more suited to their level of training. The nurses also served as role models with which the housestaff could interact and provide continuity and accessibility of care to patients being followed up by transient physicians-in-training. Various teaching conferences based on traditional inpatient models were conducted. Self-assessment and peer review techniques were structured around monthly conferences in which medical records were assessed by each participant.

Annals of Internal Medicine, Jun 15, 1993

Current Opinion in Rheumatology, Sep 1, 1999

Clinical Orthopaedics and Related Research, Mar 1, 1978

Annals of the Rheumatic Diseases, Nov 1, 1992

Annals of Internal Medicine, Nov 1, 1982

Total joint replacement surgery has revolutionized the management of chronic arthritis. Careful p... more Total joint replacement surgery has revolutionized the management of chronic arthritis. Careful patient selection, medical follow-up, patient education, and rehabilitation management produce the best results. The indications, contraindications, and results of total knee and hip replacement are reviewed.

Elsevier eBooks, 2011

Publisher Summary Epidemiology is the study of the distribution of illnesses and diseases and the... more Publisher Summary Epidemiology is the study of the distribution of illnesses and diseases and the factors affecting their incidence and clinical course in the population. Systemic lupus erythematosus (SLE), an autoimmune disease with a broad spectrum of clinical and immunological manifestations, is a major challenge to study epidemiologically, but research on SLE has been carried out in many parts of the world. These include descriptive studies of incidence and prevalence, observational studies of SLE prognosis, and the identification of potentially preventable causes of morbidity and mortality. Analytic and genetic epidemiologic studies suggest a multifactorial etiology of SLE. A better understanding of the epidemiology of SLE should help us understand its etiology, identify predictors of morbidity and mortality, and improve SLE care and outcomes. Epidemiologic clues for potential cause(s) remain elusive, not so much from lack of effort, but lack of strong signals. Even the most established risk factors, except for gender, explain the minority of cases. Overall, epidemiologic studies demonstrate a good and possibly improved prognosis since its first description, making SLE a chronic but potentially dangerous illness. Studies also indicate considerable variations in outcome and differences between ethnic groups and between industrial and preindustrial countries that are probably increasing, comprising a major research challenge and a possible public health opportunity to correct these inequalities. Long-term morbidity is appreciated but its study is only just beginning. Future studies will need to look at what is really modifiable and to test interventions rigorously.

Annals of the New York Academy of Sciences, Aug 1, 1997

Arthritis & Rheumatism, Dec 1, 1998

Nature clinical practice rheumatology, 2006

Original article Ibanéz et al. (2005) Adjusted mean systemic lupus erythematosus disease activity... more Original article Ibanéz et al. (2005) Adjusted mean systemic lupus erythematosus disease activity index-2K is a predictor of outcome in SLE.

Arthritis & Rheumatism, Sep 1, 1995

Rising public expectations, increasing medical and surgical specialization, and increased technol... more Rising public expectations, increasing medical and surgical specialization, and increased technological capacity have fueled rising health care costs-now 14% of the US Gross National Product. Efforts to slow and contain health care costs have largely failed, and the last effort at a major restructuring, the Clinton Administration's Health Reform Plan, has died. Not a single new piece of health legislation has been enacted, but the health care system has undergone profound change, downsizing, and privatization. A growing proportion of the Nation is now under some form of managed health care; the health insurance industry has essentially captured control of health care providers and of how health care will be delivered. Clinical practice guidelines (I), systematically developed statements to assist practitioners and patients about appropriate health care for specific clinical circumstances, have been around since the 1960s as decision rules, prediction rules, standards, algorithms, protocols, or practice parameters. What is new are the enormous human and financial resources that are dedicated to producing them. Depending on one's viewpoint (manager, patient, physician], guidelines are seen as: a way to ensure accountability, reduce the demonstrated wide varia

Arthritis & Rheumatism, Nov 1, 2004

... We gratefully acknowledge the invaluable contributions of Elizabeth Concepcion, Kaleena Scamm... more ... We gratefully acknowledge the invaluable contributions of Elizabeth Concepcion, Kaleena Scamman, Mary Scamman, Victoria Gall, RPT, and Connie Herndon. Amy Miller coordinated and supported the meeting in Düsseldorf and the production of the resultant manuscript. ...

