Diabetes

Join ACP Quality Connect: Diabetes, an ABIM-approved practice improvement module. Receive free personal coaching and much more. Enroll now.

Clinical Update on Diabetes

Join ACP Quality Connect: Diabetes, an ABIM-approved practice improvement module. Receive free personal coaching and much more. Enroll now.

Care Coordination

Join ACP Quality Connect: Diabetes, an ABIM-approved practice improvement module. Receive free personal coaching and much more. Enroll now.

Adult Immunization & Quality Improvement for Residents

ACP residency program in adult immunization seeks to increase the rates of adult immunization by residents through education.

Atrial Fibrillation: Using Quality Improvement to Analyze and Transform Care and Management of Patients

ACP Quality Connect Atrial Fibrillation

ACP, in collaboration with the Heart Rhythm Society, has launched the ACP Quality Connect Atrial Fibrillation (AF), which provides participants with the skills to lead practice transformation and QI efforts, resulting in real and meaningful change in AF management and stroke prevention. The program takes a collaborative, team-based approach to implement practice transformation and QI strategies that improve care of patients with AF and help prevent stroke. The skills gained through participation can be applied to a number of other clinical conditions and quality challenges.

Quality Improvement in Healthcare | Resources and Programs | ACP

ACP Advance is a robust program that gives resources to help members and clinicians learn quality improvement in healthcare. Learn more.

Well-being Champion Curriculum

This self-paced learning series empowers you to lead meaningful change as a Well-being Champion by equipping you with leadership skills, evidence-based strategies, and practical tools to foster sustainable communities of well-being and professional fulfillment—right from where you are in your life and career.

Culture Change Interventions to Reduce Physician Burnout | ACP

Reduce physician burnout and improve well-being with these 10 culture change interventions. The American College of Physicians (ACP) is concerned about the health of internists and internal medicine and has compiled these interventions that can foster a culture of wellness and help physicians thrive.

Resources for Institutional Strategies to Promote Resilience and Reduce Burnout

These resources offer additional strategies to prevent burnout and promote well-being at the practice level.

Annals Story Slam - But You Used to Be a Man

Annals Story Slam - The Little Things

Annals Story Slam - The Gift

Annals Story Slam - A Time to Die

Annals Story Slam - Only at Temple

Annals Story Slam - Who Knew?

Annals Story Slam - Death of a Patient

Annals Story Slam - Getting to Know My People

Annals Story Slam - Seeing the Body, or Two Sparks

Annals Consult Guys – Pros and Cons of Therapy to Increase Bone Mineral Density

ACP Embroidered Logo Black Zip-up Hoodie

ACP Embroidered Logo Black Zip-up Hoodie

POCUS 7: Patient Centered Scanning Module

POCUS 7: Patient Centered Scanning Module

X-Express: The ABCs of Prescribing Buprenorphine

X-Express: The ABCs of Prescribing Buprenorphine This one-hour course will provide a thorough overview of the role that buprenorphine plays in the management of opioid use disorder. Since the previously required 8-hour training for buprenorphine prescribing has been eliminated,the goal of this course is to increase prescribing confidence among attendees and have every attendee's "X-waiver" application in progress by the end of the session. Specifically, the emphasis will be on how to recognize opioid use disorder; which patients are appropriate for buprenorphine; how to initiate buprenorphine and how to adjustbuprenorphine; how to manage buprenorphine in patients with acute or chronic pain; reviewing real-world prescribing tips; and addressing barriers to care for buprenorphine patients and providers. Product Code: PNMGT21O5EM

Resident Well-being 3: Promoting Collaborative Learning Environments for Well-being

