Women's Health

Viral Infections

Venous Thromboembolism

Vector-borne Diseases

Vasculitis

Valvular Heart Disease

Vaccination/Immunization

A collection of immunization and vaccination activities in the Online Learning Center.

Urologic Cancer

Travel Medicine

Thrombotic Disorders

Statement to the PPAC Regarding Y2K Readiness and the HCFA's New Medicare Coverage Process.

Written Testimony to the House Small Business Committee on Medical Student Loan Debt

Statement for the Record on Developing a Viable Medicare Physician Payment Policy

Statement to the Senate Finance Committee Roundtable Discussion on Medicare Physician Payments: Perspectives from Physicians

Using Innovation to Reform Medicare Physician Payment

Statement to the House Ways & Means Subcommittee on Health at the Hearing on the Uninsured

ACP Statement for the Record to the House Labor-Health and Human Services-Education Appropriations Subcommittee for FY2014

ACP Written Testimony for the Record to the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies for FY2018

ACP Written Testimony for the Record to the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies for FY2018

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Performance Measures

Performance measurement allows us to assess healthcare against evidence-based clinical guidelines and nationally recognized standards of care.

Zoster (Shingles) Vaccination

The percentage of patients 50 years of age and older who have a Varicella Zoster (shingles) vaccination.

Vitamin D Level - Effective Control of Low Bone Mass/Osteopenia and Osteoporosis: Therapeutic Level Of 25 OH Vitamin D Level Achieved

Percentage of patients aged 65 years and older diagnosed with osteopenia or osteoporosis whose most recent serum 25 Hydroxy-Vitamin D results is greater than or equal to 30.0 ng/dL

Venous Thromboembolism Prophylaxis

This measure assesses the number of patients who received venous thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. This measure is part of a set of six nationally implemented prevention and treatment measures that address VTE (VTE-2: ICU VTE Prophylaxis, VTE-3: VTE Patients with Anticoagulation Overlap Therapy, VTE-4: VTE Patients Receiving UFH with Dosages/Platelet Count Monitoring, VTE-5: VTE Warfarin Therapy Discharge Instructions and VTE-6: Hospital Acquired Potentially-Preventable VTE) that are used in The Joint Commission’s accreditation process.

Use of Opioids from Multiple Providers in Persons without Cancer

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids from four (4) or more prescribers AND four (4) or more pharmacies.

Use of Opioids from Multiple Providers and at High Dosage in Persons without Cancer

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids with a daily dosage greater than 120mg morphine equivalent dose (MED) for 90 consecutive days or longer, AND who received opioid prescriptions from four (4) or more prescribers AND four (4) or more pharmacies.

Use of Opioids at High Dosage in Persons Without Cancer

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids with a daily dosage greater than 120mg morphine equivalent dose (MED) for 90 consecutive days or longer

Use of Imaging Studies for Low Back Pain

The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis

Use of High-Risk Medications in the Elderly

Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported: a. Percentage of patients who were ordered at least one high-risk medication b. Percentage of patients who were ordered at least two different high-risk medications.

Use of Appropriate Medications for People with Asthma

INACTIVE REVIEW: This measure review is older than five years. The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year

Annals Consult Guys - Acute Coronary Syndrome and Anemia: When to Transfuse?

Annals Consult Guys - COVID-19 and Surgery: A Postpandemic Update

Annals Consult Guys - The Diagnosis and Pathophysiology of Claudication

Annals Consult Guys - Reversals of Care Started After a Myocardial Infarction

Annals Consult Guys - Postoperative Euglycemic Diabetic Ketoacidosis

Annals Consult Guys - Surgery After Thromboembolic Stroke

Annals Consult Guys - Postoperative Troponin Elevation

Annals Consult Guys - Blood Cultures: How Many Are Enough?

