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

March 21, 2025

Promoting Well-being at ACP Internal Medicine Meeting 2025

Professional Fulfillment Zone

Well-being Champion Curriculum Available Now to ALL ACP MembersWe are excited to announce that the ACP Well-being Champion modules are now available through the Online Learning Center!

Patients Before Paperwork

Advocacy in ActionLatest ACP AdvocacyACP advocates for you on policy changes that will make a difference in your daily work, your professional development, and your patients' health.Read here!

Noteworthy Resources for Well-being

New! WBC Social Share ZoneAttention all WBCs and ACP Chapter Leaders! Please take some time to explore our new Social Share Zone. We have compiled shareable graphics and resources highlighting well-being that you can use on social media, in presentations, or at your events. In addition, you will find resources on trauma education, physician suicide awareness, and ACP's Mini But Mighty Skills.Social Share Zone

In the News

Physicians Are Not Providers: The Ethical Significance of Names in Health Care: A Policy Paper From the American College of PhysiciansAnnals of Internal Medicine: L. Snyder Sulmasy, JD; J.K. Carney, MD, MPHACP Urges Precision in Health Care Terms: Don't Label Physicians Providers

From the Trenches

“Creative Wellness: A Journey Through Trust, Art, and Healing”In an essay originally published in REVAMP by the Center for Human and Organizational Potential, Vidya Sundareshan, MD, MPH, FACP, FIDSA, discusses how creativity isn't a luxury or a side project. It's a form of self-care, as essential as sleep or exercise.Read here!

March 20, 2026

Start a Domino Effect for Well-being Right Where You Are“Being a Well-being Champion came with some struggles early on, but it taught me how to welcome challenges and bring about change.

Patients Before Paperwork

What are ACP's Legislative, Regulatory, and Advocacy Priorities for 2023? Join us for our next webinar! ACP's legislative, regulatory, and advocacy priorities are always evolving. Join us on March 23, 2023, at 8:00 p.m. ET, as Shari Erickson, MPH (ACP's Chief Advocacy Officer and Senior Vice President of Governmental Affairs and Public Policy) takes a deep dive into ACP's priorities for 2023 and the role they play in shaping health care. Following the presentation, there will be a live Q&A session. Please submit your questions in advance when registering.

“Redlining” Maps and Contemporary Firearm Violence Research: Is It Time to Ask New Questions?

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.

Low-Value Care: A Multilayer Problem Requiring Multilayer Solutions

Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations

A Salty Odyssey: A Potassium-Enriched Journey Inspired by Don Quijote

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.

What You May Have Missed in 2023: Keeping Up With the Constant Flow of New Medical Evidence

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.

Cardiovascular Disease Mortality Among Native Hawaiian and Pacific Islander Adults Aged 35 Years or Older, 2018 to 2022

Background: Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults. Objective: To describe CVD mortality among NHPI adults. Design: Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022. Setting: Fifty states and the District of Columbia. Participants: Adults aged 35 years or older at the time of death. Measurements: CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death. Results: From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]). Limitation: Potential misclassification of underlying cause of death or race group. Conclusion: NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention. Primary Funding Source: National Institute of General Medical Sciences, National Institutes of Health.

Social, genetic factors improve prediction of CHD risk

MKSAP Quiz: Evaluation for painless hematuria

Many stroke survivors don't follow recommendations for physical activity, study finds

Updated guidance released on ART for HIV

Vote for your favorite entry

Antipsychotics associated with risk for acute respiratory failure in older patients with COPD

Urate-lowering therapy associated with benefit in patients with gout and CKD

MKSAP Quiz: UTI prevention in a patient with catheter

Risk for CVD events elevated years before type 2 diabetes diagnosis

Cost-effectiveness of HPV vaccination after age 26 low, varies by risk factors

Initiation of naltrexone at discharge reduced heavy alcohol use at three months | ACP Hospitalist

Hospital-onset resistant infection rate rose during pandemic, stayed elevated | ACP Hospitalist

Falls common after ICU stays, especially in first three months after discharge | ACP Hospitalist

When AI plays doctor | ACP Hospitalist

Therapeutic anticoagulation improves outcomes in sickle cell ACS vs. prophylactic dose | ACP Hospitalist

The spark of contrast in the kidney | ACP Hospitalist

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

Stroke risk may be lower than expected in patients diagnosed with AF while admitted | ACP Hospitalist

Elevated troponin level at sepsis diagnosis did not predict in-hospital mortality | ACP Hospitalist

Correction to ‘Choices in C. diff Care’ | ACP Hospitalist

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.

