ACP Multimedia Education

Mini But Mighty Skills for Well-being: Peer Coaching to Support Individuals and Organizations (15 minutes) Identify core coaching skills and ways to leverage them to support a colleague(s) in need. View here!

March 29, 2024

Patients Before Paperwork

ACP Advocate Newsletter Feature: State of the Union Address Included Promising Proposals for Improving the U.S. Health Care System ACP encouraged by president's pledge to improve mental health care, continue premium subsidies for marketplace health insurance, and provide additional funding to combat COVID-19.

In the News

Championing Well-being Amid COVID-19 (ACP Well-being Champions Featured) by Mollie Frost, ACP Internist Throughout the pandemic's constant challenges, ACP members have taken care of each other by creating supportive spaces, working together, telling stories, and even climbing mountains. For more on this theme, see the sidebar for the essay “The case for centering the patient-physician relationship” by NY ACP Well-being Champion Maria Maldonado, MD, FACP.

March 25, 2022

Internal Medicine Meeting 2022 Well-being Activities and Creating and Sustaining Change Resources

Professional Fulfillment Zone: Internal Medicine Meeting 2025 Preview

Career and Professional Development CenterVisit us in the Exhibit Hall Location G!

Patients Before Paperwork

Advocacy in Action Where We Stand…the Latest in ACP Advocacy Efforts ACP advocates for you on policy changes that will make a difference in your daily work, your professional development, and your patients' health. View here!

Noteworthy Resources for Well-being

ACP: Design Your Own Well-being Program Explore these tools to create a well-being program tailored to any organization's needs and budget. View here!

In the News

Fighting Medical Misinformation and Disinformation ACP is committed to stopping and preventing the spread of disinformation and misinformation and vigorously supports the use of science and scientific expertise based on the best available evidence. The College's efforts range from publishing evidence-based scientific content weekly, creating educational materials, issuing public statements, and collaborating with like-minded organizations.

From the Trenches

“Well-being interventions for rural health professionals: A scoping review” Skye McKennon, PharmD, BCPS, ACSM-GEI; Suzanne Fricke, DVM, MLIS; Dawn DeWitt, MDMSc, CMedEd, MACP, FRACP, FRCP-London

Warning Symptoms May Prevent Some Cases of Sudden Cardiac Arrest

The Effect of Heat Exposure on Myocardial Blood Flow and Cardiovascular Function

Background: Heat extremes are associated with greater risk for cardiovascular death. The pathophysiologic mechanisms mediating this association are unknown. Objective: To quantify the myocardial blood flow (MBF) requirements of heat exposure. Design: Experimental study. (ClinicalTrials.gov: NCT04549974) Setting: Laboratory-based. Participants: 61 participants, comprising 20 healthy young adults (mean age, 28 years), 21 healthy older adults (mean age, 67 years), and 20 older adults with coronary artery disease (CAD) (mean age, 70 years). Intervention: Participants were heated until their core temperature increased 1.5 °C; MBF was measured before heat exposure and at every increase of 0.5 °C in core temperature. Measurements: The primary outcome was MBF measured by positron emission tomography–computed tomography. Secondary outcomes included heart rate, blood pressure, and body weight change. Results: At a core temperature increase of 1.5 °C, MBF increased in healthy young adults (change, 0.8 mL/min/g [95% CI, 0.5 to 1.0 mL/min/g]), healthy older adults (change, 0.7 mL/min/g [CI, 0.5 to 0.9 mL/min/g]), and older adults with CAD (change, 0.6 mL/min/g [CI, 0.3 to 0.8 mL/min/g]). This represented a 2.08-fold (CI, 1.75- to 2.41-fold), 1.79-fold (CI, 1.59- to 1.98-fold), and 1.64-fold (CI, 1.41- to 1.87-fold) change, respectively, from preexposure values. Imaging evidence of asymptomatic heat-induced myocardial ischemia was seen in 7 adults with CAD (35%) in post hoc analyses. Limitations: In this laboratory-based study, heating was limited to about 100 minutes and participants were restricted in movement and fluid intake. Participants refrained from strenuous exercise and smoking; stopped alcohol and caffeine intake; and withheld β-blockers, calcium-channel blockers, and nitroglycerin before heating. Conclusion: Heat exposure that increases core temperature by 1.5 °C nearly doubles MBF. Changes in MBF did not differ by age or presence of CAD, but some older adults with CAD may experience asymptomatic myocardial ischemia. Primary Funding Source: Canadian Institutes of Health Research.

