Iron Deficiency Treatment: 5 Pearls Segment

In this episode of Core IM the team tackles understanding the nuances of oral and intravenous approaches, addressing special considerations regarding different formulations, managing patients with chronic inflammatory disorders, and recognizing associated complications and side effects of treatment. Join them for Iron Deficiency Treatment: 5 Pearls Segment!

Iron Deficiency: Grey Matters Segment

Iron deficiency is a common diagnosis and frequent cause of morbidity. However, there is significant variation in how it is diagnosed, with divergent practice patterns and uncertainty among providers. In this episode the team explores the state of current guidelines regarding how to implement iron testing and areas of ongoing clinical uncertainty including iron deficiency in chronic inflammation.

Iron Deficiency Anemia

Iron deficiency anemia (IDA) is caused by iron deficiency, a common yet underrecognized clinical entity. Populations at greatest risk include children, menstruating and pregnant persons, and people of low socioeconomic status. Timely diagnosis and management of iron deficiency are key to preventing IDA and require thorough assessment of the underlying cause and appropriate iron repletion through either oral or parenteral therapy.

Invasive Fungal Diseases: 5 Pearls Segment

Invasive fungal diseases are increasingly common but often under-recognized due to outdated risk frameworks, misinterpretation of diagnostic tests, and unfamiliarity with antifungal therapies. Many clinicians struggle to appropriately identify at-risk patients, interpret fungal markers like Beta-D-Glucan and galactomannan, and initiate timely antifungal treatment. This podcast addresses these gaps by providing practical strategies for risk assessment, diagnostic testing, and evidence-based management of fungal infections.

Intimate Partner Violence: Educating and Connecting

When, where, and how you ask about intimate partner violence matter. In this interactive course, the second in a two-part series, you will learn universal education approaches that both promote prevention and improve health and safety outcomes. Audio Version Now Available Modules and CME/MOC credit are free to ACP Members. Nonmembers may purchase access to claim CME/MOC credit for each module for $25. Copyright 2022 American College of Physicians. All Rights Reserved.

Intimate Partner Violence: Dynamics and Effects

Gain the strategies you need to effectively care for your patients affected by intimate partner violence (IPV) and exploitation. This interactive online activity explores the dynamics and effects of IPV and offers evidence-backed approaches for effective prevention and response. See part two of this series for more practical tips and universal education approaches to prevent IPV and improve health outcomes.

Inpatient Management of Patients With Cirrhosis

Cirrhosis affects millions of U.S. adults and costs the U.S. health care system upward of $6 billion annually. Cirrhosis is underrecognized, and the only cure is transplantation. Complications, including bleeding, infection, ascites, and renal injury, contribute to high rates of hospitalization, readmission, and mortality in this population. Evidence-based practices and guidelines offer quality recommendations for clinicians, but many of these guidelines have changed recently. This article provides an update on the current guidelines for the inpatient management of cirrhosis.

Improving Research Reports: Avoiding P Values

In this episode of Annals On Call, Dr. Centor discusses how to go beyond statistical significance testing when interpreting study findings with Dr. David Savitz. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.

Immune-Related Adverse Events of Immune Checkpoint Inhibitors

Immune-related adverse events (irAEs) are toxicities that arise after the administration of monoclonal antibodies targeting immune checkpoints (immune checkpoint inhibitors [ICIs]) in patients with cancer. They can occur at any time after initiation of ICI treatment, with a broad clinical phenotype that can be organ-specific or systemic. Although most irAEs manifest as mild to moderate signs and symptoms, severe forms of irAEs can lead to irreversible organ failure and have acute life-threatening presentations. Treatment should be tailored to the specific organ involved and the severity.

Immune Checkpoint Inhibitor Adverse Events 2.0: 5 Pearls Segment

Although internal medicine providers are familiar with checkpoint inhibitors and their immune-related adverse events (IRAE), there is a gap in the knowledge of specific characteristics of these drugs. They are clinically relevant because their adverse events can present similar to other medical conditions and a high degree of suspicion is needed to identify IRAEs.

