Conferences

ConferencesConferences

Why attend conferences?Why attend conferences?

Bolster clinical skills with didactics.

Peer-to-Peer Education

Foster Morale and Communication

Fun

Google CalendarGoogle Calendar

Conference Schedule (Summer)Conference Schedule (Summer)

9am – 10am 12pm – 1pm

Monday Morning Report A + B (MCQ) Summer Conference

Tuesday Morning Report A + B (Interpretive) Summer Conference

Wednesday Special Conferences Summer Conference

Thursday Summer Conference Pulmonary Conference

Friday Chief’s Case Summer conference

Summer ConferencesSummer Conferences

July and AugustCore medicine lecturesInterns MUST attend (Upper years should

carry their beepers).

Upper years are welcome too!

Conference ScheduleConference Schedule

9am – 10am Noon

Monday Morning Report A + B (MCQ) GIM Grand Rounds

Tuesday Morning Report A + B (Interpretive)

CPC/M&M (11:30 – 12:30)

Wednesday Journal Club + Special Conferences Grand Rounds (11:30 – 12:30)

Thursday Intern Report Pulmonary Conference

Friday Chief’s Case Cardiology Grand Rounds

Morning Report – Part AMorning Report – Part A

Monday and Tuesday 9:00am

Goals– A forum to help integrate evidence-based medicine into

daily patient care - “Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime.”

– Address clinical questions that Internal Medicine residents often encounter

– Should not be based just on “the latest NEJM article”.

Morning Report – Part AMorning Report – Part A 25 Minutes

– Topic must coincide with theme of the week (cardiology, primary care, etc..)

Come up with a well built clinical question (PICO)– Patient, Population, or Problem

What are characteristics of the patient population? What is the condition or disease you are interested in?

– Intervention or Exposure What do you want to do with this patient (e.g. treat, diagnose,

observe)– Comparison

What is the alternative to the intervention (e.g. placebo, different drug, surgery)

– Outcome What are the relevant outcomes (e.g. morbidity, death, complications)

PICO ExamplePICO Example

28 year old woman comes to your clinic with acute sinusitis.

Specific PICO question:– In a 28 y/o woman with acute sinusitis, do

prophylactic antibiotics decrease duration of illness compared with no antibiotics?

Primary review of the literature is not always expected or wanted (We have a journal club for that)– Do not spent too much time on graphs/charts– Do not focus too much on statistical minutiae– Do not go into too much detail about the nitty-

gritties of study design.– Show only key charts/graphs/curves/numbers.

Morning Report Part AMorning Report Part ASample Outline

– 1) PICO Question– 2) Brief background information on topic of

interest– 3) Short user-friendly descriptions of the main

studies and their results.– 4) Conclusions (You do not need to have a

smashing answer to your question, but you should talk about how you are going to apply your findings to your patient.)

Brief Background InformationBrief Background Information

Easiest part!Short background about the PICO question

Review Articles (NEJM, JAMA, BMJ)Up-to-DateHarrison’s Textbook of medicine

Drilling for the Best InformationDrilling for the Best InformationStart at the Top!Start at the Top!

Slide adapted from Strayer, S, University of Virginia

Cochrane LibraryEBM Reviews

Expert Committee Guidelines

Specialty-specificJournals

Reviews, NEJM

Textbooks,UpToDate, 5–MinuteClinical Consult

Pubmed, Ovid

http://library.temple.eduhttp://library.temple.edu

What if your question isn’t in the What if your question isn’t in the Cochrane Database?Cochrane Database?

Doesn’t mean it’s a bad question!

Continue to look at other sources of data

Come to us if you need help finding studies/reviews.

Ending your Morning Report AEnding your Morning Report A

Complete the clinical loop - Always end with your patient and explain why you would or would not pursue the proposed intervention based on your evidence.

Remember - finish in 25 minutes in order to allow time for discussion.

