Free CME

Activity Description / Statement of Need:
In this online, self-learning activity:

Chronic lymphocytic leukemia (CLL) is a diverse group of hematologic cancers in which B-cells accumulate in the blood, bone marrow, and lymphatic tissue, constituting as absolute lymphocytosis of mature-appearing lymphocytes with an appropriate immunophenotype. Elderly patients comprise the vast majority of those diagnosed with CLL with a median patient age of 71 years. Men have close to twice the risk of women of developing CLL, and there are over 20,000 cases per year, with an annual mortality rate in excess of 4,400.

Target Audience:
HCPs including: Medical oncologists and hematologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and other healthcare professionals who commonly encounter patients with CLL.

Each year, over 268,000 cases of prostate cancer are diagnosed. Although early prostate cancer may be cured with surgery or radiation therapy, more than 50% of men will experience recurrence after definitive treatment. New treatment options for advanced prostate cancer have further improved survival and increased the number of patients living with castration-resistant prostate cancer (CRPC). But despite the established improvements in survival, a cornerstone of treatment, androgen deprivation therapy (ADT), has been associated with well-characterized negative effects on bone health like skeletal-related events (SREs) and bone metastases. These complications the primary drivers of morbidity and mortality among people with CRPC. Maintaining bone health in patients with CRPC requires routine monitoring and proactive management. Bone mineral density (BMD) loss places men with CRPC at elevated risk for osteoporosis and future fractures.

Activity Description / Statement of Need:
In this online, self-learning activity:

Psoriasis is a T-lymphocyte-mediated condition that is one of the most common immune-mediated inflammatory diseases in the North America and Europe. Plaque psoriasis is the most common form of psoriasis, but several, rarer subtypes of psoriasis have been described, including pustular psoriasis, wherein neutrophils infiltrate the epidermis and present as raised, sterile pustules. One form of pustular psoriasis is generalized pustular psoriasis (GPP), which is characterized by primary, macroscopically visible pustules on the non-acral skin that may occur with or without systemic inflammation and may be relapsing or persistent. Another form is palmoplantar pustulosis (PPP), a persistent condition that is persistent and localized to the palms, soles, or both. These subtypes may be severe and life-threatening and pose a significant healthcare burden, contributing to hospital admissions, higher healthcare resource utilization, and reducing patient quality of life. One survey shows that a majority of patients live under psychological duress and experience at least two flares annually. The same sample reports that condition has a significant impact on their activities of daily living.

Target Audience:
HCPs including: Dermatologists, primary care physicians, and emergency medicine physicians; physician assistants, nurse practitioners, nurses, and pharmacists who practice in the aforementioned areas of specialty; and those with an interest in or commonly encounter patients with pustular psoriasis.

Each year, more than 290,000 cases of breast cancer are diagnosed, making it the leading cause of cancer among females in the United States. Although earlier screening and more effective treatment options have improved outcomes among people with breast cancer, more than 43,000 people die from this type of cancer each year. Throughout the course of breast cancer management, bone health remains an important consideration. In early breast cancer, chemotherapy-induced ovarian failure and endocrine therapy can contribute to BMD loss and subsequent osteoporosis and fracture. In advanced breast cancer, about 70% of all patients will experience bone metastases, placing patients at risk for SREs. In fact, breast cancer is associated with the highest risk of SREs among all tumor types.

Maintaining bone health in patients with breast cancer requires routine monitoring and proactive management to minimize the risk of BMD loss, osteoporosis, and SREs. Guidelines therefore recommend that patients with non-metastatic breast cancer initiating aromatase inhibitors or other treatment that causes bone loss undergo dual-energy X-ray absorptiometry (DXA) scans to assess baseline BMD. Furthermore, patients at risk for osteoporosis should receive regular follow-up DXA scans to monitor for BMD loss. This represents an opportunity for ongoing education about the need for monitoring to ensure maintenance of optimal bone health.

Activity Description / Statement of Need:

In this online, self-learning activity:

Neutropenia, a decrease in the number of a type of white blood cell (WBC) in the body, is a common complication in patients undergoing myelosuppressive chemotherapy that can result in serious, life-threatening infections. Febrile neutropenia (FN), or neutropenia accompanied by a fever, poses an even greater risk to patients and the frequent treatment complication results in over 100,000 hospitalizations in the U.S. each year. Neutropenia can manifest up to twelve days following treatment with a chemotherapy agent and FN occurs in about eight per 1,000 patients receiving chemotherapy. Fever is defined as a single oral temperature of 38.3+ °C or 38.0+ °C over the course of an hour, with neutropenia defined as less than 500 neutrophils/mcL or less than 1000 with a predicted decline to less 500 over the following 48 hours. Development of FN may lead to hospitalization with costs estimated at approximately $15,000 per visit, and it may also complicate care by reducing chemotherapy relative dose intensity (RDI) and possibly compromise treatment efficacy and lower survival rates.

Target Audience:

Oncologists and hematologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and other HCPs with an interest in or who clinically encounter patients with FN or at risk of developing it.

Activity Description / Statement of Need:

In this online, self-learning activity:

Dry eye disease (DED) is a condition with a diverse group of etiologies and whose common symptoms include discomfort or pain, visual disturbance, tear film instability, and ocular surface inflammation. Compared with those without the condition, patients with DED experience higher rates of loss of work productivity, impaired of daily activities, medical visits, and sleep and mood disorders, and worse emotion well-being and overall quality of life. Although the prevalence of DED varies based on a variety of patient factors, estimates place it as high as 20% of the adult population and more than 34% in the elderly. The aggregate U.S. economic impact is estimated be over $3 billion in direct medical expenses and $55 billion in indirect expenses annually. Nonetheless, DED is both underdiagnosed and undertreated.