Reducing Low-Value Health Care

Death Need Be in All Caps: The Risk of “Risk Calculation” When Black Folk Are Dying

Moving Beyond Aggregation: Seeking Effective Tools to Advance Health Equity

Estimating the Effects of Health Policy Initiatives: Where We Are and Where We Need to Go

Relaxing Transfusion Thresholds for Patients With Myocardial Infarction: Findings From the MINT Trial

Revised REACH-B Model for Hepatocellular Carcinoma Risk Prediction in Patients With Chronic Hepatitis B

Determining Women’s Willingness to Screen for Breast Cancer: Does False-Positive Recall Matter?

Long COVID Diagnostics: An Unconquered Challenge

NT-proBNP thresholds insufficient to diagnose HF in ambulatory patients with chronic dyspnea

Supine hypertension worrisome, measuring BP in noisy environment can be acceptable, accurate

Put words in our mouth

Registration open for Clinical Skills Center's hands-on learning opportunities

Report outlines alcohol's health effects, seeks public comment

MKSAP Quiz: Evaluation for exertional dyspnea

Antivirals have little to no effect on nonsevere influenza, review indicates

Expert commission defines obesity, sets advice on treatment

And the winner is …

Spotlight on internal medicine physician leaders

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

Studies highlight risk of rehospitalization among patients who've experienced violence | ACP Hospitalist

Strokes after surgery | ACP Hospitalist

Risk scores, POCUS could be used in place of radiology for many with AKI, study finds | ACP Hospitalist

No benefit to immunocompromised CAP patients from empiric broad-spectrum antibiotics | ACP Hospitalist

Metastatic Lobular Carcinoma of the Breast Masquerading as Gallstone Disease – A Case Report | Annals of Internal Medicine: Clinical Cases

The gallbladder is a rare site of breast cancer metastasis. We report the patient case of a 60-year-old woman with isolated metastasis to the gallbladder, which was surgically removed for symptomatic cholelithiasis, with a subsequent new diagnosis of infiltrating lobular carcinoma (ILC) of the breast. ILC tends to metastasize to unusual sites such as the gastrointestinal and genitourinary tracts, but these usually occur concurrently with other more common sites of distant metastasis such as the bone, lungs, and liver. Our case underscores the need for routine histologic examination of gallbladder after cholecystectomy.

Diffuse Alveolar Hemorrhage as an Unusual Pulmonary Manifestation of Multisystem Inflammatory Syndrome in Adults | Annals of Internal Medicine: Clinical Cases

Multisystem inflammatory syndrome–A (MIS-A) is a rare postacute complication of COVID-19 infection in adults. It is a hyperinflammatory condition presenting as cardiogenic and vasogenic shock leading to multiorgan failure. Diffuse alveolar hemorrhage (DAH) is a rare pulmonary condition, with diverse etiologies ultimately leading to the extravasation of red blood cells into alveoli, resulting in respiratory compromise. The association between MIS-A and DAH has not been reported in the literature. Here, we describe a case of a 33-year-old man who presents with shock and diffuse alveolar hemorrhage in the setting of a highly inflammatory state, consistent with MIS-A.

Massive Splenomegaly | Annals of Internal Medicine: Clinical Cases

Massive splenomegaly, defined as length spleen greater than 20 cm, is a relatively rare entity with a broad differential. Primary splenomegaly occurs in the setting of leukemias and lymphomas, whereas secondary splenomegaly is more common and carries a broad differential. We present a case of massive splenomegaly with an approach to differential diagnoses and brief discussion of splenic marginal zone lymphoma.

Point-of-Care Ultrasound: An Emerging Tool for Diagnosing Calciphylaxis | Annals of Internal Medicine: Clinical Cases

Calciphylaxis is a disease involving medial calcification of dermal arterioles, resulting in cutaneous necrosis. Diagnosis is typically clinical, but it is frequently misdiagnosed. Skin biopsy, the gold standard diagnostic test, is hindered by risk, patient refusal, and difficulties with histologic evaluation. This case series investigates using soft tissue point-of-care-ultrasound (POCUS) to aid in diagnosis. It describes ultrasound images obtained from patients diagnosed with calciphylaxis. These potentially pathognomonic sonographic findings in the proper clinical context include superficial hyperechoic foci lining small-caliber vessels with posterior acoustic shadowing. This demonstrates the diagnostic potential of POCUS in evaluating patients with possible calciphylaxis.

