管家婆心水论坛

May 2014

ACP Internal Medicine 2014 Highlights
Orlando, Florida

Internal Medicine 2014, ACP's premier annual meeting, was held in Orlando, Florida from April 10-12, 2014 and had an attendance of over 6,000 physicians. The event featured more than 260 workshops, lectures, panel discussions, and interactive courses for doctors of internal medicine and its subspecialties.

At the Convocation ceremony on April 10, over 400 physicians were inducted as ACP Fellows and recognized for their medical scholarship and achievement and over 60 members became Masters of the College or received another award. The College bestowed Honorary Fellowships to four presidents of international internal medicine societies.

Following the ceremony, members, friends, and families gathered at the annual ACP International Reception that included over 300 international internal medicine leaders and attendees along with ACP leaders. During the reception, Molly Cooke, MD, MACP, ACP President, gave a few words to welcome everyone. International Fellowship Exchange Program (IFEP) awardees were also recognized and honored at this event.

ACP was honored to host presidents and representatives of internal medicine societies from around the world. The international delegates were part of the stage party in the Convocation ceremony. They also participated in ACP's 8th Annual International Forum, entitled "The Role of Continuing Medical Education and Certification/Recertification in Your Country". The Forum provided an opportunity for ACP leaders and the presidents and special representatives from international internal medicine societies to discuss this important topic that crosses national boundaries and affects the health care of people around the world.

On Saturday, April 12, new ACP officers started their terms. David A. Fleming, MD, MA, FACP, of Columbia, Missouri, became the 2014-2015 ACP President; Robert M. Centor, MD, FACP, of Huntsville, Alabama, became the 2014-2015 Chair of the Board of Regents; Wayne J. Riley, MD, MPH, MBA, MACP of Brentwood, Tennessee, became the ACP President-elect; and Tanveer P. Mir, MD, MACP, of New York, New York, became the Chair-elect of the Board of Regents.

Internal Medicine 2015, which coincides with ACP's centennial celebration, will be held April 30 - May 2, 2015 in Boston, Massachusettes. For more information, please visit: .

Honorary Fellows

Honorary Fellows at Convocation

Left to right: Dr. Jam Chin Tay, President, College of Physicians of Singapore; Dr. Fernando Nicanor Carballo Ordonez, President, Peruvian Society of Internal Medicine; Dr. Molly Cooke, 2013-14 ACP President; Dr. Charles Cutler, 2013-14 Chair, ACP Board of Regents; Dr. Soo-Kon Lee, President, Korean Association of Internal Medicine; Dr. Loic Guillevin, President, National French Society of Internal Medicine.

Special Representatives

Special Representatives at Convocation

Left to right, back row: Dr. Natalia Londono Palacio, President, Colombian Association of Internal Medicine; Dr. Carlos Nitsch, President, Guatemalan Association of Internal Medicine; Dr. Maria Ines Marulanda, President, Venezuelan Society of Internal Medicine; Dr. David T. Martin, International Director, Royal College of Physicians of London; Prof. Donald Li, President, Hong Kong Academy of Medicine; Dr. H. A. M. Nazmul Ahasan, President, Bangladesh Society of Medicine.

Left to right, front row: Dr. Eric Ulloa, President, Panamanian Society of Internal Medicine; Dr. Sally Nasution, Secretary General, Indonesian Society of Internal Medicine; Dr. Molly Cooke, 2013-14 ACP President; Dr. Charles Cutler, 2013-14 Chair, ACP Board of Regents; Dr. Dragan Lovic, General Secretary and President Elect, Serbian Society of Internal Medicine; Dr. Hanne Thurmer, President, Norwegian Society of Internal Medicine.

Special Representatives at Convocation

Left to right, back row: Dr. Rodolfo Bado, President, International Society of Internal Medicine; Dr. Maria Cristina Jimenez, President, Paraguayan Society of Internal Medicine; Dr. Jean-Michel Gaspoz, President, Swiss Society of Internal Medicine; Dr. John Crowe, President, Royal College of Physicians of Ireland; Dr. Miles Fisher, President, Royal College of Physicians of Glasgow; Dr. Claudia Arias, Past President, Dominican Republic Society of Internal Medicine.

