Physician Charter on Professionalism

The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession.

Need for a Physician-Spokesperson on the Medical and Health Consequences of Bioterrorism. Letter to President George W. Bush.

Bioterrorism Protection Act of 2001 (BioPAct). Letter to Congress.

Bioterrorism Preparedness in the FY 2002 Defense Appropriations Act (H.R. 3338). Letter to the House and Senate FY 2002 Defense Appropriations Conferees.

Bioterrorism Preparedness Funding (S. 1747). Letter to Senate Appropriations Committee.

Bioterrorism Preparedness Funding. Letter to Senate Health, Education, Labor and Pensions Committee.

Bioterrorism Preparedness Funding. Letter to Representative Ganske.

Bioterrorism Preparedness Funding. Letter to President George W. Bush and to Congress.

Bioterrorism. Letter to President George W. Bush and all members of the House of Representatives and Senate.

Bioterrorism. Letter to the American Medical Association (AMA).

Modernizing the United States’ Public Health Infrastructure: A Position Paper From the American College of Physicians

The United States’ public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation’s public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors.

Monkeypox: Challenging Clinical Questions

Insights From Rapid Deployment of a “Virtual Hospital” as Standard Care During the COVID-19 Pandemic

Background: Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation. Objective: To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system. Design: Prospective case series. Setting: Atrium Health, a large integrated health care organization in the southeastern United States. Patients: 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH. Intervention: A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19. Measurements: Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data. Results: 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission. Limitation: Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols. Conclusion: Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond. Primary Funding Source: Atrium Health.

Development and Performance of a Checklist for Initial Triage After an Anthrax Mass Exposure Event

Background: Population exposure to Bacillus anthracis spores could cause mass casualties requiring complex medical care. Rapid identification of patients needing anthrax-specific therapies will improve patient outcomes and resource use. Objective: To develop a checklist that rapidly distinguishes most anthrax from nonanthrax illnesses on the basis of clinical presentation and identifies patients requiring diagnostic testing after a population exposure. Design: Comparison of published anthrax case reports from 1880 through 2013 that included patients seeking anthrax-related care at 2 epicenters of the 2001 U.S. anthrax attacks. Setting: Outpatient and inpatient. Patients: 408 case patients with inhalation, ingestion, and cutaneous anthrax and primary anthrax meningitis, and 657 control patients. Measurements: Diagnostic test characteristics, including positive and negative likelihood ratios (LRs) and patient triage assignation. Results: Checklist-directed triage without diagnostic testing correctly classified 95% (95% CI, 93% to 97%) of 353 adult anthrax case patients and 76% (CI, 73% to 79%) of 647 control patients (positive LR, 3.96 [CI, 3.45 to 4.55]; negative LR, 0.07 [CI, 0.04 to 0.11]; false-negative rate, 5%; false-positive rate, 24%). Diagnostic testing was needed for triage in up to 5% of case patients and 15% of control patients and improved overall test characteristics (positive LR, 8.90 [CI, 7.05 to 11.24]; negative LR, 0.06 [CI, 0.04 to 0.09]; false-negative rate, 5%; false-positive rate, 11%). Checklist sensitivity and specificity were minimally affected by inclusion of pediatric patients. Sensitivity increased to 97% (CI, 94% to 100%) and 98% (CI, 96% to 100%), respectively, when only inhalation anthrax cases or higher-quality case reports were investigated. Limitations: Data on case patients were limited to nonstandardized, published observational reports, many of which lacked complete data on symptoms and signs of interest. Reporting bias favoring more severe cases and lack of intercurrent outbreaks (such as influenza) in the control populations may have improved test characteristics. Conclusion: A brief checklist covering symptoms and signs can distinguish anthrax from other conditions with minimal need for diagnostic testing after known or suspected population exposure. Primary Funding Source: U.S. Department of Health and Human Services.

What Recent History Has Taught Us About Responding to Emerging Infectious Disease Threats

Presidential administrations face any number of unexpected crises during their tenure, and global pandemics are among the most challenging. As of January 2017, one of the authors had served under 5 presidents as the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. During each administration, the government faced unexpected pandemics, ranging from the HIV/AIDS pandemic, which began during the Reagan administration, to the recent Zika outbreak in the Americas, which started during the Obama administration. These experiences underscored the need to optimize preparation for and response to these threats whenever and wherever they emerge. This article recounts selected outbreaks occurring during this period and highlights lessons that were learned that can be applied to the infectious disease threats that will inevitably be faced in the current presidential administration and beyond.

CDC updates tularemia treatment, prophylaxis recommendations

MKSAP Quiz: ED visit for progressive weakness

MKSAP Quiz: Evaluation in the ED for rash

MKSAP Quiz: 5-day history of a lesion

Textbook edition reflects evolution of hospital medicine

Textbook reflects evolution of hospitalists | ACP Hospitalist

Insidious Spinal Brucellosis and Psoas Abscess in a 67-Year-Old Patient: A Case Report | Annals of Internal Medicine: Clinical Cases

A 67-year-old man presented with chronic low-back pain, unintentional weight loss, and intermittent fevers in the setting of a recent trip to Mexico. Imaging showed discitis and osteomyelitis, and epidural cultures confirmed brucellosis. Brucellosis is a zoonotic infection endemic to Eurasia and South America but has a low incidence in the United States. Although the vast majority of cases of vertebral osteomyelitis are due to common bacterial organisms, a thorough history can prompt earlier consideration of atypical infections. This case highlights brucellosis as an etiologic consideration in cases of unexplained osteomyelitis and how expanded history-taking can help clinicians more readily identify risk factors for less common infections.