News
Bioterrorism Class On-Line
You can access a free accredited CME program on bioterrorism developed by Idaho physicians on-line. Simply go through the ACMEC website, WWAMI website or the Idaho Academy of Family Physicians website to the Bioterrorism Course. Drs. Blackman, Blue, Epperly, and Hahn developed the course. You can't beat the price
Changes in CME
We can work to improve CME by asking presenters to focus on evidence based medicine in their discussions augmenting this information with other information and their own thoughts. This is not an easy request; we have found some presenters experience their own pain and loss when asked to pare out both the basic and abstruse information, leaving only evidence based information. We can also aid learners who attend CME presentations by delineating a learning objective up front in program evaluation forms to help attendees think through their learning needs before the presentation. Another change is to give physicians more control over their own learning by providing point-of-care CME. This new type of CME provides physicians with CME credit for going through a three-step process of :
Our CME Christmas wish list is that physicians learn what it is they wish to learn and when they wish to learn it. Just as physicians are embracing patient-centered care, we need to focus on learner-centered education.
- Defining their knowledge deficit or clinical question.
- Using a source of information at the point of care to find the information they need.
- Documenting the effect of this learning session on the care they provided to the patient for whom the question was generated. The American Medical Association is considering guidelines for tracking Point of Care learning sessions and awarding credit. The American Academy of Family Physicians has approved Prescribed Credit for Point of Care learning. Point of Care CME, while a large departure from how we have received CME, places learning back in the hands of physicians, literally, since a prime method of accomplishing it will be hand held computers.
Please make note of the following room change for the Friday morning Grand Rounds at Saint Alphonsus. DECEMBER 16 - Liberty Building Conference Room
Upcoming Conferences
January 12-15, 2006 VA Winter Retreat - McCall
January 20, 2006 Crowe Lectures in Dermatology - St. Luke's RMC
February 17-20, 2006 Ada County Medical Society Winter Clinics - Sun Valley
July 14-16, 2006 Idaho Medical Association Annual Meeting - Boise
Anderson Center - Wednesday, 8:00 a.m.
7 J. Brent Muhlestein, MD, Director, Cardiology Research, Intermountain Health Care & LDS Hospital; Associate Professor, Medicine, University of Utah.
14 Steve Edelman, MD, Director, Diabetes Care Clinic, VA Hospital; Professor of Medicine, Division of Endocrinology/Metabolism, University of California, SD.
Mercy Medical Center - Wednesday, 12:30 p.m. - Winter Room
7 J. Brent Muhlestein, MD, Director, Cardiology Research, Intermountain Health Care & LDS Hospital; Associate Professor, Medicine, University of Utah.
14 Steve Edelman, MD, Director, Diabetes Care Clinic, VA Hospital; Professor of Medicine, Division of Endocrinology/Metabolism, University of California, SD.
Centennial Room - Friday, 8:00 a.m.
2 Douglas Blank, M.D., Cardiologist, Idaho Heart Institute, Eastern Idaho RMC
Tumor Boards
Mercy Medical Center - Tuesday, 12:00 noon
Saint Alphonsus Regional Medical Center - Thursday, 12:00 noon
Breast Care Panel-Saint Alphonsus RMC - Tuesday, 7:00 a.m.
St. Luke’s Regional Medical Center - Tuesday, 12:00 noon
Breast Tumor Board-St. Luke’s RMC - Thursday, 7:00 a.m.
MSTI Pediatric Tumor Board - 2nd & 4th Wednesday, 12:00 noon
Meridian Tumor Board - 1st & 3rd Thursday, 12:00 noon
CHEERS (Children's Hospital Education Enrichment Review)
1st, 2nd, 4th, Thursday, 8 a.m., Anderson Center - Ada -2
MEMBERSHIP: The following members were approved:
Provisional Membership:: Barbara Bess, M.D.; Amit Sharma, M.D.; Robert Sigman, M.D.; Mary Dittrich, M.D.; Maisa Morris, M.D.; Angela House, D.O. Suzanne Rice, M.D.; Kelly Siudzinski, M.D.
Upcoming Events:
Jan. 19, 2006 Quarterly Membership Meeting, Doubletree Riverside Hotel, 6:00 pm., Guest speaker to be announced.Feb 17-20, 2006 Winter Clinics, Sun Valley Resort and Convention Center. Registration brochures being mailed November 25.
There were three country churches in a small Texas Town: the Presbyterian church, the Lutheran church, and the Catholic church.
Each church was over run with pesky squirrels.
One day the Presbyterian church called a meeting to decide what to do about the squirrels. After much prayer and consideration they determined that the squirrels were predestined to be there and they shouldn't interfere with God's divine will.
