Consumer Directed Healthcare and Health Savings Accounts

ACP Comment Letter Meaningful Use Stage 2 Proposed Modifications NPRM

ACP Comment Letter to CMS on MACRA Proposed Rule

Reforming Physician Payments to Achieve Greater Value in Healthcare Spending

ACP Comments on the Meaningful Use Stage 3 Proposed Rule

Joint Letter to Senate Leadership Urging Opposition to AHCA

ACP Submits Statement to House Oversight and Reform Committee on Examining Pathways to Universal Health Care

ACP Statement for the Record to the House Energy and Commerce Committee on Legislation to Lower the Costs of Prescription Drugs

Joint Letter to House Leadership in Support of HR 8067 and for AHRQ to Conduct Research Regarding COVID-19 Response

America's Frontline Physicians on Health Care Priorities for Biden Administration

Cannabis-Based Products for Chronic Pain: An Updated Systematic Review: Annals of Internal Medicine: Vol 179, No 2

Background: Benefits and harms of cannabinoids for chronic pain are uncertain. Purpose: To update an evidence synthesis on cannabinoids for chronic pain. Data Sources: Ovid MEDLINE, PsycINFO, Embase, the Cochrane Library, and Scopus to 28 July 2025. Study Selection: Randomized placebo-controlled trials. Data Extraction: Data extraction, risk of bias, and strength of evidence were dually reviewed. Cannabinoids were categorized by tetrahydrocannabinol (THC)-to-cannabidiol (CBD) ratio (high, comparable, or low), source (synthetic, purified, extracted), and administration method. Data Synthesis: 25 short-term (1 to 6 months) randomized controlled trials (n = 2303; 64% neuropathic pain) assessed cannabinoids. Oral synthetic/purified high THC-to-CBD (THC only) may slightly reduce and oromucosal, extracted, comparable THC-to-CBD ratio products probably slightly reduce pain severity (pooled differences, −0.78 and −0.54 points, respectively, [0 to 10 scale]), with moderate or large increased dizziness, sedation, and nausea. Among THC-only products, nabilone moderately reduced pain severity but dronabinol did not (pooled differences, −1.59 and −0.23 points, respectively). Low THC-to-CBD interventions may not improve outcomes. Although low THC-to-CBD mixed THC/CBD products may increase dizziness, sedation, and nausea, CBD alone may not increase harms. Limitation: Variability within categories; lack of product details; unclear U.S. availability of studied products; restricted to English-language studies. Conclusion: Comparable and high THC-to-CBD ratio cannabinoid products may result in small improvements in pain and increased common adverse events during short-term treatment of primarily neuropathic pain; among high-ratio THC-only products, nabilone (but not dronabinol) reduced pain. Low THC-to-CBD products may not improve outcomes. Studies are needed on long-term outcomes and other cannabis product types. Primary Funding Source: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (PROSPERO: CRD42021229579).

Efficacy of a Very-Low-Calorie Weight Loss Diet Plus Exercise Compared With Exercise Alone on Hip Osteoarthritis Pain: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 178, No 9

Background: Exercise is recommended to manage hip osteoarthritis, but weight loss recommendations are conflicting. Objective: To evaluate the efficacy of a weight loss diet added to exercise on change in hip pain. Design: 2-group superiority randomized trial. (ClinicalTrials.gov: NCT04825483) Setting: Community. Participants: 101 adults with hip osteoarthritis and overweight or obesity. Intervention: Both the exercise only group and very-low-calorie diet (VLCD) plus exercise group were provided with a 6-month home exercise program via 5 telehealth consultations. The VLCD plus exercise group also received a VLCD via 6 telehealth consultations. Measurements: The primary outcome was 6-month change in hip pain severity (11-point scale; range 0 to 10, with higher scores indicating worse pain; minimum clinically important difference of 1.8). Secondary end points included other measures of hip pain, physical function, quality of life, body weight, body composition, and adverse events. Results: 99 (98%) and 95 (94%) participants provided 6- and 12-month primary outcomes, respectively. Although VLCD plus exercise lost 8.5% more weight than exercise only, VLCD plus exercise was not more effective for change in hip pain severity (mean difference, −0.6 units [95% CI, −1.5 to 0.3]) at 6 months. Between-group differences for other secondary outcomes at 6 months favored VLCD plus exercise except Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function. At 12 months, weight, body mass index, HOOS pain and function, and overall hip improvement, but not quality of life and physical activity, favored VLCD plus exercise. There were no serious related adverse events. Limitation: Participants were unblinded. Conclusion: Adding a weight loss diet to exercise did not change hip pain but improved most secondary outcomes. Primary Funding Source: National Health and Medical Research Council.

