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Medicine
Date: 
Wednesday, November 25, 2015
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Course topic: 

Dementia and Diversity in Primary Care: A Primer - Guidelines, Ethnic Differences, and Assessment

Internet Enduring Material Sponsored by:

Stanford University School of Medicine

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Presented by:

Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine

Course Description

Although dementia is the most common diagnosis in older adulthood it is under-recognized in primary care. This gap in recognition is even greater for patients, their caregivers and families who belong to various ethnic and racial minority populations. As U.S. residents are aging, and becoming more racially and ethnically diverse, physicians and other healthcare providers will increasingly need to tailor their care to specific populations. This series of continuing education activities is designed to help healthcare providers recognize dementia, select culturally appropriate assessment tools, and communicate effectively about dementia care in ethnically and racially diverse populations. This initial course, Dementia and Diversity in Primary Care: A Primer - Guidelines, Ethnic Differences, and Assessment, will introduce primary care physicians and members of their care teams to the “ethnogeriatric imperative” and its impact on dementia. Future courses will provide information on assessing and caring for diverse racial and ethnic groups.

Intended Audience

This course is designed for physicians in primary care, family practice, internal medicine and psychiatry specialties and nurses and social workers who work with older people. 

Dates, Duration & Fee

  • Release Date: November 25, 2015
  • Expiration Date: November 27, 2017
  • Estimated Time to Complete: 1.5 Hours
  • CME Credits Offered: 1.50
  • Registration Fee: FREE

Please review all of the information on this page before clicking the Courseware tab at the top of the page to begin the course.

To Obtain CME Credits

  • Review the information below and complete the entire activity.
  • Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the CME post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

Learning Objectives

At the conclusion of this activity, participants should be able to:

  • Compare the risk of developing Alzheimer’s disease in racial and ethnic minorities to the general population.
  • Identify the barriers faced by ethnic/racial minorities in obtaining diagnosis and services after onset of dementia.
  • Identify dementia in older adults from diverse race/ethnic backgrounds.

Table of Contents

  1. Introduction
  2. Overview of Dementia and Ethnicity
  3. Diagnostic Guidelines for Neurocognitive Disorders
  4. Overview of Dementia Care for Primary Care Providers
  5. Literature Regarding Ethnic Differences in Dementia Treatment
  6. Dementia Assessment for Primary Care Providers
  7. Diagnosis and Treatment of Dementia for Primary Care Providers 
  8. Course Wrap-Up 
  9. Resources and References
  10. Help! 

Disclosures

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Nancy Morioka-Douglas, MD, MPH 
Clinical Professor, General Medicine Disciplines
Stanford University School of Medicine
Medical Director for Patient Centered Care in Primary Care, Stanford Health Care
Co-Director, Stanford Geriatric Education Center 
Course Director
Speaker

Dolores Gallagher-Thompson, PhD, ABPP 
Professor of Research, Department of Psychiatry and Behavioral Sciences
Director, Stanford Geriatric Education Center 
Stanford University School of Medicine
Co-Course Director
Speaker

Nusha Askari, PhD  
Program Manager
Department of Psychiatry/Public Mental Health & Population Sciences 
Stanford University School of Medicine
Planner

Kala Mehta, DSC, MPH
Associate Professor
Department of Epidemiology and Biostatistics, University of California, San Francisco
Program Evaluation Consultant, Stanford Geriatric Education Center 
Stanford University School of Medicine
Planner

Yuan Marian Tzuang, MSW 
Program Coordinator, Stanford Geriatric Education Center 
Stanford University School of Medicine 
Planner

Annecy Majoros, BA
Research Assistant
Department of Psychiatry/Public Mental Health & Population Sciences
Program Assistant
Department of Medicine/General Internal Medicine
Stanford University School of Medicine
Planner

Gwen Yeo, PhD, AGSF 
Director Emerita, Stanford Geriatric Education Center
Stanford University School of Medicine 
Speaker

Michael D. Greicius, MD, MPH  
Associate Professor, Department of Neurology & Neurological Science 
Associate Professor (by courtesy), Department of Psychiatry and Behavioral Science
Stanford University School of Medicine 
Speaker

Technical Design and Development

Mike McAuliffe
Stanford EdTech 

Greg Bruhns
Stanford Online

Jim Neighbours 
Stanford Center for CME

Jenny Xu
SGEC Instructional Designer

Hardware/Software Requirements

  • Computer with Internet connection
  • Current version of Chrome, Firefox or Safari browser. You must have javascript enabled.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The California Board of Registered Nursing recognizes that Continuing Medical Education (CME) is acceptable for meeting RN continuing education requirements as long as the course is certified for AMA PRA Category 1 Credits™ (rn.ca.gov). Nurses will receive a Certificate of Participation following this activity that may be used for license renewal.

