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July 2012


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ACP Leaders on the Road: Australia

Virginia L. Hood, MBBS, MPH, MACP

In May I took the 20 hour flight from Burlington, VT to Brisbane, QLD for the 2012 Congress of the Royal Australasian College of Physicians. Held in the convention center near the banks of the Brisbane River in the heart of the city, it provided an opportunity to enjoy the river, parks, art galleries and street fairs while coming and going to scientific sessions. Brisbane has recovered from devastating floods that engulfed the whole commercial district and many homes just 18 months ago when its long snake like river overflowed the banks as the result of unexpected torrential rains. Each morning as I walked over one of the many bridges enjoying the beauty of the river and city, I marveled at the rapidity of the recovery that had involved the whole community in a monumental team effort. All the while I could not help remembering our colleagues and the people in Japan who faced even more devastating challenges just a few months later and who too demonstrated the uncomplaining resilience and fortitude that recovery from natural disasters requires.

On the first evening, the convocation for the new fellows was held, providing us all with the chance to celebrate with talented young physicians who are the future of our great profession. During the ceremony, Professor John Mattick delivered the Arthur E. Mills Oration reminding us that while genomic analysis will revolutionize the diagnosis and bring more precision to treatment of individual cancers and many other diseases, it will require physicians to help patients understand and deal with the flood of information that has the potential to overwhelm us all. This will be an even greater issue as the cost of each individual’s genetic analysis drops from the 3 billion dollars it took to sequence the human genome in 2001 to less than $300 in a few years.

The opening session the next day was prefaced by a tribute to the traditional aboriginal landowners, followed by a performance of story-telling about the place with singing and didgeridoo accompaniment. The three days of scientific sessions encompassed updates on most areas of specialty and subspecialty knowledge and practice skills that internists value as well as sessions that included as diverse topics as the regenerative power of peripheral stem cells and the social determinants of health outcome inequalities whose solutions will require us to consider health in every sector of our economies.

I was fortunate to meet with the presidents of 10 international Colleges and Academies of Physicians (and Surgeons) at a luncheon where we discussed the challenges each of our countries faced with respect to graduate medical education particularly to address changes in patient needs and workforce. It is surprising how many issues are common to all our institutions and populations. While we did not solve any problems, the session did provide stimulating perspectives and ideas.

The always welcome social occasions where we catch up with colleagues, make new connections and renew our enthusiasms, included a reception for the new fellows, a dinner for the whole congress another dinner for the international leaders and a delightful morning catamaran trip on beautiful Moreton Bay. This latter event not only provided a brief respite from our busy lives but a chance to network with international colleagues.

Held in warm autumn weather with matching hospitality, the RACP Congress 2012 was a most enjoyable as well as instructive experience. My special thanks to Professor John Kolbe and the outstanding RACP staff.

Left to right: Dr. Anne Kolbe, New Zealand; Prof. Kriang Tungsanga, Thailand; Dr. Datuk Arumugam, Malaysia; Prof. Virginia Hood, USA, enjoying Queensland hospitality.





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ACP Leaders on the Road: Philippines

Darren Taichman, MD, PhD, Executive Deputy Editor, Annals of Internal Medicine

Left to right: Dr. Jaime Montoya, PCP Immediate Past President; Dr. Oscar Cabahug, PCP Vice President and Overall Program Chair; Dr. Norbert Lingling Uy, PCP President; Dr. Taichman

It was a wonderful experience to attend the Philippines College of Physicians’ 42nd Annual Convention in Manila. I was thrilled to have the chance to meet so many engaged and committed physicians at the conference and to talk with them about the challenges to healthcare in the Philippines. Most remarkable to me was just how familiar the “burning issues” being addressed by colleagues at the PCP seemed to those being grappled with in the United States: healthcare reform, addressing the needs of under-served patient groups without access to affordable care, the challenges facing Internal Medicine and Primary Care practice. I was struck by the dedication of the PCP’s Board of Regents, whose members spoke of their work to promote legislation to improve access to healthcare and the challenges facing the practice of primary care. Jim Ott (ACP’s SVP for International Programs) and I could easily have thought we were at a leadership meeting of the American College of Physicians as we listened to the issues facing the PCP! But even if the issues had been completely different, we would quickly have felt at home as our hosts could not have been warmer or more welcoming.

