Free CME

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:

Advances in ALL management has led to considerable improvements in outcomes over the past several years, with modern-day treatment leading to remission rates of up to 99% and cure rates of about 90% in children with ALL. However, achieving these high rates of response require multiple phases of treatment, including induction, consolidation, interim maintenance, delayed intensification, and maintenance therapy. 

Chemotherapy was previously the standard of care in this setting but is associated with considerable toxicities. Novel, less toxic options are available or being studied for children who have relapsed after treatment as are new pharmacotherapies specific to patients with Philadelphia chromosome–positive disease and novel formulations of asparaginase. Helping the clinician discern the role of each of the first- and subsequent-line novel therapies based on the most up-to-date research merits continuing education programming in ALL. Indeed, a survey of oncology providers revealed that 86% indicated that added professional guidance would be helpful in incorporating more recent therapies into care.

And despite the inclusion of newer agents in pediatric ALL guidelines, a survey of oncologists and other providers who treat patients with the condition found that 40% of respondents had never prescribed, dispensed, or administered them. Challenges include lack of expertise and management of side effects. Furthermore, recently published guidelines, therefore, also inherently suggest a gap in medical practice and justify the need for educational programming.

Target Audience:

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

Activity Description / Statement of Need:

In this online, self-learning activity:

Atopic dermatitis (AD) is a chronic, highly pruritic inflammatory skin disease that is one of the most common skin disorders in children but may develop at any age. It affects 15-30% of children and two to ten percent of adults in developed countries, and between 10-30% of children who have the condition continue to experience it in adulthood. AD is thought to arise from a complicated interplay between multiple genes and environmental triggers, with known risk factors including family history and loss of function mutations in filaggrin. Complications include food allergy, asthma, and allergic rhinitis, and aside from genetics, its pathophysiology involves T-cell mediated inflammation and epidermal dysfunction. The disease is associated with a considerable healthcare burden placed on patients and their families; pruritis aside, patients not uncommonly suffer a loss of sleep and experience secondary infections, anxiety, and depression.

Target Audience:

The following HCPs: Pediatric and adult dermatologists, allergists, and internists; physician assistants, nurse practitioners, and pharmacists who treat patients with dermatologic conditions; and any other HCPs with an interest in or who diagnose, treat, or manage patients with AD.

This case study features expert discussion surrounding a real HCM patient and is designed to raise awareness about the frequency of atrial fibrillation in HCM patients and the challenges associated with managing atrial fibrillation symptoms.

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.

This online learning module is designed to raise awareness for HCM and provide an understanding of how HCM progresses over time and the associated mortality. 

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:

Lung cancer is the leading cause of cancer-related death in the United States with over 235,000 new cases diagnosed and representing a quarter of all cancer deaths at a rate of 132,000 annually. While smoking contributes to 82% of lung cancer deaths, nonsmoking-related lung cancer deaths still fall in the top ten causes of cancer deaths and represents a growing proportion of cases. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer diagnosed, accounting for approximately 80% of patients diagnosed. Despite clear guidance on surveillance for disease in individuals at high risk, late diagnosis is a fundamental obstacle to improving lung cancer outcomes. 55% of NSCLC cases are diagnosed after metastasis, at which point the two- and five-year survival rates are 20% and 6.1%, respectively, whereas patients diagnosed with local disease experience survival rates of 81% and 61.4%, respectively. Treatment decisions are influenced by disease stage, histology (squamous vs. non-), and the tumor’s molecular features (e.g., PD-L1, EGFR, ALK, BRAF, NTRK, ROS1), although patient factors like performance status and comorbidities should also inform the development, optimization, and personalizing of individual treatment plans. First-line therapy for patients with advanced-stage NSCLC who are anti-programmed-death 1 (PD-1) positive is immunotherapy with a targeted monoclonal antibody. Targeted therapies are also preferred over platinum-based doublets as first-line therapy in patients whose tumors have targetable genetic mutations. The care plan need take into account management of adverse events from therapy, which may result in treatment delays, increased morbidity, or contribute to treatment failure.

Target Audience:

HCPs specializing in: Oncology, pulmonology, and pathology; 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 advanced NSCLC.