February 21, 2020

Strengthening Well-being and Professional Fulfillment Through Collaboration

February 15, 2019

Announcements Hello Well-being Champions!

Patients Before Paperwork

ACP provided feedback on two CMS requests for information regarding how to improve and streamline the CMS Center for Program Integrity. Within our feedback, we highlighted our previous recommendations to CMS that more clarity is needed around what they will actually accept as far as the updated documentation requirements.

Noteworthy Resources

The Curbsiders Podcast #166 Advocacy and Hot Topics in Health Care Policy With Robert McLean MD, FACP

New ACP Webinars

Appreciative Inquiry Kerri Palamara, MD, FACP January 23, 9:00–10:00 a.m. ET

In the News

Physician-Friendly States for Mental Health: A Review of Medical Boards By Pamela Wibble, MD, and Arianna Palermini, OMS2; Pamela Wibble, MD Blog

December 20, 2019

Announcements Helping in our own way through advocacy

August 16, 2019

Announcements ACP Supports National Physician Suicide Awareness Day, September 17 (National Suicide Prevention Lifeline: 1-800-273-8255 and crisis text line at 741-741)

April 19, 2019

Announcements Thank You So Much to Our Well-being Champion Volunteers at the Champion Training and Internal Medicine Meeting 2019! Thank you so much to all our volunteers who championed well-being as speakers and teachers during the 2019 Internal Medicine Meeting in Philadelphia.

Publication/Ways to Share Your Work

Outcomes of Bariatric Surgery in Patients With Diabetes

Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative

Kidney Transplants for Patients With Hepatitis C Virus Infection

Medicines for Patients After an Opioid Overdose

High Blood Pressure During Pregnancy and Development of Risk Factors for Cardiovascular Disease

Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes

Sigmoidoscopy Screening for Colorectal Cancer

Do Electric Cars Interfere With Pacemakers and Defibrillators?

Use of E-Cigarettes Among Smokers Who Plan to Quit After a Hospitalization

Hemoglobin A1c Targets for Nonpregnant Adults With Type 2 Diabetes Mellitus

Childhood cancer survivors at earlier risk for aging-related disease

MKSAP Quiz: 1-week history of gross hematuria

Many U.S. women undergo annual mammograms despite guideline recommendations

Study details high prevalence of prescription stimulant use, misuse

Put words in our mouth

Alcohol cessation linked with worsening of cholesterol levels

Limited evidence supports continuing buprenorphine for acute pain in patients with OUD

MKSAP Quiz: Headaches, fever, painful rash

Tool may allow earlier detection of heart failure in the community

ACP guideline offers advice, evidence on treating acute episodic migraines

OPAT with vancomycin via midline catheters associated with higher complication risk | ACP Hospitalist

ATS updates guideline on community-acquired pneumonia | ACP Hospitalist

Ventilators, other devices recalled | ACP Hospitalist

Transfusions provide mortality benefit early in hospitalization, but not later | ACP Hospitalist

The long tail of infection | ACP Hospitalist

Take a quiz about the July 16 issue! | ACP Hospitalist

Solid pills may be safer than crushed in poststroke dysphagia | ACP Hospitalist

New score predicts mortality risk during stay for COPD exacerbation | ACP Hospitalist

Adjunctive fosfomycin increases treatment success but also toxicity in staph bacteremia | ACP Hospitalist

Take a quiz about the July 9 issue! | ACP Hospitalist

Lungs of a Chronic Smoker: The Case of Heroin-Induced Emphysema in a 35-Year-Old Man | Annals of Internal Medicine: Clinical Cases

Recently, heroin has become more easily accessible, which has led to an increase in its tolerance, addiction, and misuse potential. According to several reports, among many modes of use, smoking and inhaling heroin are the most common methods of its misuse among young adults. As a result, many users younger than age 40 years are now presenting with severe airway disease. In this case report, a 35-year-old man with a history of heroin use subsequently had severe emphysema with numerous bullae. The patient reported a long-standing history of inhaling heroin vapor. A genetic work-up for alpha-1 antitrypsin deficiency was negative. Here, we raise the concern of heroin-induced bullous emphysema.

A Case of Daptomycin-Induced Eosinophilic Pneumonia | Annals of Internal Medicine: Clinical Cases

Daptomycin is commonly used for methicillin-resistant Staphylococcus aureus infections, but 1 rarely reported adverse reaction for its use is daptomycin-induced eosinophilic pneumonia. It is unclear how or why the drug produces this reaction. Workup includes ruling out other infectious causes and discontinuing daptomycin, and bronchoscopy showing more than 25% eosinophils is diagnostic. Here, we report a rarely described patient case of daptomycin-induced eosinophilic pneumonia and discuss its management.

Partial Splenic Artery Embolization in the Management of Acute Immune Thrombocytopenia Refractory to Medical Treatment | Annals of Internal Medicine: Clinical Cases

Our case details a 60-year-old man with cirrhosis from hepatitis C referred to hematology for severe thrombocytopenia after right hemiglossectomy in the setting of squamous cell tongue cancer. Acute immune thrombocytopenia was diagnosed. Platelet transfusions, high-dose steroids, intravenous immunoglobulin ×2, romiplostim, and rituximab were administered without adequate platelet response (2000/µL), and patient developed gastrointestinal bleeding. Partial splenic artery embolization was performed urgently for refractory thrombocytopenia resulting in ∼60% splenic infarction. His platelet count increased in the next few days and was sustained. Our case demonstrates partial splenic artery embolization as an underused approach to severe thrombocytopenia in the setting of acute immune thrombocytopenia resistant to steroids and medications.