Opening Ceremonies PCP 42nd Annual Convention

I hope my colleagues at the PCP learned as much from me as I did from them. Following my talk on guidelines for the evaluation and care of patients with pulmonary hypertension, I heard from physicians in primary care medicine, pulmonary and cardiology about their attempts to obtain the drugs needed for the treatment of some patients that are too often prohibitively expensive. Dr. Linda Lim-Varona, Editor of the Philippine Journal of Internal Medicine generously offered to arrange for me to present a discussion of the challenges of peer review and medical publishing with researchers, authors, and the editors of the PJIM and other PCP-affiliated journals. It was exciting to hear their ideas and innovations to simultaneously improve upon the quality of the papers submitted to their journals while mentoring medical trainees in research methodology and medical writing.

My visit was too short. Manila is a bustling and fascinating city steeped in history. A “short” drive out of Manila and you arrive at gorgeous views of volcanoes jutting up from within lakes, themselves within even larger volcanoes. I say a “short” drive as there is one thing about getting around Manila that is all too familiar – traffic! And, traffic to make any US city look tame. But, unlike on this side of the Pacific, even in the most crowded and grid-locked of cars, “Jeepneys,”pedestrians and mopeds no one seemed angry about the wait in grid-locked traffic! I knew I had indeed traveled to the other side of the world.

Finally, we at that ACP have a lot to learn about celebrations from the PCP. It seemed everyone was having fun at the PCP Fellowship Night and wanted to make sure Jim Ott and I did the same – from sampling the food to enjoying the vibrant music and dance. We got a real kick out of the both hilarious and poignant music videos produced by local PCP chapters from all around the country. Watching the crowd enjoy their friends and colleagues singing, rapping and dancing in their white coats was a scene not to be missed. I look forward to our growing collaboration!

From left: Dr. Norbert Lingling Uy, PCP President; Dr. Imelda Mateo, PCP Distinguished Fellow Awardee for 2012; Dr. Oscar Cabahug, PCP Vice President and Overall Convention Chair



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International Fellowship Exchange Program
Application Deadline: August 1, 2012

ACP is pleased to announce that applications for the IFEP are now being accepted! Up to four (one-month) observerships at an institution in the US or Canada, will be awarded to early-mid career internists from countries outside the US and Canada, with an interest in Women's Health. Potential areas of study within Women’s Health include HIV/AIDS, breast cancer, cervical cancer, osteoporosis, cardiovascular disease, medical problems related to pregnancy, and depression. Faculty mentors will engage fellows in individual and group clinical and educational experiences and discussions, and facilitate the design of an independent project to be implemented in each fellow’s own country upon his or her return.

Funding will be provided for travel and expenses for one month, as well as expenses related to attendance at the following ACP Internal Medicine Meeting. For full details, please visit www.acponline.org/IFEP or contact Kristin Dunn at kdunn@acponline.org for any questions on the program or application process.

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Update Your Knowledge with MKSAP 15 Q & A

A 45-year-old woman is evaluated because of the gradual onset of right-sided hearing loss and a 3-year history of tinnitus. She does not have ear pain or drainage, dizziness, or headache. There is no history of trauma to the ear or excessive exposure to loud noises.

On examination, the patient is unable to hear numbers whispered 2 feet from the right ear with the left auditory canal blocked. Examination of the external auditory canals and tympanic membranes is normal. Neurologic examination is normal. When a tuning fork is placed on the top of her head, she reports that the sound is heard toward the left ear (Weber test). Results of audiometry show normal hearing on the left and 45-decibel high-frequency hearing loss on the right.

Which of the following is the most likely diagnosis?

A. Acoustic neuroma
B. Cholesteatoma
C. Meniere disease
D. Otosclerosis
E. Presbycusis

Click here for the answer and critique.

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International Meetings Update

ACP Chile Chapter Meeting
May 8-9, 2012

The ACP Chile Chapter held it's annual Chapter Meeting in Santiago, Chile on May 8-9, 2012. David Bronson, MD, FACP, ACP President, was the ACP Leadership Liaison at the meeting. He spoke on the topic "Improving Diabetes Care Quality - Does the EMR Matter"? He also presented an ACP Update and served as a member of the Evaluator Committee for the Associates and Students Poster Session.

For pictures from the Chile Chapter meeting, click here.

ACP Venezuela Chapter Meeting
May 19-21, 2012

The Annual Meeting of the ACP Venezuela Chapter was held in Caracas, Venezuela on May 19-21, 2012 in conjunction with the Venezuelan Congress of Internal Medicine. Maximo Brito, FACP served as the ACP International Ambassador and Yul Ejnes, MACP, Immediate Past Chair, ACP Board of Regents, was the ACP Leadership Liaison. They each gave several scientific talks and participated in an ACP Update.