Morning Report – Part BMorning Report – Part B

Monday 9:30am – Multiple Choice Questions

Tuesday 9:30am – Interpretive Skills

Morning Report – Part B – Morning Report – Part B – MCQ (Mondays)MCQ (Mondays)

15 minutes Adhere to the theme of the week

– Available on the Google Calendar

Choose a couple of MCQs from MKSAP Ideally should address diseases that we rarely see

(eg: tick-borne illnesses)– Explain the right and wrong answers, but indepth

discussions of topics are NOT REQUIRED OR ADVISED.

Morning Report – Part B – Morning Report – Part B – Interpretive Skills (Tuesdays)Interpretive Skills (Tuesdays)

Pilot Project Formal training in interpretive skills by experts. Just bring a powerpoint file with 3 images

(CXR/EKG/etc) and clinical scenarios. The preceptor will interactively interpret it with the housestaff.

Will start in July with CXR (with Tom Grookett) and EKGs (with Dr. Bindi Shah) on alternate Tuesdays – Refer to google calendar.

Morning Report – Part B – Morning Report – Part B – Interpretive Skills – ExampleInterpretive Skills – Example

45 year old man comes with acute left upper and lower extremity weakness. PMH – HTN. Meds – HCTZ. Family history – DM, CAD.

Morning Report – Part B - Morning Report – Part B - InterpretiveInterpretive

Even basic EKG/CXRs will do – don’t need to bring exotic syndromes.

Should be a real case that you have seen/whose record you have reviewed (be prepared to provide details if the attending asks for them).

Morning ReportsMorning Reports

Remember the goals Prepare Early Practice

Expect to be called by the chiefs 2 weeks in advance to help you come up with ideas.

Review the slides with the chiefs at least two days in advance in order to ensure that the goals are being met. (Please call us, or we’ll call you!)

Remember, this is your opportunity to educate your peers! Make the best of it!


9am – 10am Noon


Tuesday Morning Report A + B (Interpretive) CPC/M&M (11:30 – 12:30)




Resident M&MResident M&M

Fourth Tuesday of the Month 11:30am

In the 8th floor library (Not in Erny in front of the whole faculty…)

Voluntary presentation by residents of adverse outcomes in a non-judgmental and protected fashion.

“The airline industry doesn't need a plane crash to learn how to crash planes.” - talking about near misses is also important.

Come with a problem, leave with a solution.


9am – 10am Noon







9am – 10am Noon







9am – 10am Noon






Should I see my patients or Should I see my patients or should I attend conferences?should I attend conferences?

Conferences are mandatory!*Conferences are mandatory!* Education is paramount. Patient care is not supposed to routinely

interfere with conference attendance!

If things are busy, assign interns to finish stuff off on floors while you attend conferences.

Come in a little earlier in the morning.

The knowledge gained during conferences will help you make quicker clinical decisions on floors.

*During certain electives, different policies may apply.

Our part of the bargainOur part of the bargain

Keeping things interesting

Maintaining the quality of conferences

Making it worth your time to attend

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Type 2 diabetes mellitus is a metabolic disease that is diagnosed on the basis of sustained hyperglycemia. People with type 2 diabetes are at elevated risk for a number of serious health problems, including cardiovascular disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, and cognitive decline.1 In prospective epidemiologic studies, the incidence of many of these outcomes is directly associated with the degree of hyperglycemia, as measured by the plasma glucose or the glycated hemoglobin level, a measure of the mean blood glucose level during the previous 2 to 3 months. Thus, after adjustment for other risk factors, an increase of 1% in the glycated hemoglobin level is associated with an increase of 18% in the risk of cardiovascular events,2 an increase of 12 to 14% in the risk of death,3,4 and an increase of 37% in the risk of retinopathy or renal failure.4The graded relationship between the glycated hemoglobin level and cardiovascular events and death suggested that a therapeutic strategy to lower glycated hemoglobin levels might reduce these outcomes. This hypothesis was supported by findings from some but not all previous clinical trials.1 However, the hypothesis was not explicitly tested in adequately powered, randomized trials focusing on cardiovascular outcomes. Nevertheless, data from basic science, epidemiologic analysis, and limited trials have been used to support guideline recommendations to target near-normal levels of glycated hemoglobin and glucose in selected patients with type 2 diabetes mellitus,5,6,7,8 despite a paucity of evidence regarding the risks and benefits of doing so with currently available therapies. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was specifically designed to determine whether a therapeutic strategy targeting normal glycated hemoglobin levels (i.e., below 6.0%) would reduce the rate of cardiovascular events, as compared with a strategy targeting glycated hemoglobin levels from 7.0 to 7.9% in middle-aged and older people with type 2 diabetes mellitus and either established cardiovascular disease or additional cardiovascular risk factors. The finding of higher mortality in the intensive-therapy group led to a decision to terminate the intensive regimen in February 2008, 17 months before the scheduled end of the study. We report the effects of the intensive intervention on mortality and the primary composite outcome of major cardiovascular events in all patients and in prespecified subgroups.

