Search Results for ""
- ACP Online (7460)
- Annals of Internal Medicine (6914)
- ACP Store (242)
- IM Matters (3165)
- ACP Hospitalist (2449)
- Annals of Internal Medicine: Clinical Cases (499)
Displaying 381 - 390 of 7460 in ACP Online
Patients Before Paperwork
Advocacy in Action ACP Preps Advocacy To-Do List for New Trump Administration In the wake of the election of President-elect Donald Trump, there has been much media speculation about whom he will appoint to his Cabinet and what health care legislation may be repealed or dissected for parts; the American College of Physicians is currently working to make sure its voice will be heard.
Noteworthy Resources for Well-being
ACP: Design Your Own Well-being Program Explore these tools to create a well-being program tailored to any organization's needs and budget. View here!
In the News
Association of Work Control With Burnout and Career Intentions Among U.S. Physicians: A Multi-Institution Study Annals of Internal Medicine: Christine A. Sinsky, MD; Roger L. Brown, PhD; Lisa Rotenstein, MD; Lindsey E. Carlasare, MBA; Purva Shah, BS; and Tait D. Shanafelt, MD
From the Trenches
“Top 10 Tips to Beat Loneliness at Work” In this article from ACP's I.M. Matters, Kerri Palamara, MD, MACP, discusses how the challenge of isolation and loneliness at work can be exacerbated by personal and societal circumstances, workplace stressors, and technology. Read here!
Professional Fulfillment Zone: Internal Medicine Meeting 2026 Preview
The ACP Internal Medicine Meeting Heads to the West Coast April 16-18, 2026!Register now to join us at the Internal Medicine Meeting in San Francisco, CA!Register here!
Patients Before Paperwork
Advocacy in ActionACP: New Federal Changes to Student Loan Forgiveness Programs and Loan Limits Threaten the Physician Pipeline and Patient AccessACP is advocating against a new final rule on the Public Service Loan Forgiveness Program that will restrict program eligibility for certain nonprofit employers.
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
Efficacy of Individual-Level Interventions to Mitigate the Risk for Burnout Among Health Care Professionals: A Systematic Review and Meta-analysis of Randomized Controlled TrialsAnnals of Internal Medicine: G. Collett, PhD; J. Gupta, MD; A. Eltayeb, MBBS, MPH; A. Korszun, MD, PhD; L. Sharples, PhD; K. Rice, PhD; A.K. Gupta, MD, PhD
From the Trenches
“The lake at night: Music helped solve a medical mystery.”Learn how music helped solve a medical mystery from a special issue of ACP Hospitalist.Read here!
Displaying 381 - 390 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.
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.
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.
Viral Load–Based Prediction of Hepatocellular Carcinoma Risk in Noncirrhotic Patients With Chronic Hepatitis B: A Multinational Study for the Development and External Validation of a New Prognostic Model: Annals of Internal Medicine: Vol 177, No 10
Background: A nonlinear association between serum hepatitis B virus (HBV) DNA levels and hepatocellular carcinoma (HCC) risk has been suggested in patients with chronic hepatitis B (CHB). Objective: To develop and externally validate a prognostic model for HCC risk in noncirrhotic adult patients with CHB and no notable alanine aminotransferase (ALT) elevation. Design: Multinational cohort study. Setting: A community-based cohort in Taiwan (REVEAL-HBV [Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus]; REACH-B [Risk Estimation for HCC in CHB] model cohort) and 8 hospital-based cohorts from Korea and Hong Kong (GAG-HCC [Guide with Age, Gender, HBV DNA-HCC] and CU-HCC [Chinese University-HCC] cohorts). Participants: Model development: 6949 patients with CHB from a Korean hospital-based cohort. External validation: 7429 patients with CHB combined from the Taiwanese cohort and 7 cohorts from Korea and Hong Kong. Measurements: Incidence of HCC. Results: Over median follow-up periods of 10.0 and 12.2 years, the derivation and validation cohorts identified 435 and 467 incident HCC cases, respectively. Baseline HBV DNA level was one of the strongest predictors of HCC development, demonstrating a nonlinear parabolic association in both cohorts, with moderate viral loads (around 6 log10 IU/mL) showing the highest HCC risk. Additional predictors included in the new model (Revised REACH-B) were age, sex, platelet count, ALT levels, and positive hepatitis B e antigen result. The model exhibited satisfactory discrimination and calibration, with c-statistics of 0.844 and 0.813 in the derivation and validation cohorts with multiple imputation, respectively. The model yielded a greater positive net benefit compared with other strategies in the 0% to 18% threshold. Limitation: Validation in cohorts of other races and receiving antiviral treatment was lacking. Conclusion: Our new prognostic model, based on the nonlinear association between HBV viral loads and HCC risk, provides a valuable tool for predicting and stratifying HCC risk in noncirrhotic patients with CHB who are not currently indicated for antiviral treatment. Primary Funding Source: Korean government.
