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 how IE presents. How should patients with possible IE be evaluated? When should treatment be initiated? What antibiotic coverage should be started? Use the information at DynaMed Plus: Infective Endocarditis, a benefit of your ACP membership.
What bacteria are most commonly involved? Which valves? Do the answers differ with DUA-IE?
What are the indications for valve surgery in patients with IE? Why has surgery for DUA-IE been controversial? What are the concerns and possible ethical considerations? Invite a cardiac surgeon to join your discussion. Would she or he perform valve surgery in a patient who has recently used intravenous drugs?
Do your learners understand how to address a patient's substance use and its importance in the care of patients with DUA-IE?
Ask your learners why they think hospitalizations are longer among patients with DUA-IE than among those without it. The authors address this in the paper's discussion.
What duration of antibiotic therapy is required for IE? Is parenteral therapy required?
Ask your learners why the prevalence of AF is higher among patients with HF. How might structural and electrical changes associated with AF and HF perpetuate a vicious cycle?
What are the medical options for treating AF?
When should catheter ablation be considered for treatment of AF? How is it performed? Are there contraindications? Ask an interventional cardiologist to join your discussion and show your learners the catheterization films of a procedure to help understand what is done.
What are the possible complications of catheter ablation for AF?
Ask who is at increased risk for RA.
What are the possible presentations of RA? Describe the “classic” articular findings.
Teach at the bedside! Identify patients on your service with articular findings that are typical of RA. Ask them whether they would allow you to demonstrate these findings to your learners. Ask the patient to tell your learners how RA affects his or her daily life.
How is RA diagnosed? What is the role of laboratory testing?
Are radiographs required to establish a diagnosis? Should “baseline” films be obtained?
How should treatment be approached? Why is methotrexate considered the “backbone” of treatment? When should biologic disease-modifying antirheumatic drugs be considered?
What are the goals of treatment, and how is it monitored?
When should a patient be referred to a rheumatologist?
Use the provided multiple-choice questions to help introduce topics for discussion, and log on to enter your answers to earn CME/MOC credit for yourself!
Listen to an audio recording, read by Dr. Virginia Hood.
Ask your learners if they have asked patients whether they fear death. If so, what have they said they fear?
In addition to controlling physical suffering, how can we assist patients in addressing emotional suffering as they face death?
Do we as physicians frequently feel we must have an answer for any concern a patient has?
Ask your learners to look quietly at each of the 6 drawings without reading the artist's comments.
Have your learners share their thoughts on each drawing, and then read the artist's comments. Did people see different things?
In the first drawing, Dr. Bao asks, “At what point are we treating ‘numbers' instead of treating the patient?” Have your learners ever asked that same question? Is this question asked enough?
Do any of the drawings change how your learners will think about patients in similar situations? How?
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Taichman DB. Annals for Educators - 1 January 2019. Ann Intern Med. ;170:ED1. doi: 10.7326/AFED201901010
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Published: Ann Intern Med. 2019;170(1):ED1.
Cardiac Diagnosis and Imaging, Cardiology, Endocarditis, Heart Failure, Infectious Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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