Following the smell of chocolate, PAFP members and other family medicine physicians from across Pennsylvania, as well as some surrounding states, flooded the Hershey Lodge in Hershey, Pa. for a weekend of clinical education activities and networking opportunities at the Hershey CME Conference, March 7 through 9. Coinciding with the Penn State Milton S. Hershey Medical Center Primary Care Update, CME events started Thursday, March 6; the PAFP picked up the educational baton Friday afternoon continuing through Sunday morning.
To expand the impact of this educational weekend, some sessions were streamed live on the Internet, offering CME to a variety of physicians unable to travel to the Lodge for the event. Faculty members, staff and attendees also spread key messages on Twitter during the sessions. Here is a sampling of their Tweets and other notes from select lectures. Visit the PAFP's Facebook page page to see pictures of your primary care peers and conference highlights from the event!
TOPICS: Prescribing Therapeutic Lifestyle Changes in the Management of Osteoarthritis in Older Adults | The Impact of Environment on Children's Health | Osteoarthritis: Practical Implementation of 'Ask, Advise, Refer' | Multiple Sclerosis: Diagnosis and Management of Current Therapies | Case Studies of Common Behavioral Health Scenarios | Update on New Anticoagulants (Apixaban, Dabigatran and Rivaroxaban) | 'How Do You Sleep in That Thing?' A Guide to Working with Patients with Disabilities | Update on the Diagnosis and Treatment of Venous Thrombomebolism | Managing COPD at End-of-Life | Evidence-Based Plan to Prevent and Reverse Cardiovascular Events with Lifestyle Therapies
PRESCRIBING THERAPEUTIC LIFESTYLE CHANGES IN THE MANAGEMENT OF OSTEOARTHRITIS IN OLDER ADULTS
Managing OA in older adults pre-test answers: (1) Worsening pain with use is a symptom of OA, (2) obesity is not a contributor to decreased forces across a joint, and (3) the American College of Rheumatology strongly recommends aquatic therapy for OA.
27 million people in the U.S. have osteoarthritis. It’s the most common type of arthritis.
There is no gold standard test for diagnosing OA. Primary diagnosis is through X-rays, history and exam.
Every 1 kg extra weight = 10 percent increased risk of OA symptoms.
Want to fix osteoarthritis without meds? Combine low-impact exercise with weight loss and heating pads.
American College of Rheumatology top non-pharmacological treatments: aerobic and resistance land exercise, aquatic exercise, weight loss, self-management and manual therapy.
Physicians should facilitate the maintenance of physical activity and weight loss.
THE IMPACT OF ENVIRONMENT ON CHILDREN'S HEALTH
Close your eyes. Picture the environment. Visualize it. Does your picture include humans? No? Your vision of the environment must include human beings. Environmental health = how each impacts the other.
It’s important to understand the differences between children and adults and how those differences impact interactions with the environment.
Exposures preconception and in utero can lead to birth defects or later problems.
Mothers who smoke have increased risk of child with cleft if have defects in homeobox genes.
Poverty associated with poor housing, poor nutrition and inadequate/no access to healthcare services.
We do not know the impact of most of the chemicals in the environment on children.
OSTEOARTHRITIS: PRACTICAL IMPLEMENTATION OF 'ASK, ADVISE, REFER'
Ask, Advise, Refer (AAR) is a brief intervention that gives busy clinicians a simple and practical plan.
AAR is a condensed version of the “5 As” – an evidence-based model for behavioral change and health modification.
PA cAARds! is the first integrated initiative of its kind in Pennsylvania. http://beabridge.org/pacaards
Engage community based interventions: Group Exercise Programs, Health Communication Campaigns, Self-Management Education Programs
MULTIPLE SCLEROSIS: DIAGNOSIS AND MANAGEMENT OF CURRENT THERAPIES
MS Incidence: 400,000 Americans and 2.5 million worldwide.
It’s critical for primary care physicians to understand the pathophysiology, etiology, diagnosis, clinical presentation and disease course of Multiple Sclerosis.
Risk factors for MS? Childhood at high altitude, female, smoking.
Treating Acute Exacerbations: IV or PO methylprednisolone for 5 days, no taper.
Plasmaphoreisis and Immunoglobulin are both options for Acute Attacks
Disease Modifying Meds include Interferon-1a, Interferon-1b which is credited with 1/3 reduction of relapses, Glatiramer which mimics and competes with myelin basic protein, and Fingolimod which is fungal derived and sequesters lymphocytes in lymph nodes.