Displaying 381 - 390 of 3165 in IM Matters
Displaying 381 - 390 of 2449 in ACP Hospitalist
Displaying 381 - 390 of 499 in Annals of Internal Medicine: Clinical Cases
Hemophagocytic Lymphohistiocytosis in Refractory Celiac Disease Type II Transformed into Enteropathy-Associated T-Cell Lymphoma | Annals of Internal Medicine: Clinical Cases
Celiac disease (CD) can lead to small intestinal damage from gluten exposure. Refractory celiac disease type II (RCD2), a complication of CD, can transform to enteropathy-associated T-cell lymphoma (EATL). Hemophagocytic lymphohistiocytosis (HLH) is a rare complication that has been reported in patients with CD, RCD2, and EATL. We report the case of a 61-year-old man with a history of CD complicated by RCD2 that transformed into EATL with HLH as its presenting syndrome.
Hospital Stay Considerations in Hypermobile Ehlers-Danlos Syndrome: An Exemplary Case With Insights for Coexisting Symptoms | Annals of Internal Medicine: Clinical Cases
Ehlers-Danlos syndrome, hypermobility type, is a complex medical condition understood to be a genetic disorder resulting in abnormal collagen synthesis. It is characterized by joint hypermobility as well as skin laxity, poor wound healing, and other manifestations. It may present in conjunction with autonomic, neurologic, and immune abnormalities. Hypermobility spectrum disorder is similarly characterized by joint hypermobility but holds less extensive diagnostic criteria. When in the hospital setting, systemic differences resulting from hypermobility syndromes must be recognized to avoid harm. Here, we present the first case, to our knowledge, of a full hospital course with hypermobility syndrome–comorbidity-related complications described.
Deep Vein Thrombosis in a Patient With an Absent Infrarenal IVC | Annals of Internal Medicine: Clinical Cases
Absence of an infrarenal inferior vena cava is a rare anomaly that can be associated with deep venous thrombosis in young patients with no other provoking factors. Here, we present a patient case of a young man having groin pain and found to have gonadal vein and pampiniform plexus thromboses with an absent infrarenal inferior vena cava.
Peri-infarction Pericarditis: A Fading Complication of Myocardial Infarction | Annals of Internal Medicine: Clinical Cases
A 52-year-old man presenting with an anterior ST-segment elevation myocardial infarction (MI) had stent placement in the mid-left anterior descending coronary artery. A diagnosis of peri-infarction pericarditis (PIP) was made. The patient received acetaminophen and colchicine with complete symptom resolution and no complications. One of the diagnostic challenges with PIP is that the electrocardiographic changes are typically masked by the electrocardiographic changes seen in MI. Nonsteroidal anti-inflammatory drugs (except aspirin) and glucocorticoids should be avoided for 7 to 10 days after an acute MI because of the theory that impairment of collagen deposition and scarring can increase the risk for serious post-MI complications.
