American College of Physicians: Internal Medicine — Doctors for Adults ®

Advertisement

Internal Medicine 2012 News



Scientific Meeting News for April 21, 2012




Highlights

Manage myalgias in statin patients

Your 5 o'clock add-on patient is a 55-year-old man with diabetes who has been having myalgias. His baseline LDL cholesterol is 125. He started having myalgias when he took atorvastatin three months ago. The myalgias stopped when he stopped the drug. He switched to pravastatin three weeks ago and the myalgias started again. What do you recommend? More...

Preventing, and measuring risks for, periop problems

A healthy patient asks how long he needs to fast before his 8 a.m. elective surgery. What do you say? More...

CT screening can detect lung cancer in smokers, but with 'bugaboos'

Low-dose computed tomography (CT) screening for lung cancer in current and former smokers has some advantages, as it can detect more cancers than chest X-ray and at an earlier stage, according to James R. Jett, MD. It can also improve rates of smoking cessation and may detect ancillary cancer and other life-threatening diseases, he said. More...


Breaking news

ACP recommends ways to reform Medicare in the age of deficit reduction

A dozen recommendations to ensure that Medicare beneficiaries have access to high-quality, coordinated care were provided yesterday by the American College of Physicians in its newly released policy paper, "Reforming Medicare in the Age of Deficit Reduction." More...

Physicians call for improvements to country's public health system

ACP called yesterday for an improved public health infrastructure that works collaboratively with physicians to ensure the public's safety and health, in its policy paper "Strengthening the Public Health Infrastructure." More...


For attendees

Recapping a hope-filled year for infectious disease experts

There are several reasons to feel hopeful about the current state of infectious diseases, according to John G. Bartlett, MD, MACP, professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Dr. Bartlett will review those reasons, and other hot topics, in his Update in Infectious Diseases today. The update will be held in Auditorium A from 11:15 a.m.-12:45 p.m. More...

ACP Annual Business Meeting to be held today

All members are encouraged to attend ACP's Annual Business Meeting today. Current College Officers will retire from office and incoming Officers, new Regents and Governors-Elect will be introduced. More...


Highlights


.
Manage myalgias in statin patients

Your 5 o'clock add-on patient is a 55-year-old man with diabetes who has been having myalgias. His baseline LDL cholesterol is 125. He started having myalgias when he took atorvastatin three months ago. The myalgias stopped when he stopped the drug. He switched to pravastatin three weeks ago and the myalgias started again. What do you recommend?

A) Start ubiquinone (coenzyme Q10)

B) Switch to simvastatin

C) Add an NSAID

D) Stop pravastatin and start red yeast rice

When polled, the audience of "Dangerous Drugs and How to Minimize Their Dangers" on Friday morning favored coenzyme Q10 (82%), with red yeast rice as the next most popular choice (12%). Either is a good option, according to Douglas Paauw, MD, MACP, of the University of Washington in Seattle.

Coenzyme Q10 has conflicting results in the literature. One study was positive; the other, negative. "The good news about coenzyme Q10 is that you can get it anywhere. It's benign. It's worth a try. I don't want to oversell it because the jury is still out on its effectiveness," Dr. Paauw said.

A small study of red yeast rice in 62 statin-intolerant patients appeared in Annals of Internal Medicine. Randomized patients took 1,800 mg twice daily (a dose about equivalent to 4 mg of lovastatin) or placebo. Red yeast rice modestly lowered LDL, about 35 mg/dL, with no difference in myalgia between it and placebo.

Nonsteroidal anti-inflammatory drugs aren't a good choice because many patients take statins for cardiovascular risk protection, and the other choice, simvastatin, has a higher degree of drug interactions than the other statins, Dr. Paauw said.

"It still is a frustrating area because the effectiveness of these options is limited," he said.

Myalgias are by far the predominant side effect of statins, with an incidence rate from 5% to 18%, he said, far greater than rhabdomyolysis (0.1%), hepatotoxicity (rare) or liver failure (0.0001%). In the PRIMO study, 10.5% of patients had muscle symptoms on statins.

