Peer Perspectives: Mark Owusu, MD, MPH

Mark Owusu, MD, MPHLocum HospitalistHCA Tristar System at Tristar Summit Medical Center, Hermitage/Nashville, TNTristar Parkridge Medical Center, Chattanooga, TNTristar Hendersonville Medical Center, Hendersonville, TNTristar Greenview Medical Center, Bowling Green, KY

Peer Perspectives: Isaure Hostetter, MD, MPH

Isaure Hostetter, MD, MPH Primary Care Physician ACP Council of Resident/Fellow Members, 2023-2025 1. What is your current professional position? Primary care physician. 2. Why did you choose internal medicine?

Peer Perspectives: Elysia Engelage, MD

Elysia Engelage, MD Primary Care Internist, Kaiser Permanente San Francisco (KPSF) Associate Program Director, KP Northern California HIV Medicine Fellowship Core Faculty, KPSF Internal Medicine Residency Program San Francisco, CA 1. What is your current professional position?

Peer Perspectives: David D. Chen, MD, MPH

HospitalistChristianaCare Health SystemWilmington and Newark, DEClinical Assistant ProfessorThomas Jefferson University Hospital-Sidney Kimmel Medical CollegePhiladelphia, PA

Peer Perspectives: Clarissa Barnes, MD, MBA, FACP, ACPA-C

Clarissa Barnes, MD, MBA, FACP, ACPA-C Chief Medical Officer, South Dakota Medicaid Hospitalist, Avera McKennan Hospital and University Health Center Clinical Professor, Internal Medicine Department, University of South Dakota President, American College of Physician Advisors

Peer Perspectives: Camile Gooden, MD, FACP

Physician AdvisorNYU Langone Hospital–SuffolkPatchogue, NYClinical Assistant Professor of MedicineNYU Grossman Long Island School of MedicineMineola, NY1. What is your current professional position?

Peer Perspectives: Bruce Smith, Jr., MD

Bruce Smith, Jr., MD Hospitalist and Attending Physician, Department of Medicine, Cooper University Health Care, Camden, NJ Assistant Professor of Medicine, Cooper Medical School of Rowan University, Camden, NJ 1. What is your current professional position?

Peer Perspectives: Andre Hollingsworth, MD, FACP, FAAP

Internal Medicine Associate Program Director Internal Medicine Section ChiefTrinity Health Grand Rapids HospitalGrand Rapids, MIClinical Assistant ProfessorMichigan State College of Human MedicineGrand Rapids, MI

Peer Perspectives: Alexander Diaz de Villalvilla, MD, FACP

Alexander Diaz de Villalvilla, MD, FACP Primary Care Physician, Medical Associates of Rhode Island, Bristol, RI Clinical Assistant Professor of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 1. What is your current professional position?

Early Career Physicians Engagement Inspiration: ACP South Dakota Chapter

Eric Chow, MD, FACP Chair, Early Career Physicians Committee Hospital Medicine Monument Health, Rapid City, SD How long have you been leading the South Dakota Chapter Early Career Physicians (SDECP)? Please also share a little about yourself—where and how you practice? I have been chair of the SDECP for almost 2 years. Currently, I am a hospitalist at a community hospital. Previously, I was a primary care physician. How many members do you serve?

Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians

Background: Many U.S. states have legislated to allow nurse practitioners (NPs) to independently prescribe drugs. Critics contend that these moves will adversely affect quality of care. Objective: To compare rates of inappropriate prescribing among NPs and primary care physicians. Design: Rates of inappropriate prescribing were calculated and compared for 23 669 NPs and 50 060 primary care physicians who wrote prescriptions for 100 or more patients per year, with adjustment for practice experience, patient volume and risk, clinical setting, year, and state. Setting: 29 states that had granted NPs prescriptive authority by 2019. Patients: Medicare Part D beneficiaries aged 65 years or older in 2013 to 2019. Measurements: Inappropriate prescriptions, defined as drugs that typically should not be prescribed for adults aged 65 years or older, according to the American Geriatrics Society’s Beers Criteria. Results: Mean rates of inappropriate prescribing by NPs and primary care physicians were virtually identical (adjusted odds ratio, 0.99 [95% CI, 0.97 to 1.01]; crude rates, 1.63 vs. 1.69 per 100 prescriptions; adjusted rates, 1.66 vs. 1.68). However, NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing. For both types of practitioners, discrepancies in inappropriate prescribing rates across states tended to be larger than discrepancies between these practitioners within states. Limitation: The Beers Criteria addresses the appropriateness of a selected subset of drugs and may not be valid in some clinical settings. Conclusion: Nurse practitioners were no more likely than physicians to prescribe inappropriately to older patients. Broad efforts to improve the performance of all clinicians who prescribe may be more effective than limiting independent prescriptive authority to physicians. Primary Funding Source: The Robert Wood Johnson Foundation and National Science Foundation.

Universal Masking in Health Care Settings: A Pandemic Strategy Whose Time Has Come and Gone, For Now

Demonstration Project of Long-Acting Antiretroviral Therapy in a Diverse Population of People With HIV

Background: Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) regimen approved for people with HIV (PWH). Long-acting ART holds promise for improving outcomes among populations with barriers to adherence but is only approved for PWH who have virologic suppression with use of oral ART before initiating injectables. Objective: To examine LA-ART in a population of PWH that includes those with viremia. Design: Observational cohort study. Setting: Urban academic safety-net HIV clinic. Patients: Publicly insured adults living with HIV with and without viral suppression, high rates of unstable housing, mental illness, and substance use. Intervention: Demonstration project of long-acting injectable CAB–RPV. Measurements: Descriptive statistics summarizing cohort outcomes to date, based on pharmacy team logs and electronic medical record data. Results: Between June 2021 and November 2022, 133 PWH at the Ward 86 HIV Clinic were started on LA-ART, 76 of whom had virologic suppression while using oral ART and 57 of whom had viremia. The median age was 46 years (IQR, 25 to 68 years); 117 (88%) were cisgender men, 83 (62%) had non-White race, 56 (42%) were experiencing unstable housing or homelessness, and 45 (34%) had substance use. Among those with virologic suppression, 100% (95% CI, 94% to 100%) maintained suppression. Among PWH with viremia, at a median of 33 days, 54 of 57 had viral suppression, 1 showed the expected 2-log10 reduction in HIV RNA level, and 2 experienced early virologic failure. Overall, 97.5% (CI, 89.1% to 99.8%) were projected to achieve virologic suppression by a median of 33 weeks. The current virologic failure rate of 1.5% in the cohort is similar to that across registrational clinical trials at 48 weeks. Limitation: Single-site study. Conclusion: This project demonstrates the ability of LA-ART to achieve virologic suppression among PWH, including those with viremia and challenges to adherence. Further data on the ability of LA-ART to achieve viral suppression in people with barriers to adherence are needed. Primary Funding Source: National Institutes of Health, City and County of San Francisco, and Health Resources and Services Administration.

Infectious Diseases: What You May Have Missed in 2022

In 2022, COVID-19 remained the infectious disease at the top of most internal medicine physicians' minds. However, it was not the only infectious disease that was the topic of clinically relevant research that year. This article highlights some important infectious disease evidence unrelated to COVID-19 that was published in 2022. The literature was screened for sound new evidence relevant to internal medicine specialists and subspecialists whose focus of practice is not infectious diseases. The publications highlighted relate to various organisms in different patient populations. One article provides insight into the role of Helicobacter pylori eradication in the treatment of functional dyspepsia. The descriptive epidemiology of bacterial (Staphylococcus aureus) and viral (mpox) infections are the focus of 2 other articles. Several articles address the management of resistant and difficult-to-treat infections: multidrug-resistant gram-negative infections, resistant HIV-1, rifampin-resistant tuberculosis, cryptococcal meningitis, and invasive fungal infection in the setting of neutropenia. Another article provides data on effective HIV preexposure prophylaxis in women, an understudied population. Finally, given the urgent need to reduce inappropriate use of antibiotics, an article on antibiotic stewardship for hospitalized patients with presumed sepsis in a non–intensive care unit setting is also included.

