Primary Care Challenges for Today’s Practitioner: Practice Strategies for Internal and Family Medicine

Day 1

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.

 Delirium in the Elderly – Current Concepts.

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 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.

Evaluation and Treatment of Dementia in Seniors. 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.

Distinguish the central role of caregiver education and support in treating seniors with dementia.

Day 2

Vitamin B-12 and Vitamin D in Seniors.      

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.

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.

Advanced Nutritional Assessment and Therapy.

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.

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.

Recommend the follow-up required to assess the therapeutic efficacy of the treatment options.

Day 3

Contemporary Issues in End of Life Care.

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.

Venous Thromboembolism (VTE): Diagnosis and Treatment.

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

1. Determine the diagnostic testing for evaluating a patient for possible VTE.
2. Apply the algorithm for diagnosing a pulmonary embolism in multiple clinical settings.
3. Differentiate the advantages and disadvantages of outpatient treatment compared to inpatient treatment for venous thromboembolism (VTE).
4. Order the frequency of monitoring and the adjustments needed for warfarin therapy in the treatment of VTE.

Improving Communication Skills in Medical Practice.

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.

Contraceptive Options – Helping Women Make an Informed Choice.

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

1. Appraise the pharmacologic differences in oral contraceptives and their role in contraceptive efficacy.
2. Formulate the treatment options for contraception other than oral contraceptives.
3. Specify the relative and absolute contraindications to oral contraceptives.
4. Relate the circumstances that would be eligible for emergency contraception and the appropriate emergency contraception method for each situation.

Day 4

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.

Outpatient Anticoagulation Issues, Part 1.

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

1. Manage outpatients on warfarin using current CHEST guidelines and The Joint Commission 2016 National Patient Safety Goals.
2. Determine factors leading to alterations in the international normalized ratio (INR).
3. Advise patients on the appropriate choice, duration, and intensity of anticoagulation in a variety of clinical scenarios.
4. Develop a familiarity with the new oral anticoagulants.

Osteoporosis: Treatment and Prevention.

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

1. Debate the importance of the risk factors for an osteoporosis fracture.
2. Employ the diagnostic testing for patients at risk with osteoporosis.
3. Select the therapeutic medication to treat osteoporosis based upon the indications and side effects.
4. Assess the therapeutic role of repeating the DXA scan in patients treated for osteoporosis.

Outpatient Anticoagulation Issues, Part 2. 

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

1. Develop an evidence-based approach on perioperative management of antithrombotic and anticoagulant medications.
2. Recognize the proper use of IVC filters using evidence-based medicine.
3. Develop a practical approach when transitioning patients on and off anticoagulants or switching between anticoagulants.

Identify appropriate use of anticoagulant and antithrombic medications in combined therapy.

Day 5

Evaluation of the Patient with Syncope. 

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

1. Appraise the various etiologies of syncope.
2. Use clues in the history and physical as well as simple office testing to risk stratify patients with syncope.
3. Develop a plan for appropriate use of additional testing in patients with syncope to include indications for EP testing as per the AHA Syncope Algorithm and the ESC Guidelines.
4. Assess the role of lifestyle measures, medication, and more invasive measures to prevent recurrent syncope.

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. 

Drug Interactions and Side Effects. 

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

1. Determine the most common mechanisms for drug interactions.
2. Identify some of the most frequent culprit drugs such as Warfarin and Acetaminophen, AED’s, NSAIDs, and Statins.
3. Counsel patients regarding some of the most frequent side-effects seen with commonly used medications.
4. Employ The Joint Commission 2016 Ambulatory Care National Patient Safety Goals.

Evaluation and Initial Management: Benign Breast Disease

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

1. Differentiate the signs and symptoms associated with benign breast disease.
2. Formulate an evaluation for breast pain (mastalgia), breast lumps, and nipple discharge.
3. Specify the treatment options for breast pain, nipple discharge and breast infections.
4. Distinguish the symptoms and physical findings associated with rare benign breast disease conditions.