MEDS 370: Organ Failure: Non-Communicable Chronic Disease
Weekday TBA 1 hour 50 minutes
2 units
INSTRUCTORS:
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Stuart Swadron, M.D., Assistant Dean for Pre-Health Undergraduate Studies, Associate Professor of Emergency Medicine, Keck School of Medicine of USC
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Guest Faculty from the Keck School of Medicine
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Office Address: 1975 Zonal Avenue, KAM 100F, Los Angeles, CA 90089-9020
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Office Phone: (323) 442-4300
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Office hours by appointment: please contact Erin Yamauchi at eyamauch@usc.edu
ADMINISTRATIVE ASSISTANT:

Erin Yamauchi o eyamauch@usc.edu
Introduction and Purpose
Chronic diseases have emerged as the leading cause of mortality and morbidity in both the developed and developing worlds. No meaningful conversation about the future of health care can occur without a solid understanding of the natural history, management and prevention of the major chronic diseases.
This course will use an organ system-based approach to examine the chronic diseases that have the greatest impact on individuals, families and society as a whole. We begin with a discussion of the underlying pathophysiologic processes of each disease process. We will then examine the clinical presentation, diagnostic evaluation and therapy. Students will gain a familiarity with the medical literature by the incorporation of selected review articles published in leading medical journals to cover the material.
A special emphasis will be placed on the psychological, economic and social consequences of each disease. In order to facilitate this, we will invite patients and family members coping with some the conditions discussed as guests to the class to share their personal experiences.
Upon successful completion of this course, the student should be able to demonstrate a working knowledge of:
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The major chronic non-communicable diseases in the United States and abroad
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The economic impact of chronic disease
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The psychological and social impact of chronic diseases
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Strategies for the prevention of chronic disease
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A basic understanding of the pathophysiology and management of: o Congestive Heart Failure o Stroke o Cancer
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o Chronic Obstructive Pulmonary Disease o End-stage Renal Disease o Cirrhosis (end-stage Hepatic Disease) o Diabetes Mellitus o Alzheimer’s Dementia
Course Requirements and Grades
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There is no required textbook for the course. Course material will be drawn from a variety of sources and catalogued on-line using the on-line learning management system.
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Course materials include a selection of articles from the peer-reviewed medical literature. These required readings are listed below under Class Sessions.
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The course will consist of one 110 minute meeting each week, which will involve a dynamic combination of lecture, videos, class discussion and special guests.
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Prior to each class meeting, students will receive communication with material to read, listen to, and/or watch in preparation for the session. Students will be expected to be able to discuss the material during class.
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After each meeting, students will receive an email with questions involving material from the session. These questions will not be graded, but will instead act as practice questions for the final examination.
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Grading breakdown: Letter Grade
10% of the grade will be for attendance and participation
35% of the grade will be for the mid-term examination
55% of the grade will be for the final exam
Grading Scale:
A 94-100
A- 90-93
B+ 87-89
B 83-86
B- 80-82
C+ 77-79
C 75-76
C- 74-70
D+ 69-67
D 66-64
D- 63-60
F 59-0
Examinations:
Exams will be multiple choice and/or short answer questions or short essays as appropriate and will cover didactic information provided within the class discussions and readings.
Class Sessions: 1 hour 50 minutes
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Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Introduction
The Burden of Chronic Disease – Part I
Epidemiology
Required reading:
1. Norrving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology. 2013 Jan 15;80(3 Suppl 2):S5-12
2. Sherwin R, Jastreboff AM. Year in diabetes 2012: The diabetes tsunami. J Clin
Endocrinol Metab. 2012;97(12):4293-301
The Heart: Congestive Heart Failure
Required reading:
1. Arroll B, Doughty R, Andersen V. Investigation and management of congestive heart failure. British Medical Journal. 2010;341
2. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348(20):2007-18.
3. King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam
Physician. 2012 Jun 15;85(12):1161-8.
4. Heart Failure Society of America. The stages of heart failure—NYHA classification. www.abouthf.org/questions_stages.htm.
Cancer: The Challenge of Our Generation
Required reading:
1. Are C, Rajaram S, Are M, et al. A review of global cancer burden: trends, challenges, strategies, and a role for surgeons. J Surg Oncol. 2013 Feb;107(2):221-6.
The Burden of Chronic Disease – Part II
Economic and Social Implications
The Lungs: Chronic Obstructive Pulmonary Disease
Required reading:
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Week 7
Week 8
Week 9
1. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
Am J Respir Crit Care Med. 2013;187(4):347-65.