Left to right, front row: Dr. Priscilla Caguioa, President, Philippine College of Physicians; Dr. Frank Bosch, President, Netherlands Association for Internal Medicine; Dr. Molly Cooke, 2013-14 ACP President; Dr. Charles Cutler, 2013-14 Chair, ACP Board of Regents; Dr. Hans-Peter Kohler, Secretary General, International Society for Internal Medicine; Dr. Leslie Bolitho, President, Royal Australasian College of Physicians.

 

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Photos from Internal Medicine 2014

 

 

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New International ACP Masters

The following international physicians were awarded Mastership at Internal Medicine 2014.

Masters (MACP) comprise a small group of highly distinguished physicians who have achieved recognition in medicine by exhibiting a preeminence in practice or medical research, holding positions of high honor, or making significant contributions to medical science or the art of medicine. Mastership is considered a special class of membership. However, Masters are selected confidentially by the Awards Committee from among Fellows and are not self-nominated. More information regarding awards is available at . Nomination materials are due by July 1, 2014.
 

Dr. Al-Hadramy

Mohamad Salim Al-Hadramy, MD, MACP
Saudi Arabia

 

 

 

 

 

 

 

 

 

 

 

Dr. DeWitt

 

 

 

 

 

 

 

 

 

 

 

Dawn E. DeWitt, MD, MACP
Canada

 

 

 

 

 

 

 

 

 

 

 

Dr. Rodriguez-Portales

 

 

 

 

 

 

 

 

 

 

 

Jose A. Rodriguez-Portales, MD, MACP
Chile

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Roscoe

 

 

 

 

 

 

 

 

 

 

 

 

 

Janet M. Roscoe, MD, MACP
Canada

 

 

 

 

 

 

 

 

 

 

 

 

 

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International Fellowship Exchange Program Awardees

ACP's 2013-2014 International Fellowship Exchange Program (IFEP) provided opportunities for early to mid-career physicians from outside the United States and Canada to gain expertise in a focused area relating to the prevention, diagnosis, and/or management of a clinical problem affecting women's health. Through observation, mentorship, and study of the work of senior faculty physicians, fellows were funded to acquire knowledge, experience, and skills that they can apply, utilize, and disseminate to colleagues upon return to their home country. Faculty mentors engaged fellows in individual and group clinical and educational experiences and discussions, and helped facilitate the design of an independent project to be implemented in each fellow's own country upon his or her return. Fellowships were observational and lasted approximately four weeks. For the 2013-2014 program 3 fellows were funded by Merck and 2 received private funding. Information about the 2014-2015 program may be found on ACP's website at: .

Awardees for 2013-14 are pictured below.

From left: Suchitra Behl, MD (India); Gonzalo Wilson, MD (Chile); ACP Immediate Past President Molly Cooke, MD, MACP; Muhammad Ahmed Saeed, MBBS (Pakistan); Samia Rashid, MD (India); and Zainah Al Duhailib, MBBS (Saudi Arabia).

 

 

 

 

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Update Your Knowledge with MKSAP 16 Q & A

The new Medical Knowledge Self-Assessment Program庐 (MKSAP庐 16) provides you with the most current and critical information in the core of internal medicine and its subspecialties so you can stay aware of what you need to know as a practicing physician in internal medicine today.

For more information on MKSAP 16, or to order your copy, visit

MKSAP 16 Q & A

A 42-year-old man is seen for follow-up of hepatitis C. Three years ago, serologic tests were positive for hepatitis A virus and negative for hepatitis B virus. He received a single dose of hepatitis B vaccine but was lost to follow-up. He feels well today without specific symptoms. Findings on physical examination are unremarkable.

