April 2014

From left Befikir Astil MD a PGY-2 resident and ACP ResidentslashFellow Member and James W Reed MD MACP a professor of medicine and chief of the medical service at Grady Memorial Hospital for the

For hypertension, how low to go?

Updated blood pressure guidelines may have created more questions than closure, internists have found, as they try to determine how aggressively to treat the condition and what goals to set for subpopulations of patients, such as those with diabetes. Experts react to the “paradigm shift” in lowering hypertension.

Maintaining men's health in middle age

Adrenopause, somatopause, andropause... manopause? They all give internists pause when considering men's health as they reach middle age. As men try to maintain optimum health, doctors need to define what exactly that is.

Refine your referrals to physical rehab with thought, timeliness

Internists can vastly improve outcomes for patients by referring more patients to physical rehabilitation earlier, more often, and for more conditions than they might think.

Unique state of payments as Maryland uses uniform prices

Hospital charges in Maryland have been set by the state for 4 decades, and more reforms are on the way. The effort has led to all insurers paying the same price for the same services in the same hospitals, and now, the state is looking to improve facilities' readmission rates and other quality metrics.

Potential changes questioned for advanced cardiac life support

The Advanced Cardiac Life Support guidelines are due out in 2015 and may pose some shocking changes: faster beats-per-minute chest compressions, a de-emphasis on hypothermia, and a new length of time for continuing cardiopulmonary resuscitation.

ACP and the ‘house of medicine’

ACP's outgoing president reflects on her past year, milestones the College has achieved, and what future goals remain.

What did 11 years, 16 patches and $154 billion get us? Nothing

There are plenty of examples of wasteful government spending, but the sustainable growth rate formula is hard to top.

Better, not broken: pursuing empathy during medical training

Empathy is a crucial element to good care and improved patient outcomes. Why doesn't medical education promote more of it?.

Hypertension guidelines lead to vigorous debate

This issue includes stories centered on various aspects of hypertensions, as well as topics specific to mean's health, electronic health records and physical rehabilitation referrals.

ICD-10 will require more precision in documenting visits

ACP staff answers questions that have arisen as members ramp up their efforts to comply with the new implementation standards.

Practice Tips: Connecting the dots—why benchmarking matters

Efficient practices not only run better, they offer better patient outcomes. Benchmarking is the first step in this process because it shows where to focus attention first.

Cardiac risks of testosterone, saxagliptin under investigation

This regulatory update covers an FDA review of the risk of stroke, heart attack and death in men taking testosterone products, as well as a possible increase in heart failure associated with saxagliptin.

EHRs' advantages may carry malpractice risks as well

Electronic health records have numerous advantages but also some potential pitfalls, as design flaws, complex templates and structured progress notes may lead to more complexity and more challenges to defense against malpractice.

ACP Annual Business Meeting

The ACP Annual Business Meeting will occur at Internal Medicine 2014 in the Orange County Convention Center on Saturday, April 12, from 12:45 p.m. to 1:45 p.m.

MKSAP Quiz: ED evaluation for midsternal pain

A 59-year-old woman is evaluated in the emergency department for midsternal chest pain. The pain began several hours ago as a vague ache in her left upper sternal region that progressed in intensity and severity. The pain abated spontaneously after approximately 45 minutes. She had no further chest pain until several hours later, when it recurred unprovoked by exertion. She has no shortness of breath, nausea or vomiting, syncope, previous history of chest pain, or known cardiac disease or risk factors for venous thromboembolism. Medical history is significant for hyperlipidemia and hypertension. She does not smoke cigarettes. Medications are simvastatin, aspirin, lisinopril, and hydrochlorothiazide. Following a physical exam, electrocardiogram and chest radiograph, what is the most appropriate initial management?.

Crossed Words: Spitting into the wind

ACP Internist's puzzle feature challenges readers to find clues placed horizontally in rows to reveal an answer written vertically.