January 16, 2026

Creating Connections and Bridging Communities at ACP's Internal Medicine Meeting“The best part of attending … is the networking.

Patients Before Paperwork

Over the years, the federal government has prioritized initiatives to improve the electronic exchange of health information and ensure that a patient's health information follows the patient across the health care continuum. ACP has been supportive of these goals and believes improved interoperability across the entire health care continuum will ultimately help decrease a lot of existing burden. However, it is not feasible for physicians to expend the time and resources necessary to become compliant with the recent health information sharing regulations given the ongoing COVID-19 pandemic.

Noteworthy Resources

Bibliotherapy Virtual Book Club Join your ACP colleagues and friends for a virtual book club! In January, the club is reading Quackery: A Brief History of the Worst Ways to Cure Everything by Lydia Kang, MD and Nate Peterson, with a Zoom discussion on January 31, 2021, at 5 p.m. EST. Discover what we can learn from wild, comical, and dangerous medical treatments prescribed by doctors in the past.

New ACP Webinars

Well-being Champion Webinar: Interprofessional Happy Hours as a Wellness Experience During the COVID-19 Pandemic Diana McNeill, MD, MACP; Kristin Dickerson

In the News

“National Physician Burnout Expert Shares Insights: ‘We Can Certainly Do Better’” By Christopher Cheney, HealthLeaders Dr. Tait Shanafelt discusses changes that need to be made at the organizational level and within the culture of medicine itself to help combat clinician burnout. While organizations must improve their health care delivery models, it is also important that individual physicians not see themselves as victims of a system they cannot control.

From the Trenches

By Brian Lich, Oklahoma Well-being Champion Though we are all glad to say goodbye to 2020, there is a lot that we should be proud of as we turn to the New Year. Twelve months ago, could you imagine that we as health care workers would be called superheroes? That there would be parades for us all around the country as we took a pandemic head-on? That you would bond with physicians across the world to take on a common enemy? Have you ever felt so close to your colleagues? To your patients? Have you ever had so many patients thank you for the work that you do?

January 15, 2021

Taking Care of Ourselves and Each Other

Well-being Activities at ACP Internal Medicine Meeting 2020

There are many well-being and professional fulfillment activities to choose from this year at the ACP Internal Medicine Meeting 2020. Browse the pre-courses, scientific programs, and nonticketed sessions at the Clinical Skills Center, and design an experience best suited to your interests and needs.

Patients Before Paperwork

ACP provided comments on a the recent Stark Law and Anti-Kickback Proposed Regulations that had several burden reduction elements, including provisions that would allow clinicians to claim full financial risk exceptions/safe harbors without submitting any additional documentation requirements.

Noteworthy Resources

Core IM Podcast Interprofessional Education Series Listen as Dr. Shreya Trivedi and the Core IM team welcome home health aides, social workers, case managers, and other care team members to discuss their training, scope of practice, and what physicians should know to work on effective interprofessional teams.

Moving Beyond Central Line–Associated Bloodstream Infections

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.

Resurgence of Dengue in the Era of Genomic Surveillance and Vaccines

Annals Video Summary - Attention Among Health Care Professionals: A Scoping Review

Annals Video Summary - Effect of Weight Loss Interventions on the Symptomatic Burden and Biomarkers of Polycystic Ovary Syndrome

Factors Associated With Recurrent Pediatric Firearm Injury: A 10-Year Retrospective Cohort Analysis: Annals of Internal Medicine: Vol 177, No 10

Background: Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. Objective: To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. Design: Multicenter, observational, cohort study. Setting: 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. Participants: Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. Measurements: From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients’ residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. Results: During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. Limitation: Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. Conclusion: Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. Primary Funding Source: National Institutes of Health.