And rates differ among different statins. The percentages of patients suffering myalgia have been calculated at 5.1% with fluvastatin, 10.9% with pravastatin, 14.9% with atorvastatin and 18.2% with simvastatin. That's almost a fourfold difference between the top and bottom drugs.

"For patients who have myalgias, it appears to be dose- and drug-related, that certain statins have more of a problem than others, and the higher the dose, the higher the risk for it," Dr. Paauw said.

This could set up a conflict between the internist and the cardiologist, who may prescribe a large dose initially. "I like to start on a lower dose and titrate up to a higher dose rather than just starting them on a higher dose to begin with," Dr. Paauw said.

He offered his step-by-step process for managing myalgias.

  • Stop the statin to see if it alleviates the symptoms.
  • If so, restart the statin at a lower dose or switch to another statin.
  • Set the dose at two to three times a week, such as fluvastatin 80 mg on alternate days.
  • Check thyroid-stimulating hormone levels, for two reasons. Hypothyroid patients are more likely to get myalgias with statins, and hypothyroidism can independently cause myalgia.

Myalgias are more common in patients with low body mass and in Asian populations because of a genetic difference in the ability to process statins, Dr. Paauw said. He also noted, "Like everything this year, vitamin D gets dragged into the argument." While studies suggest that people with low vitamin D levels have more myalgias, there is no proof that replacing vitamin D levels solves the problem, he said.


.
Preventing, and measuring risks for, periop problems

A healthy patient asks how long he needs to fast before his 8 a.m. elective surgery.

What do you say?

If you tell him he can have no solid foods after midnight, but can drink clear liquids up to six hours before surgery, you're in line with what most audience members thought at Friday's "New Recommendations in Perioperative Medicine" session.

They (and you) were partly correct. Food after midnight should indeed be avoided, but a patient can actually drink clear liquids all the way up until two hours before surgery, said session speaker Karen F. Mauck, MD, FACP, an assistant professor of medicine at Mayo Clinic in Rochester, Minn.

This rule, which comes from the 2011 revised practice guidelines on fasting from the American Society of Anesthesiologists (ASA), applies to healthy patients who are having elective surgery involving general anesthesia, regional anesthesia or sedation/analgesia, she said. It's not meant for women in labor, or for patients with impaired upper airway protective reflexes or risk factors for aspiration.

"This is actually an update of the 1999 guideline that said the same thing, and yet none of us are doing it," said Dr. Mauck, to embarrassed laughter from the audience. "We tell patients nothing after midnight, and they come in totally dehydrated. So maybe [the ASA] updated the guidelines just so people will listen."

Clear liquids comprise water, fruit juices without pulp, carbonated beverages, clear tea and black coffee. "I did have a patient ask if it was OK to drink his bourbon—NO! Alcohol is not on the list," Dr. Mauck said.

A Mayo Clinic anesthesiologist has found that devout coffee drinkers are less inclined to have headaches when they wake from anesthesia if they drink java right up to the two-hour deadline for clear liquids, she added.

With patients who have significant gastroesophageal reflux disease (GERD), physicians may want to forbid clear liquids for six hours before surgery, to be on the safe side, she said. Six hours is the limit for non-human milk, too.

There's not much evidence that pharmacologic agents (like gastric acid blockades or gastrointestinal stimulants) reduce aspiration risk, so they aren't recommended for routine use, she added.

Dr. Mauck also discussed the risk of poor outcomes during and after surgery. Patients who have surgery within two months of a recent myocardial infarction have an especially high risk of postoperative myocardial infarction (MI) and death, she noted, so physicians should consider delaying elective surgery by at least two months, and ideally four to six months, for these patients.

"Even at six months, the risk of postoperative MI is still four times higher" than for those without a history of recent MI, she noted. "So, even if it's after six months, you and the surgeon and the patient need to be aware there is a higher risk."