Management of Hyperglycemia in Hospitalized Patients

People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital. At discharge, standardized checklists should be used to ensure successful transitions of care.

Management of Heart Failure in Hospitalized Patients

Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.

Management of Newly Diagnosed HIV Infection

No field in medicine has moved as swiftly as HIV/AIDS over the past 35 years. Because of the rapid turnover of key information, this In the Clinic focuses on essential principles of care for newly diagnosed adults with HIV-1 infection and how to prevent infection in persons at risk. To ensure continued usefulness, future directions in therapy and how to access updated information on a continuous basis are emphasized.

In chronic nonspecific neck pain, adding Alexander Technique lessons or acupuncture to usual care improved pain

Source Citation MacPherson H, Tilbrook H, Richmond S, et al. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Ann Intern Med. 2015;163:653-62. 26524571

Review: Opioids improve chronic noncancer pain, but difference may not be clinically meaningful in most patients

Source Citation Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA. 2018;320:2448-60. 30561481

Maintaining Weight Loss

Association Between Hospital Type and Resilience During COVID-19 Caseload Stress: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 177, No 10

Background: Imbalances between hospital caseload and care resources that strained U.S. hospitals during the pandemic have persisted after the pandemic amid ongoing staff shortages. Understanding which hospital types were more resilient to pandemic overcrowding-related excess deaths may prioritize patient safety during future crises. Objective: To determine whether hospital type classified by capabilities and resources (that is, extracorporeal membrane oxygenation [ECMO] capability, multiplicity of intensive care unit [ICU] types, and large or small hospital) influenced COVID-19 volume–outcome relationships during Delta wave surges. Design: Retrospective cohort study. Setting: 620 U.S. hospitals in the PINC AI Healthcare Database. Participants: Adult inpatients with COVID-19 admitted July to November 2021. Measurements: Hospital-months were ranked by previously validated surge index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity) percentiles. Hierarchical models were used to evaluate the effect of log-transformed surge index on the marginally adjusted probability of in-hospital mortality or discharge to hospice. Effect modification was assessed for by 4 mutually exclusive hospital types. Results: Among 620 hospitals recording 223 380 inpatients with COVID-19 during the Delta wave, there were 208 ECMO-capable, 216 multi-ICU, 36 large (≥200 beds) single-ICU, and 160 small (<200 beds) single-ICU hospitals. Overall, 50 752 (23%) patients required admission to the ICU, and 34 274 (15.3%) died. The marginally adjusted probability for mortality was 5.51% (95% CI, 4.53% to 6.50%) per unit increase in the log surge index (strain attributable mortality = 7375 [CI, 5936 to 8813] or 1 in 5 COVID-19 deaths). The test for interaction showed no difference (P = 0.32) in log surge index–mortality relationship across 4 hospital types. Results were consistent after excluding transferred patients, restricting to patients with acute respiratory failure and mechanical ventilation, and using alternative strain metrics. Limitation: Residual confounding. Conclusion: Comparably detrimental relationships between COVID-19 caseload and survival were seen across all hospital types, including highly advanced centers, and well beyond the pandemic’s learning curve. These lessons from the pandemic heighten the need to minimize caseload surges and their effects across all hospital types during public health and staffing crises. Primary Funding Source: Intramural Research Program of the National Institutes of Health Clinical Center.

Physician Humility: A Review and Call to Revive Virtue in Medicine

Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians’ actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.

Beating burnout | ACP Hospitalist

PCPs in the hospital | ACP Hospitalist

MI performance measures, health literacy and LOS, and more | ACP Hospitalist

Report from Puerto Rico | ACP Hospitalist

The Royal Infirmary of Edinburgh | ACP Hospitalist

Working up high | ACP Hospitalist

The high-value care conversation | ACP Hospitalist

Clearing up confusion about cirrhosis | ACP Hospitalist

Fight diuretic resistance with the right dose | ACP Hospitalist

Meds to get patients off the bottle | ACP Hospitalist