Free CME

This case study features expert discussion surrounding a real HCM patient and is designed to raise awareness for best practice treatment of symptomatic patients with obstructive HCM and provide you with an understanding of how heart failure symptoms should be managed.

Activity Description / Statement of Need:

In this online, self-learning activity:

Gaucher disease (GD) is characterized by a deficiency of the lysosomal enzyme glucocerebrosidase, resulting in the accumulation of sphingolipids throughout the body but most manifesting prominently in the bones. GD is subcategorized based on clinical features: type 1 GD is the non-neuronopathic form and affects mainly the inner organs, while types 2 and 3 are the acute and sub-acute neuropathic forms, whose pathology manifests predominantly within central nervous system. GD has an estimated prevalence of 0.70 to 1.75 per 100 000 in the general population, it affects individuals of Ashkenazi Jewish heritage in significantly higher numbers. One of the first of GD’s complications is the chronic anemia and a persistent bleeding risk. Another is the hepatosplenomegaly, which may be a part of the initial clinical presentation, as may the anatomical abnormalities of bone deformities and stunted growth.

This learning activity has been designed to bring healthcare professionals’ knowledge of the strategies for treatment and management of GD up to date and to improve their competence and performance in treating it.

Target Audience:

The following healthcare professionals: Pediatricians, neurologists, endocrinologists, and primary care physicians; physician assistants and nurse practitioners in those areas of specialty; pharmacists who practice in specialty pharmacies that treat patients with rare diseases; and any other healthcare professionals with an interest in or who may clinically encounter patients with GD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Hemophilia is a genetic disease caused by mutation of one of the genes for coagulation proteins leading to dangerous, uncontrolled bleeding. In hemophilia B, a mutation in the gene for factor IX (FIX) leads to an endogenous deficiency in the clotting factor. The incidence of hemophilia B is the same in all geographic regions, populations, and ethnic groups, affecting approximately 1 out of every 30,000 male births. The condition is diagnosed by measuring FIX activity, and patients with severe hemophilia have levels of 1% or less. Patients with severe hemophilia B are at risk for spontaneous, life-threatening bleeding episodes. Untreated, the life expectancy is approximately 20 years, and painful or even life-threatening morbidities include: intracranial hemorrhage, severe bleeding in other organ systems, musculoskeletal injury, and joint injury. In contrast, in people with moderate or mild hemophilia, abnormal bleeding usually occurs after minor trauma or surgery. Unfortunately, the literature shows that not only do clinicians struggle with the classification of hemophilia severity and that there are gaps in knowledge present that contribute to delayed diagnosis and treatment, with an attendant increase in morbidity and mortality. Challenges in diagnosis and classification are only the first of several gaps in care that patients with hemophilia face.

Target Audience:

The following HCPs: hematologists and pediatricians; physician assistants, nurse practitioners, and pharmacists who practice in hematology, and other HCPs who practice in hemophilia treatment center; and any other clinicians with an interest in or who clinically encounter patients with hemophilia B.

Activity Description / Statement of Need:

In this online CME self-learning activity:

Bipolar disorder is a mood disorder characterized by episodes of mania, hypomania, and depression. It affects 3-4% of the U.S. population, represents a substantial societal and economic burden in the United States, is also found to be strongly associated with other major public health concerns like diabetes and cardiovascular disease as well as suicide.

The literature demonstrates that medication nonadherence is a major issue among patients with bipolar disorder. Nonadherence affects approximately 60% of patients and can result in hospitalization, poor effectiveness, increased relapses, and increased risk of morbidity. Other factors, such as patient perceptions, illness severity, and the relationship between the physician and patient, come into play and should be taken into account to optimize adherence.

Target Audience:

Healthcare professionals specializing in: family medicine, internal medicine, mental health, neurology and psychiatry, or those who otherwise commonly care for patients with bipolar or related psychiatric diseases.

