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 a multiple-choice question. We've provided one below!
Ask your learners to list possible adverse events associated with statin therapy. How frequently do they occur? What evaluation or action is indicated for each?
Watch this month's episode of the Annals Consult Guys, “Is It Statin Myalgia? What a Pain!”
How do your learners assess whether patients who are prescribed statins are taking them? How often do they think drugs such as these are not being taken regularly (or at all) even if patients say they are taking them? Do the results of this study alter the importance your learners will assign to assessing adherence to statin prescriptions?
How should your learners counsel patients who report muscle aches or other intolerance to statins? The editorialist believes that many patients' reports of statin-related adverse events represent a “nocebo” effect. What does that mean? Do your learners agree?
The editorialist stresses that physicians must counter the “dangerous cults” of nonscientific and misleading information (frequently found on the Internet) by educating patients. Pretend to be a patient who has read about the dangers of statins on the Internet. How should your learners respond?
Some patients who report intolerance to statin medications may be assessed and successfully restarted on medication by using an “n-of-1” trial. Review a study of such an approach specifically related to statin use.
Ask your learners what hormonal treatments are used in gender-affirming care. What are the goals of such treatments? How are they used, and how is treatment response monitored?
What are the long-term health concerns for the use of testosterone and estrogen in transgender men and women, respectively? What are the limits to what is known? Why might information from studies of cisgender men and women be inadequate?
Are clinicians with the necessary experience available to patients at your institution to provide cross-sex hormone therapy for transgender adults? The authors of this article note that 50% of transgender adults report having to teach their clinicians how to care for them. Does this surprise your learners? How would they react if a patient aimed to “educate” them about a clinical issue with which they have insufficient expertise?
Ask your learners why tobacco companies might benefit from the growing use and acceptance of e-cigarettes.
Do your learners think that rehabilitation of the tobacco industry's image as providers of health-related products poses a threat to public health?
Could e-cigarettes be useful as harm reduction tools for some patients who smoke combustible cigarettes? What are the risks? Might some patients who may otherwise never have used tobacco products try and become addicted to e-cigarettes? Is this harmful? Where might it lead?
How do we balance the potential benefits and harms of e-cigarettes? Can we balance them?
Do your learners ask their patients whether they use e-cigarettes? What counsel do they provide if the answer is yes?
Ask your learners what the goals of a meta-analysis are. Why is it important to assess the studies that are included in a meta-analysis when assessing the value of the analyses' conclusions? What aspects of the included studies should be evaluated?
Might it be inappropriate to “pool” the results of studies performed in markedly different populations, with different interventions or definitions of the relevant end points? Are your learners aware that some meta-analyses are performed despite these problems? Help your learners understand why it is problematic to assume these analyses are meaningful.
What does the I2 value mean?
How does one read a forest plot? Invite an expert in systematic review and meta-analysis to join your discussion.
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Taichman DB. Annals for Educators - 15 August 2017. Ann Intern Med. 2017;167:ED4. doi: https://doi.org/10.7326/AFED201708150
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Published: Ann Intern Med. 2017;167(4):ED4.
Cardiology, Coronary Risk Factors, Dyslipidemia, Endocrine and Metabolism.
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