This is a comprehensive, 100-hour continuing education program designed to strengthen physician associates'/assistants' knowledge and clinical decision-making across a broad range of common and complex conditions affecting adult health. The curriculum integrates evidence-based approaches to cardiovascular and metabolic disease, musculoskeletal and neurologic disorders, behavioral health, pain and substance-related concerns, and ethical and end-of-life care. Topics include heart failure, hypertension, diabetes, overweight and obesity, osteoporosis, back pain, Parkinson disease, behavioral addictions, opioid safety, anabolic steroid use, medical ethics, and counseling patients and families at the end of life. The program also addresses the evidence, safety considerations, and potential drug interactions associated with natural medicines and dietary supplements used for depression, anxiety, and weight loss. Emphasizing whole-person care, this program equips physician assistants to apply current evidence and clinical principles to the assessment, management, counseling, and ongoing care of diverse adult patients.
- 1. Part I— Treatment of Heart Failure: An Update — 10 CREDITS
- 2. Part II — Hypertension: Strategies to Improve Outcomes — 5 CREDITS
- 3. Part III — Low Back Pain — 15 CREDITS
- 4. Part IV — Alternative Therapies for Depression and Anxiety — 5 CREDITS
- 5. Part V — Medical and Illicit Use of Anabolic Steroids — 5 CREDITS
- 6. Part VI — Supplements for Weight Loss — 5 CREDITS
- 7. Part VII — Type 2 Diabetes: Treatment Strategies for Optimal Care — 5 CREDITS
- 8. Part VIII — Diagnosing and Treating Overweight and Obese Patients — 5 CREDITS
- 9. Part IX — Osteoporosis: Diagnosis and Management — 5 CREDITS
- 10. Part X — Behavioral Addictions — 15 CREDITS
- 11. Part XI — Parkinson Disease — 10 CREDITS
- 12. Part XII — Counseling Patients at the End of Life — 5 CREDITS
- 13. Part XIII — Medical Ethics for Physicians — 5 CREDITS
- 14. Part XIV — Opioid Safety: Balancing Benefits and Risks — 5 CREDITS
This course is designed for physician assistants and interested healthcare professionals.
Patricia Lea, RN, DNP, MSEd, CCRN, received a Bachelor of Science degree in Nursing in 1973 from Houston Baptist University in Houston, Texas. She returned to graduate school to complete a Master’s degree in Education, specifically Health Education, in 1996 from Baylor University in Waco, Texas, and a Doctorate in Nursing Practice in Executive Leadership in 2014 from American Sentinel University in Aurora, Colorado. Dr. Lea specializes in critical care nursing, with an emphasis on heart failure and sepsis. She started her career at the Houston Methodist Hospital in the cardiovascular ICU and opened an acute dialysis unit at what is now Baylor St. Luke’s Medical Center in the Houston Medical Center. Dr. Lea was a Cardiovascular Clinical Coordinator and Director of the Heart Failure Clinic at Hillcrest Baptist Medical Center in Waco, Texas. In 2004, Dr. Lea returned to Houston and was employed as a Senior Research Clinical Nurse Specialist at the Texas Heart Institute coordinating stem cell and cardiac stent trials. She is currently Associate Professor and Baccalaureate Program Director at the University of Texas Medical Branch School of Nursing in Galveston, Texas.
John J. Whyte, MD, MPH, is currently the Chief Medical Officer at WebMD. In this role, he leads efforts to develop and expand strategic partnerships that create meaningful change around important and timely public health issues. Previously, Dr. Whyte was the Director of Professional Affairs and Stakeholder Engagement at the FDA’s Center for Drug Evaluation and Research and the Chief Medical Expert and Vice President, Health and Medical Education at Discovery Channel, part of the media conglomerate Discovery Communications.
Prior to this, Dr. Whyte was in the Immediate Office of the Director at the Agency for Healthcare Research Quality. He served as Medical Advisor/Director of the Council on Private Sector Initiatives to Improve the Safety, Security, and Quality of Healthcare. Prior to this assignment, Dr. Whyte was the Acting Director, Division of Medical Items and Devices in the Coverage and Analysis Group in the Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency responsible for administering the Medicare and Medicaid programs. In his role at CMS, Dr.Whyte made recommendations as to whether or not the Medicare program should pay for certain procedures, equipment, or services. His division was responsible for durable medical equipment, orthotics/prosthetics, drugs/biologics/therapeutics, medical items, laboratory tests, and non-implantable devices. As Division Director as well as Medical Officer/Senior Advisor, Dr. Whyte was responsible for more national coverage decisions than any other CMS staff.
