Annals for Educators - April 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesApril 2022Annals for Educators - April 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202204190 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsEstimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening CohortReducing the Burden of Overdiagnosis in Breast Cancer Screening and BeyondOverdiagnosis from screening can result from detection of indolent preclinical cancer or progressive preclinical cancer where the person would have died of an unrelated cause before clinical diagnosis. This study used statistical modeling to account for both types of overdiagnosis in estimating the rate of screen-detected breast cancer that is overdiagnosed. The authors of the accompanying editorial note that screening tests can provide benefit by detecting disease when it is more easily treatable and discuss what is needed to reduce the burden of breast cancer diagnosis.Use this article and the editorial to:Review breast cancer screening recommendations from various professional organizations. This article will help. Ask your learners to define breast cancer overdiagnosis. What are the 2 types of overdiagnosis this study examines?Discuss the potential consequences of the 2 types of overdiagnosis.Discuss breast cancer screening strategies that would limit overdiagnosis.Contribution of Individual- and Neighborhood-Level Social, Demographic, and Health Factors to COVID-19 Hospitalization OutcomesThis study used the social vulnerability index and data from 38 hospitals in Michigan to compare COVID-19 outcomes (acute organ dysfunction, organ failure, invasive mechanical ventilation, intensive care unit stay, mortality, and discharge disposition) among patients living in low- versus high-vulnerability ZIP codes.Use this article to:Ask your learners if, among the patients with COVID-19 who they cared for during the pandemic, there were characteristics they observed to be associated with poor clinical outcomes.How do their observations relate to the factors in the social vulnerability index used in this study?Discuss potential clinical and policy interventions that could reduce the disparities in outcomes observed in this study.Cost-Effectiveness of Long-Acting Injectable HIV Preexposure Prophylaxis in the United States. A Cost-Effectiveness AnalysisDetermining the Most Appropriate Use of Available Regimens for HIV Preexposure ProphylaxisLong-acting injectable cabotegravir (CAB-LA) was recently approved by the U.S. Food and Drug Administration for use as HIV preexposure prophylaxis (PrEP) among men who have sex with men and transgender women in the United States. This study reports on a cost-effectiveness analysis comparing CAB-LA with both branded and generic tenofovir-based regimens. The accompanying editorial discusses the findings and how they lay the groundwork for addressing important clinical and policy questions related to PrEP.Use this article and the editorial to:Review the indications for prescribing PrEP for HIV infection.Invite a pharmacist or infectious disease specialist to your session to review available PrEP regimens. What are the advantages and disadvantages of the regimens?Many of the data on PrEP come from studies of men who have sex with men and transgender women. Given this, discuss whether PrEP should also be considered for cisgender women at risk for HIV infection.Beyond the GuidelinesHow Would You Treat This Patient With Acute and Chronic Pain From Sickle Cell Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterThe American Society of Hematology guidelines on pain management in patients with sickle cell disease feature conditional recommendations, including about the use of ketamine for acute pain and initiation and discontinuation of long-term opioid therapy for chronic pain. In this article, 2 hematologists discuss these guidelines and make contrasting recommendations for a specific patient.Use this article to:Watch the patient video with your learners, and then ask them how they would manage the patient's pain.Invite a specialist involved in the care of patients with sickle cell disease to your session to describe resources for treating sickle cell pain crises in your health system.Have your learners test their knowledge by completing the quiz that accompanies the article.Discuss the advantages and disadvantages of managing sickle cell pain crises in an infusion center versus the emergency department. This article provides context for the discussion. Community-Acquired PneumoniaCommunity-acquired pneumonia is an important cause of morbidity and mortality. It can be caused by bacteria, viruses, or fungi. Community-acquired pneumonia can be prevented through vaccination with pneumococcal, influenza, and COVID-19 vaccines. Diagnosis requires suggestive history and physical findings in conjunction with radiographic evidence of infiltrates. Laboratory testing can help guide therapy. Important issues in treatment include choosing the correct treatment venue, timely initiation of the appropriate antibiotic or antiviral, deescalation after negative culture results, switching to oral therapy, and short treatment duration.Use this article to:Discuss the criteria for the diagnosis of community-acquired pneumonia.When should antibiotics or antivirals be prescribed? How long should they be continued?Discuss the criteria for hospitalization of a patient with community-acquired pneumonia.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Clinical GuidelinesWhat Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 2)This article presents the final updated recommendations from the American College of Physicians (ACP) on the use of SARS-CoV-2 antibody tests for diagnosis and to predict the degree or duration of natural immunity.Use this article to:Review the ACP's recommendations on the use of SARS-CoV-2 antibody tests.Discuss why measuring SARS-CoV-2 antibody levels is not a reliable indicator of immunity.Have your learners role-play discussions with patients who request measurement of SARS-CoV-2 antibody levels to indicate that they do not need COVID-19 vaccination or can safely attend a crowded event.Outpatient Evaluation and Management of COVID-19This article summarizes the ACP/Annals COVID-19 Forum VIII, held on 9 February 2022.Use this article to:Watch the video of the program as a group.Ask your learners what they would do in each of the cases presented, and then listen to the panelists' answers.Assemble a list of questions about the outpatient evaluation and management of COVID-19 that your learners would like addressed in future programs, and share the list with the Annals editors here. Clinical Skills Proposals for Internal Medicine Meeting 2023Clinical Skills Proposals Are Currently Being Accepted for Internal Medicine Meeting 2023Interested in teaching procedural, physical examination, or communication skills?ACP is accepting proposals for hands-on, interactive workshops that focus on the acquisition or improvement of procedural skills, physical examination skills, and communication skills for Internal Medicine Meeting 2023, which will be held April 27–29, 2023, in San Diego, California.The deadline to submit proposals is May 3, 2022. For more information and to submit a proposal, please visit this page. 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. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics April 2022Volume 175, Issue 4Page: ED4 ePublished: 19 April 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...