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Displaying 371 - 380 of 7460 in ACP Online
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10 physicians reported experiencing inappropriate feelings of anger, tearfulness, or anxiety, and nearly 5 in 10 have withdrawn or isolated themselves from others.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.
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. Revisit Coaching Skills of GROW and Appreciative Inquiry Watch Video
January 20, 2023
Coaching Resources for Well-being Champions
Patients Before Paperwork
Advocacy in Action Now available: ACP's 2023 end-of-year graphic demonstrating ACP's advocacy in action. View here! ACP and the AMA AMA House of Delegates Takes Action on Medicare Payment, Prior Authorization, Physician Network Inadequacies and More
Noteworthy Resources
How to Ask Coaching Questions Carol Kauffman, PhD, ABPP, PCC, founder and co-chair of the Institute of Coaching at McLean, Affiliate of Harvard Medical School, shares an overview of and foundational skills for asking coaching questions. View here!
In the News
Benefits of Coaching for Individuals and Organizations 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! Research IDs Factors Linked to Internal Medicine Resident Flourishing by Elana Gotkine
From the Trenches
Supporting a Colleague in Need by Kerri Palamara, MD, MACP Republished from the January 2023 issue of I.M. Thriving
ACP Multimedia Education
Mini But Mighty Skills for Well-being: Appreciative Inquiry (15 minutes) View here!
Professional Fulfillment Zone
AVAILABLE NOW to ACP Members!The new year is the perfect time to prioritize your personal and professional growth. ACP's member-exclusive Physician Peer Coaching Program offers multiple opportunities to receive expert support to help you set a vision, create a plan, and achieve meaningful change in a sustainable way.
Displaying 371 - 380 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.
Cardiology: What You May Have Missed in 2023
Cardiology and all its subspecialties continue to push the envelope in developing new treatment strategies for a wide variety of diseases. After screening more than 1300 articles, we highlight a selection of important cardiology articles published in 2023. Starting with prevention, we note articles that look at the effect of semaglutide in patients with obesity as well as a first-in-class drug, bempedoic acid, on cardiovascular outcomes. We have also examined new evidence comparing conservative management with invasive management of frail, older patients with non–ST-segment elevation myocardial infarction (NSTEMI). In patients with cardiac arrest secondary to NSTEMI, another article examines the rationale for expedited transfer to a cardiac arrest center. The STREAM-2 (Strategic Reperfusion in Elderly Patients Early After Myocardial Infarction) trial builds on looking at half-dose thrombolysis in older populations with STEMI. Emphasis is placed on guideline-directed medical therapy before hospital discharge in those with heart failure. In addition, in patients with stable symptomatic coronary artery disease, initial noninvasive testing using coronary computed tomography angiography may be a viable option compared with invasive strategies. More details have emerged on anticoagulation strategies in those with device-detected atrial fibrillation. Finally, transcatheter approaches to treat both mitral and tricuspid regurgitation have also been included.
Effect of Four Hemoglobin Transfusion Threshold Strategies in Patients With Acute Myocardial Infarction and Anemia: A Target Trial Emulation Using MINT Trial Data: Annals of Internal Medicine: Vol 177, No 11
Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain. Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia. Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods. (ClinicalTrials.gov: NCT02981407) Setting: 144 clinical sites in 6 countries. Participants: 3492 MINT trial participants with acute MI and a hemoglobin level below 10 g/dL. Intervention: Four transfusion strategies to maintain patients’ hemoglobin concentrations at or above thresholds of 10, 9, 8, or 7 g/dL. Protocol exceptions were permitted for specified adverse clinical events. Measurements: Data from the MINT trial were leveraged to emulate 4 transfusion strategies and estimate per protocol effects on the composite outcome of 30-day death or recurrent MI (death/MI) and 30-day death using inverse probability weighting. Results: The 30-day risk for death/MI was 14.8% (95% CI, 11.8% to 18.4%) for a <10-g/dL strategy, 15.1% (CI, 11.7% to 18.2%) for a <9-g/dL strategy, 15.9% (CI, 12.4% to 19.0%) for a <8-g/dL strategy, and 18.3% (CI, 14.6% to 22.0%) for a <7-g/dL strategy. Absolute risk differences and risk ratios relative to the <10-g/dL strategy for 30-day death/MI increased as thresholds decreased, although 95% CIs were wide. Findings were similar and imprecise for 30-day death. Limitation: Unmeasured confounding may have persisted despite adjustment. Conclusion: The 30-day risks for death/MI and death among patients with acute MI and anemia seem to increase progressively with lower hemoglobin concentration thresholds for transfusion. However, the imprecision around estimates from this target trial analysis precludes definitive conclusions about individual hemoglobin thresholds. Primary Funding Source: National Heart, Lung, and Blood Institute.
