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Physician Open Payments (Sunshine Rule)

The following information will help you and your staff understand the Physician Payment Sunshine Rule (also referred to as the National Physician Payment Transparency Program, or Open Payments), which requires transparency in defined payment relationships with physicians and teaching hospitals by applicable manufacturers and group purchasing organizations.

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Displaying 101 - 110 of 500 in Annals of Internal Medicine: Clinical Cases

Occult JAK2+ Myelofibrosis Presenting With Splanchnic Vein Thrombosis | Annals of Internal Medicine: Clinical Cases

Splanchnic vein thrombosis (SVT) is a rare manifestation of venous thromboembolism within the portal, mesenteric, hepatic, and/or splenic veins. Major risk factors include abdominal cancer, cirrhosis, and myeloproliferative neoplasms (MPNs). Myeloproliferative neoplasms can be associated with JAK2 V617F mutations, representing unique thrombotic risk factors. Discussed below is an atypical case of occult JAK2+ myelofibrosis with normal blood counts presenting as SVT, which would have been missed without high clinical suspicion. This case demonstrates the need to test for thrombophilia syndromes, JAK2, and occult MPNs in otherwise unexplained SVT to optimize treatment and prevent life-threatening manifestations such as portal hypertension sequelae and cirrhosis.

Cytomegalovirus-Related Splenic Infarcts: Viral Twist and a Vascular Phenomenon | Annals of Internal Medicine: Clinical Cases

Cytomegalovirus (CMV) infections in an individual who is immunocompetent can range from asymptomatic to infectious mononucleosis syndrome. More severe complications are seen in individuals who are immunocompromised, and these complications are associated with life-threatening conditions. One of them is CMV-associated thrombosis, commonly seen in individuals who are immunocompromised, who are transplant recipients, or who are people living with HIV/AIDS. In this case report, we present a unique case of acute CMV infection in a 35-year-old healthy individual who is immunocompetent and who developed the rare complication of isolated splenic infarction.

Foodborne Listeria monocytogenes Rhombencephalitis and Brainstem Abscess During a National Outbreak: Case Report and Literature Review | Annals of Internal Medicine: Clinical Cases

We report a rare case of Listeria monocytogenes rhombencephalitis with brainstem abscess in a previously healthy adult amid a nationwide outbreak linked to deli meat. The 56-year-old man exhibited rapid neurologic deterioration, requiring intensive care and prolonged antibiotic therapy. Diagnostic imaging confirmed multiple brainstem abscesses, and aggressive antibiotics stabilized his condition. This case underscores the importance of prompt recognition and treatment of neurolisteriosis, especially in foodborne outbreaks, as well as the potential for severe complications in otherwise healthy individuals, highlighting the need for heightened vigilance even among patients who are not immunocompromised.

Presentation and Management of Thyroid Involvement in Systemic and Primary Thyroid Lymphoma: A Case Series | Annals of Internal Medicine: Clinical Cases

This case series describes 4 female patients with thyroid lymphoma, including 3 primary thyroid lymphomas and 1 secondary thyroid involvement due to Burkitt lymphoma. Identified within a cohort of 878 lymphoma patients (2018–2022), primary thyroid lymphomas represented a 0.5% prevalence. Cervical ultrasound, computed tomography, or magnetic resonance imaging revealed thyroid abnormalities. Fine-needle aspiration biopsy followed by biopsy confirmed diagnoses. Positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) highlighted metabolic activity correlating with aggressiveness. This series emphasizes the complementary roles of imaging and pathology in diagnosis and highlights the importance of a multidisciplinary approach to managing these rare malignancies.

Intentional Nitrite Ingestion: Clinical Presentation and Emergency Management in a Young Female Patient | Annals of Internal Medicine: Clinical Cases

Sodium nitrite (NaNO₂) is an inorganic salt used in food preservation and industrial products, recently implicated in self-harm due to its easy online availability. We report a case of severe methemoglobinemia in a 20-year-old woman following sodium nitrite ingestion in a suicide attempt. The patient presented with cyanosis, hypotension, and elevated methemoglobin levels (64.1%). After poison control consultation, activated charcoal and methylene blue were administered, resulting in rapid clinical improvement and normalization of methemoglobinemia. This case emphasizes the importance of early recognition and treatment of sodium nitrite poisoning, highlighting the life-saving role of methylene blue.

A Case of Bromism Influenced by Use of Artificial Intelligence | Annals of Internal Medicine: Clinical Cases

Ingestion of bromide can lead to a toxidrome known as bromism. While this condition is less common than it was in the early 20th century, it remains important to describe the associated symptoms and risks, because bromide-containing substances have become more readily available on the internet. We present an interesting case of a patient who developed bromism after consulting the artificial intelligence–based conversational large language model, ChatGPT, for health information.

Subarachnoid Racemose Neurocysticercosis in a Patient From India: A Case Report | Annals of Internal Medicine: Clinical Cases

Neurocysticercosis is endemic in Latin America, Africa, and Asia. However, the subarachnoid form is a rare manifestation of neurocysticercosis that often is overlooked. Subarachnoid racemose neurocysticercosis consists of the proliferation of lobulated cysts and can present with headaches, intracranial hypertension, and infarcts. We report a rare case of subarachnoid racemose neurocysticercosis in a patient from India. She showed improvement on clinical and radiologic testing after initiation of high-dose steroids and dual anthelmintic therapy.

Immune Checkpoint Inhibitor–Induced Sicca Syndrome: Early Recognition Is Key | Annals of Internal Medicine: Clinical Cases

Dry mouth and eyes (sicca syndrome) is an underreported side effect of immune checkpoint inhibitors (ICIs), which can be debilitating and significantly impact the quality of life. With the increased use of ICIs, it is imperative to recognize this adverse event and initiate prompt treatment.