Activity Description / Statement of Need: The COVID-19 pandemic has led to unprecedented changes in health care delivery worldwide, affecting the way that nearly every medical specialty can safely practice. As with other fields of medicine, oncology has its own challenges in navigating the pandemic. Based on pre-pandemic estimates, 1.8 million new cancer diagnoses would be expected in 2020, equating to approximately 5,000 new cancer diagnoses per day. Evidence thus far suggests that COVID-19 is associated with significantly more complications and a higher risk of death in patients with cancer or with a history of cancer. Furthermore, patients with cancer have also been shown to have a higher COVID-19 infection rate than the general population, suggesting increased susceptibility, potentially due to immunosuppression, comorbidities, or poor health status related to cancer or its treatment. Based on these data, oncology specialists are said to be fighting “a war on two fronts” by balancing the risks of COVID-19 transmission and acquisition with the risks of delayed cancer diagnosis and treatment. This represents an unmet need among oncology practitioners as they navigate this new health care landscape.

Target Audience:

Healthcare professionals, including medical oncologists; radiation oncologists; surgical oncologists; surgeons; radiologists; nuclear medicine specialists; nurse practitioners and physician assistants who practice in oncology; and other healthcare providers who manage cancer.

By the end of the session the participant will be able to:

• Recall the symptoms of COVID-19 infection and best practices for screening patients, health care providers, and staff in the oncology setting.
• Develop a plan to provide oncology care in the setting of the COVID-19 pandemic.
• Describe the risks of delaying cancer diagnosis and treatment against the risk of COVID-19 exposure and infection.
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In this online CME self-learning program: Mucopolysaccaridoses (MPS) are group of genetic disease characterized by a deficiency of lysosomal enzymes responsible for the hydrolysis of glycosaminoglycans (GAGs), whose manifold biological roles resulting in a variety of clinical manifestations in patients presenting with MPS. MPS has seven different subcategories, of which Hunter syndrome is MPS II. A deficiency in iduronate 2-sulfatase results in relatively high levels of the GAGs heparan and dermatan sulfate, resulting in physical signs similar to MPS I with the addition of aggressive behavior and developmental delay. Hunter syndrome is an X-linked recessive genetic disease, with males more likely to develop disease and females more likely to be carriers

Target Audience:

The following healthcare professionals: Pediatricians, neurologists, endocrinologists and primary care physicians; physician assistants, nurse practitioners, nurses, and pharmacists; and any other healthcare professionals with an interest in or who may clinically encounter patients with Hunter syndrome.

By the end of the session the participant will be able to:

• Determine the likelihood of a Hunter syndrome diagnosis using established diagnostic methods, given a patient case.
• Describe current and investigative options available for management of Hunter syndrome, and design a medical plan to treat a patient with Hunter syndrome.
• Describe present barriers to care in the treatment of patients with Hunter syndrome.
• Describe the clinical outcomes associated with Hunter syndrome treatment.
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In this online CME self-learning program: Alcohol use disorder (AUD), referred to colloquially as alcoholism, is an integration of past terms that have include in past as alcohol dependence or abuse, and may be marked by any one of a number of different symptoms or behaviors that include physical cravings, compulsion, guilt, and frequent consumption over an extended period of time. A quarter of adults report at least one day of heavy drinking over the past year. Alcohol accounts for over 687,000 emergency department visits in the U.S. by people under age 20 per year; worldwide, 76.3 million people are estimated to have AUDs, and they account for an annual mortality rate of 1.8 million. AUD is largely under-recognized and undertreated, constituting one gap in care and justifying continuing HCP education. HCPs are considered well-positioned to be able to recognize AUD, and one of the first missed opportunities to do so is failing to employ a validated screening tool, which might identify a condition well before it reaches the full scale of its adverse psychosocial potential.

Target Audience:

HCPs who are: psychiatrists, primary care physicians, emergency medicine physicians, physician assistants, nurse practitioners, pharmacists, and those who otherwise commonly treat patients suffering from or have a clinical interest in AUD.

