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January 2015


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Register Today for ACP's 100th Anniversary Internal Medicine Meeting!

Register for Internal Medicine 2015 by January 31 to receive the lowest registration rate. Join ACP and thousands of your colleagues in Boston, Massachusetts, from April 30 - May 2, 2015 and transform the way you practice medicine. Internal Medicine 2015 will allow you multiple opportunities to refresh your internal medicine knowledge, sharpen your practice management skills, network with colleagues from around the world in a beautiful location.

Click here to watch a brief video explaining why you should attend Internal Medicine Meeting 2015

For the 100th anniversary, ACP is offering special registration and delegation rates for many international attendees. ACP members in low income/low middle income countries and upper middle income countries, as defined by the World Bank Economic Indicators, will be offered these special discount registration rates for ACP Internal Medicine 2015 in Boston. Discounts will apply to individual registrations as well as group delegations.

To see the individual registration rates by country of residence, visit the International Rates page at im2015.acponline.org/internationalrates.

ACP Internal Medicine 2015 Flyer

Consider forming a delegation of 10 or more attendees to receive the greatest registration discounts. More information can be found on ACP's website at www.acponline.org/delegations.

If you have questions, please contact internationaloffice@acponline.org.


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Spanish Language Interpretation of Select Courses at IM 2015

This year, for the first time, ACP will be offering simultaneous interpretation of select scientific courses for attendees who would prefer to hear lectures in Spanish. Headsets will be available for pickup onsite for those who are interested. The courses that will be interpreted into Spanish include:

Friday, May 1, 2015

  • Update in Hospital Medicine - 8:15-9:15 AM
  • Update in Critical Care - 9:30-10:30 AM
  • Update in Women's Health - 11:15-12:45 PM
  • Update in Cardiology - 2:15 - 3:45 PM

Saturday, May 2, 2015

  • Update in Geriatric Medicine - 8:15-9:15 AM
  • Update in Nephrology - 9:30-10:30 AM
  • Update in Infectious Diseases - 11:15-12:45 PM
  • Update in Pulmonary Medicine - 2:15-3:45 PM

All courses will be conveniently located in Ballroom East of the Convention Center.

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ACP India National Conference

ACP held its first national conference in India on September 5-6, 2014, at the Le Meridien Hotel in New Delhi. Physicians from various parts of India attended the highly-rated, two-day conference focusing on "The Burden of Non-communicable Diseases."

The conference featured informative sessions on Hypertension, Diabetes, Gastroenterology & Hepatology, Hematology & Oncology, Infectious Diseases, Gerontology, and Cardiology. Many of these sessions were presented in a panel format comprised of 1 U.S. and 1 Indian speaker. Five of the 23 sessions are now available for viewing:

ACP held its first national conference in India on September 5-6, 2014 in New Delhi. Physicians from various parts of India attended the highly-rated, two-day conference focusing on "The Burden of Non-communicable Diseases."

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Update Your Knowledge with MKSAP 16 Q & A

The new Medical Knowledge Self-Assessment Program® (MKSAP® 16) provides you with the most current and critical information in the core of internal medicine and its subspecialties so you can stay aware of what you need to know as a practicing physician in internal medicine today.

For more information on MKSAP 16, or to order your copy, visit http://www.acponline.org/products_services/mksap/16/

MKSAP 16 Q & A

A 45-year-old woman is evaluated in the hospital after radical hysterectomy for cervical carcinoma. Aside from postoperative pain, she has no symptoms. She has no history of venous thromboembolism or excessive bleeding. Her only current medication is morphine as needed.

On physical examination, temperature is normal, blood pressure is 110/72 mm Hg, and pulse rate is 84/min. There is trace edema in the legs. Prothrombin time, activated partial thromboplastin time, and INR are normal.

In addition to early ambulation, which of the following interventions is the most appropriate in this patient for thromboembolism prophylaxis?

A. Enoxaparin for 5 weeks
B. Inferior vena cava filter placement
C. Unfractionated heparin until discharge
D. Warfarin for 3 months

Click here for the answer and critique.

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ACP Leaders on the Road: Taipei, Taiwan

Gerald W. Smetana, MD, FACP
Associate Professor of Medicine, Harvard Medical School, Boston, MA
Taiwan Society of Internal Medicine
November 22-23, 2014

I had the pleasure of representing the ACP at the Taiwan Society of Internal Medicine (TSIM) annual meeting in Taipei, Taiwan on Nov. 22-23, 2014. This annual session included presentation of original research, and also continuing education sessions on core topics in internal medicine.