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html

CME Privacy Policy

Click here to review the Stanford Center for CME Privacy Policy.

Contact Information

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu

Bibliography

Braun KL, Takamura JC, Mougeot T. Perceptions of dementia, caregiving and help-seeking among Vietnamese immigrants. J Cross Cult Gerontol. 1996;11(3):213-28.

CALD Dementia Strategic Model. (2008). Australia.

DiGregorio M, Salemink O. Living with the dead: The politics of ritual and remembrance in contemporary Vietnam. Journal of Southeast Asian Studies. 2007;38(3):433-440.

Hinton L. Improving care for ethnic minority elderly and their family caregivers across the spectrum of dementia severity. Alzheimer Disease and Associated Disorders. 2002;16(Suppl 2):S50-S55.

Hinton L, Franz C, Yeo G, Levkoff S. Conceptions of dementia in a multi-ethnic sample of family caregivers. J Am Geriatr Soc. 2005;53(8):1405-10. 

Hinton L, Levkoff SA, Fox K. Introduction: exploring the relationships among aging, ethnicity, and family dementia caregiving. Cult Med Psychiatry. 1999;23(4):403-13. 

Hinton L, Tran JNU, Tran C, Hinton D. Religious and Spiritual Dimensions of the Vietnamese Dementia Caregiving Experience. Hallym Int J Aging HIJA. 2008;10(2):139-160. 

Phan T, Silove D. An overview of indigenous descriptions of mental phenomena and the range of traditional healing practices amongst the Vietnamese. Transcultural Psychiatry. 1999;36(1):79–94. 

Samton JB, Ferrando SJ, Sanelli P, Karimi S, Raiteri V, and Barnhill, JW. The clock drawing test: diagnostic, functional, and neuroimaging correlates in older medically ill adults. J Neuropsychiatry Clin Neurosci. 2005;17(4):533-40. 

Schipper, KM. The Taoist Body. Berkeley, CA: University of California Press, 1993 

Timberlake EM, Cook KO. Social work and the Vietnamese refugee. Social Work. 1984;29(2):108-113. 

Tran JNU, Yeo G. Older Vietnamese Americans. In: Adler RN, Kamel HK, eds. Doorway Thoughts: Cross-cultural Health Care for Older Adults. Boston, MA: Jones & Bartlett, 2004. 

U.S. Census Bureau (2001). The Asian and Pacific Islander Population in the United States: March 2000. Retrieved from http://www.census.gov/population/www/socdemo/race/api.html. 

Yeo G, Tran JNU, Hikoyeda N, Hinton L. Conceptions of dementia among Vietnamese American caregivers. Journal of Gerontological Soical Work. 2001;36(1-2):131-52. 

Yeo G, Gallagher-Thompson D. (eds). Ethnicity and the Dementias. New York, NY: Routledge, 2006.

©2015 Stanford University School of Medicine

CME Dementia and Diversity

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About this Course

Around the world, we find ourselves facing global epidemics of obesity, Type 2 Diabetes and other predominantly diet-related diseases. To address these public health crises, we urgently need to explore innovative strategies for promoting healthful eating. There is strong evidence that global increases in the consumption of heavily processed foods, coupled with cultural shifts away from the preparation of food in the home, have contributed to high rates of preventable, chronic disease. In this course, learners will be given the information and practical skills they need to begin optimizing the way they eat. This course will shift the focus away from reductionist discussions about nutrients and move, instead, towards practical discussions about real food and the environment in which we consume it. By the end of this course, learners should have the tools they need to distinguish between foods that will support their health and those that threaten it. In addition, we will present a compelling rationale for a return to simple home cooking, an integral part of our efforts to live longer, healthier lives.

View the trailer for the course here: https://www.youtube.com/watch?v=z7x1aaZ03xU

Subtitles available in English
Instructor(s): 
Maya Adam
Stanford Food and Health

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Date: 
Thursday, January 21, 2016
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ABOUT THIS COURSE

This course provides an overview of women's health and human rights, beginning in infancy and childhood, then moving through adolescence, reproductive years and aging. We consider economic, social, political and human rights factors, and the challenges women face in maintaining health and managing their lives in the face of societal pressures and obstacles.

We focus on critical issues, namely those that may mean life or death to a woman, depending on whether she can exercise her human rights. These critical issues include: being born female and discrimination; poverty; unequal access to education, food, paid work and health care; and various forms of violence. Topics discussed include son preference, education, HIV/AIDS, reproductive health, violence in the home and in war and refugee circumstances, women's work, sex trafficking, and aging.

