Annals for Educators - 2 January 2018
Authors: Darren B. Taichman
Journal: Annals of Internal Medicine (2018)

Web Exclusives2 January 2018Annals for Educators - 2 January 2018FREEDarren B. Taichman, MD, PhDDarren B. Taichman, MD, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AFED201801020 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsEffect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer. An Observational Cohort StudyThe optimal interval for concurrent high-risk human papillomavirus (HPV) and cytology testing (co-testing) to detect cervical cancer and its precursors is a question of great interest. Data from a large regional integrated health system were analyzed to determine whether a history of negative high-risk HPV and cytology co-testing results at 3 or 5 years has an effect on such detection.Use this study to:Start a teaching session with a multiple-choice question. We've provided one below!Ask your learners what the risk factors for cervical cancer are. What is the role of HPV in the pathogenesis?What are your learners' approaches to screening their patients for cervical cancer? Whom do they screen? How? How often?What do guidelines recommend? Use the information at DynaMed Plus: Cervical Cancer Screening (a benefit of your ACP membership). Do your learners use HPV testing and/or cytology testing? Do they perform co-testing? How might the results of this study help inform future cervical cancer screening guidelines with regard to the necessary frequency of screening? Use the accompanying editorial to help frame your discussion. Preventing Cognitive Impairment and DementiaPhysical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia. A Systematic ReviewPharmacologic Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia. A Systematic ReviewOver-the-Counter Supplement Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia. A Systematic ReviewDoes Cognitive Training Prevent Cognitive Decline? A Systematic ReviewThese systematic reviews evaluate several types of interventions that have been proposed to help prevent the development or progression of mild cognitive impairment or dementia.Use these studies to:Ask your learners whether they assess their patients for mild cognitive impairment or dementia. How is each diagnosed? What tools are available to help in the evaluation?Have your team list possible interventions to prevent the development or progression of cognitive impairment. Does their list include the approaches studied in these systematic reviews (physical activity, medications, over-the-counter supplements, and cognitive training)? Have their patients expressed concern about preventing cognitive decline? Do your learners recommend any of these approaches to prevention?Assign individuals to briefly summarize the findings of these systematic reviews at your next session so that each is reviewed for the group.After hearing each presentation, ask whether your team believes anything can be done to prevent cognitive decline. Why do they think that finding solutions to this enormous problem is so difficult? Use the accompanying editorial to help frame your discussion. The editorialist suggests recommendations that might prevent cognitive decline later in life. Each recommendation is something we should already be doing but are less than perfect at adhering to. Do your learners think that the possibility of delaying or preventing cognitive decline will be a better incentive to exercise or quit smoking than the reasons we already give our patients? How would your learners explain these recommendations to their patients?In the Clinic: Travel MedicinePrimary care physicians are frequent sources of health advice for U.S. international travelers. In addition, returned travelers who have become ill may seek care in primary care settings. Thus, physicians need to be familiar with destination-specific disease risks, travel and routine vaccines, chemoprophylaxis regimens, and self-treatment regimens for infectious and noninfectious illnesses. Are your learners ready?Use this review to:Invite a member of your institution's travel clinic to join your discussion. What services do they provide? What questions do they ask?Ask your learners whether they ask patients about planned travel. What immunizations are required? How can your learners arrange for these immunizations for their patients?Who requires malaria prophylaxis, and what are the options?What should your learners tell their patients about preventing travelers' diarrhea? Should they provide antibiotics in case they are needed? What should travelers pack in a traveler's kit? Review the Box (Travel Health Kit for International Travelers).What advice should your learners give their patients in case they become ill during travel?Answer these and the other questions addressed in this eminently practical review.Download the teaching slides to help run a teaching session. Use the provided multiple-choice questions to introduce new topics along the way, and be sure to log on and enter your answers to earn CME/MOC credit for yourself!Annals Graphic Medicine and Annals Story SlamAnnals Consult Guys - Back to WorkDr. Farris recalls the trying moments of being “Doctor Mom.”Use this feature to:Before the teaching session, ask your learners who are parents whether they would like to discuss the challenges they have faced with their colleagues. Make sure they are comfortable saying no or setting limits on what they will discuss.Share the comic with your learners.Watch some of the Annals Story Slam videos from July 2017, in which physicians discuss their experiences being “Doctor Mom.” What specific challenges are faced by mothers as they balance being a parent with being a physician? Are the challenges different than for fathers? Do your learners think that your program is sufficiently helpful in supporting physicians who are parents? How could it be improved?MKSAP 17 QuestionA 26-year-old woman is evaluated during a routine examination. Her last Pap smear was performed 1 year ago and was normal. She has received a complete human papillomavirus (HPV) quadrivalent vaccine series. Medical history is unremarkable. Family history is noncontributory. She takes no medications.On physical examination, temperature is normal, blood pressure is 110/72 mm Hg, and pulse rate is 78/min. The remainder of the physical examination is normal.Which of the following is the most appropriate management of this patient's cervical cancer screening?A. Obtain HPV testing in 2 yearsB. Obtain Pap smear in 2 yearsC. Obtain Pap smear and HPV testing nowD. Obtain Pap smear and HPV testing in 2 yearsCorrect AnswerB. Obtain Pap smear in 2 yearsEducational ObjectiveScreen for cervical cancer in a young woman.CritiqueThis patient should receive a Pap smear in 2 years. According to the U.S. Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists, women aged 21 to 65 years should be screened for cervical cancer every 3 years with cytology (Pap smear). Performing screening more frequently adds little benefit while significantly increasing harms. Harms can include evaluation and treatment of transient lesions as well as false-positive screening results, which may lead to unnecessary colposcopies and emotional distress. Screening for cervical cancer is not recommended in women younger than 21 years, women age 65 years and older who are not at high risk and have had adequate prior Pap smears, and women who have had a hysterectomy with removal of the cervix with no previous history of a precancerous lesion. This patient had a normal Pap smear 1 year ago; therefore, she will be due for her next Pap smear in 2 years.Owing to poor specificity, screening with human papillomavirus (HPV) DNA testing alone is not recommended. HPV testing is not recommended in women younger than 30 years, as HPV is not only highly prevalent but is also more likely to resolve without treatment in this age group. In women aged 30 to 65 years who want to lengthen the screening interval, a combination of cytology and HPV testing can be performed every 5 years. Women should be informed that there is an increased likelihood of receiving a positive screening result with HPV testing and cytology than with cytology alone. A positive HPV test result likely requires additional immediate testing and also involves more frequent surveillance.All females aged 11 to 26 years should be vaccinated against HPV. HPV vaccination status does not alter recommendations for cervical cancer screening.Key PointWomen aged 21 to 65 years should be screened for cervical cancer every 3 years with cytology (Pap smear); in women aged 30 to 65 years who want to lengthen the screening interval, a combination of cytology and human papillomavirus testing can be performed every 5 years.BibliographyMoyer VA; U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Jun 19;156(12):880-91, W312.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: 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. Previousarticle Advertisement FiguresReferencesRelatedDetails Metrics 2 January 2018Volume 168, Issue 1Page: ED1KeywordsCell biologyCervical cancerCervical cancer screeningGraduate medical educationHuman papillomavirusInfectious diseasesLesionsMild cognitive impairmentSystematic reviewsVaccines ePublished: 2 January 2018 Issue Published: 2 January 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...