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- Annals of Internal Medicine (6914)
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- Annals of Internal Medicine: Clinical Cases (499)
Displaying 361 - 370 of 7460 in ACP Online
Create and sustain positive work and learning environments and culture in medicine
Apply positive systems changes skills in 2 mins. or less with ACP’s unique mobile-friendly microlearning resources. Learn about Promoting Psychological Safety, Your Circles of Control and Influence, and Standing Up to Bias and Harassment.
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
Displaying 361 - 370 of 6914 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
Colorectal Cancer Screening Completion and Yield in Patients Aged 45 to 50 Years: An Observational Study: Annals of Internal Medicine: Vol 177, No 12
Background: Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years. Objective: To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years. Design: Retrospective cohort study. Setting: Kaiser Permanente Northern California, Washington, and Colorado. Patients: Those distributed a FIT kit during January to September 2022. Measurements: FIT completion within 3 months, FIT positivity, receipt of colonoscopy within 3 months after a positive FIT result, and colonoscopy yield. Results: A total of 267 732 FIT kits were distributed: 213 928 (79.9%) to patients aged 45 to 49 years, and 53 804 (20.1%) to those aged 50 years. Overall, FIT completion was slightly higher in patients aged 45 to 49 years (38.9% vs. 37.5%; adjusted risk ratio [aRR], 1.05 [95% CI, 1.04 to 1.06]), although at Colorado, those aged 45 to 49 years were substantially less likely to complete a FIT (30.7% vs. 40.2%; aRR, 0.77 [CI, 0.73 to 0.80]). Overall, FIT positivity was lower in patients aged 45 to 49 years (3.6% vs. 4.0%; aRR, 0.91 [CI, 0.84 to 0.98]), and receipt of colonoscopy after a positive FIT result was similar between groups (64.9% vs. 67.4%; aRR, 1.00 [CI, 0.94 to 1.05]). Adenoma detection was lower in the younger group (58.8% vs. 67.7%; aRR, 0.88 [CI, 0.83 to 0.95]). Yields were similar for adenoma with advanced histology (13.2% vs. 15.9%; aRR, 0.86 [CI, 0.69 to 1.07]), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR, 0.68 [CI, 0.44 to 1.04]), sessile serrated lesion (10.3% vs. 11.7%; aRR, 0.92 [CI, 0.71 to 1.21]), and CRC (2.8% vs. 2.7%; aRR, 1.10 [CI, 0.62 to 1.96]). Limitation: The small number of neoplasia events contributed to wide CIs. Conclusion: Similar FIT completion and yield rates in people aged 45 to 50 years support initiation of CRC screening at age 45 years. Primary Funding Source: Kaiser Permanente Sidney R. Garfield Memorial Fund.
Infectious Diseases: What You May Have Missed in 2023
In 2023, published research on COVID-19 remains prominent. The aim of this article is to highlight important developments in infectious disease evidence unrelated to COVID-19 that were published in 2023. The literature was screened for sound new evidence relevant to internal medicine specialists and subspecialists whose focus of practice is not infectious diseases. The highlighted publications relate to various organisms and patient populations. One article provides insight into the updated guidelines for the diagnosis and management of infective endocarditis. Several articles address the management of sepsis and bacteremia: comparison of cefepime versus piperacillin–tazobactam, ceftobiprole for the treatment of complicated Staphylococcus aureus bacteremia, and early switch from intravenous to oral antibiotics in patients with gram-negative bacteremia. Another article examines differences in all-cause mortality in patients with Clostridioides difficile infection who receive different treatments. Additional articles provide evidence about the treatment of patients with HIV infection: the utility of preexposure prophylaxis to prevent HIV infection, the efficacy of pitavastatin in reducing cardiovascular disease, and the efficacy of dexamethasone for the treatment of tuberculous meningitis in persons with HIV.