COVID-19–Mediated Electrical Storm Managed With Milrinone in a Vaccinated Patient | Annals of Internal Medicine: Clinical Cases

SARS-CoV-2 infection (COVID-19) can lead to an inflammatory response affecting multiple organs. Ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation (VF), have been reported in otherwise-healthy individuals who have not been vaccinated. A young, otherwise-healthy man who was vaccinated and recently diagnosed with COVID-19 was admitted for refractory VF. Common pharmaceutical agents for VF were given to no avail. VF resolved with use of low-dose milrinone infusion. An inotropic agent usually used in patients with heart failure, milrinone also possesses proven anti-inflammatory effects, which may have allowed it to succeed where the traditional agents failed.

Immune Checkpoint Inhibitor-Induced Polyarthritis: A Case Series | Annals of Internal Medicine: Clinical Cases

Immune checkpoint inhibitors (ICIs) have revolutionized cancer care; however, they are associated with ICI-related adverse events (ICI-AEs). Polyarthritis is a rare ICI-AE. Here we describe 2 patient cases of ICI-induced polyarthritis, induced by nivolumab/ipilimumab and sasanlimab for melanoma and urothelial cancer, respectively. Both patients had a medical history of nonrheumatological autoimmune disease, developed symptoms within 8 weeks of ICI, and had negative autoantibodies. Symptoms resolved with glucocorticoids. Neither patient discontinued their anticancer therapy. These cases add to the literature on ICI-induced polyarthritis. As ICIs become the standard of care, clinicians should familiarize themselves with their adverse effects.

What and Where Else: Hypervirulent Klebsiella pneumoniae With Pyogenic Liver Abscess and Disseminated Multifocal Osteomyelitis | Annals of Internal Medicine: Clinical Cases

Hypervirulent Klebsiella pneumoniae (hvKp), a pathotype of Klebsiella pneumoniae presents many clinical challenges. hvKp often causes disseminated, invasive disease in immunocompetent hosts. It is primarily associated with pyogenic liver abscesses, but also causes osteomyelitis, necrotizing fasciitis, endophthalmitis, and meningitis. The diagnosis of hvKp is largely clinical because many laboratories lack the ability to test for the associated biomarkers. To emphasize the need to assess for disseminated invasive infection in such patients, we present a patient with hvKp who had bacteremic and tibial osteomyelitis, but also pyogenic liver abscess and multifocal osteomyelitis with a pathologic fracture.

An Atypical Presentation of Progressive Multifocal Leukoencephalopathy With Newly Diagnosed HIV Infection | Annals of Internal Medicine: Clinical Cases

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating infectious disease of the central nervous system that typically presents in immunosuppressed patients with history of AIDS, hematologic malignancies, or immunosuppressant drug treatment. We report a case that highlights the importance of differentiating PML from acute/chronic ischemic stroke. Distinction is made between acute ischemic stroke and demyelinating disease with the T2-gradient recalled-echo weighted imaging. Failure to test for HIV in patients with suspected chronic ischemic stroke can lead to increased morbidity, decreased highly active antiretroviral therapy efficacy, and poorer patient outcomes. Clinicians should strongly consider PML in immunocompromised patients with frequent, progressive neurologic symptoms.

ACTH-Dependent Cushing Syndrome in Metastatic Acinic Cell Carcinoma: A Poor Prognostic Factor | Annals of Internal Medicine: Clinical Cases

Acinic cell carcinoma (ACC) with high-grade transformation is an aggressive subtype of salivary gland neoplasm. Only a few cases of adrenocorticotropic hormone (ACTH) production in metastatic ACC have been documented. We present a patient case of ACTH-dependent Cushing syndrome (CS) that developed 18 months after surgical resection of ACC. The original tissue sample was found to stain positive for ACTH, and the development of CS coincided with aggressive progression of ACC. Our case highlights the potential significance of ACTH staining in ACC and the development of CS as a signal of dedifferentiation, disease progression, and a poorer prognosis.

Medical Management of Emphysematous Gastritis | Annals of Internal Medicine: Clinical Cases

A 95-year-old man presented to the hospital with altered mental status, sepsis, and coffee-ground emesis. His chest radiograph showed gas along the lesser curvature of the stomach, prompting abdominal computed tomography, which demonstrated intramural gastric air. This patient's clinical presentation and computed tomography findings were suggestive of emphysematous gastritis (EG). He was successfully managed with an intravenous proton-pump inhibitor and broad-spectrum antibiotics. Details of the case are presented to encourage the early diagnosis of EG, which may make conservative management more successful.

Chylothorax as the Initial Manifestation of Follicular Lymphoma | Annals of Internal Medicine: Clinical Cases

Chylothorax is the presence of chyle in the pleural space, which can occur with any disruption of the thoracic duct or its main tributaries. Here we describe the case of a 64-year-old nonsmoking woman who presented with shortness of breath and had findings of a massive right-sided chylous pleural effusion. She was subsequently diagnosed with high-grade follicular lymphoma and had chest tube placement and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy with complete response.