COURSE OBJECTIVES

Learn how to directly apply the most recent relevant clinical trial evidence to your patients with common chronic illness.

Module on Stepping up to Insulin in Type 2 Diabetes:

At the conclusion of this activity, you will know:

1. How to combine oral medications rationally to bring down HbA1c.
2. When and how to start patients on insulin or other injectable medications.
3. Which injectable to use. How to determine dosing, monitoring, and adjustment of injectable medications, including prandial dosing of ultra short acting insulin.
4. What premixed formulations are most useful.
5. How to adjust oral medications when starting injectables.
6. Patient profile appropriate for inhaled insulin.
7. You will also have the option to choose from two additional performance-improvement activities for additional CME credit, and eligibility for Part IV specialty board credit.
8. You will apply the principles you learn in this module to an online case, and then with support from course faculty you will implement insulin or other injectable therapy on at least 3 of your diabetic patients who are not at goal despite maximal oral therapy.

Module on Promoting Colorectal Cancer Screening Through Behavioral Counseling:

You will:

1. Learn how to increase patient acceptance rates for colorectal cancer screening, reducing risk for delayed and missed diagnosis.
2. Receive updates on the state-of-the art in patient communication theory underlying promoting successful patient behavior change.
3. Learn motivational interviewing techniques tailored to each individual patient.
4. Improve skills from study of interactive multimedia, including online video vignettes, to boost patient acceptance of sigmoidoscopy or colonoscopy and fecal occult blood testing.
5. Practice specific techniques on your own patients during the course.
6. Have the option to participate in an additional performance-improvement activity for additional CME credit.

Module on Congestive Heart Failure:

1. When seeing a patient with new onset heart failure, will perform workup in accordance with AHA Guidelines for diagnosis and evaluation.
2. When seeing a patient with known heart failure will:
   • prescribe an ACE-I (preferred) or ARB (or ensure patient is already on), assuming no contraindication
   • prescribe a beta blocker, titrating according to guidelines
     
   • prescribe spironolactone in appropriate NYHA class 4 and class 3 patients
     
   • recognize patients for whom digoxin is appropriate, and prescribe in low dose, according to guidelines
     
   • identify patients who are candidates for nitrates and hydralazine vasodilator therapy
     
   • prescribe antiplatelet and anticoagulation therapy when appropriate
     
   • understand the importance of establishing a 'dry weight' for each patient, and note in chart
     
   • know how to educate patients about dry weight, and establish a plan for fluid weight gain
     
   • recognize those patients who may benefit from device therapy, specifically biventricular pacing, and defibrillator therapy, making referrals as appropriate
3. Considering a patient with acutely decompensated heart failure, will state an approach to diagnosis and therapy including management of oxygenation, fluid overload, and blood pressure.
4. State similarities and differences between systolic dysfunction and diastolic dysfunction heart failure.

Module on Preventive Cardiology:

At the conclusion of this activity, you will be able to:

• State the role depression and anxiety play in pre and post MI states.
• Discuss depression treatment methods and outcome data in the post MI patient.
• Describe the data and mandate of cardiac rehabilitation.
• Propose a cardiac rehabilitation practice improvement process.
• Articulate the importance of initiating medications after MI to decrease morbidity and mortality.
• Explain the medications used for symptomatic treatment and improved quality of life after MI.
• Implement proper medical management after certain coronary interventions associated with MI.
• Describe the importance of lifestyle modification in the care of patients following myocardial infarction.
• Describe the components of comprehensive lifestyle modification and risk reduction.
• Apply these recommendations to your patients in the inpatient and outpatient settings.

Module on Advising Patients on Advance Directives:

At the conclusion of this activity, you will be able to:

• Explain the legal ramifications of the Patient Self-Determination Act of 1991.
• List 3 goals of advance directives.
• Use goals of care in negotiating advance directives with patients.
• Present an evidence based approach to the completion of advance directives in the outpatient office setting.

Reduce risk of medical error and malpractice associated with cancer screening, diagnosis, follow-up, and counseling. You will learn how to:

Module on Medical Errors:

• Assess your practice for possible “failure points” where critical data could be lost or not acted upon, such as test results, patient follow through with referrals, and other risk points.
• You will be guided through a sequential process of estimating the impact of each risk point, and
• Design and implement simple and quick office systems solutions to mitigate the impact of the risk points you identified and thus
• Reduce the risk associated with delayed or neglected management of critical clinical information.