Target Audience:

The following HCPs: ophthalmology and optometry; physician assistants and nurse practitioners who practice or are interested in ophthalmology; and any other healthcare professionals with an interest in or who clinically encounter patients with dry eye.

Primary immunodeficiency disorders (PIDD) comprise a group of 430 different known inborn errors of immunity. The heterogeneous etiology of PIDD leads to a vast array of clinical presentations, including infection, malignancy, autoimmunity, and inflammation. Once thought to be exceedingly rare, PIDD is increasingly being recognized as an underdiagnosed disease affecting between one in 1,000 to one in 5,000 births.

Because a significant percentage of people with PIDD are undiagnosed, improving the recognition of PIDD signs and symptoms necessarily forms the foundation of PIDD-focused medical education efforts. Early treatment improves outcomes and health-related quality of life in children and adults with PIDD, yet time from symptom onset to diagnosis can exceed 4 years. Diagnostic lag has serious consequences for many patients with PIDD due to recurrent infections, which may take a toll on pulmonary function. In a large-scale analysis of patients with common variable immunodeficiency, a common form of PIDD, risk of death increased by 1.7% each year of diagnostic delay.  The most up-to-date guidance around the classification of PIDD and how to determine related genetic tests has been published relatively recently. Communicating related information to HCPs in a timely manner is a demonstrated need.

Activity Description / Statement of Need:
In this online, self-learning activity:

Acute lymphoblastic leukemia (ALL) is one of a group of malignancies marked by unregulated growth of immature lymphoid cells. Each year, over 6,500 new cases are diagnosed, and ALL claims an estimated 1,390 lives in the same timeframe. The incidence of ALL peaks at 1 to 4 years of age, and it accounts for three quarters of cases of acute leukemia in children. The signs and symptoms of ALL are nonspecific and can include fatigue, malaise, or palpitations associated with anemia; fever with or without infection due to leukopenia or leukocytosis; petechiae; and bleeding or bruising of the oral mucosa or skin. Although the precise etiology of ALL remains unknown, some cases have been associated with exposure to ionizing, toxic chemicals, and herbicides; genetic conditions such as Down syndrome, Fanconi syndrome, neurofibromatosis; and viruses like human T-lymphotropic viruses 1 and 2 and Epstein-Barr virus.

Target Audience:
HCPs including: pediatric hematology-oncology, hematology, oncology, pathology, and those who otherwise commonly care for or clinically encounter patients with ALL.

Activity Description / Statement of Need:

In this online, self-learning activity:

Osteoporosis is a disease common among elderly patients and is increasing in frequency as senior citizens begin to represent a larger share of the US population. In the US, fragility fractures are associated with 1.7 million hospitalizations, and the number of annual of osteoporotic fractures is expected to rise to three million annually in the next few years, with annual treatment costs expected to be $25.3 billion. Despite the morbidity and mortality associated with osteoporosis, practice gaps related to suboptimal screening, risk assessment, and management practices have led to underdiagnosis and undertreatment of this condition. Osteoporosis screening may identify people at increased risk of low-trauma fracture who may benefit from interventions to minimize risk. The USPSTF recommends screening for osteoporosis with BMD testing in all women 65 years or older and in postmenopausal women younger than 65 years but at increased risk of osteoporosis. However, the literature has consistently illustrated underutilization of screening and diagnostic measures. About 60% of women for whom the USPSTF recommends screening do not receive BMD testing,  with some patient populations more likely than others to miss out on screening and care. Clinicians should be aware that prior fragility fracture is sufficient for diagnosis of osteoporosis, and yet only one-quarter of patients with a prior fragility fracture were aware they had this condition. Underdiagnosis therefore represents a compelling safety consideration, as 20% of patients become dependent on long-term care after a hip fracture, and 20% die within a year from related complications.

Target Audience:

HCPs specializing in: endocrinology, internal medicine, geriatrics, and women’s health; physician assistants, nurse practitioners, and pharmacists who practice in those areas of specialty; and those who otherwise commonly care for or clinically encounter patients with postmenopausal osteoporosis.

Activity Description / Statement of Need:

In this online, self-learning activity:

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. While there are many complications resulting from this disease, this CME proposal focuses on treating diabetic foot ulcers that occur in the setting of peripheral neuropathy. Diabetic foot complications are the most common cause of non-traumatic foot injuries leading to amputation, and are also the most frequent reason for hospitalization in patients with diabetes in the United States Diabetic wound care treatments are varied with mixed results, and all current methods require some degree of medium to long-term follow-up and management by an interdisciplinary team which is costly and a significant burden to both the patients and the healthcare system as a whole.

A single treatment with an ultrasonic probe has demonstrated a high rate of complete healing with low recurrence and complication rates. Using these types of devices are relatively inexpensive when compared to more extensive and complex wound care regimens and are easily learned by those experienced in managing this condition. The treatment of diabetic foot ulcers with ultrasonic probes is an evolving standard of care and is becoming an alternative to traditional treatments. This treatment involves fragmenting, emulsifying, and removing thickened scar tissue beneath the wound crater, as well as removing osseous prominences to decrease pressure on the wound bed and promote healing.

There have been recent developments in the available treatments for diabetic foot ulcers. Communicating related information to HCPs, including recent guideline updates, is a demonstrated need.

Target Audience:

The following HCPs who specialize in diabetic care: Endocrinologists, podiatrists, foot and ankle surgeons, primary care physicians, physician assistants, nurse practitioners, and wound care RNs.