Robert H. Hopkins

Screening for colorectal cancer: A guidance statement from the american college of physicians

DESCRIPTION Colorectal cancer is the second leading cause of cancer-related deaths for men and women in the United States. The American College of Physicians (ACP) developed this guidance statement for clinicians by assessing the current guidelines developed by other organizations on screening for colorectal cancer. When multiple guidelines are available on a topic or when existing guidelines conflict, ACP believes that it is more valuable to provide clinicians with a rigorous review of the available guidelines rather than develop a new guideline on the same topic. METHODS The authors searched the National Guideline Clearinghouse to identify guidelines developed in the United States. Four guidelines met the inclusion criteria: a joint guideline developed by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology and individual guidelines developed by the Institute for Clinical Systems Improvement, the U.S. Preventive Services Task Force, and the American College of Radiology. GUIDANCE STATEMENT 1: ACP recommends that clinicians perform individualized assessment of risk for colorectal cancer in all adults. GUIDANCE STATEMENT 2: ACP recommends that clinicians screen for colorectal cancer in average-risk adults starting at the age of 50 years and in high-risk adults starting at the age of 40 years or 10 years younger than the age at which the youngest affected relative was diagnosed with colorectal cancer. GUIDANCE STATEMENT 3: ACP recommends using a stool-based test, flexible sigmoidoscopy, or optical colonoscopy as a screening test in patients who are at average risk. ACP recommends using optical colonoscopy as a screening test in patients who are at high risk. Clinicians should select the test based on the benefits and harms of the screening test, availability of the screening test, and patient preferences. GUIDANCE STATEMENT 4: ACP recommends that clinicians stop screening for colorectal cancer in adults over the age of 75 years or in adults with a life expectancy of less than 10 years.

Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association

DESCRIPTION The American College of Physicians (ACP) developed this guidance statement to present the available evidence on screening for HIV in health care settings. METHODS This guidance statement is derived from an appraisal of available guidelines on screening for HIV. Authors searched the National Guideline Clearinghouse to identify guidelines on screening for HIV in the United States and used the AGREE (Appraisal of Guidelines Research and Evaluation) instrument to evaluate guidelines from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention. GUIDANCE STATEMENT 1: ACP recommends that clinicians adopt routine screening for HIV and encourage patients to be tested. GUIDANCE STATEMENT 2: ACP recommends that clinicians determine the need for repeat screening on an individual basis.

Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians.

DESCRIPTION The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the screening, monitoring, and treatment of adults with stage 1 to 3 chronic kidney disease. METHODS This guideline is based on a systematic evidence review evaluating the published literature on this topic from 1985 through November 2011 that was identified by using MEDLINE and the Cochrane Database of Systematic Reviews. Searches were limited to English-language publications. The clinical outcomes evaluated for this guideline included all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, chronic heart failure, composite vascular outcomes, composite renal outcomes, end-stage renal disease, quality of life, physical function, and activities of daily living. This guideline grades the evidence and recommendations by using ACPs clinical practice guidelines grading system. RECOMMENDATION 1 ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence) RECOMMENDATION 2 ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker. (Grade: weak recommendation, low-quality evidence) RECOMMENDATION 3 ACP recommends that clinicians select pharmacologic therapy that includes either an angiotensin-converting enzyme inhibitor (moderate-quality evidence) or an angiotensin II-receptor blocker (high-quality evidence) in patients with hypertension and stage 1 to 3 chronic kidney disease. (Grade: strong recommendation) RECOMMENDATION 4 ACP recommends that clinicians choose statin therapy to manage elevated low-density lipoprotein in patients with stage 1 to 3 chronic kidney disease. (Grade: strong recommendation, moderate-quality evidence).

Problem residents: prevalence, problems and remediation in the era of core competencies.

a S A g The American Board of Internal Medicine (ABIM) has defined the “problem resident” as a learner who demonstrates problem behaviors significant enough to require intervention by program leadership, typically the residency program director or chief resident. It has been over a decade since Yao and Wright’s report on the prevalence of “problem residents” in internal medicine residency training programs. Their survey of program directors reported performance problems in 6.9% of residents. We are unaware of any subsequent large studies in internal medicine of this important topic. Although the term “problem resident” has been used frequently, we will refer to these individuals as “residents in difficulty.” The purpose of this study was to assess internal medicine program director experiences with residents in difficulty in the era of Accreditation Council for Graduate Medical Education (ACGME) competencies.