A Case of DILI and Subsequent HLH Induced by Allopurinol | Annals of Internal Medicine: Clinical Cases

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome that occurs because of uncontrolled immune cell activation and can present as a primary or acquired disorder. It is an illness with a high mortality rate that has been increasing in incidence over the past decade. There are few reports of allopurinol-induced HLH. This case describes a patient who was initially diagnosed with drug-induced liver injury secondary to allopurinol and subsequently diagnosed with HLH secondary to allopurinol. The discussion highlights the pathophysiology, clinical findings, diagnostic work-up, and treatment of HLH, along with mentioning interventions that focus on prevention of these diseases.

Multiple Organ Dysfunction Syndrome Secondary to Multiple Wasp Stings: A Case Report | Annals of Internal Medicine: Clinical Cases

Wasp sting is common in resource-limited countries like Viet Nam. Symptoms can range from mild (itching, urticaria, and angioedema) to severe (multiorgan dysfunction), which increases mortality. Rhabdomyolysis and acute respiratory distress syndrome are rare complications but yield a high risk of death, thus requiring emergent interventions. We present a case of a 32-year-old man suffering from multiple wasp stings. The patient manifested several swollen, erythematous, and tender stings, and then developed a high fever, dyspnea, and reddish urine. He was diagnosed with multiple organ dysfunction syndrome, including severe hemolysis, acute kidney injury, liver injury, and acute respiratory distress syndrome.

Primary Cardiac Angiosarcoma: Pericardial Erosion and Disseminated Metastasis in a Young Active Duty Man | Annals of Internal Medicine: Clinical Cases

Primary cardiac tumors are exceedingly rare with a reported prevalence of 0.0017% to 0.028%. Seventy-five percent of these tumors are benign. Of the primary malignant tumors, the most common are sarcomas. Primary cardiac sarcomas are often rapidly progressive and carry a very poor prognosis because of distant metastasis, erosion within the heart, and the development of circulatory obstruction. We describe an unfortunate case of primary cardiac angiosarcoma leading to the death of an otherwise healthy young man.

Disseminated Cutaneous Herpes Simplex Virus: A Severe Case of Erythema Herpeticum in a Clinically Immunocompetent Patient | Annals of Internal Medicine: Clinical Cases

Herpes simplex virus (HSV)–induced eczema herperticum is seen in clinical practice most commonly as lesions of the mucosa or epidermis. Disseminated cutaneous infection caused by HSV-1 is rarely reported. Here, we present the patient case of a woman in her late 20s who came in for a presumed eczema flare that quickly developed into a disseminated cutaneous disease. Skin biopsy revealed HSV-1 as the causative factor. Valacyclovir therapy led to almost complete resolution of her skin lesions.

Chronic Lymphocytic Leukemia Involving the Liver Without High-Grade Transformation | Annals of Internal Medicine: Clinical Cases

Chronic lymphocytic leukemia is most frequently encountered among the elderly population. Hepatic infiltration may be present at the time of diagnosis, but significant extranodal involvement rarely occurs without high-grade transformation. Abnormal liver enzymes have important prognostic implications in terms of staging the disease and initiating treatment. We describe an atypical presentation of chronic lymphocytic leukemia in a patient who presented with rising liver enzyme levels, extensive hepatic infiltration, and portal hypertension but with no evidence of high-grade transformation on liver biopsy.

Unmasking of Asymptomatic Celiac Disease and Microscopic Colitis After Acquiring COVID-19 | Annals of Internal Medicine: Clinical Cases

Previous studies have suggested that viruses may trigger the development of autoimmune diseases such as celiac disease. We report a 75-year-old elderly man who developed intractable diarrhea after acquiring COVID-19. We suspect the COVID-19 unmasked or triggered histology-proven celiac disease (CD) and microscopic colitis (MC), which caused the diarrhea. Clinicians should be aware of the existence of CD and MC unmasked by SARS-CoV-2 in a COVID-19 patient who developed intractable diarrhea.