Rheumatology: What You May Have Missed in 2023
Many patients with rheumatologic conditions receive care from physicians other than rheumatologists. Here we note key findings from 6 studies in rheumatology published in 2023 that offer valuable insights for internal medicine specialists and subspecialists outside of rheumatology. The first study investigated the effect of low-dose glucocorticoids on patients with rheumatoid arthritis (RA) over 2 years and challenged existing perceptions about the risks of glucocorticoids in this setting. The second study focused on the updated guideline for preventing and treating glucocorticoid-induced osteoporosis. With the chronic and widespread use of glucocorticoids, the American College of Rheumatology emphasized the importance of assessing fracture risk and initiating pharmacologic therapy when appropriate. The third study explored the potential use of methotrexate in treating inflammatory hand osteoarthritis, suggesting a novel approach to managing this challenging and common condition. The results of the fourth article we highlight suggest that sarilumab has promise as an adjunct treatment of polymyalgia rheumatica relapse during glucocorticoid dosage tapering. The fifth study evaluated sublingual cyclobenzaprine for fibromyalgia treatment, noting both potential benefits and risks. Finally, the sixth article is a systematic review and meta-analysis that assessed the therapeutic equivalence of biosimilars and reference biologics in the treatment of patients with RA. Knowledge of this recent literature will be useful to clinicians regardless of specialty who care for patients with these commonly encountered conditions.
Long COVID Definitions and Models of Care: A Scoping Review: Annals of Internal Medicine: Vol 177, No 7
Background: Definitions of long COVID are evolving, and optimal models of care are uncertain. Purpose: To perform a scoping review on definitions of long COVID and provide an overview of care models, including a proposed framework to describe and distinguish models. Data Sources: English-language articles from Ovid MEDLINE, PsycINFO, the Cochrane Library, SocINDEX, Scopus, Embase, and CINAHL published between January 2021 and November 2023; gray literature; and discussions with 18 key informants. Study Selection: Publications describing long COVID definitions or models of care, supplemented by models described by key informants. Data Extraction: Data were extracted by one reviewer and verified for accuracy by another reviewer. Data Synthesis: Of 1960 screened citations, 38 were included. Five clinical definitions of long COVID varied with regard to timing since symptom onset and the minimum duration required for diagnosis; 1 additional definition was symptom score–based. Forty-nine long COVID care models were informed by 5 key principles: a core “lead” team, multidisciplinary expertise, comprehensive access to diagnostic and therapeutic services, a patient-centered approach, and providing capacity to meet demand. Seven characteristics provided a framework for distinguishing models: home department or clinical setting, clinical lead, collocation of other specialties, primary care role, population managed, use of teleservices, and whether the model was practice- or systems-based. Using this framework, 10 representative practice-based and 3 systems-based models of care were identified. Limitations: Published literature often lacked key model details, data were insufficient to assess model outcomes, and there was overlap between and variability within models. Conclusion: Definitions of long COVID and care models are evolving. Research is needed to optimize models and evaluate outcomes of different models. Primary Funding Source: Agency for Healthcare Research and Quality. (Protocol posted at https://effectivehealthcare.ahrq.gov/products/long-covid-models-care/protocol.)
Ethics and Academic Discourse, Scientific Integrity, Uncertainty, and Disinformation in Medicine: An American College of Physicians Position Paper
Respect for the scientific process and a diversity of views; open discourse and debate based on principles of ethics, best available evidence, and scientific inquiry and integrity; and an understanding of evidence gaps and uncertainty and how to communicate about them are important values in the advancement of science and the practice of medicine. Physicians often must make decisions about their recommendations to patients in the face of scarce or conflicting data. Are these characteristics of medicine and science widely understood and effectively communicated among members of the profession and to patients and the public? Issues of scientific integrity are longstanding, but COVID-19 brought them to the forefront, in an environment that was sometimes characterized by communication missteps as guidance came and went—or changed—quickly. Today, is open debate flourishing? Have some debates shed more heat than light? Are people losing confidence in science and medicine? In health care institutions? The American College of Physicians explores these issues and offers guidance in this position paper.
Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians
Cannabis, also known as marijuana, is the dried flowers, stems, seeds, and leaves of the Cannabis sativa plant. It contains more than 100 compounds, including tetrahydrocannabinol, which has psychoactive effects. Federal law prohibits the possession, distribution, and use of cannabis outside limited research activities, but most states have legalized cannabis for medical or recreational use. However, research into the potential therapeutic and adverse health effects of cannabis has been limited, in part because of the drug’s federal legal status. In this position paper, the American College of Physicians (ACP) calls for the decriminalization of possession of small amounts of cannabis for personal use and outlines a public health approach to controlling cannabis in jurisdictions where it is legal. ACP recommends the rigorous evaluation of the health effects and potential therapeutic uses of cannabis and cannabinoids as well as research into the effects of legalization on cannabis use. It also calls for evidence-based medical education related to cannabis and increased resources for treatment of cannabis use disorder.