Higher pneumococcal disease vaccination rates needed to protect more at-risk US adults.

Abstract Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the availability of an effective pneumococcal polysaccharide vaccine (PPSV23), vaccination rates among adults remain suboptimal. This is of immediate concern given the current H1N1 pandemic, since secondary bacterial infection with Streptococcus pneumoniae is common and can contribute to morbidity and mortality. The Centers for Disease Control and Prevention has recently called for increased efforts to vaccinate recommended persons against pneumococcal disease. Long-term trends including the growth of the elderly population and an increase in the number of patients with chronic conditions also underscore the importance of improving pneumococcal vaccination rates. It is important for health care providers, public health officials, and policy makers to recognize the serious health impact of pneumococcal disease in adults and to ensure increased coverage; at present, this is the best way to protect against invasive pneumococcal infection and its consequences.

Challenges with Continuity Clinic and Core Faculty Accreditation Requirements

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

Adult immunization guidelines: challenges and opportunities.

Annually, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention issues a revised Adult Immunization Schedule that is approved by the major specialty soc...

Effective Immunization of Older Adults Against Seasonal Influenza

The 2017-2018 influenza season reminds us that it is important for health care professionals to be prepared for the annual onslaught of this contagious respiratory disease associated with potentially serious complications. Vaccination is by far the best method to prevent and control influenza, reducing illness, hospitalizations, and mortality. The highest rates of influenza-associated morbidity and mortality are observed in older adults. The immune function of older adults decreases with increasing age, a phenomenon termed immunosenescence. Immunosenescence not only confers increased susceptibility to influenza disease, but also renders vaccination less effective. To address the need for improved vaccines that provide enhanced protection to this high-risk group, 2 formulations-a high-dose vaccine and an adjuvanted vaccine-have been approved in recent years specifically for people aged 65 years and over. Here we discuss: the challenges of influenza immunization in those 65 years and older; the recent advancements in vaccines targeted at this age group; and the latest influenza vaccine recommendations for the 2017-2018 influenza season in the United States.

Immunization guidelines in the United States: new vaccines and new recommendations for children, adolescents, and adults.

It is increasingly apparent that prevention, rather than treatent, of infectious diseases offers significant health and economic enefits to individuals and populations. Combined with the increasng virulence of some pathogens, and the increasing rates of ntimicrobial resistance, as well as the tremendous costs associted with treating disease once it has occurred, vaccines are a highly ost-effective public health strategy. Despite this, and the widespread availability of vaccines in the S, an estimated annual average of 50,000 Americans die of potenially vaccine-preventable diseases each year, with more than 99% f these deaths occurring in adults. This means that at the start f each year, 1 out of every 7000 Americans will die of a disase that might be prevented by already existing and available accines. Several factors commonly conspire to prevent routine immuization, including cost, lack of knowledge and awareness, missed pportunities, and the lack of a systems-level approach to providng vaccines. Excellent resources are available for setting up an mmunization program and are available from the American Colege of Physicians at http://www.acponline.org/aii/index.html and rom the CDC at http://www.cdc.gov/vaccines/. In addition, a free nd very helpful smart phone app is available through the iTunes tore (ACP Immunization Advisor). The purpose of the annual immunization guidelines is to provide n evidence-based schedule of routine immunizations demontrated to be safe and effective, based on age and concurrent edical conditions. This is the approved official schedule for use in he US, and allows all clinicians to provide vaccines in a harmonious anner regardless of geographic location. The schedule is develped by a federal advisory committee (the Advisory Committee on mmunization Practices – ACIP), which consists of experts in vacciology, public health, infectious diseases, and related disciplines. These new recommendations describe each vaccine, its use, ndications and contraindications, background data, and other nformation, and can be accessed at http://www.immunize. rg/catg.d/p2010.pdf. The full adult immunization schedule is vailable at http://www.cdc.gov/vaccines/schedules/downloads/ dult/adult-schedule-bw.pdf. These schedules can be found in ppendix A. Below we provide brief commentary on the major changes cliicians should be aware of: