TPJ Soul of the Healer Contents -- Winter 2008 TPJ

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••Winter 2008/Vol. 12, No. 1

CME Evaluation Form --
Complete this form and submit it to earn CME credits online.

Physicians may earn up to 4 AMA PRA Category 1 credits for reading and analyzing the four designated articles. Other clinicians for whom CME is acceptable in meeting educational requirements may report up to four hours of attendance.

You may earn CME credit for reading the four qualifying articles from this issue of The Permanente Journal that are listed below and then taking this online quiz. To participate, select the most appropriate answer to the questions and complete the online evaluation form. You must complete all sections to receive credit.

The Kaiser Permanente National Continuing Medical Education Program (KPNCMEP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The KPNCMEP designates this educational activity for 4 AMA PRA Category 1 credits. Each physician should claim only those hours of credit that s/he actually spent in the educational activity. Author disclosure statements may be found at the end of each CME-identified article.

The Permanente Journal has been reviewed and is acceptable for up to 8 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 01/01/07. Term of approval is for one year from this date. This issue is approved for 2 Prescribed credits. Credit may be claimed for one year from the date of this issue.

The Permanente Journal - Vol. 12, No. 1 - Winter 08

Article 1.
Myocardial Infarction and Its Association with the Use of Nonselective NSAIDs: A Nested Case-Control and Time-to-Event Analysis

On the basis of this study, which of the following NSAIDs are associated with an increased risk of myocardial infarction?
a. ibuprofen
b. indomethacin
c. rofecoxib (>25mg/d dose)
d. all of the above
e. b and c

Indicate the incorrect statement:
Cyclooxygenase 1 (Cox1) is associated with:
a. endothelial wall vasodilation
b. stimulation of platelet aggregation
c. inhibition of platelet aggregation

Article 2.
Laparoscopic Colorectal Surgery

Compared with open surgery, laparoscopic surgery for colon cancer:
a. is associated with higher rates of port-site metastases
b. has higher complication rates
c. is equivalent in terms of oncologic safety for all stages of colon cancer
d. has no additional advantages for patients

Advantages of laparoscopic colorectal surgery include:
a. less postoperative pain
b. an earlier return of bowel function
c. shorter hospital stay
d. possible immune benefits
e. all of the above

Article 3.
The “Party Drug” Crystal Methamphetamine: Risk Factor for the Acquisition of HIV

Differences between cocaine and Crystal Methamphetamine (CM) include:
a. cocaine has an extracellular effect at the nerve synapse on dopamine levels; CM affects dopamine levels at both the synapse and intracellular level
b. nerve damage caused by CM use is temporary but nerve damage caused by cocaine use can be permanent
c. nerve damage caused by cocaine use is temporary but nerve damage caused by CM use can be permanent
d. a and b
e. a and c

Crystal Methamphetamine is considered the “ideal” party drug because it:
a. increases sensory acuity, energy levels, and appetite, while reducing fatigue and the need for sleep
b. increases sensory acuity and energy levels, while reducing fatigue, the need for sleep, and appetite
c. increases confidence and sex drive but decreases energy levels
d. makes people see brighter colors and hallucinate

Article 4.
When Is a Computed Tomography Angiogram Necessary to Rule Out Pulmonary Embolus in the Emergency Department?

The combination of a clinical score ≤4 and a negative D-dimer assay is a reliable method to rule out pulmonary embolus without computed tomography angiography in suspected outpatients. Single points on a clinical score for a sample patient would be added for each of the following (check all that apply):
a. prostatectomy 12 months prior with subsequent undetectable PSAs
b. prior episode of deep venous thrombophlebitis
c. shortness of breath
d. heart rate of 94 beats/min
e. outpatient arthroscopy three weeks prior

In outpatients with otherwise unexplained breathing difficulty (chest x-ray normal) where pulmonary embolus is a consideration, the combination of a low clinical score (≤4) and a negative D-dimer assay can potentially spare approximately what percentage of CT angiograms?
a. 10%
b. 20%
c. 30%
d. 40%

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

The article covered the stated objectives I learned something new that was important I plan to use this information as appropriate I plan to seek more information on this topic I understood what the author was trying to The article covered the statedsay

Article 1

Article 2

Article 3

Article 4

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

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Title:*
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