Summary and Results of CLIA Inspection Process Survey

Resource-based Practice Expenses. Letter to the Health Care Financing Administration

Prospective Payment System (PPS) for Hospital Outpatient Services. Joint Letter to the Health Care Financing Administration

Over-the-Counter Drugs: Proposed Labeling Requirements. Letter to Department of Health and Human Services.

Medicare Program; Negotiated Rulemaking Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services. Letter to Health Care Financing Administration.

Medicare Program; Negotiated Rulemaking Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services. Letter to Health Care Financing Administration.

Medicare Program; Negotiated Rulemaking Coverage and Administrative 2000 Medicare Documentation Guidelines (DGs) for Evaluation and Management (E/M) Services . Letter to Health Care Financing Administration.

Letter to CMS regarding the New Mexico Centennial Care Medicaid Waiver

ACP Letter to ONC Providing Feedback on Health IT Playbook

ACP letter of support for the Medicare SGR Repeal and Beneficiary Access Improvement Act, S. 2110

Put Your Own Oxygen Mask On First

Telemedicine and Office-Based Care for Behavioral and Psychiatric Conditions During the COVID-19 Pandemic in the United States

Fighting Prejudice and Absorbing Refugees From Nazism: The National Committee for the Resettlement of Foreign Physicians, 1939–1945

In the 1930s and 1940s, the medical profession reacted with hostility and erected formidable barriers to refugee physicians from Nazi-dominated Europe who sought to practice medicine in the United States. Yet, refugee physicians ultimately succeeded, with 77% of them working as doctors by 1945 and 98.6% by 1947. Although physician skills are readily transferable, and the United States had a genuine need for doctors after World War II drew 55 000 physicians into the military, refugee physicians' success can be attributed to the courageous physician leaders who lobbied on their behalf and the creation of the National Committee for the Resettlement of Foreign Physicians—an organization that helped immigrant physicians pass licensing examinations, identify locations for employment, and overcome barriers to integration into American society.

Update Alert 2: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers

Reopening Colleges and Universities During the COVID-19 Pandemic

Stepped Exercise Program for Patients With Knee Osteoarthritis: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 174, No 3

Background: Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. Objective: To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). Design: Randomized controlled trial. (ClinicalTrials.gov: NCT02653768) Setting: 2 U.S. Department of Veterans Affairs sites. Participants: 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. Intervention: Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. Measurements: Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. Results: In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, −10.5 to −3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. Limitation: Participants were mostly male veterans, and follow-up was limited. Conclusion: Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. Primary Funding Source: Department of Veterans Affairs, Health Services Research and Development Service.

Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the United States

Addressing Postpandemic Clinician Mental Health: A Narrative Review and Conceptual Framework: Annals of Internal Medicine: Vol 173, No 12

Previous pandemics have seen high psychiatric morbidity among health care workers. Protecting clinician mental health in the aftermath of coronavirus disease 2019 (COVID-19) requires an evidence-based approach to developing and deploying comprehensive clinician mental health support. In a narrative review of 96 articles addressing clinician mental health in COVID-19 and prior pandemics, 7 themes emerged: 1) the need for resilience and stress reduction training; 2) providing for clinicians' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, personal protective equipment); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions; and 7) normalization and provision of mental health support programs. In addition to the literature review, in collaboration with the Collaborative for Healing and Renewal in Medicine (CHARM) network, the authors gathered practice guidelines and resources from health care organizations and professional societies worldwide to synthesize a list of resources deemed high-yield by well-being leaders. Studies of previous pandemics demonstrate heightened distress in health care workers years after the event. The COVID-19 pandemic presents unique challenges that surpass those of previous pandemics, suggesting a significant mental health toll on clinicians. Long-term, proactive individual, organizational, and societal infrastructures for clinician mental health support are needed to mitigate the psychological costs of providing care during the COVID-19 pandemic.

