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in the ABIM’s MOC program. It is the CME activity provider's among MKSAP’s physician-contributors. When appro- responsibility to submit participant completion information priate, the MKSAP Editors will also rely on MKSAP 19 to ACCME for the purpose of granting MOC credit. Digital’s expanded use of multimedia enhancements, including video and audio, to explore and more fully explain issues surrounding the presentation of MKSAP Disclosure Policy 19 clinical content as it relates to race and ethnicity. It is the policy of the American College of Physicians (ACP) MKSAP 19 users are encouraged to contact the Editors to ensure balance, independence, objectivity, and scientific at mksap .editors@acponline.org to help us identify rigor in all of its educational activities. To this end, and con opportunities for improvement in this area. sistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- tributors to all ACP continuing medical education activities Hospital-Based Medicine are required to disclose all relevant financial relationships For the convenience of subscribers who provide care in with any entity producing, marketing, re-selling, or dis- hospital settings, comprehensive hospital-focused con- tributing health care goods or services consumed by, or tent aligned with the ABIM Focused Practice in Hospital used on, patients. Contributors are required to use generic Medicine blueprint is integrated throughout the syllabus, names in the discussion of therapeutic options and are and self-assessment questions that are specific to the required to identify any unapproved, off-label, or investiga- hospital setting are specially designated with the blue tive use of commercial products or devices. Where a trade hospitalist icon (FJ). name is used, all available trade names for the same prod- uct type are also included. If trade-name products manu factured by companies with whom contributors have rela- High Value Care Key Points tionships are discussed, contributors are asked to provide Key Points in the text that relate to High Value Care concepts evidence-based citations in support of the discussion. The (that is, concepts that discuss balancing clinical benefit with information is reviewed by the committee responsible for costs and harms) are designated by the HVC icon [HVC]. producing this content. If necessary, adjustments to topics or contributors’ roles in content development are made to balance the discussion. Further, all readers of this content Educational Disclaimer are asked to evaluate it for evidence of commercial bias and The editors and publisher of MKSAP 19 recognize that send any relevant comments to mksap_editors@acponline. the development of new material offers many opportu- org so that future decisions about content and contributors nities for error. Despite our best efforts, some errors may can be made in light of this information. persist in print. Drug dosage schedules are, we believe, accurate and in accordance with current standards. Readers are advised, however, to ensure that the recom- Resolution of Conflicts mended dosages in MKSAP 19 concur with the informa- To resolve all conflicts of interest and influences of vested tion provided in the product information material. This is interests, ACP’s content planners used best evidence and especially important in cases of new, infrequently used, updated clinical care guidelines in developing content, or highly toxic drugs. Application of the information in when such evidence and guidelines were available. All MKSAP 19 remains the professional responsibility of the content underwent review by external peer reviewers not practitioner. on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can be The primary purpose of MKSAP 19 is educational. found with the list of contributors’ names and those of ACP Information presented, as well as publications, technol-

in the ABIM’s MOC program. It is the CME activity provider's among MKSAP’s physician-contributors. When appro- responsibility to submit participant completion information priate, the MKSAP Editors will also rely on MKSAP 19 to ACCME for the purpose of granting MOC credit. Digital’s expanded use of multimedia enhancements, including video and audio, to explore and more fully explain issues surrounding the presentation of MKSAP Disclosure Policy 19 clinical content as it relates to race and ethnicity. It is the policy of the American College of Physicians (ACP) MKSAP 19 users are encouraged to contact the Editors to ensure balance, independence, objectivity, and scientific at mksap .editors@acponline.org to help us identify rigor in all of its educational activities. To this end, and con opportunities for improvement in this area. sistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con- tributors to all ACP continuing medical education activities Hospital-Based Medicine are required to disclose all relevant financial relationships For the convenience of subscribers who provide care in with any entity producing, marketing, re-selling, or dis- hospital settings, comprehensive hospital-focused con- tributing health care goods or services consumed by, or tent aligned with the ABIM Focused Practice in Hospital used on, patients. Contributors are required to use generic Medicine blueprint is integrated throughout the syllabus, names in the discussion of therapeutic options and are and self-assessment questions that are specific to the required to identify any unapproved, off-label, or investiga- hospital setting are specially designated with the blue tive use of commercial products or devices. Where a trade hospitalist icon (FJ). name is used, all available trade names for the same prod- uct type are also included. If trade-name products manu factured by companies with whom contributors have rela- High Value Care Key Points tionships are discussed, contributors are asked to provide Key Points in the text that relate to High Value Care concepts evidence-based citations in support of the discussion. The (that is, concepts that discuss balancing clinical benefit with information is reviewed by the committee responsible for costs and harms) are designated by the HVC icon [HVC]. producing this content. If necessary, adjustments to topics or contributors’ roles in content development are made to balance the discussion. Further, all readers of this content Educational Disclaimer are asked to evaluate it for evidence of commercial bias and The editors and publisher of MKSAP 19 recognize that send any relevant comments to mksap_editors@acponline. the development of new material offers many opportu- org so that future decisions about content and contributors nities for error. Despite our best efforts, some errors may can be made in light of this information. persist in print. Drug dosage schedules are, we believe, accurate and in accordance with current standards. Readers are advised, however, to ensure that the recom- Resolution of Conflicts mended dosages in MKSAP 19 concur with the informa- To resolve all conflicts of interest and influences of vested tion provided in the product information material. This is interests, ACP’s content planners used best evidence and especially important in cases of new, infrequently used, updated clinical care guidelines in developing content, or highly toxic drugs. Application of the information in when such evidence and guidelines were available. All MKSAP 19 remains the professional responsibility of the content underwent review by external peer reviewers not practitioner. on the committee to ensure that the material was balanced and unbiased. Contributors’ disclosure information can be The primary purpose of MKSAP 19 is educational. found with the list of contributors’ names and those of ACP Information presented, as well as publications, technol- principal staff listed in the beginning of this book. ogies, products, and/or services discussed, is intended to inform subscribers about the knowledge, techniques, and experiences of the contributors. A diversity of professional Language Reflecting Diversity, Equity, opinion exists, and the views of the contributors are their and Inclusion Within MKSAP 19 own and not those of the ACP. Inclusion of any material MKSAP 19’s Editors and contributors commit to using in the program does not constitute endorsement or rec language and images that support ACP’s commitment ommoendation by the ACP. The ACP does not warrant the to being an anti-racist organization that supports diver safety, reliability, accuracy, completeness, or usefulness sity, equity, and inclusion throughout health care and of and disclaims any and all liability for damages and health education. ACP also continues to ensure diversity claims that may result from the use of information,

