Seasonal influenza is a contagious viral respiratory illness that causes yearly epidemics.

There is limited evidence of the strategies to mitigate burnout among all health care professionals (HCPs).

Sepsis is the leading cause of death worldwide. Mortality has improved in the past few decades but remains high, and survivors frequently have long-term complications. Initial diagnostic evaluation focuses on risk stratification and source and pathogen identification. Treatment includes intravenous fluids, vasopressors, steroids if shock is present, antimicrobial therapy targeting the most likely source of infection, and source control. Patients with shock or high-risk organ failure syndromes should be admitted early to an intensive care unit. After initial antimicrobials and resuscitation, care should focus on antimicrobial deescalation, volume management, and high-quality supportive care. Shared decision making about goals of care and transitions is important to support survivors after discharge.

Health care systems are investing significant resources in social needs screening and intervention programs.

Perinatal depression can have a deleterious impact on mothers and infants.

Urinary albumin-creatinine ratio (UACR) and urinary protein-creatinine ratio (UPCR) are both used in clinical practice to diagnose and monitor chronic kidney disease (CKD). Which measure exhibits stronger associations with clinical outcomes and whether this varies by patient characteristics are unknown.

Safe and reliable venous access is critical for high-quality cancer care. Patients with both solid and hematologic cancers require vascular access devices (VADs) for systemic chemotherapies and for supportive treatments, including blood products, antimicrobials, antiemetics, and fluids. However, VADs are associated with serious complications, including bloodstream infection and venous thromboembolism. Evidence-based guidance could maximize benefits and reduce risks in the selection and management of VADs in patients with cancer. The authors convened a 9-member international multidisciplinary panel and used the RAND/UCLA Appropriateness Method to develop recommendations for VAD selection, insertion, and management in patients with cancer. A literature review informed the development of clinical scenarios, which were rated by the panel for appropriateness based on cancer type, treatment indication, urgency, comorbidities, and anticipated duration of use. Of 1422 scenarios, 502 (35%) were rated as appropriate, 400 (28%) were rated as neutral/uncertain, and 520 (37%) were rated as inappropriate. Appropriateness of VAD selection varied by type of cancer, treatment urgency, and planned dwell time. For patients with acute hematologic cancers requiring urgent chemotherapy, placement of a double-lumen peripherally inserted central catheter (PICC) or a tunneled central venous catheter (CVC) was rated as appropriate, regardless of treatment intensity or infusate characteristics. For patients with malignant solid tumors, a single-lumen tunneled CVC or implanted port was rated as appropriate for delivering chemotherapy, regardless of treatment intensity, urgency, or duration. In patients with advanced chronic kidney disease, coordination of care with a nephrologist to ensure vein preservation in the context of cancer prognosis was recommended. By developing comprehensive, evidence-informed expert recommendations, the Michigan Appropriateness Guide for Intravenous Catheters in Adult Patients With Cancer (MAGIC-ONC) aims to improve clinical care, reduce complications, support quality improvement efforts, and advance the safety of vascular access for patients with cancer.

Recent developments and controversies in organ transplantation necessitate the reaffirmation and application of foundational ethical norms as the laudable goal of increasing viable organs for transplantation is pursued. The physician's primary duties are to individual patients under the physician's care. For physicians of prospective donor-patients, the "bright line" between serving the best interests of donor-patients and their families and serving potential recipient-patients and the public interest can become blurred in ethically problematic ways. This paper provides ethical guidance for clinicians involved in organ transplantation as well as for patients, families, the public, policymakers, and others to help maintain trust and encourage participation in this life-saving enterprise. It clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on the best interests of donor-patients and their families independent of organ donation potential. It also emphasizes the importance of truly informed consent for organ donation and advocates for prioritizing equity and transparency in transplantation processes.

Cardiac implantable electronic devices (CIEDs) have increased the quality and duration of life for millions of patients. As their utilization continues to grow exponentially, clinicians need to diagnose and manage several device-associated complications that may arise during the CIED life cycle. This primer is tailored for the general internal medicine physician or hospitalist, who will inevitably take care of patients with CIEDs, to provide a contemporary update on the incidence and clinical manifestations of the 4 most common CIED complications, with the latest evidence to guide clinical management and expected outcomes. Specifically, this review focuses on: 1) generator/lead failure, which has decreased to less than 1% per year due to continuous advances in manufacturing and programming and is mostly managed conservatively with close monitoring; 2) CIED infections, which, while also rare at approximately 1% per year, carry a short-term mortality of 10% to 20%, thus requiring immediate diagnosis and often urgent treatment with lead extraction because antibiotic treatment is rarely effective; and 3) lead-related venous obstruction, which has highly variable incidence (5% to 30%) and manifestations, ranging from arm swelling to superior vena cava syndrome. Management options range from anticoagulation to balloon venoplasty, often with unsatisfying results. This review will also focus on 4) lead-related tricuspid regurgitation, which affects 20% to 30% of CIEDs and has become an area of intense interest with the development of percutaneous tricuspid treatments-where evidence is urgently needed to inform the need for lead extraction versus jailing during tricuspid interventions. The progressive adoption of leadless devices may significantly reduce many of these complications. Nonetheless, optimal management requires input from a multidisciplinary team of electrophysiologists and imaging, heart failure, and structural interventional specialists-who should be able to recognize and treat each complication promptly based on a rapidly evolving evidence base.