Dr. Whyte is a board-certified internist. He completed an internal medicine residency at Duke University Medical Center as well as earned a Master’s of Public Health (MPH) in Health Policy and Management at Harvard University School of Public Health. Prior to arriving in Washington, Dr. Whyte was a health services research fellow at Stanford and attending physician in the Department of Medicine. He has written extensively in the medical and lay press on health policy issues.
Mark Rose, BS, MA, LP, is a licensed psychologist in the State of Minnesota with a private consulting practice and a medical research analyst with a biomedical communications firm. Earlier healthcare technology assessment work led to medical device and pharmaceutical sector experience in new product development involving cancer ablative devices and pain therapeutics. Along with substantial experience in addiction research, Mr. Rose has contributed to the authorship of numerous papers on CNS, oncology, and other medical disorders. He is the lead author of papers published in peer-reviewed addiction, psychiatry, and pain medicine journals and has written books on prescription opioids and alcoholism published by the Hazelden Foundation. He also serves as an Expert Advisor and Expert Witness to law firms that represent disability claimants or criminal defendants on cases related to chronic pain, psychiatric/substance use disorders, and acute pharmacologic/toxicologic effects. Mr. Rose is on the Board of Directors of the Minneapolis-based International Institute of Anti-Aging Medicine and is a member of several professional organizations.
Chelsey McIntyre, PharmD, is a clinical pharmacist who specializes in drug information, literature analysis, and medical writing. She earned her Bachelor of Science degree in Genetics from the University of California, Davis. She then went on to complete her PharmD at Creighton University, followed by a clinical residency at the Children’s Hospital of Philadelphia (CHOP). Dr. McIntyre held the position of Drug Information and Policy Development Pharmacist at CHOP until her move to Washington state in 2017, after which she spent the next six years as a clinical editor for Natural Medicines, a clinical reference database focused on natural products and alternative therapies. She continues to create rigorous professional analysis and patient education materials for various publications while also practicing as a hospital pharmacist. Her professional interests include provider and patient education, as well as the application of evidence-based research to patient care.
Lisa Hutchison, LMHC, has more than 20 years of experience providing individual and group counseling with adults. She specifically focuses on teaching assertiveness, stress management, and boundary setting for empathic helpers. Ms. Hutchison graduated from the University of Massachusetts, Boston, with a Master’s degree in education for mental health counseling.
John M. Leonard, MD, Professor of Medicine Emeritus, Vanderbilt University School of Medicine, completed his post-graduate clinical training at the Yale and Vanderbilt University Medical Centers before joining the Vanderbilt faculty in 1974. He is a clinician-educator and for many years served as director of residency training and student educational programs for the Vanderbilt University Department of Medicine. Over a career span of 40 years, Dr. Leonard conducted an active practice of general internal medicine and an inpatient consulting practice of infectious diseases.
Contributing faculty, Patricia Lea, RN, DNP, MSEd, CCRN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John J. Whyte, MD, MPH, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Mark Rose, BS, MA, LP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Chelsey McIntyre, PharmD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Lisa Hutchison, LMHC, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John M. Leonard, MD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
John V. Jurica, MD, MPH
John M. Leonard, MD
The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
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#41970: The Adult Patient: Evidence-Based Care for Mind and Body
Part 9 of 14 · Chapter 1 of 11
Table of Contents
To appropriately prevent, diagnose, and treat osteoporosis, physicians and other healthcare providers should understand the epidemiology, physiology, and management. The purpose of this course is to provide members of the interdisciplinary team, including physicians, nurses, and other healthcare professionals, with the information regarding causes and treatment of osteoporosis necessary to effectively provide patient-centered care.
Upon completion of this course, you should be able to:
- Discuss the clinical background of osteoporosis, noting the various definitions used in the past few years.
- Discuss the epidemiology of osteoporosis in the United States, based on age, sex, race, and other factors.
- Identify the primary and secondary causes of osteoporosis.