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Future Worldwide Internal Medicine Meetings

14º Congreso Internacional de Medicina Interna del Hospital de Clínicas, Buenos Aires
(14th Internal Medicine Congress of the Hospital de Clinicas)
August 14-17, 2012
Sheraton Buenos Aires Hotel, Argentina

Attendees can choose from 10 simultaneous scientific sessions given by prominent local and international physicians. It is an excellent opportunity to get updated on a variety of topics and enjoy the beautiful city of Buenos Aires.

If you are planning on being at the Congress, please stop by the American College of Physicians’ exhibit booth.

For more information, please visit the congress website:
www.congresoclinicas.com.ar

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 July 1, 2012. They are listed by current location and may have been credentialed through a different Chapter.

Argentina

  • Jorge A. Farias, MD, FACP - Capital Federal

Bangladesh

  • Mohammad M. Rahman, MBBS, FACP - Dhaka

  • Syed Md Akram Hussain, MBBS, FACP - Dhaka

Brazil

  • Jean Rodrigo Tafarel, MD, FACP - Curitiba

  • Roberto Pecoits-Filho, MD, PhD, FACP - Curitiba

Canada

  • Jacques J. B. Bedard, MD, FACP - Sherbrooke, QC

  • Martine S. Chamberland, MD, FACP - Fleurimont, QC
  • Patrick L. Ergina, MD, MPH, FACP - Montreal, QC
  • Susan L. Gold, MD, FACP - Montreal, QC
  • Fayad Famideh, MD, FACP - Mississauga, ON
  • Naufal Mohammed, MBBS, FACP - Ancaster, ON

Chile

  • Hans Karl Muller Ortiz, MD, FACP - Concepcion

  • Helia Morales, MD, FACP - Santiago
  • Rodrigo Alfredo Cornejo Rosas, MD, FACP - Santiago

India

  • Rafi Ahmed Jan, MD, FACP - Srinagar Kashmir

  • Atul Bhasin, MD, FACP - New Delhi

Indonesia

  • Mochammad Thaha, MD, FACP - Surabaya East Java

Japan

  • Masayuki Shiseki, MD, FACP - Tokyo

Kuwait

  • Fahad A. Al-Ghimlas, MD, FACP - Nuzha Al-Aasima

Lebanon

  • Bernard S. Abi-Saleh, MD, FACP - Beirut

Mexico

  • Ruben Antonio G. Gomez Mendoza Sr., MD, FACP - Mexico DF

Nigeria

  • Bashir Mohammed Tijjani, MBBS, FACP - Kano

  • Shamsideen Abayomi Ogun, MBChB, FACP - Lagos

Pakistan

  • Bushra Ali, MBBS, FACP - Karachi

Panama

  • Julio A. Miranda, MD, FACP - Panama City

Philippines

  • Charles Yu, MD, FACP - Dasmarinas City Cavite

  • Edgardo F. Faustino, MD, FACP - Paranaque City

Saudi Arabia

  • Abdallah A. Alhokail, MD, FACP - Riyadh

  • Alhussain M. Asiri, MD, FACP - ABHA Asir
  • Ali H. Albenmousa, MBBS, FACP - Riyadh
  • Ismael A. Qushmaq, MD, FACP - Jeddah
  • Khalid A. Al-Saleh, MBBS, FACP - Riyadh
  • Marzooq A. Marzooq Al Badi, MBBS, FACP - Riyadh
  • Raed M. Al-Bukhari, MBBS, FACP - Al-Khobar
  • Reem M. Alamoudi, MD, FACP - Dammam
  • Tariq A. Madani, MD, FACP - Jeddah

Singapore

  • Alan Ng, MBBS, FACP - Singapore

Switzerland

  • Edouard J. Battegay, MD, FACP - Switzerland

  • Jean-Michel Gaspoz, MD, FACP - Geneve

Taiwan

  • Victor C. Kok, MD, FACP - Changhua

Thailand

  • Siwaporn Chankrachang, MD, FACP - Chiang Mai

  • Sming Kaojarern, MD, FACP - Bangkok

United Arab Emirates

  • Fatma N. Al-Maskari, MBChB, FACP - Al-Ain

  • Sajid Naeem Choudhry, MBBS, FACP - Sharjah
  • Wael Lateef Jebur, MBChB, FACP - Dubai

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist June 2012

  • Making opiates safe, efficient in the office
    Managing opiates leads to a host of issues with patients, for pre-empting pain while ensuring communication of clear limits and preventing abuse. These goals confound many internists, but clear-cut and easy guidelines presented at Internal Medicine 2012 can help internists achieve the best outcomes.

