Free CME

Activity Description / Statement of Need:

In this online, self-learning activity:

Non-alcoholic steatohepatitis (NASH) is a form of non-alcoholic fatty liver disease (NAFLD) characterized by steatosis, with the accumulation of fat in the liver in excess of five percent of the liver’s weight, together with hepatic inflammation in the presence or absence of fibrosis. Risk factors for NASH include a number of comorbid metabolic diseases and disorders, including metabolic syndrome, obesity, type 2 diabetes, hypertension, and dyslipidemia. The prevalence of NASH is estimated to be 1.5%-6.45% of the U.S. population, and prevalence of NASH among NAFLD patients to be 59.1% globally.

Target Audience:

The following HCPs in: Gastroenterology, hepatology, and endocrinology; physician assistants, nurse practitioners, and pharmacists who practice in the aforementioned areas of specialty; and those who otherwise have an interest in or commonly care for or clinically encounter patients with NAFLD.

Sickle cell disease (SCD) is the most common monogenic blood disorder, affecting millions of people worldwide and approximately 100,000 Americans. Although it may be found in various areas of the world, SCD predominantly affects individuals of African or Hispanic heritage. It is caused by the inheritance of b-globin alleles that code for hemoglobin S, resulting in an amino acid substitution in hemoglobin’s b chain and clinical disease. Patients with SCD have impaired circulation, and lysis of the erythrocytes contributes to a chronic inflammatory response, causing severe pain and less efficient oxygen delivery. The hallmark clinical features of SCD are hemolytic anemia and painful vaso-occlusive crises (VOCs), which may lead to emergency department visits, hospitalization, and potentially fatal complications such as acute chest syndrome, stroke, or pneumonia. In one US study, 45% of deaths among people with SCD were related to cardiopulmonary causes, and VOCs alone have been shown to increase the risk of death by 50%. SCD may disrupt employment or school and is associated with a significant reduction in quality of life. This learning activity has been designed to bring HCPs’ knowledge of rationale behind treatment of SCD up to date and to enhance their competence and performance in the condition’s management.

Activity Description / Statement of Need:

In this online, self-learning activity:

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 large part to earlier detection. However, while detection at the loco-regional stage is associated with a five-year overall survival (OS) rate of 90%, patients with metastatic breast cancer (mBC) may expect five-year OS rates closer to 28%.

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 (HR+) in the absence of human epidermal growth factor receptor 2 overexpression (HER2+) has traditionally conferred a better prognosis. In contrast, HER2+ status is associated with a more negative prognosis, as it is associated with an increase in growth signals that are associated with accelerated tumor growth patterns, faster rates of recurrence, and higher mortality rates.

This activity has been designed to bring healthcare professionals’ knowledge of the rationale behind treatment of HER2+ mBC up to date and to improve their competence and performance in treating it.

Target Audience:

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 breast cancer.

Activity Description / Statement of Need:

In this online, self-learning activity:

The WHO defines vaccine hesitancy (VH) as a “delay in acceptance or refusal of vaccines despite the availability of vaccination services.” Despite substantial progress in rates of routine immunization over the decades prior to the most recent one, more recent trends suggest that immunization rates are beginning to plateau. Beyond VH and skepticism, there is also the embrace of outright vaccine rejection or denial fostered by the presence disinformation on conventional and social media platforms including claims that vacines are unsafe or unnecessary. Recent outbreaks of largely eradicated diseases such as measles, mumps, and diphtheria suggest that herd immunity may have suffered, putting those ineligible for vaccination at additional risk of infection. These developments have been attributed in part to VH and denial.

One large group with increasing VH is parents. A 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Another study saw that in up to 35% parents of well-vaccinated children demonstrate VH. Parents may raise issues that many providers feel ill-equipped to answer, due to lack of thorough knowledge of all vaccines or lack of evidence-based communication strategies. Unfortunately, only few evidence-based strategies exist to guide providers in their discussions with vaccine-hesitant parents.

