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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.

Physical therapy can ease symptoms if internal bleeding has damaged a patient’s joints, and surgery may be necessary if internal bleeding has caused severe damage. However, the current standard of therapy for hemophilia B is intravenous infusion of therapeutic factor concentrates. Through the reduction in the number of bleeding incidences and improvement in quality of life, factor replacement therapy has significantly reduced the morbidity and mortality of hemophilia. Furthermore, prophylactic therapy has the demonstrated benefit of reducing the development of hemophilic arthropathy.

Target Audience:

The following healthcare professionals: hematology, primary care physicians, and pediatricians; physician assistants, nurse practitioners, nurses, and pharmacists who practice in hematology as well as other Hemophilia Treatment Center HCPs; and any other clinicians with an interest in hemophilia B.

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

• Describe the risk factors and occurrence of hemophilia B.
• Identify available prophylactic and treatment options for hemophilia B and apply them to a patient case.
• Identify the new treatment options for hemophilia B.
• Identify adherence barriers in and deliver effective treatment counseling to patients with hemophilia B.

Activity Description / Statement of Need:

In this online, self-learning activity:

Immune thrombocytopenia (ITP) is a phenomenon characterized by a peripheral platelet count of less than 100 x 109/L in the absence of any discernable cause, with an increased risk of bleeding. Also known as thrombocytopenic purpura, it occurs in around two to four cases per 100,000 adults, with incidence peaking bimodally: Once between 20-30 years with female predominance and also at 60 years with even distribution between the sexes.

The diagnosis of ITP is one of exclusion and includes platelet autoantibody testing. However, it is complicated and associated with documented gaps in care, with preventable delays in diagnosis and misdiagnosis not uncommon. One study found that one in seven patients diagnosed with ITP were misdiagnosed and reclassified as they received additional clinical evaluation. Another study found that over 22% of patients with ITP did not receive guideline-recommended peripheral blood film examination. These diagnostic challenges have real-world consequences on patient lives, creating anxiety in 73% of patients who experience a delayed diagnosis.

Treatment goals include prevention of severe bleeding episodes, maintaining platelet counts for symptomatic patients, minimizing treatment toxicity, and maximizing health-related quality of life. Conventional therapy includes corticosteroids, intravenous immunoglobulin (IVIg), and anti-D IVIg. However, treatment challenges remain, including variability in practice between providers and high rates of relapse between following standard first-line therapies together with considerable patient frustration. Moreover, some patient subpopulations are more challenging to treat and are less likely to achieve therapeutic success.

Target Audience:

HCPs specializing in: hematology; physician assistants, nurse practitioners, nurses, pharmacists; and any other healthcare professionals with an interest in or who clinically encounter patients with ITP.

Hemophilia is a genetic disease caused by mutation of one of the genes for coagulation proteins leading to dangerous, uncontrolled bleeding. In hemophilia A, a mutation in the gene for factor VIII (FVIII) leads to an endogenous deficiency in the clotting factor. The incidence of hemophilia A is the same in all geographic regions, populations, and ethnic groups, affecting approximately 1 out of every 5000 male births. The condition is diagnosed by measuring FVIII activity, and patients with severe hemophilia have FVIII activity of 1% or less. Patients with severe hemophilia A 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.

Target Audience:

The following healthcare professionals: hematology, primary care physicians, and pediatricians; physician assistants, nurse practitioners, nurses, and pharmacists who practice in hematology as well as other Hemophilia Treatment Center HCPs; and any other clinicians with an interest in hemophilia A.

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

• Describe the risk factors and occurrence of hemophilia A.
• Identify available prophylactic and treatment options for hemophilia A and apply them to a patient case.
• Identify the new treatment options for hemophilia A.
• Identify adherence barriers in and deliver effective treatment counseling to patients with hemophilia A.

Antimicrobial resistance (AMR) is a phenomenon fueled by the selection pressure leveled against microorganisms through the use and misuse of antimicrobials in clinical and agricultural settings as well as horizontal gene transfer between pathogens. The WHO predicts that there will be 50 million deaths caused by infectious diseases, and the U.N. General Assembly has designated the emergence of AMR the largest world health problem.

