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 to list the ways in which elderly patients might be abused. What forms of abuse need to be considered, beyond physical and psychological? Use the accompanying editorial to help frame the discussion.
When should we consider the possibility that our patients have been victims of elder abuse?
Road trip! Have your learners ever visited a nursing home? Do they think visiting one (or more) might help them to better understand their patients' worlds and factors that might be important to consider when providing care and/or planning ongoing care? Can you plan a visit to one of the nursing homes where patients on your service reside?
In what ways might patients be financially abused? By whom?
During team rounds, ask each of the patients on your service about his or her living arrangement. Do they like them? Do they feel safe? What would they change given their medical needs? To whom can they turn for help when they have problems?
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners to describe the physical examination findings of opioid overdose. What findings may be seen at the skin? The eyes? What are the cardiovascular complications? What are the arterial blood gas findings? Use the information in DynaMed Plus: Opioid Overdose (a benefit of your ACP membership) to help prepare a teaching session.
How should an opioid overdose be managed? What are the immediate concerns? Who requires intubation and mechanical ventilation?
Review the results of this study. Ask your learners if they have prescribed naloxone to their patients who use opioids for treatment of chronic pain. Should they? What might be the benefits or concerns? What does the Centers for Disease Control and Prevention recommend? Use the accompanying editorial to help frame your discussion.
How is naloxone prescribed? How are patients and their families taught to use it? See the patient educational material included as an appendix to this research paper. Could these materials be helpful in your learners' practice?
Is naloxone being coprescribed with long-term opioids to outpatients in your health system? Could your learners design a study using your electronic health record to find out? Are any approvals needed for such a study? How could they use the results to help educate clinicians? How would your learners propose to measure the effect of such an intervention?
Take a brief break with your team to watch the video.
Ask your team what the theoretical rational for supplemental oxygen use is in acute coronary syndromes. Are there mechanisms by which it might be harmful?
How do practices become “entrenched” in medical practice if they have not been proven to be effective?
What do your learners plan to do in the future? Will they use supplemental oxygen in all their patients with myocardial infarction?
Enter your answers to the brief multiple-choice questions online to earn CME for yourself!
Ask what the goal of randomization is in a clinical trial. What are the benefits and shortcomings of population heterogeneity in a clinical trial?
Review phase 1, 2, and 3 trials and their goals. The author provides a concise summary.
Ask why “conventional” trials that enroll and randomize patients on the basis of the primary tumor site and stage might be less than optimal in oncology. How does current understanding of tumor biology and progression, together with the emergence of drugs targeting the effects of specific gene mutations, suggest the potential benefit of a “basket” trial?
Invite an oncologist and/or someone expert in oncology clinical trials to discuss what the terms “basket,” “enrichment,” and “umbrella” designs mean. Use the article's figures to help illustrate.
Ask your learners to define sepsis.
Ask why early identification of patients with sepsis can be important.
Apply the quick Sequential Organ Failure Assessment (qSOFA) to each of your team's patients on morning rounds. What does this tell you about a patient's risk for sepsis? Does your team find this useful? What do the authors suggest the value is (see the end of this short piece)?
Taichman DB. Annals for Educators - 16 August 2016. Ann Intern Med. 2016;165:ED4. doi: https://doi.org/10.7326/AFED201608160
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Published: Ann Intern Med. 2016;165(4):ED4.
Emergency Medicine, Geriatric Medicine, Hospital Medicine, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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