Spot Urine Protein Testing for Proteinuria in Pregnancy Scarlett Gard, DO, Tracy Williams, MD, Bonnie Tackett, MD,

Jennifer Callison, DO, Vu Nguygen, DO, Tara Neil, MD

KUSM – Wichita Family Medicine Residency at Via Christi

CONCLUSIONS METHODS

RESULTS

FUTURE STUDIES

REFERENCES

CLINICAL QUESTION

BACKGROUND

• Literature search – Identify various methods used to detect proteinuria

• Search engines – PubMed, Google Scholar, Medline

• Search phrases – “preeclampsia” AND

• “Urine spot protein creatinine ratio”

• “protein creatinine ratio”

• “albumin creatinine ratio”

• Inclusion criteria:

• English

• Published between 2003 – 2013

• Pregnant women after 20 weeks gestation

• No chronic hypertension

• Blood pressure greater than or equal to 140 mm Hg systolic or greater than

or equal to 90 mm Hg diastolic on two separate occasions

• Review found too many differences in methodology

amongst the studies for definitive answer

• PCR is a faster, easier test that can safely rule out

proteinuria in pregnancy

• Cost varies but remains a consideration and 24-hour

urine is generally cheaper than PCR

Are spot urine protein tests, as compared to 24 hour

proteinuria assays, sufficient to rule out significant

proteinuria when considering a diagnosis of

preeclampsia?

Table 1. Comparison of Urine Assays

Urine Dip Test PCR 24-hour Urine Protein

Collection Simple Simple Difficult

Accuracy

High false

negative, false

positive rates

Correlates with 24-

hour urine

protein3,5,9

Poor

“Gold standard”

Cutoff for

proteinuria 1+ > 0.3 mg/dL > 300 mg / 24-hr collection

Cost

(Quest

Diagnostics)

$20 $90 $35

Limitations Spot check Spot check under-collection, patient

compliance

• Large-scale meta-analysis to analyze current data

• Compare 24-hr urine protein to PCR and ACR

among same patients

• Determine degree to which time of day or recent food

intake affects spot ACR8 or PCR, and most

significant cutoff values1

• Anticipate PCR cost to decrease when demand

increases

1. Huang Q, Gao Y, Yu Y, Wang W, Wang S, Zhong M. Urinary Spot Albumin: Creatinine Ratio for

Documenting Proteinuria in Women With Preeclampsia. Reviews in Obstetrics & Gynecology 2012, 5 (1):

9-15.

2. Leeman, L. Hypertensive Disorders of Pregnancy. American Family Physician. July 2008; 78(1):93-100.

3. Morris RK, Riley RD, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to

creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with

suspected pre-eclampsia: systematic review and meta-analysis. BMJ 2012;345:e4342.

4. Nissel H, Trygg M, Back R. Urine albumin/creatinine ratio for the assessment of albuminuria in

pregnancy hypertension. Acta Obstetricia et. Gynecologica. 2006; 85: 1327-1330.

5. Sanchez-Ramos L, Gillen G, Zamora J, Stenyakina A, Kaunitz A. The Protein-to-Creatinine Ratio for

the Prediction of Significant Proteinuria in Patients at Risk for Preeclampsia: a Meta-Analysis. Annals of

Clinical & Laboratory Science 2013; 43(2): 211-220.

6. Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. American College of

Obstetricians and Gynecologists. Practice Guideline. 2013.

7. Wheeler TL, Blackhurst DW, Dellinger EH, et al. Usage of spot urine protein to creatinine ratios in the

evaluation of preeclampsia. Am J Obstet Gynecol 2007; 196; 465.e1-465.e4.

8. Wikstrom A-K, Wikstrom J, Larsson A, Olovsson M. Random albumin/creatinine ratio for quantification

of proteinuria in manifest preeclapmsia. BJOG 2006; 113: 930-934.

9. Wilkinson C, Lappin D, Vellinga A, Heneghan HM, O’Hara R, Monoghan J. Spot urinary protein

analysis for excluding significant proteinuria in pregnancy. Journal of Obstetrics and Gynecology. 2013;

33: 24-27.

