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Displaying 181 - 190 of 7458 in ACP Online

From the Trenches

Well-being Champions Support Clinician Well-being Through COVID-19 Crisis We appreciate and applaud all our Well-being Champions for the work they are doing on the front lines of this pandemic and on the front lines of fighting burnout and supporting well-being. Below, we wanted to highlight just a few of the many ways our Champions are making a difference.

May 29, 2020

Supporting You Through These Difficult Times

Patients Before Paperwork

On April 9, 2021, ACP co-hosted the Evaluation and Management (E/M) State of the Note Summit with the Electronic Health Record Association (EHRA) to discuss clinical documentation best practices considering the recent 2021 E/M documentation updates. The Summit was attended by various physician societies and EHR vendors. Among other things, a goal of the collaborative work was to identify answers to such questions as how much detail is necessary without adding additional documentation burden and note bloat.

Noteworthy Resources

ACP Well-being Champion Library of Interventions ACP's new Library of Well-being Interventions for Well-being Champions and ACP chapter leaders can assist Well-being Champions in their mission of battling burnout and increasing professional fulfillment in their chapters. Curated resources are grouped into categories that include advocacy; peer support; diversity, equity, and inclusion; organizational interventions; and more. These interventions are easy to implement and can help you with your ACP chapter work.

New ACP Webinars

Back to Basics – Preventing Burnout, Building Trust, and Coping with the EMR Mark Linzer, MD, MACP, and Sara Poplau June 1, 2021, 11 a.m.–Noon ET

In the News

We Need a National Strategy to Help Health Workers Recover From the Stress of the Pandemic By Victor J. Dzau, MD The Los Angeles Times In this opinion article in The Los Angeles Times, Dr. Victor Dzau, Chair of the National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience, argues for a national strategy to measure and respond to clinician burnout.

From the Trenches

By Kerri Palamara, MD, MACP Some call it burnout. Some call it languishing. Others call it loneliness. Regardless of the term you use, it is increasingly clear that the struggle we face as physicians is not only more prevalent but also different from how it's ever been. Many say, “I can't wait for things to go back to normal.” To that, I say, “It had better not!” Rather than things going back to a place where burnout is the norm for physicians, we have an opportunity to create a new normal focused on physician thriving rather than struggling.

May 21, 2021

ACP is offering targeted interventions designed for well-being leaders.

Professional Fulfillment Zone

Internal Medicine Meeting 2025 Recap

Patients Before Paperwork

Advocacy in Action New ACP Policy Paper Offers Guidance to Reduce Disparities and Improve Access to Health Care in Rural Communities ACP Advocate, April 2025 As rural communities continue to face disparities in health and access to health care, the American College of Physicians is urging policymakers to take action and offers guidance in a new policy paper published in Annals of Internal Medicine.

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Displaying 181 - 190 of 499 in Annals of Internal Medicine: Clinical Cases

Near-Simultaneous Development of Coronary and Pulmonary Thrombosis in a Patient With COVID-19 | Annals of Internal Medicine: Clinical Cases

Venous thromboembolism and in situ thrombosis are recognized complications of SARS-CoV-2 infection and are associated with adverse outcomes. The development of multiple thrombotic events in patients with COVID-19 has been reported, although the combination of venous and arterial thrombotic events is rarely recognized. Here, we describe a 42-year-old man without significant risk factors for cardiovascular disease who developed a segmental pulmonary thrombus and coronary thrombus within hours while hospitalized for the treatment of nonsevere COVID-19 pneumonia.

Severe Presentation of Acute Eosinophilic Pneumonia Possibly Secondary to Recent E-Cigarette Use | Annals of Internal Medicine: Clinical Cases

A 52-year-old man with type 2 diabetes mellitus presented with fever and hypoxemic respiratory failure requiring intubation. He had no history of pulmonary disease but recently started smoking nicotine-containing electronic cigarettes (e-cigarettes) after 10 years of tobacco abstinence. He had diffuse bilateral ground-glass opacities on chest imaging, 11% peripheral eosinophilia (absolute eosinophil count 1300/µL), and 50% eosinophilia in the bronchoalveolar lavage fluid without evidence of bacterial, viral, fungal, or parasitic infection. Hypoxia and pulmonary infiltrates rapidly resolved after initiation of high-dose corticosteroids after bronchoscopy. A diagnosis of acute eosinophilic pneumonia was made, possibly secondary to recent e-cigarette use.

Hypertension and Headache in the Setting of Vertebral and Carotid Fibromuscular Dysplasia | Annals of Internal Medicine: Clinical Cases

A 98-year-old woman presented in the context of headache and was found to have evidence of a beaded appearance of the bilateral carotid and vertebral arteries. Fibromuscular dysplasia of the carotid and vertebral arteries is rare but may present with symptoms of headache, dizziness, transient ischemic attack, or stroke. Management of symptomatic patients focuses on the use of antihypertensive drugs and secondary prevention with antiplatelet agents. Surgical intervention is referred for those cases that are nonresponsive to the aforementioned treatments.