The rationale and design of the trial and a description of the glycemia intervention have been reported previously.9,10 Briefly, the ongoing multicenter clinical study, which is sponsored by the National Heart, Lung, and Blood Institute (NHLBI), is being conducted in 77 clinical centers (aggregated within seven networks) across the United States and Canada. We recruited volunteers who had type 2 diabetes mellitus and a glycated hemoglobin level of 7.5% or more and who either were between the ages of 40 and 79 years and had cardiovascular disease or were between the ages of 55 and 79 years and had anatomical evidence of significant atherosclerosis, albuminuria, left ventricular hypertrophy, or at least two additional risk factors for cardiovascular disease (dyslipidemia, hypertension, current status as a smoker, or obesity).9 Key exclusion criteria included frequent or recent serious hypoglycemic events, unwillingness to do home glucose monitoring or inject insulin, a body-mass index (the weight in kilograms divided by the square of the height in meters) of more than 45, a serum creatinine level of more than 1.5 mg per deciliter (133 µmol per liter), or other serious illness. All 10,251 patients were randomly assigned to receive comprehensive intensive therapy targeting a glycated hemoglobin level of less than 6.0% or to receive standard therapy targeting a level of 7.0 to 7.9%. With the use of a double two-by-two factorial design, 4733 patients were randomly assigned to lower their blood pressure by receiving either intensive therapy (systolic blood-pressure target, <120 mm Hg) or standard therapy (systolic blood-pressure target, <140 mm Hg). In addition, 5518 patients were randomly assigned to receive either fenofibrate or placebo while maintaining good control of low-density lipoprotein cholesterol with simvastatin.11 These blood-pressure and lipid trials are continuing, and results regarding them remain masked. The study protocol was approved by the institutional review board or ethics committee at each center, as well as by a review panel at the NHLBI. All patients provided written informed consent. Patients received instructional materials and behavioral counseling regarding diabetes care and were provided with glucose-lowering medications (from a study-supervised formulary) and glucose-monitoring supplies. Any marketed antihyperglycemic therapy that was not provided by the formulary could also be prescribed to any patient but was not provided by study investigators. Therapeutic regimens were individualized at the discretion of the investigators and patients on the basis of study-group assignment and the response to therapy. Adverse effects of therapy were carefully audited both locally and centrally to ensure the safety of the patients.12

Patients in the intensive-therapy group attended monthly visits for the first 4 months and then every 2 months thereafter, with at least one interim phone call, with the aim of rapidly and safely reducing glycated hemoglobin levels to below 6.0%. Additional visits were scheduled as needed to achieve glycemic goals, as described previously.9,10 Patients in the standard-therapy group had glycemic-management visits every 4 months.

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We are constantly open to We are constantly open to suggestions.suggestions.

Our door is always open.Our door is always open.

Conferences

Documents

huge blurry tables

glycated hemoglobin level

morning report part

morning report

cardiovascular events

cardiovascular disease

acute sinusitis

tiny font