Critical Care: What You May Have Missed in 2023
Critical care medicine is a specialty that brings together a truly wide spectrum of patient populations, disease states, and treatment methods. This article highlights 10 important pieces of research from 2023 (and 1 from 2022) in critical care. The literature was screened for new evidence relevant to internal medicine physicians and hospitalists whose focus of practice is not critical care but who may be taking care of seriously ill patients. The articles highlight the diverse spectrum of pathology and interplay of various specialties that go into critical care. Topics include transfusion medicine, fluid resuscitation, safe intubation practices and respiratory failure, and the management of acute ischemic stroke. Several trials are groundbreaking, forcing clinicians to reconsider preexisting dogma and likely adopt new treatment strategies.
Oncology: What You May Have Missed in 2023
Advances in oncology treatment methods have improved outcomes and quality of life for patients with cancer. However, care of these patients can be complex, and the contribution of physicians from different specialties is crucial. This article highlights important publications from 2023 on topics across a wide spectrum relating to the management of oncology patients. The literature was screened for significant new evidence that is relevant to internal medicine specialists and subspecialists whose focus is not oncology. Two articles address the importance of social interventions targeting end-of-life care for low-income and minority patients and the well-being of caregivers. Two additional articles address screening considerations in patients at risk for colorectal and lung cancer. Two more articles address safe use of hormone-related therapies to treat symptoms of menopause and prevent disease recurrence or progression in patients diagnosed with noninvasive breast neoplasia. Finally, several articles were included on topics related to COVID-19 vaccination in patients with cancer, use of cannabinoids for cancer pain control, chronic autoimmune adverse effects related to use of immune checkpoint inhibitors, and the incidence of second primary neoplasms.
Gastroenterology/Hepatology: What You May Have Missed in 2023
This article summarizes clinically important gastroenterology developments from 2023 for internal medicine specialists. In colorectal cancer screening, a new RNA fecal screening test is on the horizon, as well as a new analysis on the benefits of using artificial intelligence in screening colonoscopy to detect more polyps. There is new evidence for management of gastrointestinal bleeding, a new drug for treatment of recurrent small-intestinal angiodysplasia, and a new endoscopic treatment method in patients with gastrointestinal tumor bleeding. The authors feature a randomized trial about amitriptyline as treatment for patients with irritable bowel syndrome by primary care providers and bring you news about new biologic agents for inflammatory bowel disease and eosinophilic esophagitis. Finally, they review 2 important articles on new terminology and management of metabolic dysfunction–associated fatty liver disease.
Displaying 371 - 380 of 3165 in IM Matters
Displaying 371 - 380 of 2449 in ACP Hospitalist
Displaying 371 - 380 of 499 in Annals of Internal Medicine: Clinical Cases
Male Mammary Myofibroblastoma | Annals of Internal Medicine: Clinical Cases
Mammary myofibroblastoma is a rare mesenchymal neoplasm that represents less than 1% of breast tumors. It is a benign lesion first described in 1987 and to date has a minimal number of reported cases. Clinical knowledge of its presence is important as it can strongly resemble malignant tumors owing to its nonspecific imaging findings and morphologically similar appearance to its aggressive counterparts. We present a case of a unilateral myofibroblastoma in a late 50-year-old male. The rare tumor was found incidentally during a cardiac work-up, which led to extensive imaging and immunohistochemical analysis to definitively make the diagnosis.
An Uncommon Cause of Cardiac Arrest: Tamponade Secondary to Malignant Pericardial Effusion From Myxoid Sarcoma | Annals of Internal Medicine: Clinical Cases
Primary tumors involving the pericardium are rare and often are incidentally discovered with transthoracic echocardiography. These tumors cause complications from obstruction of cardiac function with hemodynamic instability. We present a case of a 30-year-old man with primary myxoid sarcoma that resulted in cardiac arrest from malignant pericardial effusion. Despite partial resection and chemotherapy, the patient died. Despite being rare, with a 2-year survival of 60%, it is important for clinicians to be able to recognize complications from this tumor. Although no formal guidelines exist, performing surveillance echocardiography in this patient population could prevent some complications.
Lacrimal Gland Enlargement as an Extraintestinal Manifestation of Crohn Disease: A Case Report | Annals of Internal Medicine: Clinical Cases
A 29-year-old woman was referred for a 3-month history of recurrent fever, abdominal pain, and diarrhea. Abdominal computed tomography (CT) scans revealed diffuse intestinal wall thickening involving the transverse colon. When her abdominal pain recurred 1 month later, she noticed bilateral upper eyelid edema with an “S-shaped” contour. Lacrimal gland CT scans revealed enlarged lacrimal glands. Crohn disease sometimes presents with extraintestinal symptoms including ocular complications. Dacryoadenitis is rarely associated with ocular complications. Enteroscopy revealed a noncaseating granuloma in the small intestine, and Crohn disease was diagnosed. We report the characteristics of dacryoadenitis resulting from Crohn disease and review published case reports.
