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ANNALS OF INTERNAL MEDICINE Annals of Internal MedicineAnnals of Internal Medicine15 October 2019 Volume 171 Number 8ESTABLISHEDIN1927BY THEAMERICAN COLLEGEOFORIGINAL RESEARCH15 October 2019Personalized Prediction of Cardiovascular Benefits andBleeding Harms From Aspirin for Primary Prevention.A Benefit–Harm Analysis529Establishing the Prevalence and Prevalence at Birth ofHemophilia in Males. A Meta-analytic Approach UsingNational Registries540Blood Culture Results Before and After AntimicrobialAdministration in Patients With Severe Manifestations ofSepsis. A Diagnostic Study547REVIEWAnnals.orgVolume 171ACP JOURNAL CLUBEvidence Relating Health Care Provider Burnout and Qualityof Care. A Systematic Review and Meta-analysisPRECISION MEDICINEOn Being a Doctor 591On Being a Patient 593Ad Libitum 604Letters 595Complete Contents I-5Cases in Precision Medicine: Should You Participate in aStudy Involving Genomic Sequencing of Your Patients?SPECIAL ARTICLEJC37PHYSICIANSFirearm-Related Injury and Death in the United States: A Callto Action From the Nation’s Leading Physician and PublicHealth Professional OrganizationsNumber 8IDEASANDOPINIONS555568573Fool Me Twice? The Reemergence of Rofecoxib and theOrphan Drug Act578Ensuring Sustainability of Needed Antibiotics: Aiming for theDART Board580(Pages 529 –604)EDITORIALSIndividualize Treatment With Aspirin for Primary Prevention583Global Hemophilia Care: Data for Action585Antibiotics and the Yield of Blood Cultures: Sequence Matters587Deciphering the Relationship Between Health Care ProviderBurnout and Quality of Care589Annals.orgEssential Engaging Practice-ChangingThe Annals website features full contentand a responsive design that matches anyscreen size, from desktop to phone.Prefer an app? Stay up-to-date withthe latest content. Download the freeapp on Google Play (Android) or theApp Store (iOS).Multimedia FeaturesAnnals Beyond the GuidelinesAnnals.orgAnnals of Internal Medicine is themost influential and widely-cited journalfocused on internal medicine and its subspecialties. Annals incorporates originalpractice-changing research, systematicevidence-based reviews, clinical guidelines,and more. ACP members receive full accessto the digital edition of Annals.Monthly Features:In the Clinic In-depth review on the practical management of common clinical conditions.Multimedia educational series based onBeth Israel Deaconess Medical CenterGrand Rounds. Earn CME credit andMOC points.Annals Consult GuysLearn and laugh with the popular monthlymedical consultation talk show. Earn CMEcredit and MOC points.Annals Graphic MedicineGraphic narratives, comics, animation,and other visual media.Annals Latest PodcastHighlights from the latest issue.Annals On Call PodcastACP Journal ClubSummaries of the best internal medicine evidence from over 120 clinical journals.Host Dr. Bob Centor and guest experts discuss influential Annals articles. EarnCME credit and MOC points.Annals for HospitalistsHighlights of relevant Annals and ACPJournal Club content. It summarizesand links to “Inpatient Notes,” which offersunique perspectives on contemporarytopics in hospital medicine.Annals Story Slam Building on the popular Annals feature“On Being a Doctor,” storytellers sharebrief stories with an audience.Keep Up With New ContentSign up for Annals Alerts. Latest From Annals Annals for Educators Annals for Hospitalists Annals Fresh Look Annals Trending NowAnnals.org800-ACP-1915 priority code CAT93009

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My ACPACP NEWS PUBLICATIONSACP Internist Internist INT0619 FINAL.qxp 5/22/19 1:17 PM Page 1ACP Hospitalist March 2019 www.acphospitalist.orgJune 2019 Vol. 39 No. 6 www.acpinternist.org I NTERNAL M ED I CI NE M E E T I NG 2019 I SSUEPalliative care’splace outside cancerFIghtIng resIstAnce Inthe IcUAntibiotic stewArdship tipsBy Ryan DuBosarIConvocation at Internal Medicine Meeting 2019 showcased excellence in medicineand recognized new Fellows, Masters, and College awardees.magine a firefighter rushing toward aburning house and being stopped by aneighbor.“The house is on fire!” says the fireman.“I worry that if you go in there, it mightsend the wrong message to the family,” saysthe neighbor.“But I’m with the fire department,” thefireman responds.