• 19 published articles found based on search phrases and 8 articles reviewed

based on inclusion criteria

• High correlation (r=0.88) between spot PCR and 24-hr urine protein7

• Many clinicians suggest that PCR >0.3 should be followed by a 24-hr urine

collection5

• Discrepancy between use of albumin/creatinine ratio (ACR) vs PCR3,4

• AAFP criteria (2008) refer to 24-hr urine but note that they accept PCR of <0.21

to rule out significant proteinuria in pregnancy2

• November 2013, American Congress of Obstetrician

and Gynecologists (ACOG) added protein/creatinine

ratio (PCR) ≥ 0.3 mg/dl to the criteria for

preeclampsia as an alternative to 24-hr urine

protein6

• Degree of proteinuria does not change management

or classification of preeclampsia6

• Proteinuria is not necessary for diagnosis of

preeclampsia if other diagnostic criteria are present:

Thrombocytopenia,

Renal insufficiency,

Impaired liver function

Pulmonary edema

Cerebral or visual symptoms6

CONTACT

Scarlett Gard, DO

sgard@kumc.edu

KUSM–Wichita Family Medicine Residency at Via Christi

Physician Oral Contraceptive Prescribing Practices Cole Gillenwater, BS, Trisha Melhado, MPH, Terry Ast, BA, and Rick Kellerman, MD

University of Kansas School of Medicine – Wichita, Department of Family and Community Medicine

BACKGROUND

METHODS

RESULTS

CONTACT

CONCLUSIONS

OBJECTIVE

Sample:

• A convenience sample of family physicians

• Family Medicine Research and Data Information

Office (FM RADIO) electronic survey

Instrument:

• 9 item questionnaire

– Physicians’ OC prescribing practices

– Practice hiring practices based on OC

prescribing

– Practice’s policy regarding prescribing OC

– Physician demographics

Statistical Analysis: Descriptive statistics Cole Gillenwater, BS

cgillenwater@kumc.edu

University of Kansas School of Medicine – Wichita

• No practices have a written policy regarding OC

prescribing status for patients

• Most practices do not have an unwritten

procedure regarding prescribing OC

• The state of Kansas passed legislation SB 62 in

July 2012

– Expands the opportunity for physicians to

refuse prescribing birth control

o Pills

o IUDs

o Emergency contraception

– Vague language

– Freedom to deny reproductive health care

– No legal repercussions

• Previous research has not examined the potential

mismatch between physicians’ practice policies for

prescribing oral contraceptives (OC) and patient

requests for contraception

Assess practice policies and current procedures

for OC prescribing among family physicians in

the state of Kansas

• Response rate = 56% (42/75 physicians)

• 95% (n=40) of physicians prescribe and

5% (n=2) do not prescribe OC

• Among the physicians that prescribe OC, 92% work in a practice where all of the

physicians prescribe OC and 8% work in a practice where some of the physicians do not

prescribe OC

• Among the two physicians who do not prescribe OC, one works in a practice where all of

the physicians prescribe OC and one works in a practice where some of the other

physicians do not prescribe OC

• Physicians’ practices hiring practices

– 79% (n=30) would hire a physician who did not prescribe OC

– 21% (n=8) would NOT hire a physician who did not prescribe OC

• 100% report practice does not have a written policy regarding OC prescribing practices

• Unwritten OC prescribing practice policy

– 38 (93%) practices do NOT have an unwritten OC prescribing policy

– 3 (7%) practices have an unwritten OC prescribing policy

• Physician comments related to unwritten OC prescribing procedures:

– “We have non-physicians prescribing OCs”

– “The patient is advised to talk to the Doctor [regarding] limitation in the use of

contraceptives…[and] informed that that visit will be at no cost to the patient or their

insurance”

– “We are a Catholic institution and formal Bishops policy forbids use of

contraception… We are supposed to clearly distance ourselves from the institution

when prescribing contraception but I mostly ignore that policy”

REFERENCE

2012, Kansas House Substitute for SB 62 by Committee

on Judiciary. Concerning medical care facilities; relating to

abortion; sterilization. 2011-2012 Leg.

Table 1: Physician characteristics (N=42)

Characteristic %

Gender

Male 55

Female 45

Age – mean (range) 50 (29-72)

Practice location

Urban 26

Suburban 19

Midsize Rural 14

Small Rural 41

Years in Practice – mean (range) 20 (.05-40)

DISCUSSION

LIMITATION

• Surveyed physicians in Kansas and response rate

was 56%.

