acg grand rounds - cp ls edits-no animations - compatibility … · 2020. 11. 23. · week 35:...

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Welcome to the Virtual Grand Rounds Waiting Room – The educational activity will begin promptly at 12 Noon Eastern.


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American College of Gastroenterology

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www.gi.org/research‐awards

Read the Grant Flyer, FAQs, or visit the webpage for the RFAs.

Application Deadline: December 4, 2020

SEVEN different award types; INCREASED Junior Faculty FUNDING; NEW Mid‐Career Bridge Funding; Med Resident and Student Awards


Participating in the Webinar

All attendees will be muted and will remain in Listen Only Mode.

Type your questions here so that the moderator can see them. Not all questions will be answered but we will get to as many as possible.

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How to Receive CME and MOC Points

LIVE VIRTUAL GRAND ROUNDS WEBINAR

ACG will send a link to a CME & MOC evaluation to all attendees on the live webinar.

ABIM Board Certified physicians need to complete their MOC activities by December 31, 2020 in order for the MOC points to count toward any MOC requirements that are due by the end of the year. No MOC credit may be awarded after March 1, 2021 for this activity.

MOC QUESTION

If you plan to claim MOC Points for this activity, you will be asked to: Please list specific changes you will make in your

practice as a result of the information you received from this activity.

Include specific strategies or changes that you plan to implement.THESE ANSWERS WILL BE REVIEWED.

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ACG Virtual Grand RoundsJoin us for upcoming Virtual Grand Rounds!

Visit gi.org/ACGVGR to Register

Week 35: Vaccinations for the Immunocompromised in the Era of COVID Francis A. Farraye, MD, MSc, FACGDecember 3, 2020 at Noon EDT

Week 36: New Therapeutic Options for EoE and EGIDs on the HorizonIkuo Hirano, MD, FACG December 10, 2020 at Noon EDT

NOTE: There will be no Virtual Grand Rounds on November 26 due to Thanksgiving

Disclosures:

Speaker: Timothy B. Gardner, MD, MS, FACGDr. Gardner has no conflicts of interest related to this talk.

Moderator: Linda S. Lee MDDr. Lee has no conflicts of interest related to this talk.

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Virtual Grand Rounds universe.gi.org

Timothy B. Gardner, MD, MS, FACGAssociate Professor of Medicine

Geisel School of Medicine at DartmouthSection of Gastroenterology and Hepatology

Dartmouth-Hitchcock Medical Center

ACG Virtual Grand Rounds

ACG Clinical Guideline:Chronic Pancreatitis


Objectives

2. Diagnosis

1. Designing Clinical Guidelines

5. Management of EPI

4. Management of Pain

3. Etiology and Natural History

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Objectives

Hermits are still out there…

North Pond Hermit, Maine


Chief Complaint: Chronic abdominal pain

Case Presentation

History of Present Illness:

- 42-year-old male- Insidious onset of pain for several years- Epigastric with radiation to the back- 20-30 ounces of alcohol daily- Unremarkable lab testing- Normal fecal elastase- CFTR ΔF508 heterozygote

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Case Presentation

Serology: Normal amylase, lipase, TTG, IgG4, CA 19-9


Case Presentation

4 EUS Morphologic Criteria

• Hyperechoic duct wall (body)

• Hyperechoic foci (head, body, tail)

• Hyperechoic strands (head, body, tail)

• Lobularity in body and tail

Hyperechoic strands and foci

Lobularity

Hyperechoic duct wall

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Case Presentation

How does one interpret these results?

Does he have chronic pancreatitis?

How should he be treated?


Designing Clinical Guidelines

2. Diagnosis





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Literature Search – major databases from 1946-present

Best evidence – i.e. RCTs, systematic review and meta-analysis

PICO questions for answerable questions- Population/Problem- Intervention- Comparison- Outcome

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Designing Clinical GuidelinesPICO QUESTIONS



Once you have designed the PICO questions…

- Evaluate the literature to answer your questions

- If you have enough evidence to answer the questions, start the GRADE evaluation process

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A few reminders about guidelines…

- They are limited by the amount of clinical trial evidence available

- There are multiple types of guidelines – beware of those that do not follow the GRADE system (i.e. beware of expert opinion)

- Not all important clinical questions can be answered – or even addressed – if using evidence-based guidelines



Two Types of Statements

1. Recommendations- Evidence- Grade System

2. Key Concepts- Not amenable to Grade- Often expert opinion

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Objectives

2. Diagnosis






DiagnosisRecommendation Statements

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EUS Diagnosis: The Perfect Storm

No gold standard

Highly sensitive test

Confusing nomenclature

Increasing availability

Heavy reliance on expert opinion

Lack of specificity

Wide interobserver

variation



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Gardner and Levy. GIE 2010;71(7):1280-90.


DiagnosisKey Concepts

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Diagnosis


Objectives

2. Diagnosis





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Etiology and Natural HistoryRecommendation Statements


Etiology and Natural HistoryRecommendation Statements

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Etiology and Natural HistoryKey Concepts


Objectives

2. Diagnosis





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Management of PainRecommendation Statements



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Management of PainKey Concepts


Objectives

2. Diagnosis





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Management of EPIRecommendation Statements

Gardner TB et al. Am J Gastroenterol 2014109:624-5.


Management of EPIKey Concepts

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Objectives

2. Diagnosis






Future Areas of InvestigationInvestigate the Mechanistic Definition of CP…

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Future Areas of Investigation

Further comparative effectiveness treatment trials…


Future Areas of Investigation

A reckoning of how these patients are demonized, mistreated, and cared for by our profession…

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Thank You“Man cannot discover new oceans unless he has the courage to lose sight of the shore”

- Andre Gide 1947 Nobel prize for literature


Questions?

Speaker: Timothy B. Gardner, MD, MS, FACG

Moderator: Linda S. Lee MD

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acg grand rounds - cp ls edits-no animations - compatibility … · 2020. 11. 23. · week 35:...

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