Muscular Polyarteritis Nodosa: A Case Series Study of 6 Patients | Annals of Internal Medicine: Clinical Cases
A subset of polyarteritis nodosa known as muscular polyarteritis nodosa (MPAN) is a disease process that remains mostly limited to the muscle. Here, we report 6 patient cases of MPAN for which we investigated the clinical features. We examined 6 patients who visited our department between April 2010 and October 2019 and had a confirmed diagnosis of MPAN. The clinical features of MPAN include fever, myalgia, muscle tenderness without restricted joint range of motion, elevated C-reactive protein levels, and normal creatine kinase levels. In the presence of such features, MPAN should be suspected and magnetic resonance imaging and biopsy be performed.
Pylephlebitis With Concomitant Fusobacterium Bacteremia: Lemierre's Syndrome Variant of the Gut | Annals of Internal Medicine: Clinical Cases
Pylephlebitis is a rare complication of intra-abdominal infections, and Fusobacterium, traditionally associated with thrombophlebitis of the internal jugular vein, is an extremely rare causative organism. This infection is associated with high morbidity and mortality, and there is still some controversy about management. Here, we report a patient who presented with pylephlebitis and Fusobacterium bacteremia and responded well to a short course of intravenous antibiotics, finished therapy in the outpatient setting, and made a full recovery. We also review relevant literature on treatment strategies including antibiotics, anticoagulation, and screening endoscopy.
Unstable Atrial Fibrillation RVR and DNR: A Challenging Ethical Dilemma | Annals of Internal Medicine: Clinical Cases
An 82-year-old man with history of dementia and atrial fibrillation (AF) was admitted for sepsis and subsequently developed AF with rapid ventricular response (RVR). Given a recent do not resuscitate (DNR) order, there was disagreement among providers regarding the use of direct current cardioversion (DCCV). This patient case reveals the ethical challenges faced by providers when patients with a DNR order develop unstable AF with RVR and discusses an ethical framework for decision-making regarding DCCV in patients with a DNR order. This case also promotes changes to clinical practice, such as discussing DCCV when discussing code status and replacing DNR with “no cardiopulmonary resuscitation.”
Cryoglobulinemic Glomerulonephritis Presenting as Acute Kidney Injury on Chronic Kidney Disease in Rheumatoid Arthritis | Annals of Internal Medicine: Clinical Cases
Cryoglobulinemic vasculitis (CV) is one of the manifestations of rheumatoid arthritis (RA). Here, we present a case of a 69-year-old woman with uncontrolled long-standing RA who presented with heart failure exacerbation and had an incidental finding of persistent acute kidney injury, which led to the diagnosis of CV. The rarity of its co-occurrence with RA and the serious consequences from progressive kidney damage makes this case a key learning encounter.
Paget-Schroetter Syndrome in Nonathletic 31-Year-Old Female Without Hypercoagulopathy | Annals of Internal Medicine: Clinical Cases
Paget-Schroetter syndrome is an infrequent event in which an upper-extremity thrombosis forms typically after strenuous overhead activities, such as weight-lifting, swimming, pitching, and wrestling. This occurs most frequently in athletic men in their second or third decade of life and may be associated with thoracic outlet anatomical abnormalities that result in venous compression and increased risk for repetitive microtrauma leading to thrombosis. An atypical presentation in a 31-year-old nonathletic woman information technology worker without hypercoagulability is presented here.
Antineutrophil Cytoplasmic Antibody–Associated Orbital Inflammatory Syndrome Without Extraocular Manifestations | Annals of Internal Medicine: Clinical Cases
The differential diagnosis of acute visual loss includes many ischemic, infiltrative, and rheumatologic etiologies. We present a case of antineutrophil cytoplasmic antibody (ANCA)-associated orbital inflammatory syndrome without extraocular manifestations. Initial complaints were vision loss and pain during mastication. Giant cell arteritis was suspected, but biopsy was negative. On withdrawal of steroids, symptoms returned and a head computed tomography scan showed an orbital pseudotumor. Testing showed strongly positive c-ANCA, and symptoms resolved after pulsed steroids. The patient was discharged with a probable diagnosis of ANCA-associated orbital inflammatory syndrome, prednisone, and methotrexate. This case highlights the importance of an extensive work-up in the evaluation of acute visual loss.
Alanine Aminotransferase Deficiency in a Patient With Hyperferritinemia, Steatosis Hepatis, and Hepatosplenomegaly | Annals of Internal Medicine: Clinical Cases
The glutamate pyruvate transaminase enzyme, also called alanine aminotransferase (ALT), plays an important role in gluconeogenesis and amino acid metabolism. It catalyzes the reversible transamination of L-alanine and α-ketoglutarate to pyruvate and L-glutamate. ALT is mostly located in the liver but is also present in other organs like kidney, heart, skeletal muscle, pancreas, and spleen. ALT deficiency was reported in a case of hepatitis B and hepatitis C infection, whereas complete absence of ALT, to our knowledge, has only been reported in 1 case of acute liver failure.