Primary Care: An Overview of Geriatrics, Rheumatology, and Endocrinology

Day 1

Approach of the Patient with Rheumatic Diseases (Brent)  

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

1. Demonstrate the importance of the history and physical exam including patterns of joints involvement and extra-articular findings in evaluating patients with rheumatic diseases.
2. Distinguish inflammatory (i.e. rheumatoid arthritis) and structural arthritis (i.e. osteoarthritis).
3. Differentiate patterns of articular involvement associated with different arthritides.
4. Utilize laboratory and radiological studies in the evaluation of patients with rheumatic diseases.

Lyme Disease and Other Topics in Rheumatology (Brent) 

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

1. Apply CDC and Infectious Diseases Society of America Guidelines for the diagnosis, treatment, and prevention of Lyme disease.
2. Evaluate skin rashes as manifestations of systemic diseases.
3. Using the Guidelines of the Bone Research Society of the United Kingdom to prescribe appropriate therapy for patients with Paget’s disease of the Bone.

Crystal Arthritis (Brent) 

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

1. Demonstrate the clinical presentations and manifestations in the course of gout.
2. Monitor and prescribe treatment for patients with gout according to the EULAR and ACR recommendations and guidelines.
3. Demonstrate the clinical presentations, manifestations, and treatment of calcium pyrophosphate deposition disease (CPPD) and pseudogout.

Delirium in the Elderly – Current Concepts (Oberlender) 

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

1. Specify diagnostic features and common causes of delirium in seniors.
2. Distinguish the causes of persistent delirium.
3. Use evidence based medicine to formulate treatment approaches to delirious seniors.
4. Recognize treatment options for intermittent agitation using evidence based medicine.

Evaluation and Treatment of Dementia in Seniors (Oberlender)  

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

1. Determine the common causes of cognitive dysfunction and dementia in seniors.
2. Develop an evidence based evaluation of seniors with cognitive dysfunction.
3. Evaluate the relative risks and benefits of available treatment options for dementia in seniors.
4. Distinguish the central role of caregiver education and support in treating seniors with dementia.

Day 2

Advanced Nutritional Assessment and Therapy (Oberlender)  

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

1. Integrate readily available clinical data to make accurate nutritional assessments in seniors.
2. Relate metabolic changes in aging to assess risk for malnutrition.
3. Apply an evidence based approach to treatment of undernutrition in seniors.

Vitamin B-12 and Vitamin D in Seniors (Oberlender) 

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

1. Integrate the normal physiology of Vitamins B-12 and D.
2. Differentiate the pathologic syndromes associated with B-12 and D deficiency.
3. Develop an evidence based evaluation of B-12 and D deficiency for seniors.
4. Develop an evidence based approach to treatment options for B-12 and D in seniors.

Rheumatoid Arthritis  (Brent)

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

1. Demonstrate the role of genetics, environmental factors, immune cells, and proinflammatory cytokines in the pathogenesis of rheumatoid arthritis.
2. Illustrate the clinical features, extra-articular manifestations, and complications of rheumatoid arthritis.
3. Utilize and compare various methods of measuring disease activity in rheumatoid arthritis.
4. Compare and contrast the mechanisms of action of current and emerging therapies for RA and prescribe treatment for patients with rheumatoid arthritis according to ACR guidelines.

Spondyloarthropathies (Brent) 

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

1. Distinguish the clinical features of the different spondyloarthropathies to improve diagnostic accuracy.
2. Utilize clinical features, laboratory studies, and radiological studies to make a diagnosis of axial spondyloarthropathy.
3. Prescribe pharmacologic agents according to ACR and EULAR recommendations and evidence-based results from clinical trials for patients with spondyloarthropathies.

Infectious Arthritis (Brent) 

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

1. Determine the risk factors associated with septic arthritis.
2. Utilize the British Society of Rheumatology Guidelines for management of the hot swollen joint in adults to differentiate septic arthritis from other causes of acute monoarticular arthritis.
3. Utilize epidemiological and clinical clues to determine bacterial etiology in patients with septic arthritis.