Our MOOC will have a special focus on creating an international network of engaged students. We will ask students to take part in interactive discussions and cooperative exercises and to share their own experiences. We also ask students to engage with the communities they live in, in order to deepen their understanding of the issues and tie academic ideas to real-life circumstances.

To find out more details about this course and its principles, please visit our Project Page at www.internationalwomenshealth.org

Our Facebook is: https://www.facebook.com/internationalwomenshealth
Twitter: https://twitter.com/intwomenshealth, #intlwomenshealth #iwhhr
Tumblr: http://intlwomenshealth.tumblr.com/

COURSE STAFF

Course Staff Image #1

Anne Firth Murray

Anne Firth Murray, a New Zealander, was educated at the University of California and New York University in economics, political science and public administration, with a focus on international health policy and women’s reproductive health.

For the past twenty-five years, Anne has worked in the field of philanthropy, serving as a consultant to many foundations. From 1978-1987, she directed the environment and international population programs at the William and Flora Hewlett Foundation in California. She is the Founding President of The Global Fund for Women, which aims to seed, strengthen, and link groups committed to women’s well-being and human rights. In 2005, Anne was nominated along with a thousand activist women for the Nobel Peace Prize.

Anne is a Consulting Professor in Human Biology at Stanford University, where she teaches on women's health, human rights and love as a force for social justice. She is the author of the books Paradigm Found: Leading and Managing for Positive Change and From Outrage to Courage: The Unjust and Unhealthy Situation of Women in Poorer Countries and What They Are Doing About It, on international women's health.

 

Course Staff Image #2

Kevin Hsu

Kevin heads an educational design studio, Skyship Design, which specializes in developing open online courses (MOOCs) and deploying digital tools in the classroom. He is dedicated to crafting new experiences for students and developed some of Stanford’s earliest social science MOOCs for a global audience, including "Democratic Development" featuring Professor Larry Diamond.

Kevin also teaches in the Program on Urban Studies at Stanford University, where he is an instructor for International Urbanization, which explores the sustainable development of cities, and Civic Dreams, Human Spaces, a Stanfordd.school (design school) class focused on creating vibrant, inclusive public spaces.

FREQUENTLY ASKED QUESTIONS

What basic principles form the foundation course?

Because we believe that what we do is important but that the way we do it is more important, we attempt to teach and learn according to a set of principles that will guide the content and processes of the course. These are: compassion, mutual learning, respect, transparency, trust, and truth. 

What do I need to take this course?

An interest in health and social justice. It will be useful to have an open mind, willingness to hear different points of view, and a commitment to positive social change. 

Access to the Internet. A stable internet connection will also be useful, as much of the other content, including video interviews and lectures will be delivered online.

The course already started! Is it too late to join?

No you don't have to worry.Because it is an online class, you can comfortably jump into this course the first couple weeks while it is running. You get to review the material and watch video lectures and interviews on your own time! However, you'll want to get up to speed so you can interact with the other students in this international online community.

Is there a textbook for the class?

The primary text for the class is a book on international health and human rights, From Outrage to Courage: The Unjust and Unhealthy Situation of Women in Poorer Countries and What They Are Doing About It (Second Edition), by Anne Firth Murray. If you are interested in having a copy of the book, you can obtain one from Amazon.com. We will also make individual chapters available online during the course.

Can I receive a Statement of Accomplishment for this course?

Yes, participants who successfully complete the required elements of the course will receive a personalized Statement of Accomplishment. The Statement of Accomplishment does not confer a Stanford University grade, course credit or degree.

 

PLEASE NOTE: The content of this course is intended to promote contemplation and discussion of global health issues. Certain issues may be controversial in some cultures and/or disturbing to some people. As such, participants must be aware that some content may be objectionable or uncomfortable to view/read/access. If you feel you might be offended by the content of this course, you should not continue. You access this material at your own risk and are solely responsible for compliance with the laws applicable to your country of residence.

International Women's Health

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Date: 
Wednesday, January 6, 2016
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Course topic: 

WELCOME TO PALLIATIVE CARE ALWAYS.

We are excited to have you join our community of participants interested in improving quality of life for patients and families experiencing serious illness. 

ABOUT THIS COURSE

Palliative care can help ease suffering and improve wellbeing in people living with serious illnesses such as cancer.

