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.
Start a teaching session with multiple-choice questions. We've provided 2 below!
Ask your learners to name potential HDPs.
How frequently should blood pressure be monitored during pregnancy? What blood pressure readings warrant concern, and what should be done? How are gestational hypertension and preeclampsia diagnosed? Do your learners know how these are managed?
What do we know about the risk for CVD among women with a history of an HDP? Do your learners ask about this history? Does it alter how they monitor their parous patients?
Review the design and results of this study. What prepregnancy cardiovascular risk factors were accounted for in the analysis? Why weren't prepregnancy blood pressure, lipid, and glucose values accounted for? Why does that matter?
How does this limitation affect what this study can tell us about the nature of the relationship between HDPs and future CVD? Do HDPs per se contribute to the increased CVD risk, or do they simply identify women who have “failed” the cardiometabolic stress test of pregnancy because of a preexisting increased propensity for CVD? Use the accompanying editorial to help frame your discussion.
Should the results of this study alter when your learners evaluate cardiovascular risk factors in their patients who have a history of an HDP?
Ask your learners what medical treatments may be used to align their patients' physical appearance with their gender identity.
What risks may be increased by the hormone treatments used? Why might cardiovascular outcomes specifically be affected? Are there other potential risks?
What did this study find regarding the risk for venous thromboembolism among transfeminine persons compared with cisgender women and cisgender men? Do these results fit with what your learners know about the risks associated with these hormones when they are used for other indications?
Where can patients find expert transgender medicine care in your area?
Ask your learners what the implications are of chemotherapeutic agents that target cell processes common to both normal and malignant cells. Ask your learners to list examples of “tissue targeting” in current chemotherapies for cancer (for example, HER2 in breast cancer or BCR-ABL in chronic myelogenous leukemia).
What does a “tissue-agnostic” approach to cancer treatment mean? How does this differ from an approach based on the histologic origin of a tumor?
What is a basket trial?
Assign members of your team to read the succinct examples of applying a tissue-agnostic approach (for example, BRAF inhibition in melanoma and lung cancer or immune checkpoint blockade for cancers with mismatch repair deficiencies). Have them explain what they read to the rest of the team.
Invite an oncologist to discuss how these approaches are altering oncologic practice.
Ask your learners how they would approach the evaluation of a pregnant patient with concern about possible venous thromboembolism.
Then, take a break with your learners to watch the short video.
Answer the short multiple-choice questions with your team. Be sure to log on and enter your own answers to earn CME/MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Virginia Hood.
Ask your learners who Lyra is.
Ask if Lyra's presence makes things easier or harder to bear.
Ask your learners whether they have ever asked their patients how they deal with their challenges and fears as they embark on medical care. Are there patients on your service who might appreciate telling you and would be willing to do so?
Have your learners ever been torn about doing what seemed medically correct when their heart was saying to do something else?
How do we decide whether to deviate from what we think is, strictly speaking, the medically appropriate path? When is it appropriate to act as Dr. Lu did when patients request opioids?
What can we do in such situations to minimize the risks?
Do your learners believe they are able to look past what seems an inappropriate request for opioids to see the person and story behind the request? Do we fear doing so?
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Taichman DB. Annals for Educators - 21 August 2018. Ann Intern Med. ;169:ED4. doi: 10.7326/AFED201808210
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Published: Ann Intern Med. 2018;169(4):ED4.
Cardiology, Coronary Risk Factors, Hematology/Oncology, Hypertension, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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