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 the potential adverse reactions to DAAs are. How does the presence of renal insufficiency, hepatic dysfunction, or cirrhosis alter plans for their use? How should patients be monitored during treatment? Use the recent In the Clinic: Hepatitis C Virus to answer these questions.
Ask your learners how they would recognize and evaluate acute hepatitis occurring in a patient receiving DAA therapy for hepatitis C. How would they interpret antibody test results for hepatitis C and B?
How useful are adverse event reports for assessing whether a specific drug is the cause? How are single event reports helpful, and what are their limitations? How should this report from the FDA affect practice? Use the accompanying editorial to help frame your discussion.
Do your learners know when and how to report adverse drug reactions? What responsibilities do individual physicians have to report events? What about institutions? Where are reports made? Use the information at the FDA Web site to help frame your discussion.
Ask your learners whether hepatitis C may be transmitted from mother to fetus. What about hepatitis B or HIV? What other viruses of concern?
Can transmission from mother to fetus be prevented?
What congenitally acquired infections can your learners name? Is screening for each recommended? Do your learners screen pregnant patients for hepatitis B or C? Should they? Why might it be important?
What is known about the safety of treatments for hepatitis C during pregnancy? Use the accompanying editorial to help frame your discussion.
Start a teaching session with a multiple-choice question. We've provided one below!
What are the risk factors for osteoporosis in men and women? Ask your learners how the risk for a fragility fracture may be predicted. Do your learners know how to use and interpret FRAX (the World Health Organization's Fracture Risk Assessment Tool)?
Do your learners look for osteoporosis in their patients? In men as well as women?
Review how osteoporosis is diagnosed.
What are the therapeutic options? What does the ACP recommend as the first-line therapy? What are the differences among the drugs and the evidence for their efficacy? Use Table 2 in the guideline. Do your learners treat men with osteoporosis?
Should bone mineral density be monitored during therapy? What did the guideline developers conclude, and why? Should this guideline's recommendations apply to all patients? Use the accompanying editorial to help frame your discussion.
How long should therapy be continued once initiated? Do your learners agree with the recommendations?
Watch a video interview of the patient with your learners.
Ask them whether they would recommend bariatric surgery to this patient. Why or why not?
Assign half of your team to review and concisely summarize the major arguments in favor of bariatric surgery presented by Dr. Jones, and assign the other half to summarize the arguments of Dr. Wee. After hearing both sides, what would your learners recommend?
What questions would you ask a patient in helping him or her decide whether bariatric surgery might be appropriate? How would you explain the potential benefits and risks?
Do your learners know what gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion and duodenal switch involve? Invite a bariatric surgeon to review these.
What are the potential benefits of bariatric surgery beyond weight loss, and what are the potential complications? How will your learners evaluate patients in the future, and when do they think they might recommend surgery for weight loss?
Ask your learners what symptoms should prompt consideration of a diagnosis of IBS.
What are the diagnostic criteria? What evaluation should be performed?
What are IBS-C, IBS-D, and pain-predominant IBS? Why is this differentiation important?
How should patients be managed? What nonpharmacologic and pharmacologic measures should be considered?
What should patients be told to expect from therapy?
Download the teaching slides to help prepare an educational session. Use the provided multiple-choice questions to break up a teaching session and introduce topics for discussion. Be sure to log on and enter your answers to earn CME credit for yourself!
Taichman DB. Annals for Educators - 6 June 2017. Ann Intern Med. 2017;166:ED11. doi: https://doi.org/10.7326/AFED201706060
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Published: Ann Intern Med. 2017;166(11):ED11.
Endocrine and Metabolism, Gastroenterology/Hepatology, Infectious Disease, Metabolic Bone Disorders, Viral Hepatitis.
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