American Educational Institute

09/04/2026

PSA screening finds cancer. The problem is which cancer it finds.

Systematic biopsy after an elevated PSA catches a lot of Gleason 3+3 tumors that are unlikely to progress, unlikely to metastasize, and unlikely to have needed detecting at all. Meanwhile, clinically significant cancers can be missed in up to 30% of cases.

That's not a screening win. That's a sorting problem.

A landmark NEJM trial of nearly 38,000 men showed that adding MRI before biopsy and targeting only suspicious lesions cut clinically insignificant cancer detections in half while maintaining detection of the cancers that actually matter.

PI-RADS v2.1 is what makes that possible. A structured prostate MRI read gives the urologist and the patient something PSA alone never could: anatomically specific, risk-stratified information about what's there before anyone decides whether to biopsy, where to biopsy, and what to watch.

September is Prostate Cancer Awareness Month. If you're a radiologist reading prostate MRI, a urologist making biopsy decisions, or a primary care physician starting the PSA conversation, the evidence for MRI-integrated screening is no longer emerging. It's here.

Robert M. Marks, MD, FSAR covers prostate MRI and PI-RADS scoring in AEI Seminars' Radiology Update. Accredited CME, 55+ destinations.

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08/28/2026

The treatments keeping your patient's autoimmune disease under control are also the reason they're vulnerable to the infections that could hospitalize them.
That's the trade-off at the center of every biologic and targeted DMARD prescription. And most clinicians are tracking the first half of that equation much more carefully than the second.

A 2026 scoping review of infection risk across modern immunomodulatory therapies found that each drug class creates its own specific vulnerabilities. TNF inhibitors are linked to reactivation of granulomatous infections like TB and opportunistic pathogens like Histoplasma and Listeria. JAK inhibitors carry a clear herpes zoster signal, particularly in older patients. B-cell depletion with rituximab drives hypogammaglobulinemia. And high-dose glucocorticoids remain the single biggest driver of serious infections across the board, with one study documenting 40 serious infections per 100 person-years in patients on 30+ mg daily for four or more weeks.

These aren't theoretical risks. They're predictable patterns that require screening before therapy initiation, targeted prophylaxis during treatment, and systematic surveillance throughout the course.

Here's where it compounds.

When these patients get hospitalized for a flare, a procedure, or an infectious complication, they're entering an environment where healthcare-associated infection risk collides with their already-suppressed immune defenses. A 2024 narrative review made the case plainly: HAI prevention isn't a secondary goal of antimicrobial stewardship. It's the first principle, because every preventable infection in an immunocompromised host drives broader-spectrum antibiotic use and feeds the resistance cycle that makes the next infection harder to treat.

The clinical question isn't whether your immunosuppressed patients are at risk. They are. The question is whether your screening, prophylaxis, and stewardship protocols reflect the specific vulnerabilities created by the specific agents you're prescribing.

Nasia Safdar, MD covers healthcare-associated infection prevention in AEI Seminars' State Requirements Course. Accredited continuing medical education across 55+ destinations.

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The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/26/2026

The drug your patients are using changed. The question is whether your protocols changed with it.

Most clinicians learned buprenorphine induction on he**in. Wait for moderate withdrawal, dose, stabilize. Clean, predictable. The problem is that fentanyl is 50 to 100 times more potent than morphine, parks itself in adipose tissue for days, and is now laced into stimulants and counterfeit pills your patients don't even know contain opioids.

So a patient hits the withdrawal threshold. You dose. And fentanyl that's still quietly redistributing from tissue stores triggers the exact precipitated withdrawal you were trying to avoid.

This isn't rare. A 2025 narrative review found that fentanyl use produces more rapid and severe withdrawal with lower treatment retention compared to he**in. The same review found that low-dose induction and extended-release buprenorphine initiation are giving clinicians better, more reliable paths in.

Now consider the other side of that encounter.

In a study of over 10,500 ED visits, only 16% of patients with an opioid-related discharge diagnosis left with a naloxone prescription. Patients with a psychiatric diagnosis had roughly half the odds of getting one. The patients who did receive naloxone came back to the ED less.

That's not a resource problem. That's a decision being made at the bedside, thousands of times, shaped by assumptions about who deserves the prescription and who doesn't.