Which of the following is the most appropriate management of this patient's hepatitis B vaccination?

A. Complete the hepatitis B vaccine series
B. Measure hepatitis B surface antibody
C. Restart the hepatitis B vaccine series
D. No further vaccination or serologic testing for hepatitis B is needed

Click here for the answer and critique.

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ACP Leaders on the Road: Bangladesh

David L. Bronson, MD, MACP, ACP President Emeritus
Bangladesh Society of Medicine Meeting - March 1-2, 2014

 

Dr. Bronson and wife Kathy Franco (pictured in the middle) with Dr. Rabbi Fazle Rabbi Chowdhury (pictured far right) and his wife (pictured far left).
 

 

It has taken several weeks for me to sort out my many feelings and observations following my recent trip to Bangladesh. To begin with, I must thank the leaders of the Bangladesh Society of Medicine for their kind invitation to attend their 14th Annual Meeting. To get ready for the trip, I read about the history of Bangladesh, the unique Bangla language, the population of 160 million people in an area the size of Iowa, the democratic secular government in a majority Muslim state, and the economic challenges of this developing nation. I read about the medical education system with 26 public medical colleges, and more than 50 private medical schools and the challenges of ensuring educational quality. Despite my reading I wasn't prepared for what I experienced, the warmth and sincere friendliness of the Bangladeshi people.

My wife, Kathy, and I arrived at Hazrat Shah Jalal International Airport, 11 miles from Dhaka proper around 8:30 PM one full day before the meeting. The airport was a scene of controlled chaos and the drive in was unlike any other trip. A mass of cars, dented buses, bikes, and motorized and non-motorized rickshaws weaved their way on wide roads without lane markers dodging animals, children, pedestrians and each other all the while honking horns to warn of the next daring maneuver. After an hour, we arrived at our hotel. We were greeted by a young physician, Dr. Fazle Rabbi Chowdhury, who warmly welcomed us and reported by phone to his superior of our safe arrival. He asked us to call him Rabbi ("Robbie") and arranged to meet us the next morning for a tour of the city.

The next day we began our tour and got to know more about Rabbi. The son of teachers and the first physician in the family, he was named after Dr. Fazle Rabbi, a noted cardiologist and professor executed during the War of Liberation. Rabbi is an assistant professor and a registrar in a hospital 6 hours away from Dhaka by bus. He has a Master's degree in tropical medicine from the University of Liverpool. He is a remarkable young physician with an engaging intellect and polite and respectful manner. He has published 2 books of interesting case studies. He was an excellent guide for our visit and a rising star in medicine in Bangladesh.

The next morning Rabbi took us to old Dhaka where saw open air markets for vegetables, live chickens tied together in big round baskets, fresh meat hanging in the open air, goats in carts, and men carrying gigantic baskets balanced on their heads filled with everything from aluminum cooking pots to cauliflower to fabric. Everywhere you looked and at all hours were the colorful rickshaw bicycle riders carrying people, businessmen, families and ladies in saris or black burkas. We spent the day visiting historic sites including the University of Dhaka, the Liberation Monument, the Armenian Church, and a 600-year-old mosque. I was impressed with the work ethic and friendliness of the people. Unfortunately, air pollution is a significant problem.

The conference began that night and had about 300 attendees including medical students. The quality of the presentations were varied, but often quite good. After my keynote address, I participated in "Professor's Rounds" and heard a case of a 19-year-old woman with a recent stroke. In the end, it was related to her tuberculosis.

I was impressed with the passion for medicine displayed by so many attendees and their desire to learn. Many faculty physicians reported that after a full day of work at the hospital, they had evening office hours until 9 or 10 p.m. to supplement their incomes. I attended a medical licensure prep session taught by a senior faculty member and was impressed by the focus on accurate observation and physical exam skills and the enthusiasm of the students.