Annals Consult Guys - Spontaneous Coronary Artery Dissection

Annals Consult Guys - Management of Dual-Antiplatelet Therapy in a Patient Undergoing Colonoscopy

Annals of Internal Medicine: Clinical Cases: Archive

Annals of Internal Medicine: Clinical Cases: Vol 4, No 12

Correction: Aortic Valve Papillary Fibroelastoma | Annals of Internal Medicine: Clinical Cases

From Dyad to Triad: Artificial Intelligence in the Patient–Physician Relationship | Annals of Internal Medicine: Clinical Cases

Lid Lifter Versus Renal Tissue: A Case of Disseminated Zygomycosis | Annals of Internal Medicine: Clinical Cases

We present a case of a man in his forties with hereditary hemochromatosis who presented with abdominal pain and discolored urine. Further work-up revealed bilateral hydronephrosis secondary to fungal bezoars requiring a prolonged posaconazole course. This case highlights the rarity of bilateral fungal bezoars while also providing insight into atypical causes of hydronephrosis in the adult population.

Diffuse Large B-Cell Lymphoma Presenting as Aortic Aneurysm Rupture: A Case Report | Annals of Internal Medicine: Clinical Cases

We present a rare case of diffuse large B-cell lymphoma (DLBCL) mimicking an abdominal aortic aneurysm rupture. A 78-year-old male with prior endovascular aneurysm repair presented with abdominal pain, hypotension, and renal failure. Imaging revealed a periaortic mass concerning for aneurysm leak; however, PET/CT and biopsy confirmed DLBCL. This case underscores the diagnostic challenge posed by periaortic lymphoma masquerading as vascular emergencies. Clinicians should maintain a broad differential, as early recognition may avoid unnecessary surgery and enable appropriate oncologic management.

Atypical Pediatric Impetigo Masked by Witch Hazel and Topical Corticosteroids | Annals of Internal Medicine: Clinical Cases

Superficial bacterial skin infections in children typically present with easily recognizable lesions. However, topical corticosteroids and home remedies can alter their appearance, leading to misdiagnosis. We present a 3-year, 11-month-old girl with a nasal-tip lesion initially treated with witch hazel and over-the-counter hydrocortisone. The lesion lacked classical honey-colored crusting, complicating diagnosis. Treatment with topical mupirocin and oral clindamycin for 7 days resulted in complete resolution. The modified presentation was consistent with impetigo incognito, a steroid-altered form of impetigo. This case underscores the need for clinicians to inquire about nonprescription treatments and recognize altered presentations of common infections.

Unusual Presentation of Vaginal Squamous Cell Carcinoma in Older Woman With Hyperarousal and Unwanted Orgasms | Annals of Internal Medicine: Clinical Cases

Vaginal squamous cell carcinoma is a rare gynecologic malignancy that typically presents with nonspecific symptoms, such as abnormal vaginal bleeding, discharge, and pelvic pain. It most often arises in postmenopausal women and is strongly associated with persistent high-risk human papillomavirus infections. Here, we discuss a unique case of an 87-year-old woman who presented with spontaneous orgasmic sensations. Pelvic magnetic resonance imaging revealed a vaginal mass and necrotic inguinal lymph node; biopsy confirmed squamous cell carcinoma. This case highlights considering vaginal cancer in postmenopausal women with atypical sexual symptoms.

Emphysematous Pancreatitis Complicated by Hemoperitoneum: A Rare Presentation | Annals of Internal Medicine: Clinical Cases

We report a rare case of emphysematous pancreatitis complicated by hemoperitoneum and abdominal compartment syndrome in a 54-year-old male with a history of alcohol use. This patient had drainage, antibiotics, and eventual surgical debridement guided by a step-up approach.

Salivary Gland Choristoma at the Esophagogastric Junction Associated With Chronic Gastroesophageal Reflux Disease | Annals of Internal Medicine: Clinical Cases

Salivary gland choristoma at the esophagogastric junction (EGJ) is a rare benign lesion, typically presenting as a nodule. Though heterotopic salivary tissue can appear in the head, neck, or GI tract, its occurrence at the EGJ is uncommon. It is often discovered incidentally during endoscopy for chronic GERD. The origin remains unclear, with theories including embryologic misplacement, inflammation-induced differentiation, or proliferation of native glandular cells. We report two cases of EGJ choristomas in patients with Barrett's esophagus and chronic GERD. We aim to emphasize the importance of recognizing choristoma as a potential differential diagnosis when encountering a new nodule.

Put words in our mouth

I.M. Matters Weekly from ACP wants readers to create captions for our new cartoon and help choose the winner. Pen the winning caption and win a $50 gift certificate good toward any ACP product, program, or service.

