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 what steps are required immediately in the management of a patient with an opioid overdose. What interventions should be considered after management of acutely life-threatening issues?
Ask your learners what options are available for patients with opioid use disorder. How do methadone, buprenorphine, and naltrexone work? How are they prescribed? Who may prescribe them, and what monitoring is required? How effective are they at reducing risk for subsequent overdose and/or death?
How would your learners arrange for outpatient care of patients presenting with an opioid overdose? How often is this actually done at your center?
Why do your learners think MOUDs are underused? What are the legal barriers to their use? Should these be changed? Review a recent ACP position paper to help frame your discussion.
The editorialists believe that the persistent belief that MOUDs “substitute a new addiction for an old one” is part of the problem. What are reasonable concerns regarding MOUDs? Do the benefits outweigh the risks? Invite a specialist in substance abuse to join your discussion.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners how a diagnosis of diabetes is established. How do they do it? Do they confirm an abnormal glycemic test result on a separate sample? If not, why not?
Should the results of this study alter how we diagnose diabetes? Why or why not? What are the study's limitations?
What properties should we require of a diagnostic test?
Given that diagnosing diabetes with tests performed on a single blood sample would be easier for patients and clinicians, why not take this approach now? Use the accompanying editorial to help frame your discussion.
Ask your learners if they know how patients should dispose of unused opioids. How should this be done?
Do your learners ever talk about safe storage of opioids and what to do with the remaining supply after the drug is no longer needed for the reason it was prescribed? Have they ever discussed with their patients the potential for the drug's diversion and the role that might play in harming others?
How would your learners counsel their patients? What specific advice would they provide?
Watch the short video of the patient's interview.
Ask your learners what criteria should determine eligibility for antihypertensive treatment in persons aged 60 years or older. What should their target blood pressure be? Which antihypertensive agents are preferable?
Watch the grand rounds presentation with your learners. Now how would they answer these questions?
How would your learners discuss with a patient whether to initiate antihypertensive treatment?
Be sure to answer the multiple-choice questions to earn CME/MOC credit for yourself!
Ask your learners who is at risk for herpes zoster.
Who should be vaccinated against varicella zoster virus? How effective is the vaccine?
Is laboratory testing required to diagnose herpes zoster? What is the differential diagnosis?
When should an ophthalmologist or an otolaryngologist be consulted?
How is herpes zoster treated? When is intravenous treatment needed?
Use the multiple-choice questions to help introduce topics for discussion with your team, and log on to enter your answers to earn CME/MOC credit for yourself.
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask what a “good death” is.
What is our role in a patient's death? How would your learners have responded when this patient indicated with a smile that he would die that day?
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Taichman DB. Annals for Educators - 7 August 2018. Ann Intern Med. ;169:ED3. doi: 10.7326/AFED201808070
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Published: Ann Intern Med. 2018;169(3):ED3.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Hypertension.
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