Day 3

Sensible Approaches to Geriatric Infections (Oberlender)  

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

1. Recognize atypical presentations of infectious illness in the elderly.
2. Differentiate the causes of pneumonia and UTI in seniors.
3. Specify an evidence based approach to appropriate antibiotic usage.
4. Appraise evidence based considerations in emerging antibiotic resistance.
5. Apply evidence based options in the prevention and treatment of C. difficile illness in seniors.

Thyroid Case Studies (Winters)  

Upon completion of this session, using evidence-based medicine and clinical practice guidelines, to include the American Thyroid Association Guidelines, the participant should be able to: ^{EBM, COMP, GL}

1. Appreciate the role of a diagnostic thyroid scan or ultrasound.
2. Evaluate a patient for hyperthyroidism.
3. Prescribe therapeutic options for patients diagnosed with hypothyroidism.

Geriatric Depression: Advances in Diagnosis and Treatment (Oberlender)  

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

1. Differentiate the variety of clinical presentations of depressive disorders in seniors.
2. Appraise the utility of, and plan to use, the Geriatric Depression Scale.
3. Apply an evidence based approach to antidepressant drug therapy in seniors.
4. Apply the evidence based recommendations for use of non-drug antidepressant therapy.

Polycystic Ovary Syndrome (Winters)  

Upon completion of this session, using evidence-based medicine and clinical practice guidelines, to include Rotterdam Guidelines, the participant should be able to: ^{EBM, COMP, GL}

1. Recognize the distinguishing features of PCOS.
2. Prescribe appropriate laboratory tests to evaluate women with hirsutism.
3. Describe the non-reproductive aspects of PCOS.

Sensible Prescribing Practices for the Elderly (Oberlender) 

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

1. Appraise and appreciate the limits of published trials studies on drug safety and efficacy for seniors.
2. Assess the subtle but significant drug side effects in the elderly.
3. Distinguish undesirable prescribing practices and employ better approaches based on current evidence-based referenced literature.

Day 4

Contemporary Issues in End-of-Life Care (Oberlender) 

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

1. Develop a practical approach to assessment of the whole patient in a hospice setting.
2. Formulate effective approaches to common physical symptoms in the terminally ill.
3. Integrate effective clinical care of patients and their families in the last days of life based on current evidence-based literature, Guidelines and recommendations of the American Geriatrics Society and the National Hospice and Palliative Care Organization.
4. Relate dementia as a terminal illness.

Male Hypogonadism (Winters)  

Upon completion of this session, using evidence-based medicine from the JCEM, NEJM and others, the participant should be able to: ^{COMP, EBM}

1. List the classic causes of male hypogonadism.
2. Appreciate the entity of adult onset hypogonadism.
3. Describe the risks and benefits of testosterone use and apply toward decision making when reviewing treatment options.

A Practical Approach to Falls and Urinary Incontinence in the Elderly (Oberlender) 

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

1. Integrate the concept of multifactorial causes underlying falls and employ the American Geriatrics Society Guidelines for the Prevention of Falls and urinary incontinence in seniors.
2. Develop a full assessment approach to evaluate different causes, using detailed physical examination and functional performance evaluations.
3. Differentiate the effects of normal aging from pathologic processes and adverse drug effects as risk factors for falls and incontinence.
4. Apply NIH guidelines to formulate a preventative and therapeutic plan of care.

Hypo and Hypernatremia (Winters)  

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

Improving Communication Skills in Medical Practice (Oberlender) 

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

1. Appraise the variety of ways that people perceive communication and process information.
2. Assess your personal communication strengths and limitations.
3. Determine communication issues unique to older patients.
4. Develop practices and apply skills to maximize effective communication and listening based on current literature.