Aspirin Use Prevalence for Cardiovascular Disease Prevention Among U.S. Adults From 2012 to 2021

Cost-Effectiveness of Extending Human Papillomavirus Vaccination to Population Subgroups Older Than 26 Years Who Are at Higher Risk for Human Papillomavirus Infection in the United States

Background: In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision making regarding potential human papillomavirus (HPV) vaccination of men and women aged 27 to 45 years (“mid-adults”). Objective: To examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case of expanding HPV vaccination to subgroups of mid-adults at increased risk for HPV-related diseases in the United States. Design: Individual-based transmission dynamic modeling of HPV transmission and associated diseases using HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation). Data Sources: Published data. Target Population: All U.S. mid-adults and higher-risk subgroups within this population. Time Horizon: 100 years. Perspective: Health care sector. Intervention: Expanding 9-valent HPV vaccination to mid-adults and higher-risk subgroups. Outcome Measures: ICERs and NNVs. Results of Base-Case Analysis: Expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated was projected to cost an additional $2 005 000, $763 000, and $1 164 000 per quality-adjusted life-year (QALY) gained, respectively. The NNVs to prevent 1 additional HPV-related cancer case were 7670, 3190, and 5150, respectively, compared with 223 for vaccination of persons aged 9 to 26 years (vs. no vaccination). Results of Sensitivity Analysis: The mid-adult strategy with the lowest ICER and NNV was vaccinating infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86 000 per QALY gained; NNV, 470). Limitation: Uncertainty about rate of new sex partners and natural history of HPV among mid-adults. Conclusion: Vaccination of mid-adults against HPV is substantially less cost-effective and produces higher NNVs than vaccination of persons younger than 26 years under all scenarios investigated. However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened. Primary Funding Source: Centers for Disease Control and Prevention.

Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A Cohort Study: Annals of Internal Medicine: Vol 177, No 11

Background: Use of a gestational (“surrogate”) carrier is increasingly common. Risk for maternal and neonatal adversity is largely unknown in this birthing population. Objective: To determine the risk for severe maternal morbidity (SMM) and severe neonatal morbidity (SNM) in gestational carriers. Design: Population-based cohort study. Setting: All of Ontario, Canada. Participants: All singleton births at more than 20 weeks’ gestation, from 2012 to 2021. Measurements: Exposure was type of conception, namely, gestational carriage (main exposure), unassisted conception (comparison group 1), and in vitro fertilization (IVF) (comparison group 2). Main composite outcomes were SMM and SNM. Modified Poisson regression models generated weighted relative risks (wRRs) using propensity score–based overlap weighting. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage. Results: Of all eligible singleton births, 846 124 (97.6%) were by unassisted conception, 16 087 (1.8%) by IVF, and 806 (0.1%) by gestational carriage. Respective risks for SMM were 2.3%, 4.3%, and 7.8%. The wRRs were 3.30 (95% CI, 2.59 to 4.20) comparing gestational carriage with unassisted conception and 1.86 (CI, 1.36 to 2.55) comparing gestational carriage with IVF. Respective risks for SNM were 5.9%, 8.9%, and 6.6%, generating wRRs of 1.20 (CI, 0.92 to 1.55) for gestational carriage versus unassisted conception and 0.81 (CI, 0.61 to 1.08) for gestational carriage versus IVF. Hypertensive disorders, postpartum hemorrhage, and preterm birth at less than 37 weeks were also significantly higher contrasting gestational carriers to either comparison group. Limitation: Absence of information about indications for choosing a gestational carrier, and oocyte or sperm donor source. Conclusion: Among singleton births of more than 20 weeks’ gestation, a higher risk for SMM and adverse pregnancy outcomes was seen among gestational carriers compared with women who conceived with and without assistance. Although gestational carriage was associated with preterm birth, there was less clear evidence of severe neonatal morbidity. Potential mechanisms for higher maternal morbidity among gestational carriers require elucidation, alongside developing special care plans for gestational carriers. Primary Funding Source: The Canadian Institutes of Health Research.