Governor-elect election results announced

The Executive Committee of the Board of Governors is pleased to announce the Governor-elect Designees representing the Class of 2031.

Recording available for ACP, Annals of Internal Medicine forum on protecting patients from misinformation

The session explored how misleading social media “cures,” dangerous remedies, and questionable advice about medications, food, and supplements can complicate clinical conversations.

Gamifying exercise boosted physical activity among patients with peripheral artery disease

A fully home-based intervention for patients with peripheral artery disease used gamification and automated coaching to increase patients' average daily step count by nearly 2,000 steps over the course of a 16-week intervention and eight-week follow-up.

MKSAP Quiz: Diabetic ulcer on the left foot

A 58-year-old patient is evaluated for an ulcer on their left foot. Medical history is significant for type 2 diabetes mellitus, diabetic neuropathy, and hypertension. Following a physical exam, what is the most appropriate diagnostic test to perform next?

Incubation period for novel mpox variant slightly longer than for previous variants

Patients infected with mpox virus clade Ib, first detected in September 2023, had a median incubation period from exposure to rash of 13.6 days with high viral load, suggesting that currently recommended monitoring may be too short, according to the authors of a new analysis.

Single-dose HPV vaccine noninferior to two doses, large trial finds

A trial randomized more than 20,000 adolescent girls in Costa Rica to receive one or two doses of human papillomavirus (HPV) vaccine between November 2017 and February 2020 and followed them for 60 months to assess the rate of new HPV type 16 or 18 infections.

Put words in our mouth

I.M. Matters Weekly from ACP wants readers to create captions for our new cartoon and help choose the winner. Pen the winning caption and win a $50 gift certificate good toward any ACP product, program, or service.

New AI-powered alcohol conversation tool available from ACP

The member-exclusive tool is designed to help clinicians practice conversations about alcohol use with simulated patients in a safe, supportive environment.

ACP encourages adults to get vaccinated during National Influenza Vaccination Week

ACP urges all eligible adults to receive their flu shot for the 2025-2026 season to protect themselves and their communities.

Take a quiz about the Nov. 26 issue!

Every week, ACP Hospitalist posts a question about a previous week's issue. See how well you remember what you've read compared to other readers.

Steroids reduce short-term mortality in non-COVID-19 severe pneumonia, review finds

Low-dose, short-term systemic corticosteroids probably reduce short-term mortality in patients with severe pneumonia or severe acute respiratory distress syndrome and have little to no effect on hospital-acquired infection risk, a review of trials in patients who did not have COVID-19 found.

Preadmission GLP-1 receptor agonist use not linked with adverse ICU outcomes

There were no significant differences in mortality or length of stay between ICU patients with and without prior glucagon-like peptide-1 (GLP-1) receptor agonist use, according to a retrospective single-center study.

Patients perceived as difficult across settings

A survey of clinicians caring for hospitalized veterans found that 67% of patients considered difficult as inpatients were also rated as difficult by their primary care clinicians.

IDSA statement explains society's position on community-acquired pneumonia guidelines

The Infectious Diseases Society of America (IDSA) has explained that differences in opinion on empiric antibiotic use led the organization to not endorse the latest guidelines on community-acquired pneumonia from the American Thoracic Society.

A piece of good news

Hospitalists should take a pat on the back, according to the authors of a study finding that inpatient mortality has resumed its prepandemic downward trend.

Thin to win

A little knowledge of history inspires caution and reflection about anticoagulation.

The power of a physician's words

A patient's tears offered a lesson in communication.

The missing blanket

Sometimes the thing a patient needs most is very simple.

The lake at night

Music helped solve a medical mystery.

Alert on continuous glucose monitors

Certain FreeStyle Libre 3 and FreeStyle Libre 3 Plus sensors are being recalled because they can provide incorrectly low glucose readings.

Case report of diabetic muscle infarction

A recent case described a complicated instance of this rare complication of diabetes.

Preadmission GLP-1 receptor agonist use not linked with adverse ICU outcomes

There were no significant differences in mortality or length of stay between ICU patients with and without prior glucagon-like peptide-1 (GLP-1) receptor agonist use, according to a retrospective single-center study.

Spotlight on GLP-1s and cancer

Recent observational studies have indicated that glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with a lower risk of obesity-related cancers, but a new systematic review of randomized controlled trials did not find evidence of significant effects.