Annals of Internal Medicine, May 1, 1978

The management of asymptomatic hyperuricemia is controversial. Reported benefits from treatment p... more The management of asymptomatic hyperuricemia is controversial. Reported benefits from treatment prevention of acute gouty arthritis, chronic tophaceous gout, urolithiasis, or gouty nephropathy. A review of experimental and clinical data suggests that the risks of asymptomatic hyperuricemia are small or unknown and the efficacy of long-term treatment in preventing gout or renal disease is unproved. The costs and risks of prolonged drug administration and practical considerations such as patient compliance mitigate against long-term therapy in asymptomatic persons. We offer some recommendations for an expectant approach to the management of asymptomatic hyperuricemia.

Archives of internal medicine, Jun 1, 1982

For patients visiting a primary care office practice for acute low back pain, we compared the ben... more For patients visiting a primary care office practice for acute low back pain, we compared the benefits, risks, and costs of obtaining a roentgenogram of the lumbar spine routinely at the initial visit with performing a roentgenogram only if the patient's pain does not improve during and eight-week follow-up period. The cost-effectiveness analysis indicated that, to avert one day of physical suffering in a population of patients, the population would have to be subjected to the additional risk of 3,188 mrad of radiation and an additional cost of $2,072. While, in the individual case, circumstances might lead to a different conclusion, in general, the risks and costs of obtaining lumbar roentgenograms at the initial visit in patients with acute low back pain do not seem to justify the relatively small associated benefit.

The New England Journal of Medicine, May 23, 1985

The New England Journal of Medicine, Jun 14, 1984

JAMA, Nov 2, 2011

ABSTRACT Last year a resident sent an e-mail harangue about how much time it was taking her to do... more ABSTRACT Last year a resident sent an e-mail harangue about how much time it was taking her to do the things her preceptor had asked her to do for patients. It had eaten into her “free time” to take care of these patients. Although she may have been tired at the time she wrote the e-mail, this resident is a very conscientious physician. She wanted to say that being a physician is a “job,” that she should not be spending so much of her time “following up from clinic,” and that her preceptor “has to stop doing so much for the patients,” because this was part of that clinic. She listed examples: she had answered a question from neurology about the necessity of referring a patient to neurosurgery for his debilitating back pain; she had answered a question from pharmacy about a patient's hyalgan injection (a last-ditch effort to avoid either an electric scooter or a knee-replacement surgery); she had talked to a patient who was unclear about his medication after leaving the clinic (she was the resident who saw him); she had had to clarify whether an MRI was necessary in a patient and then whether or not to use contrast; she had to call a patient at home after arranging a 23-hour observation to begin rituxan infusions to give him the date of admission. Incredulous and saddened, we felt it highlighted a generational change in what it means to be a physician and the expectations of some of its younger members.1

Scandinavian Journal of Rheumatology, 1997

For over 20 years silicone breast implants have been used for cosmetic and breast reconstruction ... more For over 20 years silicone breast implants have been used for cosmetic and breast reconstruction purposes. They have been recently banned by the American Food and Drug Administration other than for reconstruction or in the setting of a study. Complications of rupture, leaking, bleeding, capsular thickening and contracture are acknowledged but the potential of silicone implants in causing classic rheumatic diseases or a new syndrome has caused much controversy; there are millions of dollars at stake in legal suits. The biological plausibility of silicone breast implants causing disease is not without merit. The epidemiological evidence linking the two are reviewed. There is considerable concern as to whether there will ever be a definitive study of the question.