Default 90-day statin prescriptions reduced racial, income disparities in practice, trial finds

New guidance issued on cholesterol management in older patients with no history of cardiovascular disease

Updated guidance on HIV, periop management, and more stories

Teamwork needed to fight challenges to rural health care

Tallying the cardiac risk calculators

Primary care preps patients perioperatively

Postdischarge care: When a phone call is not enough

Our challenge to live, thrive through ‘interesting times'

MKSAP Quiz: 2-week history of dysphagia

Looking at ‘long COVID,’ five years later

Delaying broad-spectrum antibiotics does not affect outcomes, study finds | ACP Hospitalist

BMA discharge of Medicare patients with OUD associated with high readmission, mortality rates | ACP Hospitalist

Thinking harder about heparin | ACP Hospitalist

Take a quiz about the Jan. 22 issue! | ACP Hospitalist

Several core functions common to hospitals' discharge-by-noon interventions | ACP Hospitalist

Rules developed by new study help decide when to terminate resuscitation | ACP Hospitalist

Pulmonary embolism and deep venous thrombosis | ACP Hospitalist

Mobile vegetations pose highest embolism risk in infective endocarditis | ACP Hospitalist

In-hospital exercise improved physical function in heart failure patients | ACP Hospitalist

Unpalette-able | ACP Hospitalist

Cerebral Amyloid Angiopathy-Related Inflammation Presenting as Nontraumatic Subdural Hematoma | Annals of Internal Medicine: Clinical Cases

A 77-year-old woman presented with headache and confusion. Computed tomography of the head demonstrated an acute left falcine and tentorial subdural hemorrhage. Magnetic resonance imaging of the brain additionally showed sulcal hyperintensity on postcontrast T2-fluid attenuated inversion recovery images throughout the posterior left hemisphere with associated leptomeningeal enhancement. Magnetic resonance imaging 6 weeks later showed progression of these radiologic changes, prompting brain biopsy, which confirmed cerebral amyloid angiopathy-related inflammation (CAA-ri). To our knowledge, this is the first reported case of biopsy-proven CAA or CAA-ri presenting as acute nontraumatic subdural hemorrhage. This case suggests that CAA and CAA-ri may account for some nontraumatic subdural hemorrhages.

An Uncommon Progression of a Common AIDS-Defining Diagnosis: Metastatic Kaposi Sarcoma to Lung and Bone | Annals of Internal Medicine: Clinical Cases

AIDS-associated Kaposi sarcoma (KS) is an aggressive human herpesvirus 8–induced vascular tumor that presents as violaceous lesions on the skin or mucosal membranes. Although less common, extracutaneous metastasis of KS can involve the gastrointestinal tract, lungs, and lymph nodes. Here, we present a rare case of a newly diagnosed patient with HIV with typical KS of the gums and was found to have metastasis to the lung and ilium. This case highlights a rare presentation of an AIDS-defining disease and the importance of early diagnosis and metastatic screening.

A Case of Hypereosinophilia With Serositis Responsive to Mepolizumab | Annals of Internal Medicine: Clinical Cases

Idiopathic hypereosinophilic syndrome (IHES) is a disorder characterized by blood and tissue eosinophilia with eosinophil-driven tissue damage most commonly affecting the skin, lungs, and gastrointestinal tract and to a lesser degree the cardiovascular and coagulation systems. We discuss a case of IHES in a 62-year-old man who presented with serositis-predominant symptoms including ascites, pleural effusion, and an inflammatory polyarthritis with 6.0 × 109 eosinophils per liter with exclusion of other conditions to explain disease. This was a unique case of IHES with serositis at presentation without detectable autoimmune serologies and adds to the variability of a heterogeneous group of disorders with inadequately understood pathology.