Rethinking Professionalism Assessments in Medical Education

Comfort Measures Only

Reducing the Burden of Overdiagnosis in Breast Cancer Screening and Beyond

Bias Against the Willfully Unvaccinated

Associations of Atrial Fibrillation After Noncardiac Surgery With Stroke, Subsequent Arrhythmia, and Death: A Cohort Study: Annals of Internal Medicine: Vol 175, No 8

Background: Postoperative atrial fibrillation (AF) after noncardiac surgery confers increased risks for ischemic stroke and transient ischemic attack (TIA). How outcomes for postoperative AF after noncardiac surgery compare with those for AF occurring outside of the operative setting is unknown. Objective: To compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery. Design: Cohort study. Setting: Olmsted County, Minnesota. Participants: Patients with incident AF between 2000 and 2013. Measurements: Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF). Results: Of 4231 patients with incident AF, 550 (13%) had postoperative AF as their first-ever documented AF presentation. Over a mean follow-up of 6.3 years, 486 patients had an ischemic stroke or TIA and 2462 had subsequent AF; a total of 2565 deaths occurred. The risk for stroke or TIA was similar between those with postoperative AF and nonoperative AF (absolute risk difference [ARD] at 5 years, 0.1% [95% CI, −2.9% to 3.1%]; hazard ratio [HR], 1.01 [CI, 0.77 to 1.32]). A lower risk for subsequent AF was seen for patients with postoperative AF (ARD at 5 years, −13.4% [CI, −17.8% to −9.0%]; HR, 0.68 [CI, 0.60 to 0.77]). Finally, no difference was seen for cardiovascular death or all-cause death between patients with postoperative AF and nonoperative AF. Limitation: The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations. Conclusion: Postoperative AF after noncardiac surgery is associated with similar risk for thromboembolism compared with nonoperative AF. Our findings have potentially important implications for the early postsurgical and subsequent management of postoperative AF. Primary Funding Source: National Institute on Aging.

Building Connections Between Guidelines and Quality Improvement

Outpatient Evaluation and Management of COVID-19

Professional Courtesy

Epstein–Barr Viral Load Monitoring Strategy and the Risk for Posttransplant Lymphoproliferative Disease in Adult Liver Transplantation: A Cohort Study: Annals of Internal Medicine: Vol 176, No 2

Background: Primary infection with or reactivation of Epstein–Barr virus (EBV) can occur after liver transplant (LT) and can lead to posttransplant lymphoproliferative disease (PTLD). In pediatric LT, an EBV-DNA viral load (EBV VL) monitoring strategy, including the reduction of immunosuppression, has led to a lower incidence of PTLD. For adult LT recipients with less primary infection and more EBV reactivation, it is unknown whether this strategy is effective. Objective: To examine the effect of an EBV VL monitoring strategy on the incidence of PTLD after LT in adults. Design: Cohort study. Setting: Two university medical centers in the Netherlands. Patients: Adult recipients of first LT in Leiden between September 2003 and January 2017 with an EBV VL monitoring strategy formed the monitoring group (M1), recipients of first LT in Rotterdam between January 2003 and January 2017 without such a strategy formed the contemporary control group (C1), and those who had transplants in Leiden between September 1992 and September 2003 or Rotterdam between 1986 and January 2003 formed the historical control groups (M0 and C0, respectively). Measurements: Influence of EBV VL monitoring on incidence of PTLD. Results: After inverse probability of treatment weighting of the 4 groups to achieve a balance among the groups for important patient characteristics, differences within hospitals between the historical and recent era in cumulative incidences—expressed as the number of events per 1000 patients measured at 5-, 10-, and 15-year follow-up—showed fewer events in the contemporary era in both centers. This difference was considerably larger in the monitoring center, whereas the 95% CI included the null value of 0 for point estimates. Limitation: Retrospective, low statistical power, and incompletely balanced groups, and non-EBV PTLD cannot be prevented. Conclusion: Monitoring EBV VL may reduce PTLD incidence after LT in adults; larger studies are warranted. Primary Funding Source: None.

2021 E/M Coding Change: Making Sense of Unexpected Findings

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Hydrochlorothiazide no better than placebo for preventing kidney stone recurrence

Put words in our mouth

Antibiotic stewardship improved prescribing for suspected UTI in frail older adults

Register now for ACP's and Annals of Internal Medicine's forum on overweight and obesity

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ACP calls for policies to protect reproductive health care

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Drug shortages drag on | ACP Hospitalist

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Could you repeat that? | ACP Hospitalist