Palliative Care Always is an online, case-based course for health care practitioners who work in cancer care. We believe that incorporating the principles of palliative care—symptom management, goals of care and effective communication—into clinical practice can improve the quality of life for our patients and their support systems. We also believe palliative medicine can improve quality of life for clinicians. We’ve designed this course to educate you about palliative medicine and how it integrates with oncology, and to help you develop primary palliative care skills. Our hope is that you feel increasingly equipped to support the diverse needs of your patients and your own needs as a healthcare provider.

Palliative Care Always features presentations from a variety of Stanford palliative medicine clinicians as well as video scenes with a fictional patient experiencing colon cancer. The course also includes interactive discussions with other participants to learn from role play and practical experiences.

By the end of the course clinicians will be able to:

  • Describe the scope and role of palliative care as part of a patient and family’s care plan 
  • Describe the components of an interdisciplinary treatment plan for physical, psychosocial, and spiritual care, including screening, assessment and management of patient needs
  • Practice basic symptom and distress management and determine when to involve palliative care specialists for extra support
  • Describe the issues around transitions in care (e.g. survivorship or hospice transition) and key needs for patients and caregivers at these times 
  • Respond to common caregiver needs throughout the care continuum
  • Practice effective communication skills with other healthcare providers, patients, and their families; including responding to emotion, coaching in self-management of symptoms and distress, and discussing goals of care

PREREQUISITES

This course is ideal for nurses, social workers, oncologists, patients and families. No prior experience with palliative medicine or cancer care is necessary.

COURSE STAFF

This course was developed by faculty members in Palliative Medicine at the Stanford Health Care. Your course moderator is Erika Tribett, MPH. 

Course Staff Image #1

Kavitha Ramchandran MD

Kavitha Ramchandran MD, graduated with an undergraduate degree in Human Biology from Stanford University, did medical school and residency training in medicine at University of California, San Francisco and completed her fellowship in Medical Oncology and Palliative Medicine at Northwestern University, Chicago. She joined faculty at Stanford University in 2007. Currently she is a Clinical Assistant Professor of Medicine in the Division of Oncology and Division of General Medical Disciplines. 

Contributing faculty include:

  • Ellen Brown, MD - Physician and Medical Director of Pathways Hospice 
  • Kelly Bugos, MA RN ANP-BC - Nurse Practitioner and Manager of the Survivorship program at Stanford Health Care
  • Sandy Chan, LCSW - Social worker and Manager of Outpatient Palliative Care at Stanford Health Care
  • Joshua Fronk, DO - Palliative care physician at Stanford Health Care
  • Lynn Hutton, MSW - Social work fellow at Lucile Packard Children's Hospital
  • Ed Kilbane, MD - Psychiatrist
  • Lori Klein, BCC - Chaplain and Director of Spiritual Care Services at Stanford Health Care
  • Judy Passaglia, RN MS ACHPN - Palliative nurse and Manager of Inpatient Palliative Care at Stanford Health Care
  • Kim Sickler, CNS - Palliative nurse specialist at Stanford Health Care

COURSE STRUCTURE

The course is a series of twelve modules. Each module will introduce you to a specific aspect of palliative medicine—from effective communication and symptom management to addressing goals of care and specific types of distress. You will learn tips and tools to help you screen for palliative needs and offer basic palliative care. 

Module 1: Introduction to Palliative Care

Module 2: Communicating with Families and Patients

Module 3: Psychosocial Support

Module 4: Goals of Care

Module 5: Pain Assessment and Management

Module 6: Nausea and Fatigue Management

Module 7: Survivorship

Module 8: Spiritual Care

Module 9: Psychological Support

Module 10: Child Social Support

Module 11: Hospice Care

Module 12: Reflection

Each module consists of four main sections: 

  • Reading and Reflection - description
  • Scenes with Sarah - description 
  • Lecture - description
  • Interactive Group Discussion - description

OFFICE HOURS

Each week, faculty will post a video that answers your questions and discusses current issues related to the week's topic. Questions may be submitted Wednesday through Sunday, and videos will be posted by Tuesday of the following week.

WEEKLY DISCUSSION SESSIONS

Each module will close with a discussion session with a small group of your peers. The goal is to practice and reflect on the skills you’ve picked up during each module and learn from others in the course. Each discussion will last approximately 45 minutes. The platform we will use for online discussions is called Talkabout. In order to access Talkabout, you will need to make sure your computer is set up to use Google Hangout. Please follow the instructions here to load and join Talkabout.

If you prefer not to use Talkabout, you can complete these discussions in person or in another manner of your choice. In order to receive credit for these discussion sessions, you will need to submit a 100-word response that reflects on your experience. The free response is located in the "Talkabout Discussion" section of each module. 

FREQUENTLY ASKED QUESTIONS

How much time will I spend on this course each week?