Switching gears, Dr. Mauck noted there is a new calculator available to determine intraoperative or 30-day postoperative MI or cardiac arrest risk in surgical patients generally (not just patients who had a recent MI). Devised by Himani Gupta, MBBS, ACP Associate Member, and colleagues, its predictive performance is better than the Revised Cardiac Risk Index, and it applies to patients undergoing a variety of surgical procedures, she said.

Best of all, it's available as a free smartphone app, and for download to a desktop. The latter will prompt for a password, "but you can just use anything," Dr. Mauck said.

The calculator is fairly simple, asking for information on five factors: age, creatinine, ASA class, procedure type and dependent functional status, she noted. It was derived from a historical cohort study of 469,000 patients.

A second calculator, derived by Dr. Gupta and colleagues from the same cohort study and with excellent predictive performance, evaluates risk of 30-day postoperative respiratory failure. It calculates the risk based on a patient's type of surgery, emergency case, ASA class, preoperative sepsis and dependent functional class, and is available online.

"[Dr.] Gupta has also looked at predictors for calculating postop pneumonia," Dr. Mauck said. "I'm not sure when it will be in press, but watch for it!"


.
CT screening can detect lung cancer in smokers, but with 'bugaboos'

Low-dose computed tomography (CT) screening for lung cancer in current and former smokers has some advantages, as it can detect more cancers than chest X-ray and at an earlier stage, according to James R. Jett, MD. It can also improve rates of smoking cessation and may detect ancillary cancer and other life-threatening diseases, he said.

But testing comes with drawbacks, such as false positives and the resulting patient anxiety, said Dr. Jett, who spoke at a Friday morning session on "Lung Cancer: What the Internist Should Know." He presented the pros and cons of low-dose CT screening in high-risk patients, based on current research.

Another downside is noncalcified nodules. "They are the bugaboo of screening," Dr. Jett said. In a study he and his colleagues conducted, annual CT screening for five years yielded 3,356 noncalcified nodules in 1,118 (73.5%) participants.

"This is what I tell any patient before they elect to go ahead with screening: 'There's a substantial chance we're going to find a noncalcified nodule and it may require follow-up,'" said Dr. Jett, who is on the faculty of National Jewish Health in Denver.

This high likelihood can lead to patient anxiety, another potential downside of CT screening, Dr. Jett said. However, he pointed out that according to research, there's a less than 1% chance of malignancy for nodules that are 7 mm or smaller.

"That's the number I use for patients with these small little nodules," he said. "I tell them I don't worry about them. The chance that it's going to be malignant is very small."

If a nodule is found, Dr. Jett said, the most common management guidelines are the Fleischner guidelines, which were published in Radiology in 2005. In high-risk patients with a nodule 4 mm or smaller, the guidelines recommend one follow-up scan in 12 months, with no further follow-up if the nodule is unchanged. If the nodule is 4 to 6 mm, the guidelines recommend follow-up in 6 to 12 months and again in 18 to 24 months.

Dr. Jett also discussed the results of the National Lung Cancer Screening Trial, published last year in the New England Journal of Medicine, which randomly assigned 50,000 current or former smokers 55 to 74 years of age to low-dose CT or chest X-rays once annually for three years.

The study yielded substantial false-positive rates and led to unnecessary procedures, Dr. Jett said. "So what's the upside?" he asked. "The upside is that this study, the first of its kind, absolutely showed a mortality reduction from lung cancer of 20%."

Future recommendations on screening in high-risk patients will likely take these and other recent data into account, Dr. Jett indicated.



Breaking news


.
ACP recommends ways to reform Medicare in the age of deficit reduction

A dozen recommendations to ensure that Medicare beneficiaries have access to high-quality, coordinated care were provided yesterday by the American College of Physicians in its newly released policy paper, "Reforming Medicare in the Age of Deficit Reduction."