Therapeutic Low-Density Lipoprotein Cholesterol-Lowering in a Patient With Familial Hyperlipidemia Refractory to PCSK9 Monoclonal Antibody (Evolocumab) | Annals of Internal Medicine: Clinical Cases

Patients with heterozygous familial hypercholesterolemia if untreated are at increased risk for atherosclerotic cardiovascular disease events by age 40 years. Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a demonstrated potent approach to low-density lipoprotein cholesterol (LDL-C)-lowering in this population. We describe a 67-year-old patient with heterozygous familial hypercholesterolemia who developed a paradoxical increase in LDL-C while on a PCSK9 monoclonal antibody but had a subsequent reduction in LDL-C when started on inclisiran, a PCSK9-directed oligonucleotide. The overall mechanism of monoclonal antibody refractoriness remains to be determined, but it indicates that PCSK9 as a target is still a viable option using a different mechanism.

A Case of Hyperviscosity Syndrome in Rheumatoid Arthritis | Annals of Internal Medicine: Clinical Cases

Hyperviscosity syndrome (HVS) is a rare complication of both monoclonal and polyclonal disorders associated with elevation of immunoglobulins. Here, we describe a female patient who presented with shortness of breath and a history of seropositive rheumatoid arthritis with deformities, significant barriers to care, and poor therapeutic adherence. Her rheumatoid factor titer was greater than 1000 kIU/L, and she had an elevated serum viscosity level with her presentation consistent with HVS which improved significantly after therapeutic plasmapheresis. Our case highlights the presentation of rare but potentially life-threatening HVS that can occur in patients with systemic autoimmune rheumatic disorder.

A Rare Observation of Silicone-Associated Scleroderma-Like Syndrome: How to Recognize and Diagnose Similar Cases | Annals of Internal Medicine: Clinical Cases

Although silicone breast implants are generally considered safe medical devices, implant ruptures and silicone leakage are not uncommon. In this brief report, we describe an unusual case of a woman with ruptured breast implants and long-standing unexplained systemic symptoms. She developed an atypical and localized scleroderma-like syndrome, with a rare observation of histopathologically confirmed silicone depositions in distant sclerotic cutaneous biopsies. This observation with silicone-specific modified oil-red-o staining strongly suggests a direct inflammatory reaction to the distant (sub)cutaneous silicone depositions from her ruptured breast implants. We propose clinical recommendations on how to recognize and diagnose possible similar cases.

Hypertriglyceridemia-Induced Acute Pancreatitis Secondary to Glycogen Storage Disease Type Ia: Successful Treatment With Plasmapheresis | Annals of Internal Medicine: Clinical Cases

Glycogen storage disease type Ia (GSD-Ia) is a rare autosomal recessive disorder caused by a loss-of-function mutation in glucose-6-phosphatase, resulting in recurrent fasting hypoglycemia. This leads to several systemic metabolic complications, including hypercholesterolemia and hypertriglyceridemia, which can induce acute pancreatitis episodes. We report on using early plasmapheresis in addition to oral fibrate therapy as a successful treatment of a 27-year-old GSD-Ia patient with hypertriglyceridemia-induced acute pancreatitis. Plasmapheresis was initiated the day after admission and continued daily for three treatments, ultimately resulting in a seven-day admission.

Pulmonary Reperfusion Injury After Catheter-Directed Thrombectomy for Acute Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

An 82-year-old man had catheter-directed thrombectomy for intermediate-high–risk pulmonary embolism. Shortly after the procedure, the patient developed new alveolar and interstitial infiltrates found on chest computed tomography (CT) as well as life-threatening hemoptysis, likely related to pulmonary reperfusion injury after thrombus removal. Pulmonary reperfusion injury after minimally invasive thrombectomy in acute pulmonary embolism is a rare and life-threatening complication and should be considered in the differential diagnosis of acute pulmonary hemorrhage syndromes.

A Case of Gas-Containing Brain Abscess, From Superficial to Deep | Annals of Internal Medicine: Clinical Cases

Gas-containing brain abscess is a rare clinical emergency. Brain abscess with a distant history of mastoid surgery is uncommon. Management of this rare condition involves clinical vigilance, prompt diagnosis, surgical drainage, and antibiotics treatment. We report a case of a 45-year-old Filipino woman with tympanomastoidectomy 2 months prior who presented with headache and right retroauricular wound with discharge. Prompt diagnosis and surgical drainage resulted in excellent neurologic outcome. The knowledge of characteristics of pathogens is vital in pharmacologic management.

COVID-19–Induced Left Ventricular Thrombus in a Functionally Normal Heart | Annals of Internal Medicine: Clinical Cases

Left ventricular (LV) thrombus is a complication primarily associated with significant left ventricular dysfunction and/or other identifiable medical conditions. This clinical vignette presents the first case of an isolated left ventricular thrombus caused by minimally symptomatic COVID-19 in a functionally normal heart of previously healthy individual.

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