The Bangladeshi people are exceptionally generous, giving their smiles and friendship, and their sincere hospitality. They work hard and are not impeded by barriers to success. The physicians I met were dedicated to our profession and proud of the great progress Bangladesh has made since independence. For example, life expectancy has increased by 10 years since 2000 from 59 to 69, and the per capita GDP has doubled since 1975. They are very appreciative of the support of ACP in their efforts to improve health care in their country. Kathy and I felt we made many new friends and look forward to returning someday.

Dr. Bronson and wife Kathy Franco are pictured with leadership from the Bangladesh Society of Medicine.






 

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ACP Leaders on the Road: India Lecture Series

Molly Cooke, MD, MACP, ACP Immediate Past President
India Lecture Series - March 10-15, 2014

ACP Members dinner in Mumbai hosted by Dr. Cooke. From left to right: Mohan Kinila, MD, FACP, S.B. Gupta, MD, FACP (Hon), Molly Cooke, MD, MACP, Nikhil Kulkarni, MD, V.M. Bhalerao, MD.
 

Molly Cooke, MD, FACP, Immediate Past President, 管家婆心水论坛 (ACP), recently completed a week-long lecture series in India with the goal of sharing medical knowledge and helping ACP increase visibility in the region. The lecture series took place from March 10-15, 2014. Organized by MCI Group, Dr. Cooke's trip took her to institutions in Mumbai, Bengaluru, and Delhi. During each of her visits she gave multiple scientific lectures on a variety of topics.

While in Mumbai, Dr. Cooke spoke at Hinduja Hospital, Hiranandani Hospital, Dr. Balabhai Nanavati Hospital, and Lokmanya Tilak Hospital. During these visits, Dr. Cooke's spoke on the topics "Current issues in DVT and pulmonary embolism" and "Assessment of cardiovascular risk/primary and secondary risk reduction".

Dr. Cooke also had the opportunity to participate in an ACP members' dinner at Jamavar restaurant in Mumbai where she was able to interact with several ACP members.

After Mumbai, Dr. Cooke continued her travels in Bengaluru, where she spoke at Manipal Hospital, M. S. Ramajah Medical College, Association of Physicians of India (API) Karnataka Chapter, Vydehi Institute of Medical Sciences and Research Centre, and St. John's Medical College. During her time in Bengaluru, she enjoyed a dinner meeting with ACP and API Karnataka members from Bangalore at API Bhavan. In addition to the topics she spoke on in Mumbai, her lectures in Bengaluru also featured a talk on ACP Clinical Guidelines and a talk on the topic "Digital pedagogies, flipped classrooms, MOOC's: what they mean for health professionals' education".

Finally, during her stopover in Delhi, Dr. Cooke spoke at the All India Institute of Medical Sciences (AIIMS), the University College of Medical Sciences (UCMS), Safdarjung Hospital, and Artemis Hospital, Gurgaon. A dinner was hosted for ACP members from Delhi and nearby cities at My Humble House restaurant.

Physicians at the All India Institute of Medical Sciences (AIIMS) announcing Dr. Cooke's lecture. From left to right: Rita Sood, MD, P.K. Julka, MD, Molly Cooke, MD, MACP.
 

Overall, Dr. Cooke's lecture series was very well received among Indian physicians. The topic "Current issues in DVT and pulmonary embolism" was of special interest to most institutions as it is a condition that affects patients across specialties. Many physicians who attended the lectures or the members' dinners also expressed interest in seeing the creation of an ACP India Chapter and being able to participate in chapter activities.

During the various lectures, Dr. Cooke also promoted the upcoming ACP India National Conference that will take place September 5-6, 2014 in New Delhi at Le Meridien Hotel. For more information on the ACP India National Conference, visit .

Dr. Cooke presenting the ACP Fellow Certificate to O.P. Kalra, MD, FACP, Principal of the University College of Medical Sciences, University of Delhi.


 

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Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in Venezuela and Japan.

A complete list of other Future Worldwide Internal Medicine Meetings is available here.