Brian Fuehrlein, MD, PhD covers exactly this in AEI Seminars' State Requirements Course: fentanyl pharmacology, overdose prevention, and the clinical protocols that actually match the drug supply your patients are navigating. Accredited continuing medical education across 55+ destinations.

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The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/21/2026

Your patient spent years hearing their symptoms were stress, or nothing the scans could confirm. Now they have a name for a rare autoinflammatory disease, an off-label biologic with a thin evidence base, and a decision only they can make.

That decision doesn't come with a settled playbook. Most of what's known about treatment response in these conditions comes from case reports and small series, not large trials. The patient is being asked to weigh disease control against everything it costs them outside the clinic: sometimes a career, sometimes the chance at a family, always some version of an ordinary day.

This is where the principles that anchor clinical ethics, autonomy, beneficence, non-maleficence, and justice, stop being theoretical. They're the operating logic behind every treatment escalation conversation, every informed consent process for a therapy without long-term safety data, every quality-of-life discussion about whether tighter control is worth its cost.

A 2022 paper in HEC Forum, by Weidmann-Hügle and Monteverde, argues clinical ethics consultation has been slow to catch up to this reality. The biomedical model most consultations run on treats autonomy as a single judgment made at a single moment. Patients living with chronic illness for years function as something closer to lay experts of their own condition. When ethics conversations discount that expertise, the authors call it epistemic injustice: treating years of self-knowledge as less credible than a chart note.

A related body of work on rare disease ethics finds something similar from the patient side. Patients report feeling dismissed before diagnosis and unheard after it, not through clinician carelessness but because most training never covers a condition this uncommon. The proposed fix wasn't more paternalism to offset the uncertainty. It was more partnership: staying open-minded, treating patients as capable of navigating their own care, and supporting autonomy instead of assuming it.

Clinical ethics education has spent decades centered on the ICU, the ventilator, the family gathered around a bed. For rare and autoinflammatory disease patients, that moment may come. But the ethical terrain starts well before it, in the ordinary exam room conversation about a treatment nobody can fully predict.

In AEI's State Requirements Course, Adam Marks, MD, MPH, FAAHPM, faculty ethicist at the University of Michigan, walks through autonomy, surrogate decision-making, and the limits of medical futility through real-world end-of-life cases. Attend accredited CME across 55+ destinations, and bring a framework built for the ethics conversations that happen long before, and long after, the ICU.

The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/19/2026

0.46. That's the interobserver reliability score, on a scale where 1.0 is perfect agreement, when two radiologists graded bone marrow edema on the same rheumatoid arthritis follow-up MRI using a computer-aided scoring tool. The same radiologist reading their own scan twice: 0.99. That gap is where a treatment escalation decision can go sideways.

Most of the AI conversation in diagnostic imaging centers on detection: catching the nodule, flagging the lesion. Patients with rheumatoid arthritis and axial spondyloarthritis already have a diagnosis. What they need is consistent tracking of whether disease activity is rising or settling on treatment, scan after scan. That's exactly where reader variability creeps in on synovitis and bone marrow edema scoring, the two features clinicians lean on most to judge whether a treatment is actually working.

Fully automated quantification models are starting to close that gap. Segmentation tools measuring bone marrow edema against expert visual scoring have shown strong correlation (r = 0.83), and models tracking synovitis volume against RAMRIS scores have matched manual grading closely enough to distinguish real treatment response from reader noise. In one 48-week trial, an AI model tracked RAMRIS scores dropping from 20.6 to 18.3 on a biologic, a level of granularity that supports a confident response call rather than a single reader's impression.

For any clinician ordering serial imaging on a chronic inflammatory patient, this reaches past the reading room. It's the difference between telling a patient their joints are measurably improving and guessing off a scan that "looks a little different."

Lawrence Tanenbaum, MD, FACR breaks down where this technology is headed, and where radiologists should stay cautious, in his session on AI and the imaging enterprise. Join him at AEI's Radiology Update for accredited CME on the tools reshaping chronic disease monitoring.

The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/14/2026

Up to 40% of patients with rheumatoid arthritis are regular opioid users.

