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 the symptoms of hypertrophic cardiomyopathy. How are these symptoms explained by the pathophysiology? What are the potential complications? Use the information in DynaMed Plus: Hypertrophic Cardiomyopathy, a benefit of your ACP membership.
What pharmacologic interventions are currently used to treat hypertrophic cardiomyopathy? How effective are they?
Is surgical myectomy or percutaneous alcohol septal ablation available at your center? Who is or is not a candidate? What are the risks? Is an implantable defibrillator recommended?
Is genetic testing needed in patients with hypertrophic cardiomyopathy? What about their family members?
What is the mechanism by which mavacamten might improve symptoms in hypertrophic cardiomyopathy? What were the results of this study? What are their limitations, and why are larger trials required?
Ask your learners when they should consider evaluation for possible PFO.
How is a PFO diagnosed? Ask an echocardiologist to show your learners images of bubble contrast echocardiograms from patients with and without a PFO. Is a transesophageal echocardiogram needed? Use the accompanying editorial to help frame your discussion.
How prevalent is PFO in the general population? How often was it found in this study? Do the results surprise your learners?
How might the presence of PFO and the occurrence of paradoxical embolism influence the duration of therapy for pulmonary embolism?
Should patients with PFO undergo closure of the atrial defect?
Ask your learners how Fournier gangrene presents. What are the risk factors? What are the potential complications?
By what mechanism do SGLT2 inhibitors help decrease serum glucose levels? What adverse events are known to be associated with their use?
Review how cases of Fournier gangrene were identified for this study. What is the FDA Adverse Event Reporting System (FAERS)? Is reporting voluntary or mandatory? In what way might that affect the results of this study?
How did the investigators evaluate whether the presence of diabetes itself, rather than the use of an SGLT2 inhibitor, was a likely risk associated with Fournier gangrene? What did they find?
What are potential benefits and limitations of case reports and case series such as this one?
Do your learners think that SGLT2 inhibitors should be used? How might this case series influence further study? How should these results alter our care of patients with diabetes?
Ask your learners what are the most common causes of firearm-related injury or death. Are mass shootings responsible for most?
The authors discuss 3 categories of persons who are at increased risk for firearm-related death and injury. Review them with your learners.
Do your learners think it is important to ask about firearms when risk factors for injury are present? What should be emphasized in such discussions with patients? How might they help to improve patient safety and prevent injury?
Are patients who are at risk for suicide the only ones with whom we should discuss firearms? How about patients with small children or grandchildren? Patients with dementia or family members with dementia?
Why don't physicians discuss firearms with patients as often as necessary? How can we overcome such barriers to promoting patient safety?
Do your learners know what questions to ask, and how? Do they know how to counsel patients about safe firearm storage?
Use the provided multiple-choice questions to introduce topics during a teaching session. And, log on to enter your answers and earn CME/MOC credit for yourself.
Listen to an audio recording, read by Dr. Virginia Hood.
Ask your learners whether they have cared for patients with mild cognitive impairment or dementia. Have they asked whether they are aware of the deficits? What do patients fear? Should we ask them? What about their family members?
Have you or any of your learners had an experience with a loved one similar to what Dr. Lee describes? How do a patient's cognitive deficits affect those around him or her? Are the challenges only emotional?
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Taichman DB. Annals for Educators - 4 June 2019. Ann Intern Med. 2019;170:ED11. doi: 10.7326/AWED201906040
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Published: Ann Intern Med. 2019;170(11):ED11.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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