Article 1. Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women

Which of the following statements is incorrect? The Early Start Program
a. screens for substance use risk at the first prenatal visit by a self administered questionnaire and urine toxicology testing
b. refers patients who are at risk for substance use during their pregnancy to CDRP for treatment
c. reduces adverse pregnancy outcomes such as placental abruption, preterm labor, and stillbirth
d. reduces adverse neonatal outcomes such as assisted ventilation, low birth-weight, and preterm delivery
e. showed a direct cost savings for babies whose mother received ES intervention compared to babies of substance abusers with no intervention, after six months of follow-up post-delivery

Which of the following statements is incorrect? The development and implementation of the Early Start Program
a. was partially a result of two prevalence studies conducted in the early 1990s confirming that prenatal substance abuse as a significant problem among Kaiser Permanente Northern California Region members
b. was piloted at the Oakland Medical Center from 1990-1993 and reached almost full implementation among the Northern California Region in 2006
c. helped providers identify substance abusing patients who they would have otherwise missed prior to the implementation of the program
d. required a completed and thorough evaluation of the program before full regional funding was granted
e. was/is solely funded by TPMG

Article 2. Promoting Patient Safety: The Rapid Medical Response Team

Which of the following statements is incorrect? A Rapid Medical Response Team:
a. increases safety for hospitalized patients
b. costs a significant amount to develop
c. improves quality of care for hospitalized patients
d. enhances communication and clinical skills among staff

Which of the following statements is incorrect?
By using a RMRT, a hospital may be able to:
a. decrease adverse events
b. decrease mortality
c. decrease unplanned transfers to ICU
d. decrease staff understanding of physical deterioration

Article 3. Diagnosis and Treatment of Major Depression 2007

The two question screen for major depressive disorder:
a. is diagnositic for major depression if both questions are answered “yes”
b. is diagnositc for major depressision if one question is answered “yes”
c. can rule out most cases of major depression if both questions are answered no
d. can be used to follow patient progress over time

Proven treatment strategies for patients with major depression whose symptoms do not resolve after six weeks of treatment with intial antidepressant therapy include which of the following (more than one answer may be correct):
a. changing to an antidepressant in the same class
b. adding psychotherapy
c. changing to St John’s wort
d. combining SSRIs and venlafaxine
e. changing to an antidepressant in a different class
f. augmenting with pindolol

Article 4. Tachycardia-Induced Heart Failure

What is the most common arrhythmia believed to be responsible for tachycardia induced cardiomyopathy?
a. Atrial fibrillation
b. Automatic atrial tachycardia
c. Atrial flutter
d. Atrioventricular nodal reentry tachycardia
e. Ventricular Tachcardias

In regards to controlling atrial fibrillation, which of the following statements is true?
a. Controlling the rate has been shown to be superior to controlling the rhythm
b. Controlling the rhythm has been shown to be superior to controlling the rate
c. Controlling either the rhythm or the rate is acceptable
d. It is best to have initial treatment consist of atriventricular nodal ablation with pacemaker implantation
e. Any of the above statements is acceptable

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Objectives
1) to inculcate the use of evidence based medicine as part of the science of medicine.
2) to stress the art of medicine via enhanced patient physician communication, improved care experience for patients, and more satisfying care giving experience for physicians and staff through better teamwork.
3) to review appropriate updates on the diagnosis and treatment of clinical conditions.
4) to describe infrastructure and systems improvements that lead to improvements in outcomes and patient care experiences.

Referring to the CME articles and the stated objectives,
please choose your level of agreement next to each statement as appropriate

What change(s) (if any) do you plan to make in your practice as a result of reading these articles?

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