Annals of Internal Medicine ( IF 39.2 ) Pub Date : 2019-12-03 , DOI: 10.7326/awed201912030 Darren B. Taichman
Clinical Practice Points
Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group
Start a teaching session with a multiple-choice question. We've provided one below!
What are the immediate considerations for evaluation and management of patients with potential UGIB?
Ask your learners what the risk factors are for UGIB.
Do all patients with UGIB require hospitalization? How do your learners decide? Review the variables of the Glasgow Blatchford score. What score is recommended to identify a sufficiently low risk for rebleeding to consider outpatient management? Is this in line with practice at your hospital? Do your learners think it should be?
Which patients require blood transfusion? Note the difference in thresholds for transfusion recommended in the multiple-choice question below and in the guideline. Why might recommendations differ? What do your learners plan to do?
How should proton-pump inhibitors be administered, and for how long? How does a patient's need for anticoagulant or antiplatelet therapy influence the approach to proton-pump inhibitor therapy?
Cases in Precision Medicine: A Personalized Approach to Stroke and Cardiovascular Risk Assessment in Women
Read the presentation of a 46-year-old woman seeking advice about her risk for cardiovascular disease with your learners.
Ask your learners how they would answer this patient's question regarding a “test” to assess whether “stroke is in her genes.”
How would your learners assess this patient's risk?
Is there a role for genetic testing?
How does this patient's history of migraine influence your learners' assessment of her risk? What other variables influence her risk? Use the Figure.
Beyond the Guidelines
Should This Patient Be Screened for Atrial Fibrillation? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Watch the video interview of Dr. V, a 69-year-old woman with an asymptomatic episode of tachycardia noted during ambulatory blood pressure monitoring.
Ask your learners whether they would recommend screening patients for atrial fibrillation. Why or why not?
What are the potential benefits and harms?
Review the background material and the arguments made by the 2 discussants. Alternatively, watch the video of the grand rounds presentation.
Have your learners changed their minds about screening?
In the Clinic
In the Clinic: Obstructive Sleep Apnea
Ask your learners what conditions increase the risk for OSA. See the Box: Risk Factors for Obstructive Sleep Apnea.
Should we screen for OSA? If so, in whom? How would your learners do so? Are they familiar with the STOP-BANG approach?
What evaluation should occur if OSA is suspected?
Are in-laboratory sleep studies required for diagnosis or treatment?
How is treatment initiated? Is evaluation by a specialist always required?
Use the provided multiple-choice questions to introduce topics during a teaching session. Be sure to log in and enter your answer to claim CME and MOC credit.
Humanism and Professionalism
A Veteran-Centric Model of Care: Crossing the Cultural Divide
Ask your learners whether they have noted differences in their interactions with patients who are veterans compared with those who have not served in the military.
Do your learners ask patients who are veterans about their service history? Should they? When? What questions should be asked? Use the Table. Why might these questions be helpful?
Have your learners encountered the kinds of misunderstanding or miscommunication described by the author?
On Being a Doctor: The Liver Transplant Unit
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they are ever jarred by thoughts of a loved one when they see a patient with an illness.
Is it different to face a loved one's illness as a physician? Do our knowledge of medicine and our experiences with advanced disease make things better or worse?
MKSAP 18 Question
中文翻译:
教育家通志-2019年12月3日
临床实践要点
非静脉曲张性上消化道出血的处理:国际共识小组的指南建议
从选择题开始教学。我们在下面提供了一个!
对具有潜在UGIB的患者进行评估和管理的直接考虑是什么?
询问您的学习者UGIB的危险因素是什么。
所有UGIB患者都需要住院吗?您的学习者如何决定?查看格拉斯哥Blatchford分数的变量。为了确定再出血风险足够低以考虑门诊管理,建议采用什么评分?这符合您医院的做法吗?您的学习者认为应该吗?
哪些患者需要输血?请注意下面和指南中的多项选择题所建议的输血阈值的差异。为什么建议会有所不同?您的学习者打算做什么?
质子泵抑制剂应如何施用,持续多长时间?患者对抗凝或抗血小板治疗的需求如何影响质子泵抑制剂治疗的方法?
精密医学案例:女性中风和心血管风险评估的个性化方法
阅读一位46岁女性的演讲,与您的学习者一起寻求有关其患心血管疾病风险的建议。
询问您的学习者,他们将如何回答该患者有关“测试”的问题,以评估“中风是否存在于她的基因中”。
您的学习者将如何评估该患者的风险?
基因测试有作用吗?
该患者的偏头痛病史如何影响您的学习者对其风险的评估?还有哪些其他变量会影响她的风险?使用该图。
超越准则
该患者应进行房颤筛查吗?贝丝以色列女执事医疗中心举行的大回合讨论
观看V博士的视频采访,V博士是一名69岁的女性,在动态血压监测过程中发现了无症状的心动过速。
询问您的学习者他们是否建议对患者进行房颤筛查。为什么或者为什么不?
潜在的利弊是什么?
回顾背景材料和两名讨论者提出的论点。或者,观看大回合演讲的视频。
您的学习者是否改变了对筛查的想法?
在诊所
在诊所:阻塞性睡眠呼吸暂停
询问您的学习者哪些情况会增加OSA的风险。参见方框:阻塞性睡眠呼吸暂停的危险因素。
我们应该筛查OSA吗?如果是这样,在谁那里?您的学习者将如何做?他们是否熟悉STOP-BANG方法?
如果怀疑OSA,应该进行什么评估?
诊断或治疗是否需要实验室内睡眠研究?
如何开始治疗?是否总是需要专家进行评估?
使用提供的多项选择题在教学过程中介绍主题。请务必登录并输入答案以索取CME和MOC信用额。
人文主义和专业精神
以老兵为中心的护理模式:跨越文化鸿沟
询问您的学习者,与没有服兵役的人相比,他们是否注意到与退伍军人的相互作用。
您的学习者是否向退伍军人患者询问服务历史?应该吗 什么时候?应该问什么问题?使用表。为什么这些问题会有所帮助?
您的学习者是否遇到过作者所描述的各种误解或误解?
关于当医生:肝脏移植科
收听由Michael LaCombe博士朗读的录音。
询问您的学习者,当他们看到患病的患者时是否曾被亲人的念头所震撼。
作为医生面对亲人的疾病有什么不同吗?我们的医学知识和晚期疾病的经验会使事情变得更好或更糟吗?