On November 22, I led a roundtable discussion for one dozen key leaders in medical education across multiple departments at the National Taiwan University Hospital (NTUH), which is a tertiary referral center and the largest academic medical center in Taiwan (2400 beds). The focus of the roundtable discussion was faculty development and promotion for clinician educators in an academic environment. After having recently been promoted to Professor of Medicine myself at Harvard Medical School, it was a chance for me to reflect on those strategies and activities that were most useful to advance my academic career, and to share some suggestions with the audience. This discussion focused on teaching, opportunities for scholarly writing for clinician educators, the importance of serendipity in career paths, and strategies to grow from a local to a national and international reputation.

On November 23, I gave a lecture at a plenary session on the management of depression in primary care practice. My hosts, the TSIM, had requested this topic as they felt it was relevant and important in primary care practice. The focus was on the rational use of antidepressant medications based on efficacy and unique side effect profiles of different drugs. The other international invited guest was Dr. Rolf Streuli, past president and secretary general of the International Society of Internal Medicine. Dr. Streuli spoke on preoperative medical evaluation. This was followed by a panel discussion.

I had the honor of meeting many general internists and medical specialists in internal medicine, at the meeting. My local host was Dr. Pei Ming Yang, the president of the TSIM. Dr. Yang was a very gracious host.

I had the opportunity to share the benefits and value of international membership in the ACP with attendees at both the roundtable discussion and lecture session. Currently, approximately 35 internists in Taiwan are ACP members. The addition of new members would allow the Taiwanese membership to apply for recognition as an ACP chapter. The ACP has had a longstanding relationship with the TSIM; my visit continued a tradition of teaching and collaboration between the ACP and the TSIM.

Pictured: Gerald W. Smetana, MD, FACP (left) pictured with Pei-Ming Yang, MD, PhD, FACP, President, Taiwan Society of Internal Medicine.

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ACP Leaders on the Road: Ontario

Thomas A. Bledsoe, MD, FACP
Governor, Rhode Island Chapter
ACP Ontario Chapter Meeting
October 28 - November 1, 2014

I was very pleased to have been invited to present a talk at the ACP Ontario Chapter meeting in early November in Toronto. Shortly after arriving in the evening I was handed a clipboard to serve as judge for an impressive array of clinical vignettes presented by the resident and medical student members of the Chapter. At the meeting itself the following morning, approximately 100 Chapter members were present. Each of the presenters at the meeting took a few moments to discuss how Fellowship in the College was an important part of their professional identity, complimentary to that provided by the Canadian Society of Internal Medicine or the Ontario Medical Association. My talk, entitled “Building an integrated medical practice community from the ground up: The Rhode Island Experience” focused on advanced primary care practices (a.k.a. Patient-Centered Medical Homes), in particular on connecting them through a learning collaborative to improve both effectiveness and cost-effectiveness of care.

Those themes also resonated with a subsequent speaker who discussed “Choosing Wisely Canada”, the campaign to help patients and physicians reduce unnecessary tests, treatments and procedures. (The Canadian health care system also struggles with the need to control costs!) In follow-up questioning, I was able to highlight the tools and resources available through the College’s High Value Care Initiative which resonated with the audience, demonstrating our mutual interest in addressing the high cost of healthcare. More information about ACP’s High Value Care Initiative can be found at https://hvc.acponline.org/

Pictured Left to Right: Thomas A. Bledsoe, MD, FACP, Rhode Island Chapter Governor, Ross D. Feldman, MD, FACP, Ontario Chapter Governor, and Eric P. Brass, MD, PhD, Professor of Medicine, David Geffen School of Medicine at UCLA.

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Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in India, Panama City, and Bangladesh.

A complete list of other Future Worldwide Internal Medicine Meetings is available here.

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New International Fellows

ACP is pleased to announce the following newly elected International Fellows, who were recommended by the Credentials Committee and approved for election by the Board of Regents as of January 1, 2015. They are listed by current location and may have been credentialed through a different Chapter.

Bahrain

  • Sumaya M. Al Ghareeb, MBBCh, FACP – Hamad Town

Bangladesh

  • Ramendra N. Mazumder, MBBS, FACP - Dhaka

Brazil

  • Herlon S. Martins, MD, FACP - Sao Paulo

Chile

  • Marco A. Arrese, MD, FACP – Santiago

India

  • S. K. Agarwal, MD, FACP – New Delhi

  • Chandran Gnanamuthu, MD, FACP – Bangalore Karnataka
  • Chakravarthy S. Maddipati, MD, FACP – Kochi
  • Brij Mohan Makkar, MD, FACP – New Delhi
  • Charanjit Singh, MD, FACP – Baramulla J & K
  • Anuradha Subramanian, MD, FACP – New Delhi

