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  Vol. 31 No. 8 August 2008
 David C. Dale, MD, FACP, Editor-in-Chief   Daniel D. Federman, MD, MACP, Founding Editor
 Wendy Levinson, MD, FACP, Associate Medical Editor, What's New in ACP Medicine
 
 IN THIS ISSUE
The ACP Medicine Weekly Curriculum for Internal Medicine Residency Programs
Chronic Hepatitis
Cirrhosis of the Liver
Anemia: Production Defects
Schizophrenia
Menopause
Corrections

  PRACTICE OF MEDICINE

The ACP Medicine Weekly Curriculum for Internal Medicine Residency Programs

David C Dale, MD
University of Washington Medical Center

DOI 10.2310/7900.2008.NCaug

ACP Medicine is a unique medical text. Every month, our expert authors, staff, and editors produce six to eight new or revised chapters accompanied by a set of clinical questions with answers and commentaries. This type of continuing medical education (CME) has been part of ACP Medicine from its very beginnings as Scientific American Medicine more than 30 years ago. The goal of our text has always been to help busy physicians keep up with what is new and important in internal medicine.

Three years ago, we began to encourage internal medicine residency programs to use ACP Medicine as an integral part of residency education and training. The idea is to use the carefully written, illustrated, and referenced materials in ACP Medicine for a systematic approach to reviewing and learning internal medicine. Residents receive the following:

The program director receives all of these materials, the option of receiving the residents' responses to the case-based questions, ACP Medicine Online, and the bound edition of ACP Medicine. More importantly, participation in this program ensures that residents will have a steady stream of excellent educational materials to augment their clinical experiences and questions and answers to assess their preparedness for board certification and maintenance of certification throughout their careers.

There are now more than 70 programs enrolled in the ACP Medicine weekly curriculum. Program directors and their residents receive an e-mail announcement every Wednesday customized to their program and residents. Residents are instructed to send their answers to their program director or their designated recipient. It is the program's responsibility to grade the tests and to keep track of how the residents performed. A new feature soon will be an online logbook that residents can use to take their tests and program directors can use to see how the residents are doing and who has completed the tests. Program directors are very excited about this feature, which we will be launching next month. Directors and residents have provided many useful ideas for the launch of the program and will be continually involved in making it more useful and effective for enriching and standardizing residents' educational experiences. We are working on developing a matching set of teaching slides to accompany the text; we know at present that directors and faculty often use the illustrations and tables in ACP Medicine in their didactic presentations.

You can learn more about the ACP Medicine weekly curriculum at http://www.acpmedicine.com . For more information about joining ACP as an associate, member, or fellow, go to http://www.acponline.org . We greatly appreciate your ideas for the further development of this program in support of excellence in internal medicine.

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THIS MONTH'S UPDATES

4 Gastroenterology

VIII Chronic Hepatitis

Peter F Malet, MD
Professor of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX

[Buy Chapter]

10.2310/7900.S04C08

The Waning Popularity of Lamivudine

Lamivudine is being used less commonly for treatment of chronic hepatitis B, because of a high rate of resistance development and the availability of more potent agents, such as entecavir. Resistance to lamivudine therapy occurs in 14 to 32% of patients after 1 year of therapy, 38% after 2 years, 49% after 3 years, 66% after 4 years, and 69% after 5 years. Generally, lamivudine resistance can be managed by substituting or adding another oral agent, such as entecavir or adefovir.

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4 Gastroenterology

IX Cirrhosis of the Liver

Ramón Bataller, MD
Staff Member, Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Catalonia, Spain
Pere Ginès, MD
Director, Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Catalonia, Spain

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10.2310/7900.S04C09

A New Test for Diagnosing Cirrhosis

Transient elastography is a new technique that assesses liver stiffness based on the velocity of an elastic wave via an intercostally placed transmitter. It helps differentiate cirrhosis from milder fibrosis and also can predict the degree of portal hypertension. The examination is limited by morbid obesity, ascites, and small intercostal spaces.

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5 Hematology

III Anemia: Production Defects

Elizabeth A Price, MD
Clinical Instructor, Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA
Stanley L Schrier, MD
Professor of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA

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10.2310/7900.S05C03

New Recommendations for Cancer-Related Anemia

Although responses to treatment with erythropoietic stimulating agents (ESAs) have been reported in patients with cancer, the use of ESAs in patients with active cancer may be harmful, with studies showing decreased locoregional progression-free survival and overall survival. A black box warning has been added to the prescribing information for both erythropoietin and darbepoetin, indicating that ESAs are not indicated in patients with solid or nonmyeloid hematologic malignancies not receiving chemotherapy or radiation therapy. Accordingly, both the American Society of Hematology and the American Society of Clinical Oncology have recommended against the use of ESAs in this population.

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13 Psychiatry

VII Schizophrenia

Gunvant K Thaker, MD
Professor of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
William T Carpenter, JR, MD
Professor of Psychiatry and Pharmacology, University of Maryland School of Medicine, Baltimore, MD

10.2310/7900.S13C07

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So Many Genes, So Little Effect

Although considerable data suggest that schizophrenia is a heritable illness, the search for genes that might cause schizophrenia has produced disappointing results. Genome-wide scans using microarray technology that included 500,000 polymorphic markers densely covering the genome have served principally to stress the heterogeneous nature of the disorder. It appears that many genes may cause vulnerability to schizophrenia, each with a modest effect, and that these genes probably interact with one another and with environmental factors.

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16 Women's Health

XI Menopause

Susan D Reed, MD
Associate Professor, Departments of Obstetrics & Gynecology and Epidemiology, University of Washington School of Medicine, Seattle, WA
Eliza L Sutton, MD
Assistant Professor, Department of Medicine, University of Washington School of Medicine, Seattle, WA

10.2310/7900.S16C11

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Hormone Therapy Minimalism

Doses of hormone therapy can be classified as standard, low, and ultra-low; these reduce vasomotor symptoms by 80%, 65%, and 60%, respectively. Low-dose formulations for vasomotor symptoms include oral conjugated estrogen 0.3 mg, oral estradiol 0.5 mg, and transdermal estradiol 0.025 mg, which are estimated to be one-sixth to one-eighth as potent as " low-dose" oral contraceptives. Commonly, women use low-dose estrogen therapy and, more recently, ultra-low-dose (0.0125–0.014 mg) transdermal estradiol estrogen therapy formulations, to minimize risks and side effects.

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CORRECTIONS

In Section 7, Chapter XIV " Antimicrobial Therapy," (Vol. 29, No. 8, August 2006), important information on ketolides is out of date. Please note the following change:

" Telithromycin was originally approved by the FDA in 2004 for the treatment of acute exacerbations of chronic bronchitis, acute bacterial sinusitis, and community-acquired pneumonia with the potential to be used as a fluoroquinolone-sparing agent in situations in which macrolide resistance was a concern. Subsequent reports of acute hepatotoxicity,55 including fatalities, have led to removal of the indications for acute exacerbations of chronic bronchitis and acute bacterial sinusitis as well as black box warnings for hepatotoxicity. Additional serious adverse events include potential visual disturbances, loss of consciousness, and QTc prolongation. Telithromycin is also contraindicated in patients with myasthenia gravis as there have been reports of fatal and life-threatening respiratory failure."

A revision of this chapter will appear in the September 2008 update.

In Section 1, Chapter IV " Atrial Fibrillation" (Vol. 31, No. 2, February 2008), numbers were transposed in Table 9, " Stroke Risk Stratification Schemes for Patients with Atrial Fibrillation" for the Framingham study (2003). The table should appear as follows:

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