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Displaying 351 - 360 of 7513 in ACP Online
July 15, 2022
Take Steps Toward Promoting Belonging “We all belong in the circle of human concern” - Othering & Belonging Institute
Patients Before Paperwork
ACP Advocate Newsletter Feature: ACP Joins Amicus Briefs in Support of Vaccine Mandates Ahead of special Supreme Court hearing, amicus briefs provide medical perspective for judges considering challenges to mandates for health care workers and employees at large companies.
Noteworthy Resources
COVID-19 Recovery: Promoting Well-being in Residency Programs through Quality Improvement Coaching This webinar recording features panel presentations from resident champions who share how working with a QI coach helped them achieve their quality goals and promoted well-being during the COVID-19 pandemic, followed by a moderated discussion. CME/MOC available. Watch Recording
In the News
Ten Changes That Could Keep Clinicians in the Workforce in a Pandemic By Marcia Frellick, MD Edge The 10-point, one-page checklist [in the Annals of Internal Medicine Getting Through Covid-19: Keeping Clinicians in the Workforce] includes providing “practical support in the areas that clinicians identify as causing emotional stress or moral injury,” such as managing anger and grief when patients have chosen not to be vaccinated or confronting misinformation.
From the Trenches
Opportunities to Connect: Topic: Game Plan Refresh Series for Trained ACP Well-being Champions “Revisit Coaching Skills of GROW and Appreciative Inquiry”
Patients Before Paperwork
Request for Information; National Directory of Healthcare Providers & Services [RIN 0938–ZB72] Updates provided by Nadia Daneshvar, ACP Advocacy team ACP responded to a request for information from CMS related to the creation of a “National Provider Directory,” which has some burden-reduction implications for ACP members. The letter was drafted with input from the Medical Informatics Committee (MIC) and came from the MIC chair on behalf of ACP.
Noteworthy Resources
Well-being Champion Training: Coaching Revisit your coaching curriculum for a refresher. This training explains coaching and the role you may decide to assume as an ACP WBC peer coach. Even if you decide not to be a peer coach, the techniques you will learn in this training will help you succeed in your role as a WBC.
In the News
Benefits of Coaching by Institute of Coaching McLean, Affiliate of Harvard Medical School Explore evidence-based coaching research and the benefits of coaching for individuals and organizations. Read Now! Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians by Tyra Fainstad, MD, Adrienne Mann, MD, Krithika Suresh, PhD, et al JAMA Network
From the Trenches
Supporting a Colleague in Need by Kerri Palamara, MD, MACP Looking out for colleagues is an important role of Well-being Champions, and one that is more important than ever. A 2021 Physicians Foundation study (1) of 2500 physicians found that nearly 6 in 10 physicians reported experiencing inappropriate feelings of anger, tearfulness, or anxiety, and nearly 5 in 10 have withdrawn or isolated themselves from others. In addition, one-third of physicians reported feeling hopeless or without a purpose.
Displaying 351 - 360 of 6736 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
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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.
Time-Restricted Eating in Adults With Metabolic Syndrome: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 177, No 11
Background: Time-restricted eating (TRE), limiting daily dietary intake to a consistent 8 to 10 hours without mandating calorie reduction, may provide cardiometabolic benefits. Objective: To determine the effects of TRE as a lifestyle intervention combined with current standard-of-care treatments on cardiometabolic health in adults with metabolic syndrome. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT04057339) Setting: Clinical research institute. Participants: Adults with metabolic syndrome including elevated fasting glucose or hemoglobin A1c (HbA1c; pharmacotherapy allowed). Intervention: Participants were randomly assigned to standard-of-care (SOC) nutritional counseling alone (SOC group) or combined with a personalized 8- to 10-hour TRE intervention (≥4-hour reduction in eating window) (TRE group) for 3 months. Timing of dietary intake was tracked in real time using the myCircadianClock smartphone application. Measurements: Primary outcomes were HbA1c, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance, and glycemic assessments from continuous glucose monitors. Results: 108 participants from the TIMET study completed the intervention (89% of those randomly assigned; 56 women, mean baseline age, 59 years; body mass index of 31.22 kg/m2; eating window of 14.19 hours). Compared with SOC, TRE improved HbA1c by −0.10% (95% CI, −0.19% to −0.003%). Statistical outcomes were adjusted for age. There were no major adverse events. Limitation: Short duration, self-reported diet, potential for multiple elements affecting outcomes. Conclusion: Personalized 8- to 10-hour TRE is an effective practical lifestyle intervention that modestly improves glycemic regulation and may have broader benefits for cardiometabolic health in adults with metabolic syndrome on top of SOC pharmacotherapy and nutritional counseling. Primary Funding Source: National Institutes of Health.