• Implication – patients may end up with physicians

who are not able to meet their request for OC

• Patients should have clear information about

practices’ and physicians’ OC prescribing habits

prior to appointments

• Next steps

– Patient experience obtaining OC

– Explore potential OC expectation mismatches

between patients and physicians

Efficacy of Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Literature Review Brett Hoffecker, MD, Aaron Hightower, MD, Jessica Jarvis, MD,

Douglas Lewis, MD and Jennifer Wipperman, MD, MPH

KUSM-Wichita Family Medicine Residency at Via Christi

CLINICAL QUESTION

METHODS

RESULTS

REFERENCES

CONCLUSIONS BACKGROUND

• Literature search – reviewed studies

published Jan 2007 to Nov 2014

• Search engines – PubMed and Cochrane

• Search terms – carpal tunnel syndrome

steroid, corticosteroid, injection

• Inclusion criteria

• Adults ages 18 and older

• All severities of CTS

• CTS defined using clinical or

electrodiagnostic criteria

• Local steroid injection for CTS provides

improvement in symptoms for greater than

1 month (SOR A) and up to 12 months

(SOR B)

• Local steroid injection decreases need for

surgery at 1 year in patients with non-

severe CTS (SOR B)

• Local steroid injection is a valuable

treatment option for patients with CTS and

should be offered

• While rare, potential risks of nerve injury

and tendon rupture should be discussed

with patients

- None of these events occurred in any

of the trials

• Larger studies are needed to confirm

length and magnitude of benefit, as well as

potential effects on surgical outcomes In patients with carpal tunnel

syndrome (CTS), do local

corticosteroid injections provide

symptomatic relief beyond one

month? 1. Visser LH, Ngo Q, Groeneweg SJ, Brekelmans G. Long term effect of local corticosteroid

injection for carpal tunnel syndrome: a relation with electrodiagnostic severity. Clinical

neurophysiology. Apr 2012;123(4):838-841.

2. Ustun N, Tok F, Yagz AE, et al. Ultrasound-guided vs. blind steroid injections in carpal

tunnel syndrome: A single-blind randomized prospective study. American journal of

physical medicine & rehabilitation. Nov 2013;92(11):999-1004.

3. Karadas O, Tok F, Akarsu S, Tekin L, Balaban B. Triamcinolone acetonide vs procaine

hydrochloride injection in the management of carpal tunnel syndrome: randomized

placebo-controlled study. Journal of rehabilitation medicine. Jun 7 2012;44(7):601-604.

4. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised

controlled trial of local corticosteroid injections for carpal tunnel syndrome in general

practice. BMC family practice. 2010;11:54.

5. Berger M, Vermeulen M, Koelman JH, van Schaik IN, Roos YB. The long-term follow-up

of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When

are multiple injections indicated? The Journal of hand surgery. Jul 2013;38(6):634-639.

6. Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone injections for the carpal

tunnel syndrome: a randomized, placebo-controlled trial. Annals of internal medicine.

Sep 3 2013;159(5):309-317.

7. Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. Corticosteroid injection for carpal

tunnel syndrome: a 5-year survivorship analysis. Hand. Jun 2012;7(2):151-156.

8. Ly-Pen D, Andreu JL, Millan I, de Blas G, Sanchez-Olaso A. Comparison of surgical

decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-

year clinical results from a randomized trial. Rheumatology. Aug 2012;51(8):1447-1454.

• Carpal tunnel syndrome (CTS) is the most

common compressive neuropathy of the

upper extremity

• Non-surgical management is the initial

strategy for most patients with mild-

moderate CTS, and may also be curative

• Local corticosteroid injection is a simple,

quick office procedure that family

physicians can offer patients

• 2007 Cochrane review found local steroid

injection provides relief for up to 1 month in

patients with CTS, however recent

evidence suggests longer-term benefit

• Thirty-eight relevant studies were found; eight studies met the inclusion criteria

CONTACT

Brett Hoffecker, MD

bhoffecker@kumc.edu

University of Kansas School of Medicine – Wichita

Summary of Articles that Evaluate Local Corticosteroid Injection for CTS

Ref

# N

Study

design

Study

length

(months)

Max # of

injections Treatment Main Results

1 419 R 60 2 40 mg methylprednisolone

(MPS)

Improved symptoms at 6, 12 and 18

months

2 46 RCT 3 1 40 mg MPS – ultrasound

vs. blind technique

Improved symptoms and function at 6

and 12 weeks, ultrasound > blind

3 57 RCT 6 1 40mg triamcinolone

acetonide (TCA) or saline

Improved symptoms and EPS scores at

2 and 6 months

4 69 RCT 12 2 10 mg TCA or saline Improved symptoms and function at 1,

3, 6 and 12 months

5 120 P 12 3 40 mg MPS Improved symptoms at 1 year

6 111 RCT 12 1 80mg or 40mg MPS or

saline

Improved symptoms at 10 weeks, less

likely to have surgery at 1 year

7 824 P 60 1 20 mg MPS + splint Rate of surgery 14% at 1 year, 33% at 5

years

8 163 RCT 24 2 20 mg paramethasone

acetonide vs CTD

No difference in symptoms at 12

months, slight improvement at 24

months CTD > steroid R=retrospective cohort RCT=randomized controlled trial P=prospective cohort