Providers play a crucial role in vaccinating populations, but it is not and should not be their sole responsibility. Clinical practice sites, community organizations, health organizations, and government all contribute to addressing VH. Understanding potential solutions outside the office, such as media campaigns and policy changes, also provide insight into vaccine hesitancy and potential directions for future use.

Target Audience:

The following HCPs: Primary care physicians, pediatricians, and public health professionals; physician assistants, nurse practitioners, nurses, and pharmacists who practice in adult internal medicine and pediatrics; and any other clinicians who commonly encounter patients eligible for protection against vaccine-preventable diseases.

Activity Description / Statement of Need:

In this online, self-learning activity:

Cardiovascular (CV) disease (CVD) is the leading cause of mortality and morbidity in adults worldwide, accounting for around one-third of mortality in the United States. High blood pressure, diabetes, and obesity are health conditions that can increase the risk of heart disease, and over half of American adults have at least one major risk factor for adverse cardiovascular events. In particular, T2DM is a risk factor, with CV events implicated in the mortality of two-thirds of patients with T2DM. About one and a half million new cases of diabetes mellitus are diagnosed in in the United States each year, and the incidence of T2DM is increasing owing in part to Western-style diets, sedentary lifestyle, and changing demographics, and the disease is the largest contributor to a number of vascular outcomes, including end-stage chronic kidney disease (CKD) and blindness in individuals under age 75. CKD is itself a major CVD risk factor and affects millions, yet the literature shows that patients with CKD are underserved with respect to CV risk reduction efforts.

This activity has been proposed to enhance the knowledge, competence, and performance of several members of HCPs in mitigating heart and kidney disease risk in patients with T2DM while addressing barriers to optimal care.

Target Audience:

The following HCPs: Endocrinologists, nephrologists, cardiologists, and primary care physicians; certified diabetes educators, physician assistants, nurse practitioners, nurses, and pharmacists who practice in diabetes and endocrinology; and any other HCPs with an interest in or who clinically encounter patients with diabetes.

Activity Description / Statement of Need:

In this online, self-learning activity:

Transthyretin amyloidosis (ATTR) is a progressive, multisystem, life-threatening disorder characterized by the extracellular deposition of misfolded, insoluble amyloid fibrils. As TTR is a protein present in human serum, and its role is to transport thyroxine and retinol-binding proteins, it is vital for behavior, cognition, nerve regeneration, and axonal growth. TTR itself is innately amyloidogenic even without the presence of genetic mutations. The familial variant of the disease (hATTR) is ATTR that is passed to offspring through autosomal dominant inheritance, whereas the wild type variant (wtATTR) refers to ATTR that occurs independently of genetic mutations. hATTR may present as late as mid-adulthood, but its symptoms usually start between the ages of 2 and 10 years. Left untreated, the average life expectancy of ATTR is 3 to 15 years from symptom onset.

Target Audience:

The following HCPs: neurologists, cardiologists, and hematologists; physician assistants, nurse practitioners, nurses, and pharmacists in the aforementioned areas of specialty; and any other HCPs with an interest in or who may clinically encounter patients with ATTR.

Activity Description / Statement of Need:

In this online, self-learning activity:

Pompe disease (PD) is a progressive, often fatal, autosomal recessive, neuromuscular disorder caused by mutations of the α-glucosidase gene on chromosome 17. PD is characterized by glycogen accumulation in skeletal, cardiac and smooth muscles due to a deficiency in α-glucosidase (GAA), an important lysosomal enzyme responsible for glycogen catabolism. PD is categorized into three groups based on symptoms and age of onset. The classic infantile form presents in the first year of life, usually in the first two months, with hypertrophic cardiomyopathy. The non-classic infantile form presents later in the first year of life, without or with less severe cardiomyopathy. The late onset form of PD presents any time after one year of life, usually without cardiac complications.

