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.
Ask your learners how patients with CRPS present. How is it diagnosed? What is the differential diagnosis? Use the information in DynaMed Plus: Complex Regional Pain Syndrome (a benefit of your ACP membership) to help prepare.
What is known about the pathophysiology of CRPS? This is discussed by the editorialists.
How did understanding the pathophysiology prompt the hypothesis that IVIg might be effective therapy? How is IVIg derived, and for which conditions does it work? Do we know how it works?
The editorialists do not believe that this trial should end a focus on immune regulation as an approach to CRPS therapy. What do your learners think?
How is CRPS treated now? How effective are these interventions? What do your learners think it means to have a rare disease for which we lack reliable therapy? How can we help these patients avoid despair and hopelessness?
Ask your learners how much of their day is spent sitting. How many engage in routine physical exercise? How intense is it?
Do the results of this study alter how your learners think about the importance of physical activity? Does engaging in moderate-to-vigorous physical activity alter the association between sedentary time and mortality? Does it “protect” us from our sedentary habits?
In addition to total sedentary time, the authors examined longer and shorter bouts of sedentary time. Why? What did they find? How might these variables alter the risk for death? Use the accompanying editorial to help frame your discussion.
Teach at the bedside! Ask patients on your service what their daily activities involve and how much of their time is sedentary. Would they be able to alter that if they wanted to? What could be recommended? Should we make recommendations based on this study?
Ask your learners what confounding is and how it might be important in an observational study such as this. The authors quantified the potential effect of an “unmeasured confounder” on their findings. What is an unmeasured confounder? How do the results of this sensitivity analysis help to provide confidence in the authors' conclusions? Use a recent editorial to help frame your discussion.
Watch the video interview with Mr. O, a 74-year-old man who has undergone carotid ultrasound. After watching, ask your learners whether they think patients like Mr. O should be screened for CAS. Why or why not?
Who is at risk for CAS, and does pharmacotherapy affect its natural history? Does carotid endarterectomy (CEA) reduce the risk for stroke in asymptomatic patients? What level of risk from CEA is acceptable?
Evaluate the answers to these questions provided by the discussants. Watch the video of the grand rounds discussion, ask your learners to read it before your teaching session, or assign individuals or teams to summarize the arguments made by the primary care physician and the vascular surgeon. Use the provided slide sets to help.
After reviewing the points made, ask whether your learners have changed their minds. Will they suggest screening to their patients? If so, how will they discuss its potential benefits and harms?
Regarding his past carotid studies, Mr. O comments, “Why not? I mean the more information the better, right?” Is he right? Is more information always better?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners whether we should screen for UTI or asymptomatic bacteriuria.
In which patients with asymptomatic bacteriuria is prevention of symptomatic UTI recommended?
Should women with recurrent symptomatic UTI receive antibiotic prophylaxis? If so, how? How successful are interventions?
What is the differential diagnosis of acute cystitis? How is each condition diagnosed and treated?
When is consultation with an infectious disease specialist or a urologist appropriate?
Use the accompanying multiple-choice questions and teaching slides to help introduce topics for discussion. Be sure to log on and enter your answers to claim CME/MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Virginia Hood.
Ask your learners whether they have ever helped care for a victim of sexual assault. Did it scare them?
How do our own fears of being on the other side of the examination table make us better doctors?
Do your learners ask their patients about sexual abuse? Do they know what to do when a patient reports having been the victim of sexual abuse?
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Taichman DB. Annals for Educators - 3 October 2017. Ann Intern Med. ;167:ED7. doi: 10.7326/AFED201710030
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Published: Ann Intern Med. 2017;167(7):ED7.
Infectious Disease, Nephrology, Neurology, Neuropathy, Urinary Tract Infection.
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