2. Soriano JB, Lamprecht B. Chronic obstructive pulmonary disease: a worldwide problem. Med Clin North Am. 2012 Jul;96(4):671-80.
Mid-Term Examination 1 hour 50 minutes
The Kidneys: End Stage Renal Disease and Dialysis
Required Reading
1. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012 Jan 14;379(9811):165-80.
2. Rivera JA, O'Hare AM, Harper GM. Update on the management of chronic kidney disease. Am Fam Physician. 2012 Oct 15;86(8):749-54.
3. Himmelfarb J, Ikizler TA. Hemodialysis. N Engl J Med 2010; 363:1833-1845.
The Liver: Cirrhosis
Required Reading
1. Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam
Physician. 2011 Dec 15;84(12):1353-9.
2. Bachir NM, Larson AM. Adult liver transplantation in the United States. Am J Med
Sci. 2012;343(6):462-9.
The Burden of Chronic Disease – Part III
Health Care Policy and Chronic Disease
Week 10
Week 11 The Endocrine System: Diabetes Mellitus
Required Reading
1. Ismail-Beigi F. Glycemic Management of Type 2 Diabetes Mellitus. N Engl J Med
2012; 366:1319-1327
2. Gupta SK, Singh SK. Diabetic foot: a continuing challenge. Adv Exp Med Biol.
2012;771:123-38.
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Week 12
Week 13
Week 14
Week 15
3. Peach G, Griffin M, Jones KG, et al. Diagnosis and management of peripheral arterial disease. BMJ. 2012 Aug 14;345:e5208.
The Immune System: Rheumatologic and Autoimmune Disease
Required Reading
1. Upchurch KS, Kay J. Rheumatology (Oxford). 2012 Dec;51 Suppl 6:vi28-36.
Evolution of treatment for rheumatoid arthritis.
The Brain: Stroke, Alzheimer’s Dementia and Neurodegeneration
Required Reading
1. Ballard C, Gauthier S, Corbett A, et al. Alzheimer's disease. Lancet. 2011 Mar
19;377(9770):1019-31.
2. Simmons BB, 2. Hartmann B, Dejoseph D. Evaluation of suspected dementia. Am
Fam Physician. 2011 Oct 15;84(8):895-902.
The Burden of Chronic Disease – Part IV
Modifiable Risk Factors: Obesity, Smoking and Hypertension
Required Reading
1. Giovino GA, Mirza SA, Samet JM, et al. Tobacco use in 3 billion individuals from
16 countries: an analysis of nationally representative cross-sectional household surveys.
Lancet. 2012 Aug 18;380(9842):668-79.
2. Labarthe DR, Dunbar SB. Global cardiovascular health promotion and disease prevention: 2011 and beyond. Circulation. 2012;125(21):2667-76.
Chronic Non-Cancer Pain Syndromes
Required Reading
1. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet.
2011;377(9784):2226-35.
FINAL FINAL EXAM 1 hours 50 minutes
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Statement for Students with Disabilities
Any student requesting academic accommodations based on a disability is required to register with
Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP. Please be sure the letter is delivered to me as early in the semester as possible. DSP is located in STU 301 and is open 8:30 a.m.–5:00 p.m., Monday through
Friday. The phone number for DSP is (213) 740-0776.
Statement on Academic Integrity
USC seeks to maintain an optimal learning environment. General principles of academic honesty include the concept of respect for the intellectual property of others, the expectation that individual work will be submitted unless otherwise allowed by an instructor, and the obligations both to protect one’s own academic work from misuse by others as well as to avoid using another’s work as one’s own. All students are expected to understand and abide by these principles. Scampus, the Student
Guidebook, contains the Student Conduct Code in Section 11.00, while the recommended sanctions are located in Appendix A: http://www.usc.edu/dept/publications/SCAMPUS/gov/. Students will be referred to the Office of Student Judicial Affairs and Community Standards for further review, should there be any suspicion of academic dishonesty. The Review process can be found at: http://www.usc.edu/student-affairs/SJACS/.
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Emergency Preparedness/Course Continuity:
In case of emergency, and travel to campus is difficult, USC executive leadership will announce an electronic way for instructors to teach students in their residence halls or homes using a combination of Blackboard, teleconferencing, and other technologies. Instructors should be prepared to assign students a "Plan B" project that can be completed at a distance. For additional information about maintaining your classes in an emergency please access: http://cst.usc.edu/services/emergencyprep.html
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