Free CME

Activity Description / Statement of Need:

In this online, self-learning activity:

Growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone by the pituitary gland. The condition may arise from a variety of causes, including tumors, radiation, medications, traumatic brain injury, or genetic defects. In children, GHD is characterized by pronounced short stature, defined as 2 or more standard deviations from the mean based on age and sex. Because short stature may be caused by a variety of other factors, including genetics, hypothyroidism, and Turner syndrome, estimating the prevalence of GHD in the pediatric population is challenging. Studies suggest that GHD may occur in 1 out of every 4,000 children. There are also related conditions whose features overlap, including idiopathic short stature (ISS), and primary insulin-like growth factor-I deficiency (PIGFD), complicating diagnosis.

This program has been designed to bring HCPs’ knowledge of the rationale behind management of pediatric GHD up to date and to enhance their competence and practice in caring for pediatric patients with GHD. Topics addressed will include: clinical presentation, diagnostic tests, and safety and efficacy of present and emerging therapy, including dose selection, monitoring, transition into adulthood, and providing patient-centered care.

Target Audience:

The following HCPs: Endocrinologists, pediatricians, and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in endocrinology; and any other HCPs with an interest in or who clinically encounter patients with GHD.

Activity Description / Statement of Need:

In this online CME 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. Risk for osteoporosis should be determined by a formal clinical measurement tool, such as FRAX™, which assesses 10-year fracture risk. Diagnosis of osteoporosis can be made based on the history of fragility fracture or with a T score of 2.5 SD or more below the young adult mean BMD.

However, the literature has consistently illustrated underutilization of screening and diagnostic measures. 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. Because these outcomes represent significant quality and safety considerations, a number of national quality measures that are strongly supported by the evidence have been developed to address shortcomings in care. 

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.

Activity Description / Statement of Need:

In this online, self-learning activity:

Psoriasis, characterized by chronic inflammation of the skin and hyperproliferation and abnormal differentiation of the stratified epidermis, is one of the most common autoimmune diseases in the US. With a clinical presentation of red, scaly plaques on the skin that range in severity from minor, localized lesions to complete body coverage, it is also associated with inflammation of the joints and enthesial attachments and has potential of articular destruction—a complication known as psoriatic arthritis that affects up to 30% of those with the disease. Aside from its direct effects on the skin, it is also reduces quality of life associated with cardiac and psychiatric comorbidities. Over half of patients with psoriasis are unsatisfied with their disease management, and half of patients with mild disease are untreated while the same is true for a fifth of patients with severe disease.

This activity has been designed to bring HCPs’ knowledge of current and emerging screening and treatment strategies for psoriasis up to date and to improve their competence and performance in treating it. This program has also been designed to review treatment strategies and raise awareness of gaps in care of patients with psoriasis and review strategies to promote adherence.

Target Audience:

HCPs specializing in: Dermatologists and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in dermatology; and any other healthcare professionals with an interest in or who clinically encounter patients with psoriasis.

Activity Description / Statement of Need:

In this online, self-learning activity:

Heart failure (HF) is a clinical syndrome arising from diminished ventricular filling or ejection of blood. HF with reduced ejection fraction (HFrEF) is characterized by abnormality in the systolic function and a left ventricular ejection fraction (LVEF) of <40%. The prevalence of HF is about 40 million people globally and approximately 6.5 million in the U.S., and as the global population continues to age, the prevalence of HF is expected to continue increasing over the coming decades. HFrEF constitutes a major public health concern, with five-year survival rates as low as 25%, and it carries with it a significant risk of emergency department visits and hospitalizations.

There has been increased focus recently on guideline-directed medical therapy (GDMT) in HFrEF, and evidence suggests that each ten percent improvement in measures of guideline-recommended composite care is associated with a thirteen percent lower odds of 24-month mortality. Nonetheless, research shows that substantial portions of patients are not treated with guideline-recommended doses, even after taking into account dose-limiting physiological parameters, and that guideline non-adherent practice is associated with poorer outcomes.

Target Audience:

The following HCPs: Cardiologists and PCPs; physician assistants, nurse practitioners, and pharmacists who practice in cardiology; and any other HCPs with an interest in or who clinically encounter patients with HFrEF.

