Editorial

Objectives

NARRATIVE DESCRIPTION

Following this course, the participant should be able to formulate a practical approach to common disorders found in the hospitalized adult patient; determine the diagnostic tests that can be used to determine the severity of the patient's problem and make an accurate diagnosis; apply the various treatment options available and recognize when to treat and when to call for a specialist.  This activity is expected to result in improved competence in making an appropriate diagnosis and providing effective treatment and consultation with the overall goal of improving patient outcomes.

The emphasis will be on aligning physician behavior with current guidelines and evidence-based medicine, as indicated within each topic’s specific objectives.  As recent advances in diagnostic modalities and treatments make it necessary to improve competence in an inpatient setting, this course was designed as an update for all practitioners at the level of a practicing physician in the hospital setting.

Program

SPECIFIC OBJECTIVES

Day 1

Approach to the Patient with Rheumatic Diseases.

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.

Rheumatoid Arthritis.

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.

Rheumatologic Procedures.

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

1. Use techniques for appropriate indications for intra-articular and soft tissue injections in rheumatology.
2. Employ appropriate pharmacologic and non-pharmacologic therapies including injections for painful joints as per the ACR recommendations and the various sited rheumatologic and META analysis studies.

Adrenal Insufficiency- Primary and Secondary.

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

1. Apply principles learned to evaluate the diagnostic tests used to confirm the diagnosis or primary or secondary adrenal insufficiency. 
2. Employ therapeutic options for patients including pregnant patients with primary or secondary adrenal insufficiency.

Thyroid Case Studies.

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: ^{COMP, EBM, 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.

Day 2    

Polycystic Ovary Syndrome.

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

Male Hypogonadism.

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

1. Outline 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.

Disorders of Calcium Metabolism.

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

1. Outline the causes of hypercalcemia.
2. Recommend diagnostic testing for hyperparathyroidism.
3. Recognize secondary hyperparathyroidism.
4. Determine appropriate need for surgical intervention using clinical practice guidelines for asymptomatic hyperparathyroidism.

Systemic Lupus Erythematosus.

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

1. Describe the varied clinical presentations and manifestations in the course of systemic lupus erythematosus. 
2. Order and interpret laboratory testing used in the diagnosis of systemic lupus erythematosus in accordance with ACR Guidelines. 
3. Monitor and employ treatment options for patients with systemic lupus erythematosus according to EULAR recommendations and evidence-based results from clinical studies.

Lyme Disease and Other Topics in Rheumatology.

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.

Day 3

Bronchial Asthma: An Update.

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

1. Appraise the pathophysiology of this inflammatory disease.
2. Develop a stepwise approach to treatment of asthma and management of status asthmaticus.
3. Differentiate the patient who is not responding and specify indications for subspecialty referral.

Pleural Diseases: Effusions and Pneumothorax.

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

1. Determine the etiology of various pleural effusions by means of cases.
2. Formulate the investigation and management of pleural effusions.
3. Detect the presentation of pneumothorax.
4. Develop the clinical approach to management of pneumothorax using the ACCP Delphi Guidelines.

Pulmonary Cases - Challenges for the PCP. (Wani)

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

1. Develop a differential diagnosis and approach to a patient with a non-resolving infiltrate.
2. Assess the causes and determine the evaluation of solitary lung nodule.
3. Evaluate idiopathic pulmonary fibrosis and employ current management using the ATS/ERS Guidelines.

Septic Shock.

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

1. Define shock and differentiate the various types of shock.
2. Develop and apply the concept of sepsis management bundles.
3. Formulate and manage the early resuscitation of septic shock, vasopressor use and monitoring.
4. Specify the current controversies in management of septic shock based on SCCM/Survival Sepsis Campaign Guidelines.

Critical Care Cases - A Primary Care Review.  (Murali)          

1. Pulmonary complications in Patients with Chronic Liver Disease
   1. Discuss the pathophysiology of pleural effusion, hypoxemia and porto-pulmonary hypertension in patients with cirrhosis
   2. Describe the management of pulmonary complications of cirrhosis
   3. Review other complications of patients with cirrhosis in critical care
2. Management of Hyponatremia and Hypernatremia
   1. Recognize clinical features of patients with hyponatremia and hypernatremia
   2. Describe the workup of sodium imbalance
   3. Review the treatment of hyponatremia and hypernatremia
3. Detect pulmonary edema in the ICU and formulate a plan for the management of ARDS.

Day 4

Pneumonia.

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

1. Differentiate the presentation of various cases of pneumonia and management.
2. Distinguish the different pathogens that cause pneumonia.
3. Apply evidence-based recommendations for prevention of pneumococcal pneumonia.
4. Plan the approach to health care associated pneumonia.

COPD – Overview of Patient Management.

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

1. Appraise the definition and integrate the pathophysiology of COPD.
2. Assess the clinical management of various issues regarding COPD.
3. Treat acute exacerbations and outpatient management including long-term oxygen and pharmacologic treatment based on ATS/ACCP Guidelines.
4. Evaluate the need of referral for surgical and newer treatments for emphysema.
5. Develop the management of a patient with acute gastro-intestinal bleeding.

Pulmonary Cases - A Primary Care Review. (Murali)

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

1. Identify and properly evaluate sleep apnea and excessive daytime sleepiness.
2. Specify the various causes of hemoptysis and develop an appropriate plan for management.
3. Apply the evidence-based recommendations of pulmonary embolism including thrombolysis or appropriate referral for vena caval filters.

Non-Invasive Ventilation and Oxygenation in Respiratory Failure.

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

1. Review the indications for NIV in acute respiratory failure
2. Understand the benefits and risks of NIV
3. Discuss the strategies for initiation of NIV and monitoring response
4. Discuss the use of NIV on the wards, outside of the ICU setting
5. Briefly review NIV use in COVID-19 patients

Critical Care Cases - Challenges for the PCP. (Wani)

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

1. Detect acute renal failure in the ICU and employ appropriate management using the International Consensus Guidelines.
2. Detect and assess hypertensive emergencies in the ICU and prescribe appropriate management.

Speakers

Arshad A. Wani, M.D. 
Associate Professor of Medicine, Perelman School of Medicine, University of Pennsylvania; Director, Respiratory Care and Principal Instructor, Point of Care Ultrasound Education; Attending Physician, Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania-Penn Presbyterian, Philadelphia, PA

Stephen Winters, M.D. 
Professor of Medicine, Chief, Division of Endocrinology, Metabolism and Diabetes, University of Louisville

Lawrence H. Brent, M.D.
Professor of Medicine, Division of Rheumatology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
 

Diverse

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