Resident physicians are in a unique role where their work environment and learning environment are one and the same. Simultaneously providing patient care, learning clinical medicine, and mastering core competencies and skills, residents are both working and learning towards independent clinical practice as an attending physician. ACP’s online Resident Well-being Curriculum connects residents with evidence-based strategies to foster well-being and mitigate burnout. Resident Well-being Learning Series Ideal for a residency program, the curriculum is designed to be used in a flipped classroom model. Residents review online material prior to a live small group discussion. The curriculum is aligned with the new ACGME requirements for resident training in well-being. The curriculum consists of three online, multimedia modules that can be taught individually or as a complete program and offers individual and organizational strategies. Modules are free to ACP Members. Nonmembers may purchase access. Promoting Collaborative Learning Environments for Well-being Learn the value of collaborative learning environments and positive social interaction, as well as how to recognize harmful signs of burnout in oneself or peers and how to seek help. Product Code: RWB2103

Resident Well-being 2: Individual and Organizational Strategies

Resident physicians are in a unique role where their work environment and learning environment are one and the same. Simultaneously providing patient care, learning clinical medicine, and mastering core competencies and skills, residents are both working and learning towards independent clinical practice as an attending physician. ACP’s online Resident Well-being Curriculum connects residents with evidence-based strategies to foster well-being and mitigate burnout. Resident Well-being Learning Series Ideal for a residency program, the curriculum is designed to be used in a flipped classroom model. Residents review online material prior to a live small group discussion. The curriculum is aligned with the new ACGME requirements for resident training in well-being. The curriculum consists of three online, multimedia modules that can be taught individually or as a complete program and offers individual and organizational strategies. Modules are free to ACP Members. Nonmembers may purchase access. Individual and Organizational Strategies Explore organizational well-being strategies, the existing ACGME well-being requirements and leave policies, and learn how to build a personal well-being plan. Product Code: RWB2102

Resident Well-being 1: Well-being and Burnout in Residency

Resident physicians are in a unique role where their work environment and learning environment are one and the same. Simultaneously providing patient care, learning clinical medicine, and mastering core competencies and skills, residents are both working and learning towards independent clinical practice as an attending physician. ACP’s online Resident Well-being Curriculum connects residents with evidence-based strategies to foster well-being and mitigate burnout. Resident Well-being Learning Series Ideal for a residency program, the curriculum is designed to be used in a flipped classroom model. Residents review online material prior to a live small group discussion. The curriculum is aligned with the new ACGME requirements for resident training in well-being. The curriculum consists of three online, multimedia modules that can be taught individually or as a complete program and offers individual and organizational strategies. Modules are free to ACP Members. Nonmembers may purchase access. Well-being and Burnout in Residency Study burnout, its effects on physicians and patients, and the unique challenges faced by residents. Product Code: RWB2101

ACP Pain Management: Chronic Pain: Beyond Opioids

ACP Pain Management: Chronic Pain: Beyond Opioids

ACP Pain Management: Back Pain: Get Your Patient Back in the Game

ACP Pain Management: Back Pain: Get Your Patient Back in the Game

ACP Pain Management: Osteoarthritis: What Works

ACP Pain Management: Osteoarthritis: What Works

ACP Pain Management: Back Cases

ACP Pain Management: Back Cases

And the winner is …

Topical corticosteroids linked to peptic ulcer risk

MKSAP Quiz: Evaluation for recurrent syncope

Risk of second cancer after early breast cancer only slightly higher than average

Azelastine nasal spray may prevent COVID-19, trial finds

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Article, podcast highlight challenges to trust

Community health worker intervention improved anxiety, depression in minority patients

MKSAP Quiz: Pain, tenderness of multiple peripheral joints

Remote bone health service increased osteoporosis screening in high-risk men

Take a quiz about the Feb. 4 issue! | ACP Hospitalist

Study finds wide variation in antibiotic prescribing for COPD exacerbations | ACP Hospitalist

Rapid tests for pleural fluid infections compared | ACP Hospitalist

Med students meet Medicaid | ACP Hospitalist

Functional outcomes were better with tenecteplase in extended window after stroke | ACP Hospitalist

