January 16, 2026

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

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I.M. Thriving

ACP I.M. Thriving is an every other month newsletter that highlights learnings, news, and resources in the intersection of well-being and professional fulfillment, quality, and team-based care.

ACP Well-being Champions Chapter Leadership Program

Contact your ACP chapter for more detailsA key part of ACP’s Physician Well-being and Professional Fulfillment initiative is its chapter-based Well-being Champion program.

Physician Well-being and Professional Fulfillment Program | ACP

The Physician Well-being and Professional Fulfillment program fosters physician wellness, reduces administrative burdens, and more. Prevent physician burnout here.

Toolkit for Physicians and Caregivers on Informal Caregiving

This resource shares training and resources to help physicians partner with caregivers to improve health outcomes for patients and caregivers. Access it here.

Team-Based Care Toolkit

This toolkit shares resources and examples of successful team-based healthcare models for internal medicine physicians working with NPs and PAs. Read more.

Patient and Interprofessional Approach to Content Development

Learn about our content development process which follows a patient-centered approach, best practices for team-based healthcare, and an instructional design framework.

Healthcare Resources for Refugees, Asylees, and Non-Detained Asylum Seekers Living in the US

Physicians and their teams play an essential role in caring for asylum seekers, refugees, undocumented immigrants, and migrants. Clinicians may use this toolkit to better understand the background, healthcare coverage options and health considerations for this patient population.

Patient and Interprofessional Education

ACP’s Patient and Interprofessional Partnership Committee works to promote high quality education for all members of the healthcare team. Learn more.

The Ethics of Cancer Screening Based on Race and Ethnicity

Racial and ethnic disparities in incidence and mortality are well documented for many types of cancer. As a result, there is understandable policy and clinical interest in race- and ethnicity-based clinical screening guidelines to address cancer health disparities. Despite the theoretical benefits, such proposals do not typically address associated ethical considerations. Using the examples of gastric cancer and esophageal adenocarcinoma, which have demonstrated disparities according to race and ethnicity, this article examines relevant ethical arguments in considering screening based on race and ethnicity. Race- and ethnicity-based clinical preventive care services have the potential to improve the balance of harms and benefits of screening. As a result, programs focused on high-risk racial or ethnic groups could offer a practical alternative to screening the general population, in which the screening yield may be too low to demonstrate sufficient effectiveness. However, designing screening according to socially based categorizations such as race or ethnicity is controversial and has the potential for intersectional stigma related to social identity or other structurally mediated environmental factors. Other ethical considerations include miscategorization, unintended negative effects on health disparities, disregard for underlying risk factors, and the psychological costs of being assigned higher risk. Given the ethical considerations, the practical application of race and ethnicity in cancer screening is most relevant in multicultural countries if and only if alternative proxies are not available. Even in those instances, policymakers and clinicians should carefully address the ethical considerations within the historical and cultural context of the intended population. Further research on alternative proxies, such as social determinants of health and culturally based characteristics, could provide more adequate factors for risk stratification.

The Annual Cost of Cancer Screening in the United States

Background: Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. Objective: To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Design: Model using national health care survey and cost resources data. Setting: U.S. health care systems and institutions. Participants: People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. Measurements: The number of people screened and associated health care system costs by insurance status in 2021 dollars. Results: Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. Limitations: All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. Conclusion: The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. Primary Funding Source: None.

Glucagon-Like Peptide-1 Receptor Agonists and Risk for Suicidal Ideation and Behaviors in U.S. Older Adults With Type 2 Diabetes: A Target Trial Emulation Study: Annals of Internal Medicine: Vol 177, No 8