Colorectal cancer is the second leading cause of cancer-related deaths for both men and women. Screening for colorectal cancer is an effective strategy to reduce morbidity and mortality, but uptake remains suboptimal. Several performance measures for colorectal cancer screening and surveillance are currently used in pay-for-performance, public reporting, and/or accountability programs. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care. The ACP believes that a performance measure must be methodologically sound and evidence-based to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential effect to physician administrative work and reputation and reimbursement and to prevent unintended consequences on patient care. The ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. This article aims to present a review of current performance measures for colorectal cancer screening and surveillance to inform physicians, payers, and policymakers in their selection and use of performance measures and make recommendations for measures that could be developed. The PMC appreciates the importance of colorectal cancer screening in the prevention and early detection of colorectal cancer and supports performance measures based on strong recommendations. The PMC reviewed 5 performance measures for colorectal cancer screening relevant to internal medicine and supports 1 performance measure ("Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy") for use.

Chronic coronary artery disease (CCAD) is a leading cause of death in the United States and many other countries. The defining pathobiology is an imbalance between the metabolic demands of the myocardium and oxygen supply, which most often results from coronary artery atherosclerosis. The classic presenting symptom of CCAD is angina, but clinical presentation varies greatly among patients. Since the last In the Clinic on CCAD (previously termed "stable ischemic heart disease") in 2019, several new medications have been approved to reduce ischemic complications.

Users of GRADE (Grading of Recommendations Assessment, Development and Evaluation) make judgments about the size of intervention effects on desirable and undesirable people-important health outcomes or on benefits and harms. Benchmarking effect sizes by using decision thresholds (DTs) can help to facilitate these judgments and the process. This article provides GRADE guidance for use of DTs for judgments about the magnitude of desirable and undesirable health effects, such as in a health guideline or health technology assessment. Through iterative discussions and refinement in in-person and online meetings of a GRADE project group and through e-mail communication, the authors developed guidance for using DTs in Evidence-to-Decision (EtD) frameworks. The authors applied the approach and used these examples from guidelines and the results of a randomized methodological study to develop official GRADE guidance. Several alternatives for determining and using DTs are presented. In the first main approach, outcome-specific DTs for trivial, small, moderate, and large effects are determined through a calculation using empirically derived generic coefficients and the outcome's utility value and are compared with the effect estimate obtained from an evidence synthesis. In the second main approach, outcome-specific DTs are also determined, but through direct surveying of decision makers to explicitly assign thresholds for the prioritized health outcomes. The article also describes how these approaches can be combined. The suggested approaches provide transparency for judgments in EtD frameworks that are based on findings from evidence syntheses.

GIM/FP/GP: [Formula: see text].

Despite growing adoption of point-of-care ultrasound (POCUS) education by internal medicine residency programs (IMRPs), there is no consensus on the specific skills that should be taught, the most effective teaching methods for content delivery, and the optimal strategies for evaluating trainees.

Screening for multiple types of cancer with a single blood test is potentially transformative.

Internal medicine physicians are specialists who promote health, emphasize disease prevention, manage complex acute and chronic conditions in adults, and receive extensive training in the diagnosis and treatment of diseases affecting all systems of the human body. As a result, internal medicine performance measures (PMs) target several topics. Many PMs are not based on high-certainty evidence of at least moderate net benefit and are burdensome, with low or no value to patient care. The American College of Physicians (ACP) wants to provide a national focus to improve the quality of health care in the United States. The ACP is a leader in the evidence-based world, being the only physician organization designated as a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Center, an Appraisal of Guidelines for Research and Evaluation (AGREE) Center, and a member of the Cochrane U.S. Network. Using a structured, stepwise, evidence-based approach, ACP identified the most important clinical topics evaluated and treated by internal medicine physicians. The ACP is also actively working toward recommending essential PMs for each core clinical topic that can be used to evaluate and improve patient care. This position paper describes ACP's method and results of identifying core clinical topics. It also offers a blueprint for defining core PMs and illustrating the principals through application to 2 core clinical topics. The ACP plans to apply this method on PMs for other core clinical topics.

Nearly 14% of Americans have chronic kidney disease (CKD), which includes persistent decrements in glomerular filtration rate or the presence of albuminuria. Although CKD is commonly attributed to diabetes or hypertension, there is growing awareness of the interplay among cardiovascular, kidney, and metabolic health. Progression of CKD can result in metabolic abnormalities and end-stage kidney disease, but cardiovascular events are even more common. The main goals of CKD treatment include slowing the decline in kidney function, preventing cardiovascular disease, and treating metabolic complications. Recent pharmacologic advancements have yielded effective therapeutic agents capable of concurrently addressing all of these objectives.

Rapid changes in the legalized cannabis market have led to the predominance of high-concentration delta-9-tetrahydrocannabinol (THC) cannabis products.

Optimal transfusion strategies for patients with acute myocardial infarction (AMI) are uncertain. The aim of this guideline is to provide recommendations for red blood cell transfusion in patients with AMI.

Accurate blood pressure measurement (BPM) is essential for managing hypertension, but previous studies have not systematically compared different monitoring methods across varying BP levels. To address this gap, a comprehensive analysis using network meta-analysis (NMA) and meta-regression was done to evaluate their agreement and clinical implications.