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Displaying 341 - 350 of 7460 in ACP Online
From the Trenches
What Does Well-being Mean to You Today? Supplement Resource to Coaching Practice by Kerri Palamara, MD, MACP Well-being Wheel Exercise Video We talk a lot about well-being, but it is often hard to define for others and for ourselves.
ACP Multimedia Education
Game Plan Refresh Series for Trained WBCs Marion McCrary, MD, FACP, and NC Well-being Champion (WBC), revisits strategies learned during your WBC training and new skills to grow your toolkit to support you and your colleagues. You Don't Need All of the Answers! Three Steps to Better Connect With a Colleague Who Needs You Watch Video
March 17, 2023
ACP Internal Medicine Meeting 2023 Well-being Activities and Career and Professional Development Opportunities
Patients Before Paperwork
Recently Proposed Changes to Race and Ethnicity Standards Will Have Important Impact on Research and Data Collection The Office of Management and Budget is proposing an update to the Race and Ethnicity Statistical Standards to expand the number of categories and make them more specific. View Here!
Noteworthy Resources
Team-Based Care Toolkit ACP has developed this toolkit to share best practices and real-life examples of successful team-based clinical care models that include internal medicine physicians working with nurse practitioners, physician assistants, and other members of the clinical care team. This toolkit includes resources to help foster productive and purposeful internal medicine teams. View here!
In the News
You're Not Alone in Feeling Lonely By Dr. Vivek Murthy, U.S. Surgeon General Loneliness is an experience so many of us have. But what's surprising is how loneliness impacts both our mental and physical health. To mark the release of a groundbreaking new Surgeon General's advisory on loneliness and social connection, Dr. Murthy answers the most common questions he's asked about loneliness. He also shares some of the surprising science around the positive health effects of social connection. This episode is one worth sharing with a friend.
From the Trenches
WBCs in Their Community: Promoting Positive Working and Learning EnvironmentsPuerto Rico WBC Melba Feliciano, MD, FACP, and her team in action. Check out photos from well-being activities at their chapter and in the community. Photo story here!Loneliness & BelongingBy Kerri Palamara, MD, MACP
ACP Multimedia Education
Game Plan Refresh Series for Trained WBCs Marion McCrary, MD, FACP, and NC Well-being Champion (WBC), revisits strategies learned during your WBC training and new skills to grow your toolkit to support you and your colleagues. You Don't Need All the Answers! 3 Steps to Better Connect With a Colleague Who Needs You Watch Video
Displaying 341 - 350 of 6914 in Annals of Internal Medicine
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Association Between Hospital Type and Resilience During COVID-19 Caseload Stress: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 177, No 10
Background: Imbalances between hospital caseload and care resources that strained U.S. hospitals during the pandemic have persisted after the pandemic amid ongoing staff shortages. Understanding which hospital types were more resilient to pandemic overcrowding-related excess deaths may prioritize patient safety during future crises. Objective: To determine whether hospital type classified by capabilities and resources (that is, extracorporeal membrane oxygenation [ECMO] capability, multiplicity of intensive care unit [ICU] types, and large or small hospital) influenced COVID-19 volume–outcome relationships during Delta wave surges. Design: Retrospective cohort study. Setting: 620 U.S. hospitals in the PINC AI Healthcare Database. Participants: Adult inpatients with COVID-19 admitted July to November 2021. Measurements: Hospital-months were ranked by previously validated surge index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity) percentiles. Hierarchical models were used to evaluate the effect of log-transformed surge index on the marginally adjusted probability of in-hospital mortality or discharge to hospice. Effect modification was assessed for by 4 mutually exclusive hospital types. Results: Among 620 hospitals recording 223 380 inpatients with COVID-19 during the Delta wave, there were 208 ECMO-capable, 216 multi-ICU, 36 large (≥200 beds) single-ICU, and 160 small (<200 beds) single-ICU hospitals. Overall, 50 752 (23%) patients required admission to the ICU, and 34 274 (15.3%) died. The marginally adjusted probability for mortality was 5.51% (95% CI, 4.53% to 6.50%) per unit increase in the log surge index (strain attributable mortality = 7375 [CI, 5936 to 8813] or 1 in 5 COVID-19 deaths). The test for interaction showed no difference (P = 0.32) in log surge index–mortality relationship across 4 hospital types. Results were consistent after excluding transferred patients, restricting to patients with acute respiratory failure and mechanical ventilation, and using alternative strain metrics. Limitation: Residual confounding. Conclusion: Comparably detrimental relationships between COVID-19 caseload and survival were seen across all hospital types, including highly advanced centers, and well beyond the pandemic’s learning curve. These lessons from the pandemic heighten the need to minimize caseload surges and their effects across all hospital types during public health and staffing crises. Primary Funding Source: Intramural Research Program of the National Institutes of Health Clinical Center.
Displaying 341 - 350 of 3165 in IM Matters
Displaying 341 - 350 of 2449 in ACP Hospitalist
Displaying 341 - 350 of 499 in Annals of Internal Medicine: Clinical Cases
Colon Perforation in the Setting of Sevelamer Crystals | Annals of Internal Medicine: Clinical Cases
Sevelamer is frequently used as a phosphate binder in patients with end-stage renal disease. It can also cause gastrointestinal side effects including colitis, obstruction, and, rarely, perforation.