Physician Humility: A Review and Call to Revive Virtue in Medicine
Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians’ actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.
Visual Guideline - Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Visual Clinical Guideline From the American College of Physicians
The purpose of this visual clinical guideline is to provide a visual summary of ACP's clinical guideline, “Newer Pharmacologic Treatments in Adults With Type 2 Diabetes.” In addition, this visual clinical guideline features an interactive data visualization of findings associated with ACP's clinical recommendations for this topic.
Displaying 351 - 360 of 4549 in IM Matters
Displaying 351 - 360 of 2336 in ACP Hospitalist
Displaying 351 - 360 of 500 in Annals of Internal Medicine: Clinical Cases
Antineutrophilic Cytoplasmic Antibody–Positive Vasculitis Associated With Thromboangiitis Obliterans in a Middle-Aged Man | Annals of Internal Medicine: Clinical Cases
Antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitides are autoimmune diseases with multisystem manifestations. We report the case of a 55-year-old Asian man with a history of cigarette smoking who presented with ischemic lesions of the extremities, a positive ANCA, and crescentic glomerulonephritis. We entertained the diagnosis of ANCA-positive vasculitis associated with thromboangiitis obliterans, a nonatherosclerotic inflammatory vascular disorder. The patient responded well to a combination of immunosuppressive medications and smoking cessation. Cigarette smoking could be a common pathogenic factor in both conditions. To our knowledge, this is the first case of its kind describing an association between ANCA-associated vasculitis and possible thromboangiitis obliterans.
Immunotherapy-Related Cutaneous Leukocytoclastic Vasculitis in a Patient With Metastatic Renal Cell Carcinoma | Annals of Internal Medicine: Clinical Cases
Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that presents as cutaneous palpable purpura. It is typically seen as a reaction to infection or certain drugs, most commonly nonsteroidal anti-inflammatory drugs or beta-lactams. Although less common, LCV can present as an adverse reaction to checkpoint inhibitor immunotherapy. Here, we present a rare case of an immunotherapy-induced LCV in a patient with metastatic renal cell carcinoma who was treated with nivolumab. This case highlights a rare side effect of a commonly used immunotherapy and highlights how quick recognition and initiation of treatment can easily improve clinical outcomes.
Pancreatic Intrapapillary Mucinous Neoplasm–Superior Mesenteric Vein Fistula Causing Pancreatitis Panniculitis and Polyarthritis Syndrome | Annals of Internal Medicine: Clinical Cases
Pancreatitis, panniculitis, polyarthritis is a rare syndrome attributed to leak of pancreatic enzyme into systemic circulation. Our patient presented with lower-extremity nodules and polyarthralgia. After extensive negative rheumatologic work-up, pancreatitis, panniculitis, polyarthritis syndrome was suspected. Pancreatic lipase level was greater than 20 000 U/L, without acute pancreatitis on imaging. He was initially managed with octreotide, with significant improvement noted. Ultimately, a fistula between a benign intraductal papillary mucinous neoplasm and the superior mesenteric vein was identified and managed surgically with symptom resolution. We discuss this rare triad, with a description of the diagnostic challenges and conservative management while awaiting definitive surgical treatment.
Mycoplasma hominis: A Case of Peritonitis and Hyperammonemia Syndrome in a Healthy Postpartum Woman | Annals of Internal Medicine: Clinical Cases
An 18-year-old woman with a recent uncomplicated spontaneous vaginal delivery presented with altered mental status and new ascites. She had elevated ammonia and blood urea nitrogen levels with normal hepatic enzymes. Peritoneal cultures eventually grew Mycoplasma hominis. She was successfully treated with 2 peritoneal drains and a prolonged course of moxifloxacin. A thorough literature review demonstrates, to our knowledge, that this is the second reported case of primary peritonitis due to M hominis in an immunocompetent patient, a possible index case of M hominis in a postpartum patient, and a potential index case of M hominis-induced hyperammonemia syndrome in an immunocompetent patient.
Spur-Cell Hemolytic Anemia | Annals of Internal Medicine: Clinical Cases
A woman was referred to our hospital for jaundice, subcutaneous bleeding, and anemia. Biopsy findings confirmed liver failure due to alcoholic cirrhosis. A peripheral-blood smear showed red blood cells with irregularly spaced spur-like projections, which indicated spur-cell hemolytic anemia. Spur-cell anemia is an acquired hemolytic anemia associated with liver cirrhosis. The condition is characterized by the increased presence of large red blood cells covered with spike-like projections that vary in width, length, and distribution. Despite the poor prognosis of spur-cell anemia, supportive measures have been effective for 9 months in this case in anticipation of a liver transplantation.
Use of Maribavir for Multidrug-Resistant Cytomegalovirus in an Immunocompromised Host With HIV and Common Variable Immunodeficiency | Annals of Internal Medicine: Clinical Cases
We present a case of multidrug-resistant Cytomegalovirus (CMV) and the use of maribavir, a novel oral treatment of resistant CMV, in a nontransplant immunocompromised host. Our patient initially was diagnosed with CMV pharyngitis on biopsy. Although his initial CMV pharyngitis resolved, the CMV isolated from blood became resistant to ganciclovir and cidofovir and eventually required treatment with foscarnet. Our patient was given a trial of maribavir. After 6 weeks, the patient's viremia resolved and remained undetectable for 6 months after treatment initiation with maribavir. This case demonstrates the feasibility of using maribavir for resistant CMV in a nontransplant, immunocompromised patient.
Immune Thrombocytopenic Purpura Associated With Capnocytophaga Bacteremia | Annals of Internal Medicine: Clinical Cases
Capnocytophaga canimorsus is a gram-negative, capnophilic bacillus commonly found in the oral flora of healthy dogs and cats. C canimorsus can be transmitted to humans via animal bites, scratches, or close contact. Previously, severe C canimorsus sepsis has been associated with thrombotic microangiopathies, such as hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation. We present here a novel case of secondary immune thrombocytopenia caused by C canimorsus bacteremia following a dog bite to underscore the importance of a thorough history in patients presenting with severe, unexplained thrombocytopenia.
Tegsedi-Induced Warm Antibody Autoimmune Hemolytic Anemia | Annals of Internal Medicine: Clinical Cases
Autoimmune hemolytic anemia is a hemolytic disorder in which antibodies attack erythrocytes, causing their destruction. Many medications have been linked to autoimmune hemolytic anemia, such as antibiotics, chemotherapy agents, and nonsteroidal anti-inflammatory drugs. Inotersen (Tegsedi [Sobi]) is a medication used for stage 1 or stage 2 polyneuropathy in patients with hereditary transthyretin-mediated amyloidosis. It limits production and deposition of the transthyretin protein. Serious adverse effects include anemia, thrombocytopenia, and glomerulonephritis. We present a case of warm antibody autoimmune hemolytic anemia in a patient with hereditary transthyretin-mediated amyloidosis on Tegsedi that has not yet been reported in current literature, to our knowledge. This finding establishes the importance of continuous laboratory monitoring when administering this medication.
Successful Salvage Therapy With Infliximab in Carbamazepine-Induced Toxic Epidermal Necrolysis Complicated With Severe Acute Colitis | Annals of Internal Medicine: Clinical Cases
Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction to drugs. We report a case of a severe acute colitis mimicking an ulcerative colitis concomitant with carbamazepine-induced TEN. Five days of intravenous methylprednisolone did not improve the digestive symptoms. Intensified infliximab treatment led to a complete clinical and endoscopic remission. No relapse occurred after 2 years of follow-up without maintenance treatment. Our case suggests that infliximab is a new therapeutic option in this rare extracutaneous manifestation of TEN.
Severe, Refractory Primary Warm Autoimmune Hemolytic Anemia Requiring 90 Erythrocyte Transfusions | Annals of Internal Medicine: Clinical Cases
A previously healthy 60-year-old man presented to the hospital with a hemoglobin of 3.5 g/dL. He was diagnosed with severe warm autoimmune hemolytic anemia with reticulocytopenia on hospital day 1 that was not responsive to steroids, immune globulin, and rituximab. Over a 42-day hospital stay, the patient remained continuously transfusion-dependent with a 90 red cell unit requirement for his refractory disease. He was trialed on therapeutic plasma exchange before ultimately undergoing inpatient splenectomy that led to a response within hours. He remains in complete remission at 6 months of follow-up.