0%

10%

20%

30%

40%

50%

60%

70%

80%

Atroshi Berger Jenkins Ly-Pen Peters

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Berger Visser Peters Ly-Pen

No Improvement

Improvement

Figure 1: Percentage of

patients with significant

improvement in CTS at 12

months

Figure 2: Percentage of

patients receiving surgery

1 year after local steroid

injection for CTS

44%

23%

18%

13%

2%

Thoughts on Reducing ED Use

More clinic hours

Nothing

Same day appts

Other (clinic issue, transportation)

Faster service

Why My Patients Visit the Emergency Department A Quality Improvement Project

Sheila Owens, MD1,2, Trisha Melhado, MPH1, David Miller, MD1,2 ¹University of Kansas School of Medicine – Wichita, Department of Family and Community Medicine

2KUSM – Wichita Family Medicine Residency at Wesley Medical Center

BACKGROUND

OBJECTIVE

DISCUSSION

NEXT STEPS

RESULTS

METHODS

Emergency Department (ED) visits have

increased 34% from 15 years ago, with over 130

million ED visits in 2010

Many ED visits are for non-urgent concerns,

which could be equally addressed in an

outpatient setting

Within the Wesley Family Medicine (WFM)

Residency Clinic, our patients often visit the ED

Learning about our patients who visit the ED can

guide interventions to reduce ED visits

Reducing ED visits by our clinic patients can

Decrease the ED’s patient burden

Provide more cost effective medical care

Enhance continuity of care by PCP’s

Increase patient satisfaction with PCP care

Understand patients’ reasons for using the ED in

order to guide quality improvement projects

aimed at reducing non-urgent ED use.

Participants

WFM patients who used ED from 12/2/13 –

4/30/14 participated in a telephone interview

during Summer 2014 regarding their ED visit

Data sources

Electronic medial record

Demographics: sex, age, insurance

Chief complaint

Telephone survey

Demographics: race/ ethnicity, education

Outcome of ED visit

Frequency of ED use

Reason ED used vs clinic

Thoughts on reducing ED use

Analysis: descriptive

100 responded to the survey and 335

did not respond (response rate = 23%)

EMR responder characteristics

60% female

37% parents answering for children

<18 years old, followed by 31-40 year

olds (18%) and 21-30 year olds (13%)

51% have Medicaid as primary

insurance

Chief complaint: Musculoskeletal

(20%), GI (15%), Respiratory (15%),

Trauma (10%)

Self reported characteristics

52% reported non-Hispanic White

81% of adults had a high school

diploma or higher

79% of patients discharged home

Visits evaluated were primarily by patients who

were >18 years old, female, white, and/or had

Medicaid

Most visits resulted in patients being discharged

home, with the most common concern being

musculoskeletal

An overwhelming majority of responders use the

ED at least once every 6 months, if not more

Patients who use the ED more than once a

month may be candidates for targeted ED

education

Patients most often used the ED because “the

clinic was closed” and they had “real

emergencies”

Patients thought they would use the ED less with

more clinic hours and same day appointments,

however, these changes are difficult to

implement in a timely manner

Offering patients help in deciding what

constitutes a “real emergency”, via educational

materials and phone triage lines, may be a more

readily available approach to decreasing ED use

Evaluate logistics of implementing extended

clinic hours and increased same day visits

Create advertising to promote phone triage

lines and education regarding when to use ED

Investigate targeted ED education for patients

who use the ED more than once a month

CONTACT INFORMATION

Sheila Owens, MD

Wesley Family Medicine Residency, PGY-3

sowens2@kumc.edu

417-631-9148

12%

33%

37%

16%

2%

Frequency of ED Use

> Once a month

Once a month

Every 6 months

Once a year

< Once a year

47%

25%

13%

7%

4% 4%

Reason ED Used vs Clinic

Clinic closed

Real emergency

Can't recall

No appts available

No PCP/ insurance

PCP told me to go to ED

Primary Hyperventilation Syndrome: Need for Early Outpatient Intervention A Case Report