First Manifestation of Adult-Onset Still Disease After COVID-19 Vaccination: Two Cases | Annals of Internal Medicine: Clinical Cases
Adult Still disease (ASD) is a rare autoinflammatory condition of unknown cause. Viral or bacterial infections can trigger the onset of ASD. We describe the clinical features, treatment, and follow-up of 2 patients with new-onset ASD following COVID-19 vector vaccination. Our cases emphasize the importance of early diagnosis and lend weight to an association between COVID-19 vector vaccination and new-onset ASD.
Cutaneous Vasculopathy and Recalcitrant Lower-Extremity Ulcerations | Annals of Internal Medicine: Clinical Cases
Lower-extremity ulcerations are a frequent cause of hospitalization, and those that persist despite appropriate treatment warrant careful scrutiny. We present a case of chronic, progressive leg ulcerations in a young woman accompanied by oral and genital ulcers and retiform purpura. Repeat skin biopsy revealed an intravascular lymphoid infiltrate ultimately consistent with T-cell prolymphocytic leukemia, and she was treated successfully with alemtuzumab and allogeneic hematopoietic stem cell transplantation. Our case illustrates the importance of maintaining a broad differential for patients with ulcers recalcitrant to treatment or with acute on chronic worsening. Our report also highlights the successful response of this aggressive disease to hematopoietic stem cell transplantation.
Idiopathic, Self-limiting Bilateral Bell Palsy | Annals of Internal Medicine: Clinical Cases
Bilateral facial palsy is exceedingly rare, representing only 0.3% to 2.0% of facial palsy cases (1). In contrast to the oft-recognized unilateral facial palsy, bilateral facial palsy is usually related to an underlying systemic disorder with a broad range of differentials including infections, autoimmune disorders, and sarcoidosis.
Rumpel-Leede Phenomenon | Annals of Internal Medicine: Clinical Cases
We report a case of Rumpel-Leede phenomenon in an 80-year-old man presenting in the context of lightheadedness, dizziness, and elevated at-home blood pressure readings. In this case, the finding was found quite incidentally, by a routine blood pressure measurement, and was characterized by a purpuric rash on both upper extremities, which was nonpalpable and nonblanching with pressure. The pathophysiology of this rare clinical entity involves acute rupture of dermal capillaries from capillary fragility, resulting in a self-limiting nonpurpuric rash that resolves spontaneously without intervention.
Coccidioides Meningitis: An Unusual Presentation of a Devastating Disease | Annals of Internal Medicine: Clinical Cases
Coccidioidomycosis, a fungal infection caused by the dimorphic Coccidioides genus, spans from asymptomatic exposure to fatal disseminated disease, most notably meningitis. A patient in a nonendemic area presented with neurologic symptoms and imaging concerning for subarachnoid hemorrhage. Cerebral angiogram and cerebrospinal fluid analysis were inconsistent with hemorrhage, and subsequent imaging revealed leptomeningitis. Further history revealed previous travel in endemic regions and laboratory studies confirmed disseminated coccidioidomycosis. This patient case illustrates the importance of obtaining a thorough epidemiologic history and maintaining a high clinical suspicion despite an unusual presentation.
Gradenigo Syndrome: Retro-orbital Pain, Abducens Palsy, and Petrous Apicitis | Annals of Internal Medicine: Clinical Cases
Gradenigo's syndrome is a rarely encountered triad of otitis media, retro-orbital pain, and abducens nerve palsy. Originally described in the early 1900s by Giuseppe Gradenigo, it is the physical manifestation of a lesion involving the petrous apex of the temporal bone, oftentimes in the setting of a pneumatized petrous apex/temporal bone; a noted normal anatomical variant that may predispose to infection. Local irritation of the ipsilateral trigeminal and abducens nerves leads to retro-orbital pain and abducens palsy, respectively.
Bouveret Syndrome: Rare but Quite Impactful | Annals of Internal Medicine: Clinical Cases
Bouveret syndrome is a rare cause of gastric outlet obstruction that arises from a gallstone passing through a choledochoduodenal fistula. It remains poorly understood and is frequently misdiagnosed. We describe a case in which a patient was successfully treated for Bouveret syndrome. The patient presented with recurrent abdominal pain, anorexia, and intractable nausea and vomiting. Esophagogastroduodenoscopy revealed a large, affected stone in the proximal duodenum. The stone was removed via exploratory laparotomy, and the patient was discharged with a prescription for ursodiol. This case aims to serve as a guide to physicians in the early identification of Bouveret syndrome.
Hepatocellular Carcinoma at Initial Diagnosis of Cirrhosis | Annals of Internal Medicine: Clinical Cases
Cirrhosis is a common diagnosis that clinicians will see throughout their career. We encountered a 36-year-old man who presented to the hospital about concerns of alcohol withdrawal. In the hospital, he was initially diagnosed with cirrhosis via imaging studies, and a subsequent magnetic resonance imaging scan uncovered hepatocellular carcinoma. This patient case underscores the importance of screening individuals with cirrhosis for hepatocellular carcinoma, even early in their diagnosis.
Laryngeal Histoplasmosis in an Immunocompromised Host | Annals of Internal Medicine: Clinical Cases
Laryngeal histoplasmosis is a rare manifestation of histoplasmosis infection and presents as a diagnostic challenge. It has been documented to occur in immunocompromised and immunocompetent hosts. This is a case of laryngeal histoplasmosis in a patient with idiopathic CD4 lymphocytopenia, an immunocompromising condition that presents similarly to HIV. There is no known cause or standardized treatment of idiopathic CD4 lymphocytopenia, which leaves patients at risk for opportunistic infections and malignancy.