It varies, as some of the modules contain more content than others. In general, you should expect to spend between 2 and 3 hours on Palliative Care Always each week. This accounts for light reading, watching videos, answering assessment questions and participating in interactive discussions.

Can I obtain a Statement of Accomplishment for this course?

Yes. To receive a "Statement of Accomplishment" for this course (i.e., a passing grade), you must receive a score of at least 75%. 

Are there required assignments?

For those who are interested in a Statement of Accomplishment, grades include completion of Assessment questions throughout all 12 modules (50%), submission of reflection posts on the course discussion forum (25%), and participation in interactive discussion sessions (25%). Of course, you are welcome to do only the components of the course you are interested in, if the grade doesn't matter to you.

Palliative Care

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Date: 
Monday, January 25, 2016
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COURSE DESCRIPTION

Physical health, emotional well-being, social relationships, and professional success all require the ability to regulate our thoughts, emotions, and actions. Advances in psychology, neuroscience, medicine, and mind-body research are beginning to paint a new picture of what willpower is, why it matters, and how to develop it. 

Is willpower in the mind or in the body? Is it possible to run out of willpower, and how do you build a bigger reserve? What motivates people to change? Why do we talk ourselves out of things we really want or need to do? How much control over our thoughts and feelings do we really have, and what are the healthiest ways to regulate them? This course will address those questions through lectures, readings, and discussions and will give students the opportunity to apply the ideas of the course toward making an important change or pursuing a major goal in their lives. 

This course may not be taken for a Letter Grade. 

Kelly McGonigal, Senior Teacher, Center for Compassion and Altruism Research and Education (CCARE), Stanford

Kelly McGonigal teaches for a wide range of programs at Stanford, including the School of Medicine and the Graduate School of Business. In collaboration with CCARE, she has conducted scientific research on the benefits of compassion training. She has received the Walter J. Gores Award for Excellence in Teaching at Stanford. She is the author of The Upside of Stress and The Willpower Instinct. McGonigal received a PhD in psychology from Stanford.

Textbooks for this course

(Recommended) McGonigal, The Willpower Instinct (ISBN 978-1583334386)

DOWNLOAD THE PRELIMINARY SYLLABUS » (subject to change)

Science of Willpower and Change

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Date: 
Wednesday, October 28, 2015
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Overview

Recent cutting-edge, translational research in diagnostics and nano-therapies is having a major influence on how we treat and prevent cancer and cardiovascular diseases. This course covers state-of-the-art and emerging bio-sensors, bio-chips, imaging modalities and nano-therapies studied in the context of human physiology—the nervous system, circulatory system and immune system.

Instructors

  • Shan Wang Professor of Electrical Engineering
  • Adam de la Zerda Assistant Professor, Electrical Engineering

Topics Include

  • 3D and 4D body images
  • Cancer
  • Cardiovascular disease
  • In-vitro diagnostics
  • In-vivo imaging
  • Ultrasounds
  • X-rays
 

Prerequisites

None, however, a basic knowledge of electromagnetism, optics, chemistry, thermodynamics, or human biology will be complementary.

 


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Date: 
Friday, October 23, 2015
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Course topic: 

Now Open!

Presented by:

The Psychiatry and Behavioral Sciences Department at Stanford University School of Medicine

Course Description

This CME activity provides a practical approach to the management of prescription drug misuse and addiction, including how to use the clinical interview and CURES (California’s Prescription Drug Monitoring Program) to identify if a problem exists, and how to intervene once the problem has been identified. Animated didactic videos, interactive slides, and video case scenarios will be used to put these principles into practice with a treatment algorithm. The most compassionate approach to tapering patients down and off the medication they are misusing will also be discussed.

Intended Audience

This course is designed for physicians and all health care providers who interact with patients around the issue of prescription medication, e.g. nurses, pharmacists, physician assistants.

Dates, Duration & Fee

  • Release Date: October 23, 2015
  • Expiration Date: August 31, 2018
  • Estimated Time to Complete: 2 hours
  • CME Credits Offered: 2.00
  • Registration Fee: FREE

Please review all of the information on this page before clicking the Courseware tab at the top of the page to begin the course.

To Obtain CME Credits

  • Review the information below and complete the entire activity.
  • Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

Learning Objectives

At the conclusion of this activity, participants should be able to:

  • Describe the current state of the prescription drug misuse problem.
  • Describe the role of the provider in the prescription drug misuse problem.
  • Recognize drug-seeking patterns and strategies used by patients who are misusing prescription medications.
  • Diagnose a prescription drug use problem when it is present.
  • Reduce or avoid using enabling and defensive behaviors which exacerbate the problem in the patient.
  • Describe the implications for treatment and outcomes when prescription drug misuse is recognized as a chronic medical illness.
  • Interpret findings on CURES, California’s prescription drug monitoring program, to identify a prescription drug problem.