Racism and Health in the United States: A Policy Statement From the American College of Physicians

Racial minorities in the United States have reported experiencing widespread racism throughout all aspects of life, from housing to education to employment. Existing research has examined the role of racism, discrimination, and violence in one's interaction with the health care system and their association with poorer mental and physical health. Systemic racism that underlies the fabric of society often manifests itself in prominent institutions, such as law enforcement agencies, regardless of individual intent. Overt and covert racist laws and policies, personal implicit biases, and other factors result in Black individuals and other people of color being the subject of law enforcement violence and criminal justice system interactions at disproportionately high rates. The demonstrated association between discriminatory law enforcement practices and violence and personal and community health necessitates treating these issues as public health issues worthy of a public policy intervention. Addressing some of the sources of institutional racism and harm through transparency and accountability measures is the first of many steps required to begin correcting historical racial injustices.

The Effects of Four Doses of Vitamin D Supplements on Falls in Older Adults: A Response-Adaptive, Randomized Clinical Trial: Annals of Internal Medicine: Vol 174, No 2

Background: Vitamin D supplementation may prevent falls in older persons, but evidence is inconsistent, possibly because of dosage differences. Objective: To compare the effects of 4 doses of vitamin D3 supplements on falls. Design: 2-stage Bayesian, response-adaptive, randomized trial. (ClinicalTrials.gov: NCT02166333) Setting: 2 community-based research units. Participants: 688 participants, aged 70 years and older, with elevated fall risk and a serum 25-hydroxyvitamin D [25-(OH)D] level of 25 to 72.5 nmol/L. Intervention: 200 (control), 1000, 2000, or 4000 IU of vitamin D3 per day. During the dose-finding stage, participants were randomly assigned to 1 of the 4 vitamin D3 doses, and the best noncontrol dose for preventing falls was determined. After dose finding, participants previously assigned to receive noncontrol doses received the best dose, and new enrollees were randomly assigned to receive 200 IU/d or the best dose. Measurements: Time to first fall or death over 2 years (primary outcome). Results: During the dose-finding stage, the primary outcome rates were higher for the 2000- and 4000-IU/d doses than for the 1000-IU/d dose, which was selected as the best dose (posterior probability of being best, 0.90). In the confirmatory stage, event rates were not significantly different between participants with experience receiving the best dose (events and observation time limited to the period they were receiving 1000 IU/d; n = 308) and those randomly assigned to receive 200 IU/d (n = 339) (hazard ratio [HR], 0.94 [95% CI, 0.76 to 1.15]; P = 0.54). Analysis of falls with adverse outcomes suggested greater risk in the experience-with-best-dose group versus the 200-IU/d group (serious fall: HR, 1.87 [CI, 1.03 to 3.41]; fall with hospitalization: HR, 2.48 [CI, 1.13 to 5.46]). Limitations: The control group received 200 IU of vitamin D3 per day, not a placebo. Dose finding ended before the prespecified thresholds for dose suspension and dose selection were reached. Conclusion: In older persons with elevated fall risk and low serum 25-(OH)D levels, vitamin D3 supplementation at doses of 1000 IU/d or higher did not prevent falls compared with 200 IU/d. Several analyses raised safety concerns about vitamin D3 doses of 1000 IU/d or higher. Primary Funding Source: National Institute on Aging.

Catch Parkinson's early for better support

Closing care gaps in adult congenital heart disease

4 concepts can help bolster age-friendly care

Telehealth expands reach of palliative care in rural areas

New warnings for gabapentinoids; other drugs approved

New report proposes solutions to drug shortages

MKSAP Quiz: 5-month history of exertional chest discomfort

Nonpharmaceutical interventions have strongest evidence support for poststroke rehab

Internet-based rehab safe, effective for chronic vestibular syndrome, study finds

New thinking about Alzheimer's diagnosis

Study finds higher thresholds of troponin I associated with death after cardiac surgery | ACP Hospitalist

Bedspacing not associated with adverse outcomes in general internal medicine patients | ACP Hospitalist

Discharge ed, doctor harassment, and more | ACP Hospitalist

Strategies for recruiting NPs and PAs | ACP Hospitalist

De-Mentored | ACP Hospitalist

Bundling consent in the ICU | ACP Hospitalist

Pulmonary rehab, thiamine for sepsis, and more | ACP Hospitalist

Why and how to apologize | ACP Hospitalist

Syncope, sepsis resuscitation, and more | ACP Hospitalist

Nutrition, contrast and AKI, and more | ACP Hospitalist