Background: A major concern has recently emerged about a potential link between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and increased risk for suicidal ideation and behaviors based on International Classification of Diseases codes. Objective: To investigate the association between GLP-1 RAs, compared with sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is), and risk for suicidal ideation and behaviors in older adults with type 2 diabetes (T2D). Design: Two target trial emulation studies comparing propensity score (PS)–matched cohorts for GLP-1 RAs versus SGLT2is and GLP-1 RAs versus DPP4is. Setting: U.S. national Medicare administrative data from January 2017 to December 2020. Patients: Older adults (≥66 years) with T2D; no record of suicidal ideation or behaviors; and a first prescription for a GLP-1 RA, SGLT2i, or DPP4i. Measurements: The primary end point was a composite of suicidal ideation and behaviors. New GLP-1 RA users were matched 1:1 on PS to new users of an SGLT2i or DPP4i in each pairwise comparison. A Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% CIs within matched groups. Results: This study included 21 807 pairs of patients treated with a GLP-1 RA versus an SGLT2i and 21 402 pairs of patients treated with a GLP-1 RA versus a DPP4i. The HR of suicidal ideation and behaviors associated with GLP-1 RAs relative to SGLT2is was 1.07 (95% CI, 0.80 to 1.45; rate difference, 0.16 [CI, −0.53 to 0.86] per 1000 person-years); the HR relative to DPP4is was 0.94 (CI, 0.71 to 1.24; rate difference, −0.18 [CI, −0.92 to 0.57] per 1000 person-years). Limitations: Low event rate; imprecise estimates; unmeasured confounders, such as body mass index; and potential misclassification of outcomes. Conclusion: Among Medicare beneficiaries with T2D, this study found no clear increased risk for suicidal ideation and behaviors with GLP-1 RAs, although estimates were imprecise and a modest adverse risk could not be ruled out. Primary Funding Source: American Foundation for Pharmaceutical Education, Pharmaceutical Research and Manufacturers of America Foundation, National Institute on Aging, and National Institute of Diabetes and Digestive and Kidney Diseases.

Pain Reduction With Oral Methotrexate in Knee Osteoarthritis: A Randomized, Placebo-Controlled Clinical Trial: Annals of Internal Medicine: Vol 177, No 9

Background: Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain. Objective: To assess symptomatic benefits of methotrexate in knee OA (KOA). Design: A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41) Setting: 15 secondary care musculoskeletal clinics in the United Kingdom. Participants: A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion. Intervention: Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia. Measurements: The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs). Results: A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren–Lawrence grade 3 to 4) were randomly assigned to methotrexate (n = 77) or placebo (n = 78). Follow-up was 86% (n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2). Limitation: Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance. Conclusion: Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months. Primary Funding Source: Versus Arthritis.

Why Hospitals Must Provide Abortions in Pregnancy Emergencies

En Garde or On Board? Travel Medicine for Immunocompromised Patients in the COVID-19 Era

Shedding Light on the Health of Latino Populations in the United States

Putting Adult Vaccine Recommendations Into Action

How Would You Manage HIV Pre-exposure Prophylaxis in This Patient With Medical Comorbidities?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 177, No 4

Despite advances in treatment, HIV infection remains an important cause of morbidity and mortality, with more than 30 000 new cases diagnosed in the United States each year. There are several interventions traditionally used to prevent HIV transmission, but these vary in effectiveness and there are challenges to their implementation. In 2014, the Centers for Disease Control and Prevention published initial guidance on the use of antiretroviral pre-exposure prophylaxis (PrEP) to prevent transmission of HIV infection in persons at risk based on multiple studies that showed it to be highly efficacious in various populations. It was updated in 2021 to reflect new drug options. The U.S. Preventive Services Task Force also recently updated its recommendations for PrEP, which strongly support its use in persons at risk. Despite its well-established effectiveness, the implementation of PrEP in clinical practice has been variable, especially among populations underserved by the medical system and marginalized by society. Fewer than one third of persons in the United States who are eligible for PrEP currently receive it. Here, 2 physicians experienced in HIV PrEP debate how best to identify patients who might benefit from PrEP, how to decide what regimen to use, and how to monitor therapy.

Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis: A Sham-Controlled, Randomized Trial: Annals of Internal Medicine: Vol 177, No 6

Background: No randomized controlled trials have substantiated endoscopic decompression of the pancreatic duct in patients with painful chronic pancreatitis. Objective: To investigate the pain-relieving effect of pancreatic duct decompression in patients with chronic pancreatitis and intraductal stones. Design: 24-week, parallel-group, randomized controlled trial (ClinicalTrials.gov: NCT03966781) Setting: Asian Institute of Gastroenterology in India from February 2021 to July 2022. Participants: 106 patients with chronic pancreatitis. Intervention: Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with sham procedures. Measurements: The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Secondary outcomes were assessed after 12 and 24 weeks and included 30% pain relief, opioid use, pain-free days, questionaries, and complications to interventions. Results: 52 patients in the ESWL/ERP group and 54 in the sham group were included. At 12 weeks, the ESWL/ERP group showed better pain relief compared with the sham group (mean difference in change, −0.7 [95% CI, −1.3 to 0] on the VAS; P = 0.039). The difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up. The number of pain-free days was increased (median difference, 16.2 days [CI, 3.9 to 28.5 days]), and the number of days using opioids was reduced (median difference, −5.4 days [CI, −9.9 to −0.9 days]) in the ESWL/ERP group compared with the sham group at 12-week follow-up. Safety outcomes were similar between groups. Limitation: Single-center study and limited duration of follow-up. Conclusion: In patients with chronic pancreatitis and intraductal stones, ESWL with ERP provided modest short-term pain relief. Primary Funding Source: Asian Institute of Gastroenterology and Aalborg University Hospital.

MKSAP Quiz: Sleeplessness in patient with panhypopituitarism

CDC revises pneumococcal, COVID-19 vaccine recommendations

New recommendations released on primary prevention of stroke

Put words in our mouth

New tool assists caregiver decision making about firearms for dementia patients

Patients with OUD less likely to stop methadone than buprenorphine/naloxone

MKSAP Quiz: Evaluation for heart failure

Celebrate Internal Medicine Day on Oct. 28

New primary care guidance released on HIV care

And the winner is …

SHM releases updated core competencies for procedures | ACP Hospitalist

Pancytopenia | ACP Hospitalist

Older patients who discontinued antipsychotic medications had lower risk of readmission | ACP Hospitalist

JAK inhibitors improved survival in hospitalized COVID-19 patients, review finds | ACP Hospitalist

Adverse events frequently occur during inpatient wait for guardianship, VA study finds | ACP Hospitalist

Take a quiz about the May 7 issue! | ACP Hospitalist

Rule using family info effective for finding pre-existing dementia in hospitalized patients | ACP Hospitalist

Private equity acquisition of hospitals linked with increased postop mortality risk | ACP Hospitalist

Fixed-rate insulin for DKA tied to shorter length of stay, no change in time to resolution | ACP Hospitalist

Fighting the trust fall | ACP Hospitalist

Pulmonary Mucormycosis With Dissemination: A Case of Unrelenting Fever and Chest Pain | Annals of Internal Medicine: Clinical Cases

Pulmonary mucormycosis is a rare entity that requires a high index of clinical suspicion for diagnosis. Untreated mucormycosis results in dissemination with exceedingly high mortality rates. Here, we present the patient case of a previously healthy 21-year-old man who presented with fever, dyspnea, chest pain, and progressive pulmonary consolidation. This patient case highlights the expanded differential diagnosis of presumed bacterial pneumonia that fails to respond to initial management and details the clinical, radiographic, and pathologic findings consistent with diagnosing pulmonary mucormycosis.

Acute Severe Hyperlipidemia Leading to a Diagnosis of Pancreatic Cancer in an Elderly Woman | Annals of Internal Medicine: Clinical Cases

There are multiple secondary causes of hyperlipidemia, including obstructive cholestasis. We present a patient case of a 72-year-old woman with controlled hyperlipidemia presenting for a routine primary care visit. Laboratory results showed marked hyperlipidemia. Subsequent evaluation revealed biliary obstruction resulting from pancreatic adenocarcinoma.

Correction: Diffuse Necrosis: A Rare Case of Idiopathic Black Esophagus, Duodenum, and Jejunum | Annals of Internal Medicine: Clinical Cases

Diffuse Necrosis: A Rare Case of Idiopathic Black Esophagus, Duodenum, and Jejunum | Annals of Internal Medicine: Clinical Cases

Black esophagus, or acute esophageal necrosis (AEN), is a rare, life-threatening disorder that typically presents in patients who have multiple comorbid conditions and is essential to diagnose as soon as possible. Although AEN is commonly seen in patients who are critically ill, it is unusual for patients to have mild subjective symptoms and otherwise remain clinically stable. We present a peculiar case of a patient who had endoscopic findings showing extensive necrosis of his esophagus, duodenum, and jejunum with sparing of the stomach and only mild symptomatology.