The World Health Assembly has endorsed a Global Action Plan on Antimicrobial Resistance, including one step to address AMR: the sustainable investment in and development of new antimicrobials. Helping the clinician discern the role of these advances merits continuing healthcare professional education, as research suggests that HCPs are oftentimes unable to keep up with the steady publishing of literature and evolution of clinical practice. In so doing, the goal is to educate clinicians about the appropriate role of novel antibiotics so that they may more effectively address the challenge of AMR rather than contributing to it.

Target Audience:

HCPs specializing in: Infectious disease, critical care, and primary care; physician assistants, nurse practitioners, nurses, and pharmacists who practice in the aforementioned areas of specialty; and any other healthcare professionals with an interest in or who treat patients with antimicrobials.

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

• Identify key findings from the ID Week 2019 conference.
• Apply the changes in CAP guidelines 2019 from 2007.
• Identify novel drugs approved in 2019 and their potential.
• Understand the implications of some current research and paradigm shifts.
• Review HIV progress in the last year.

Activity Description / Statement of Need:

In this online, self-learning activity:

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, hematopoietic stem cell disorder characterized by complement-mediated destruction and loss of erythrocytes and the eponymous clinical manifestation of pink-red discoloration of the urine due to presence of hemoglobin. PNH is a rare disorder with a reported incidence of clinically significant disease of between 1 to 2 cases per million. However, it is possible that this range may be underestimated, as a subset of patients remain undiagnosed. PNH occurs worldwide with no known specific ethnic or geographic distribution patterns.

Approximately 40% of patients with PNH saw at least five or more specialists before receiving a diagnosis. PNH diagnosis is complicated by the rarity of the disorder and the nonspecific findings, meriting continuing healthcare educational programming.

Target Audience:

The following healthcare professionals: Hematologists; physician assistants, nurse practitioners, and pharmacists specializing in hematology and transplant medicine; and any other healthcare professionals with an interest in or who may clinically encounter patients with PNH.

Activity Description / Statement of Need:

In this online, self-learning activity:

Multiple myeloma (MM) is a hematologic malignancy of the lymphocytes, and while the true cause is unknown, associated factors are thought to include: radiation, genetics, viral infections, and the human immunodeficiency virus. Myeloma is most common of the hematologic malignancies after non-Hodgkin lymphoma, with an incidence of over 34,000 and an annual mortality rate of over 12,000. The peak incidence age of MM is at about 70 years of age, and the disease occurs twice as commonly in African Americans as it does in whites.

Goals of care in MM are prolonging survival rates and improving quality of life, and treatment begins with induction and post-induction therapy, followed by hematopoietic stem cell transplant or maintenance therapy in patients ineligible for transplant. Relapse is indicated by any of several clinical signs, including new soft tissue plasmacytomas, hypercalcemia, renal insufficiency, anemia, new bone lesions, or hyperviscosity related to serum paraprotein.

Target Audience:

Hematologists and oncologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with RRMM.

Over a quarter million women and almost 2,700 men in the U.S. are diagnosed with breast cancer each year, and it is the second leading cause of cancer death in women. The prognosis associated with breast has improved in the last few decades due in larger part to earlier detection. Detection at the loco-regional stage is associated with a five-year overall survival (OS) rate of ≥ 85% in contrast to 27% for distant or metastatic breast cancer (MBC).

Because it is not curable, the goals of care in MBC are: palliation of symptoms, improvement of quality-of-life, and extension of survival. Hormone receptor positivity has traditionally conferred a better prognosis. In contrast, the presence the human epidermal growth factor receptor 2 (HER2) is associated with a more negative prognosis. Finally, there remains a basal-like group lacking in those markers, miscellaneously labeled triple-negative (TNBC), with some cancers observed to be more aggressive, but with the overall population similar in prognosis to hormone-positive breast cancer, owing to TNBC’s heterogenous nature.

Target Audience:

The following healthcare professionals: Medical oncologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and any other HCPs with an interest in or who clinically encounter patients with breast cancer.