Second Line Medications: Natalizumab, Mitoxantrone and Vitamin D.
CASE STUDIES OF COMMON BEHAVIORAL HEALTH SCENARIOS
Physicians must develop strategies to talk with patients experiencing behavioral health difficulties.
Key points to getting valid/reliable data include: (1) pay attention to body language, (2) avoid any evidence of personal discomfort during assessment, and (3) avoid appearing hurried
Techniques to generate valid data: (1) behavioral incident, (2) shame attenuation, (3) gentle assumption, (4) symptom amplification, (5) denial of specific, and (6) normalization.
Behavioral Health should be included in your Medical Home; if you don’t have a Medical Home, identify and reach out to local Behavioral Health providers and create your own “neighborhood”.
UPDATE ON NEW ANTICOAGULANTS (APIXABAN, DABIGATRAN AND RIVAROXABAN)
Physicians should compare and contrast the pharmacological properties of the new oral anticoagulants.
Pre-test Q: ACCP guidelines prefer Dabigatran 150mg BID as therapy for Atrial Fibrillation with a CHADS2 score of 2 or greater.
Dibigatran and Apixaban = Reduced risk of stroke and systemic embolism in patients with Non-Valvular Atrial Fibrulation.
Rivaroxaban = DVT prophylaxis, as well as treatment after knee or hip replacement, and reduced risk of stroke and embolism in Non-Valvular Atrial Fibrillation patients.
Rivaroxaban superior to placebo. pic.twitter.com/eFuGGlhMln
'HOW DO YOU SLEEP IN THAT THING?' A GUIDE TO WORKING WITH PATIENTS WITH DISABILITIES
P-DAT trainer Trieste Kennedy is discussing her child’s development and eventual diagnosis of PDD-NOS at 2 years, 3 months old.
Physicians have feelings about such diagnoses: anxiety, fear, sadness, guilt, hopelessness, helplessness. Feelings are cyclical; they come and go.
Remember the Ten Commandments for Communicating with People with Disabilities! http://www.rehab.cahwnet.gov/DisabilityAccessInfo/The-10-Commandments.html …
Alex is telling his story. Doctors said he wouldn't live past first birthday. He's almost 24! pic.twitter.com/Kw0TqxkM44
Alex Gardner is talking about avoiding the R-word at #HersheyCME. Spread the word to end the word! http://www.r-word.org / @EndTheWord
UPDATE ON THE DIAGNOSIS AND TREATMENT OF VENOUS THROMBOEMBOLISM
Important: VTE is the third leading cause of cardiovascular death.
75 percent of VTE cases are outpatient acquired.
DVT Diagnosis à Venus ultrasound à MR, CT, Phlebography
PE Diagnosis à Chest CT à Lung scan à Venous ultrasound à Transesophageal ECHO or MR, invasive pulmonary angiography
VTE causes approximately 100,000 deaths per year, which is roughly equal to one jumbo jet crash per day.
Pharmacological therapies: Enoxaparin, Fondaparinux, UFH, Warfarin, Rivaroxaban, Apixaban, Edoxaban, Dabigatran.
Preventing Venous and Arterial Thrombosis: ACCP guidelines DO NOT recommend ASA.
MANAGING COPD AT END-OF-LIFE
Make a plan for self-care for the COPD patient at the end of life. Now.
William Sonnenberg, MD: “Cigarettes are the devil incarnate when it comes to COPD!”
More women will die of COPD this year than of breast cancer.
Learn how to assess where a patient is on disease progression timeline to help develop end of life plan.
EVIDENCE-BASED PLAN TO PREVENT AND REVERSE CARDIOVASCULAR EVENTS WITH LIFESTYLE THERAPIES
Dietary and exercise therapies have been shown to prevent some cardiovascular disease events.
Steven Masley, MD, is an enthusiastic advocate of proper nutrition to combat cardiovascular events.
CV events cause approximately 35 percent of deaths in America and more than $200 billion annually in healthcare expenses.
Steven Masley, MD: “A tsunami of health problems are about to hit the US.”
Measuring advanced lipid profiles: VAP, SpectraCell and NMR. Looking at LDL particle count, LDL size, HDL type, and Lp(a).
Plaques most likely to rupture are small (20%-40%) obstructions. They account for 80 percent of events.
One therapy goal: Add beneficial foods, especially FIBER, and avoid refined carbs and hydrogenated (trans fat).