Oophorectomy at the Time of Hysterectomy: The Debate Continues

How Would You Manage This Patient With Clostridioides difficile Infection?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 176, No 8

The Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and the American College of Gastroenterology recently released updated guidelines on management of patients with Clostridioides difficile infection. Although these 2 guidelines generally agree, there are a few important differences in their advice to clinicians. In these rounds, 2 experts, an infectious diseases specialist and a gastroenterologist, discuss antibiotic treatment options for nonsevere disease, the role of fecal microbiota transplantation for fulminant disease, and the use of bezlotoxumab to prevent recurrence in the context of Ms. C, a 48-year-old woman with fulminant C difficile infection.

Perioperative Management of Antihypertensive Agents: More Answers or More Questions?

Hunger and the Obesity Epidemic: Old Insights Reaffirmed by New Medicines?

Misinterpretation of Clinical Research Findings and COVID-19 Mortality

Chronotype, Unhealthy Lifestyle, and Diabetes Risk in Middle-Aged U.S. Women: A Prospective Cohort Study: Annals of Internal Medicine: Vol 176, No 10

Background: Evening chronotype may promote adherence to an unhealthy lifestyle and increase type 2 diabetes risk. Objective: To evaluate the role of modifiable lifestyle behaviors in the association between chronotype and diabetes risk. Design: Prospective cohort study. Setting: Nurses’ Health Study II. Participants: 63 676 nurses aged 45 to 62 years with no history of cancer, cardiovascular disease, or diabetes in 2009 were prospectively followed until 2017. Measurements: Self-reported chronotype using a validated question from the Morningness-Eveningness Questionnaire. The lifestyle behaviors that were measured were diet quality, physical activity, alcohol intake, body mass index (BMI), smoking, and sleep duration. Incident diabetes cases were self-reported and confirmed using a supplementary questionnaire. Results: Participants reporting a “definite evening” chronotype were 54% (95% CI, 49% to 59%) more likely to have an unhealthy lifestyle than participants reporting a “definite morning” chronotype. A total of 1925 diabetes cases were documented over 469 120 person-years of follow-up. Compared with the “definite morning” chronotype, the adjusted hazard ratio (HR) for diabetes was 1.21 (CI, 1.09 to 1.35) for the “intermediate” chronotype and 1.72 (CI, 1.50 to 1.98) for the “definite evening” chronotype after adjustment for sociodemographic factors, shift work, and family history of diabetes. Further adjustment for BMI, physical activity, and diet quality attenuated the association comparing the “definite evening” and “definite morning” chronotypes to 1.31 (CI, 1.13 to 1.50), 1.54 (CI, 1.34 to 1.77), and 1.59 (CI, 1.38 to 1.83), respectively. Accounting for all measured lifestyle and sociodemographic factors resulted in a reduced but still positive association (HR comparing “definite evening” vs. “definite morning” chronotype, 1.19 [CI, 1.03 to 1.37]). Limitations: Chronotype assessment using a single question, self-reported data, and homogeneity of the study population. Conclusion: Middle-aged nurses with an evening chronotype were more likely to report unhealthy lifestyle behaviors and had increased diabetes risk compared with those with a morning chronotype. Accounting for BMI, physical activity, diet, and other modifiable lifestyle factors attenuated much but not all of the increased diabetes risk. Primary Funding Source: National Institutes of Health.

Remote mindfulness training aided veterans with chronic pain

MKSAP Quiz: Bone health evaluation

New appropriate use criteria offer framework for preop cardiac testing

Yoga no more effective than general exercise in reducing incontinence in women

And the winner is …

Observe National Immunization Awareness Month with ACP resources

Statins not commonly used among younger cohorts even after ASCVD diagnosis

MKSAP Quiz: Evaluation after multiple motor vehicle collisions

Spouses of cancer patients at increased risk of suicide attempts, deaths

Alternative criteria could identify more patients who may benefit from lung cancer screening

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