MKSAP quiz: Diabetes diagnosis

This month's quiz asks readers to evaluate a 22-year-old man admitted 2 days ago for severe hyperglycemia associated with diabetic ketoacidosis.

Corticosteroid use during pregnancy not associated with gestational diabetes risk overall

Gestational diabetes risk was only increased if oral corticosteroid exposure occurred during the fourth to sixth week of pregnancy, not during other time periods, according to an analysis of more than one million pregnancies in Korea.

Diabetes associated with heightened risk of sudden cardiac death, Danish study finds

Sudden cardiac death was an important contributing factor to shortened life expectancy for patients with type 1 and type 2 diabetes, attributable to losses of 3.4 years and 2.7 years, respectively.

ADA's Standards of Care for 2026 released

New recommendations from the American Diabetes Association (ADA) do away with treatment prerequisites for automated insulin delivery and provide guidance on using obesity medications in people with diabetes, among other topics.

Oral semaglutide gets new indication from FDA

The medication is now indicated to reduce the risk of major adverse cardiovascular events such as cardiovascular death, heart attack, or stroke in adults with type 2 diabetes who are at high risk for these events.

Patients with hyperglycemia during ICU stay have higher risk of postdischarge diabetes

Critical illness-associated hyperglycemia is associated with a 4.1% risk of new-onset diabetes within five years of discharge, compared to 1.8% in patients who didn't develop high blood glucose levels in the ICU, a Swedish study found.

In adults aged 45 to 49 y, active screening choices via patient portal reduced screening rates vs. mailed FIT at 6 mo

The finding that trial participants preferred mailed fecal immunochemical testing (FIT) to active choice of colonoscopy or FIT suggests that those in this age group are more likely to accept screening when it is easy and convenient and could benefit from a menu of targeted interventions, an ACP Journal Club commentary said.

Case reports examine infection, other GI topics

Whipple disease, cutaneous gangrene in ulcerative colitis, and emphysematous pancreatitis were described recently.

Mediterranean diet could be an effective first-line intervention for IBS

Patients with irritable bowel syndrome (IBS) who were randomized to six weeks of a Mediterranean diet had greater improvement in symptoms than those assigned to a traditional healthy diet, a British trial found.

GI effects compared across GLP-1 drugs in real-world study

Patients who took the glucagon-like peptide-1 (GLP-1) receptor agonists dulaglutide or semaglutide or the GLP-1/glucose-dependent insulinotropic polypeptide receptor agonist tirzepatide had similar rates of adverse GI events, a database study found.

MKSAP Quiz: Hospitalized for pleural effusion

A 58-year-old woman is hospitalized for dyspnea due to recurrent right-sided pleural effusion. She has autoimmune hepatitis with cirrhosis. Following lab studies and other scans, what is the most appropriate next step in management?

Study assesses remission, complication rates with vedolizumab in early, late Crohn's

Patients with Crohn's disease who started vedolizumab within two years of diagnosis were significantly more likely to reach clinical and endoscopic remission than those who had been diagnosed more than two years earlier and already received anti-tumor necrosis factor agents, a manufacturer-supported trial found.

Opioids after IBD hospitalization tied to worse outcomes

Patients with inflammatory bowel disease (IBD) who filled an opioid prescription within seven days of a hospital or ED visit were more likely to come back to the hospital, to receive a corticosteroid prescription, or to have an escalation of medical therapy.

Anti-interleukins, JAK inhibitors linked with lower infection risk in ulcerative colitis

Both anti-interleukins and Janus kinase (JAK) inhibitors were associated with a lower risk of serious infections than tumor necrosis factor antagonists, according to a retrospective study of more than 9,000 patients with ulcerative colitis.

In primary CDI, fecal microbiota transplantation was noninferior to vancomycin for clinical cure at 14 d without recurrence at 60 d

Although fecal microbiota transplantation is a potentially attractive treatment for primary Clostridioides difficile infection (CDI), it's unlikely to become the standard of care in the near future because of both clinical questions and logistical issues, an ACP Journal Club commentary said.

Case reports cover rare gastroenterology, hepatology topics

One recent case discusses dysphagia lusoria, and another describes acute liver failure secondary to herpes simplex virus hepatitis.