Thrombotic Microangiopathy Secondary to Sirolimus Monotherapy in Orthotopic Liver Transplant | Annals of Internal Medicine: Clinical Cases

Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor often used in clinical conjunction with calcineurin inhibitors (CNIs) or mycophenolate mofetil to prevent solid organ transplant rejection. While nephrotoxicity is a well-known side effect of CNIs, renal injury because of mTOR inhibitors is exceedingly rare and limited to case reports, primarily in the setting of renal transplant and post-hematopoietic stem cell transplant. This case demonstrates a rare occurrence of sirolimus-induced thrombotic microangiopathy after orthotopic liver transplant.

Primary Hepatic Neuroendocrine Tumor in a Patient With Tuberous Sclerosis | Annals of Internal Medicine: Clinical Cases

Tuberous sclerosis is a rare multisystemic disease with common benign manifestations. However, recent research suggests a rare association with malignant tumors. We describe the case of a primary hepatic neuroendocrine tumor in a patient with tuberous sclerosis that is, to our knowledge, unique in the literature. A 23-year-old woman with tuberous sclerosis presented with an enlarging liver mass. Biopsy specimen pathology was consistent with a neuroendocrine tumor. She received chemotherapy and had an extensive resection which revealed a 12-cm, well-differentiated, primary hepatic neuroendocrine tumor.

Mycobacterium tuberculosis Myositis Without Concurrent Pulmonary Symptoms in a Patient With Immunosuppression | Annals of Internal Medicine: Clinical Cases

We describe a rare presentation of extrapulmonary tuberculosis in a patient with type 1 diabetes mellitus and dermatomyositis on immunosuppressive therapy. This case highlights important diagnostic considerations in particular patient populations and raises several interesting questions about the pathophysiology underlying this patient's complex disease presentation.

Subacute Invasive Pulmonary Aspergillosis Presenting With Pneumothorax | Annals of Internal Medicine: Clinical Cases

We report the case of a 43-year-old woman with subacute invasive aspergillosis after COVID-19 infection who presented with a pneumothorax. We discuss the spectrum of pulmonary disease due to Aspergillus and suggest that clinicians consider pulmonary aspergillosis in patients after respiratory viral infections such as COVID-19.

A Case of Pancreatic Schwannoma, a Rare and Often-Misdiagnosed Entity | Annals of Internal Medicine: Clinical Cases

Pancreatic schwannomas are an extremely rare form of schwannoma that can undergo malignant transformation. Patients can be asymptomatic or have nonspecific symptoms. Imaging also can be nonspecific. Biopsy with immunohistochemical staining can lead to diagnosis after excluding other neoplasms. Surgical excision is preferred, but conservative monitoring is performed if patients are not surgical candidates. We present a case of a 64-year-old man with a reported history of an intra-abdominal fibrosarcoma who was later found to have a pancreatic schwannoma after undergoing comprehensive diagnostic testing.

A Case of Retrograde Duodenal Prolapse Causing Gastric Outlet Obstruction | Annals of Internal Medicine: Clinical Cases

Antral prolapse of redundant duodenal mucosa is a rare cause of gastric outlet obstruction. We present a case of a 59-year-old man with recurrent postprandial emesis, nausea, and abdominal pain caused by intermittent pyloric obstruction from duodenal prolapse. This case highlights the importance of considering atypical causes to avoid diagnostic errors, ensure optimal outcomes, and reduce premature closure bias.

Ectopic Adrenocorticotropic Hormone–Secreting Metastatic Pancreatic Neuroendocrine Tumor Initially Presenting as Gastrinoma: A Case Report | Annals of Internal Medicine: Clinical Cases

Pancreatic neuroendocrine tumors (pNETs) account for 1% to 2% of all pancreatic malignancies; approximately one-third are associated with hormone secretion which can result in a range of symptoms. It is rare for pNETs to transform from secreting one type of peptide hormone to another. We present a case of metastatic pNET that originally presented as a gastrinoma, and later transformed to an ectopic adrenocorticotropic hormone–secreting pNET, treated with bilateral adrenalectomy. We describe the presentation and management of the patient and review the available literature on management of ectopic adrenocorticotropic hormone production in patients with neuroendocrine tumors.