Primary Care Update in Internal Medicine and Family Medicine

Day 1

Systolic and Diastolic Heart Failure.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Appropriately manage decompensated heart failure in hospitalized patients.
2. Assess the indications for positive inotropic agents and ultrafiltration in systolic heart failure.
3. Distinguish the treatment of systolic versus diastolic heart failure, as per the 2013 ACCF/AHA Guidelines for heart failure management.

 Atrial Fibrillation in the Hospitalized Patient.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Assess and evaluate treatment options for atrial fibrillation with rapid ventricular response, as per the 2010 HFSA Guidelines.
2. Employ appropriate anticoagulation strategies for atrial fibrillation.
3. Distinguish the advantages of rhythm versus rate control treatment strategies, 2014 ACC/AHA Guidelines for atrial fibrillation management.
4. Determine the possible underlying causes of CHF exacerbations.

 Update in Perioperative Medicine.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Appraise pre-operative cardiac risk stratification and management strategies, as per the ACC/AHA Risk Clinical Predictors.
2. Determine the role of non-invasive stress testing, echocardiography, coronary angiography and the use of biomarkers to assess peri-operative cardiac risk, as per the ACC/AHA (2014) Perioperative CV Evaluation Guidelines.
3. Relate the indications for beta blockers, statins and aspirin in the peri-operative period.
4. Evaluate the bleeding risks of commonly prescribed medications and OTC supplements taken pre-operatively.

 Migraine Headaches – Update on Diagnosis and Treatment.

Upon completion of this session, using the International Headache Society and U.S. Headache Consortium Guidelines and the National Guideline Clearinghouse and the evidence-based reports from Clinical Evidence, the participant should be able to: ^{EBM, GL, COMP}

1. Construct the approach for evaluating a patient with possible migraine headaches.
2. Assess the advantages of supportive therapy and lifestyle changes in treating migraine headaches compared to pharmacologic therapy.
3. Appraise the pharmacologic options for treating the acute pain of a migraine headache.
4. Recommend a prophylactic therapy regimen for patients with recurrent migraine headaches.

 Use and Interpretation of Thyroid Tests.

Upon completion of this session, using the American Thyroid Association Guidelines and the Cochrane Abstract Database, the participant should be able to: ^{EBM, GL, COMP}

1. Integrate the serum tests for thyroid function.
2. Interpret thyroid tests results that occur in clinical settings.
3. Recommend the appropriate follow-up testing of abnormal thyroid tests and the frequency of these evaluations.
4. Appraise the need to treat subclinical hypothyroidism or subclinical hyperthyroidism.

Day 2

Pain Treatment; Reducing Opioid Abuse; Medication Assisted Treatment of Opioid Use Disorder

Upon completion of this session, the participant should be able to: ^{COMP, GL}

1. Implement general principles and goals for the treatment of pain.
2. Summarize the best practices for pharmacologic management of acute pain including potential benefits and risks of opioid analgesics.
3. Describe the cultural change in approach pain management.
4. Discuss the latest guidelines for pain management.
5. Apply nonpharmacologic pain management strategies.
6. Summarize ways to reduce opioid abuse
7. Describe the treatment options for patients with opioid used disorder.

 Chronic Obstructive Pulmonary Disease (COPD): Evaluation and Treatment.

Upon completion of this session, using the ACCP GOLD guidelines, the AACVPR practice guidelines and the evidence-based reports from Clinical Evidence, the participant should be able to: ^{EBM, GL, COMP}

1. Appraise patient specific data to determine if they meet diagnostic criteria for COPD.
2. Analyze the role of cigarette smoking in the etiology and natural history of COPD.
3. Formulate a treatment plan for the stages of COPD.
4. Recommend the follow-up required to assess the therapeutic efficacy of the treatment options.

Evaluation and Treatment of Hypertensive Patients.

Upon completion of this session, using the most recent JNC Guidelines, the Cochrane Abstract Database and the evidence-based reports from Clinical Evidence, the participant should be able to: ^{EBM, GL, COMP}

1. Employ the non-pharmacologic treatment options to manage hypertension.
2. Specify the pharmacologic treatment options for patients with compelling indications based upon JNC Guidelines.
3. Formulate the therapeutic goal for controlling blood pressure in different patient populations and the combination of medications that can achieve that goal.
4. Distinguish the side effect risks for each class of antihypertensive medications.

 Challenging Infections: MRSA and C. difficile.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Assess and apply appropriate treatment strategies for different types of methicillin resistant staph aureus infections.
2. Employ rational use and relate the precautions of newer antibiotics when treating resistant bacteria.
3. Distinguish Guideline based treatment of Clostridium difficile

Intro to Palliative care.

Upon completion of this session, the participant should be able to: ^COMP

1. Identify pain and symptom management, which enhances quality of life, as a primary focus of palliative care
2. Analyze best practices for discussions on disease prognosis, goals of care, suffering, advance care planning, and code status.
3. Evaluate the treatment of anxiety, shortness of breath, insomnia, and constipation in patients with multiple serious chronic medical conditions.

Day 3

Consultative Medicine: Transfusion Guidelines,

Delirium in the Hospitalized Patient.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Interpret changes in the updated 2012 American College of Chest Physicians Evidence-Based Guidelines for Antithrombotic Therapy.
2. Assess restrictive red blood cell transfusion strategy as recommended by American Association of Blood Banks (AABB) guidelines.
3. Evaluate clinical factors that make patients more prone to hospital and postoperative delirium.
4. Employ evidence-based strategies to treat delirium in hospitalized patients.

Novel Oral Anticoagulants.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Differentiate the advantages and disadvantages of commonly used anticoagulants.
2. Employ evidence-based anticoagulation bridging regimens.
3. Assess the approved indications for various anticoagulation agents.
4. Apply the evidence-based indications for anticoagulation in hospitalized patients.

Adult Health Screening and Immunizations – Evidence-Based Approach.

Upon completion of this session, using the USPSTF and Cochrane Abstract Database, the participant should be able to: ^{EBM, GL, COMP}

1. Apply the evidence-based recommendations for preventive screening tests for adults.
2. Determine the immunizations required for adults.
3. Appraise the side effects of adult immunizations.
4. Select the contraindications for each adult immunization and their alternative therapy.
5. Plan when screening tests can be discontinued in adults.

Treating Patients with Type 2 Diabetes Mellitus.

Upon completion of this session, using the American Diabetes Association, the European Association for the Study of Diabetes Guidelines and the Cochrane Abstract Database, the participant should be able to: ^{EBM, GL, COMP}

1. Evaluate the therapeutic goals in treating type 2 diabetes and their impact on morbidity and mortality.
2. Recommend the approach for choosing an oral hypoglycemic agent to treat type 2 diabetes.
3. Specify the clinical situations that would require the use of insulin to treat type 2 diabetes and the probable dosage form and average amounts required for control of A1c.
4. Develop the therapeutic options for preventing diabetic complications.

Common Cases Walking Through Your Office Door.

Clinical Cases will be solicited throughout the week from the participants.  These cases will be selected and managed by the presenters. Diagnoses, next steps in management and expected clinical outcomes will be discussed.  The format will include panel discussion and audience participation.