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

Web ExclusivesJanuary 2022Annals for Educators - January 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202201180 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsInfluenza Vaccine Uptake and Missed Opportunities Among the Medicare-Covered Population With High-Risk Conditions During the 2018 to 2019 Influenza Season. A Retrospective Cohort StudySeasonal influenza causes substantial morbidity and mortality among older U.S. adults and those with comorbid health conditions. The authors examined seasonal influenza vaccine uptake during the 2018–2019 influenza season and identified factors associated with missed opportunities for vaccination among Medicare beneficiaries.Use this article to:Review the Centers for Disease Control and Prevention's recommendations for influenza vaccination.Review whether your institution routinely offers influenza vaccination to eligible patients being discharged from the hospital during “influenza vaccination season.” If not, discuss whether this is a quality-of-care issue that should be addressed.Ask your learners to list the reasons patients commonly give for declining influenza vaccination.Role-play conversations with hypothetical patients to address some of the reasons for declining vaccination that your learners identified.Cost-Effectiveness of Screening Mammography Beyond Age 75 Years. A Cost-Effectiveness AnalysisOn Breast Cancer Screening in Older WomenThe U.S. Preventive Services Task Force recommends screening mammography for women only through age 74 years, whereas the American Cancer Society recommends screening mammography for women beyond age 74 years if they have a life expectancy of 10 or more years. This modeling study attempted to resolve this discrepancy and concluded that biennial breast cancer screening for women aged 75 to 79 years can save lives and be cost-effective. The accompanying editorial calls for risk-based screening and other measures to improve inefficient screening practices.Use this article and the editorial to:Ask your learners what their typical recommendation for breast cancer screening is for women over age 75 years. After reading this article, how likely are they to modify what they currently recommend?Review the breast cancer screening recommendations of various U.S. professional organizations. This American College of Physicians guidance statement may be helpful. Discuss what is meant by the term “overdiagnosis” in the context of cancer screening and the potential harms associated with overdiagnosis of breast cancer.Ask your learners to discuss whether the U.S. Preventive Services Task Force should consider cost-effectiveness when developing guideline recommendations.Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation. A Multicenter Prospective Cohort StudyThe clinical importance of patients with pulmonary embolism isolated to the subsegmental vessels is unknown. This multicenter prospective cohort study sought to determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation.Use this article to:Ask your learners to define subsegmental pulmonary embolism.Discuss the rate of recurrent venous thromboembolism observed in this study and whether it warrants routine use of anticoagulation in patients with subsegmental pulmonary embolism.Discuss patient factors that should be considered when balancing the risks and benefits of anticoagulation in the setting of subsegmental pulmonary embolism.Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis. A Randomized Controlled TrialBariatric surgical approaches, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), are effective treatments for obesity and can reduce hepatic fat, inflammation, and fibrosis. This trial compared the effect of RYGB versus SG on hepatic steatosis and fibrosis in patients with type 2 diabetes and obesity.Use this article to:Invite a bariatric surgeon to describe current bariatric surgery procedures, and discuss the risks and benefits of each one.Ask your learners to list the comorbidities that warrant consideration of bariatric surgery for a patient with obesity.Discuss the nonsurgical management of nonalcoholic fatty liver disease. This In the Clinic review may help guide the discussion. A Possible Sterilizing Cure of HIV-1 Infection Without Stem Cell TransplantationThe Esperanza Patient: More Hope for a Sterilizing HIV-1 CureA sterilizing cure of HIV-1 infection has been reported in 2 persons with HIV-1 who had allogeneic hematopoietic stem cell transplants. This article describes the virologic and immunologic characteristics of an “elite controller” who may have achieved complete clearance of all replication-competent HIV-1 proviruses during natural infection. The accompanying editorial explains the differences between functional and sterilizing cures and outlines research that is needed to better understand elite controllers as a model of an HIV-1 cure.Use this article and the editorial to:Ask your learners to describe what is meant by a functional versus a sterilizing cure of HIV.Ask your learners if they think that the patient described in this case likely has a functional or sterilizing cure.Invite an HIV expert to join your group to discuss whether this case has implications for future approaches to HIV therapeutics.Review reporting guidelines for case reports, and critique the quality of the reporting of this case. Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction. An International Collaborative Meta-analysisHigh-Sensitivity Cardiac Troponins and Clinical Decision Making in Caring for Patients With Chest PainHigh-sensitivity cardiac troponin strategies are commonly used to triage patients with suspected acute myocardial infarction. The 2020 European Society of Cardiology guidelines recommend the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm. This review compared the diagnostic accuracy of each algorithm and how this varied by test and population characteristics. The accompanying editorial calls for research to more accurately identify patients at very high risk for adverse cardiac events and better prioritize testing for those most likely to benefit.Use this article and the editorial to:Invite a cardiologist or emergency medicine physician to discuss the process and the troponin assays used to evaluate patients with chest pain who present to the emergency department at your institution.Discuss whether the findings of this review suggest ways to improve the processes used to evaluate patients with chest pain who present to the emergency department at your institution.The editorial calls for research to more accurately identify patients with chest pain who are at high risk for adverse cardiac events. Discuss what such research might look like.Opioid Use DisorderOpioid use disorder (OUD) is a chronic, relapsing disease characterized by loss of control of opioid use, compulsive use, and continued use despite harms. If untreated, OUD is associated with significant morbidity and mortality. Buprenorphine and methadone reduce fatal and nonfatal opioid overdose and infectious complications of OUD and are the first-line treatment options. Physicians have an important role to play in diagnosing OUD and its comorbidities, offering evidence-based treatment, and delivering overdose prevention and other harm reduction services to people who continue to use opioids. Interdisciplinary office-based addiction treatment programs support high-quality OUD care.Use this article to:Ask your learners to identify how to diagnose OUD.Discuss how to manage patients with opioid withdrawal in the outpatient and inpatient settings.Invite an addiction specialist to join your teaching session to discuss local resources for the treatment of OUD and processes for referral of patients to receive treatment.ProfessionalismTrends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019. A Repeated Annual Cohort StudyInterns Are Increasingly Using Mental Health Services, but More Can Still Be DoneIncreasing concern about the mental health of physicians in training has led to changes in work hour regulations and residency training programs. This study examined trends in depressive symptoms before and during the first year of residency over a 13-year period and found increased prevalence of risk factors for depression, a decrease in depressive symptoms, and an increase in interns with depression seeking treatment. The accompanying editorial discusses what should be done to address the mental health of physicians in training.Use this article and the editorial to:Ask your learners whether they found the trends observed in this study to be expected or unexpected.Review resources available to physicians in training who are experiencing burnout or depression.Discuss the appropriate course of action your learners should take if they are concerned about depression or suicidal thoughts in themselves or a colleague.Take a group tour of the American College of Physicians' resident well-being resources. 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 January 2022Volume 175, Issue 1Page: ED1 ePublished: 18 January 2022 Issue Published: January 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...