Table of Contents

  1. Introduction
  2. Describing the Prescription Drug Epidemic
  3. The Doctor-Patient Relationship
  4. How Doctors Can Help Instead of Harm?
  5. Course Wrap-up
  6. Resources and References
  7. Help!

Disclosures

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Anna Lembke, MD

Assistant Professor of Psychiatry and Behavioral Sciences
Director, Stanford Addiction Medicine Program
Stanford University School of Medicine
Course Director
Speaker

Technical Design and Development

Mike McAuliffe
Stanford EdTech

Kimberley Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Role Play Actor

Pamela Nemecek

Hardware/Software Requirements

  • Computer with Internet connection
  • Current version of Chrome or Safari browser. You must have javascript enabled.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The California Board of Registered Nursing recognizes that Continuing Medical Education (CME) is acceptable for meeting RN continuing education requirements as long as the course is certified for AMA PRA Category 1 Credits™ (rn.ca.gov). Nurses will receive a Certificate of Participation following this activity that may be used for license renewal.

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the portal: http:/ /lane.stanford.edu/portals/cultural.html.

CME Privacy Policy

Click here to review the Stanford Center for CME Privacy Policy.

Contact Information

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu

Bibliography

Administration SA and MHS. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

Centers for Disease Control and Prevention (institution). No Title. http://www.cdc.gov/vaccines/about/terms/glossary.htm#e. Accessed July 30, 2015.

Chen LH, Hedegaard H, Warner M. QuickStats: Rates of deaths from drug poisoning and drug poisoning involving opioid analgesics—United States, 1999–2013. MMWR Morb Mortal Wkly Rep. 2015;64(01):32.

Crews F, He J, Hodge C. Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol Biochem Behav. 2007;86(2):189-199.
Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 2013.

Drugfree.org. 2012 Partnership Attitude Tracking Study. 2013. http://www.drugfree.org/wp-content/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf. Accessed December 16, 2013.

George O, Le Moal M, Koob GF. Allostasis and addiction: role of the dopamine and corticotropin-releasing factor systems. Physiol Behav. 2012;106(1):58-64.
 
Humphreys K. Circles of Recovery: Self-Help Organizations for Addictions. Vol (Edwards G, ed.). Cambridge: Cambridge University Press; 2004.

Kauer JA, Malenka RC. Synaptic plasticity and addiction. Nat Rev Neurosci. 2007;8(11):844-858.

Lembke A. From self-medication to intoxication: time for a paradigm shift. Addiction. 2013;108(4):670-671.

Lembke A. Why doctors prescribe opioids to known opioid abusers. N Engl J Med. 2013;368(5):485.

Manchikanti L. National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician. 2007;10(3):399-424.

Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11:S63-S88.

McDonald DC, Carlson K, Izrael D. Geographic variation in opioid prescribing in the U.S. J Pain. 2012;13(10):988-996.

Nestler EJ. Is there a common molecular pathway for addiction? Nat Neurosci. 2005;8(11):1445-1449.

Paulozzi LJ. Prescription drug overdoses: a review. J Safety Res. 2012;43(4):283-289.

Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- {United States}, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-1492.

Ries RK, Fiellin DA, Miller SC, Saitz R. Principles of Addiction Medicine, 4th Ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Williams; 2009.

Robison LM, Sclar DA, Skaer TL, Galin RS. National trends in the prevalence of attention-deficit/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990-1995. Clin Pediatr (Phila). 1999;38(4):209-217.

Schultz W. Potential vulnerabilities of neuronal reward, risk, and decision mechanisms to addictive drugs. Neuron. 2011;69(4):603-617.

Selemon LD. A role for synaptic plasticity in the adolescent development of executive function. Transl Psychiatry. 2013;3:e238.

Steketee JD, Kalivas PW. Drug wanting: behavioral sensitization and relapse to drug-seeking behavior. Pharmacol Rev. 2011;63(2):348-365.

Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD; 2013.

Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the United States: promises and perils. Pain. 2013;154 Suppl:S94-S100.

Warner M, Chen LH, Makuc DM, Anderson RN MA. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no 81 Hyattsville, MD US Dep Heal Hum Serv CDC. 2011.

Weisner CM, Campbell CI, Ray GT, et al. Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders. Pain. 2009;145(3):287-293.

Wise RA, Koob GF. The development and maintenance of drug addiction. Neuropsychopharmacology. 2014;39(2):254-262.

