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.

Independent Practice Resources

ACP helps medical practices with the business side of medicine. Learn about our medical practice management resources here.

Tech Tips and Support for Peer Coaching Programs

General Requirements The program is delivered via an online platform. You will log into the platform using your first and last name and the email address you used when registering (your ACP account email—see https://www.acponline.org/myacp to check if you aren’t sure which email address is your primary on your ACP account).

Physician Coaching & Training Program | Peer Coaching

Train in evidence-based coaching techniques through ACP’s peer coaching program to support colleagues, boost well-being, and earn CME credit.

What to Expect from Coaching

What can you expect from your coaching session? Your coach will help you define the area of focus for your session, explore what success looks like within that area, and identify the potential ways to move forward. You will be provided with a safe space where you will be listened to and have time to organize your thoughts. Your coach will offer reflections and ask questions to help you find the answers.

Individual and Group Coaching Services

ACP’s Physician Peer Coaching program offers a suite of program offerings to provide you with ongoing support to help you thrive personally and professionally.

Group Coaching Sessions

ACP has designed a series of 1-hr group coaching sessions to support your career and professional development. During each session, you and up to 5 of your peers will work with an ACP Physician Peer coach on the following topics. There are currently no group coaching sessions available. Check back soon for updates.

Group Coaching Resources for Early Career Physicians

Work with an ACP Physician Peer coach and up to 5 fellow early career physicians in this series of 1-hr group coaching sessions. Participate in one or attend multiple sessions to gain insights in key areas designed to help support your career and professional development.

Get to Know Your ACP Physician Peer Coaches

Bisi Alli, DO, MS, DipABLM, FACP, FAMWAWellNEST Medicine LLCPhoenix, AZAll settingsEarly-Mid-CareerLinkedIn Link

Body Mass Index Thresholds for Asians: A Race Correction in Need of Correction?

Reversal of Intestinal Failure With Teduglutide in PERCC1-Associated Enteropathy: A Case Report

Medicare Negotiation’s Drug Reformulation Problem

Use of Telehealth Among Medical Visits in the United States: Results From the 2021 Medical Expenditure Panel Survey

Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities: An Ecological Study: Annals of Internal Medicine: Vol 178, No 2

Background: The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria. Objective: To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility. Design: Cross-sectional ecological study. Setting: U.S. census tracts. Participants: 71 691 census tracts. Measurements: The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality. Results: Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts. Limitation: Analyses did not account for travel time or cost. Conclusion: Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality. Primary Funding Source: Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.

Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort

Background: False-positive results on screening mammography may affect women’s willingness to return for future screening. Objective: To evaluate the association between screening mammography results and the probability of subsequent screening. Design: Cohort study. Setting: 177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC). Patients: 3 529 825 screening mammograms (3 184 482 true negatives and 345 343 false positives) performed from 2005 to 2017 among 1 053 672 women aged 40 to 73 years without a breast cancer diagnosis. Measurements: Mammography results (true-negative result or false-positive recall with a recommendation for immediate additional imaging only, short-interval follow-up, or biopsy) from 1 or 2 screening mammograms. Absolute differences in the probability of returning for screening within 9 to 30 months of false-positive versus true-negative screening results were estimated, adjusting for race, ethnicity, age, time since last mammogram, BCSC registry, and clustering within women and facilities. Results: Women were more likely to return after a true-negative result (76.9% [95% CI, 75.1% to 78.6%]) than after a false-positive recall for additional imaging only (adjusted absolute difference, −1.9 percentage points [CI, −3.1 to −0.7 percentage points]), short-interval follow-up (−15.9 percentage points [CI, −19.7 to −12.0 percentage points]), or biopsy (−10.0 percentage points [CI, −14.2 to −5.9 percentage points]). Asian and Hispanic/Latinx women had the largest decreases in the probability of returning after a false positive with a recommendation for short-interval follow-up (−20 to −25 percentage points) or biopsy (−13 to −14 percentage points) versus a true negative. Among women with 2 screening mammograms within 5 years, a false-positive result on the second was associated with a decreased probability of returning for a third regardless of the first screening result. Limitation: Women could receive care at non-BCSC facilities. Conclusion: Women were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk. Primary Funding Source: National Cancer Institute.

Annals Video Summary - Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease

Glomerular Filtration Estimating Equations and Clinical Outcomes: What Are We Measuring?