By the end of the session the participant will be able to:

• Describe the common clinical presentation(s) of AUD.
• Recall recommended AUD diagnostic criteria, and apply them to a patient case.
• List current treatment options for AUD, including behavioral and pharmacologic therapies and apply them to patient cases using evidence-based medicine.
• Describe challenges to the successful management of AUD relating to treatment adherence.
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Fabry disease is characterized by a deficiency of the glycoside hydrolase enzyme alpha galactosidase A, resulting in the accumulation of the glycolipid globotriaosylceramide throughout the body, particularly prominently in the blood vessels. A defect in the enzyme alpha galactosidase A results in glycosphingolipid accumulation, ultimately leading to multi-organ dysfunction and the patient’s premature death. Early symptoms, which occur during childhood, involve pain and may include Raynaud phenomenon, paresthesias, and arthralgia in the extremities and proximal limbs, as well as impaired gastrointestinal emptying, resulting in abdominal pain, diarrhea, early satiety, postprandial bloating, nausea, and vomiting. In adulthood, the disease’s impact spreads beyond and begins to affect the cardiac and renal systems.

Target Audience:

The following healthcare professionals: cardiologists, nephrologists, pediatricians, and primary care physicians; physician assistants, nurse practitioners, nurses, and pharmacists; and any other healthcare professionals with an interest in or who may clinically encounter patients with Fabry disease.

By the end of the session the participant will be able to:

• Describe the pathophysiology of Fabry disease diagnosis and treatment.
• Describe the challenges associated with diagnosis of Fabry disease.
• List present and emerging treatment options for Fabry disease and apply them to patient cases using evidence-based medicine.
• Describe the benefits and any applicable risks of therapeutic approaches to Fabry disease and take them into account when formulating a treatment plan for patients.

Activity Description / Statement of Need:

Clostridioides difficile (formerly known as Clostridium difficile) is a gram-positive obligate anaerobe that produces exotoxins in the gastrointestinal (GI) tract resulting in watery, loose stool, abdominal pain, and nausea. The U.S. incidence of Clostridioides difficile infection (CDI) is about half a million people, with 28% community-acquired, 37% healthcare-associated, and 36% associated with long-term care facilities. Additionally, CDI has incurred one billion dollars in costs to the U.S. healthcare system. Antibiotic exposure causes changes to the GI microflora and increases the risk of developing CDI, which is especially seen in carbapenems, third-/fourth- generation cephalosporins, clindamycin, and fluoroquinolone use. Other risk factors include acid suppressive therapy; age; prolonged hospitalizations or other recent healthcare exposure; recent tube feeding or GI surgery; and immunocompromised states, including recent chemotherapy.

Target Audience:

HCPs including: infectious diseases physicians, gastroenterologists, hospitalists, and intensivists; physician assistants, nurse practitioners, and pharmacists who practice in the aforementioned areas of specialty; and any other HCPs with an interest in or who clinically encounter patients with CDI. 

Migraine headache is the leading condition of recurrent cephalalgias of moderate or severe intensity. It is the most common type of headache presented by patients that seek medical treatment, and the World Health Organization (WHO) has ranked migraine in the top fifteen most disabling medical conditions. The condition has been identified as one of the most common neurological disorders, and in the United States, its prevalence in the general population is approximately 12%. In children, the prevalence ranges from 1% to 4% and does not present more commonly in either sex. However, after menarche, its prevalence in females (18%) is approximately three times higher than in males.

Moreover, professional guidelines relating to the classification, diagnosis, prophylaxis, and treatment of migraine headaches have been updated recently, and communicating related information to healthcare professionals in a timely manner is a demonstrated need. The literature suggests that practicing healthcare professionals are often times unable to keep up with the steady publishing of literature and evolution of clinical practice, and awareness of professional guidelines is no exception. Recently published guidelines therefore also inherently suggest a gap in medical practice and justify the need for educational programming. Generalists may be at particular risk for missing updates in standards relating to migraine subtypes like menstual and abdominal migraines.

Target Audience:

Neurologists and any other healthcare professionals who otherwise come into regular clinical contact with and provide care for patients with migraine.

By the end of the session the participant will be able to:

• Recall the pathophysiology and clinical presentation of headache in patients with COVID-19.
• Describe migraine basic science, epidemiology, outcomes, and therapy findings presented at the American Headache Society (AHS) Virtual Annual Scientific Meeting of 2020.
• Categorize new therapies and those in development based on data presented.
• Synthesize overall presentation material from the AHS CME meeting for further clinical application.