The disease-modifying therapy is doing exactly what it should: joint damage slows, inflammation markers improve. The opioid prescription renews anyway, quarter after quarter, because pain and disease activity turned out to be two different problems on two different timelines.

A 15-year review of UK primary care data found the same pattern repeating across rheumatic and musculoskeletal disease categories. Fibromyalgia opioid use rose 4.5-fold between 2006 and 2021, and average morphine milligram equivalents climbed across every diagnosis studied.

This is the structural blueprint that produced the opioid epidemic at scale, and it's playing out inside a patient population that rarely gets flagged as high-risk.

Brian Fuehrlein, MD, PhD, Associate Professor of Psychiatry at Yale and Director of the Psychiatric Emergency Room at VA Connecticut, traces that history back to its origins in the State Requirements Course. His session is built for physician education on opioid prescribing: the policy decisions and clinical culture that let overprescribing take hold, and what risk assessment and patient education look like when applied to a population still being missed.

For primary care and family medicine physicians managing the pain component of chronic inflammatory disease, and for rheumatologists relying on primary care to carry that load, the lecture connects that history directly to the prescribing decisions made this week.

Attend the State Requirements Course, an 8-hour add-on available with any AEI program, for accredited CME, CLE & CE hours that count toward your state's continuing education requirements, including opioid prescribing education.

The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/13/2026

Nearly 1 in 4 patients newly diagnosed with an autoimmune rheumatic disease are prescribed an opioid within their first year of care.

That number is down from a peak of 38% in 2014, and non-opioid options have grown alongside it. Physical therapy use doubled. Anticonvulsant use doubled. Yet opioid prescribing hasn't disappeared from the standard first-year treatment pattern, even as the evidence base for alternatives keeps expanding.

For young patients, that default carries a different weight. A recent systematic review followed 1,739 children ages 2 to 18 across 11 clinical studies and found that non-drug interventions, including cognitive behavioral therapy and hypnotherapy, produced measurable reductions in pain severity and meaningful gains in quality of life. The tools exist. The question is whether they reach the exam room before the prescription pad does.

John F. Dombrowski, MD, FASA, a veteran anesthesiologist and pain management specialist, builds that exam-room framework in the Medical-Dental-Legal Update. His session walks through pain evaluation and differential diagnosis, then moves through the full multidisciplinary toolkit, psychological and pharmacologic options beyond opioids, plus a clear referral pathway for cases that need a specialist.

Primary care and family medicine physicians remain the first and most sustained clinical contact for young patients living with autoinflammatory and chronic inflammatory disease. For them, and for the pediatricians and rheumatologists who share that care, this session builds a pain management plan grounded in evidence-based medicine rather than habit.

Join John F. Dombrowski, MD, FASA, for an evidence-based session on acute and chronic pain management in the primary care setting, part of the Medical-Dental-Legal Update. Attend for accredited CME, CLE & CE hours.

08/07/2026

MRI grade 2 erosions are 98% specific for progression to inflammatory arthritis. Their sensitivity is 7%.

This matters because of who these patients are. A recent meta-analysis pooled 39 studies and more than 10,000 people with joint pain and nothing to find on physical examination. Roughly one in five went on to develop rheumatoid arthritis. At the moment they were scanned, nobody knew which one.

That is the situation the radiologist is actually working in. Not confirming a diagnosis someone else has made, but describing inflammation in a person whose disease has no name yet. Ultrasound and MRI can both pick up synovitis and tenosynovitis long before a joint looks or feels abnormal in clinic. What happens to that finding depends on how precisely it gets characterized and how clearly the report signals what it means.

Imaging has moved to meet this. A UK group built a whole-body MRI protocol that covers the spine, sacroiliac joints, shoulders, hips, hands, knees and feet in under 20 minutes. Among 46 patients who arrived with joint symptoms and no diagnosis, the baseline scans predicted who would be diagnosed with rheumatoid arthritis a year later.

The same study is candid about where imaging misleads. Sacroiliac joint findings could not separate patients from healthy volunteers, and the healthy volunteers actually showed more SI joint abnormality. Bone marrow oedema there shows up in runners and after pregnancy. Calling it pathology in an undiagnosed patient sends someone down the wrong road.