"This position paper considers the potential advantages and disadvantages of proposals to reform Medicare in an attempt to quell rising Medicare/health care costs. Options such as transforming Medicare into a premium support program, increasing the Medicare eligibility age, and applying income-based Medicare premiums are discussed," said Virginia L. Hood, MBBS, MPH, MACP, outgoing president of ACP. "We have long supported efforts to ensure that Medicare beneficiaries have access to affordable, high-quality, coordinated care, so want to have evidence that a revised system would meet these criteria."

The Medicare program is a defined benefit, where enrollees receive guaranteed financial contributions for a package of health benefits. Some proposals to reform the Medicare system would transform the Medicare program to a defined contribution (or premium support) program, where beneficiaries would receive a finite amount of financial assistance to purchase health insurance.

"Too little is known today about the impact of a Medicare premium support on patient access to care for a risky decision to be made to transition away from the current guaranteed benefit structure," cautioned Dr. Hood. "Rather than rushing a decision, we propose testing a premium support program on a demonstration project basis, with strong protections to ensure that costs are not shifted to enrollees to the extent that it hinders their access to care. Until we have reassuring data from pilots, ACP can't support adoption of this model, just as physicians would not recommend a new treatment to our patients without data from clinical trials on potential benefits and harms."

ACP also commented on proposals to advance the age when persons would be eligible for Medicare from age 65 to age 67, suggesting that this could open up a "coverage gap" unless alternative programs provide coverage for people who would have to wait two years longer to become eligible for Medicare. For instance, Congress could give people between the ages of 55 and 67 the option of buying into Medicare.

"As an alternative to proposals to shift costs to beneficiaries, many of whom cannot afford to pay more, Medicare should adopt policies to reform payment and delivery systems that get at the true drivers of rising Medicare costs," continued Dr. Hood.

ACP specifically offered these recommendations for ensuring Medicare's solvency, reducing costs, and maintaining access to affordable care for beneficiaries:

  • The Medicare program must lead a paradigm shift in the nation's health care system by testing and accelerating adoption of new care models that improve population health, enhance the patient experience, and reduce per beneficiary cost.
  • To improve the way health care is delivered and ensure the future of primary care, the College recommends that Medicare accelerate adoption of the patient-centered medical home model and provide severity-adjusted monthly bundled care coordination payments, prospective payments per eligible patient, fee-for-service payments for visits, and performance assessment-based payments tied to quality, patient satisfaction and efficiency measures.
  • ACP does not support conversion of the existing Medicare defined benefits program to a premium support model. However, ACP could support pilot testing of a defined benefit premium support option, on a demonstration project basis, with strong protections to ensure that costs are not shifted to enrollees to the extent that it hinders their access to care.
  • ACP supports policies to ensure that Medicare Advantage plans are funded at the level of the traditional Medicare program.
  • The Medicare eligibility age should only be increased to correspond with the Social Security eligibility age if affordable, comprehensive insurance is made available to those made ineligible for Medicare.
  • ACP supports continuing to gradually increase Medicare premiums for wealthier beneficiaries as well as modest increases in the payroll tax to fund the Medicare program.
  • Congress should consider giving Medicare authority to redesign benefits, coverage and cost sharing to include consideration of the value of the care being provided.
  • ACP supports combining Medicare Parts A and B with a single deductible under specified circumstances.
  • Supplemental Medicare coverage, called Medigap plans, should only be altered in a manner that encourages use of high-quality, evidence-based care and does not lead Medicare beneficiaries to reduce use of such care because of cost.
  • Medicare should provide for palliative and hospice services, including pain relief, patient and family counseling, and other psychosocial services for patients living with terminal illness.
  • The costs of the Medicare Part D prescription drug program should be reduced by the federal government acting as a prudent purchaser of prescription drugs.
  • Congress should amend the authority for an Independent Payment Advisory Board in specified ways, including giving Congress the right to approve or disapprove the board's recommendations by a simple majority.