Endoscopic Ultrasound-Guided Rendezvous Technique Versus Precut Sphincterotomy as Salvage Technique in Patients With Benign Biliary Disease and Difficult Biliary Cannulation: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 177, No 10

Background: The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a relatively newer method. Prospective comparative data between these 2 techniques as salvage for biliary access in patients with benign biliary disease and difficult bile duct cannulation is lacking. Objective: To compare EUS-RV and precut sphincterotomy as salvage technique for difficult bile duct cannulation in benign biliary obstruction. Design: Participant-masked, parallel-group, superiority, randomized controlled trial. (Clinical Trials Registry of India: CTRI/2020/07/026613) Setting: Tertiary care academic institute from July 2020 to May 2021. Participants: All patients with benign biliary disease and difficult bile duct cannulation requiring salvage strategy. Intervention: Patients were randomly assigned by computer-generated randomized blocks sequence in 1:1 fashion to either EUS-RV or precut sphincterotomy. Patients with failure in EUS-RV were crossed over to precut sphincterotomy and vice versa. Measurements: The primary outcome measure was technical success. The other outcome measures included procedure time, radiation dose, and adverse events. Results: In total, 100 patients were randomly assigned to EUS-RV (n = 50) and precut sphincterotomy (n = 50). The technical success rate (92% vs. 90%; P = 1.00; relative risk, 1.02 [95% CI, 0.90 to 1.16]), median procedure time (10.1 vs. 9.75 minutes), and overall complication rate (12% vs. 10%; relative risk, 1.20 [CI, 0.39 to 3.68]) were similar between the 2 groups. Five patients (10%) in the EUS-RV group and 5 patients (10%) in the precut sphincterotomy group had developed post–endoscopic retrograde cholangiopancreatography pancreatitis. All failed cases in either salvage group could be successfully cannulated when crossed over to the other group. Limitation: Single center study done by experts. Conclusion: Endoscopic ultrasound-guided rendezvous technique and precut sphincterotomy have similar success rates as salvage techniques in the technically challenging cohort of difficult bile duct cannulation for benign biliary disease, with acceptable complications rates. Primary Funding Source: None.

A Blueprint for U.S. Health Insurance Reform

The current U.S. health insurance “system” was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of incremental and haphazard reforms. That policy history also reveals a clear but unfulfilled societal commitment to providing access to essential health care regardless of resources. To fulfill this obligation, the solution proposed in this article has 2 key elements: 1) universal coverage that is automatic, free, and basic, and 2) the option to buy supplemental coverage in a well-designed market. Such a system could, if desired, be created without raising taxes and without disrupting or changing the delivery of medical care.

New AI tool launches as part of DynaMedex

Hear from Annals of Internal Medicine authors in New Orleans

Guidance issued on providing high-value, low-carbon care

MKSAP Quiz: Progressive head tremor

Screening for breast, colorectal cancer rebounded after COVID-19

For bacterial vaginosis, concurrent male partner treatment lowers recurrence rates

Vote for your favorite entry

Physician visits decreased from 2010 to 2021, study finds

Patients with disabilities report feeling disrespect from health care professionals

MKSAP Quiz: Evaluation in the ED for hematemesis

GLP-1 receptor agonists get expanded indication, new generic | ACP Hospitalist

Take a quiz about the Dec. 18 issue! | ACP Hospitalist

Higher anticoagulation dose associated with lower mortality in hospitalized COVID-19 patients | ACP Hospitalist

Guide to a guideline | ACP Hospitalist

CMS hospital at home program includes mostly urban, nonprofit, academic hospitals | ACP Hospitalist

Ceftolozane-tazobactam associated with better outcomes for multidrug-resistant P. aeruginosa | ACP Hospitalist

App-based palliative care intervention no better than usual care at addressing family needs | ACP Hospitalist

ACE-ing eye exams | ACP Hospitalist

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Multimodal Imaging for the Diagnosis of Accessory Mitral Valve Tissue | Annals of Internal Medicine: Clinical Cases

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly often diagnosed in childhood and is associated with left ventricular outflow tract obstruction. We present a case of an asymptomatic adult man in his 60s with an incidental finding of AMVT. A transthoracic echocardiography and transesophageal echocardiography initially raised suspicion of AMVT, but the precise origin of the anomaly was established using a dynamic 4-dimensional cardiac computed tomography scan, ultimately confirming the diagnosis. This case highlights the potential value of multimodality imaging in the diagnosis of AMVT and rules out other differential diagnoses.

The Search for Diagnosis: Pericardial Tamponade in a Patient With Autoimmune Polyglandular Syndrome Type 1 | Annals of Internal Medicine: Clinical Cases

This case report describes a 28-year-old man with autoimmune polyglandular syndrome (APS) type 1 who presented with pericardial tamponade complicated by pulseless electric activity cardiac arrest. After 59 minutes of cardiopulmonary resuscitation and pericardiocentesis, spontaneous circulation returned. Although pericardial tamponade has been rarely associated with APS type 2, to the best of our knowledge, it has never been reported in APS-1. This unique case highlights the importance of recognizing autoimmune pathology as a potential cause of pericardial effusion in patients with APS.

Pericardial Effusion and Tamponade as the Manifestation of Erdheim–Chester Disease | Annals of Internal Medicine: Clinical Cases

We hereby report the case of a 77-year-old man hospitalized due to pericardial effusion and tamponade. Upon investigating potential etiologies of the pericardial effusion, we diagnosed him with non-Langerhans cell histiocytosis, also known as Erdheim–Chester disease or polyostotic sclerosing histiocytosis, a rare histiocytic neoplasm. This case underscores the importance of considering less-common causes of pericardial effusion.