Jessica Treece, D.O. KUSM – Wichita Family Medicine Residency at Wesley Medical Center

INTRODUCTION LAB RESULTS

CONTACT

CONCLUSION

CASE PRESENTATION

Jessica Treece, DO University of Kansas School of Medicine – Wichita

jtreece2@kumc.edu`

• Untreated PHS can have serious metabolic consequences

• Hallmark symptoms to screen include – dyspnea – increased resting respiratory rate – lightheadedness – palpations – chest pain – diaphoresis

• PHS can present with or without hypoxia

• Rule out organic causes including cardiopulmonary, infection, and intracranial etiology

• PHS lab abnormalities – respiratory alkalosis – hypokalemia – hypomagnesium – elevated lactic acid

• Treatment during acute exacerbation – paper bag breathing while monitoring

oxygen saturation – supplemental oxygen if hypoxic – reassurance – low dose beta-blockers – benzodiazepines

• Primary hyperventilation syndrome (PHS) – inappropriate increase in minute ventilation beyond metabolic demands

• Psychogenic or organic etiology

• Psychogenic hyperventilation syndrome – generalized anxiety disorder – episodic panic disorder

• History of shortness of breath, anxiety, rapid breathing, dizziness, palpations, diaphoresis, and/or chest pain

• 63 year old healthy female presenting to emergency department – one month history of shortness of breath – increase in shortness of breath over the

past 12 hours – complains of lightheadedness and

palpations – family history of anxiety and recent

stressor

• Patient was seen in PCP office 3 times in the last month for dyspnea without hypoxia

• Outpatient workup – cardiac stress test – normal – 2-D echo – normal – scheduled pulmonary consult

• Emergency room workup – CBC, CMP, and ABG – respiratory alkalosis with compensation

was identified – IV: hypokalemia and hypomagnesium

• Patient admitted to ICU overnight

– trials of paper bag breathing: improved symptoms and ABG

– alprazolam every 6 hours – next day ABG – pH and CO2 levels

normal

Initial labwork • WBC – 12.6 • Hgb – 15.0 • Platelet – 349 • Na – 137 • K – 2.6 • Cl – 99 • HCO3 – 19 • BUN – 16 • Cr – 1.5 • Glucose – 97 • D-dimer – 290 • BNP – 7 • Trop <0.04 • Lactic acid – 4.3 • ABG – Table 1

Vital signs • Temperature 97.0 C • Blood pressure 112/73 • Heart rate 96 • Respiratory rate 38 • Pulse oximetry 98% room air Imaging • Chest x-ray – normal • Doppler US ext – negative for

DVT • CT angio chest – negative for PE • V/Q scan – negative for PE • Renal sono – normal • MRI brain with contrast –normal

Table 1: ABG Results

Test Value (normal range)

pH 7.74 (7.35-7.45)

pCO2 10 (34-45)

P02 97 (75-100)

HCO3 13 (23-28)

1. Magarian, Gregory J. Chronic hyperventilation syndrome [Chapter]. Frontiers of stress research. Weiner, Herbert (Ed); Florin, Irmela (Ed); Murison, Robert (Ed); Hellhammer, Dirk (Ed); Kirkland, WA, US: Hans Huber Publishers 1989, pp.336-343, 458, xii.

2. Carnevali L, Sgoifo A, Trombini M, Landgraf R, Neumann ID, Nalivaiko E. Different patterns of respiration in rat lines selectively bred for high or low anxiety. PLoS One. 2013 May 17;8(5).

3. Wollburg E, Roth WT, Kim S. Effects of breathing training on voluntary hypo- and hyperventilation in patients with panic disorder and episodic anxiety. Appl Psychophysiol Biofeedback. 2011 Jun;36(2):81-91.

4. Blechert J, Wilhelm FH, Meuret AE, Wilhelm EM, Roth WT. Experiential, autonomic, and respiratory correlates of CO2 reactivity in individuals with high and low anxiety sensitivity. Psychiatry Res. 2013 Oct 30;209(3):566-73. doi: 10.1016/j.psychres.2013.02.010. Epub 2013 Mar 13.

5. Davenport, Horace W. (1974). The ABC of Acid-Base Chemistry: The Elements of Physiological Blood-Gas Chemistry for Medical Students and Physicians (Sixth ed. ed.). Chicago: The University of Chicago Press.