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Date: 
Tuesday, November 17, 2015
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ABOUT THIS COURSE

This course contains selected topics that will help participants understand applications of molecular biology in medicine. Topics include reading the primary literature, molecular techniques, DNA recombination, and genome expression. The materials consist of short videos linked to questions that help participants evaluate their understanding of the material.

PREREQUISITES

None. Participants should be able to fill gaps in their knowledge by simple web searches.

COURSE STAFF

Gilbert Chu

Gilbert Chu is a Professor of Medicine and Biochemistry at Stanford University. He has taught at Stanford since 1987 and has received several teaching awards from the school of medicine.

FREQUENTLY ASKED QUESTIONS

Will I get a Statement of Accomplishment?

No. 

Are any additional textbooks or software required?

No. Some references to additional material are provided in the videos.


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Date: 
Monday, November 2, 2015
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Now Open!

Optimizing Antimicrobial Therapy with Timeouts

Internet Enduring Material Jointly Provided by:

Stanford University School of Medicine (CME) and Tufts University School of Medicine (CPE)

Stanford School of Medicine logo     Tufts School of Medicine logo

Presented by:

The Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine

Course Description

Antibiotic misuse is widespread and has dire patient and public health consequences. National organizations, including the CDC and the Joint Commission, advocate for a formal “Antibiotic Timeout” to reassess empiric antibiotics 48-72 hours after their initiation. During this Timeout, clinicians should answer the following questions:

  • Does the patient have an infection that will respond to antibiotics?
  • If so, is the patient on the right antibiotic(s) and is it being administered in the correct dose and by the correct route and (in the case of intravenous therapy) duration of infusion?
  • Can a more targeted antibiotic regimen be used to treat the infection (i.e., de-escalation)?
  • For how long should the antibiotic(s) be administered?

This CME/CPE activity provides a practical approach to performing “Antibiotic Timeouts” in the inpatient setting. Using short, didactic sessions, we will provide examples on how to reassess antibiotic therapy started empirically using clinical, laboratory, and microbiological data. The majority of this CME/CPE will be high-yield, interactive inpatient cases covering skin and soft tissue infections, pneumonia, catheter-associated urinary tract infections, and neutropenic fever, that illustrate the timeout process and the principles of appropriate use of antimicrobials.

Intended Audience

This course is designed to meet the educational needs of physicians from a wide variety of specialties including cardiology, critical care, family practice, general surgery, hospitalists, infectious diseases, internal medicine, neurology, oncology, pediatrics, and urology, as well as pharmacists, nurse practitioners, and physician assistants.

Dates, Duration & Fee

  • Release Date: November 2, 2015
  • Expiration Date: November 2, 2017
  • Estimated Time to Complete: 2 Hours
  • CME/CPE Credits Offered: 2.00
  • Registration Fee: FREE
  • There is a $15 fee for pharmacists to obtain ACPE credit.

To Obtain CME Credits or Certificate of Participation

  • Review the information below and complete the entire activity.
  • Complete the Post-test, Evaluation Survey, and Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

To Obtain CPE Credits

  • Register and view all the course content.
  • Receive a score of 75% or higher on the post-test, you will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Complete the Evaluation Survey, which includes providing your name, email address, and NABP e-Profile ID to Stanford
  • Attest to the Activity Completion Statement at the end of the activity

After successfully attesting your completion of the activity, a link to pay for CPE credit at the TUSM OCE online store will be avilable on the Activity Completion Statement page.

All pharmacists licensed in the United States and wishing to obtain ACPE credit are required to submit to TUSM OCE; a NABP e-Profile ID and the month/day of birth in a four-digit format, e.g., January 5 = 0105. Contact hours will be issued through a NABP-managed online tracking system called CPE Monitor.

The above data and $15 fee will be required at the TUSM OCE online store for processing.

Learning Objectives

At the conclusion of this activity, participants should be able to:

  • Describe the principles and shortcomings of empiric antibiotic therapy.
  • Routinely conduct all steps of the antibiotic timeout, in accordance with CDC guidelines on antibiotic stewardship that include:
    • Analyzing laboratory and clinical data
    • Formulating a rationale for continued antibiotic use
    • Documenting rationale in patient’s electronic medical record
    • Determining the most effective duration of antibiotic therapy
    • Deciding when it is appropriate to switch from an IV to oral route of antibiotic administration

Table of Contents

  1. Introduction
  2. Empiric Antibiotic Therapy
  3. Antibiotic Timeout Cases
  4. Course Wrap-up
  5. Resources and References
  6. Help!