Sensing Error in Respironics Continuous Positive Airway Pressure Machine Risks Compromising Patient Compliance | Annals of Internal Medicine: Clinical Cases
We report a continuous positive airway pressure (CPAP) machine malfunction that may compromise patient compliance. A patient's Respironics DreamStation machine (Philips Respironics) was observed to sense “vibratory snore” events incorrectly, resulting in pressure increases that led to poor mask fit, large air leaks, and patient discomfort. A replacement machine developed the same problem. Once aware of the defect, we observed it in 2 other patients. The manufacturer acknowledges receiving a few similar reports, but our experience suggests that this may be an underreported defect. The resulting increased pressures reduce patient tolerance for CPAP. This may be an unrecognized cause for patients abandoning CPAP therapy.
Large Free-Floating Right Atrial Thrombus | Annals of Internal Medicine: Clinical Cases
We present the images of a 67-year-old man who came to the emergency department with bilateral lower extremity pain and shortness of breath. Our images include an intraoperative transesophageal echocardiogram that shows a large, continuous free-floating right atrial mass and a large 31 cm × 1 cm thrombus that was successfully extracted. The thrombus likely could not embolize because of the patient's severe heart failure.
Renal Sarcoidosis Presenting as Fanconi Syndrome | Annals of Internal Medicine: Clinical Cases
Fanconi syndrome is an extremely rare complication of renal sarcoidosis. We describe a case of biopsy-proven granulomatous interstitial nephritis secondary to sarcoidosis with the rare presenting feature of Fanconi syndrome. Our patient successfully received steroids initially, followed by mycophenolate and infliximab. These findings provide clinicians an important insight in recognizing this rare complication of sarcoidosis and opportunity to consider alternative regimens that can avoid or reduce side effects of first-line steroid therapy.
Concurrent Infective Endocarditis and Empyema From Salmonella arizonae | Annals of Internal Medicine: Clinical Cases
Although often associated with gastroenteritis, up to 30% of Salmonella infections are extraintestinal. Fewer than 50 cases of Salmonella empyema have been reported in the past century, and less than 2.9% of bacterial endocarditis cases are attributed to Salmonella species. Salmonella enterica subspecies arizonae generally causes mild disease and has been associated with reptiles or products containing rattlesnakes. We report the patient case of a 38-year-old man who presented to the hospital in septic shock and was found to have concurrent Salmonella bacteremia, endocarditis, and empyema with subspecies arizonae.
Atypical Hemolytic Uremic Syndrome Precipitated by Recurrent Pancreatitis | Annals of Internal Medicine: Clinical Cases
Atypical hemolytic uremic syndrome presents with negative direct antiglobulin test microangiopathic hemolytic anemia, acute kidney injury, and thrombocytopenia in the absence of diarrhea. Atypical hemolytic uremic syndrome may be triggered by drugs, infections, systemic lupus erythematosus, or, rarely, pancreatitis. Furthermore, recurrent hemolytic uremic syndrome should raise suspicion for complement-mediated atypical hemolytic uremic syndrome treated with eculizumab, an anti-C5 monoclonal antibody. Here, we report a case of complement-mediated atypical hemolytic uremic syndrome likely precipitated by recurrent alcohol-induced pancreatitis.
An Incidental Finding of Spontaneous Hepatic Artery Thrombosis in a Healthy Patient | Annals of Internal Medicine: Clinical Cases
Hepatic artery thrombosis (HAT) outside the setting of liver transplantation is exceedingly rare. Few cases of HAT leading to hepatic infarction have been reported, and management strategies have varied from symptom control to anticoagulation and antiplatelet therapy. Cases of spontaneous HAT without hepatic dysfunction, however, have not been previously reported. We report the case of an incidentally found spontaneous HAT without signs of hepatic dysfunction or injury in an otherwise healthy 45-year-old woman. Treatment consisted of therapeutic anticoagulation and antiplatelet therapy. Resolution of the HAT was confirmed by follow-up ultrasound imaging, and the patient remained free of HAT at 12-month follow-up magnetic resonance imaging.