An ado about antibiotics for CAP | ACP Hospitalist

ACS in premenopausal women addressed by scientific statement | ACP Hospitalist

The scarcity of SNF beds | ACP Hospitalist

Take a quiz about the Jan. 28 issue! | ACP Hospitalist

Sedating antihistamines associated with delirium in hospitalized older adults | ACP Hospitalist

Diabetes Ketoacidosis and Bilateral Cerebral Venous Sinus Thrombosis | Annals of Internal Medicine: Clinical Cases

Cerebral venous sinus thrombosis (CVST) is a rare condition marked by clot formation in the cerebral veins, often leading to significant neurologic impairment. This case involves a woman in her 60s presenting with altered mental status, slurred speech, and difficulty ambulating. She was diagnosed with diabetic ketoacidosis (DKA) and bilateral CVST with negative hypercoagulable, cardiac, or infectious screenings. Treatment included fluid resuscitation, insulin, and anticoagulation therapy, resulting in improved neurologic symptoms. This case underscores the need for clinicians to consider CVST in DKA patients with neurologic signs because early detection can prevent complications and enhance outcomes.

Parvovirus B19 Infection in Kidney Transplant Recipients | Annals of Internal Medicine: Clinical Cases

On August 14, 2024, the Centers for Disease Control issued a Health Alert Network (HAN) health advisory due to a surge in Parvovirus B19 (B19V) infections in the United States. Our report presents two cases of suspected donor-derived Parvovirus B19 infection in kidney transplant patients. Both cases had refractory anemia requiring treatment with intravenous immunoglobulin. These cases highlight the importance of awareness and monitoring of B19V infection in the context of recent epidemiologic trends to improve clinical outcomes in kidney transplant recipients.

Caseous Mitral Annular Calcification and the Utility of Multimodality Cardiac Imaging: A Case Report | Annals of Internal Medicine: Clinical Cases

Mitral annular calcification (MAC) is a common incidental finding, often associated with conditions of abnormal calcium metabolism. Caseous mitral annular calcification (CMAC) is a less common variant of mitral annular calcification that involves central liquefaction necrosis. On echocardiogram, CMAC can be misdiagnosed with other conditions, including tumors, abscesses, vegetations, or thrombi. In equivocal cases, advanced imaging modalities are necessary for further evaluation. We report a nondiagnostic case of CMAC found on transthoracic echocardiogram that required transesophageal echocardiogram, cardiac magnetic resonance imaging, and gated cardiac computed tomography for confirmation. Our patient with asymptomatic CMAC was clinically monitored without need for intervention.

Silent ST-Segment Elevation Myocardial Infarction in a Patient Discovered via Telemetry Monitoring: A Case Report | Annals of Internal Medicine: Clinical Cases

We report a case of silent ST-segment elevation myocardial infarction (STEMI) in a 59-year-old White man with a history of hypertension, type 1 diabetes mellitus, and stroke. He presented with an atypical symptom of left elbow pain. The patient was not experiencing chest pain. ST-segment elevation was first noted on telemetry monitoring. A 12-lead electrocardiogram confirmed ST-segment elevation in leads II, III, aVF, V5–V6, suggestive of inferolateral wall STEMI. Coronary angiography revealed a 99% subtotal thrombotic occlusion of the second obtuse marginal branch, treated with one drug-eluting stent. Inpatient telemetry monitoring may be beneficial in patients with a high cardiovascular risk profile.

An Extensive Undefined Osteomyelitis of the Bilateral Mandible | Annals of Internal Medicine: Clinical Cases

This case report describes a challenging and extensive destructive bilateral mandibular osteomyelitis in a 48-year-old man who presented with a chronic dental problem accompanied by persistent mandibular pain and previous failed treatments. Radiologic findings indicated diffuse sclerosing osteomyelitis, corroborated by pathologic examination and laboratory tests. Microbiological 16S rRNA sequencing testing identified Ralstonia pickettii as the predominant species, leading to tailored treatment with levofloxacin. Subsequently, the patient exhibited complete recovery in the clinical symptoms, radiologic findings, and laboratory tests, with restoration of the original condition of the mandibule. This case highlights the significance of accurate diagnosis and individualized treatment in managing complex osteomyelitis cases.

