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Displaying 121 - 130 of 7509 in ACP Online

The Basics of Quality Improvement

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

Shared Decision-Making

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

Quality Improvement Training Program for Residents in Adult Immunization

Quality Improvement Training Program for Residents in Adult Immunization Webinar.

Practice Transformation in Chronic Care Management

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

New PCMH Requirements for NCQA

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Helping the patient with "diabetes difficulties": Focus onpatients with A1c >9%

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Diabetes

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Clinical Update on Diabetes

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Care Coordination

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Adult Immunization & Quality Improvement for Residents

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

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Displaying 121 - 130 of 500 in Annals of Internal Medicine: Clinical Cases

When the Treatment Becomes the Problem: A Case of Paradoxical Case Effects of IVIG | Annals of Internal Medicine: Clinical Cases

Intravenous immunoglobulin (IVIG) is commonly used for immunomodulation in autoimmune diseases but can induce rare complications, such as hemolytic anemia. We report a case of a 19-year-old woman with Crohn disease complicated by pyoderma gangrenosum, presenting with IVIG-induced hemolytic anemia and a distinctive rash. Following two doses of IVIG, she experienced headaches, rash, and tachycardia. Laboratory findings showed anemia, hyperbilirubinemia, and a positive Coombs test. She was managed with supportive care. This case underscores the need for vigilant monitoring for hemolysis in patients receiving IVIG, especially those with cumulative doses and underlying inflammatory conditions.

Hepatic Epithelioid Hemangioendothelioma: A Case Report Emphasizing Diagnostic Challenges | Annals of Internal Medicine: Clinical Cases

Hepatic epithelioid hemangioendothelioma is a rare vascular tumor with variable clinical features, often leading to delayed diagnosis. We report a 40-year-old man presenting with abdominal distention and significant weight loss. Initial evaluations suggested cirrhosis and vascular pathologies, such as Budd–Chiari syndrome. Subsequently, liver biopsy confirmed hepatic epithelioid hemangioendothelioma. A positron emission tomography–computed tomography scan showed liver, bone, and possible colon involvement. Despite planning chemotherapy, the patient died before treatment initiation. This case highlights the importance of considering hepatic epithelioid hemangioendothelioma in the differential diagnosis of unexplained multifocal liver lesions, especially in middle-aged adults.

Cutaneous Metastasis of Pulmonary Adenocarcinoma | Annals of Internal Medicine: Clinical Cases

Lung cancer remains a leading cause of malignancy-related mortality among adults worldwide. Metastasis of primary lung adenocarcinoma to the skin is rare, morphologically heterogeneous, and may affect any body site. Cutaneous metastases portend a poor prognosis with worsened survival rates. The diagnosis is typically established via histopathology with supportive immunohistochemistry. Treatment varies based on the extent of involvement.

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.

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Displaying 121 - 130 of 253 in ACP Store

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

ACP Pain Management: Knee Cases

ACP Pain Management: Knee Cases

ACP Pain Management Module 7: Opioid Use Disorder

ACP Pain Management Module 7: Opioid Use Disorder

ACP Pain Management Module 6: Opioid Therapy

ACP Pain Management Module 6: Opioid Therapy

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