“If you tell the family that, they mightlose all hope,” says the neighbor.That’s how interactions between hospitalists and primary care doctors and palliativecare consultants sometimes go, said RebeccaN. Hutchinson, MD, FACP. She played a comicvideo including a version of the previousexchange to the audience at her talk,“Palliative Care in the Noncancer Inpatient,”to illustrate her point. The video, by JaredRubenstein, MD, of Texas Children’s Hospital,and online at https://youtu.be/BbNi wYXJE, has made its rounds among the palliative care community, proclaiming,“Palliative care. We’re the fire department,not the fire.”Ideally, palliative care should be integrated into treatment, Dr. Hutchinson said. “It’sreally just good, patient-centered care, and it’sbeneficial throughout the disease trajectory.”DSee Palliative, page 14INSIDETest Yourselfwith theMKSAP Quizthat patients give us for avoiding the influenzavaccine,” he said.Myth No. 2: Avoid the influenza vaccine, and possibly other vaccines, inpatients with a history of Guillain-Barrésyndrome due to the potential increasedrisk of relapse. “The 1976 swine flu vaccinehad probably the largest number of cases,but this has always been a concern,” said Dr.Paauw. “For many years, I did not vaccinatemy Guillain-Barré patients because Ithought, ‘Well, that makes sense.’”There aren’t a ton of data on this, but theexisting literature is convincing, he said. Onestudy, published in the March 2012 ClinicalInfectious Diseases, assessed 279 patientswith previous Guillain-Barré syndrome whoreceived a total of 989 vaccinations, including405 trivalent influenza vaccinations. No casesof recurrent Guillain-Barré occurred. TheGBS/CIDP Foundation recommends avoidingimmunizations that caused initial symptoms6Hackingclinicalworkflowproblems900 AOJL051A C1-Cover.indd 1FormerSurgeonGeneraltalks healthcare12See Myths, page 12 ACP Internist, ACP’s member newspaper,provides news and information for internistsabout the practice of medicine and reportson the policies, products, and activitiesof ACP.Some highlights include: In-depth features on clinical issues ininternal medicine Q&As with experts A practice management section Perspectives from ACP leaders Conference coverage from ACP’sannual meeting as well as otherscientific meetings Profiles of leaders in internal medicineACP Internist is published 10 times per year.18Social needs programs p 16There’s rarely a time when only diseasemodifying therapy or only comfort measuresare what’s right for the patient. Having anintegrated plan is best, she said. “You can doeverything and palliate at the same time.”One complication is that the trajectoryof illnesses other than cancer may be muchBy Mollie FrostMyth No. 1: Avoid the influenza vaccinein patients with egg allergy. This idea is basedon the fear that administering a vaccine thatwas grown in eggs might cause anaphylaxisdue to minute amounts of egg protein. “Thiswas, I think, well intentioned and reasonable,” said Dr. Paauw. “But in the last fewyears, we’ve actually had some data to look at,and we find that this generally doesn’t happen.” One review, published in the August2014 Expert Review of Vaccines, found thatin 28 studies of 4,315 patients with egg allergy(656 with a history of anaphylaxis), nopatients developed a serious reaction afterreceiving an egg-based influenza vaccine.Recommendations from the CDC andthe American Academy of Allergy, Asthma, &Immunology agree: Patients with egg allergyof any severity should receive the influenzavaccine annually, with no special waitingperiods after vaccination. Even so, Dr. Paauwsaid his clinic still asks patients about eggallergies. “If we’re going to give it anyway, whyare we asking? This should not be an excuseOpioid prescribing p 12Palliate earlyTop 10 medical myths, bustedespite the rigors of evidence-basedmedicine, some ill-informed medical axioms die hard.“There aren’t too many things that arepure myths in medicine, but there are definitely things that we were taught that werepure dogma,” said Douglas S. Paauw, MD,MACP, in April at Internal Medicine Meeting2019 in Philadelphia.Medical myths persist for many reasons,including physiologic assumptions, casereports, and tradition, he said. This last one inparticular has a strong hold on practice.“Tradition is very powerful, and remember,it’s only really in the last 100 years or so thatwe’ve really had a strong attempt to havestrong evidence for things,” said Dr. Paauw,professor of medicine at the University ofWashington School of Medicine in Seattle.During h

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