An Overuse Injury Leading to Pronator Teres Syndrome: A Case Report | Annals of Internal Medicine: Clinical Cases

Pronator teres syndrome (PTS) is a rare cause of compressive median nerve neuropathy in the proximal forearm, which often results from overuse. We present the case of a 25-year-old man who developed PTS due to work-related repetitive stress. Initially diagnosed with bursitis and carpal tunnel syndrome (CTS), investigation with electromyography and magnetic resonance imaging (MRI) confirmed PTS. Management with nonsteroidal anti-inflammatory drugs (NSAIDs), rest, and physical therapy led to significant symptom improvement. Our case highlights the importance of distinguishing PTS from other median nerve entrapment syndromes and emphasizes the utility of clinical and diagnostic evaluation in managing nerve compression.

Ignatzschineria larvae Bacteremia in a Myiatic Wound Infection: A Case Report | Annals of Internal Medicine: Clinical Cases

This case report describes the fifth confirmed instance to the author's knowledge of Ignatzschineria larvae bacteremia in the United States. A 77-year-old man from western Iowa with chronic lower extremity edema and ulcers presented with acute leg pain, systemic symptoms, and maggot-infested wounds. Laboratory tests and imaging indicated severe infection, with blood cultures positive for gram-negative rods. Identification of I larvae was confirmed through 16S ribosomal gene sequencing. The patient received intravenous antibiotics, had below-the-knee amputation, and was discharged on a regimen of oral trimethoprim/sulfamethoxazole. This case highlights the rarity of I larvae bacteremia in nontropical regions and the need for further research.

Concomitant Exogenous Cushing Syndrome and Adrenal Insufficiency From Use and Withdrawal of the Supplement Ardosons | Annals of Internal Medicine: Clinical Cases

Unregulated supplements containing undisclosed glucocorticoids can cause exogenous Cushing syndrome and adrenal suppression on abrupt withdrawal. To our knowledge, we present the first known case of a patient using Ardosons for a decade, an over-the-counter arthritis supplement containing betamethasone leading to hypercortisolism. A 47-year-old man with ankylosing spondylitis developed Cushingoid features with subsequent adrenal insufficiency after abruptly stopping Ardosons. He was treated with hydrocortisone, leading to symptomatic improvement. Five weeks later, he had lost 7.3 kg, with reduced striae. Adrenal function remained suppressed 9 months after presentation. A thorough medication reconciliation is essential to identify hidden corticosteroids in patients with mixed Cushingoid and adrenal insufficiency symptoms.

Unraveling Pernicious Anemia With Severe Hemolysis and Roth Spots | Annals of Internal Medicine: Clinical Cases

A 47-year-old man who presented with sequential findings of Roth spots and severe hemolysis was found to have vitamin B12 deficiency due to pernicious anemia. His hematologic abnormalities were quickly corrected with vitamin B12 treatment. This case highlights nonimmune and hypoproliferative hemolysis due to intramedullary phagocytosis as a rare manifestation of vitamin B12 deficiency. It also brings anemic retinopathy, an easily overlooked pathology, to the attention of internists.

A Case Report of Anti–3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Immune-Mediated Necrotizing Myopathy | Annals of Internal Medicine: Clinical Cases

We present a 75-year-old woman with 3 months of progressive proximal muscle weakness, myalgias, and dysphagia. Her admission was complicated by acute hypoxic respiratory failure requiring admission to the intensive care unit. Her clinical presentation and laboratory investigations were consistent with typical and atypical signs and symptoms of anti–3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) immune-mediated necrotizing myopathy (IMNM). Treatment with intravenous immunoglobulin, intravenous methylprednisolone, and oral methotrexate provided immediate relief of symptoms, further supporting the diagnosis of anti-HMGCR IMNM. We discuss the atypical presentations of anti-HMGCR IMNM and the complication of bulbar involvement leading to respiratory failure.