Skip Navigation

Visit Annals Teaching Tools for more resources for educators from Annals and ACP.

November 17, 2015 Issue


Clinical Practice Points

Medical Knowledge

Long-Term Prognosis of Early Repolarization With J-Wave and QRS Slur Patterns on the Resting Electrocardiogram. A Cohort Study

Whether early repolarization on a resting ECG has prognostic importance is not clear. In this cohort, the presence of J waves and QRS slurs was not associated with a clinically meaningful increase in cardiovascular death during long-term follow-up.

Use this study to:

  • Start a teaching session by asking your learners to read the ECG provided below. Do any of them recognize the presence of early repolarization? Ask what the significance is of an early repolarization pattern.
  • Review Figure 1 in this research study to see examples of how the investigators defined J waves and QRS slurs. Ask why it is so important to be certain of definitions when conducting a study such as this one. Look at Figure 2 to see how often the investigators in this study agreed.
  • Ask your readers whether an evaluation is required when early repolarization is seen on an ECG in the absence of dysrhythmias. Consider inviting a cardiac electrophysiologist to lead the discussion.
  • Ask what the limitations of this study are. What will your learners do the next time they see J waves on an ECG? Are your learners reassured that they need not be concerned?

ECG Image of Early Repolarization:

Legend: Heilman J. Early benign repolarization. 21 June 2012. Accessed at https://commons.m.wikimedia.org/wiki/File:Benign_early_repolorization.jpg on 21 October 2015.



Medical Knowledge
Patient Care
Systems-based Practice

Effectiveness of an Early Versus Conservative Invasive Treatment Strategy in Acute Coronary Syndromes. A Nationwide Cohort Study

In this large nationwide study from Denmark of patients with acute coronary syndromes, diagnostic coronary angiography within 72 hours was associated with a decreased risk for adverse cardiac events compared with angiography performed more than 3 days later or not at all.

Use this study to:

  • Ask your learners how studies of real-world practice (such as this comparative effectiveness study using observational data) might be important compared with those from a randomized, controlled trial. Make a list of the advantages and disadvantages of each.
  • Read the accompanying editorial. The editorialists discuss the limitations of comparative effectiveness studies based on observational data. Do your learners understand the importance of these limitations?
  • Ask your learners if and how they think this study is useful. Are such studies important for hypothesis generation? How should they influence clinical guidelines and practice? What should be done next to decide which approach is best in the management of acute coronary syndromes?


Medical Knowledge
Patient Care

Leukotriene-Receptor Antagonists Versus Placebo in the Treatment of Asthma in Adults and Adolescents. A Systematic Review and Meta-analysis

This study evaluated available randomized, controlled trials and found that the use of leukotriene-receptor antagonists (LTRAs) as monotherapy improved asthma control compared with placebo, although a way to identify patients who are most likely to respond is lacking.

Use this study to:

  • Review how to assess asthma severity. Use the information in the recent In the Clinic: Asthma to help prepare. Use the multiple-choice questions provided at the end to help introduce topics in your teaching session.
  • The authors discuss why their review found evidence for a benefit of LTRAs in trials of monotherapy but not in studies of LTRAs used in combination with inhaled corticosteroids. Ask your learners what might explain the difference.
  • Review the Figure in In the Clinic: Asthma. Note where LTRAs are on the therapeutic step ladder presented. When do your learners think they should be used?
  • What potential adverse events are associated with LTRAs?
  • Log on and enter your answers to the multiple-choice questions to earn CME for yourself!


Practicing Medicine

Patient Care
Systems-based Practice
Interpersonal / Communication Skills

Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper

This position statement and review of available evidence outlines the potential benefits and limitations of telemedicine.

Use this paper to:

  • Review the definition of telemedicine (use the Table). How does telemedicine differ from answering a patient's telephone call?
  • Ask what the potential advantages are to telemedicine for patients. Health care providers may worry about reimbursement or the loss of income from face-to-face visits. Are there potential advantages for health care providers or institutions? Use the accompanying editorial to help frame your discussion.
  • Does your health system provide telehealth services (e.g., remote monitoring in your or other intensive care units)? If so, consider taking your team to see how it works, and have your learners see if they are comfortable making medical decisions in this manner.
  • Review the legal challenges to the practice of telehealth. Do your learners know whether there are limitations to their practice of medicine outside of the state in which they are licensed?


Professionalism
Practice-based Learning / Improvement
Interpersonal / Communication Skills

Why Physicians Hate “Patient Satisfaction” but Shouldn't

This essay enumerates reasons physicians may resist efforts to evaluate patient satisfaction and argues why such reasons are misguided.

Use this paper to:

  • Ask your learners whether they think patient satisfaction should be routinely evaluated. Why or why not? How might such information be useful? How might it be misleading or be misused?
  • If available, present patient satisfaction scores for practices in which your learners work.
  • Do your learners agree with the criticisms of patient satisfaction evaluations enumerated by the essay's author? Do they agree with the author's counterpoints?
  • Ask why, “…the secret of the care of the patient is in caring for the patient.”


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.

×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×