Jamaica

  • Patrice M. Francis, MD, FACP – Kingston

  • Samantha S. Nicholson-Spence, MD, FACP - Kingston

Japan

  • Tetsuya Makiishi, MD, FACP – Otsu, Shiga

Mexico

  • Ricardo Berea Baltierra, MD, FACP – Mexico City

  • Elpidia Vela Martinez, MD, FACP – Mexico City

Nigeria

  • John Oghenevwirhe Ohaju-Obodo, MD, FACP – Oghara Delta

Pakistan

  • Mohammad Yousuf Awan, MBBS, FACP – Rawaplindi

Panama

  • Ana Belen Arauz Rodriguez, MD, FACP – Panama

Peru

  • Carlos Walter Contreras Camarena, MD, FACP – Lima

  • Walter Hidalgo Caceres, MD, FACP - Lima

Qatar

  • Walid S. Hassanen, MBBCh, FACP – Doha

Saudi Arabia

  • Mussa Almalki, MBBS, FACP - Riyadh

Singapore

  • Paul Michael Yen, MD, FACP – Singapore

Sri Lanka

  • Nandana Dickmadugoda, MBBS, FACP – Tangale Southern

Trinadad and Tobago

  • Taarik A. Dookie, MBBS, FACP – Maraval

United Arab Emirates

  • Hala Abuzeid Ahmed, MBBS, FACP – Abu Dhabi

  • Amer K. Albadry, MBChB, FACP - Sharjah
  • Bisher O. Mustafa, MD, FACP – Abu Dhabi

Venezuela

  • Bernardo Beker, MD, FACP - Caracas

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist November/December 2014

ACP Hospitalist December 2014

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College Corner

Chapter Excellence Award Winners

We are happy to announce that twelve international chapters are in receipt of the 2014 Chapter Excellence Award. These are the Alberta, Brazil, British Columbia, Central America, Chile, Colombia, Japan, Mexico, Ontario, Quebec, Saudi Arabia and Venezuela Chapters. These chapters are in receipt of this award because they have made great strides in chapter management in numerous ways. These include such activities as formulating an effective Governor’s Council and committees, communicating frequently with their membership, providing educational opportunities, recruiting and advancing members and celebrating their membership through local awards. Congratulations to these chapters on a job well done!

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MKSAP 16 Answer & Critique

Answer: A, Enoxaparin for 5 weeks

Educational Objective: Manage postoperative venous thromboembolism prophylaxis in a high-risk patient.

Critique: The most appropriate treatment for this patient is venous thromboembolism (VTE) prophylactic therapy for up to 5 weeks with a low-molecular-weight heparin (LMWH), such as enoxaparin. VTE is a major preventable postoperative complication, and nearly all surgical patients should receive some VTE prophylaxis postoperatively. Patients at high risk for VTE, including patients with previous VTE, patients who have undergone orthopedic surgery, and patients with some cancers (especially gynecologic malignancy) should receive extended (up to 5 weeks) prophylaxis with LMWH.

Nonpharmacologic prophylaxis against VTE, such as early ambulation, should be encouraged in all postsurgical patients. Other nonpharmacologic treatments include elastic compression stockings and pneumatic compression devices. However, these treatments are only suitable as the sole modality when either the risk of VTE is very low (outpatient surgery) or the morbidity from excess bleeding is unacceptably high (such as in patients undergoing neurosurgery). This patient's surgery for a gynecologic malignancy places her in a high-risk category, and pharmacologic prophylaxis is indicated.

Inferior vena cava (IVC) filters are sometimes used perioperatively, especially in patients with known VTE or patients with a high risk for VTE who cannot receive prophylaxis because of bleeding risk. This patient does not have an excessive bleeding risk, and IVC placement is not indicated. Although newer IVC filters are thought to be extractable following a procedure, the retrieval rate is not typically 100%, and a filter that cannot be removed postoperatively may complicate ongoing care.

Unfractionated subcutaneous heparin is an accepted medication to prevent VTE. However, in this high-risk patient, extended prophylaxis is indicated; therefore, providing prophylaxis only until the patient is discharged is incorrect.

Warfarin, in both fixed doses and adjusted doses, has been studied for VTE prophylaxis, primarily in the orthopedic setting, and been found to be effective in preventing venous thromboembolism in the perioperative period. However, 3 months of prophylaxis would not be indicated and would substantially increase the risk of bleeding once the perioperative thromboembolism risk has resolved.

Key Point: Surgical patients at high risk for venous thromboembolism, including those with previous venous thromboembolism, patients who have undergone orthopedic surgery, and patients with some cancers (especially gynecologic malignancy), should receive extended (up to 5 weeks) prophylaxis.

Bibliography:

Gould MK, Garcia DA, Wren SM, et al; American College of Chest Physicians; Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):e227S-e77S. [PMID: 22315263]

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Superior MOC Solutions from ACP

Superior MOC Solutions from ACP

Meet your requirements with our approved activities. See details.

Making the Most of Your ICD-10 Transition

Making the Most of Your ICD-10 Transition

To help you and your practice make a smooth and successful transition to ICD-10 coding, ACP and ICD-10 content developers have created multiple resources available at discounted rates for ACP members.