In this online, self-learning activity:

Multiple myeloma (MM) is the most common hematologic malignancy after non-Hodgkin lymphoma, with an incidence of over 34,000 and an annual mortality rate of over 12,000. MM-induced osteocyte apoptosis facilitates MM cell survival, and patients with MM are at high risk for bone disease. Osteolytic lesions are reported in up to four out of five newly diagnosed with MM, and throughout their disease course, up to 90% of patients will eventually develop bone lesions. The presence of bone lesions increases MM patient risk for skeletal-related events (SREs), such as fractures, spinal cord compression, or need for surgery or radiotherapy. Bone disease and SREs can have serious consequences in MM, leading to worsened quality-of-life and prospects for survival. Patients who experience fracture after MM diagnosis have a two-fold increased risk of death relative to those who do not experience fracture. Yet bone disease frequently goes untreated in patients with MM, suggesting that clinicians are not familiar with the serious effects of MM.

In this online, self-learning activity:

Osteoporosis is characterized by low bone mass and deterioration of bone tissues, which leads to an increased risk of skeletal fractures. Although osteoporosis is generally considered as a women’s health issue and often overlooked problem in men, osteoporosis in men is also an important public health issue, and its prevalence is increasing as the general population ages – rising to 11% in men by age 80. Around 1-2 million men in the United States have been estimated to have clinical osteoporosis, and an additional 8-13 million men identified to have low bone mass. In sum, 35% of men are considered to have low bone density by age 50, and that number rises to 53% by age 80.

This program has been designed to bring HCPs’ knowledge of the rationale behind prevention and treatment of male osteoporosis up to date and to improve their competence and performance in treating and preventing it.

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.

Given the rapid expansion of these product types and the presence of gaps in the area of hematologic malignancies and oncologic and supportive care therapies, this activity has been designed to bring HCPs’ knowledge of biosimilar products in those areas up to date and to improve their competence and performance in employing them in practice.

Target Audience:

The following healthcare professionals: Hematologist-oncologists and medical 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 hematologic malignancy or oncologic disease states who may receive treatment with biosimilars.

Activity Description / Statement of Need:

In this online, self-learning activity:

Renal cell carcinoma (RCC) is a cancer that is borne and takes root in the nephrons. It is responsible for most cancers of the kidney and renal pelvis, which occur in 79,000 people and account for close to 14,000 deaths in the U.S. per year. The five-year survival rate is 93% for patients with early stages of the disease. However, in patients with advanced or metastatic disease, the five-year survival is 14%, representing an area of ongoing clinical need. Treatment selection in advanced, clear cell RCC treatment depends on prognostic scoring and may include mono- or combination therapy with immunotherapy and an antiangiogenic agent, and many of the same agents are used to treat advanced, non-clear cell RCC.

Target Audience:

HCPs including: Medical oncologists and urologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with RCC.

Activity Description / Statement of Need:

In this online, self-learning activity:

Von Willebrand disease (vWD) is the most common congenital bleeding disorder worldwide. Affecting both male and female births in equal number, vWD is caused by a deficiency or defect in the von Willebrand factor (vWF) glycoprotein, which is responsible for mediating platelet and coagulation factor VIII function. vWD types 1 and 3 are caused by quantitative deficiencies in vWF. In contrast, type 2 vWD is caused by a qualitative defect in the production of vWF. Type 1 is the most common type of vWD, accounting for 60% to 70% of cases, followed by type 2, which is diagnosed in 25% to 30% of patients. Type 3 vWD, the rarest form, affects about 1 in 1,000,000 people. There is evidence that the use of factor VIII/vWF concentrates should be individualized, but no recent vWD guidelines address this issue. Although DDAVP is the treatment of choice for most type 1 vWD patients, data do not support the use of DDAVP for type 2B vWD owing in part to an increased risk for thrombocytopenia. Another practice gap is a lack of guidance around the appropriate ages at which patients with severe vWD are optimally initiated on vWF prophylaxis. Furthermore, although DDAVP is not contraindicated in pregnancy, 31% of physicians consider DDAVP a contraindication according to the results of one survey, illustrating a present area of controversy in practice.

Recent advances in replacement therapy with factor VIII/vWF concentrates have expanded treatment options. A few considerations may impact determination of best choice of agent, including hemostatic capacity and relative proportion of factor VIII. For these reasons and others, there has been a recent focus in individualizing replacement therapy in a manner that takes into account vWD type, thrombosis risk, and clinical indication and goals of therapy. Taking this information into account as well the fact that HCPs are oftentimes unable to keep up with the steady publishing of literature and evolution of clinical practice, continuing HCP education examining clinical decision-making and the appropriate selection of therapy is warranted.

Target Audience:

The following HCPs: hematologists and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in hematology; and any other healthcare professionals with an interest in or who clinically encounter patients with vWD.