The Catholic group got together and decided that they were not in a position to harm any of God's creations. So, they humanely trapped the squirrels and set them free a few miles outside of town. Three days later, the squirrels were back.
It was only the Lutherans who were able to come up with the best and most effective solution. They baptized the squirrels and registered them as members of the church. Now they only see them on Christmas and Easter.
January 2006
February 2006
Lowering cholesterol with statin drugs has become standard therapy for patients with coronary artery disease and those whose high lipids are not amenable to dietary and exercise modalities. Another study entitled, The Ideal Study, adds weight to the evidence that aggressive lowering of LDL provides further benefit in patients with stable coronary artery disease. Pedersen, et al used atorvastatin (Lipitor) 20mg/day compared with simvistatin (Zocor) 20-40mg/day. They found there was a trend in reduction in heart disease death and it did reduce the risk of non-fatal acute myocardial infarctions. There were no differences in the groups in cardiovascular or all-cause mortality. Serious adverse effects were the same in both groups. An accompanying editorial by Cannon makes several points. First, is that the evidence is now considerable that aggressive lowering of cholesterol reduces cardiovascular events. Physicians caring for patients with vascular disease should make sure that these patients receive statins at an appropriate dose. Patients with documented coronary artery disease, peripheral vascular disease, and cerebral vascular disease all deserve these drugs. If there are no contraindications diabetic patients also benefit from statin treatment, even those who have not had a coronary event. The new guidelines from the NCEEP recommend lowering the level below 100 and these may be changed to even lower levels in the coming years. (JAMA, 2005 Nov 16; 294, No. 19)
I have often thought that one of the most important interventions I did as a primary care physician was a "brown bag biopsy". Many frail elderly take a variety of medications some of which cause costly, inconvenient, and potentially dangerous side effects. This study from several U.S. Veterans Affairs hospitals examined unnecessary drug prescribing for 384 frail elderly over age 65 being discharged from the hospital. The physician/pharmacist team reviewed the patient's record and the appropriateness of each drug. At least one unnecessary drug was prescribed to nearly half of the patients and at least 18% received at least two unnecessary prescriptions. The most common being H2 receptor blockers, laxatives, genitourinary anticholinergic drugs, iron supplements, potassium, and tricyclic antidepressants. None of us should be surprised by the results of this study given the subspecialization and the fact that many patients see multiple physicians. One of the most important things that we can do at each visit is to review our patient's medication lists. (J Am Geriatr Soc 2005 Sep; 53:1518-23)
John J. Mohr, M.D.
St. Luke's Regional Medical Center - Wednesday 8am, Anderson Center
Mercy Medical Center - Wednesday 12:30pm
VA Medical Center - Thursday 8am, AW Horsley Learning Ctr.
St. Alphonsus Regional Medical Center - Friday 8am, Centennial Room
A little church squirrel humor….
4 Idaho Epidemiology Update, Christine Hahn, MD
6 Pediatric Dermatology Update , Matthew Bender, MD
11 Update on Epilepsy, Robert Wechsler, MD
13 Smoking Cessation, Suzanne Allen, MD
18 Sjogren's Syndrome, Robert Fox, MD
20 Crowe Lectures in Dermatology, Speaker TBA
25 Alcohol Addiction, Michael Carlton, MD
1 Legislative Update, Robert Seehusen
3 Allergy, Asthma and One Airway, William Palmer, MD
8 Contraception Update, Albert Yuzpe, MD
10 Osteoporosis Update, Eric Orwell, MD
15 Update in Breast Cancer, Michael Press, MD
22 Complications of Bariatric Surgery, John Witte, MD
7 Best of the AHA, J. Brent Muhlestein, MD
14 Managing Type II Diabetes, Steve Edelman, MD
21 Cardiovascular Complications of Kidney Disease, Amit Sharma, MD
28 NO CONFERENCE
7 Best of the AHA, J. Brent Muhlestein, MD
14 Managing Type II Diabetes, Steve Edelman, MD
21 Cardiovascular Complications of Kidney Disease, Amit Sharma, MD
1 Treatment of Recurrent HCV, Fred Poordad, MD (Conference at 12:00 noon instead of 8:00 a.m.)
8 Medical Residency, Military Combat, and Other Sleep Deprived States, William Thompson, MD
15 Disclosure of Adverse Events, Joanne Leone, MD
22 Practical Clinical Pharmaco-kinetics of Anti-Epileptics, Rex Lott, PharmD
2 Refractory Heart Failure and LVAD Therapy, Douglas Blank, MD
9 Third Nerve Palsy, Barbara Bess, MD
16 NO CONFERENCE
23 NO CONFERENCE
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