  • Diving into delicate patient conversations
    Delivering unpleasant news is one of the hardest tasks a physician faces. Assessing sensitive topics heightens the difficulty, and two physicians at Internal Medicine 2012 address ways to handle especially sensitive areas: sexual history, and the inability to safely drive a car.

  • Fighting obesity means fighting evolution's urges to gorge
    Physicians seeking to counsel patients on weight management need to start early, be proactive and discuss activity and nutrition at every visit, said one presenter at Internal Medicine 2012.

  • Serve your trainees a feedback sandwich
    The end of residency rotation isn't the only opportunity to teach. Assessing physicians should occur continuously, with a clear plan for a conversation between the attending and the trainee.

ACP Hospitalist May 2012

  • Ethics in Daily Practice
    ACP's recently revised Ethics Manual offers guidance on situations relevant to hospitalists, such as stewardship of resources, communicating with patients, and dealing with conflicts over treatment goals.

  • Too much of a good thing
    Inpatient hypercalcemia is most commonly associated with a malignancy, but it can be caused by other diseases and conditions as well.

  • Patient-centered care from admission to discharge
    It's hard to increase time spent with patients, so improving the quality of the time is the only workable alternative.

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College Corner

Renew Your ACP Membership for 2012-13

ACP's membership year runs from July 1 to June 30 each year. Renew your membership today to ensure the continuation of your ACP benefits.

Please note that if you currently receive print copies of ACP journals, you may elect to access them only online. This option --- available exclusively to our international members -- will lower your annual dues and provides a significant tax savings for members in Canada. You will be able to select an online-only membership when you renew.

New ACP Chapter in Colombia

On April 16, 2012, ACP's Board of Regents approved a proposal to establish a chapter in Colombia, South America effective July 1, 2012. This is the 14th ACP international chapter. The Colombia Association of Internal Medicine was instrumental in working with ACP to recruit a sufficient number of new members to qualify for chapter status. We congratulate them on this achievement.

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MKSAP 15 Answer & Critique

Answer: A, Acoustic neuroma

Educational Objective: Diagnose gradual hearing loss from acoustic neuroma.

Key Point: Hearing loss is unilateral in approximately 90% of patients with acoustic neuroma.

This patient most likely has an acoustic neuroma, which is an important cause of asymmetric sensorineural hearing loss that usually originates from the vestibular portion of the acoustic nerve. The two major symptoms are hearing loss and tinnitus. Unilateral hearing loss occurs in approximately 90% of patients with this disorder, but many patients may be unaware of the deficit. Two thirds of patients have tinnitus. Both hearing loss and tinnitus are present, on average, slightly more than 3 years prior to diagnosis, although acoustic neuroma can cause sudden acute hearing loss. Other symptoms include dizziness and headaches. MRI is the imaging modality of choice because it is more sensitive than CT for detecting small tumors.

Cholesteatoma is a growth of desquamated, stratified, squamous epithelium within the middle ear. Patients may present with otorrhea, pain, hearing loss, or neurologic symptoms. Otosclerosis is a bony overgrowth that involves the footplate of the stapes, eventually resulting in total fixation and inability to transmit vibration from the tympanic membrane along the ossicular chain. Cholesteatomas and otosclerosis cause a conductive hearing loss rather than a sensorineural loss.

Although Meniere disease also causes unilateral sensorineural hearing loss, this is most often a low-frequency loss. Patients with Meniere disease usually have episodic vertigo that lasts for several hours and is associated with tinnitus and a sensation of aural fullness. Occasionally, patients experience episodic low-frequency hearing loss that develops on a daily, weekly, or monthly basis and remits within 12 to 24 hours.

Presbycusis is the term used to describe sensorineural hearing loss associated with aging. It is typically symmetric, starts in the high-frequency range, becomes more noticeable in the sixth decade, and steadily progresses. Patients experience problems understanding speech in a crowded or noisy environment and often have tinnitus. Unilateral or asymmetric hearing loss is not typical for presbycusis and requires further evaluation when present.

Bibliography:

Spoelhof GD. When to suspect an acoustic neuroma. Am Fam Physician. 1995;52(6):1768-1774. [PMID:7484687] - See PubMed

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MKSAP 16 Holiday Special: Save 10%

MKSAP 16 Holiday Special:  Save 10%

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Maintenance of Certification:

What if I Still Don't Know Where to Start?

Maintenance of Certification: What if I Still Don't Know Where to Start?

Because the rules are complex and may apply differently depending on when you last certified, ACP has developed a MOC Navigator. This FREE tool can help you understand the impact of MOC, review requirements, guide you in selecting ways to meet the requirements, show you how to enroll, and more. Start navigating now.