Annals for Educators - February 2024
Authors: Christine Laine
Journal: Annals of Internal Medicine (2024)

Web ExclusivesFebruary 2024Annals for Educators - February 2024FREEChristine Laine, MD, MPHChristine Laine, MD, MPHAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202402200 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsHealth Care Contact Days Among Older Adults in Traditional Medicare. A Cross-Sectional StudyUnderstanding How Older Adults Use the U.S. Health Care System: From Measurement to MeaningDays spent obtaining health care outside the home can entail not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. Using the 2019 Medicare Current Beneficiary Survey and claims, this study characterized health care contact days among community-dwelling adults aged 65 years or older in traditional Medicare. The authors of the accompanying editorial find the measure a promising new way to understand how older adults use health care but emphasize that understanding whether these days are clinically necessary, are meaningful to patients, and result in benefit or harm will be critical for optimal use.Use this article and the editorial to:Ask your learners to reflect on how often patients seen as outpatients at your institution are able to get laboratory and imaging tests on the same day as their visit.This study observed a paucity of outpatient visits with subspecialists on Fridays. Are all specialty practices at your institution open on Fridays? If not, find out why not.Ask your learners to list the potential advantages and disadvantages of frequent health care contact days.Ask your learners to describe the types of studies that are needed to determine whether health care contact days are clinically necessary, are meaningful to patients, and result in benefit or harm.Trends in Discharge Rates for Acute Pulmonary Embolism in U.S. Emergency DepartmentsFew studies have assessed contemporary real-world trends in discharge rates for acute pulmonary embolism (PE) from U.S. emergency departments (EDs). This serial cross-sectional analysis evaluated whether the proportion of ED discharges for acute PE changed between 2012 and 2020 and examined which baseline characteristics are associated with ED discharge.Use this article to:Review the diagnosis and management of venous thromboembolism. This In the Clinic review can help guide the discussion. Review the records of 5 recent patients admitted from the ED to the medical service at your institution and discuss whether any of them could have been appropriately treated as outpatients.Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease. A Population-Based Cohort StudyRegulatory agencies have issued warnings about serious breathing difficulties in some patients using gabapentinoids. This propensity score–matched cohort study examined the risk for pulmonary exacerbation among patients with underlying chronic obstructive pulmonary disease (COPD) who use gabapentinoids.Use this article to:Poll your learners to determine whether they were aware that gabapentinoids were associated with an increased risk for COPD exacerbation.Invite a pharmacist to your session to review alternatives to gabapentinoids that might be considered in patients with COPD who have an indication for gabapentinoid use.Discuss the propensity score matching method of accounting for differences among patient groups in observational studies. This article can help guide the discussion. Large Language Models in Medicine: The Potentials and Pitfalls. A Narrative ReviewLarge language models (LLMs) are artificial intelligence models that generate human-like outputs, and the real-world clinical application of these models is occurring now. This accessible review article aims to help clinicians understand what LLMs are, how they are being used, how they could be used in the future, how their use might create problems, and which research areas are active.Use this article to:Poll your learners to assess their current views on whether the use of LLMs in patient care is likely to result in net benefit or net harm.Ask your learners whether they are aware of current use of LLMs at your institution.Develop a list of potential applications of LLMs in patient care that could improve quality of care, reduce administrative burden for clinicians, or both.Ask your learners about the potential benefits and harms of using artificial intelligence to guide clinical decisions. This article can help guide the discussion. Recommended Adult Immunization Schedule, United States, 2024Quality Health Communication Is Critical to Optimal Adult ImmunizationThis article provides immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for adults aged 19 years or older. The purpose of the immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations. The authors of the accompanying editorial argue that the immunization schedule demonstrates how the CDC has not sufficiently moved on to persuasive communication versus merely providing information about immunization.Use this article and the editorial to:Review the 4 changes between the 2024 adult vaccination recommendations and the 2023 recommendations.Review which of the recommended vaccines are available for administration in the primary care practices at your institution. Ask your learners whether they believe in-practice availability of a vaccine is likely to improve vaccination rates. What other interventions might help to boost rates of recommended adult vaccinations?Ask your learners to suggest ways to improve the format of the annual ACIP vaccine recommendations.Role-play conversations with the following hypothetical patients who decline influenza vaccination: a 45-year-old schoolteacher with no underlying conditions, a 70-year-old man with hypertension and type 2 diabetes, and a 60-year-old woman with asthma who is declining vaccination because her friend said she developed the flu after receiving the vaccine. This article may help guide the exercise. Talking With Patients About the New Anti-amyloid Alzheimer Disease MedicationsThe number of persons in the United States with Alzheimer disease will approach 14 million by 2060. New anti–amyloid-β infusions have been shown to reduce the volume of amyloid plaques on positron emission tomography scans and slow disease progression for patients with mild cognitive impairment and mild dementia related to Alzheimer disease. This commentary provides guidance to help physicians carefully communicate potential benefits and harms of this therapy.Use this article to:Have a neurologist or geriatrician join your session to review testing for cognitive impairment and dementia.Review the currently available pharmacologic treatments for cognitive impairment secondary to Alzheimer disease, their effectiveness, and associated adverse effects.Using the guidance provided in this article, role-play a conversation with a patient who has early dementia and whose family is requesting that you prescribe an anti–amyloid-β infusion.Beyond the GuidelinesHow Would You Prevent Subsequent Strokes in This Patient? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterStroke remains a major cause of morbidity, mortality, and disability, and having one stroke puts patients at risk for future strokes. The American Heart Association/American Stroke Association guidelines on secondary stroke prevention provide the basis for this discussion between 2 experts about monitoring for additional strokes in a patient and determining the best therapeutic strategy.Use this article to:Watch the patient video with your learners, and then ask them what they would recommend for this patient who is concerned about cognitive impairment.Have a neurologist join your session to discuss their approach to assessing patients' risk for recurrent stroke.Watch the grand rounds video with your learners, and then have them test their knowledge by completing the quiz that accompanies the article.Immune-Related Adverse Events of Immune Checkpoint InhibitorsImmune-related adverse events (irAEs) are toxicities that arise after administration of monoclonal antibodies targeting immune checkpoints (immune checkpoint inhibitors [ICIs]) in patients with cancer. They can occur at any time after initiation of ICI treatment, with a broad clinical phenotype that can be organ-specific or systemic. Although most irAEs manifest as mild to moderate signs and symptoms, severe forms of irAEs can lead to irreversible organ failure and have acute life-threatening presentations. Treatment should be tailored to the specific organ involved and the severity. Glucocorticoids are the first-line treatment for most irAEs, with immunosuppressants and biologics mainly used as second-line treatments.Use this article to:Invite a pharmacist or oncologist to your session to provide an overview of ICIs and their current uses in cancer therapy.Review common adverse effects and the recommended management.Review the contraindications to prescription of ICIs.Have your learners take the quiz that accompanies the article to assess their knowledge, and then review the correct answers as a group.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 InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, MACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueFebruary 2024Volume 177, Issue 2 ePublished: 20 February 2024 Issue Published: February 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...