"Many of the reforms proposed by members of Congress and the various deficit reduction commissions would either directly or indirectly increase the financial burden for which Medicare beneficiaries are responsible," Dr. Hood concluded. "Increasing cost-sharing responsibilities on Medicare beneficiaries, many of whom are retired and must survive on a fixed income, may encourage more cautious use of services but not necessarily those that are most appropriate for their health. Also, there is no guarantee that such changes will slow the nation's rising health care costs, which are driven by technological advancements, growth in prices for health care services, and a number of other factors. ACP is concerned that any Medicare reform efforts must ensure a balance between maintaining access to medically necessary care and reducing wasteful and limited-value care."


.
Physicians call for improvements to country's public health system

ACP called yesterday for an improved public health infrastructure that works collaboratively with physicians to ensure the public's safety and health, in its policy paper "Strengthening the Public Health Infrastructure."

"This paper points out that strengthening the public health infrastructure is imperative to ensure that the appropriate health care services are available to meet the population's health care needs and to respond to public health emergencies," said Virginia L. Hood, MBBS, MPH, MACP, ACP's outgoing president. "A strong public health infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the nation's health, yet ill-advised budget cuts at the federal, state and local levels pose a grave threat to the health of U.S. residents."

ACP's paper makes the case for adequate investments in public health, which is the practice of preventing diseases and promoting good health within groups of people. Public health depends on an underlying foundation, or infrastructure, to support the planning, delivery, and evaluation of public health activities and practices. Public health works to protect and improve the health of communities through education, policy development, promotion of healthy lifestyles, and research. It concentrates on the health of the population, rather than care of the individual patient, although these are becoming more intertwined as non-communicable diseases are becoming a priority focus for both population and patient-directed care.

The paper calls for adequate funding for the public health infrastructure, but recognizes that the tight budget environment requires that funding be prioritized. It makes the case that the consequences of underfunding essential and effective programs that prevent diseases and promote good health within groups of people would be an unwise, and ultimately very costly, use of limited resources. The paper recommends that funding priority be based on assessment of which programs have demonstrated effectiveness in achieving key public health objectives.

"ACP recognizes that funding for public health programs should be based on evidence that a particular program is effective in achieving better health outcomes for the populations," noted Dr. Hood. "Earlier this year, ACP provided Congress with recommendations to achieve hundreds of billions of dollars in federal health care savings while ensuring adequate funding of critical programs—including public health.

"We need better coordination and less fragmentation of public health agencies, which could achieve savings by eliminating duplication and costs associated with inefficient sharing of information and resources," concluded Dr. Hood.

To strengthen the public health infrastructure, ACP presents seven public policy positions:

Position 1: ACP supports investing in the nation's public health infrastructure. Priority funding should be given to federal, state, tribal, and local agencies that serve to ensure that the health care system is capable of assessing and responding to public health needs. ACP is greatly concerned that recent and proposed reductions in funding for agencies responsible for public health are posing a grave risk to the United States' ability to ensure the safety of food and drugs, protect the public from environmental and infectious health risks, prepare for natural disasters and bioterrorism, and provide access to care for underserved populations.

Position 2: In the current economic environment, it is particularly important that federal, state, tribal, and local agencies prioritize and appropriately allocate funding to programs that have the greatest need for funding and the greatest potential benefit to the public's health. All programs that receive funding should be required to provide an ongoing assessment of their effectiveness in improving population health. ACP recommends that priority for funding be given to programs based on their effectiveness in improving the health of the public.

Position 3: Having a health care workforce that is appropriately educated and trained in public health-related competencies is essential to meet the nation's health care needs. The education and training of sufficient numbers of physicians, nurses, allied health personnel, clinical scientists, health services researchers, public health laboratorians, and public health practitioners are important parts of the public health infrastructure. Accordingly, priority funding should be devoted to educational and training programs that prepare physicians, nurses, and allied health personnel who are in short supply and who help meet the health care needs of underserved populations.

Position 4: The public health workforce should educate the public on new health care delivery models and the importance of primary care. It is also important for the public health sector to promote the need to have a doctor or health center so care can be better coordinated.