Perimesencephalic Hemorrhage: Illustrative Case Report Involving “Spot Sign” | Annals of Internal Medicine: Clinical Cases

Nonaneurysmal perimesencephalic hemorrhage (PMSAH) is a form of subarachnoid hemorrhage with a generally favorable prognosis. The majority of PMSAH cases present with normal cerebral angiography with an unknown exact source of bleeding. However, it is classically thought to be venous in origin. We present a rare case of active or recent venous prepontine “spot sign” extravasation of a 59-year-old man, identified on admission computed tomography angiography but negative on catheter-based angiography and follow-up imaging, strongly suggesting an evident venous cause.

Acute Legionnaires’ Disease–Associated Complete Heart Block | Annals of Internal Medicine: Clinical Cases

Legionnaires’ disease is a systemic disease caused by Legionella species that predominantly affects the lungs; however, extrapulmonary manifestations including cardiac involvement have been reported. We present a case of a 79-year-old woman who presented with cough, reduced appetite, and syncope and was found to be in third-degree atrioventricular block. The patient had a positive urine Legionella antigen with a finding on computed tomography of the chest of bilateral infiltrates. Despite antibiotic therapy, permanent pacemaker was implanted for persistent complete heart block. At 2-week follow-up, however, patient had regained intrinsic conduction. This case highlights Legionnaires’ disease as a potential reversible cause of complete heart block.

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Displaying 101 - 110 of 253 in ACP Store

High Value Care Cases Bundle

ACP High Value Care Cases Learn ACP’s 5-step framework to help eliminate unnecessary health care costs and improve patient outcomes while earning CME and ABIM MOC patient safety and medical knowledge points.

High Value Care Cases 4: Care Setting and Cost

ACP High Value Care Cases Learn ACP’s 5-step framework to help eliminate unnecessary health care costs and improve patient outcomes while earning CME and ABIM MOC patient safety and medical knowledge points.

High Value Care Cases 3: Diagnostic Processes

ACP High Value Care Cases Learn ACP’s 5-step framework to help eliminate unnecessary health care costs and improve patient outcomes while earning CME and ABIM MOC patient safety and medical knowledge points.

High Value Care Cases 2: The Cost of Care

ACP High Value Care Cases Learn ACP’s 5-step framework to help eliminate unnecessary health care costs and improve patient outcomes while earning CME and ABIM MOC patient safety and medical knowledge points.

High Value Care Cases 1: Eliminating Health Care Waste

ACP High Value Care Cases Learn ACP’s 5-step framework to help eliminate unnecessary health care costs and improve patient outcomes while earning CME and ABIM MOC patient safety and medical knowledge points.

Module 3: Understanding and Addressing Disparities in Diagnosis: Case 2

Module 3: Understanding and Addressing Disparities in Diagnosis: Case 2

Module 2: Understanding and Addressing Disparities in Diagnosis: Case 1

Module 2: Understanding and Addressing Disparities in Diagnosis: Case 1

Module 1: Understanding and Addressing Disparities in Diagnosis

Module 1: Understanding and Addressing Disparities in Diagnosis

SUD Video Bundle from 2023 Internal Medicine Meeting

Captured from Internal Medicine Meeting 2023, this video bundle package provides 2.5 hours of high-yield video content covering strategies and management options for treating substance use disorder. Note: 2023 Premium registrants can access this content hereor CME 160 purchasers can findit here. Addiction Medicine for the Hospitalist - MTP 039 Dr. Kerri Holmes-Maybank, MSCR addresses best approaches, including pharmacologic interventions, to treating alcohol and opioid use disorders in patients admitted to the hospital. High-value care is also discussed, especially regarding ongoing management and avoiding readmissions. Outpatient Management of Opioid Use Disorder - MTP 083 Dr. Ann Garment, FACP discusses optimal strategies to best reduce barriers for treating Opioid Use Disorder (OUD), and addresses many practical OUD management topics, including working with patients to decide between buprenorphine and methadone for OUD, examining the evidence and potential drawbacks behind injectable naltrexone, naloxone overdose kits, needle exchange programs, supervised injection facilities, benzodiazepine co-prescription, and hepatitis C treatment.

POCUS Course Bundle

The POCUS Pathway Bundle includes the following courses: Foundational Skills for Internal Medicine Physicians This hands-on 2-day course is designed to teach core POCUS skills to internal medicine physicians, centering on the needed skills to use ultrasound as a patient assessment tool in a variety of settings. POCUS Mentorship Program Build on your point-of-care ultrasound (POCUS) learning and become increasingly proficient in practice. This live, virtual course provides highly-personalized, 1:1 POCUS training through expert mentorship to help Internal Medicine Physicians solidify and advance skills, with training that is customized to your learning needs. Practical POCUS Skills for Internal Medicine Physicians Continue your POCUS training and expand your outpatient clinical assessment skills with 1-day advanced, hands-on POCUS training from expert faculty. Topics include a PEARLS approach to a multisystem ultrasound physical, AAA screening, skin and soft tissue, and musculoskeletal ultrasound. Plus full access to ACP’s POCUS online curriculum (14+ hrs. of content). Purchasers of the POCUS Pathway Bundle will be granted early access to register for these courses. Here’s how it works: · Pay for the bundle now to access member-exclusive savings · You’ll be notified when course registration opens · When you register for a course, the amount due will be $0 · Your bundle purchase has no expiration date so you can register based on your scheduled preferences

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