American College of Physicians

The American College of Physicians (ACP) developed these rapid practice points addressing the efficacy, comparative effectiveness, and harms of respiratory syncytial virus (RSV) vaccines in adults aged 18 years or older who are not pregnant or immunocompromised. The ACP Population Health and Medical Science Committee developed the rapid practice points based on a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria. Adults aged 75 years or older should receive a protein subunit RSV vaccine. Adults aged 60 to 74 years who are at increased risk for severe RSV may consider receiving a protein subunit RSV vaccine.

More than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician's ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.

BackgroundThe recurrence rate of malignant pericardial effusion after pericardiocentesis is 62%. For this reason, intrapericardial instillation of therapeutic agents is performed after pericardial evacuation to improve the treatment. Cisplatin has proved to be a useful and safe agent. ObjectiveTo present our experience with intrapericardial instillation of cisplatin for the management of malignant pericardial disease. Material and MethodsWe included patients admitted to the Instituto Alexander Fleming between January 2005 and May 2009 with cardiac tamponade or severe pericardial effusion treated with pericardial drainage and instillation of cisplatin (10 mg in 20 ml of physiological solution for 5 days). Malignant pericardial effusion had to be confirmed by cytological examination or by echocardiographic evidence of malignant disease involving the pericardial space. Low treatment expectation was another requirement for inclusion. A total of 9 patients (6 men and 3 women) were included; mean age was 60 years (51-69). The primary tumors were lung cancer (n=4); breast cancer (n=1); bladder cancer (n=1); esophageal cancer (n=1), and prostate cancer (n=1). The cytological examination was positive in 6 cases. Thecatheter was removed after 7 days. Three patients presented adverse events: pain, fever and atrial fibrillation. One patient had a recurrence one month later. Eight patients died [mean time to death: 50 days (7-83)] and one is alive. Conclusion Intrapericardial instillation of cisplatin is a feasible and well-tolerated procedure. The incidence of recurrences is low.

Type 1 and type 2 diabetes are prevalent chronic illnesses, are leading causes of mortality and morbidity, and result in substantial public health burden. Timely identification and appropriate management of diabetes can help reduce adverse consequences of diabetes. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care but believes that a performance measure must be methodologically sound and evidence-based in order to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential impact on physician administrative work, reputation, and reimbursement and to prevent unintended consequences for patient care. To help improve performance measurement and reduce burden, the ACP Performance Measurement Committee (PMC) reviews performance measures using a rigorous process to recognize high-quality measures and address gaps and areas for improvement. In this article, the PMC presents its review of 14 current performance measures for diabetes that are relevant to internal medicine. The PMC supports kidney health evaluation at the individual and group practice levels, hemoglobin A1c control at the health plan level, eye examination at the health plan level, and angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy at the individual physician level.

Recently, the U.S. Food and Drug Administration (FDA) approved 18F-labeled flurpiridaz as another PET myocardial perfusion imaging (MPI) radiotracer for clinical use in adult patients with known or suspected coronary artery disease (CAD). This decision was based on recent results of a second phase 3