Acute Lower-Extremity Posterior Compartment Syndrome: A Rare Complication of Apixaban Use | Annals of Internal Medicine: Clinical Cases

Apixaban is an oral anticoagulant that directly inhibits factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in nonvalvular atrial fibrillation. Acute lower-extremity posterior compartment syndrome is a rare complication of apixaban use. We present a 78-year-old man with significant medical morbidities taking apixaban for atrial fibrillation presenting with posttraumatic extensive hemorrhagic bullae on the left proximal pretibial region secondary to anticoagulation. We recommend that clinicians develop awareness of the potential for serious bleeding complications of anticoagulants and devise strategies to identify the need for early recognition and prompt management.

Giant Coronary Artery Aneurysm After Breast Radiation in a Patient With Congenital Coronary Arteriovenous Fistula | Annals of Internal Medicine: Clinical Cases

An 84-year-old Hispanic woman with medical history of coronary artery disease, hypertension, breast cancer, and left circumflex coronary artery ectasia with arteriovenous fistula to the coronary sinus was found with a new giant obtuse marginal 1 (OM1) saccular aneurysm measuring 8.4 × 6.5 cm on gated computed tomography angiogram 15 years after the first coronary angiogram. Coronary artery aneurysms are unusual anomalies that are encountered in 0.3% to 4.9% of patients who undergo coronary angiography. The incidence of giant coronary artery aneurysm is reported at 0.02% and we are not aware of any reports of OM1. Here, we report an extremely rare case of a OM1 giant coronary artery aneurysm.

An Interesting Case of Hypercalcemia: Intrathyroidal Parathyroid Adenoma | Annals of Internal Medicine: Clinical Cases

Hyperparathyroidism is the most common cause of hypercalcemia in the general population, with most patients presenting with mild to moderate hypercalcemia on routine bloodwork. Serum parathyroid hormone levels, followed by neck imaging studies, are helpful in diagnosing and localizing parathyroid adenomas. Ectopic parathyroid adenoma causes diagnostic challenges. Here, we present the patient case of a 65-year-old man with severe and symptomatic hypercalcemia who was found to have an intrathyroidal parathyroid adenoma, confirmed only after thyroid resection. Although imaging and laboratory results were helpful in our evaluation, pathology was the key to establishing the final diagnosis.

Culture Negative Endocarditis With Tropheryma whipplei | Annals of Internal Medicine: Clinical Cases

Tropheryma whipplei endocarditis is an increasingly recognized cause of culture negative endocarditis but is challenging to diagnose and often not accompanied by typical symptoms of Whipple disease. In this report, we describe a case of T. whipplei endocarditis and share echocardiographic images from the patient case.

Massive Idiopathic Myocardial Calcification Associated With ANK2 Mutation of Uncertain Significance | Annals of Internal Medicine: Clinical Cases

Massive myocardial calcification is a rare condition for which both diagnosis and therapy are not clearly established in the literature. Although imaging features are often nonspecific, the combination of imaging pattern and clinical history may help determine the clinical implications of myocardial calcification. Here, we report a case of massive idiopathic calcification associated with a rare heterozygous ANK2 mutation of uncertain significance. Mutations in ANK2 are linked to abnormal regulation of intracellular sodium and calcium, predisposing patients to arrhythmias, but there is no description of myocardial calcification.

A Case of Lamotrigine-Induced Inflammatory Myositis | Annals of Internal Medicine: Clinical Cases

We describe a 21-year-old woman with bipolar disorder who started taking lamotrigine 2 months ago who presented with fever and weakness. Physical examination revealed an erythematous rash over the right thenar eminence, as well as proximal muscle weakness in bilateral upper and lower extremities. Magnetic resonance imaging of the lower extremities showed patchy bilateral enhancing myositis. Right quadriceps muscle biopsy revealed inflammatory myopathy. Subsequent bone marrow biopsy demonstrated hemophagocytic lymphohistiocytosis. The patient started a prednisone taper for suspected inflammatory myositis and achieved full remission. This is one of the first descriptions of lamotrigine inducing an autoimmune response presenting as an inflammatory myositis.

Letter From the AIMCC Editors | Annals of Internal Medicine: Clinical Cases

Cavernous Sinus Syndrome: A Unique Presentation of CD5+ Diffuse Large B-Cell Lymphoma | Annals of Internal Medicine: Clinical Cases

Abstract/Background Cavernous sinus syndrome (CSS) is characterized by signs and symptoms that result from the compression and/or disruption of function of the dural venous sinus. Causes of CSS include tumors, inflammation, infection, trauma, and cavernous sinus thrombosis. Although neoplasm is one of the most common causes of CSS in a series of case analyses, CSS is an exceedingly rare initial presentation of lymphoma. Additionally, CSS is a potential cause of secondary headaches, particularly in elderly patients with concomitant neurologic deficits. Here, we discuss a patient case of de novo CD5+ diffuse large B-cell lymphoma that initially presented as CSS.