Disclosures of Relevant Financial Relationships with Commercial Interests

All faculty, course directors, planning committee members and others in a position to control the content of an educational activity are required to disclose to the audience any relevant financial relationships with commercial interests. Conflicts of interest resulting from a relevant financial relationship are resolved prior to activity release.

The following planner indicated having relevant relationships with industry to disclose:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Bayer & Cubist Pharmaceuticals - Advisory Board Member

The following planners, speakers, authors, and reviewers have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Speaker/Author

Marisa Holubar, MD, MS
Clinical Assistant Professor in Medicine, Division of Infectious Disease and Geographic Medicine
Associate Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Speaker/Author

Elizabeth Robilotti, MD, MPH
Assistant Attending, Infectious Diseases
Associate Director, Infection Control
Memorial Hospital for Cancer and Allied Diseases,
Memorial Sloan Kettering Cancer Center, New York, NY
Course Director
Reviewer

Emily Mui, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Lina Meng, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Arjun Srinivasan, MD (CAPT, USPHS)
Associate Director for Healthcare-Associated Infection Prevention Programs
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Speaker

Kirthana R. Beaulac, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Tufts Medical Center, Boston, MA
Reviewer

Technical Design and Development

Mike McAuliffe
Stanford EdTech

Kimberly Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Hardware/Software Requirements

Minimum Hardware Requirements: WINDOWS: Processor: Intel Core 2 Duo, RAM: 2 GB, Operating System: Vista, Windows 7, 8, or better. MAC: Processor: Intel Core 2 Duo, RAM: 2 GB, Operating System: 10.7 or better.

Minimum Software Requirements: Web Browser: Chrome (v40.0 or higher) or Safari (v5.0.6 or higher) with Javascript enabled. If you don't have it, you will need a current version of Adobe Flash Player, which can be downloaded here: http://get.adobe.com/flashplayer/

Minimum Internet: LAN, Cable, or DSL connection is highly recommended, Cellular (4G/LTE) may also be used.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacists

Tufts University School of Medicine Office of Continuing Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This activity is available for 2.00 contact hours, Universal Activity Number: 0054-9999-15-007-H01-P

Type of continuing pharmacy education: application-based

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME/CPE activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html.

TUSM OCE Policy on Privacy and Confidentiality

Click here to review the TUSM OCE Policy on Privacy and Confidentiality

SCCME Privacy Policy

Click here to review the Stanford Center for CME Privacy Policy.

Contact Information

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team.

If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu.

For question regarding ACPE certification, please contact Tufts University School of Medicine - Office of Continuing Education at med-oce@tufts.edu or 617-636-6579.

Bibliography

Deresinski S. Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. 2007;45 Suppl 3:S177-83. PMID: 17712744

Oxman DA, Adams CD, Deluke G, et al. Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: an observational study with a pharmacist-driven intervention. J Pharm Pract. 2015;28(5):457-61. PMID: 24651641

Duchene E, Montassier E, Boutoille D, et al. Why is antimicrobial de-escalation under-prescribed for urinary tract infections? Infection. 2013;41(1):211-4. PMID: 23124907

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. PMID: 15699079

Freifeld AG, Bow EJ, Sepkowitz KA, et al, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93. PMID: 21258094

Hooton TM, Bradley SF, Cardenas DD, et al.; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63. PMID: 20175247

Mandell LA, Wunderink RG, Anzueto A, et al.; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 (Suppl 2):S27-72. PMID: 17278083

Stevens DL, Bisno AL, Chambers HF, et al, Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014; 59(2):e10-52. doi: 10.1093/cid/ciu444. Erratum in: Clin Infect Dis. 2015; 60(9):1448. Dosage error in article text. PMID: 24973422

For a complete listing see the Resources and References module in the course.

©2015 Stanford University School of Medicine

CME Optimizing Time Outs

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Date: 
Monday, September 21, 2015 to Friday, October 23, 2015
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This course is offered by Stanford Continuing Studies.

Inflammation is a double-edged sword. It is required to protect the body, but too much of it can create disease. Diabetes, cancer, depression, and stroke are just a few of the diseases associated with chronic inflammation. How can something that protects us from infection and helps us to repair and restore the body also be so bad for us? 

Chronic inflammation is associated with lifestyle factors like obesity, diet, exercise, sleep habits, and stress levels. However, the root cause can be attributed to the impact of these factors at a cellular and a molecular level. An intimate and complex network of communication is constantly taking place in our bodies, and our immune system is at the center of this network. Signals about what we eat, how much we weigh, and how much we exercise are all communicated through our immune system and impact our levels of inflammation. In this online course, we will take a closer look at how our lifestyle choices affect our health through inflammation and investigate the cellular events orchestrating our healthy and unhealthy states.


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