Pulmonology: What You May Have Missed in 2023
The field of pulmonology saw significant advances in 2023. The publications highlighted in this article address advances and changes in practice related to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pleural disorders, and sleep-disordered breathing. One article reviews data examining the efficacy of vaccination against respiratory syncytial virus, a respiratory viral illness that has had devastating effects globally. Four studies evaluate the role of various therapies in COPD, including dupilumab, ensifentrine, pulmonary rehabilitation programs, and lung volume reduction versus endobronchial valves. Another study explores the effect on vascular events of positive-pressure ventilation in patients with sleep-disordered breathing and recent stroke. The use of combination therapy with rituximab and mycophenolate mofetil on progression-free survival in patients with nonspecific interstitial pneumonia is the topic of another study. We also highlight an update of clinical recommendations for the evaluation of patients with pleural disorders and a systematic review analyzing the effectiveness of inhaled corticosteroids as a supplement to dual therapy for COPD.
Nephrology: What You May Have Missed in 2023
This article highlights a selection of important nephrology studies published in 2023 that have relevance for nonnephrologist physicians. Four studies examined progression of chronic kidney disease or cardiovascular disease with respect to finerenone use, magnesium supplementation, iron markers, and COVID-19. Two studies examined treatments to improve specific aspects of chronic kidney disease management, including daprodustat to address anemia and patiromer to address hyperphosphatemia. One study showed that acetazolamide added to loop diuretics increased diuresis in acute decompensated heart failure across a wide range of renal function. Another study found that once-daily hydrochlorothiazide did not prevent kidney stone recurrence. Finally, an antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infection in frail older adults.
Displaying 361 - 370 of 3165 in IM Matters
Displaying 361 - 370 of 2449 in ACP Hospitalist
Displaying 361 - 370 of 499 in Annals of Internal Medicine: Clinical Cases
Pyoderma Gangrenosum Mimicking Necrotizing Fasciitis in a Marathon Runner With Myelodysplastic Syndrome | Annals of Internal Medicine: Clinical Cases
A 62-year-old man with myelodysplastic syndrome presented with fever, leukocytosis, and a violaceous lesion on his right leg. His skin lesion worsened, and his fever persisted despite him receiving broad-spectrum antibiotics and multiple surgical debridements for a presumptive diagnosis of necrotizing fasciitis. Through careful review of histopathologic findings and his clinical presentation, he was subsequently diagnosed with pyoderma gangrenosum (PG). This case highlights an important diagnostic challenge. PG should be suspected in cases of nonresolving soft-tissue infection, particularly in the context of associated systemic disease, negative microbiological results, and negative work-up for autoimmune and malignant conditions.
Eosinophilic Fasciitis: Clinical Signs Leading to Diagnosis | Annals of Internal Medicine: Clinical Cases
Eosinophilic fasciitis is a rare disease characterized by peripheral eosinophilia and inflammatory infiltrate on muscular fascia and subcutaneous tissue. Patients present with edema and stiffening of limbs, progressing rapidly to fibrosis. The Groove sign is a classical physical examination finding. A skin–fascia–muscle biopsy is the gold standard for diagnosis, but nuclear magnetic resonance imaging is also useful. Glucocorticoids in high doses are the initial treatment of choice. We report the patient case of a 22-year-old man with expressive eosinophilia and whose clinical findings (Groove sign and others) led to the diagnosis.
Pediatric COVID-19–Associated Cavernous Sinus Thrombosis | Annals of Internal Medicine: Clinical Cases
This report details the physical and imaging findings associated with a pediatric case of cavernous sinus thrombosis (CST) that developed in the setting of COVID-19 infection, sinusitis, and orbital cellulitis. COVID-19 is rarely associated with CST but may contribute to the development by inducing hypercoagulability.