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist March/April 2014


  • E-cigarettes can open doors into the subject of quitting tobacco use. Although the devices lack any hard data to support their use, they can offer doctors a chance to explore with patients other options for smoking cessation.
     

  • New screening recommendations for low-dose CT for smokers will prove to be trickier to follow than most preventive care guidelines, experts say. Learn what issues to consider, where to refer patients, and how to deal with the results.
     

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

ACP Hospitalist April 2014


  • The debate over best practice may leave hospitalists wondering in which camp they and their hospitals belong.
     

  • Community hospitals can set up stroke units fairly easily, and see great results.
     

  • As insulin pumps become more common, hospitalists need plans to manage them.
     

  • There is much more to checking a pulse than noting its presence or absence.
     

 

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International Fellowship Exchange Program (IFEP) Accepting Applications for 2014-2015

ACP's International Fellowship Exchange Program (IFEP) provides opportunities for early to mid-career physicians from outside the United States and Canada to gain expertise in a focused area relating to the prevention, diagnosis, and/or management of a clinical problem in internal medicine and the subspecialties. Through observation, mentorship, and study of the work of senior faculty physicians, fellows will be funded to acquire knowledge, experience, and skills that they can apply, utilize, and disseminate to colleagues upon return to their home country. Faculty mentors will engage fellows in individual and group clinical and educational experiences and discussions, and facilitate the design of an independent project to be implemented in each fellow's own country upon his or her return. Fellowships are observational and expected to last four weeks. Candidates must be internists or subspecialists of internal medicine and must be ACP Members or Fellows. Residents in training will be considered if they reside in an ACP Chapter.

Three scholarships will be awarded for the 2014-2015 program year. Applications for consideration will be accepted through August 1, 2014. Information about the program may be found on ACP's website at . If you have any questions please contact Emily Seeling, Program Coordinator, International Programs at eseeling@acponline.org.

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MKSAP 16 Answer & Critique

Answer: A, Complete the hepatitis B vaccine series

Educational Objective: Manage vaccination in a patient in whom a multidose vaccination series has been interrupted.

Critique: This patient who received only the first of a three-dose series of hepatitis B vaccine 3 years ago should finish the series. Many vaccines require multiple doses to achieve an optimal immune response. However, the interval between doses is a minimum interval, not a maximum, and a longer than desired interval is not thought to reduce the overall antibody concentration following completion of the series. Thus, in patients with a prolonged interval since the previous dose of vaccine, the series does not need to be restarted but should be resumed with the next injection as soon as possible after the missed prescribed interval and completed as recommended.

An adequate response to immunization against hepatitis B virus is suggested by the presence of greater than 10 milliunits/mL of anti-HBs antibody in the blood. However, because the seroconversion rate in a general patient population is approximately 95%, antibody titer testing to confirm an adequate response following completion of a vaccination series is not routinely indicated except in certain high-risk patient populations (such as health care workers at high risk for exposure to bodily fluids, hemodialysis patients, and those who may be repeatedly exposed to hepatitis B virus). As this patient has not yet completed the vaccination series, antibody titer testing is not currently indicated and would not affect the recommendation to complete his remaining injections. He would require post-vaccination antibody testing only if he is in a known high-risk group or if there are concerns regarding his ability to generate an immune response owing to his existing liver disease.

Hepatitis B vaccine is currently indicated for adults at increased risk of seroconversion or increased risk of complications for hepatitis, such as patients with chronic liver disease. The patient has chronic liver disease and thus should complete a vaccination series against hepatitis B.

Key Point: In patients with a prolonged interval since the previous dose of a multiple-dose vaccine, the series should be resumed rather than restarted.

Bibliography:

Poland GA, Jacobson RM. Clinical practice: prevention of hepatitis B with the hepatitis B vaccine. N Engl J Med. 2004;351(27):2832-2838. [Erratum in: N Engl J Med. 2005;352(22):2362 and N Engl J Med. 2005;352(7):740]. [PMID: 15625334]

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