Position 5: To address current and looming pharmaceutical therapies and vaccine shortages, the federal government should work with pharmaceutical companies to ensure that there is an adequate supply of pharmaceutical therapies and vaccines to protect and treat the U.S. population.

Position 6: Programs to inform the public of the benefit of vaccinations for children, adolescents and adults, to counter misinformation about the risks of vaccinations, and to encourage increased vaccination rates, particularly for vulnerable populations, are especially important for the health of the population. Evidence-based educational strategies should be used to influence behavior and increase vaccination rates.

Position 7: ACP encourages the development and implementation of a comprehensive, nationwide public health informatics infrastructure, sharable by all public health stakeholders. This will require significant investments in new and improved technologies, standards, methodologies, human resources, and education.

"It is appropriate that today's report is being released in New Orleans, which acutely understands from experience how important it is to fund public health activities, including being prepared for natural or human-made disasters," Dr. Hood observed.

Pointing to a fact sheet that describes the specific public health challenges faced by Louisiana residents, including disaster preparedness, but also high rates of smoking, obesity, asthma, and low vaccination rates, Dr. Hood noted that "ACP's recommendations will strengthen public health, not only in New Orleans, but across the United States."



For attendees


.
Recapping a hope-filled year for infectious disease experts

There are several reasons to feel hopeful about the current state of infectious diseases, according to John G. Bartlett, MD, MACP, professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Dr. Bartlett will review those reasons, and other hot topics, in his Update in Infectious Diseases today. The update will be held in Auditorium A from 11:15 a.m.-12:45 p.m.

In mid-2011, the HIV Prevention Trials Network announced study results that found treating HIV-positive people with antiretroviral drugs lowered the risk of transmitting the virus to HIV-negative sexual partners by 96%.

"This been identified as the scientific breakthrough of the year [2011] by Science magazine. Number two on the [magazine's] list was the ability of Japanese researchers to get dust from something in orbit. I mean, those guys are serious scientists! But they are at #2 compared to HIV prevention treatment," Dr. Bartlett said.

The field of HIV care has gone, in a fairly short period of time, from one where little could be done for people with the virus to one in which a highly effective therapy helps them live to an average age of 70 to 75, he noted.

"That's pretty remarkable considering it had been a universally lethal disease. And now we are looking for the cure. There has been one man who got cured, and I will say something about some of the ideas of how to cure HIV," Dr. Bartlett said.

Also exciting is an enormous National Institutes of Health study under way in Washington, D.C. that involves testing everyone in the city for HIV and enrolling those who test positive for treatment, he said. There is a $25 incentive to get tested, and another $70 to enroll in care. The HIV-positive people who take their medicine and get to a point where there is no detectable virus—meaning the virus is suppressed—receive another $280 per year, he said.

"[Researchers] are trying to find out how much benefit there is to offering payment to get treated," Dr. Bartlett said. "So there's a lot to talk about with HIV."

Also thrilling are the changes happening in the field of diagnostic microbiology. If you go in a microbiology laboratory today, Dr. Bartlett said, it looks the same as in 1850 when Louis Pasteur was on the scene. Technicians are putting specimens on seaweed plates, sticking them in an incubator, and waiting 24 to 48 hours to see what grows. Ten years from now, however, the field will be full of machines like a modern chemistry lab—and results will be fast, he said.

"The good news is they can find all these bugs—they can find agents of bioterrorism, anthrax, herpes, MRSA, you name it—with a molecular technique that takes an hour," he added. "The bad news is they can't tell you what antibiotics to use because they can't grow it in the presence of antibiotics to see what inhibits it. So there are some disadvantages but also big advantages."

Another cause for celebration this year is the "avalanche" of new drugs that have been developed to treat hepatitis C, Dr. Bartlett said.

"I am not going to dwell on [how to use] those because it's a very subspecialty area. Instead I'll talk about what the primary care physician should do in order to be able to support the availability of new drugs," he said.