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

• Describe the prognostic and treatment implications of TN status in the diagnosis and treatment of MBC.
• Describe treatment options presently available for TN MBC, including safety, and apply them to patient cases using evidence-based medicine.
• Describe emerging treatment options presently available for TN MBC, their mechanisms of action and safety, and anticipated place in therapy.
• Discuss barriers patients with TN MBC experience in attempting to access care, including burden of disease and adverse consequences of therapy, and propose ways to ameliorate them.

Activity Description / Statement of Need:

In this online, self-learning activity: Goal-directed therapy (GDT) has been taken as the gospel in critical care since the publication of Rivers et al.’s seminal paper on the topic demonstrating a mortality benefit in patients with severe sepsis and related shock in late 2001. Its protocols were soon embraced and became ensconced in practice as standards of care, overlapping with other, high-acuity areas of medical specialty like surgery and emergency medicine. One challenge has been the conventional approach’s embrace a ‘recipe-book’ or one-size-fits all approach with directed by static parameters. The literature clearly demonstrates that indiscriminate administration of fluids is associated with a number of complications, increased length of stay, and mortality in a diverse array of patient populations, findings all the more important because only half of hemodynamically unstable patients respond to fluids. The benefits of dynamic monitoring strategies in a range of patient populations have been borne out not only by meta-analyses but also recent clinical trial evidence. 

Target Audience:

Physicians and nurses in the following areas of specialty: Anesthesiology, critical care, emergency medicine, and surgery.

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

• Describe the CMS goal of resuscitation in severe sepsis and septic shock.
• Recognize potential adverse outcomes of under and over resuscitation of the critically ill.
• Understand variability indices and changes in stroke volume to predict volume responsiveness.
• Recognize applications and limitations of non-invasive hemodynamic monitoring.
• Recognize potential benefits of guided volume resuscitation strategies.

Activity Description / Statement of Need:

In this online, self-learning activity:

Familial hypercholesterolemia (FH), also known as type II hyperlipoproteinemia, is an autosomal dominant genetic disorder characterized by substantially elevated plasma LDL-C levels. There are over 1600 different mutations associated with FH, and the condition arises from a significant or complete reduction in functional LDL-C receptors (LDL-Rs) and an attendant reduction in LDL-C clearance that predisposes individuals to premature atherosclerotic cardiovascular disease (ASCVD). The severity of FH is determined by the presence of heterozygous or homozygous genetic alterations. Patients with homozygous FH develop vascular disease during childhood, while those with heterozygous FH may not develop ASCVD until their 30s or 40s. FH is a relatively common disorder, affecting about 1 in every 299 people in the US. Among people with ischemic heart disease, the prevalence is about 10-fold higher, and among those with severe hypercholesterolemia, the prevalence is nearly 23-fold higher.

This learning activity has been designed to bring HCPs’ knowledge of the strategies for the diagnosis and treatment of FH up to date and to improve their competence and performance in treating it.

Target Audience:

Cardiologists, primary care physicians, physician assistants, nurse practitioners, and pharmacists who practice in cardiology; and any other clinicians with an interest in FH.

Activity Description / Statement of Need:

In this online, self-learning activity:

Biosimilar drugs are products meant to be similar in quality, safety, and efficacy to an already licensed reference biotherapeutic product. Whereas generics are virtually identical replicas of conventional medications, biosimilars are not the same as the original product – a practically unavoidable outcome because of the considerably large molecular structure that biologics mimic. The literature suggests that learning activities focused on the evolving landscape of biosimilars, which are germane to the therapeutic area because of their potential role in cost containment. Both the FDA and medical literature independently affirm the need for clinician education on biosimilars, including: comparative efficacy; adverse event rates and management (potential concerns have included immunogenicity); regulatory guidance on interchangeability and substitution – including prescribers retaining some degree of ability to intervene in a product’s substitution at the dispensing stage; and cost considerations. There has been significant progress in the adoption of biosimilars since the first one received FDA approval over half a decade ago. Clinicians who employ biosimilars have a generally positive view of them. However, challenges remain.

Target Audience:

The following healthcare professionals: rheumatologists, gastroenterologists, and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in the aforementioned areas of specialty; and any other healthcare professionals with an interest in or who clinically encounter patients with the immune-mediated and autoimmune disease states covered by this activity.