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!

January 16, 2026

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

Archive

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.

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.

Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists

Background: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. Objective: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. Design: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615) Setting: 6 centers across the United States. Participants: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. Intervention: Real-time use of CADx during routine colonoscopy. Measurements: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. Results: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. Limitation: Decision making based on CADx might differ outside a clinical trial. Conclusion: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. Primary Funding Source: Olympus America Corporation served as the clinical study sponsor.

Early Bird registration is open for Internal Medicine Meeting 2025

ACP announces 2024-2025 recipients of Mastership and national awards

Abnormal urine protein dipstick results rarely followed up, study finds

MKSAP Quiz: Consultation after cervical cancer diagnosis

Periop cardiovascular guideline updated, calls for avoiding overscreening

Population-based suicide care program yielded 25% reduction in suicide attempts

Put words in our mouth

Article, podcast highlight the importance of celebrating women in medicine

New ACP paper reviews performance measures for pain management

Self-guided sleep intervention reduced sedative use, improved quality rest

Treatment pathway in the ED reduced admissions for atrial fibrillation | ACP Hospitalist

Take a quiz about the Feb. 19 issue! | ACP Hospitalist

Noninvasive ventilation reduced post-cardiac surgery complications in high-risk patients | ACP Hospitalist

Lactated Ringer's as initial fluid associated with lower sepsis mortality versus saline | ACP Hospitalist

From ‘unbefriended’ to ‘unrepresented’ | ACP Hospitalist

Existing tool helps predict mortality in hospitalized patients with cancer | ACP Hospitalist

Cutting down on recurring care | ACP Hospitalist

Take a quiz about the Feb. 12 issue! | ACP Hospitalist

SEP-1 bundle hasn't been proven to reduce mortality, review finds | ACP Hospitalist

Rise in white blood cell count can be expected 48 hours after steroid dose, study finds | ACP Hospitalist

A Sole Left Coronary Artery | Annals of Internal Medicine: Clinical Cases

Coronary artery anomalies are defined as coronary patterns that do not fit the usual origins and branching patterns from the ascending aorta. One such CAA includes a single coronary artery: a rare (often incidental) finding of only 1 coronary artery supplying the entire heart. This anomaly poses risks to the patient, with complications such as myocardial infarction and sudden cardiac death. Our patient case was a woman with high-risk coronary artery disease (CAD) who was incidentally found to have a single coronary artery. This is an important anatomical anomaly that can alter signs, symptoms, and subsequent treatment of patients with CAD.

Correction: Unusual Case of an Incidentally Detected Angioplasty Wire in the Aorta | Annals of Internal Medicine: Clinical Cases

An Unusual Case of an Incidentally Detected Angioplasty Wire in the Aorta | Annals of Internal Medicine: Clinical Cases

A retained angioplasty wire is rarely described, and there are no guidelines as to how it should be managed. Thus the management of this complication remains highly individualized. In the present instance, a 74-year-old woman was found on routine transthoracic echocardiography to have a linear echogenic structure that was initially concerning for a dissection flap. A computed tomography angiogram of the aorta revealed a linear density that followed the curvature of the aortic arch, which was concerning for a retained angioplasty wire from a percutaneous coronary intervention done 11 years earlier. Because the patient had not reported any symptoms, a multidisciplinary decision was made to defer any surgical intervention.

Upper Thoracic Back Pain Due to Acute Calcific Tendinitis of the Longus Colli | Annals of Internal Medicine: Clinical Cases

A 56-year-old woman presented with acute left upper back pain and odynophagia. By thoracic computed tomography, she was diagnosed with acute calcific tendinitis of the longus colli and treated with nonsteroidal anti-inflammatory drugs.

A Case Report of Spontaneous Coronary Artery Dissection | Annals of Internal Medicine: Clinical Cases

Atherothrombosis is the leading cause of acute coronary syndrome (ACS). Spontaneous coronary artery dissection (SCAD) refers to a nonatherosclerotic lesion involving the tearing and splitting of the coronary wall. The creation of a false lumen and blockage of the true lumen generates an oxygenation mismatch in the myocardial tissue. A middle-aged woman with unremarkable medical history developed chest pain. Uptrending cardiac enzymes and electrocardiogram changes prompted further testing. Coronary angiography showed a type 3 SCAD lesion in the left circumflex artery. SCAD lacks the average risk factors of ACS and its recognition can be delayed. On the other hand, it preserves the typical presentation of ACS.

Hemorrhagic Adrenal Mass: A Rare Presentation of Primary Adrenal Choriocarcinoma | Annals of Internal Medicine: Clinical Cases

Choriocarcinoma comprises less than 5% of all germ cell tumors in men, and primary extragonadal manifestation in the adrenal glands is a subset of that low percentage. Primary adrenal choriocarcinoma is a rare yet devastating diagnosis, with few cases reported in men. Delays in diagnosis can lead to increased morbidity and mortality given choriocarcinoma's aggressive growth; therefore, clinicians must recognize this clinical entity and consider it part of the differential diagnosis of a mass in the adrenals, lung, gastrointestinal tract, or brain, and expedite treatment if index of suspicion is high.

Postpartum Recurrent Mastitis Despite Resolution of Prior Prolactinoma | Annals of Internal Medicine: Clinical Cases

We present a 35-year-old woman with history of a prolactinoma who presented 11 weeks postpartum with recurrent mastitis. Per the patient, in the past she took cabergoline but stopped about 5 years previously. Despite attempts to wean, postpartum, she continued to express an excessive amount of breast milk. Magnetic resolution imaging revealed a slightly heterogeneous appearance of the pituitary gland, and she was started on dopaminergic agents. This case demonstrates that significant lactotroph hyperplasia can occur after breastfeeding ends despite the resolution of a prior prolactin-secreting microadenoma.

Transient Perivascular Inflammation of the Carotid Artery Syndrome | Annals of Internal Medicine: Clinical Cases

A previously healthy 52-year-old woman presented with left anterior cervical pain that had persisted for 10 days. Cervical magnetic resonance imaging revealed a high-intensity signal in the region exhibiting short-inversion-time inversion recovery; therefore, the patient was diagnosed with transient perivascular inflammation of the carotid artery (TIPIC) syndrome. TIPIC syndrome is a nonspecific inflammatory finding in the soft tissues surrounding the carotid arteries and should be included in the differential diagnoses of patients with acute anterior cervical pain.

Disseminated Cutaneous Mycobacterium marinum Infection | Annals of Internal Medicine: Clinical Cases

Infection with Mycobacterium marinum has been associated with inhibitors of tumor necrosis factor alpha but rarely reported in patients given golimubab. We report an unusual case of disseminated cutaneous M marinum infection in an immunocompromised patient being treated with this agent.

A Giant Posterior Mediastinal Metastatic Mass of GIST Gastric Origin | Annals of Internal Medicine: Clinical Cases

Gastrointestinal stromal tumors (GISTs) are uncommon visceral sarcomas that predominantly arise from the gastrointestinal tract, particularly from interstitial cells of Cajal. Although the liver is a common site for metastasis, rarely GISTs show extraintestinal manifestation in the bone and lungs. We report a case patient with an uncommon location and unusually large GIST metastasis as a mediastinal mass 3 years after undergoing total gastrectomy and chemotherapy with imatinib, a tyrosine kinase inhibitor.