PD is rare, with one study estimating the incidence in the U.S. to be 1 in 22,000 births. The biggest risk factor for the disease is genetics; at conception, each sibling of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being not a carrier. Nonspecific diagnostic findings for PD may include abnormal EMG, elevated serum creatine kinase, elevated transaminases and elevated lactate dehydrogenase. A definitive diagnosis for PD involves a dried blood spot test to determine GAA enzyme activity level; reduced GAA activity (less than 40% of normal) is indicative of a positive diagnosis. A gene mutation analysis, or another GAA enzyme test using a different area of tissue, is recommended to confirm the diagnosis. The disease is not uncommonly undiagnosed or is misdiagnosed, representing one practice gap that continued HCP education may address, particularly given that earlier treatment may minimize rapid and irreversible disease progression.

Target Audience:

The following HCPs: Neurologists, pediatricians, 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 HCPs with an interest in or who may clinically encounter patients with PD.

Activity Description / Statement of Need:

In this online, self-learning activity:

 Chronic kidney disease (CKD) affects about 15% of the general population in the United States and is the tenth-leading cause of death, accounting for 52,260 deaths in 2020. Along with the risk for end-stage kidney disease (ESKD) and cardiovascular disease (CVD), CKD has also been associated with a number of complications, including anemia and hyperphosphatemia. Anemia occurs in about 15% of patients with CKD and arises from decreased erythropoiesis and abnormal iron metabolism. Hyperphosphatemia occurs in the later stages of CKD because the kidney is the primary method by which the body maintains phosphate. This retention of phosphate leads to the development of CKD-mineral bone disorder (CKD-MBD), with the literature suggesting that hyperphosphatemia occurs in a large portion of patients on dialysis based on phosphate binder (PB) usage.

This learning activity has been designed to bring HCPs’ knowledge of the treatment and screening of anemia and hyperphosphatemia in patients with CKD up to date and to improve their competence and performance in treating it. It will walk participants through treatment pathways and review of the evidence behind therapies to treat CKD’s complications.

Target Audience:

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

Activity Description / Statement of Need:

In this online, self-learning activity:

Irritable bowel syndrome (IBS) is among the most common disorders seen by primary care as well as gastroenterology specialty clinics. Patients with IBS usually present with chronic abdominal pain and altered bowel habit, in the absence of any other disease to cause these sorts of symptoms. The disorder is associated with annual healthcare expenditures of $20 billion and significant costs in lost work productivity and health-related quality-of-life.

Although not uncommon, there is still much that is unknown about IBS-C, and its diagnosis has largely remained dependent on symptom-based criteria with their share of limitations.

This activity has been designed to update HCPs’ knowledge of IBS-C and to improve their competence and performance in treating it.

Target Audience:

The following HCPs: Gastroenterologists and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in gastroenterology; and any other HCPs with an interest in or who clinically encounter patients with IBS-C.

The Evolution of Insulin Replacement Therapy consists of 4 presentations with discussion:
• Session 1: Insulin Options for Diabetes: Update on their Evolution
• Session 2: Advancing to Insulin Therapy for Type 2 Diabetes: The Impact of the New Insulin Options
• Session 3: Physiologic Insulin Replacement: Practical Approaches for the Primary Care Provider
• Session 4: The Evolution of Glycemic Monitoring and Insulin Delivery Devices: Why the Primary Care Provider Should Understand the Options

At the conclusion of The Evolution of Insulin Replacement Therapy, you will be able to:
• Identify clinically relevant pharmacokinetic and pharmacodynamic properties of the new insulins and insulin combinations
• Discuss the clinical importance of similarities and differences between a biosimilar insulin and a reference insulin
• Recognize the indications for advancement to insulin replacement therapy for people with T2DM
• Identify clinically relevant pharmacokinetic and pharmacodynamic properties of the new insulins and insulin combinations
• Describe initiation and titration methods for new insulin-based therapies to optimize achievement of glycemic goals while minimizing adverse effects
• Discuss strategies to overcome patient and clinician barriers to the successful initiation and utilization of insulin therapy in the context of the new insulin-based therapies, and monitoring and delivery devices

Target Audience:
This program is intended for US-based primary care providers, clinical endocrinologists/diabetologists, nephrologists, cardiologists, emergency department specialists, pharmacists, and other clinicians caring for patients with type 2 diabetes mellitus (T2DM).