principal staff listed in the beginning of this book. ogies, products, and/or services discussed, is intended to inform subscribers about the knowledge, techniques, and experiences of the contributors. A diversity of professional Language Reflecting Diversity, Equity, opinion exists, and the views of the contributors are their and Inclusion Within MKSAP 19 own and not those of the ACP. Inclusion of any material MKSAP 19’s Editors and contributors commit to using in the program does not constitute endorsement or rec language and images that support ACP’s commitment ommoendation by the ACP. The ACP does not warrant the to being an anti-racist organization that supports diver safety, reliability, accuracy, completeness, or usefulness sity, equity, and inclusion throughout health care and of and disclaims any and all liability for damages and health education. ACP also continues to ensure diversity claims that may result from the use of information, vi

publications, technologies, products, and/or services Unauthorized Use of This Book Is discussed in this program. Against the Law Unauthorized reproduction of this publication is unlaw- ful. ACP prohibits reproduction of this publication or any Publisher's Information of its parts in any form either for individual use or for Copyright © 2021 American College of Physicians. All distribution. rights reserved. ACP will consider granting an individual permission to This publication is protected by copyright. No part of reproduce only limited portions of this publication for this publication may be reproduced, stored in a retrieval his or her own exclusive use. Send requests in writing to system, or transmitted in any form or by any means, elec- MKSAP* Permissions, American College of Physicians, 190 tronic or mechanical, including photocopy, without the N. Independence Mall West, Philadelphia, PA 19106-1572, express consent of the ACP. MKSAP 19 is for individual or email your request to mksap_editors@acponline.org. use only. Only one account per subscription will be per- MKSAP 19 ISBN: 978-1-938245-75-6 mitted for the purpose of earning CME credits and MOC Neurology ISBN: 978-1-938245-80-0 points and for other authorized uses of MKSAP 19. Printed in the United States of America.

publications, technologies, products, and/or services Unauthorized Use of This Book Is discussed in this program. Against the Law Unauthorized reproduction of this publication is unlaw- ful. ACP prohibits reproduction of this publication or any Publisher's Information of its parts in any form either for individual use or for Copyright © 2021 American College of Physicians. All distribution. rights reserved. ACP will consider granting an individual permission to This publication is protected by copyright. No part of reproduce only limited portions of this publication for this publication may be reproduced, stored in a retrieval his or her own exclusive use. Send requests in writing to system, or transmitted in any form or by any means, elec- MKSAP* Permissions, American College of Physicians, 190 tronic or mechanical, including photocopy, without the N. Independence Mall West, Philadelphia, PA 19106-1572, express consent of the ACP. MKSAP 19 is for individual or email your request to mksap_editors@acponline.org. use only. Only one account per subscription will be per- MKSAP 19 ISBN: 978-1-938245-75-6 mitted for the purpose of earning CME credits and MOC Neurology ISBN: 978-1-938245-80-0 points and for other authorized uses of MKSAP 19. Printed in the United States of America. For order information in the U.S. or Canada call 800-ACP- Disclaimer Regarding Direct Purchases 1915. All other countries call 215-351-2600 (Monday to from Online Retailers Friday, 9 AM - 5 pM ET). Fax inquiries to 215-351-2799 or CME and/or MOC for MKSAP 19 is available only to custom- email to custserv@acponline.org. ers who purchase the program directly from ACP. ACP will not set up MKSAP CME/MOC accounts for purchasers of MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), with whom ACP has no relationship. We do not honor Errata and Revisions third party sales. CME credits and MOC points cannot be Errata and Revisions for MKSAP 19 will be available awarded to those purchasers who have purchased the pro- through MKSAP 19 Digital at mksap19.acponline.org as gram from non-authorized sellers. new information becomes known to the editors.

For order information in the U.S. or Canada call 800-ACP- Disclaimer Regarding Direct Purchases 1915. All other countries call 215-351-2600 (Monday to from Online Retailers Friday, 9 AM - 5 pM ET). Fax inquiries to 215-351-2799 or CME and/or MOC for MKSAP 19 is available only to custom- email to custserv@acponline.org. ers who purchase the program directly from ACP. ACP will not set up MKSAP CME/MOC accounts for purchasers of MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), with whom ACP has no relationship. We do not honor Errata and Revisions third party sales. CME credits and MOC points cannot be Errata and Revisions for MKSAP 19 will be available awarded to those purchasers who have purchased the pro- through MKSAP 19 Digital at mksap19.acponline.org as gram from non-authorized sellers. new information becomes known to the editors. vii