- Identify the various risk factors for osteoporosis.
- Describe the signs and symptoms of osteoporosis.
- List the various screening recommendations established for osteoporosis.
- Explain the various treatment modalities for osteoporosis.
- Describe the current dietary and physical activity recommendations related to osteoporosis.
- Discuss the pharmacologic treatment of osteo¬porosis, including indications and adverse reactions and the importance of utilizing interpreters in providing care to non-English-proficient patients.
Osteoporosis has increasingly become a major health problem. The Bone Health and Osteoporosis Foundation (BHOF) (formerly the National Osteoporosis Foundation) has estimated that 10 million Americans have osteoporosis and 44 million have low bone mass, or osteopenia, which places them at risk for osteoporosis[1,2]. Approximately 1 in 2 women and 1 in 4 men 50 years of age and older will have an osteoporosis-related fracture in their lifetime [3].
Osteoporosis is the most common type of metabolic bone disease. It results either from the body's inability to form new bone or from an increased resorption of formed bone. Essentially, when there is an imbalance between osteoblastic and osteoclastic activity, skeletal problems arise. Risk factors, such as advanced age, family history, race, estrogen deficiency, tobacco use, steroid use, low calcium intake, physical inactivity, and low body weight, contribute to this condition [4].
Several diagnostic techniques have improved the ability to diagnose osteoporosis, most notably dual-energy x-ray absorptiometry (DXA), which is considered the gold standard for diagnosing osteopenia or osteoporosis [5]. Ultrasound, radionuclide absorptiometry, quantitative computed tomography (CT), and magnetic resonance imaging (MRI) also have been used to assess risk of fracture [6]. In the United States, current diagnostic criteria are based solely on quantitative CT hip and DXA spine or hip T-score measurements [7,8]. Along with these diagnostic techniques, biochemical markers, such as hydroxyproline and collagen cross links, may be used to identify patients at risk [5,9]. Several screening guidelines have been published indicating the preferred techniques and indications.
Treatment of osteoporosis remains controversial. The focus of management has been on slowing or stopping bone loss or creating new bone. Because of the significant disability, morbidity, mortality, and costs associated with osteoporosis-related fractures, the American College of Physicians recommends that treatment be aimed at fracture prevention [10]. First-line therapy remains diet supplementation and regular weight-bearing and muscle-strengthening exercises, both of which should be started before 30 years of age [11,12]. Numerous medications, either antiresorptives or bone formation agents (anabolics), exist with different patient indications, adverse events, and contraindications. Additionally, several high-profile studies have impacted the treatment and prevention of osteoporosis. Specifically, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) have indicated some potential dangers (e.g., increased risk of breast cancer, heart attack, stroke, blood clots in the legs and lungs) associated with estrogen replacement, which until recently had been one of the mainstays of treatment [13,14].
To effectively prevent, diagnose, and treat this disease, physicians and other healthcare providers should understand the epidemiology, physiology, and management of osteoporosis. The following case study will be referenced throughout the text to illustrate the challenges of treating patients with osteoporosis.
An Asian woman, Patient D, is 64 years of age with a history of type 2 diabetes, asthma, hypertension, and degenerative joint disease. She presents to a general medicine clinic with persistent lower back pain. The patient reports that for the last few months, she has been experiencing aching pain in the lower lumbar area. It is worse with exertion. The pain is fairly localized, without radiation. She does not experience any tingling, numbness, or weakness. There is no history of trauma. On exam, blood pressure is 135/75 mm Hg, heart rate 72 beats per minute, respirations 18 breaths per minute, temperature 99 degrees Fahrenheit, height 59 inches (150 cm), and weight 99 lbs (45 kg). The patient does exhibit some tenderness to palpation in the lower lumbar area. She notes that she tries to remain active, walking about 2 to 3 miles, three or four days a week; she is also a devoted gardener. She is concerned enough about this pain that she believes she needs an x-ray. She also reluctantly remarks that she is not sure if she is exaggerating, but she feels she might be "shrinking." She recently tried on a pair of pants she purchased several years ago, and now they appear to be too long. She wants to know if this is possible. One of her sisters recently told her that she was diagnosed with "brittle bones." She asks you what this means and if she should be concerned.
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Part 9 of 14 · Chapter 1 of 11
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