Tuesday Pre-Courses

Tuesday, 8:00 a.m.-5:00 p.m.

Andrea D. Coviello, MD, MSE, FACE
Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Duke Health, Durham, NC

The number of people with diabetes continues to increase, particularly at younger ages and with the rise in rates of overweight and obesity. With longer duration of diabetes, more people develop chronic kidney disease and cardiovascular disease. Therapeutic options are also advancing, giving greater opportunities to improve the health of our patients, but the complexity of care is also increasing. This Pre-Course will discuss the diagnosis of prediabetes and diabetes, including less common forms, such as maturity-onset diabetes of the young and latent autoimmune diabetes in adults. Faculty will review the role of lifestyle interventions as well as appropriate indications and practical utilization of weight-loss medications and/or bariatric surgery in patients with overweight and diabetes. The risks and benefits of new insulin and noninsulin pharmacologic therapies will be presented. The role of diabetes medications, cholesterol-lowering agents, and blood pressure control to reduce cardiovascular risk will be discussed.

Learning Objectives:

1. Review current guidelines for the management of patients with diabetes and prediabetes.
2. Provide guidance on the evaluation, classification, and treatment of diabetes, including less common conditions, such as monogenic diabetes syndromes as well as medication-induced diabetes.
3. Review new insulin products and diabetes technology (including new pens, pumps, and sensors) available for patients with type 1 and 2 diabetes.
4. Review the current management of diabetes in pregnancy.
5. Discuss the role of nutrition and weight management in overweight patients with diabetes.
6. With a case-based approach, discuss the prevention and treatment of cardiovascular disease in patients with diabetes.
7. Within a panel discussion format, review questions and challenges that arise in your practice.

Tuesday, 8:00 a.m.-5:00 p.m.

Jennie T. Clarke, MD
Professor of Dermatology, Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT

Patients often present to their internist with skin concerns. Many of these concerns are common conditions that, once identified, can be easily addressed without a referral to a dermatologist. Additionally, many skin conditions are known to be associated with systemic comorbidities for which screening and management in primary care is indicated. With the aid of an audience-response system, faculty will engage participants in identifying many of these conditions and will review appropriate steps for their diagnosis and management in the primary care setting. Practical approaches, including biopsy techniques, will also be reviewed.

Learning Objectives:

1. Identify common dermatologic problems that present in the primary care setting, and initiate appropriate treatment.
2. Describe the potential comorbidities seen in patients with psoriasis, hidradenitis suppurativa, pruritus, and urticaria.
3. Recognize skin findings and conditions associated with short and long-term systemic complications/risk.
4. Recognize common skin cancers and benign skin growths and understand indications for various approaches to management.

Tuesday, 8:00 a.m.-5:00 p.m.

Geno J. Merli, MD, MACP, FHM, FSVM
Professor, Medicine & Surgery, Associate Chief Medical Officer and Senior Vice President, Vascular Medicine/Jefferson Vascular Department, Thomas Jefferson University Hospitals, Philadelphia, PA

This Pre-Course will review the assessment and management of patients with medical comorbidities undergoing surgical procedures. Expert faculty will discuss postoperative nausea and vomiting, preoperative blood pressure control, and fasting before surgery. Venous thromboembolism (VTE) prophylaxis in the postoperative period for patients with renal impairment, hereditary or acquired coagulation disorders, or history of recurrent VTE and the best VTE prophylaxis in joint replacement surgery will be reviewed. Preoperative validated risk assessment tools, mitigation strategies for identified comorbidities, and management of postoperative complications will be emphasized. Topics will include managing perioperative medications; preoperative cardiac findings (abnormal ECGs, aortic murmurs, pacemakers, AICD devices); pulmonary risk factors; managing the patient with chronic kidney disease and frailty risk indices with modification strategies; postoperative cardiac complications; managing cannabis, suboxone, and methadone; using the target-specific anticoagulants; and treating postoperative delirium.

Learning Objectives:

1. Understand the assessment and management of patients with medical comorbidities undergoing inpatient and outpatient surgical procedures.
2. Review guidelines and best practices for preoperative laboratory testing, perioperative medication use, and common anesthesia-related issues.
3. Review preoperative validated risk assessment tools, strategies to mitigate risk, and management of patients with a variety of pre- and postsurgery cardiac and pulmonary problems.
4. Understand management of cardiac-indicated antiplatelet agents and the appropriate use of direct oral anticoagulants in the perioperative period, which will include rescue and reversal agents for emergent surgery.
5. Assess key management strategies for frail, elderly patients; patients with chronic kidney disease; and patients with substance use disorders.

Tuesday, 8:00 a.m.-5:00 p.m.

Gigi Liu, Md, MSc, FACP
Assistant Professor of Medicine, Hospitalist/Proceduralist/COVIDist, Division of Hospital Medicine, Department of Medicine and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD

Participants will learn evidence-based approaches and techniques from national experts on ultrasound-guided procedures commonly performed by general internists. Ample hands-on learning augmented by simulation experience, including practice on phantoms, will be provided. Case-based discussions on pitfalls and ways to troubleshoot common problems will be included.

Learning Objectives:

1. Understand the indications and contraindications for the five common bedside ultrasound-guided procedures for general internists: peripheral vascular access, central vascular access, thoracentesis, paracentesis, and lumbar puncture.
2. Explain the rationale for using ultrasound guidance for these five bedside procedures.
3. Identify the relevant sonoanatomy specific for these five bedside procedures with hands-on scanning practice.
4. Understand the limitations and pitfalls of ultrasound as it relates to each procedure, anatomic differences, and the physics of ultrasound.
5. Perform ultrasound-guided peripheral vascular access, central vascular access, thoracentesis, paracentesis, and lumbar puncture using simulators with strong understanding of ultrasound needle guidance.

*Prerequisite Requirement:
Registrants for this course must have attended ACP’s Point-of-Care Ultrasound: Foundational Skills for Internists 2-day course. Alternate 2-day introductory courses that include a minimum of 50% hands-on time might be considered as a surrogate for ACP’s course. A course agenda and certificate of completion must be submitted for approval. Attestation of significant experience might also be considered as a surrogate at the course director’s discretion. Please submit this information to ACPPOCUS@ acponline.org. You will receive a response within 10 days. If you are not approved for the course, you will receive a full refund.