Deep Rectal Ulceration Associated With Hydrogel Spacer for Prostate Radiation Therapy | Annals of Internal Medicine: Clinical Cases
The report highlights the importance of having a high suspicion of rectal ulceration in patients after radiation therapy. We present a case of 57-year-old man with a history of stage IIIc prostate cancer who developed a solitary rectal ulcer after radiation therapy with a hydrogel spacer. He was diagnosed during colonoscopy and responded well to a course of hyperbaric oxygen therapy.
Human Disease Caused by Kalamiella piersonii | Annals of Internal Medicine: Clinical Cases
Rare or unusual bacteria in blood cultures can be a diagnostic challenge. Here, we report a case of Kalamiella piersonii, a novel gram-negative Enterobacterales belonging to the proposed genus Kalamiella gen nov in the Erwiniaceae family. A 56-year-old woman with a medical history of end-stage nonischemic cardiomyopathy, receiving milrinone through a tunneled catheter, presented to our emergency department with chills and was found to be bacteremic with gram-negative bacilli identified as K piersonii. She was treated with 14 days of intravenous piperacillin-tazobactam without complications.
Severe Rhabdomyolysis After COVID-19 Vaccine | Annals of Internal Medicine: Clinical Cases
A 65-year-old man presented with muscle pain and muscle weakness lasting 1 week that started after his second BNT162b2 COVID-19 vaccine. He had been taking rosuvastatin and gemfibrozil for several years. He was diagnosed with acute kidney failure caused by rhabdomyolysis resulting from a statin-fibrate interaction from a COVID-19 vaccination and was admitted for continuous venovenous hemodiafiltration. Rhabdomyolysis following messenger RNA COVID-19 vaccination is a rare but important adverse event in patients using high-dose statins combined with fibrates. Such patients should be warned to seek medical attention in case of ongoing muscle symptoms after vaccination.
Immune Checkpoint Inhibitor Use in Microscopic Colitis | Annals of Internal Medicine: Clinical Cases
Immune checkpoint inhibitors (ICIs) are a novel class of anticancer therapies that can result in autoimmune pathology known as immune-related adverse events (irAEs). Because of the risk for irAEs, patients with preexisting autoimmune diseases have been excluded from safety trials for ICIs. Although the pathophysiology of microscopic colitis is not fully understood, it is considered part of the spectrum of immune-mediated gastrointestinal diseases. Little is known about the effects of ICIs on patients with microscopic colitis. This case series describes 4 patients with microscopic colitis requiring ICIs for cancer therapy and gastrointestinal-related outcomes after ICI therapy.
Ileitis in Adult Multisystem Inflammatory Syndrome: A Case Report | Annals of Internal Medicine: Clinical Cases
Multisystem inflammatory syndrome (MIS) can manifest with nonspecific gastrointestinal symptoms, fever, shock, and cardiovascular dysfunction. Compared with children, MIS in adults (MIS-A) is rare. We present a definitive case of MIS-A (based on the Brighton criteria) in a young adult with fever, erythematous rash, and prominent gastrointestinal (ileitis) features, elevated inflammatory markers with evidence of cardiac involvement, and renal injury 4 weeks after confirmed SARS-CoV-2 infection. We highlight the histopathologic features from an ileal biopsy, which demonstrated reactive lymphocytic infiltrates. To our knowledge, this is the first report describing intestinal histopathologic findings in MIS-A.
Malignant Melanoma Disguised as Biliary Obstruction | Annals of Internal Medicine: Clinical Cases
In melanoma, symptomatic involvement of the small bowel is exceedingly rare. When melanoma spreads to the gastrointestinal tract, the prognosis worsens significantly. We present the case of a 70-year-old woman with secondary malignant melanoma of the gastrointestinal tract. Our patient, who had been treated for a stage I melanoma 4 years prior, presented with symptoms of frequent constipation, heartburn, and nausea. A biopsy of the masses on her back and axilla showed malignant melanoma. Computed tomography showed marked dilation of the common bile duct. Endoscopic retrograde cholangiopancreatography was unsuccessful owing to malignant infiltration of the ampulla. Biliary drainage via percutaneous port placement and immunotherapy were initiated.
Acute Localized Abdominal Pain From Primary Epiploic Appendagitis | Annals of Internal Medicine: Clinical Cases
This report describes primary epiploic appendagitis in a 40-year-old man. He had the classic physical finding of highly localized abdominal pain and the classic computed tomography findings of a hyperattenuating ring sign and a central dot sign.