Annals for Educators - 15 December 2020
Authors: Christine Laine
Journal: Annals of Internal Medicine (2020)

Web Exclusives15 December 2020Annals for Educators - 15 December 2020FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202012150 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsAttitudes Toward a Potential SARS-CoV-2 Vaccine. A Survey of U.S. AdultsSARS-CoV-2 Vaccine Acceptance: We May Need to Choose Our BattlesOnce a COVID-19 vaccine becomes available, maximizing uptake and coverage will be important. This national survey explored factors associated with vaccine hesitancy. The results suggest that multipronged efforts will be needed to increase acceptance of the vaccine. The editorial discusses why closing the intention-to-behavior gap is likely to have population health benefit.Use this article and editorial to:Ask your learners whether they have received COVID-19 vaccine or if they plan to when it becomes available to them. Are they hesitant or eager to be vaccinated?Discuss the various vaccines that have become available or are under study in clinical trials. Dr. Anthony Fauci summarizes COVID-19 vaccines in the video accompanying this article. Discuss the difference between FDA approval and Emergency Use Authorization. Dr. David Kessler explains these FDA processes in the video accompanying this article. Ask your learners about the types of patients they have found to be generally hesitant to receive vaccines. What strategies have they found helpful to encourage patients to get vaccinated?What do your learners think about the editorial's argument that we should focus initial efforts on making sure that people who are willing to be vaccinated actually receive the vaccine before devoting effort to trying to change the minds of people who are hesitant about vaccination?Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic TelangiectasiaHereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant disease affecting multiple organ systems. The Second International HHT Guidelines provide evidence-informed consensus guidance on diagnosis, prevention of complications, and treatment of symptomatic disease in areas not previously addressed by guidelines and areas with significant new literature.Use this article to:Start a teaching session with a multiple-choice question. We provide one below.Ask your learners to name the clinical features of HHT. Have they ever cared for a patient with this condition?Ask your learners to describe the features of trustworthy clinical guidelines, discussed in this article. When should subspecialists be involved in the care of a patient with HHT?Race and the False Precision of Glomerular Filtration Rate EstimatesThe glomerular filtration rate (GFR) plays a key role in the management and prognosis of kidney disease. Formulas for estimating it often use demographic factors (age, sex, and race) as proxies for muscle creatinine generation. This essay discusses the pros and cons of using race in these formulas.Use this article to:Ask your learners what GFR values represent a mild to moderate decrease in renal function, a severe decrease in renal function, and kidney failure.Ask your learners whether the laboratory at your institution reports race-adjusted estimates of GFR. Review some GFR reports from your institution's laboratory.What are the arguments for and against continuing to use race-based GFR estimates?Ask your learners whether they think race-based or race-agnostic approaches are best for estimating GFR.Humanism and ProfessionalismAddressing Postpandemic Clinician Mental Health. A Narrative Review and Conceptual FrameworkClinicians involved in previous pandemics encountered mental health problems, and their experience predicts that clinicians working in the COVID-19 pandemic will face similar issues. This article reviews how to prevent these problems and how to manage them as they develop.Use this article to:Ask your learners to share their experiences about the stresses they have experienced during the pandemic.What coping mechanisms have they found helpful?Do they have suggestions for things your program and health system might do to mitigate clinician stress?Have someone from occupational health or social work come to the teaching session and discuss resources that are available to clinicians who need help managing stress.The Window on the Seventh Floor: On Delivery During a PandemicIt must have been quite a sight—a 40 weeks' pregnant woman walking into the front entrance of a busy city hospital, struggling to balance a large duffle bag on one shoulder, a full bookbag on the other, her lower face fully covered with a mask. I was that woman, and I work at the hospital. However, this time I was reporting not to provide patient care but to receive it and so did not take out my badge.Use this essay to:Start the teaching session by listening to an audio recording of the essay. Ask your learners if they have ever been a patient at their own institution. If so, what did they learn from the experience?How has the limitation of visitors affected the experiences of patients and clinicians?What strategies have they used or seen colleagues use to ease the loneliness and isolation of patients hospitalized during the pandemic?MKSAP 18 QuestionWhich of the following conditions is associated with the physical examination finding shown?A. CirrhosisB. Hereditary hemorrhagic telangiectasiaC. Immune thrombocytopenic purpuraD. Normal pregnancyE. ThrombocytopeniaCorrect AnswerB. Hereditary hemorrhagic telangiectasiaEducational ObjectiveDiagnose hereditary hemorrhagic telangiectasia.CritiqueExamination of this patient's tongue reveals the characteristic arteriovenous malformations of hereditary hemorrhagic telangiectasia (also known as Osler-Weber-Rendu disease). This autosomal dominant disorder is commonly associated with epistaxis, gastrointestinal bleeding, and iron deficiency anemia. Other systemic manifestations include arteriovenous malformations in the pulmonary, hepatic, and cerebral circulations.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: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 December 2020Volume 173, Issue 12Page: ED12 ePublished: 15 December 2020 Issue Published: 15 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...