Obstructive Nephropathy Associated With Disseminated Herpes Zoster in a Patient With a Kidney Transplant | Annals of Internal Medicine: Clinical Cases

Varicella–zoster virus is a double-stranded, DNA herpesvirus responsible for causing both chickenpox (varicella) during a primary infection, and shingles (herpes zoster) on reactivation of the virus that remains dormant in neurons of dorsal root ganglia. Bladder dysfunction is a rare complication of shingles that may lead to devastating complications if not recognized. We describe the case of a 48-year-old woman with a kidney transplant who presented with skin lesions consistent with herpes zoster and also was found to have acute kidney injury in the setting of acute urinary retention and likely zoster-associated bladder dysfunction.

A Rare Case of GATA2 Deficiency Presenting as Recurrent Fever in an Adult Man | Annals of Internal Medicine: Clinical Cases

A 36-year-old man with GATA2 immunodeficiency syndrome who had fever, weight loss, and pancytopenia was diagnosed with disseminated Mycobacterium xenopi infection. He was treated for infection and later diagnosed with myelodysplastic syndrome due to GATA2 deficiency. He recovered well after allogeneic hematopoietic stem cell transplant.

Maggots: Antimicrobial Stewards and Life Savers | Annals of Internal Medicine: Clinical Cases

Maggots have been used in wound care for centuries. Their larvae secrete digestive enzymes and antimicrobial compounds that reduce the bacterial load within a wound and promote the growth of new, healthy tissue. We will discuss a series of patients with complex, nonhealing and life-threatening sacral wounds who developed multidrug-resistant sacral osteomyelitis. These wounds had failed to respond to standard and advanced strategies. Medicinal maggots were offered as a last-ditch effort in each case. In addition to saving the patients’ lives, these maggots demonstrated their underappreciated and underused role as antimicrobial stewards.

Anti-Melanoma Differentiation-Associated Protein-5 and Anti-Polymyositis/Scl-75 Antibody-Associated Interstitial Lung Disease Triggered by COVID-19 Vaccine: A Case Report | Annals of Internal Medicine: Clinical Cases

SARS-CoV-2 has resulted in a global pandemic and the development of multiple vaccines. Here we present a case of a 61-year-old woman who developed interstitial lung disease (ILD) with anti-melanoma differentiation-associated protein-5 (MDA-5) and anti-polymyositis (PM)/Scl-75 antibodies after her second dose of the BNT162b2 mRNA vaccine. Clinical, laboratory, and radiologic findings supported a diagnosis of rapidly progressive ILD. Despite aggressive treatment, her respiratory status declined, and she needed mechanical ventilation until eventual death from respiratory failure. To our knowledge, this is the first known case of BNT162b2 mRNA vaccine-induced rapidly progressive ILD associated with positive anti-MDA-5 and anti-PM/Scl-75 antibodies.

A Case of Atypical Intestinal Botulism With Rapid Recovery After Delayed Antitoxin Administration | Annals of Internal Medicine: Clinical Cases

Botulism classically manifests with descending flaccid paralysis progressing to possible respiratory failure. Atypical presentations often have symptomatic overlap with other neuromuscular junction pathologies, making it difficult to diagnose and treat quickly. Here we present the case of a 31-year-old woman hospitalized 6 days after elective abdominoplasty for dysphagia, bilateral ptosis, and upper extremity weakness who, despite delayed initiation of antitoxin therapy on day 14, showed rapid muscle tone recovery within 48 hours of administration. This case discusses the variable manifestation of botulism which leads to difficulty in diagnosis, and emphasizes the possibility of rapid recovery and even paralysis reversal despite delayed antitoxin administration.

Staphylococcus saprophyticus, an Unusual Cause of Pyelonephritis and Sepsis in Pregnancy | Annals of Internal Medicine: Clinical Cases

Maternal sepsis accounts for 13% of U.S. maternal deaths, with an estimated 2.2 deaths per 100 000 live births. Early identification and treatment are critical in sepsis. Maternal sepsis is often a polymicrobial condition. Common causative agents include Escherichia coli, Group B Streptococcus, anaerobes, and Staphylococcus aureus. Staphylococcus saprophyticus is a rare cause of pyelonephritis-associated sepsis in immunocompetent patients and is especially uncommon during pregnancy. Only a handful of cases are reported in the literature, with only 2 cases associated with pregnancy. The case being presented describes an adolescent gravid patient who was diagnosed with pyelonephritis-associated sepsis caused by S saprophyticus.

A Case of VEXAS (Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic) Syndrome With Cardiac Involvement | Annals of Internal Medicine: Clinical Cases

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome was first described in late 2020. It occurs as the result of somatic mutations in the ubiquitin-activating enzyme UBA1. Since its discovery, there have been numerous articles describing typical features of VEXAS, including alveolitis, polychondritis of the ear and nose, and thromboembolic conditions. We report a case of cardiac involvement that manifested as heart failure with nonischemic cardiomyopathy in a patient with VEXAS syndrome.