Dr. Bartlett will also instruct audience members on how to find physicians who perform stool transplants—a highly effective but underused treatment for stubborn Clostridium difficile cases.

"Primary care doctors need to know who to refer patients to in their community, and when to refer. They should know which patients are the candidates for stool transplant, and what are the outcomes," Dr. Bartlett said.

It's difficult to find physicians who do stool transplants, he added, because the procedure doesn't have a CPT (Current Procedural Terminology) code, "so it's not 'official', it's not considered part of medicine … except it works all the time!" he said. Gastroenterologists are a good place to start for referrals, because they can do the procedure with a colonoscopy, he said.

Also on the subject of C. diff, Dr. Bartlett will discuss a colon-sparing surgical method "which is entirely new and as exciting as can be," as well as how to use the newly approved drug fidaxomicin. He'll review diagnostic tests too, since they are often misunderstood.

"A doctor who sends me a patient will say the patient had a C. diff test and I always ask, 'Well, which test?' Because they are very different in terms of what they do and what they tell you," Dr. Bartlett said.

Pediatric disease in adults is on the agenda, as well, due to a resurgence in conditions like measles, mumps and rubella in the last few years. Many physicians under the age of 50 have never seen a case of measles before and thus may not recognize it, Dr. Bartlett noted.

"A few years ago, a patient from Switzerland came to a hospital in Arizona with measles and by the time it was all finished, the cost of that one case was $800,000, because they didn't know he had measles at first," he said. "He exposed a whole bunch of patients and health care workers, so they had to find out who was susceptible, who needed to be isolated, all that gumshoe epidemiology."

Likewise, there have been outbreaks of mumps in New York City and of pertussis in California and other states. As a result, vaccines once considered pediatric are now being given to adults, he noted, and primary care physicians need to know about them.

While the topics Dr. Bartlett will cover will clearly run the gamut, they have one thing in common: They will focus on the needs of the majority of his audience members.

"I'm going to talk about what I think is important to know in the field of infectious diseases specifically for people who are in primary care," he said.


.
ACP Annual Business Meeting to be held today

All members are encouraged to attend ACP's Annual Business Meeting today. Current College Officers will retire from office and incoming Officers, new Regents and Governors-Elect will be introduced.

The meeting will be held in Room 291-92 at the New Orleans Ernest N. Morial Convention Center from 12:45 p.m. to 1:45 p.m., with Virginia L. Hood, MBBS, MPH, MACP, ACP President, presiding. Dennis R. Schaberg, MD, MACP, will present the Annual Report of the Treasurer.

A key feature of the meeting is the presentation of ACP's priorities for 2012-2013 by Executive Vice President and Chief Executive Officer Steven E. Weinberger, MD, FACP. Members will have the opportunity to ask questions following Dr. Weinberger's presentation.





Has Your Contact Information Changed?

To change your e-mail address or other contact information in our records, go here or call 800-523-1546, ext. 2600 (M-F, 9 a.m. - 5 p.m. ET).

About Your Subscription

You are receiving this newsletter as a benefit of your ACP membership. To unsubscribe, simply send a blank e-mail to leave-105814-17003158N@acpnews.org.

This is a daily newsletter providing updates from this year's Internal Medicine meeting. Please forward any comments or suggestions to the editor.

ACP respects your privacy and will not sell, lease or share your e-mail address with any other organization. The College will only use e-mail for the purpose of conducting College business and for communicating with College members.

Copyright © by American College of Physicians.

Share

 
 

Internal Medicine Meeting Early Registration Discount

Internal Medicine Meeting Early Registration Discount

Register early for Internal Medicine Meeting 2015 in Boston, MA to lock in the lowest possible rate. Learn more or register now!

Are You Using ACP Smart Medicine®?

Are You Using ACP Smart Medicine?

This online clinical decision support tool is a FREE benefit of ACP membership delivering point-of-care access to evidence-based recommendations. Includes more than 500 modules, images and reference tables. Start now or watch the video tour.