Dr. Jon A. Jacobson, MD teaches inflammatory arthritis imaging as a question of interpretation rather than detection. What a finding predicts, what it rules out, and how to write an impression that helps a clinician who has not yet formed a hypothesis.

Patients with rare inflammatory and autoinflammatory conditions often describe years of being told nothing was wrong. Some of those years were spent inside a scanner.

Join Jon A. Jacobson, MD for subspecialty MSK imaging training in AEI's Musculoskeletal Imaging Update.

The The Musculoskeletal Imaging Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

08/05/2026

Adults with autoinflammatory disease wait an average of 14 years for a correct diagnosis. Children wait 3.

The diseases are identical. What differs is who is looking and what they were primed to expect.

That figure comes from a survey of 1,043 patients across 52 countries, developed by the FMF & AID Global Association with the Erlangen Center for Periodic Systemic Autoinflammatory Diseases. Before the correct diagnosis landed, adult patients had accumulated a stack of wrong ones: asthma, osteoarthritis, IBS, fibromyalgia, psychosomatic disorder.

Two details from that dataset are worth sitting with. Only 69% of patients underwent genetic testing, despite 92% reporting it was available to them. And 217 patients reported no elevation in acute-phase reactants during active disease episodes, meaning the objective marker most clinicians reach for to confirm inflammation was quiet while inflammation was occurring.

Autoinflammatory diseases run through the innate immune system. Autoimmune serology stays clean. The frameworks most of us carry into a multi-system presentation were built around antibody-mediated disease, and these patients slip underneath them.

The narrative review on diagnostic error by Vally and colleagues explains the mechanism. Experienced clinicians handle routine presentations through fast, non-analytic reasoning, which is accurate most of the time and costs almost nothing in cognitive effort. Atypical presentations require the slower analytic mode, and nothing forces that switch to happen. Premature closure ends the diagnostic process before the data justify ending it, and confirmation-seeking then protects whatever label already sits in the chart from being disturbed by the next abnormal finding.

Fourteen years of recurrent fevers, serositis, and unexplained pain is not a knowledge failure alone. It is a reasoning failure that repeats across dozens of encounters, each one reasonable in isolation.

Dr. Jonathan A. Edlow, MD covers the part of this that residency rarely teaches directly: how these biases form in high-volume acute care, and what structured clinical reasoning actually does to interrupt them mid-encounter.

When was the last time a patient's fourth visit for the same unexplained symptom made you reopen the differential instead of refining the existing one?

Join Dr. Jonathan A. Edlow, MD for a clinician's perspective on learning from diagnostic errors at the Emergency Medicine & Acute Care Update. Accredited CME for physicians and advanced practice clinicians.

The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.

07/31/2026

245,000 hospitalized patients with alcohol withdrawal, and the strongest predictor of which drug they received wasn't severity. It was which hospital they walked into.

That's the clinical gap Dr. Brian Fuehrlein, MD, PhD, is naming in the Emergency Medicine & Acute Care Update. And it lives at the exact intersection where two presentations collide: alcohol withdrawal management and alcohol-associated hepatitis, two conditions that arrive in the same patient, in the same ED encounter, and are almost never treated as the unified problem they are.

The stakes are real. Alcohol-associated hepatitis carries 28-day mortality between 25% and 40% in severe cases, defined by a MELD score above 20, a number calculable on arrival that is routinely not applied in the acute care setting. A MELD score above 20 on day 1. One calculation. A decision point that alters the entire trajectory of care. And it's being missed, skipped, or deprioritized in favor of managing withdrawal symptoms alone.

This isn't a competence problem. It's a framework problem.

Dr. Fuehrlein's dual training in addiction psychiatry and internal medicine makes him rare, someone who sees both tracks at once. Someone who can teach you to see them too.

This year, use World Hepatitis Day as a reason to look at your alcohol withdrawal protocols. Where's the hepatic assessment? Where's the MELD calculation on day 1? If it's not there, you're flying blind on half your patients.

Explore the Emergency Medicine & Acute Care Update with Dr. Brian Fuehrlein, MD, PhD. →

The Radiology Update offers medical continuing education credits in beautiful vacation destinations. View available courses today.