Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Taichman DB. Annals for Educators - 6 September 2016. Ann Intern Med. 2016;165:ED5. doi: 10.7326/AFED201609060
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Published: Ann Intern Med. 2016;165(5):ED5.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners to define nonalcoholic fatty liver disease (NAFLD), steatosis, and NASH. What conditions are associated with NAFLD? What evaluation should be performed to make this diagnosis? Use the information in DynaMed Plus: NAFLD a benefit of your ACP membership.
What are the complications of NAFLD? Who is at risk for progression from steatosis to NASH and to cirrhosis? What, if anything, may be done to prevent progression?
Arrange for a pathologist to review the histology of normal liver, as well as the changes seen in NAFLD, NASH, and cirrhosis.
What is known about the pathophysiology of NASH that might explain why diabetics are at risk? Why might thiazolidinediones be beneficial? These are discussed in the paper's introduction.
Are these results ready to be incorporated into clinical practice? Why or why not? What more would your learners like to know? Use the accompanying editorial to help frame your discussion.
Ask your learners to list the acute and chronic risks of blood product transfusions.
Invite an expert from your blood bank to discuss what questions are asked of blood donors, who is excluded from donating, and why? For what conditions, and how, are donated products actively tested?
What are prion diseases? What pathological characteristic of Alzheimer and Parkinson disease is also seen in prion-transmitted conditions, such as Creutzfeldt–Jakob disease? What are their clinical characteristics?
Before reviewing this study, ask your learners how they would use robust long-term national registries of blood donations and transfusions, together with national health records, to design a study to assess whether blood transfusion might be associated with the development of neurodegenerative diseases. What would be the limitations of such a study? What would your learners use as a “positive control” for their study (i.e., to assess whether their study is capable of detecting an infectious risk of blood donation)?
Now ask your learners to describe the cohort study design used by these investigators. What were the “exposure” and “outcomes”? What unique challenge was posed by the potential latency between when an individual might donate blood, or receive a blood transfusion, and the development of disease?
Introduce specific teaching topics with the multiple-choice questions provided, and log on to enter your answers and earn CME for yourself!
Ask what measures help to prevent hepatitis C virus infection. Can a patient who has achieved sustained virologic response from treatment be re-infected?
Who should be screened for hepatitis C, and how? How does one interpret serologic testing?
How should an infected individual be evaluated? Why is it important to determine whether there is hepatic fibrosis and its severity?
How efficacious are hepatitis C therapies? In which patients? How are they used? Does treatment require a specialist?
How should treatment be monitored?
Download the already-prepared teaching slides to help prepare a session.
Ask your learners to read it. Then, ask for their reactions.
Have they ever felt that a family member was being “selfish” for advocating for continued curative therapies for a loved one with a poor prognosis? Do they agree with the comments of the protagonist's uncle?
Do your learners think the author made the right decision? How did things turn out? Did it surprise your learners?
How would your learners have counseled this patient's family? Since sometimes things turn out differently than expected, how do we balance the known and the unknown when discussing end-of-life care with patients and their families?
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