A Tale of Two Hematological Malignancies: CML Followed by CLL in the Same Patient | Annals of Internal Medicine: Clinical Cases

Studies have reported second malignancies occurring in patients with chronic myeloid leukemia (CML) or chronic lymphoid leukemia (CLL). We discuss the case of a 77-year-old man diagnosed with CLL who later developed CML. The CLL was managed with surveillance after diagnosis for 3 years and later treated with ibrutinib and venetoclax. While on treatment with venetoclax for 4 months, the patient had worsening leukocytosis shown via peripheral flow cytometry and fluorescence in situ hybridization, with the presence of myeloid lineage cells positive for BCR-ABL and complete disappearance of lymphoid cells. This case report highlights the importance of considering a second malignancy in hematologic malignancies with variable disease prognosis.

Levetiracetam-Induced Pancytopenia in an HIV Seropositive Patient With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases

Levetiracetam is a widely used and safe antiepileptic drug, and levetiracetam-induced pancytopenia is an uncommon adverse effect. We present a patient case of a middle-aged man with seizures who developed profound pancytopenia within 4 days of starting levetiracetam. We suspected levetiracetam-induced pancytopenia, withdrew the levetiracetam, and started our patient on an alternative medication, which improved his blood count within 24 hours. This is the first patient case demonstrating levetiracetam-induced pancytopenia in an adult with coexisting HIV and SARS-CoV-2 infections, which did not contribute to his pancytopenia. Physicians should be cognizant of this adverse effect when prescribing levetiracetam to treat seizures.

A Case of Maple Syrup Urine Disease Diagnosed in Adulthood | Annals of Internal Medicine: Clinical Cases

Classic maple syrup urine disease (MSUD) is typically diagnosed in newborns, whereas nonclassic forms may manifest at any age. We describe a 58-year-old man presenting with recurrent encephalopathy, found with a nonclassic form of MSUD. This patient case highlights the importance of considering inborn errors of metabolism in the differential diagnosis of adult patients presenting with neurologic symptoms of unclear cause.

Pleural and Pericardial Plaques in Asbestos Exposure | Annals of Internal Medicine: Clinical Cases

Asbestos is a generic term for a group of naturally occurring fibers composed of hydrated magnesium silicate minerals. Transported worldwide to shipyards and factories, it is a material that was widely used in construction, mining, and manufacturing. Exposure to asbestos can cause significant benign and malignant lung, pleural, and pericardial disease. Usually asymptomatic, pleural plaques are the most common radiologic manifestation of asbestos exposure. We report a case of a man who presented with heart failure exacerbation and was incidentally found to have pleural and pericardial plaques from asbestos exposure.

Acute Limb Ischemia After Cardiac Surgery: Looking for the White Clot Syndrome | Annals of Internal Medicine: Clinical Cases

Two weeks after undergoing cardiac surgery with cardiopulmonary bypass, a 59-year-old patient presented with acute right-limb ischemia. The probability of heparin-induced thrombocytopenia was high and heparin antibody immunoassays were positive, so heparin anticoagulation was replaced by argatroban. An emergency right femoral thrombectomy yielded a macroscopically white thrombus that was rich in platelets and leukocytes on histopathological and immunologic analysis. Given that the serotonin-release assay is the gold standard and is technically demanding, type 2 heparin-induced thrombopenia is challenging to diagnose with certainty after cardiac surgery, so the white appearance of a thrombus obtained by emergency thrombectomy may help in decision-making.

Why So Salty? Transient Diabetes Insipidus After Discontinuation of Vasopressin | Annals of Internal Medicine: Clinical Cases

In recent years, vasopressin has been increasingly used as an early treatment of vasopressor-refractory septic shock. In this article, we describe 2 episodes of transient diabetes insipidus after vasopressin for the treatment of septic shock was discontinued, which adds to a modest number of case studies reporting the same phenomenon. With the anticipated continued use of vasopressin in intensive care units, it can be expected that this adverse effect will occur with some frequency. Awareness and early recognition of this phenomenon can lead to prompt diagnosis and treatment.