IMPLICATIONS

• Untreated PHS can impact patient quality of life and result in excessive clinical work up

• Health care costs – ICU, labs, and imaging estimated at

$33,000 – Outpatient care with alprazolam and paper

bag breathing behavior training estimated at $150

Pt

REFERENCES

Figure 1: Patient’s blood bicarbonate concentrations & pH superimposed on Davenport Diagram

Proof of Concept: Quarterly Webinars on Advanced Endoscopy Topics for Primary Care Physicians

Aaron Sinclair, MD, Rick Kellerman, MD, Terry Ast, BA

Department of Family and Community Medicine - KUSM-Wichita

Solution

Conclusion

Participants who incorporated information from a previous endoscopy presentation into their endoscopy or related treatments describing results: “India ink - went well. Patient needed partial colectomy and this

helped surgeon greatly.” “Improved management of Serrated Adenomas.”

Problems and Solutions

Recruit other Kansas Physicians performing endoscopy who might be interested in participating.

Expand to other topics for local and distance learners such as obstetric and practice management.

Schedule for 2015 Advanced Endoscopy Topics: Feb 5, 2015

Top Gastrointestinal P.O.E.Ms (Patient Oriented Evidence that Matters) Scott Strayer, MD

May 7, 2015 Helicobacter Pylori: Endoscopic and Laboratory Testing Strategies Chad Johanning, MD

August 6, 2015 Celiac Disease: Endoscopic and Laboratory Testing Strategies Maurice Duggins, MD

November 5, 2015 Case Based Evaluation of Common Upper Endoscopic Findings Justin Bailey, MD

Problem

Family physicians provide comprehensive, coordinated care of patients including gastrointestinal endoscopic procedures.

Gastrointestinal endoscopy continuing medical education opportunities exist to update clinicians on: New techniques Treatment guidelines Research findings

However continuing medical education: Expensive Few in number Require travel Require lost time from practice

Methods

Free quarterly seminars offered to Kansas family physicians that perform endoscopy.

Featuring local and national speakers focusing on endoscopy topics.

Presented via webinar

Aaron Sinclair, MD, FAAFP Assistant Professor, University of Kansas School of Medicine –

Wichita Wesley Family Medicine Residency faculty Has performed endoscopy for 10 years in rural practice and in

resident education Member of American Association of Primary Care Endoscopy

(AAPCE), Board of Directors 2014. Has attended endoscopy seminars through AAPCE

Organized endoscopy CME seminars for family physicians affiliated with KUSM-W Four times a year Thursday morning from 7:30-8:30 am Presenters are local and national family physicians experienced

in endoscopy Wichita area family physician who perform

endoscopy are invited to attend in person.

In May, offered via webinar to physicians across Kansas.

Physicians in rural areas contacted by mail and offered series via Internet webinar.

Results Results continued

Overall a positive experience for participants. An inexpensive way to provide quality CME on

endoscopy topics to local and distant physicians. Physicians connecting online appreciate the

opportunity for CME and information on endoscopy.

Future Plans

Problems with audio An inline microphone was added to computer used at

KUSM-W to improve audio. A continuous loop before the conference starts was

added to allow webinar participants to test audio and video connection.

Participation: Average 13 participants per session in person and online

Evaluations: Average 94% Strongly Agree or Agree that: Learning objectives were met.

Presentation addressed the learning needs in an unbiased/

evidence-based manner.

Speaker demonstrated a knowledge and expertise of topic.

Participant improved ability to integrate knowledge, new skills,

and strategies into practice.

What would you (participants) do differently after attending these seminars in 2014: February: Colon Ink: Endoscopic Tattooing Options and

Techniques by Aaron Sinclair, MD “Discuss these options more with residents.” “I feel more comfortable tattooing lesions. I will try this technique

more in my practice.” May: Colorectal Cancer Screening: Matching the Test to the

Patient by Mark Koch, MD “Discuss all options and risks and benefits for each patient.” “Assess risk vs benefit. Assess age and cultural needs.”

August: Serrated Polyps by Aaron Sinclair, MD “I will do more cold biopsies. Watch for mucus layer on top of

lesions.” “Increase cold bx with small polyps.” “Read path reports with an eye toward serrated polyps and what

that means and follow-up needs.” “Use more cold biopsy.”

October: Ensuring a Clean Colon: Selecting the Right Bowel Prep by Doug Lewis, MD “Good information but already using the preps.” “Low volume PEG Preps; scoring bowel prep with Boston

guidelines.” “Miralax/Gatorade/Dulcolax prep +/- simethicone for my prep

recs from now on.”

*For more information, contact Terry Ast at tast@kumc.edu